Occupational Therapy Interventions
What Every Occupational Therapy Practitioner Should Know
Long gone are the days where we can apply pediatric occupational therapy interventions to adult rehabilitation strategies. Unfortunately, there are now actual research articles being conducted regarding the confusion people have about occupation-based activities and the efficacy thereof. Occupational therapy is a profession that is required to be TOP-down; this means we see what is meaningful to the client and begin an activity analysis process so that all therapy is meaningful to the client. A meaningful activity does not mean it has to be a fun activity!! It does not mean we have to disguise remediation of function as a ‘fun craft’. It does not mean that occupational therapy has a free ride from understanding muscle health, exercise, functional movement patterns, physiological healing response, muscle imbalance, and body function repair. A cutting edge occupational therapy practitioner understands that their scope of practice is the upper body, lower body, cognition and executive function, neurological repair, and functional performance. It is not a trade-off. It is all. Occupational therapy is a holistic generalist profession, the scope of practice according to the OT practice framework is all of the above. The only way we will begin to be respected for our competence and scope of practice is if we, as therapists, begin to understand how to conduct occupational therapy in a competent manner and build occupational therapy interventions to reflect that.
1. AGE-APPROPRIATE OCCUPATIONAL THERAPY INTERVENTIONS
It is of crucial importance to the dignity of our clients to create age-appropriate interventions. Do NOT browse Pinterest and use pediatric interventions for an adult population! This is undignified to individuals and creates a barrier between the occupational therapy practitioner and the patient. An individual with pride being asked to do a child’s based activity, will not only feel silly, they will question the intelligence of their therapist. We are a medical-based profession, not activity leaders. Make sure your interventions are evidence-based for the age-group with whom you are working!!!
2. Understand that Occupation is not YOUR definition of occupation
There are 8 domains of occupation. By definition, an occupation is any activity a person finds meaningful. This is our scope of practice!!! This includes exercise and leisure! Occupation does not start and stop with ADLs!!! It does not start and stop with doing laundry and washing windows!!! Believe it or not, most people do not find washing windows and making their bed meaningful! Many individuals would rather pay someone to perform these tasks than do them repetitively in a ‘therapy’ session! If someone does not find washing windows meaningful, do not use this as a therapeutic interaction. It is no longer therapy at this point, you are no longer performing your role as an occupational therapist! It is better, at this point, to use your skillset as an occupational therapy practitioner in activity analysis and remediate the performance of the occupation using therapeutic exercises. This, oftentimes, is more meaningful to the client than making them wash their window in a hospital room. Please don’t do this.
3. READ YOUR OCCUPATIONAL THERAPY PRACTICE FRAMEWORK
Before you begin a job as an occupational therapy practitioner, please understand your scope of practice. Read the back of the OTPF. Understand that you are a generalist professional–only you, as an occupational therapy practitioner, can address the entire body using a biomechanical approach and using a functional approach. As an occupational therapy practitioner, only you can design interventions that address coordination, agility, ambulation, gait training, obstacle clearance, visual perceptual skills, cognitive remediation, strength training of each muscle, handwriting, AND functional performance. You are the entire body and only you can bill for that!!!!! You are not limited by a lane like other professions in the allied health world. You are a generalist!!!!!! You do it all!! You can bill for it all!!!!!! You fit into all the lanes and it is your job to blur the lines between the pathways of allied health. Work with the physical therapist and speech therapist, show them where you fit, but don’t sacrifice interventions that you can provide!!! Share them–THAT is transdisciplinary. Learn to use it for the good of our patients.
4. Understand that you can not always start with a therapeutic intervention that is an ADL or IADL…and that’s okay!
Please, please, understand that just because you are an occupational therapy practitioner does not mean you only do self-care, meal prep, and laundry! If someone has a fresh change in their status (new injury, new surgery, new progressive diagnosis, etc), having them do a task for which they have a pre-established motor plan, can cause an injury because they have not learned how to execute the 3-10 performance skills required for that occupation according to their new status! Do Not make the mistake of pushing them into an activity they aren’t ready for because you believe you have to disguise rehabilitation! It’s okay to use activity analysis, break it into its parts, and repair the parts before the whole. This is your job! This is clinical judgment…and it is all occupational therapy.
The most frustrating experience I encounter is when someone asks to skip OT because all they really need is PT. This should not be a thing!!! Occupational Therapy practitioners need to stop blowing this off! Take time to advocate for what we are doing and our vantage point. After you have stopped doing interventions that are more appropriate for pediatrics and you begin designing treatment plans specifically for your adult clients, you can begin educating your clients on the medical rationale behind your treatment plans. Advocate for your holistic approach to rehabilitation, take continuing educations so you understand the entire body and how it requires multi-modal treatment for long-term outcomes, and advocate for the occupational therapist’s ability to maintain a top-down vantage point while helping an individual reach their goals from a bottom-up mentality.