I need an Occupational Therapist - but what am I looking for?

While we’re all familiar with the term, Occupational Therapy remains an area where many professionals know they’ll need to appoint one - but what makes a great Occupational Therapist, who can truly support your client to get the best possible outcome from their rehabilitation? Steph Fleet, Specialist Rehabilitation Occupational Therapist and Head of Service Development and Customer Relationships at Think Therapy 1st, addresses some of the key questions.

What do Occupational Therapists do?

Occupational Therapists primarily focus on a person's occupations, encompassing all the tasks and activities they want and need to perform in their daily lives, ranging from simple actions like getting out of bed to more complex endeavours such as maintaining full-time employment or travel.

To achieve this, these highly skilled professionals analyse individuals' abilities and evaluate their surrounding environments.

Occupational Therapists possess a comprehensive knowledge of anatomy, physiology, various medical conditions, injuries, and diseases. Additionally, they are well-versed in neurosciences, cognition, perception, sensory function, and related disorders.

Furthermore, Occupational Therapists have expertise in psychology, mental health, sociology, and behavioural sciences, enabling them to understand how individuals adapt to changes resulting from injuries, illnesses, and disabilities. They also have a deep understanding of communities and environments which enables them to pinpoint the barriers to completing any daily activities and occupations and can take it a step further by enabling the person to return to complete the things they want and need to do in the environments they need to participate in.

They achieve this by:

Restoring Skills: Occupational Therapists work towards restoring an individual's skills to their pre-injury level or within their capabilities to complete the tasks.

For example, if someone has limited upper limb mobility and wishes to tie their hair, an Occupational Therapist will identify activities that incorporate the physical abilities required for achieving this goal. These activities are designed to be meaningful and varied, so there is opportunity for repetition and skill and strength transference between tasks.

Adapting Tasks: if a person cannot regain the physical abilities required for a specific task, Occupational Therapists explore ways to adapt the task and teach alternative methods. For example, they may suggest using hair clips instead of bands or provide equipment to stabilise the individual's arm in the necessary position or show someone an alternative way to get dressed.

Compensatory Techniques: In situations where adaption techniques are insufficient for the individual to perform the task independently, Occupational Therapists can introduce compensatory techniques. This may involve having a carer or support worker assist the person in tying their hair, or suggest specialist equipment or home adaptations.

Occupational Therapists are well-placed and provide pivotal roles in helping individuals return to their activities and occupations through restorative, adaptive and compensatory techniques that are all part of rehabilitation.

Isn’t a specialist OT the same as a rehab OT?

No. Specialist knowledge is a skill set gained in a particular area. For example, specialising in mental health, the Occupational Therapists will be working with client groups experiencing high levels of anxiety and depression and techniques are taught to enable the person to participate in the environment.

Social care specialists are highly skilled in equipment and housing adaptation.

Spinal and Neuro specialists are skilled in restoring neural pathways through functional activities. Specialists in trauma are skilled in adapting and compensating techniques to manage their pain and environment until the injury has healed or been repaired and they will also have experience of the mental health aspects of trauma with knowledge of PTSD and its impacts. Typically, individuals are discharged from hospitals with adaptive and compensatory techniques in place. Even rehabilitation units with statutory funding have limited time and scope for therapy, as the ultimate aim is to facilitate the person's discharge. On the other hand, rehabilitation specialist Occupational Therapists have expertise in multiple areas, such as neurology, complex orthopaedics and trauma.

They can identify how different symptoms interact with each other, as well as with a person's activities and environment.

These specialists focus their intervention on restoring abilities using adaptive and compensatory techniques, grading activities to improve specific cognitive or physical components.

They address multiple goals within a single activity while ensuring the individual does not experience failure, cognitive overload, increased pain, or heightened fatigue levels.

While all Occupational Therapists possess these skills, rehabilitation specialists have honed them

Environment

specifically for this client group. When looking for a Specialist Rehabilitation Occupational Therapist, it is advisable to look for someone with several specialisms who can identify creative and dynamic therapy sessions in all the environments the individual needs to participate in whilst not doing for the person what they can do for themselves.

