At Bhakti our OT department specializes in helping people with:
- Chronic Pain
- Central Sensitization Syndrome & CRPS
- Post surgical recovery
- Anxiety and Depression
Chronic Pain – How Can Occupational Therapy Help?
Broadly, occupational therapy helps clients to live and function productively. Within the context of chronic pain, occupational therapists evaluate the pain’s impact on a client’s desired activities and quality of life, and equip him or her with the skills and strategies to manage the pain.
First, therapists validate the client’s pain and work to establish trust. They identify the client’s own attitude towards the pain and the degree to which the client believes he or she can control or affect it. “If a client has high self-efficacy, or a belief that they can affect their pain, then an occupational therapy practitioner would work with them in a certain way. If a client has low self-efficacy, then we would need to work with them in a different way, working slowly to build the client’s own belief system,” McGeary says. “Clinical studies in self-efficacy for pain control showed folks with arthritis had greater control after cognitive behavioral education. But it takes time.”
Occupational therapy practitioners can show clients how to redirect their pain so that it interferes less in their daily lives. Relaxation and visualization activities cognitively redirect pain. Because of chronic pain, clients are often physically deconditioned, and the practitioner will work on gentle exercises to increase clients’ strength and stamina. They might also use such activities as self-hypnosis, meditation, and yoga, all of which can be effective ways of coping with pain.
The effectiveness of these activities, however, depends largely on the client’s attitude and beliefs about the pain. According to McGeary, a lot of current research and data suggest that chronic pain occurs because the dorsal horn cells of the spinal cord actually change and exacerbate the pain response. Dorsal horn cells are the first site for integrating and processing incoming sensory information, providing ascending information to the higher centers of the brain that influence the awareness and interpretation of pain.
“For some clients, helping them to see that there is an organic cause of some of the pain helps them to appreciate that they can indeed make a change in the pain response. If the brain changes when we have one message that we give ourselves, then there’s just as much potential for the brain to change with other messages,” says McGeary.
Why Occupational Therapy?
“Occupational therapy practitioners have a much broader view of the person [than other disciplines]. They understand the sensory, cognitive, and emotional dimensions of multi-factorial pain,” McGeary says. “Sometimes there’s a climate of distrust—the idea that people are malingering. But occupational therapy practitioners are much more willing to accept that attitudes and belief systems have a strong, powerful impact on how people see themselves and their ability to cope.”
Accessing occupational therapy specifically for pain can be a bit complicated. Often in a rehabilitation environment, clients receive both physical and occupational therapy. Pain clinics generally provide a multidisciplinary approach to pain management, including occupational therapy. A physician can refer an individual to occupational therapy, but clients must always be prepared to advocate for themselves and for what they want.
Fibromyalgia – How Can Occupational Therapy Help?
While many people with fibromyalgia have seen a physical therapist, few have seen an occupational therapist. Occupational therapy is in a unique position to instruct people with fibromyalgia in management techniques that can empower them and be used for a lifetime. Occupational therapy focuses on the whole person through their activities of daily living (ADL). Therapists work with patients to find a balance between work, rest, and play. By learning adaptive techniques, energy conservation, pain management, relaxation techniques, problem solving, sleep hygiene, communication techniques, and goal-setting, patients are able to determine life changes that will allow them to optimize their function within their limitations. With therapist assistance, patients develop a daily and weekly schedule that they will continue after discharge. The schedule is designed to provide the balance of work, rest and play needed for optimal symptom management.
One of the biggest keys to patient success in a therapy program is the patient’s grasp of two concepts:
1) Exercise is required. Patients are instructed to think of exercise as a medicine, like high blood pressure pills. People with fibromyalgia must exercise.
2) There is no magic cure. If patients’ expectations are that they will be “cured”— have no pain or fatigue—they are destined to be disappointed. It is important that therapists work with patients to establish realistic goals.
When seeking a fibromyalgia therapy program, consider and ask about these things:
- What outcome measure is used? How do you know this program works?
- What specialized services are available for people with fibromyalgia? What training has the therapist had related to fibromyalgia?
- How long does the program last? (Research suggests a program should be at an average of 6-8 weeks long for optimal patient benefit.)
- Treatment sessions should be organized and standardized to assure quality of care. While you want a program that meets your individualized needs, you also want to know there are specific topics covered and goals designed for someone with fibromyalgia.
- Set goals that are very small but progress regularly—for example: I will walk two minutes daily. Next week, I will walk three minutes.
- Expect pain to get worse before it gets better. You should expect an improvement after you have maintained a regular exercise program for 6-8 weeks.
- Expect fatigue to progressively improve with increased exercise and better quality of sleep.
What post-operative benefits can occupational therapy yield?
Patients often report feeling a sense of control over their own lives after experiencing an occupational therapy program. Benefits include the ability to:
- Manage one’s pain
- Improve physical skills, as well as endurance
- Improve language skills
- Regain competence in daily activities
- Reduce the time and amount of medical care needed in the future
- Reduce the need for a caregiver
- Reduce anxieties about life after an operation
- Foster a sense of independence
Surgery to replace a damaged hip joint offers many people the opportunity to regain lost function and to return to daily activities with increased ease and comfort, but the 6-8 week recovery period requires many changes in the way you carry out your daily activities. Occupational therapists can help by teaching new ways to move safely during recovery and by providing ingenious equipment for activities such as bathing, cooking, and dressing.
