Occupational therapy (OT) is a treatment used with individuals who have difficulty executing daily self-care, work, school and leisure activities. The difficulties may be due to pain, injury or illness, developmental or learning disabilities, psychosocial dysfunctions or age.
Occupational therapy is used to treat a variety of painful conditions (e.g., workplace injuries, chronic pain). It may be performed by a registered occupational therapist (OTR) or by a certified occupational therapy assistant (COTA) under the supervision of an OTR. The therapy can be provided in a wide variety of settings, such as hospitals, rehabilitation centers, nursing homes, schools and in a patient’s home.
An occupational therapist focuses on developing a patient’s ability to complete activities of daily living (ADLs). A number of treatment methods may be used in OT to develop strength, mobility and independence in ADLs, including:
Exercises
Activities for balance and dexterity
Instruction in posture and ergonomics
Compensatory strategies
Assistive devices
Modalities such as heat, cold or ultrasound therapy
Some occupational therapists specialize in certain areas, such as stroke rehabilitation or hand therapy (e.g., treatment of carpal tunnel syndrome). OT may be performed in conjunction with other forms of medical treatment (e.g., physical therapy, speech therapy) when appropriate.
About occupational therapy
Occupational therapy (OT) helps individuals with disabilities improve their ability to carry out daily activities, including self-care, work, school and leisure. A patient’s difficulty may be due to pain from injury or illness, developmental or learning disabilities, psychosocial dysfunctions or age-related factors. The goal of occupational therapy is to help patients achieve independent, productive and fulfilling lives to the best of their ability.
OT may be used to treat a wide variety of painful or limiting conditions, including:
Repetitive strain injuries, such as carpal tunnel syndrome and tendinitis
Chronic pain disorders such as fibromyalgia, chronic fatigue syndrome, myofascial pain syndrome and lupus
Injuries from falls, car accidents or other trauma (e.g., fractures, amputations, head injuries, burns)
Stroke, heart attack, heart failure, chronic obstructive pulmonary disease (COPD) and other cardiovascular and lung conditions
Rehabilitation after joint replacement or other surgery
Arthritis, including osteoarthritis, rheumatoid arthritis and gout
Hand injuries and conditions, such as skier’s thumb (torn ulnar collateral ligament) and trigger finger
Birth injuries, birth defects and developmental delays
Neurological disorders such as Parkinson's disease or multiple sclerosis
Causes of back pain (e.g., spinal cord injuries, spinal stenosis)
Sports injuries such as rotator cuff injuries and tennis elbow
Diabetes
Senile dementia
Psychological conditions
Occupational therapy focuses on human growth and development, with emphasis placed on the societal, emotional and physiological consequences of an illness or injury. It deals with many facets of disability (e.g., how diseases and injuries work, physical and psychological factors of being disabled) and attempts to help patients rehabilitate from many painful conditions or develop strategies to help compensate for loss of function.
OT uses a variety of treatment methods. Therapy often focuses on improving a patient’s ability to carry out activities of daily living (ADLs). These include self-care tasks, such as bathing, toilet needs and dressing. Other activities may include tasks specifically related to the patient’s life (e.g., housekeeping chores, job duties).
In addition, occupational therapists may examine a person’s home or workplace to determine changes that can be made to improve the ability to carry out tasks with less pain or more independence. In some cases, occupational therapy may incorporate ergonomics, the scientific study of the interaction between people and their work environment. Ergonomically designed objects are intended to be better adapted to the shape of the human body or to correct the user’s posture.
Occupational therapy may be performed in a wide variety of settings, including:
Hospitals
Rehabilitation centers
Outpatient clinics
Long-term care facilities
Schools
Home or community settings
Occupational therapy may also include teaching family members and caregivers how to maximize the patient's independence or care for the patient. Patients may be referred for occupational therapy by a primary care physician, orthopedist, rheumatologist (physician who specializes in arthritis and inflammatory diseases) or other physician.
Occupational therapy as a formal discipline originated in the early 20th century. Lifesaving advances in medical care, veterans returning from World War I and an increasingly industrialized society created a greater need for rehabilitative treatment of disabled people. In 1917, a group of men and women founded the National Society for the Promotion of Occupational Therapy. Meaningful activity or occupations were viewed as important therapeutic tools for the disabled.
