Occupational therapy interventions

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The goal of occupational therapy is to help you maintain everyday skills needed for independent living and productivity at home and work. Your occupational therapist will help you improve strength, movement, and coordination, train you to carry out functions of daily living (including use of adaptive and assistive technologies), help you compensate for cognitive and sensory impairments, and instruct you in strategies for maximizing energy.

In the following sections we introduce some occupational therapy interventions to address various symptoms or functional areas, such as mobility or household tasks.

 

Bathroom and personal hygiene

One area where adaptive or assistive technologies really come in handy is that of personal hygiene and bathroom use. Your occupational therapist is uniquely qualified to work with you to make your bathroom and your personal care routines safe and efficient with the right equipment and training in the best way to carry out certain tasks. A range of bathroom safety products are available, including transfer benches, shower chairs, grab bars, toilet safety frames, and many different shower and bath aids, to help you remain independent when it comes to personal care. Additionally, your occupational therapist can train you in the best ways to sit and get up off the toilet, to get in and out of the shower or bath, and the best ways to approach washing, flossing and brushing teeth, grooming, applying make-up, and cleansing yourself after using the toilet,.

 

Hand function

We depend on our hands for completing a wide range of everyday tasks and activities which we may take for granted until we develop impairments that affect the way our hands function. For instance, if you lose strength or coordination in your hands (as can happen in MS from nerve damage and may not have to do with actual muscle weakness), it may suddenly become difficult to dress or carryout personal care tasks, prepare meals, eat, or take care of common business tasks, such as writing a check or filling out forms. Your occupational therapist is specially trained to help prescribe personalized exercises for preserving hand strength and dexterity, including range-of-motion exercises, exercises for coordination, and resistance exercises.

Your occupational therapist is also specially trained to recommend and instruct you in the use of adaptive or assistive technologies or simple strategies to compensate for impairments. The table below shows some examples of assistive technology products and strategies you might be interested in if you have impaired hand function.

 

Technologies and Strategies to Compensate for Impaired Hand Function

Putting on shoes
  • Using a long-handled shoe horn and slip-on shoes will help if you have problems reaching your feet or dealing with shoelaces
  • Other alternatives to tying shoelaces include lace locks and shoes with Velcro closures
Putting on stockings
  • Use of a stocking aid can help if you can’t reach your feet
Extending reach
  • If you have trouble picking up clothing or shoes, a reacher may be useful
Buttoning
  • A buttonhook is a useful tool if you are having problems with strength and dexterity
  • Use of elastic thread for shirt cuff buttons makes it easier to slide hands through shirt sleeves without undoing buttons
  • Replacing buttons with Velcro pieces can also be helpful
Writing
  • If you’re having problems with hand weakness or tremors, a pen holder called a writing bird may be useful
  • Pens or pencils with a larger diameter and/or textured surfaces can be easier to use if your hands become easily fatigued
  • Plastic writing guides can be used to help you write in straighter lines
  • A signature stamp is a useful tool that eliminates the need for signing your name repeatedly
  • A smart pen is a note-taking and digital recording system that can be useful if you have trouble taking notes at meetings or lectures
  • Digital recording devices are a useful way of recording information without writing
Eating
  • Positioning yourself close to the table and using the surface to stabilize your arms is a useful strategy if you have problems with tremors
  • If you have tremors, light wrist weights or weighted gloves may be helpful
  • Try using utensils that are weighted: Knork Flatware is a type of silverware that is heavier and can be useful in counteracting tremors
  • Plates with an edge that is curved help contain food
  • Try using glasses or cups with lids to prevent spills

 

Fatigue

If you are affected by fatigue, a common problem for people with MS, your occupational therapist can suggest ways to increase your energy and manage on a limited energy budget. These may include ways to arrange your daily routine to conserve energy, such as taking many brief rests during the day, showering during the evening (also taking luke warm or cool showers if heat increases your fatigue), and using a variety of assistive technologies that make common tasks and activities less energy-intensive.

