Occupational therapists help people live life to the fullest despite illness, injury, or disability. In this article, we cover common questions about OT's including what they do, where they work, and how they are different from physical therapists (PT's).

What is Occupational Therapy?

Consider yourself lucky if you happen to know one of the 125,000 occupational
therapists (OTs) or occupational therapy assistants currently working in the
United States. These rehabilitation professionals dedicate their careers to
helping others live life to the fullest despite illness, injury, or disability.
When they're not busy finding ways to maximize patient participation at work,
OTs are quick to help friends and family brainstorm solutions to everyday
problems related to activity engagement or home and community safety.

For those unfamiliar, the term "occupation" can be hard to decode at first
glance. In acknowledgement of Occupational Therapy Month
[https://www.aota.org/Conference-Events/OTMonth.aspx] this April, this article
covers common questions about OT to raise awareness of the valuable helping
profession.

A pediatric outpatient OT addresses social and motor skill development through a
group game.
Your OT Questions Answered:
 * What is occupational therapy?
 * Where do occupational therapists work?
 * What do occupational therapists do?
 * What is the difference between occupational and physical therapy?


A hospital-based OT teaches a back surgery patient how to dress using
long-handled adaptive equipment.What is Occupational Therapy?
Occupation is a broad concept that can be simplified into the activities and
roles that occupy one's time. Occupations are not the same for everyone, as the
things that people want and need to do will differ based upon their age,
relationships to others, and inherent capabilities. 

Activities of daily living (ADLs) are a key component of occupation. ADLs can be
classified from the simple things people do to manage their basic needs to more
complex activities that relate to interacting with the environment and
community. Here are some examples:

Basic Activities of Daily Living (ADLs):

 * Eating
 * Grooming
 * Dressing
 * Bathing
 * Using the toilet

Instrumental Activities of Daily Living (IADLs):

 * Going to school
 * Working
 * Taking care of others
 * Managing a household
 * Driving
 * Participating in religion
 * Participating in leisure

If a person's occupations are affected by a medical event, an occupational
therapist can help them get back to performing their necessary and preferred
activities of daily living to the best of their abilities.

An certified hand therapist OT creates a splint for a stroke survivor to
maximize functional hand use.Where do occupational therapists work?
Occupational therapists work across the healthcare continuum
[http://blog.eoscu.com/blog/what-is-the-continuum-of-care], at all levels of
care within the healthcare system with people of all ages. You can find an
occupational therapist working in the following areas:

Hospital Settings
OTs work with people who are unable to participate in their preferred activities
due to a medical event. In an acute or inpatient rehabilitation hospital
setting, patients get daily occupational therapy prioritizing basic ADL
function. The goal of this setting is to ensure that the patient can resume
their necessary daily tasks like eating, dressing, and using the bathroom upon
discharge, teaching them how to use new strategies or medical equipment to
participate fully as needed.

Home and Outpatient Settings
Occupational therapists also work with people who live at home. Home health OTs
go to the patient's home to provide treatment, whereas outpatient OTs work at an
external facility that receives patients. Patients of these settings get therapy
treatment less frequently than in the hospital, usually a few hours per week or
month. Home health and outpatient therapies balance basic ADL skills alongside
the IADL tasks the patient encounters as they navigate life in their home and
community. 

Long-Term Care Settings
OTs also work with people who live in residential facilities that provide
support for self-care tasks. There are varied levels of support within the
long-term care model. Some some facilities assist residents with incidental
tasks like cooking and cleaning, while others provide constant, basic self-care
assistance in addition to bigger-picture tasks. Even if a long-term care patient
is not expected to live on their own, an OT may still provide treatment to
promote maximal participation in daily routines for improved quality of life.

A home health OT advises about office accessibility for a person with a spinal
cord injury.What do occupational therapists do?
A physician writes a referral for occupational therapy services if he or she
identifies that a patient cannot participate in their daily activities
optimally. From here, the OT process is divided into the following three
components:

Evaluation
During the initial evaluation, an OT will review the patient's medical history
and conduct an interview with the patient or their family to clarify perceived
performance limitations. The OT will also conduct assessments of domains
including strength, balance, upper extremity function, cognitive function, or
visual function to gather objective data related to the patient's complaint. 

