Role of Occupational Therapy (OT) in healthcare

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In todays world everybody wants to be healthy and keep on moving in their life journey and pursuing every new dreams by engaging in meaningful occupations. But sometimes in this journey people might face unexpected trauma, stress, loss of social participation due to many reasons like any physical injury, accidents, mental disorder, chronic diseases etc. To overcome this patients want early recovery and independence in their daily living.

To recover from any bad health condition there should always be an efficient and effective interdisciplinary team approach. It involves simultaneous working of various professionals like Physicians, Surgeons, Nurses, Physiotherapist, Occupational therapists, Speech therapist, Prosthetist, social-workers and other hospital staff. In todays article we will be learning about the role of 'Occupational therapist' (OT) in healthcare rehabilitation.

The American Occupational Therapy Association (AOTA) defines an occupational therapist as someone who “helps people across their lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). OR

OT is a client- centered health profession concerned with promoting health and well being through meaningful occupation. Occupational therapist works to bring the patient from dependent to independent living.

Goals of OT intervention:

To promote, maintain and restore functional independence in daily living skills and improve patients quality of life.
Therapeutic objectives are to diminish and control pathology, to restore functional capacity, to facilitate learning of skills and functions essential for adaptation to the environment.

OT REHABILITATION IN VARIOUS CONDITIONS

In Neurological conditions : Stroke (infarct or haemorrhage), traumatic brain injury, degenerative diseases of CNS or PNS, Hypo- and Hyper- Kinetic movement disorders, Myasthenia gravis, Brain or spinal cord tumour, cerebellar ataxia, Dementia, Meningitis etc.

In Paediatric conditions : Cerebral palsy, Autism, Down’s syndrome, Seizure disorder, ADHD, Muscular dystrophy, Intellectual disabled child (MR), Learning disabled, Meningomyelocele, NICU early intervention for Preterm infant etc.

In Orthopaedic conditions : Vertebral fracture causing Spinal cord injury, RA ,OA, Ankylosing spondylitis, upper-limb or lower-limb fracture, Shoulder dislocation, Rotator-cuff tear, Joint Replacement rehab, nerve or tendon injuries or disease, low back ache, Burn or post-burn contracture, PIVD, Cervical spondylosis etc.

In Cardiovascular and Respiratory conditions: Pre- and post- surgery coronary artery disease, Covid-19 pulmonary tuberculosis, bronchial asthma, COPD etc.

In Mental Health conditions : Schizophrenia, Bipolar-mood disorder, PTSD, Conversion disorder, Substance and alcohol use disorder, OCD etc.

ROLE OF OT IN 3 STAGES OF INJURY OR DISEASE PREVENTION :

Stage of disease prevention	Evidence based OT Intervention
1) Primary prevention (preventing occurrence of disease)	Behavioural strategies includes lifestyle modification, stress management, smoking cessation, regular physical activity, nutrition optimization, weight management etc. Injury prevention includes fall prevention in elderly, ergonomic redesign of workplace and home, healthy exercise program, community based injury prevention, low back care and education program etc
2) Secondary prevention (Acute and subacute care) in hospital settings and home.	To improve and maintain daily functional performance through therapeutic exercises like flexibility training, strengthening exercises, cognitive rehab, task-specific training, balance training, vestibular training, fabrication of splints or adaptive equipment ( for use in ADL), early intervention (for paediatric population and preterm neonates), mobility and gait training, virtual- reality plus cognitive retraining through use of robotics etc Home and environment modification for patient through family education and training, recreational activities Pre-prosthetic and prosthetic training, prescription of mobility aids like wheelchair, canes and crutches, walker.
3) Tertiary prevention (chronic care) : goal is to prevent complication and minimize the effect of condition and promote social opportunity.	Rehabilitation services for mentioned conditioned. Removal of architectural and attitudinal barrier to increase social participation. Creating disability friendly environment. Continued OT Intervention mentioned in secondary prevention Pre- vocational and Vocational rehab. Provision and calculation of disability percentage according to revised Government of India Disability gazette for locomotor disability. Hospice care or palliative care.

OT's work in full-time, part-time basis positions in a variety of settings including :

Hospitals (as a full-time therapist or consultant therapist)
Nursing homes
Private practice (also provides community based rehabilitation)
Schools
Home health agencies
Outpatient clinics
Psychiatric facilities

Why there is a need of Occupational therapy and Physiotherapy rehabilitation in hospital in India?

As per the report, published in august 2014 by Press Information Bureau Government of India : Ministry of Health and Family Welfare under rehabilitation group for professionals working under Physiotherapy and Occupational therapy mentions the supply demand gap of rehabilitation group in India as follows :

Allied health workforce category	Demands	Supply	Unadjusted Gap
Rehabilitation / other related	18,62,584	40,265	18,22,319

As per literature review, published on April 2015 by N.Mearns titled “Physiotherapy (PT) and Occupational Therapy (OT) in the Acute Medical Unit (AMU) : Guidelines for Practice” details the role of OT and PT in AMU as follows :

Facilitating early discharge, goal-setting and intervention at start of hospital journey.
Reducing the length of stay of patients who do not require an OPD stay, particularly where community support can assist in achieving this goal.
Promoting a holistic, team-based with patient-focused outcomes so that care and support to patient is delivered faster and closer to home where appropriate.
Promoting partnership working between health and social care to ensure best value is achieved by shifting the balance of care to community services.