Expert Interview: All you wanted to know about Occupational Therapy

Hello Jessica, can you briefly explain to us what occupational therapy is all about?

Occupational therapy is a health-care occupation founded on the link between human activity and health. Our goal is to maintain or help patients get back the ability to perform activities in a safe, autonomous and efficient way. We accompany the patient in her environment giving her the ability to reduce or even eliminate handicap situations she comes across in her daily life activities (personal care such as bathing, dressing, mobility, communicating, leisure activities, eating…). Occupational therapy takes her needs, life habits and environmental factors into account as well as her handicaps and proposes a customized solution. The occupational therapist develops a programme that includes re-education and/or re-adaptation that favour patient autonomy.

What qualifications do you need to practise as an occupational therapist (OT)?

To become an occupational therapist, you need to complete an HCPC-approved pre-registration occupational therapy programme at either undergraduate or postgraduate level. All programmes are accredited by the Royal College of Occupational Therapists (RCOT) and WFOT.

A full-time BSc in occupational therapy lasts three years in England and Wales and four years in Scotland. There are part-time programmes available at some institutions as well. They last around four years and require two days a week at university.

What conditions can benefit from an occupational therapist? What goals can they meet?

There are many chronic conditions that could benefit from occupational therapy. The reasons that people come in to see us can vary (physical re-education, advice on choosing a wheelchair, making their environment more accessible, retrofitting their home, installing mobility aids, etc.), but we try to help anyone who comes to see us obtain the greatest degree of independence possible in their particular circumstances.

What does an occupational therapist with a psychology degree do?

Occupational therapy will help the patient take care of himself and perform activities that are important to him as well for other people in his environment. The programmes we propose often focus on everyday life and developing a patient’s abilities in order to make him more self-reliant. For example, we might suggest a kitchen re-arrangement workshop with different end-goals depending on the patient’s needs. One example I can think of: making a grocery list (organisation/planning), getting out of the house to do the shopping (managing one’s emotions/behavioural issues), and even the physical act of carrying out the task (practising physical movements or decision making). Emotional and social skills are usually handled by OTs with a psychology degree.

What are the benefits of occupational therapy for those suffering from memory loss, notably from Alzheimer’s?

An occupational therapist can intervene at different points in the progression of the illness. At the onset, an OT may propose cognitive stimulation workshops to retain abilities. Stimulation will depend on the interest of the patient or it might be in a group setting to favour social exchanges. Further on, the OT may propose measures to compensate for memory loss in the patient’s daily activities, for example putting up a memory calendar or clock that tells Mrs X not to forget to go to the market on Thursdays. The OT can also make a person’s daily activities easier to do with technical aides. For example, we could create a cookbook with all of Mr Y’s favourite recipes to allow him to continue cooking the things he likes to eat without forgetting any important steps. Accompanying the carers of the patient is also a very important part of occupational therapy.

Can occupation therapy assist in the re-education of someone who’s suffered a stroke?

Following a stroke, the OT will come to hospital to make sure the patient has everything he needs to stay independent (mechanical bed, proper mattress, a wheelchair or walker if necessary, technical aides for eating, dressing, going to the toilet, etc.) The OT will then draw up a therapy programme (physical and/or cognitive) that is adapted to the specific needs and abilities of the patient to allow him to retain maximum autonomy. Over time, the OT will adapt the programme. When the patient leaves the hospital, the OT may visit him at his residence to do an evaluation of the home and propose changes that will help the patient ease back into home life.

How can patients get in touch with an occupational therapist?

Generally by referral.

You can get occupational therapy through the NHS or social services, depending on your situation. If you can’t pay for the therapy for yourself, talk to your GP about getting a referral or make a request at your local council.

If you have the funds, you can pay for therapy directly. The Royal College of Occupational Therapists has a list of qualified and registered occupational therapists that you can call to see if you can make an appointment. This is the quickest way to be seen, but it’s more expensive, of course.

Does a patient need to see an OT over a long period of time or are a few sessions enough for them to get the hang of it?

Everything depends on the person and her needs. Sometimes just one appointment is enough to help the patient master her daily tasks. Sometimes a few appointments are necessary. In general, we see a patient over a longer time period since, as I mentioned earlier, we tend to intervene at different points in an illness’ evolution.

How do you determine how many sessions are necessary?

We do an audit before each session, whatever the condition. Depending on the patient’s goals, the OT will propose an action plan and determine the number of sessions needed to reach those goals. The patient’s physician will also help in determining how many sessions are authorised.

Do you go directly to the hospital or do you visit patients in their homes? Do you bring anything with you?

OT’s can propose either option depending on the patient’s needs and goals.

We can certainly come directly to the patient’s home, notably to conduct an evaluation of the residence after a change in circumstances, or when the house needs to be retrofitted to give the patient more independence in his environment. An OT may visit a patient’s home as part of a larger caregiver team or as an independent.

The material we bring with us varies a lot and depends on our specialisation. Every session changes depending on the patient and there’s never really a “typical day”.

What are your patients’ biggest apprehensions? How do you put them at ease?

I’d say the biggest apprehension is just not knowing what an OT does. Sometimes patients are referred to us without knowing what we can do for them or only knowing a little bit about our services. Often, a patient will contact us to get help in just one area of their daily life and after we do an evaluation we realize that their handicap has affected many other aspects of their lives. People are often quite surprised by how we can improve their quality of life in such a wide variety of areas and grateful for the advice we give them on how they can make their daily lives better.

I generally ask patients to trust me and try it out first.