The OT compiles evaluation information into a formal document and determines if
follow-up treatment is warranted. If ongoing OT is necessary, the therapist will
write a plan of care including short-term and long-term goals that they expect
the patient to achieve within a set timeframe.

Intervention
The intervention component of OT treatment may span a few weeks to a few months
depending on the patient's diagnosis, degree of impairment, and the treatment
setting. During the intervention phase, the OT provides ongoing treatment
targeted to the patient's deficit areas. 

Treatment may involve practicing affected daily living activities fully, or
performing preparatory exercises or tasks that form the building blocks of
affected skills. The OT will adjust intervention difficulty over time and
according to patient progress to provide the just-right challenge
[http://www.lindasdailylivingskills.com/2010/11/just-right-challenge.html] to
maintain engagement.

Outcome Measurement
Throughout the treatment course, the occupational therapist continues to perform
assessments to verify whether a patient is making progress. Therapists often
revisit the same assessments from the evaluation portion at set intervals;
however, they are able to add or change assessments to the therapy plan as
needed. 

When it is determined that a patient will discharge from occupational therapy
services, the OT will perform a final round of assessments and write a summary
of patient progress over time.

A school-based OT promotes a child's age-appropriate pencil grasp for improved
writing skills.What is the difference between occupational and physical therapy?
OTs and PTs often work together with the shared goal of improving patient
function and quality of life. Both professions perform assessment and treatment
and provide patients with education and equipment recommendations. However, the
means by which they promote improved performance differs.

Physical therapists are mobility experts. PTs treat physical impairments
including musculoskeletal and neurological dysfunction with the end goals of
reducing pain, restoring movement, and preventing disability. A physical
therapist working with a post-knee replacement patient would promote strength
and flexibility of their operative leg as well as mobility skills including
getting out of bed, climbing stairs, and walking with an assistive device.

Occupational therapists are ADL experts. OTs work with patients with physical or
mental health diagnoses that impact daily task performance. Because patients
rely upon mobility skills to accomplish their routines, some aspects of OT and
PT appear similar. However, OT will always frame treatment around functional
task performance. An OT working with the same knee replacement patient would
ensure they are able to dress their lower body, get into their bathtub, and
manage cooking with a new rolling walker.



“Occupational Employment and Wages, May 2020.” Occupational Employment and Wage
Statistics, U.S. Bureau of Labor Statistics, 31 Mar. 2021,
www.bls.gov/oes/current/oes291122.htm#(1).

Occupational Therapy

Occupational Therapy Defined

Gait and balance training are key components of post-stroke rehabilitation. Try these 7 pre-gait exercises to progress your walking skills today.

Walking After Stroke: 7 Exercise to Improve Strength and Balance

Walking independently after a stroke is one of the major goals in post stroke
rehabilitation. Your gait is your specific pattern of walking that occurs in
several phases that require specific patterns of muscle activation that allow
the joints of the lower limbs to move smoothly and synchronously in
coordination. The signals to these muscles can become disrupted after stroke,
especially if hemiparesis, or one sided muscle weakness, is present.

Gait training and balance training are key components of post stroke
rehabilitation to help you learn to walk, improve your balance and coordination,
and increase the strength of your hips, knees, and ankles to support your body
when you move.

Common gait deviations observed in patients post stroke include:

 * Decreased gait speed and cadence, or steps per minute
 * Decreased step length
 * Decreased stance time on the weakened leg
 * Decreased ankle dorsiflexion, limiting foot clearance
 * Decreased standing balance and stability, especially with weight shifting

These changes result from a compromised ability to generate force to propel the
body forward, instability of the pelvis that impairs balance, and decreased
strength of the weakened leg, limiting the ability to bear weight through that
side.



Gait deviations can reduce safety and efficiency of walking, resulting in
increased fall risk.

Key muscle groups that can benefit from strength training to improve gait
quality after stroke include the:

 * Tibialis anterior: to dorsiflex the ankle, the motion of lifting the foot up
   toward the body to clear the foot from dragging and prevent tripping when
   taking a step
 * Quadriceps: to extend the knee, providing stability to the knee to improve
   weight bearing tolerance and to prevent knee buckling
 * Hip flexors: to lift the leg up to increase foot clearance and step length
 * Glutes: to extend the hip, increasing the amount of force generated to propel
   the body forward, and to increase stability of the pelvis, to support balance
   with weight shifting between each leg and changing directions

Good outcomes for post stroke rehabilitation require a high degree of
motivation, participation, and engagement of the patient.