Why choose TT1st?

Think Therapy 1st (TT1st) provides exceptional rehabilitation services through their team of highly skilled and knowledgeable Specialist Rehabilitation Occupational Therapists who operate at an advanced or consultant level. The growing business uses local Occupational Therapists (the current network comprises over 80 Occupational Therapists) because hands-on functional rehabilitation needs, at minimum, weekly sessions, but this can be up to three sessions per week if high-intensity rehabilitation is indicated. Coordination of multidisciplinary and other service providers is also part of what TT1st do – although not alone. TT1st pride themselves on not doing for the person, what they can do for themselves and use this as part of therapy to facilitate the person in being able to manage their ongoing needs or has a well-established support system in place. The goal is to create a lasting impact that extends far beyond the duration of therapy, promoting long-term independence and wellbeing.

4D Life is an evidence-based support programme for people living with Parkinson's created by a Remedial Personal trainer, a Neurological Physiotherapist and a Registered Dietitian. The programme is split into four dimensions:

1. Movement covers cardiovascular training, strength training, mobilisation, stretching and walking.

2. Nutrition follows the research to look at what to eat, what not to eat, when to eat, supplements and water.

3. Function covers balance, digestion, breathing, posture, core, dual-tasking, skill acquisition and gait cycle

4. Lifestyle looks at sleep, stress, anxiety, inactivity, planning, non-medicinal drugs and getting motivated.The programme walks people through the process of making a small change, feeling a benefit, building on the benefit to make another change, and so on, until they find a balance that works for them as an individual.

Nick Berners-Price, managing director, explains the reasoning behind the programme.

"I’ve been a personal trainer for nearly 30 years now, for the last 20 years working mostly with people with medical conditions.

"Again and again I’ve seen that by combining the benefits of many small improvements, significant results can be achieved in managing symptoms and improving outcomes.

"The evidence tells us that there are many potential ways to improve Parkinson’s symptoms and even slow condition progression.

From balance training to sleep management, exercise to food, skill acquisition to dual-tasking. One recent study by Penn State and Harvard Universities provided the strongest evidence to date that diet quality and regular physical exercise combined can help improve symptoms associated with Parkinson's (https://www.4dlife.org/research/) And of course, how we feel comes down to so much more than one condition.

There are all those things that just make us feel better, whether they directly affect Parkinson’s or notbetter breathing, better posture, less processed food.

Low levels of Dopamine in the body can make it harder to feel positive or happy, increasing propensity to feeling apathetic or anxious. Often, especially if we have a neurological condition, we have to get to the results through the domino effect.

One small step forward (a daily walk, a healthier dinner, better breathing or better sleep management) leading to feeling a little better and having a little more energy.

Using that energy to implement another small step forward, and then another, until many small changes to daily habits have led to huge improvements in condition and wellbeing. I understand this only too well. I’ve had Multiple Sclerosis for 16 years and this is exactly how I manage my condition.

Everybody has to make a choice as to how much time and effort they put into maintaining health and managing their condition, versus getting on with life and following their dreams

My team, including a specialist Neurological Physiotherapist and a Registered Dietitian, have created an online programme, called 4D Life, specifically for people with early or mid-stage Parkinson’s. We've been supported by grant funding from Parkinson's UK and are very proud of working in partnership with them, as well as being supported by Cure

Parkinson's and The European Parkinson's Therapy Centre.

Diagnosis is not the end, it can be a new beginning, but people need help to find their way through.

Everybody has to make a choice as to how much time and effort they put into maintaining health and managing their condition, versus getting on with life and following their dreams. This is such an important balance and it’s different for everybody.

But the easier it is to make changes that improve your condition, the more you are likely to make. What we’ve done in the 4D Life programme is pull together all of the elements that can help (outside of medication) and made it as easy as possible for people to find the balance that works best for them."

The programme can be accessed through www.4Dlife.org from anywhere in the UK for a membership subscription of £12.75 every four weeks.