Occupational Therapy (OT) aims to empower patients to be active participants in their rehabilitation journey. OT considers all aspects of daily living; this includes personal care, domestic skills, community living skills, work and leisure.
Through conducting a variety of assessments, the OT identifies an individual's strengths and limitations. With the aim of maximising function and independence, the Occupational Therapist may provide rehabilitation, education on new ways of doing things, and advice on equipment and environmental adaptations.
Within St George Healthcare Group there are 5 Occupational Therapists, each with knowledge and experience of working in a range of physical and mental health settings. The Occupational Therapists work with OT Assistants and Activity Co-ordinators, as well as the wider MDT. Across the three hospital sites, healthcare is provided in conditions of medium and low security and open wards, covering clinical services including Acquired Brain Injury, Autistic Spectrum Conditions, Deafness and Mental Health, Acute and Long-Term Neurological Conditions and Challenging Behaviour.
A variety of evidence-based OT models of practice such as the Model of Human Occupation and Sensory Integration are used as a framework for OT services within St George Healthcare Group. During the initial assessment period each patient receives a full OT assessment and a report is produced for the first CPA / Case Review. This report collates information gained from assessment of Personal Activities of Daily Living (PADL), Domestic Activities of Daily Living (DADL) and, where appropriate, Community Skills Assessment.
Person-centred approach to assessment
A person-centred approach is taken in regards to assessment, therefore, dependent on individual needs, further standardised and non-standardised assessments can be completed where appropriate. These may include, but are not limited to:
- Sensory Profile
- Sensory Modality Assessment and Rehabilitation Technique
- Motor or Sensory Upper Limb Assessment with the option of splinting
- Seating and Posture
- Cognition and Perception
- Mood and Behaviour
- Educational Assessments
- Risk Assessments
Patients are encouraged to engage with a structured routine through the use of a weekly planner / timetable, which incorporates a range of activities across the week covering daily living skills, community skills, education/occupational skills and leisure pursuits. Where possible local community based activities are accessed to promote community integration. Where this is not appropriate, hospital-based intervention is offered on a group and individual basis.
A functional approach to intervention is taken, which is a combination of restoration and compensation. Given the brain's capacity for recovery and plasticity, the OT will aim to restore and improve impaired functions where possible; and optimise remaining functions.
Intervention may include, but is not limited to:
- External memory aids
- Equipment provision
- Environmental adaptation
- Adapting activities
- Education on new ways of doing things
- Repetitive practice of specific activities e.g. meal preparation
- Social skills training and confidence building
- Fading prompts and assistance to develop independence with daily activities e.g. washing, shopping, using public transport
- Upper limb exercise and splinting programmes
- Food safety
- Health Promotion
- Literacy and Numeracy
- Fatigue Management
- Anxiety Management
- Money Management
Outcomes of OT Intervention
To measure the effectiveness of OT intervention and patient progression, regular reassessment occurs using a variety agreed outcome measures. These are different across the hospitals but include standardised and non-standardised assessments.
The Model of Human Occupation Screening Tool is routinely reviewed prior to each CPA review at St Mary's and any progress made is analysed Exams and tests of knowledge are conducted at All Saints, which are particularly useful following educational groups. The FIM+FAM, Northwick Park Therapy Dependency Assessment and Rehabilitation Complexity Scale are completed at St Cyril's. Also used are a variety of impairment specific scales which measure fatigue, memory, upper limb range of movement etc.
The use of self rating scales and self evaluation are encouraged as they are measurable and can support the development of self awareness and insight in patients. All these measures inform the treatment needs of the patient and identify subsequent steps in the patient's rehabilitation journey.
OT also record attendance at Therapeutic Activity to meet CQUIN standards and provide data for patient journey audits completed across the hospital group.