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Areas of OT

Occupational Therapists have an essential role in helping people of all ages to overcome disabilities resulting from illness, ageing or accident so they can perform daily living tasks that they need and want to do. To be able to provide the assessment and intervention specific to the disabilities experienced, occupational therapists gain knowledge and skills in specialty area of practice.

The following provides a broad overview of specialty areas of practice in occupational therapy:

Acute Hospital Setting

Rehabilitation

Mental Health

Developmental Pediatrics

Hand and Upper Limb

Home Visiting

Aged Care

Vocational Rehabilitation

Community

Acute Hospital Setting

Who do you see?
Anyone who has been unwell or injured and is requiring a stay in hospital.

What do you do?
Work within a large team of health professionals to promote a person’s independence within their recovery so they can leave hospital and return home. This can include assessing a person’s current abilities, reteaching and providing strategies, providing assistive equipment, working with a person’s social supports and providing modification to the home environment which all acts to promote a person’s independence.

Where do you do it?
Acute hospitals in metropolitan areas and local hospitals in regional areas.

Case Example
A young man, Mark, has been involved in a car accident and has fractures in one arm and one leg. The occupational therapist works with Mark to teach him how to move from bed to his wheelchair and teaches him how to use his wheelchair. The occupational therapist also completes a self-care assessment with Mark and retraining so Mark can go to the toilet, shower and groom himself as independently as possible. Prior to Mark discharging from hospital the occupational therapist completes an assessment of the home environment and provide assistive equipment to promote Mark’s independence at home. Mark’s family are also involved with the therapy plan with the occupational therapist providing education for the care of the person in the home setting.

How can I find out more?
Please contact the WA Occupational Therapy Association if you would like further information. The WAOTA also has an acute services interest group that can be contacted at [email protected]

Rehabilitation

Who do you see?
Anyone who has had an injury or medical condition, which has resulted in them being unable to function as they have previously.

What do you do?
Work with the person as part of an inter-disciplinary team to promote the person’s independence so that they can perform the activities they previously completed. This can include assessing the person’s physical and cognitive skills, home environment, social supports and both previous and current functioning in daily activities. From there we assist the person to retrain their skills to perform the task as they did before. This may also involve teaching the person adaptive techniques or provide equipment/aids to assist in performing the task differently.

Where do you do it?
Rehabilitation hospitals providing sub-acute care, general hospitals and local hospitals as both inpatients and outpatients
People’s homes as part community and home based rehabilitation services.
Community Associations or organisations

Case example:
A middle aged man, George, has had a stroke and consequently has significant weakness in their right arm and right leg, as well as difficulty using his right side. The occupational therapist completes an assessment of how the person is currently able to complete daily activities. The occupational therapist assists George to build strength in their right arm by practicing functional tasks (such as reaching for a cup or washing their body in the shower), and teaching him exercises. The occupational therapist teaches George techniques to ensure he see’s people/objects on his right hand side, provides adaptive cutlery to enable independence in eating, and prescribing a wheelchair to give him independence in mobilising while he returns to walking. The occupational therapist completes a home visit to ensure George can access his house and has the equipment he require to be independent and safe within their home. When the person is ready to leave hospital the occupational therapist would arrange follow up services within the home or as an outpatient, and link George to a service to assist with him transitioning back to work. The family is encouraged to be involved in the rehabilitation process and therapy plan.

How can I find out more?
Please contact the WA Occupational Therapy Association if you would like further information – [email protected]

Mental Health

Who do you see?
People who have a mental health illness and require support within their lives

What do you do?
Help people with a mental illness to complete activities of meaning within their lives. We work with the person to identify their needs that best supports their recovery and functioning. This includes: living and home management skills, prevocational and vocational skills, community engagement, access and supports, leisure and recreational activities, psychoeducational and coping skills and goal setting.

Where do you do it?
acute mental health care (hospital and community);
rehabilitation services;
private and non-government services
mental health promotion programs (i.e. schools and workplaces).
Occupational therapists can work with people individually or in a group setting.

