Despite growing knowledge of the field of occupational therapy, there is still much that is unknown about what their roles are in healthcare facilities and medical treatment teams. For those who are unfamiliar with occupational therapy, it is a field which focuses on improving patient participation in meaningful activities. These meaningful activities are known as occupations, pointing toward the use of occupation in the name. Many people believe occupation refers only to someone’s job. While this may be the focus of treatment for some individuals, occupation can refer to anything from leisure activities to parenting roles to self-care tasks.
Once someone has a basic understanding of what occupational therapy is, they are often left to guess what duties and roles are part of an occupational therapist’s job. Occupational therapists can be found in many settings, some which are common and some which remain relatively unknown. Occupational therapists most commonly work in skilled nursing facilities, hospitals, schools, and outpatient clinics. Despite differences in treatment types, the role of an occupational therapist is quite similar across each of these settings.
An occupational therapist in any practice setting will always follow the same process when seeing a patient. Occupational therapists must complete evaluations the first time they see each patient. This evaluation consists of interview-type questions to determine the patient’s likes and dislikes, medical history, primary issue (also known as the chief complaint), and goals for treatment. The evaluation process also consists of testing cognition, recording range of motion measurements, testing strength, and testing the patient’s ability to complete self-care tasks including grooming, bathing, feeding, toileting, and dressing. For children, this part of the evaluation process usually tests the child’s developmental milestones. For example, testing whether the child can use scissors, grip a pencil, and put on or take off a jacket among others.
Another important factor in any evaluation will include standardized assessments. Unlike the other aspects of an evaluation which may be completed differently according to the therapist’s training and clinical judgment, standardized assessments are tests which must be carried out using a specific set of instructions. These assessments are chosen by the therapist for their ability to test specific skills.
For example, a child who is having vision difficulties may be asked to complete tasks for the Test of Visual-Motor Integration with the assistance of a therapist. Other standardized assessments are questionnaires or rating scales filled out by a therapist after observing a patient participate in certain tasks. This is often the case for an elderly or severely impaired population. For example, an elderly individual experiencing difficulty dressing and bathing herself after a hip replacement may be scored on the Modified Barthel Index. Standardized assessments will give a specific score, often numerical, indicating their performance on the test. These tests are then retaken at re-evaluation periods and at discharge, allowing for the scores to be compared to one another to determine if progress was made.
All of the information taken during this evaluation allows a therapist to determine which of an individual’s body parts, skills, and personal factors are weakest. These areas will then be addressed using a variety of activities during treatment sessions.
Next comes the treatment process, which varies depending on the practice setting and the weaknesses a patient has demonstrated during the evaluation. Common treatments within a school setting are handwriting exercises to improve writing abilities, sensory integration treatments to calm and regulate behaviors, arts and craft activities to increase hand strength, and the practice of developmental milestones. Developmental milestones describe a child’s ability to complete age-appropriate tasks. For example, a normally developing three-year-old child will be able to assist in getting dressed and undressed, speak in two or three sentences, climb stairs, and ride a bike with training wheels. A child with a physical or cognitive disability who is not meeting these goals will work on such activities during occupational therapy treatments.
Common treatments for an adult being seen in a skilled nursing facility or hospital often focuses largely on self-care tasks. This is because hospitals and nursing facilities require successful completion, or completion with assistance, of self-care tasks before a patient returns to their home. Treatment in these settings will focus on continual practice of self-care tasks, along with activities focused on strengthening and motion. These activities may include using a stationary bike to strengthen legs and arms, balloon toss activities to improve balance and coordination, and standing activities to improve endurance and decrease levels of fatigue.
Treatments provided in an outpatient clinic setting are often similar to those provided in nursing facilities and hospitals. Patients in outpatient settings are living in the community, also known as their home, meaning they are likely independent in completing self-care tasks. Treatment in outpatient clinics often focuses on hand injuries, fine motor strengthening (weakness of the hands), pain relief, and swelling. Pain relief methods may include therapeutic ultrasound, electrical stimulation, hot packs, and ice packs. Massage can be used to improve motion and decrease swelling. Fine motor strengthening may be addressed through exercises and activities which involve the use of hands.
Health education is also an important part of occupational therapy in any setting. Since disease prevention and maintenance is one of the main ways occupational therapists prevent patients from getting injured or ill again, it is important to ensure patients are educated on how to care for their health and symptoms outside of therapy sessions. This may include home exercises, diet recommendations, habits to avoid, or training on improved seated or standing posture. This often requires an occupational therapist to have educational materials such as pamphlets, diagrams, and instructions on hand.
Documentation detailing each aspect of treatment and evaluation is another major aspect of an occupational therapist’s job. This documentation is important to record and monitor progress, receive funding from insurance companies and other agencies, and to keep medical facilities up to the required state and federal standards. Documentation in most settings follows a SOAP format. This format includes subjective (S) information such as patient pain or limitations on the day they are seen for therapy. It is also important to add objective (O) information which states what treatments were provided, assessment (A) of the patient’s current situation and remaining weaknesses, and the plan (P) which states any changes which must be made to the treatment plan.
These aspects are very important to fulfilling all the duties of an occupational therapist. Many people may wish to focus solely on the patient care process. While this is an important part to improving a patient’s situation, the patient care could not take place without the accompanying documentation. The reality of working as an occupational therapist means all of these components must be completed in order to continue doing work to improve the function of patients. Ensuring each of these duties are completed successfully and accurately will allow for an occupational therapist to make the biggest impact they wish to in the lives of others.