Occupational Therapy
Occupational therapy is intended to enhance a person's ability to perform basic self-care activities, useful work, and leisure activities. Even simple tasks require the coordination of many abilities: the ability to feel and move sufficiently (sensorimotor ability), the ability to create and execute a plan (cognitive ability), and the ability to want to do the task and to persevere until it is completed (psychologic ability).
Impairment of one of these abilities may affect task performance. Sensorimotor impairments include problems in sensation, perception, range of motion, muscle strength, muscle tone, endurance, balance, dexterity, and coordination. Cognitive impairments include inattention, distractibility, loss of concentration, impaired judgment, indecision, memory problems, and poor problem-solving skills. Psychologic impairments include apathy, depression, anxiety, perceived incompetence, frustration, a lack of persistence, and decreased coping skills. An occupational therapist may note impairments through direct observation, by specific tests, and with the aid of information provided by others.
Occupational therapists assess a person's needs by watching him perform a task in a natural environment. They also assess potential problems with the social environment (such as the effect of family members' attitudes on the person's ability to perform a task) and the physical environment (such as inadequate lighting, electrical cords obstructing walkways, and other hindrances that affect task performance).
Choice of intervention depends on the type of impairment. A person works with the occupational therapist to determine and prioritize intervention goals and select therapeutic tasks that are meaningful. For example, activities that develop fine motor skills (such as bilateral hand activities or inserting pegs on a peg board) may be used to improve coordination and the ability to use utensils when eating. A memory game may enhance recognition and recall. Adaptive techniques can help the person use his strengths to compensate for dysfunction (for example, a person with a paralyzed arm can learn new ways to dress, tie shoes, and fasten buttons). The level of difficulty increases as performance improves.
An occupational therapist is knowledgeable about devices that can help people with disabilities function more independently. For example, a person can be fitted with a splint to prevent deformity or promote function, such as the pinch needed to hold a utensil. Commonly used assistive devices are canes, grab bars on the side and back of the bathtub or toilet, shower chairs, built-up handles on eating utensils or shoehorns, and "grabbers" that help people pick items off the floor or from a shelf. Tools with built-up handles or with spring-loaded or electronic controls compensate for reduced hand mobility. Raised toilet seats and chair leg extenders compensate for diminished back or leg mobility. Sophisticated computer-assisted devices are available for people with quadriplegia and other disorders that severely limit function.
Other devices can help people with impaired vision, hearing, or memory. Larger dials can be added to telephones; a telephone ring can be replaced with a flashing light. Memory aids include automatic dialing telephones, drug organizers and reminders, and pocket devices that record and play back messages (reminders, instructions, lists) at the appropriate time.
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