Case Example:
Jessica is a 32-year-old lady with a diagnosis of Bipolar Affective Disorder. Jessica is completing a degree in teaching however is having difficulty managing her studies. Jessica is also having difficulty managing tasks within the home (cooking, cleaning, laundry) and relies on her boyfriend who is very supportive. Effects of her mental health condition include elevated mood and energy, reduced judgement, racing thoughts and erratic behaviour. The occupational therapist completes an initial interview to assess Jessica’s functioning, and to identify areas of importance for goal setting. A functional assessment (i.e. cooking) in the home environment was also completed to assess the effect it is having of Jessica’s ability to complete tasks. The occupational therapist works with Jessica to develop healthy lifestyle skills and routines such as sleep, regular exercise, healthy eating and monitoring of symptoms to assist Jessica to develop self-management skills in order to manage her condition. The occupational therapists also work with Jessica to develop a weekly routine that incorporates activities that gives her a sense of purpose and meaning to help with her recovery.

How can I find out more?
Please contact the WA Occupational Therapy Association if you would like further information – [email protected]

Developmental Pediatrics

Who do you see?
Infants, toddlers, children, adolescents and teenagers.

What do you do?
Assist children and young people to grow, learn, have fun and socialise enabling them to reach their full potential. Occupational therapists work with children and families to meet developmental milestones of self-care, school work and education, and play and leisure. With older children and adolescents occupational therapists can assist with promoting and developing independence and also working around psychosocial issues that affect teenagers. An occupational therapist would use a variety of assessments to develop an understanding of the child or young person’s current function and work with them and their families to reach the goals identified.

Where do you do it?
private practices
paediatric hospitals
community organisations
schools
developmental centres

Case Example
An occupational therapist receives a referral for a 6-year-old girl, Katie, who is having trouble concentrating in the classroom and because of this is not keeping up with the other children in her class and has become disruptive in the classroom setting. The occupational therapists completes a development assessment identifying Katie is having difficulty with her fine motor coordination which is effecting her handwriting. The occupational therapist also completes a sensory screen to get a better understanding of Katie’s sensory preferences. Because this has become tricky for Katie she easily becomes frustrated with the task and gives up, feeling she cant complete it. The occupational therapists develops a program for at home and completes a term of therapy sessions with Katie to improve her fine motor coordination and sensory regulation in the classroom. After meeting with Katie’s teacher strategies are also used in the classroom to help Katie cope and be less disruptive. Katie is reassessed by the occupational therapist at the end of the term to establish improvements and change therapy plan as needed.

How can I find out more?
Please contact the WA Occupational Therapy Association if you would like further information. The WAOTA is also affiliated with the Developmental Occupational Therapy interest group (DOT)- http://dotwa.org.au/

Hand and Upper Limb

Who do you see?
Anyone who is requiring rehabilitation to the upper limb; from the shoulder to hand. These injuries and conditions can include; Fractures, Amputations, Arthritis and rheumatic diseases, Congenital conditions, trauma, dislocations and subluxations, Ligament injury and instability, Muscle strains, tears, and avulsions, Tendon injuries, Nerve injuries, Pain conditions, Wounds and scars, and neuromuscular pathologies.

What do you do?
Treat and provide therapy for people with an injury or condition that has affected the upper limb recover and achieve maximum function. Through achieving the maximum function, the person is then able to participate in their meaningful activities. This can include but is not limited to; Therapeutic activities and exercises, splint design, fabrication, fitting, and training, Joint protection and/or energy modification in activities, Sensory re-education, mirror therapy, Scar management, Pain management, Work conditioning, Training adaptive or assistive devices, and Education for post-surgical or post-injury principles.

Where do you do it?
specific clinics,
acute, sub-acute care and rehabilitation hospital settings
privately owned businesses.

