Occupational therapy can be defined as the science of healing by occupation. Humans have a need to engage in occupations and roles, and occupation is a natural means of restoring function. Occupational therapy is traditionally prescribed for patients whose functional abilities are going to improve. However, occupational therapy is also an essential component of hospice and palliative care. Loss of independence and role can result in social death prior to biological death. Occupational therapy can help a person to adopt new and appropriate functions and roles and to maintain self-esteem.

“A person’s self-esteem, mastery and adaptation rest in the ability to be purposefully engaged in regular and familiar life experiences.” (Kent Tigges)

Occupational therapy aims to improve the quality of remaining life and focuses on rehabilitation of the whole person.

Promoting physical independence may involve an assessment of daily living skills, home visits, adapting the home to promote independence and safety and selecting suitable aids and adaptations for disability. (see Amyotrophic Lateral Sclerosis, Home Care)

Once symptoms are controlled, boredom remains a genuine problem for the many patients who remain restricted by disability or lack of energy. Such patients often find it difficult to be imaginative and to initiate activities. Skillful and enthusiastic occupational therapists can transform the remaining life of these patients. (see Boredom)

Patients can become dominated by basic medical and functional needs. The occupational therapist recognizes that social and recreational activities are also essential for a meaningful existence.

For all of us, a balanced life includes:

  • Self care (activities of daily living)

  • Work (the productive use of time)

  • Recreation (relaxation, amusement, self-expression)

Each of these has physical, social and emotional elements and a balance between dependence, independence and inter-dependence.

Assessment will include review of previous occupation and interests, previous activity levels, the limitations imposed by the disease, mental concentration, emotional preoccupation and the important priorities for that person.

«  Most patients usually want to go on being as independent and useful as possible.

Rehabilitation to full previous normal living is always the goal, but may not always be possible. The occupational therapist will encourage independence in some areas, and appropriate dependence or inter- dependence in others. As the patient’s condition deteriorates this balance shifts and activities may need to be re-graded. Continuous reassessment is more important than a single appraisal. (see Rehabilitation)

Occupational therapy may involve:

  • Assessment (living skills, work, leisure)

  • Home visits, environmental changes

  • Provision of aids and adaptations

  • Training in the use of equipment

  • Work simplification

  • Energy conservation, time management

  • Group activities

  • Group therapy (touch, role play, psychodrama)

  • Social skills or assertiveness training

  • Education in coping with change (patient and family)

  • Relaxation and stress management

  • Therapeutic activities (arts, crafts, poetry, music)

  • Reminiscence therapy

Maintaining normal social activity and conversation is often the best form of occupational therapy. Reminiscence therapy has proved a very useful tool. (see Spiritual Pain)

When a normal lifestyle is no longer possible, learning new skills can be a way of reducing the frustration of losing previous abilities. Craft work (such as embroidery, leatherwork, knitting, weaving, sewing, pottery, basketry, or making soft toys) can be therapeutic for many patients. Projects should be short-term, easy to pick up and set down, and have a pleasing result. They can then be given as presents, or left behind, or even sold as a donation. They allow the patient to give rather than to keep receiving.

A day hospice brings opportunities for group activities and games. Group entertainments are often enjoyed, such as demonstrations of crafts or cooking, or musical or theatrical performances, or short trips. (see Day Hospice)

Attention to personal appearance (barber, beautician, manicurist) and personal well-being (relaxation techniques, meditation, massage, aromatherapy) can raise morale and restore a person’s spirits.

Occupational therapy encourages patients to lift themselves out of the passive sick role (often associated with feelings of helplessness and loss of control) and to be more independent, creative and productive. It emphasizes “doing” rather than “being done to”. This can restore a sense of purpose and accomplishment.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.

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