 

Mobility and home access

Getting around your home safely and comfortably are important factors to remaining independent. Your occupational therapist is trained to help with suggestions for how to keep you mobile around your house and to make your house accessible and safe. Strategies for increasing mobility and home access may include use of furniture with adaptations that allow you to sit down and get up more easily, such as the use of portable lifter cushions, higher seats with solid arms (you can raise a seat level easily and cheaply by using a foam cushion or leg extenders), and recliners with mechanical lift systems. Your occupational therapist can also help you with techniques for sitting and getting up out of a chair or bed that make the best use of body mechanics.

In terms of making your home more accessible, there are a wide range of strategies and technologies that can be used, including systems of ramps, low-riser steps, handrails, mechanical lifts or elevators that will allow you to get in and out of your home with greater ease. Additionally, a number of home design strategies can help improve the convenience and livability of personal spaces. These strategies include appropriate door width, adequate space to maneuver with ambulation devices, appropriate height and shapes for sinks and toilets, accessibility of closets and storage areas, walk-in designs for showers, design of door handles and faucets for ease of use, and correct placement and design of light switches and electrical outlets.

 

Chores at home

The ability to take care of chores at home, from doing the wash to preparing meals, is an important part of independent living. Your occupational therapist is trained to help you find ways of overcoming impairments so that you can tackle chores around the house. He or she can recommend a myriad of assistive technology products designed to help you carry out common tasks like cooking and cleaning. Additionally, your therapist can train you to approach each and every household task in a way that will conserve energy and compensate for impairments and make tasks easier.

For instance, when it comes to preparing meals, you may want to enlist the help of a friend or family member to cut vegetables in quantity and bag them so that you don’t have to do that task each time you prepare an individual meal. Also, most grocers carry bags of vegetables that are already cut and ready for cooking. An important key in making food preparation easier and less energy-intensive is to do as much as you can ahead of time. This requires planning and organizational skills which your occupational therapist is trained to teach you. There are many different tools and utensils available that are specifically designed if you lack hand strength and dexterity, including rocker knives, electric can openers, hand blenders, and wheeled carts for transporting supplies.

 

Communication and computers

With the recent boom in the design of communication products and technologies, including cell phones, hands-free communication devices, and computer-based video tools (such as Skype), it is easier than ever to remain connected. Your occupational therapist can help you learn how to use the latest communications and computer equipment to make life easier and more enjoyable. The National MS Society (800-344-4867) can help you find an assistive technology professional who can assess your needs and make recommendations about what technologies you might find useful. You can also visit the Website for the Rehabilitation Engineering and Assistive Technology Society of North America at Resna.org to find an assistive technology professional in your area.

 

Driving

In our society, driving is almost synonymous with independence and is certainly helpful if you want to get around by yourself, go to work, or engage in any number of activities. If you have impairments that make it difficult to operate an automobile, you may want to take advantage of assistive technologies designed for use in cars, including devices to assist with steering, operate the gas pedal, and increase visibility. If you are in the market for a car, you will want to make sure that you make an informed decision about which model and type will best suit your needs.

Your occupational therapist can assist with this decision and make suggestions about seat height, accessibility of cargo spaces, availability of adequate storage for walking aids, and the ability to retro-fit an automobile with a carrier for a scooter or portable wheelchair. You may be interested in a program called CarFit (visit: Car-fit.org to find out more), that provides services to improve driving safety and comfort, including events where specialists will assess your vehicle to make sure that it fits you and serves your driving purposes and offer suggestions about types of vehicles and adaptations that might be useful to you.

If you are concerned with your ability to operate a vehicle safely or would like to improve and maintain your ability to operate a car, your occupational therapist can provide helpful advice and may refer you to a driving rehabilitation specialist. For assistance in locating a qualified driving rehabilitation specialist in your area, contact the National MS Society (800-344-4867), or visit the Website for the American Occupational Therapy Association. The Association for Driver Rehabilitation Specialists also lists qualified specialists on a state-by-state basis (866-672-9466).

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