Case Example
Karen fell on to her outstretched arm and sustained a

How can I find out more?
WAOTA Hand Interest Group- [email protected]
Australian Hand Therapy Association (AHTA)- www.ahta.com.au

Home Visiting

Who do you see?
Anyone who is having difficulty completing activities within their home environment

What do you do?
A home visit assessment is completed to gather information and assess the set up. This includes; access to and within the house particularly the bedroom, toilet, bathroom and kitchen, assessing the need for any rails to enable safety and independence, considering the need for any equipment such as shower chairs, over the toilet frames or high back chairs, looking for any trip hazards and provide safety recommendations. After the home visit interventions is provided in the way of ramps, rails and home modifications. These are then completed with the landlords’ permission via a carpenter or plumber. Equipment is provided and set up. Education is also provided to the person/family about the equipment provided and any recommendations regarding functional transfers, etc.

Where do you do it?
Peoples’ homes. Home visits can be arranged via occupational therapists working at;

public or private hospitals,
private and not-for-profit community services.

Case example:
A 25 year old man, Matt, was in a motor vehicle accident and sustained a spinal cord injury. Matt uses a self-propelling manual wheelchair for mobility. A home visit is completed when Matt is nearing the end of his rehabilitation and his level of long-term function is known. The occupational therapist assesses Matt’s house and completes the following:

Measures for a permanent ramp at his front entrance, and a small rubber ramp inside the front entrance to enable Matt to propel himself inside. Measurements are provided to a carpenter to install the ramp
Measures all doorways in his house and confirms Matt would be able to propel himself through in his wheelchair
Liaises with a carpenter/builder to complete structural modifications in Matt’s bathroom to create a level shower and install a toilet in the open bathroom so that Matt could wheel a self-propelling commode into the shower and over the toilet
Provides Matt with a self-propelling commode and education to his family on the maintenance and use of this
Provides recommendations to Matt’s family of where to move his bed for access
Provides recommendations of where to move common kitchen appliances to allow ease of access by Matt
Provides all measurements, recommendations and photos to Matt’s rehabilitation occupational therapist

How can I find out more?
OT Services in the Home Interest Group. Please contact the WA Occupational Therapy Association if you would like further information – [email protected]

Aged Care

Who do you see?
Adults living in a residential aged care facility. Usually residents are aged 65 and above and may be living with medical conditions that commonly effect the elderly.

What do you do?
Complete an initial assessment with the residents to determine their cognitive and physical functioning, as well as gather information about their past life, social situation and enjoyed leisure activities. Treatment is focussed on assisting the residents to compensate for or adapt to impairments they must enable the greatest amount of independence and safety. An occupational therapist will ensure the resident has the equipment they require to support independence and safety. The occupational therapist typically creates a monthly activity program and will assist the resident to identify activity groups that they would like to engage in. Assessments are routinely repeated to monitor and identify any deterioration in residents’ cognitive and physical functioning. The occupational therapist may also provide support to staff members to manage residents who are confused or distressed.

Where do you do it?
In residential aged care facilities.

Case example:
An elderly 79-year-old lady, Grace, has moved into a residential aged care facility after being unable to cope living at home alone and having recurrent falls. The occupational therapist receives handover from the occupational therapist at the hospital Grace was transferred from and was given an update of Grace’s current level of functioning. An initial assessment is completed with Grace upon her arrival and the occupational therapist identifies that she requires a shower chair and bedside rail, has moderate memory impairment and enjoys shopping, playing the piano and craft. The occupational therapist ensures Grace’s room is set up with a shower chair and bedside rail, and handed this information regarding her level of functioning in self-care over to the care staff. The occupational therapist assists Grace in selecting activities from the monthly program. Grace is encouraged to share her musical talent by playing the piano for the other residents three afternoons a week, which creates a sense of purpose and self-worth. The occupational therapist assists Grace to use external aids such as a calendar and alarm clock to ensure Grace remembers new appointments and when to attend the groups. The occupational therapist completes routine assessments and identified that Grace had a further deterioration in memory and was not attending many groups, hence the occupational therapist liaises with the care staff and therapy assistants to ensure Grace was collected for each group that she wanted to attend.

