OT in Physical Dysfunction

Hey readers! I just took my last final and I am officially done with the summer semester. (Yay!) This semester has been a whirlwind. The summer semester is condensed into 12 weeks, with 2 of those weeks dedicated to splinting lab and fieldwork. The two classes that I took this semester were OT in Physical Dysfunction, the focus of today’s blog post, and Leadership & Management, where we discussed healthcare policy, insurance, and leadership. Many OTs work in the area of physical dysfunction in settings such as acute care, inpatient rehabilitation, outpatient clinics, home health, skilled nursing facilities, and more. So, I thought it would be fun to recap what I’ve learned and my experience in this course. If you work with the physical dysfunction population, please feel free to comment below and tell me about your area of practice! Also be sure to check out my post about my level 1 fieldwork placement in inpatient rehabilitation!

OT’s Role

OTs have various roles in physical dysfunction depending on what population(s) you work with and what setting you are in. Some things OTs may work on include:

  • Strengthening
  • Stretching & flexibility
  • Remediating a lost or weakened ability (e.g. constraint-induced movement therapy (CIMT), neurodevelopmental treatment (NDT), repetitive task practice)
  • Energy conservation & joint protection
  • Ergonomics
  • Work preparation
  • Adaptive techniques (e.g. hemi-dressing, the lighthouse technique, red tape as a cue for unilateral neglect)
  • Adaptive equipment (e.g. shower chair, dressing stick, reacher, sock-aid, long-handled equipment, cooking tools)
  • Eating & swallowing
  • Wheelchair recommendations
  • Pressure ulcer prevention
  • Cognition, memory & concentration
  • Sexual dysfunction
  • Environmental adaptation
  • Psychological considerations
  • Physical agent modalities (e.g. heat, cold, ultrasound, electrical stimulation, paraffin, etc.)
  • Orthotic fabrication (see my post about splinting lab for more info!)

As you can tell, OTs do a lot in physical dysfunction! I’m sure there are even more things that OTs do that I left out, as well.

Physical Dysfunction Conditions

Some conditions that OTs may treat in the area of physical dysfunction include:

  • Stroke (CVA)
  • Traumatic Brain Injury (TBI)
  • Spinal Cord Injury (SCI)
  • Multiple Sclerosis (MS)
  • Huntington’s Disease
  • Parkinson’s Disease
  • Amyotrophic Lateral Sclerosis (ALS)
  • Guillain-Barre Syndrome
  • Dysphasia
  • Aphasia
  • Unilateral Neglect
  • Vision loss
  • Arthritis
  • Fractures
  • Burns
  • Oncology
  • Diabetes
  • Pulmonary conditions (e.g. Chronic Obstructive Pulmonary Disease [COPD])
  • Cardiac conditions (e.g. myocardial infarction [heart attack], coronary artery disease, congestive heart failure)

Lab

My OT in Physical Dysfunction practice class included a weekly lab where we worked on skills and actual interventions. We practiced on each other, which was really helpful. It was a fun lab and I feel like I learned so much! Lab provided me with actual hands-on practice doing the interventions that we talked about in class, which helped to prepare me if I ever want to work in the physical dysfunction setting (and for the competencies).

Example Interventions

Here are a few brief examples of what I would do with patients or clients who have certain conditions! Of course I am not an expert, and there will be a lot that I leave out. Consult a licensed occupational therapist before trying any of these interventions.

Stroke

Patient Diagnosis: R MCA CVA presenting with L hemiparesis and L unilateral spatial neglect. What would I do?

OT Interventions: To address L hemiparesis, I would work on weight bearing while performing ADLs, teach the patient hemi-dressing techniques, suggest adaptive equipment, and practice using the L UE as much as possible to regain function (e.g. modified constraint-induced movement therapy and repetitive task practice). To address L unilateral spatial neglect, I would stand on the patient’s L side during the OT session and continually cue the patient to attend to his/her L side. I would also use external cues such as red tape/marker on the side of a newspaper that the patient wants to read and the lighthouse technique to practice scanning on the L side.

Spinal Cord Injury

Patient Diagnosis: C6 ASIA A SCI with preserved wrist extension. What would I do?

OT Interventions: This patient sustained an SCI at the level of C6, which leaves his/her wrist extensors preserved. This indicates that the patient will be able to use tenodesis to grasp objects for functional movement. I would focus on preserving tenodesis and working on functional grasp during ADLs. I would also work on becoming independent in slide board transfers and functional mobility in power w/c. I would suggest adaptive equipment for ADLs and educate on the importance of pressure relief since the patient will not be able to feel if a pressure ulcer is forming. Finally, I would address sexual function and educate the patient on his/her ability to engage in intimacy after his/her SCI.

Multiple Sclerosis

Patient Diagnosis: Pt. presents with MS exacerbation and MS-related fatigue. What would I do?

OT Interventions: The main focus for OT when treating someone who has MS is typically energy conservation, since the main symptom is usually fatigue. I would begin by educating the patient on the 4 P’s of energy conservation (pace, prioritize, plan, posture). I would work with the patient to determine what occupations he/she has not been able to participate in due to fatigue and assist in planning, prioritizing, and pacing these occupations. For example, if the patient loves to cook but is unable to due to MS-related fatigue, I would recommend sitting at the kitchen counter, using a rolling cart to transport heavy items, reorganizing his/her cabinets so heavy or commonly used items are at counter-level and easy to reach, and I would recommend taking breaks and prepping meals and cooking them at different times. I would also recommend adaptive equipment specific for cooking to reduce the effort needed to perform this IADL.

Thanks for reading!

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