Occupational therapy: A means to further independence

Occupational therapy is a health and a rehabilitation profession. Occupational therapists treat patients of all ages with physical, mental, developmental and social problems to improve their everyday function and prevent disability.

They are specialists in understanding the link between occupation and health. Their practice can range from adapting household products so the patient can use them, to teaching those with mental health problems different coping strategies, to helping children with learning disabilities participate in social activities.

Occupational therapists are problem solvers who empower the patients to take control over their lives, thus enabling them to lead an independent, productive and a satisfactory lifestyle.

Occupational therapy evolved in the 18th and 19th century and the main objective was to engage patients in tasks and events of everyday life.

Therapeutic creative activities were used in rehabilitation as a major tool for patients to maintain control over their dysfunction (Buttigieg A., 2003). Towards the beginning of the 20th century, occupations were prescribed regularly as treatment for the mentally ill.

During the First World War, developments occurred in the physical field as well, and the value of occupational activities used in the restoration of function after physical illness or injury was appreciated (Busuttil J., 1986).

The development of occupational therapy in Malta started through the introduction of occupation, social and recreational activities which were given to patients in our mental hospital. While occupational and recreational activities had long been conducted in the treatment of patients, occupational therapy as a profession organised by foreign qualified staff had its origin in Malta only in 1956 (Busuttil J., 1986).

It was not until 1984 that the first locally organised course of training in occupational therapy was established (Busuttil J., 1986). A year after, the Malta Association of Occupational Therapists was founded with the aim of promoting the profession both locally and internationally.

Now occupational therapy is a fully-fledged profession that offers both in-patient and out-patient services in the hospitals and institutions of Malta and Gozo, mainly St Luke's Hospital, Zammit Clapp Hospital, Sir Paul Boffa Hospital, St Vincent De Paul Residence, Mount Carmel Hospital, Qormi Day Centre, Gozo Mental Hospital and Gozo General Hospital.

What makes occupational therapy different from other health-care professions? Occupation refers to the activities that we do everyday that are important and meaningful to us - dressing, feeding, bathing, using a computer, shopping, cooking, handwriting, playing an instrument, gardening and other life roles.

These occupations are referred to as activities of daily living. Occupational therapy works to break down the barriers which impede individuals in these activities. Occupational therapists examine not only the physical effects of an injury or disease, but also address the psycho-social, community and environmental factors that influence function.

Following a skilled assessment, the occupational therapist works with the individual, to identify customised solutions that will enable him/her to resume the daily occupations he/she enjoyed prior to the illness or injury, as quickly as possible. This might include helping a patient learn how to use aids for eating and dressing, such as sock aid or eating utensils designed to be easily held and gripped, fabricating splints, recommending adaptations to home, school and worksite environments and ensuring the correct use of adaptive equipment such as wheelchairs or simple bathing and kitchen aids.

One of the most helpful things that occupational therapists do is assessment of the home environment of the patient. They are the professionals who can best advise on strategies to modify the home to accommodate the special needs of a patient.

Occupational therapists have expertise and training in giving recommendations to enable the patient to be independent and safe in his own environment, no matter the degree of his disability.

Home recommendations may include installing grab rails on the walls of the bathtub, using a bath bench to eliminate the need to stand during bathing, lowering sinks and countertops in kitchen to accommodate wheelchairs, arranging furniture and other objects so they are not in the way, removing loose rugs from passageways to prevent falls, installing handrails on both sides of the stairways, and making sure the bed is of appropriate height to allow for safe transfers.

A wide variety of people can benefit from occupational therapy, including those with: work-related injuries including carpal tunnel syndrome or other repetitive strain injuries; limitations following a stroke or heart attack; arthritis, multiple sclerosis, or other serious chronic conditions; babies and children with learning problems or developmental disabilities; mental health or behavioural problems, including depression, schizophrenia, and post-traumatic stress; problems with substance abuse or eating disorders; burns, spinal cord injuries, or amputations; and fractured bones or other injuries from falls.

Seven-year-old Clare was very clumsy. The doctors said she would grow out of it. But the lack of coordination in her hand movements made handwriting difficult.

She was starting to dread school because everyone seemed to be picking on her. Clare's parents asked for an appointment with an occupational therapist.

After assessment, the therapist devised a programme of enjoyable games to help Clare improve her coordination. He explained Clare's problems to her teacher and recommended special pencils and pens as well as ways of anchoring her book to her desk.

Clare became much more confident and better coordinated. Her handwriting soon improved (http://www.cot.co.uk).

Michael, aged 42, had become severely depressed with a decline in appetite. Unemployed, he had isolated himself from his family and friends and rarely left his house.

His doctor became concerned and referred him to an occupational therapist. The occupational therapist visited Michael at his house and looked at his lifestyle.

Over the following months, they agreed on a list of goals. The first was to set a time in the morning to get up and make himself breakfast.

Gradually, he gained enough confidence to use public transport and, eventually, to go shopping and to attend a class in social skills. The encouragement of other people in the group boosted his self-esteem.

Michael is now back in touch with his family and friends and looking for a job (http://www.cot.co.uk).

Alison was 45 when she suffered a stroke.

At the time, she was working as a production assistant for a television station. She had difficulty with balance, concentration, problem-solving, and fatigue.

She was unable to manage her job and had difficulties with many life skills such as cooking. Her occupational therapy programme included worksite assessment to adapt her work space environment, training to compensate for some residual disability, activities to improve balance, and training in energy conservation to manage household tasks independently.

With the help of the occupational therapist, Alison was able to resume part-time work at her place of employment in a clerical position and successfully manage life skills.

Ms Calleja is senior occupational therapist, and a committee member of the Malta Association of Occupational Therapists.