In its early years, occupational therapy focused primarily on hospital care, often providing programs for people institutionalized for life from injury or illness. Changing social needs (e.g., aging population, increases in chronic health problems) and heightened awareness of the connection between lifestyle and health has greatly expanded the field of occupational therapy.
To become a registered occupational therapist (OTR), an individual must complete a graduate degree in occupational therapy from an accredited educational program, complete a supervised clinical internship, pass a national certification examination and in most states must also undergo licensing requirements that include continuing education. Along with physical therapists, OTRs can choose to undergo additional training in hand therapy and, after passing an examination, become a certified hand therapist (CHT). Some occupational therapists choose to specialize in areas such as childhood developmental disorders, mental health, stroke rehabilitation or balance retraining.
Certified occupational therapy assistants (COTAs), who treat patients under the supervision of an OTR, face similar requirements but earn a two-year degree. Occupational therapy aides, who are generally trained on the job, may help with tasks such as transporting patients and setting up equipment.
Before and during occupational therapy
Occupational therapy (OT) focuses on improving the ability to carry out daily work, school, self-care and leisure activities. Occupational therapy often targets small muscles and fine motor coordination, such as movements of the arms and hands.
A registered occupational therapist (OTR) will complete an evaluation to assess the patient's strength, mobility and execution of everyday tasks. This may include identifying particular activities or behaviors to help determine the appropriate therapy plan. Determining how motivated a patient is to recover from painful injuries or conditions can help the patient and therapist set realistic short- and long-term treatment and recovery goals.
An occupational therapy evaluation will be completed to assess the patient’s strength, mobility and execution of everyday tasks. This may include identifying particular activities or behaviors to help determine the appropriate therapy plan. Determining how motivated a patient is to recover from painful injuries or conditions can help the patient and therapist set realistic short- and long-term treatment and recovery goals.
The scope of the evaluation depends in part on the setting and the patient’s goals. For example, a head injury patient hoping to be discharged home may be assessed initially for safety in showering and dressing and later in cooking and driving. The evaluation of a nursing home resident with declining upper-body mobility may focus on wheelchair positioning and arm range of motion and coordination.
In instances where occupational therapy is necessary for a work-related injury or disability, a functional capacity evaluation (FCE) may be performed by an occupational therapist, sometimes in conjunction with a physical therapist. An FCE assesses a patient’s physical and functional abilities and establishes the physical degree of work a patient is capable of doing. There are two types of FCE:
Baseline FCE. An evaluation of a patient’s physical ability to work.
Job-specific FCE. An assessment of a patient’s physical abilities to perform a specific job. Simulated work activities are often part of a job-specific FCE.
A FCE typically emphasizes job-related goals rather than individual aptitudes, interest and personality. It may last as long as several hours in some cases. An FCE is most often performed in a controlled environment where direct observations and measurements of specific work activities can be made (e.g., job site, hospital rehabilitation department). An FCE is often useful in determining various types of information, including:
Flexibility, strength, balance, coordination, cardiovascular condition and body mechanics.
Work restrictions, modifications, or accommodations necessary to prevent further pain or injury (e.g., environmental factors).
The extent of painful impairments or disabilities.
The patient’s ability to manage pain while working either full time or on modified duty.
Predicting a patient’s ability to work after a rehabilitation program is completed.
After the patient is assessed, a treatment plan is tailored to the needs of the patient. Some individuals may require only advice or information to limit pain or handle their disability. Others may require specific treatment or equipment as part of occupational therapy. To reduce pain and improve daily functioning, occupational therapy may include:
Pain-reducing activities or exercises
Instruction in new methods to carry out tasks
Assessments of home and job safety
Improving posture and ergonomics
Splints or orthotics
Thermotherapy or cryotherapy (hot or cold packs)
Other modalities, such as hydrotherapy, ultrasound therapy or electrical therapy (e.g., transcutaneous electrical nerve stimulation)
Assistive devices (e.g., reachers, dressing aids, jar openers, rocker knives)
Installation of helpful devices (e.g., bathroom grab bars)
Once occupational therapy (OT) has concluded, some patients may benefit from some form of continued rehabilitation or education program, such as a home exercise plan or transcutaneous electrical nerve stimulation (TENS). Occupational therapists also may design a home program for energy conservation or compensation strategies to help with activities of daily living (ADLs). Programs may be modified or discontinued according to the degree of improvement the patient experiences.