The human leg contains a multitude of muscles that work together to support
balance and walking.
Strength and Balance Exercises for Better Walking

1) Ankle Dorsiflexion
 * Goal: to improve ankle dorsiflexion strength to improve foot clearance
 * How-to [https://www.youtube.com/watch?v=SBrHvR0BomM]: Loop a resistance band
   around your foot so that the force is pulling your foot down. Activate your
   tibialis anterior by drawing your foot up toward your body.
 * Progression: Increase the resistance with a higher level of resistance band.
   


2) Marching
 * Goal: to increase hip flexor strength to improve foot clearance, and increase
   single leg strength and stability when standing and weight shifting.
 * How-to [https://www.youtube.com/watch?v=XIhqeDe4TLE]: (Sitting) Begin seated
   in a chair. Lift one leg up, hold for 2 seconds, then lower. Repeat on the
   other side. (Standing) Stand next to a table, chair, wall, or other stable
   object for support. Weight shift over onto one leg while slowly lifting up
   the other, hold for 2 seconds, then lower. Repeat on the other side. Hold
   onto something for support if needed.
 * Progression: Add ankle weights in sitting or standing to increase difficulty.
   For standing marching, challenge yourself by not relying on arm support to
   maintain your balance.


3) Bridging
 * Goal: to increase glute strength to improve force generation, step length,
   and gait speed
 * How-to: Lay down on your back with your knees bent and feet flat. Draw your
   stomach in and squeeze your glutes to lift your hips up without arching your
   lower back, then lower.
 * Progression: Add a resistance band around your knees to increase glute
   activation by abducting, or pushing your legs out, against the band.
   




4) Sit to Stand
 * Goal: to increase quadriceps and glute strength for improved leg strength and
   stability
 * How-to [https://www.youtube.com/watch?v=chw2oMUrh4U]: Sit in a chair, lean
   forward, and use your legs to stand up. Then slowly lower yourself back into
   the chair with control without “plopping.” Try not to use your arms to help
   push you up from the chair.
 * Progression: Add a resistance band around your knees to increase glute
   activation by abducting, or pushing your legs out, against the band, or lower
   the seat surface to make the movement more challenging.


5) Side Stepping
 * Goal: to increase glute activation and dynamic balance and stability with
   lateral weight shifting
 * How-to: Stand in front of a wall or counter to hold onto support if needed.
   Step to the side with one leg then follow with the other. Repeat several
   times, then change directions and repeat.
 * Progression: Add a resistance band around your knees to increase glute
   activation when side stepping. Challenge yourself by not relying on arm
   support to maintain your balance.




6) Forward to Backward Weight Shifting
 * Goal: to improve foot clearance, pelvis stability, and standing balance with
   weight shifting
 * How-to [https://www.youtube.com/watch?v=6mcW7CIvj3Q]: Stand next to a table,
   chair, wall, or other stable object for support. Weight shift forward by
   taking a step forward with one foot, then lift that leg up and move it back
   behind your body to weight shift backward. Repeat several times, then switch
   sides.
 * Progression: Add ankle weights to increase difficulty. Challenge yourself by
   not relying on arm support to maintain your balance.


7) Step-ups
 * Goal: to increase hip flexor strength for improved foot clearance and step
   length, quadriceps and glute strength for improved force generation and gait
   speed, and pelvis stability and standing balance with weight shifting
 * How-to: Stand in front of a step. Step with one foot followed by the other,
   then step down. Repeat several times, then switch sides.
 * Progression: Challenge yourself by not relying on arm support to maintain
   your balance. Increase step height for added difficulty.
   




References
Wang, Yijia, et al. (2020). Gait characteristics of post-stroke hemiparetic
patients with different walking speeds. International Journal of Rehabilitation
Research. 43(1), 69-75. doi: 10.1097/MRR.0000000000000391




--------------------------------------------------------------------------------

Looking for a fun and effective way to exercise leg and core muscles for
improved walking outcomes? Check out the Neofect Smart Balance system for
therapy clinics here [https://www.neofect.com/us/smart-balance].

