Episode 4: What is Occupational Therapy?

What is occupational therapy or who is an occupational therapist or does my child need to see an occupational therapist?

Now, aren’t these questions I get a lot!

Who is an occupational therapist?

Occupational therapists are allied health professionals, just like speech therapists, but their job is quite different from that of speech therapists.

Occupational therapists assist children as well as adults to participate in activities of everyday living such as walking, eating, dressing, making friends, writing, cooking, driving, showering, etc.

The primary goal of OTs

Occupational therapists (OTs) help people engage in the occupations they want to, need to or are expected to, by improving their skills or by modifying the occupation or the environment.

For example, an OT may recommend that a client with cerebral palsy for example starts using a modified walker or a modified cup to increase a child with multiple disabilities ability to independently feed themselves a drink. They may also recommend that holding frames be installed in the bathroom of an adult who has had a stroke and may be experiencing weakness. Similarly, OTs may suggest the installation of ramps post health conditions.

The primary goal of OTs is to help people participate in the occupations of everyday living.

OTs engage in ongoing assessments to understand what occupations are important to the child or adult, any issues they may have in completing them, and understanding their goals.

OTs also help people to live with or manage long-term/ chronic health conditions e.g. diabetes, cancer, arthritis, sickle-cell, cerebral palsy, etc.

OTs help make every day living easier by either empowering their clients with knowledge and skills, helping them find new ways of doing the activities or changing their clients’ environment to suit their needs.

OTs can also prescribe, if they see fit, devices and therapy equipment to help one complete specific activities

The scope of practice for occupational therapists

The scope of practice for OTs is wide and does vary with geographic location.

In most of the developed countries such as Australia, US, UK, OTs work with babies and preschoolers

. They predominantly work with;

• Babies who have developmental delays (not holding their neck; not sitting)
• Toddlers delayed in walking
• Children with motor planning or sensory difficulties. This could be children who don’t tolerate different textures of food, being brushed their hair/teeth, children who cannot stand their nails clipped; who may not like physical contact; children who display hypersensitivities to sound, etc.
• Children with attention difficulties which prevent them from concentrating for longer than short bursts or from participating with other children
• With school-aged children, OTs may work to improve handwriting, pencil-grip and overall fine motor or hand-eye coordination issues

It’s the OTs job to help children presenting with developmental delays, multiple disabilities or specific sensory processing disorders achieve their developmental milestones and eventually achieve independent completion of whichever activity they struggled with.

For children presenting with behavioural issues, OTs help the child to maintain positive behaviour e.g. stop hitting, learn how to positively del with anger, develop appropriate social skills, etc.

For adults, OTs are involved with the client’s rehabilitation and return to independence. This may be through;

• Helping people regain or enhance participation to match their pre- health condition status. The health condition may be hip replacement, spinal injury or stroke, etc.
• Assessing and modifying client homes to improve their safety and independence
• Prescribing and educating clients and carers in the use of adaptive equipment to assist participation
• Providing splints after hand or upper limb injury

The scope of practice for OTs in Kenya

Clearly in Kenya, the scope of practice for OTs may be slimmer than what I have talked about and to be honest I am not sure why.

I mean, 1 reason like in the case of making ergonomic assessments and recommendations of such things as ramps would be something families here may just decide by themselves without needing an OT to assess or prescribe. In developed countries, this ax by an OT would usually result in the government covering the cost of the ramp whereas in Kenya, this cost would be covered by the family of the patient.

I recall when I worked in a rehab setting in New Zealand, which is a hospital that admits adults post-stroke, so post discharge from acute ward, they would usually be admitted into a rehab hospital for say a few weeks and receive intensive occupational therapy, speech therapy, PT, etc. all under 1 roof and without leaving the facility.

I use to see the OTs helping the adults learn how to sequence the steps required to say tie their shoe laces, wipe their bottoms or make a cup of tea while remaining safe.

I don’t see OTs here involved with this kind of work.

I don’t see too many OTs who assist children with their pencil grip, improving their handwriting or even toilet-training.

And yes, it may be a matter of what the government here funds for, but I think it is also a matter of the training curriculum OTs in Kenya for example receive, which may not include a wide scope.

Final word

That said, my response to any parent that asks me whether their child should drop occupational therapy for speech is always the same.

Ask your child’s OT to discuss what they are working on- so the goals based on the assessment they conducted then decide whether these are in line with the goals they have for your own child and if they are, great; if they are not then it’s probably a good time to request re-adjustment, seek another opinion or request to be discharged.

A misconception I have noted particularly here in Kenya is the idea that a child cannot have both occupational therapy and speech therapy at the same time. For instance, that a child who isn’t walking cannot possibly do speech therapy until they are done with occupational therapy.

Anyway, there you have it, I hope this series helps clarify the role of OTs and hopefully you can now be better placed to make decisions about whether or not your child requires occupational therapy and whether your provider is best suited to provide those services to your child.

As always, do check out our other series if this particular topic has raised something new for you. Thanks

(Reference; http://aboutoccupationaltherapy.com.au/what-does-an-ot-do/)