Why Is Occupational Therapy The Preferred Service For People Recovering From Hip Replacement Surgery?
Occupational therapy education is based on the physical and psychological implications of illness and injury and their effects on people’s ability to perform the tasks of daily living. The clinician’s knowledge of adapting tasks and modifying the environment to compensate for functional limitations is used to increase the involvement of clients and to promote safety and success.
During hospitalization and as you prepare to return home, your occupational therapist will:
It is important not to bend forward in your chair or cross your knees or ankles until your doctor gives permission. Sit in a raised chair or an elevated surface for maximum safety and comfort.
- Teach how much weight to put on the operated leg and how to keep your hip properly aligned.
- Demonstrate safe techniques for entering and exiting from a car
- Teach you methods for transferring from the walker to a chair, a bed, or a bath chair in the tub or shower
- Educate your family and caregivers about your surgical hip precautions and the best way to help you
- a dressing stick to pull on underwear or slacks without bending from the waist
- a sock aid to position and draw a sock or stocking onto the operated leg
- a shoe horn to put on shoes without bending at the waist
- A firm bed that is not too low is the most safe and comfortable option.
- carry hot liquids in covered containers
- slide objects along the counter rather than lifting them
- sit on a high stool when working at the counter
- use a reacher to pick up objects from the floor
- use a basket or bag attached to your walker to free your hands
- remove scatter rugs to prevent tripping.
The proliferation of commercials for various antidepressant medications has convinced many Americans that managing depression is as simple as popping a pill. Although medication can be an important component of treating depression, occupational therapy practitioners can help those with depression to restructure their daily lives, find meaning in daily occupations, and redefine their sense of identity.
What Causes Depression?
The causes of depression vary. For some people, depression is caused exclusively by decreased neurotransmitters in the brain, and may be genetic. For others, “the cause can be life events—the inability to gain satisfaction from their relationships, or life experiences that failed to provide them with the skills to manage and cope with their responsibilities,” Mahaffey says. “However, an argument can be made that although some forms of depression can be traced to a person’s life events, the thinking patterns of people with depression affect the brain’s ability to produce neurotransmitters. There is a mind–body connection, which might be why people respond so well to antidepressant medications that raise neurotransmitters, allowing them to engage in other forms of therapy and skill development.” These in turn may reduce the need for medication.
How Can Occupational Therapy Help?
Occupational therapy practitioners can examine the life roles that are meaningful to clients with depression and help adapt their responsibilities to give them the opportunity to participate and gain a sense of accomplishment. “Usually I go through the roles important to a client—worker, student, family member, friend, hobbyist—and we talk about how all of those roles have a set of responsibilities that, when met, have an outcome that is both desirable and rewarding,” Mahaffey explains.
Practitioners then determine what interferes with a person’s ability to meet those responsibilities, such as a getting to work late everyday or finding work tasks overwhelming. “Sometimes I’ll break down tasks. For example, I might have a mom identify some simple meals and make a shopping list so she can get her kids fed while she works through her depression,” says Mahaffey.
Self-esteem and identity also play large roles in managing depression. “I look at self-esteem from the perspective of how choices that we make in our lives impact how we think and consequently how we feel about ourselves,” Mahaffey says. Practitioners might talk with clients about structuring the day and replacing bad habits with good ones. For example, what will persons with depression do to fill and structure all of that time previously spent alone, maybe in bed or in front of the TV?
Occupational therapy practitioners can help persons with depression examine how to balance leisure, work, and relationships. “We look at daily structure and include certain occupations and strategies to ensure that clients follow through on things so that they meet the responsibilities of the roles that are meaningful to them,” Mahaffey says.
A Case Example
In one unusual case, a very intelligent 45-year-old man had started a successful business. He had a daughter and a great marriage. “He came into the hospital suicidal and depressed and couldn’t understand why because his life was going so well,” says Mahaffey. Mahaffey did an Occupational Performance History Interview (Keilhofner, et al., 1997) and an interest checklist. “Together, we learned that throughout the early part of his life he had set goals, and he always worked hard to meet them. He had gotten to a point in his life where he had met every goal he’d had and could no longer gain a sense of meaning in his day,” says Mahaffey. The client identified oil painting as a past interest, but he had given it up. He still had the materials, so with encouragement from Mahaffey, he set a goal to dig them out and paint something for his house. A year and a half later, he had a gallery opening.
Occupational Therapy & Central Sensitization and Complex Regional Pain
excerpted from report by Ok Yung Chung, MD, MBA
Clinical experience clearly indicates that physiotherapy is vital for the successful treatment of CRPS. It is a requisite for the patient’s rehabilitation to provide the best recovery of function and quality of life. Standardized physical therapy has been shown to produce long-term relief of both pain and physical dysfunction, especially in children.
Physical and, to a lesser extent, occupational therapy can reduce pain and improve active mobility in CRPS type I. Patients who initially have less pain and better motor function are likely to benefit the most from physical therapy. Physical therapy for CRPS has been shown to be both more effective and less costly than either occupational therapy or control treatments. Recent studies have demonstrated that a combination of hand laterality, recognition training, imagination of movements, and mirror movements reduce pain and disability in patients with CRPSs. Therefore, physiotherapy, occupational therapy and attentional training are essential for an eventual successful outcome.
Health Insurance: services are typically covered by health insurance.
Flex Spending Accounts and Health Savings Accounts: services are considered a qualified medical expense and reimbursable using these accounts.