Physical Therapy

Walking After Stroke: 7 Exercises to Improve Strength and Balance

While many physical therapists turn to virtual care, how can you be sure if telerehab is right for you? Find out here if you should join the telerehab train.

Is Post-Stroke Telerehab For Me? What You Need to Know

COVID-19 has disrupted many aspects of daily life. On the other hand, it has
accelerated the way in which you are able to access healthcare services. Now,
thanks to technology, you can connect to healthcare specialists with a few
clicks of a mouse. 

Telerehabilitation for post-stroke care has been around for over a decade.
Lately, it has become more mainstream, especially after the pandemic began. It
is a way to connect with your physical therapists to improve upper arm function,
strength, balance, and walking after a stroke. 

Many research studies have supported the use of post-stroke telerehabilitation
for physical therapy [https://pubmed.ncbi.nlm.nih.gov/21097560/]. But, you still
may have questions about the pros and cons of virtual care. Below you will find
helpful information about whether telerehab is right for you. 


Telerehab makes physical therapy (PT) treatment possible through video or audio
technology.Benefits of telerehabilitation for stroke survivors
Telerehabilitation, or telerehab, is the delivery of rehabilitation services
through video or audio format. It also allows for easy access to experts in
post-stroke care without leaving the comfort of home. 

Other benefits of post-stroke telerehabilitation include: 

 * Real time health monitoring
 * The ability to share information with caregivers
 * Providing immediate feedback on exercise technique

Before the pandemic, post-stroke telerehab was used for people who could not
easily travel to appointments. Now, stroke survivors with COVID-19, who are
asymptomatic or have mild symptoms in self-quarantine, can see providers without
gaps in treatment. 

Research studies have found post-stroke telerehab to be equally effective as
face-to-face care.
[https://www.sciencedirect.com/science/article/abs/pii/S1052305715005005] Simply
put, post-stroke telerehab can still help you reach meaningful outcomes, like
arm function, independence with walking, and balance, like face-to-face rehab. 


Instead of clinic equipment, a telerehab session may make use of things
available in your home environment.Drawbacks to telerehabilitation
Unfortunately, there are a few barriers to post-stroke telerehab.

There is always the possibility of delays in WiFi connectivity or poor video
quality. Depending on where you live, legal barriers
[https://www.apaservices.org/practice/clinic/covid-19-telehealth-state-summary#indiana] 
may affect the timing and delivery of your care. 

Several research studies have looked at the cost of post-stroke telerehab in
comparison to face-to-face visits. The general consensus is that there is not a
significant cost difference
[http://nebula.wsimg.com/5ffa0b7e108a03a8e6f6f658b515f0fb?AccessKeyId=369F185A9EFA841F6B6A&disposition=0&alloworigin=1] 
between the two. 

Despite this, insurance companies have been slow to offer coverage of telerehab
visits. Be sure to check with your insurance provider before setting up virtual
appointments . This will ensure that you are not slapped with an enormous bill
at the end of your care.

Determining whether telerehab is right for you depends on a few factors,
including your comfort with technology and the type of interaction that you
prefer with your therapists. If you like face-to-face interaction, getting out
of the house, and personal contact, then telerehab may not be the best option
for you. 


A telerehab PT will guide you through session activities and monitor your
performance over live video.


Is post-stroke telerehab going to be the new norm?
In short, yes. 

If this year has taught us one thing, it is that virtual medical and
rehabilitation appointments are here to stay. Once the outbreak is over, expect
to see telerehab practices continue as more clinicians, and insurance companies
get on board.



The reality of telerehabilitation
Telerehabilitation has become an effective way to deliver post-stroke
rehabilitation without increasing your risk of getting infected with COVID-19. 

It allows physical therapists and other rehabilitation experts to deliver
treatments that are important to you. Virtual services also improve access for
stroke survivors who live in rural areas with limited local resources. 

Telerehab will be more successful once the issues with software and legal
concerns are resolved. Despite its drawbacks, post-stroke telerehab can still be
a useful tool because it allows for access to expert care as you continue to
work towards your mobility goals. Moving forward, you can expect telerehab to
become the new standard for post-stroke care. 




--------------------------------------------------------------------------------

Home rehab is easy and effective with Neofect’s Smart Rehabilitation Solutions
for stroke! Check out our cutting-edge home exercise products here
[https://www.neofect.com/us/for-home].