Occupational Therapy

Occupational Therapists: An Overview

What is an Occupational Therapist?

The Occupational Therapist (OT) profession grew from the idea that patients’ health and wellness would improve if they were engaged in meaningful activities, also known as occupations. Occupational therapy began in mental health settings, such as psychiatric hospitals. Then, activities were limited and largely craft-based. Now, OTs practice in many common settings. Their work surrounding meaningful occupation has extended to self-care, community involvement, home management, social interactions, productive leisure, and more. An OT’s role in mental health settings has now expanded to wellness education, relapse prevention, behavior management, emotion regulation, and communication skills.

Where do Occupational Therapists work?

Usually when people think of occupational therapists, they think of the hospitals where they work. However, hospitals are just the start of where OTs are found. These versatile therapists also work in nursing facilities, schools, and outpatient clinics. OTs also practice in most mental health settings, such as psychiatric units of hospitals, since these are the settings where OTs originally worked when the field began.

What do Occupational Therapists do?

OTs are able to address most rehabilitative needs of their patients. Areas they work on include strengthening, pain management, range of motion, coordination, balance, and vision skills. All of these skills are in addition to basic self-care tasks ranging from toileting, bathing, eating, dressing, and grooming. They also assist with more intricate self-care tasks such as doing laundry, taking medications, paying bills, cleaning the house, and driving. Other areas OTs are able to address include communication, behavior management, health education, leisure, play skills in children, and performance in work and school settings. 

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Patients receive referrals to occupational therapy from their physician. Occupational therapists work with physicians to complete prescribed treatment plans.

The daily work of an OT consists of evaluation, treatment, and education.

Evaluation

An occupational therapist in any practice setting will always follow the same process when seeing a patient. Occupational therapists must complete an evaluation 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, OTs test whether the child can use scissors, grip a pencil, and put on or take off a jacket among others.

Part of the evaluation will include standardized assessments. Other aspects of an evaluation will vary based on the therapist’s training and clinical judgment. Contrastingly, standardized assessments are tests which must be carried out using a specific set of instructions. The therapist chooses these assessments for their ability to test specific skills. 

For instance, a child who has vision difficulties completes tasks of 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, the OT scores an elderly individual experiencing difficulty dressing and bathing herself after a hip replacement using 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. The OT compares the scores to determine the patient’s progress.

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. The OT plans treatment sessions and activities to address these areas.

Treatment

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 can 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 focus 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 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 improve motion and decrease swelling. Exercises and activities which involve the use of hands drive fine motor strengthening.

Education

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.

How do I become an Occupational Therapist?

Occupational Therapists must hold a Master’s or Doctoral degree in their field in order to practice occupational therapy. To learn more about getting into Occupational Therapy programs, check out SDN’s How to Get Into Occupational Therapy School guide.

Where can I learn more about Occupational Therapists?

For more information on the basics of Occupational Therapy, check out The Ultimate Beginner’s Guide To Occupational Therapy. You can also check out the SDN Occupational Therapy forums.

References

  • American Journal of Occupational Therapy. (2017). Occupational therapy practice framework: Domain and process (3rd edition). American Journal of Occupational Therapy, 68, S1-S48. doi:10.5014/ajot.2014.682006
  • American Journal of Occupational Therapy. (2014). Scope of practice. American Journal of Occupational Therapy, 68, S34-S40. doi:10.5014/ajot.2014.686S04
  • American Occupational Therapy Association. (2017). Evidence-based practice. Retrieved from www.aota.org/About-Occupational-Therapy/Professionals/EBP.aspx
  • American Occupational Therapy Association (2018). What is occupational therapy? Retrieved from www.aota.org/Conference-Events/OTMonth/what-is-OT.aspx
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Brittany Ferri is an occupational therapy consultant, certified clinical trauma practitioner, and certified light therapist. Her specialties are mental illness, health writing, and complementary modalities. She is passionate about disease prevention and meeting the emotional and physical needs of al... Brittany Ferri is an occupational therapy consultant, certified clinical trauma practitioner, and certified light therapist. Her specialties are menta...