One of the glorious tricks of the OT trade is that we can use everyday tasks for rehabilitative treatment. Seriously. As an OT, you can go into a patient’s room, assist them to dress, brush their teeth, and eat their breakfast. You leave, charge two 15 minute treatment codes to the insurance company and be paid for your valiant service.
I mean...that’s kind of how it works.
Actually, occupational therapy actually doesn’t work like that at all. At least, occupational therapy shouldn’t work like that. We absolutely use activities of daily living (ADL)--dressing, bathing, toileting, grooming/hygiene, eating, etc.--for rehabilitation, but the key that sets our profession apart from other beloved healthcare professions is that we use ADL for a specific, goal-focused purpose.
As occupational therapists, we are concerned with ADL because self-cares are basic occupations that each and every one of our patients has the right to complete independently. Our goal is that no barrier will limit our clients’ independence in their everyday self-care activities.
Not hemiplegia from a cerebral vascular accident. Not the cognitive changes that result from a traumatic brain injury. Not the debilitating fear of a falling after a fall with a hip fracture.
We will be our clients’ champions for ADL, but we don’t just help our clients complete these basic occupations. We use self-care tasks as a means to improve their own independence.
An OT may teach her client with hemiplegia to button a shirt with the use of only one hand. An OT may guide his client with a traumatic brain injury to practice brushing his teeth again and again so that she knows to use a toothbrush and not a hairbrush. An OT might encourage his client to comb his hair in standing to improve his confidence in his balance without both hands on the walker.
A specific, goal-focused purpose.
For a new-grad or a seasoned OT, this one should be a no brainer. Of course you should work on dressing.
In the cases of s/p stroke, break down the dressing task itself--which part of the shirt donning task is your client hung-up on? Is it threading her flaccid arm through the right hole of the shirt? Is it pulling her head through the top of the shirt? Or does she struggle to pull the back of the shirt down?
Practice that simple step over and over and over again until she has improved her skill. Then, add the simple task back into the whole task of donning her shirt.
You can take the same concept for donning pants. If the client has difficulty threading his feet through the legs of the pants, have him practice just that part of the task repeatedly. Once he has mastered the threading, then practice the whole task again.
Some other ideas:
Zip, snap, or button clothes...first off the body and then while wearing the garment (fine motor coordination/strength, bilateral upper extremity coordination, problem solving)
Organize and don jewelry (cognitive training and/or reminiscing in the cognitively impaired/dementia population; fine motor coordination; bilateral upper extremity coordination)
Shoe tying (bilateral upper extremity coordination)
Grasp and release of cups
I should keep count with the number of clients who tell me one of their top goals is “to be able to pick up a cup of coffee again.” To work on this task repetitively, I will line up 5-10 cups and have them pick each up and move it across a taped line. To progress the task, I will add more weight to the cup, first with a dry material and then progress to (room temperature) liquid.
Another repetitive drink task I employ is the simple act of bringing a cup from a table to their mouth. With the low-level hemiplegic arm, I start by securing the cup to their hand and use hand over hand for elbow flexion. I instruct them to do x number of repetitions, very similar to therapeutic exercises such as dumbbell curls. Remember, more repetitions equals a greater likelihood of neuroplasticity. Hundreds of repetitions.
Some other ideas:
Put cups/glasses away in an upper cabinet (for standing balance/tolerance)
Have patient stand to wash several cups (for standing balance/tolerance, for bilateral upper extremity coordination)
Pour liquid into cups (for the low level arm, start by having the patient simply stabilize are you pour--this would be an isometric exercise; to upgrade: have the patient do the bilateral coordination and strengthening task of pouring water from a pitcher to a cup on their own)
Pill bottles. Jars. Spice containers. The options are almost endless, the repetitive nature of the task can easily be placed back into a whole-task scenario, and the ability to grade this task is simple.
For low level arm function: choose a lid that simply sits on top of the container.
For high level arm function: choose smaller lids, and maybe even pill bottles with ‘child lock’ mechanisms.
For whole-task intervention options consider:
Filling weekly medicine containers.
Cooking or baking
Completing a craft
Technically an instrumental activity of daily living. Specific laundry tasks are another easy option to achieve repetitive task training with simple grading.
For a low level task: fold wash clothes. Upgrade by having the patient stand and maybe placing the washcloths in a place that facilitates trunk rotation and lateral weight shifting. An effective OT intervention for bilateral upper extremity coordination, standing tolerance, standing balance, cognitive training.
For a higher level: fold sheets and heavy blankets.
Some other ideas:
Practice task of putting laundry into the washer, changing over from washer to dryer, and retrieving from the dryer. Then do it again. (for standing balance/tolerance, strengthening, activity tolerance)
Have the patient change the sheets on their bed and then make it (I love this task as a discharge intervention--it can really prove to my clients how far they have come! In some cases, they couldn’t even get out of that bed when we started and to have the stamina to complete this high-level task at the end of our time together is equivalent to climbing a mountain!)
Don pillow cases (bilateral upper extremity coordination)
Sort and match socks (cognitive training; visual rehabilitation; facilitation of L/R sided awareness; bilateral upper extremity coordination)
Place clothes on hangers and then hang them in a closet (trunk rotation/strengthening; cognitive training; standing tolerance/balance; activity tolerance)
In some of the most difficult times in a person’s life, they may lose the ability to care for themselves. As an occupational therapist, I find true honor in the opportunity to help those clients regain the basic skills that every person has the right to complete independently. To guide them to once again dress themselves. Feed themselves. Toilet themselves. Bath themselves.
Activities of Daily Living. How OTs earn our keep. How OTs stand apart from our healthcare colleagues. How OTs make a difference.