A relapse of a painful condition (e.g., workplace injury, lupus) may in some cases prompt a physician to again prescribe occupational therapy. Certain medications, such as anti-inflammatories, may be prescribed by a physician to reduce pain and inflammation.
Patients may be scheduled for periodic evaluations to monitor their conditions. OTs may need to adjust a hand splint or adapt a program as the patient's condition changes over time. Physicians may make follow-up referrals for occupational therapy after their examination.
Benefits and risks of occupational therapy
A significant number of adults and children either have or develop painful health conditions that hinder the ability to perform daily tasks. The goal of occupational therapy (OT) is to help these people develop a greater level of independence in their daily lives. Occupational therapists offer creative solutions or alternatives to patients for performing routine actions. Potential benefits of occupational therapy may include:
Improved ability to perform daily activities
Reduced pain
Increased strength and flexibility
Education about the source of pain
Strategies to increase productivity and prevent injury
Individualized treatment
Performance assessments
Increased self-esteem
Family/caregiver assistance
Recommendations for adaptive equipment
Home, workplace or school evaluations
Although education and treatment for painful conditions may be helpful, the functional ability of patients with certain progressive or incurable diseases may have limited progress with occupational or other therapy. Some methods (e.g., splints) may reduce pain but decrease mobility or cause other adverse effects contrary to the overall purpose of occupational therapy.
Treatment modalities sometimes used in occupational therapy or physical therapy may cause injury if employed incorrectly.For example, misuse of ultrasound therapy or other types of thermotherapy can cause burns.
In some cases, skills or knowledge developed while in therapy may not be applied properly or consistently in home or work settings. This can potentially lead to increased pain or discomfort. Daily quality-of-life factors (e.g., stress, fatigue, disease status) may decrease the perceived effectiveness of occupational therapy or amplify patient perceptions of pain. Patients must be monitored for any changes that may require a re-evaluation by an occupational therapist.
Treatments related to occupational therapy
Occupational therapy (OT) helps individuals limited by pain from injury or illness, developmental or learning disabilities, psychosocial dysfunctions or age improve their ability to carry out daily work and leisure activities. In addition to occupational therapy, other forms of treatment may be used to treat pain, including:
Physical therapy. Treatment of muscular, nerve and skeletal disorders to restore physical function and prevent disability. Occupational therapy and physical therapy are closely related and are commonly used together to help a patient regain function.
Speech-language pathology. Professionals in this field study and treat disorders that affect communication skills or swallowing. Occupational therapists often work with speech-language pathologists, particularly on swallowing and feeding disorders.
Chiropractic. Chiropractors are trained in adjustment of the muscular and skeletal systems of the body. Chiropractic and other types of manipulation therapy may be useful in treating problemsassociated with back pain and neck pain.
Recreational therapy. The primary purpose of recreational therapy is to restore, remediate or rehabilitate patients through the use of recreational activities (e.g., cooking, arts and crafts, music). Recreational and occupational therapy may be used together to treat different aspects of painful medical conditions in adults and children.
Rehabilitation counseling. Individuals in this field assess the goals of patients and their motivation to return to work and family life. Rehabilitation counselors often work with patients with painful or limiting conditions.
Respiratory therapy. Respiratory therapists care for patients with breathing or other cardiopulmonary disorders (e.g., chronic asthma, emphysema). Occupational therapy may involve respiratory care in some cases.
Questions for your doctor
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about occupational therapy:
Is occupational therapy appropriate for treating my condition?
How do I find an occupational therapist? Do you recommend any particular therapist or facility?
How can occupational therapy help me?
Are there specific treatments or goals you want my occupational therapy to address?
Are there any weight-bearing activities, exercises, physical agents or other things my therapy should not include?
For a hand or arm injury, do you recommend I see a certified hand therapist?
For how long will I need occupational therapy? How long will my sessions last, and how many times a week?
What measures can I take outside of my therapy to reduce my pain and increase function?
Can an occupational therapist recommend assistive or adaptive equipment to help my condition?
