Canadian Association of Occupational Therapists

How occupational therapy works with relevant case studies

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Introduction

Occupational therapy works to reduce the costly effects of disability and dependent living. It can mean the difference between returning to work or relying on disability payment income. It can also reduce or avoid huge expenses for personal care assistance and equipment such as hospital beds and wheelchairs.

Occupation's impact on health

Research shows that an individual's health and well-being is influenced by his/her ability to engage in life's occupations. Withdrawal or changes in occupation can lead to increased dependency, lack of confidence, and depression. Conversely, it has also been proven that restoring an individual's ability to function independently, and exercise choice and control over his/her daily activities increases productivity and life satisfaction.

Occupation is everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities (work/productivity).

Occupational therapy works to break down the barriers which impede individuals in their everyday 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 based on standardized tests, the occupational therapist works with the individual, to identify customized 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 can include recommending adaptations to living and work site environments and ensuring the correct use of adaptive equipment such as wheelchairs or simple bathing and kitchen aids.

Occupational therapists are team players. Although firmly client-centred, they are careful to coordinate the care plan with employers, other health professionals and family members.

Occupational therapists help people who are…

Recovering from a work-related injury, such as carpal tunnel syndrome or other repetitive strain injuries. 
Having difficulty coping with chronic pain due to arthritis or whiplash and back injuries.
Recovering from hip replacements, spinal cord injuries, burns, head injuries, strokes, and other traumatic injuries.
Finding it increasingly difficult to live independently due to a chronic and progressive illness such as Multiple Sclerosis, Alzheimer's Disease or cancer.
Under excessive stress which is affecting their work and everyday living.
Children with learning disabilities, congenital difficulties or other dysfunctions.
Coping with mental illness or substance abuse.
Subject to injury from working in high risk areas.

Occupational therapy - the professional advantage

Occupational therapists are experts, recognized by government and consumers for evaluating and promoting performance in daily occupations. For example...

The Canada Revenue Agency recognizes occupational therapy as a tax deductible medical expense.
Occupational therapists are recognized by Revenue Canada to authorize disability tax credits for persons with a physical disability.
Occupational therapists are recognized by Revenue Canada to authorize income tax deductions for therapy services provided to persons with a physical disability by a nonregulated health provider.
Occupational therapists are authorized to prescribe assistive devices such as wheelchairs, mobility devices and communication aids in provinces with provincial assistive device funding programs.
Authorization by an occupational therapist is required by many consumer organizations for co-funding the purchase of assistive devices.
The credentials of occupational therapists are recognized by provincial governments for assessing mental health competency.
Occupational therapy driving evaluations are recognized by provincial governments for assessing an individual's ability to safely operate a motor vehicle.

Trained to enable function - a professional profile

Occupational therapists are university-trained, regulated health professionals whose unique training enables them to understand not only the medical and physical limitations of a disability or injury, but also the psycho-social factors that impact on an individual's ability to function independently. Their approach is based on research which proves that an individual's ability to engage in occupation increases their health and well being.

Occupational therapists have...

Graduated from an accredited university programme with a four year baccalaureate degree in occupational therapy or a master's degree in occupational therapy or rehabilitation.
Successfully completed a minimum of 1000 hours of fieldwork education.
Successfully passed the certification examination administered by the Canadian Association of Occupational Therapists, or met provincial registration qualifications.

Occupational therapists' tool kit

Through occupational therapy, people return to work faster, costs of a long term disability are prevented and people have more control and satisfaction with their life.

An occupational therapist's return-to-work tool kit includes:

Functional assessments
Physical demands analysis
Transferable skills analysis
Vocational aptitude testing
Interpretation of neuro-psych and vocational aptitude testing for functional implications
Stress management
Health promotion
Work conditioning
Graduated return-to-work programmes
Job search
Training/education


Case Study: Jill*  (*Pseudonym for actual case study)

Jill was employed as a graphic design analyst for a large computer company. She experienced neck, right arm and right hand pain for approximately two years that progressed in severity. The pain was attributed to the constant use of the mouse. A reduction in her work schedule to half days and exercise therapy did not improve her condition. She was referred to an occupational therapist for an ergonomic evaluation.

Jill's occupational therapist identified the following risk factors contributing to her pain:

Inappropriate location of the keyboard, mouse and monitor.
Poor seating.
Difficulty managing job demands and work stress.
Neck and upper back tension.

The following ergonomic solutions were implemented based on the occupational therapist's recommendations:

A new keyboard and mouse tray to position the mouse closer to the user for correct neck, arm and wrist postures.
The monitor was relocated for appropriate height, distance and viewing angle.
A new ergonomic chair to provide full support for the spine and arms.
Upper body stretching and strengthening programme.
Education in proper posture.
Education in relaxation and pacing techniques.

A work schedule was designed to properly pace Jill's work, to gradually increase her tolerance, and to include breaks for relaxation and stretching.

Total cost of equipment: $935.00

Value for all…

The Client
Jill was able to resume full-time work within three months. She was more aware of her posture and its influence on muscle fatigue and pain. She was doing frequent stretch breaks during her work day. She reported that she was satisfied with the equipment recommended and the new organization of her computer equipment.

The Employer
Jill was able to resume her level of productivity within a short time period resulting in less cost to the employer for replacement staff. Discussions regarding job demands with her employer allowed delegating some tasks to other staff for a more manageable workload.

The Insurer
Occupational therapy intervention avoided lost work-time and disability payments.


Case Study: Linda*

*Pseudonym. Case study based on Katsouras, Nancy. (1998). Occupational therapy and limited return to work. Outcomes that Matter: A Case Study Review, p.41

Linda was 31 years old when she had a stroke as a result of a brain aneurysm. At the time, she was working as a production assistant for a TV station. She had difficulty with balance, attention, problem-solving, and fatigue. She was unable to manage her job and had difficulties with many life skills such as doing the laundry and taking the subway.

Her occupational therapy program included:

Work site assessment to adapt her work space environment.
Training to compensate for some residual disability; for example organization techniques.
Activities to improve balance.
Training in energy conservation to manage household tasks independently.

Value for all...

The Client
Linda was able to resume part-time work at her place of employment in a clerical position and successfully manage life skills. Her fatigue level decreased. She was able to start using the subway in non-busy hours.

The Employer
Meetings with the occupational therapist and the client assisted the supervisor in accommodating Linda to the work-site. The employer was able to retain a valuable employee.

The Insurer
Linda was able to return to the highest possible level of productivity. Costs were contained by timely occupational therapy intervention and return to work.

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