How can I find out more?
Please contact the WA Occupational Therapy Association if you would like further information – [email protected]

Vocational Rehabilitation

Who do you see?
People who have an injury/ illness that impact their ability to complete tasks in their workplace. Can also see employers and insurers to provide workplace education.

What do you do?
The occupational therapist completes a comprehensive assessment of the worker and their mental/ physical abilities, the workplace environment and work tasks performed. The occupational therapist liaises closely and provides education and advise to employers and insurers on the needs of the worker such as workplace modification, safe work practices and provision of assistive devices. The occupational therapist would work with all parties involved to develop a graded return to work program to enhance the workers’ functional performance and productivity.

Where do you work?
Vocational rehabilitation and injury consultant companies.

Case Example:
Rob in a 49-year-old man who works fulltime as a Storeman in a wine distribution company. Rob has a left shoulder injury (dominant arm)- subacromial bursitis and had been experiencing a gradual onset of symptoms over a period of 1 month. Rob has received a medical certificate as he was continuing to struggle with stacking duties which are normally 8- 12kg in weight and it is impacting on his sleep at night.

The occupational therapist gathers information about how the injury occurred, current medical guidelines, Robs’ current status and the treatment he is receiving. The occupational therapist works with Rob and his employer to determine barriers to return to work (RTW). For example, Robs’ injury doesn’t appear to be healing and this may be due to continuous strain on shoulder when completing stacking duties. A job analysis is completed to determine details of Robs’ work tasks including essential and non-essential tasks and physical demands. This would involve consulting with Rob and his employer and observing Rob completing work tasks. In consultation with Robs medical team, the occupational therapist provides recommendations for tasks and weight restrictions. Rob is asked to avoid lifting/ carrying of items above chest level and have a weight restriction of 6 kgs. The occupational therapist meets with Rob and his employer to discuss the graded RTW Program which is continually reviewed and adjusted throughout the entire process.

How can I find out more?
Please contact the WA Occupational Therapy Association if you would like further information – [email protected]

Community

Who do you see?
People who live at home and have an injury or illness and require support to access and engage in their community and meaningful activities.

What do you do?
The occupational therapist completes assessments of the person’s environment and identifies potential barriers to community engagement. This would involves applying a client centred approaches to include advising, accessing and skills training to support performance and engagement in local community settings such as the shops, school, recreational centre, accessing transport, university and work place.

Where do you work?
outpatient hospital services
government and non-government community organisations
health promotion services.

Case Example:
Sam is a 24-year-old female who experienced a spinal cord injury 1 year ago in a motor vehicle accident. Since her injury Sam has engaged in functional rehabilitation to support a variety of occupational performance areas such as ADLs and wheelchair mobility skills. Sam has also received support from home visiting occupational therapists to make necessary home modifications; and to engage in ADLs and home management skills within the home environment. Recently Sam has reported feeling isolated and depressed due to limited social opportunities and would like to develop more independence in accessing her local community.

The occupational therapist begins by establishing Sam’s goals and priorities. An interest checklist is utilised to identify past and current interests, and the occupational therapist and Sam could begin exploring local community resources aligned with her interests. The occupational therapist would use an activity analysis approach to observe Sam transporting to/ from shops, accessing shops and engaging in chosen activities.

The occupational therapist completes a comprehensive assessment of the physical environment and facilities (entrances, toilets, seating etc.) and provide education and skills training to facilitate engagement. Furthermore, the occupational therapist is aware of any social barriers/ stigma that may impact on Sam’s confidence and engagement.
The occupational therapist establishes a graded program and assist with linking Sam with additional community supports to facilitate her engagement in leisure and social occupations.

How can I find out more?
Please contact the WA Occupational Therapy Association if you would like further information – [email protected]