Ot the forgotten therapy discipline

Richard S. Kaplan, M.D.Medical Director / Inpatient Rehab Unit

Media Articles Periodically Surface:“Medicare Waste – Occupational Therapyfor Retired People”

Occupational Therapy is Therapy to help train patients for a new career

Occupational Therapy is Physical Therapy for the Arms

ADLs (Activities of Daily Living) Improving FUNCTION Typically involves upper extremity function –

but not necessarily Function/ADLs are key, not necessarily Arms

“Duct Tape and Velcro” Making the best of a situation Creative Solutions

Dressing Bathing Toileting◦ Transfers◦ Clothing Management◦ Bowel/Bladder Function

Eating Grooming Bed Mobility

Cooking Managing Finances Shopping Working Driving

3 hours of HELP Not 3 hours on a treadmill!

Acute decline in function for any reason◦ Fracture◦ Weakness◦ Deconditioning◦ Pain◦ Loss of Body Part

Stroke Hip Fracture Joint Replacement Typically written as “PT/OT”

ER or Observation Status:◦ “ My mom can’t manage by herself”

Recently Extubated Patient Recovery from Other Critical Illness

Elderly patient in ER with rotator cuff tear

Unsure if safe alone

Upper extremity injury in elderly patient

Injury to any 2 limbs

Discharge Disposition◦ Home vs. Subacute Rehab (PCC) vs. Acute Rehab

(IRU)◦ Often OT is more critical than PT in this process

Must have PT or RN as admitting service Typographical Error In Federal Regulations

Rheumatoid Arthritis Shoulder Injuries Upper Extremity Amputations

*** Early Referral is Extremely important If not referred Within first few weeks of an

upper extremity amputation, may never use prosthesis

Yes, OTs can help with “Occupational” training to return to a PRIOR job

Need to be interpreted by physician like any other diagnostic test

Measures of statistical validity important◦ Correlation of heart rate with effort◦ Rapid exchange grip test◦ Coefficient of Variation

If submaximal effort, may suggest minimum rather than maximum physical ability

Always a function of physical fitness Restrictions vs. Limitations

Are these appropriate referrals?◦ 29 Year Old Coal Miner acutely hospitalized after

traumatic leg amputation – Inpatient OT Evaluation for vocational training◦ 89 Year Old Widow who lives alone is hospitalized

for a stroke – OT referral for ADL Eval◦ 91 Year Old Widow in ER for non-surgical treatment

of Rotator Cuff Tear – Referred to OT to assess ER disposition

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