Author Archive for: jentwistle

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

So, we have slept, are out of bed, groomed and dressed.  Now what?  Typically we head to the kitchen to grab something to eat.  Admittedly, I am a terrible cook.  And on top of this I am leery of ready-made foods, and think the microwave is the root of all cancer.  So, let’s just say I struggle with everything that is meal preparation.  Many of my clients struggle with this also, but for much more legitimate reasons…

For most of us, breakfast is typically simple.  Cereal, toast, maybe eggs, pancakes, granola or fruit.  Lunch slightly more complicated, and dinner is an effort.  So what if you have a brain injury and have difficulty planning meals?  Or, you cannot drive, or can no longer access public transit so you have problems getting items at the store?  Maybe you are on a strict budget and can only get food from a food bank.  Perhaps you have food in the house, but your appetite is supressed from medication, depression, or some other physiological or mental illness.  The dishes might be too heavy to lift if you have upper extremity problems, or you have one hand you can’t use at all which makes cutting, peeling, and carrying heavy pots very difficult.  If you have a special diet, or cannot consume foods by mouth, meals take on another form – pureed, soft, smoothies, Ensure, or even through a feeding tube.  If the meal is made, perhaps you just can’t carry it to the table as you use a wheelchair, or cane, and the last time you tried the meal ended up on the floor.  If you have tremors, shakes or dizziness, walking carrying anything is a challenge.  Once you are at the table with your food, an upper extremity or visual problem might make it hard to get the food onto the fork, spoon, or into your mouth.  Chewing could be another problem if you have oral-motor difficulties.  Then you have to swallow and choking or aspiration are possible.

Occupational therapy treats all that.  We provide strategies and supports to enable shopping, and aids that might help get the groceries into the car, into the house, and into the cupboard, fridge or freezer.  Or to improve memory we can help to set up systems that enable people to shop efficiently and effectively, including meal planning, creation of lists, mapping out products in isles, and providing strategies on ways to prevent visual and auditory overload common to most stores.  When cooking, occupational therapists look at safety around appliances, provide strategies to reduce bending, standing, or reaching, or even aids to reduce bilateral (two-handed) tasks if necessary.  If there are dietary concerns, occupational therapy can provide aids and education, and can work with a speech therapist or dietitian to make people are able to manage nutritional needs.  If there are negative eating behaviors, we can treat that through cognitive and behavioral therapy, tracking, and helping people access other resources and programs.  For consuming food, there are several devices that we can use to address a visual-perceptual neglect, a dominant hand impairment, and train people how to eat with a prosthetic.  We can make customized utensils and splints to bridge the gap between a hand and mouth if the two can’t connect.

Spoken quite simply – occupation is everything that is eating: from planning what to eat, getting the food from the store to the house, preparing this safely, and making sure the food meets the mouth, or the stomach.  If these things are a challenge for you, occupational therapists treat that.

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

Okay, so you are up, out of bed, heading to the bathroom.  “Occupation” is also the process of managing personal care tasks involved in toileting, grooming, showering or bathing, and dressing.

Assume you have reached the bathroom.  What happens if your back is too sore to bend you towards the sink, or the toilet is too low and you don’t have the lower extremity mobility or strength to crouch to that level?  Or, maybe you have lost bowel and bladder abilities and you are required to toilet differently?  What if when you look in the mirror your thoughts start racing to negative, derogatory or harmful comments about yourself?  You want to shower or take a bath, but you can’t stand that long, can’t get your cast wet, or have hypersensitivity to the water hitting your skin.  Maybe you can’t get to the bottom of the bathtub, or even if you sit to shower, can’t reach your shower head, lift your shampoo bottle, or lack the arm, hand and finger abilities to scrub your body or your hair.  If you are using a wheelchair or commode, maybe you can’t even get into the bathroom in the first place, or if you can, can’t get into the shower, under the sink, or can’t see yourself in the mirror.  Or, perhaps your depression limits your motivation to shower, or to brush your teeth or hair in the first place.

Maybe you have managed to do your grooming, toileting and washing.  What if you can’t get dressed?  Perhaps you are on the main floor because you can’t do the stairs, but all your clothes are in your upper bedroom.  Or, your clothes are not clean because you lack the ability to do so.  Maybe you dresser is too high, or too low, or you can’t reach the shelves in your closet due to pain, limited strength or mobility.  Putting on a bra requires significant shoulder movements and putting on socks requires flexion and external rotation of the hips, or bending, and you can’t do any of that?

Occupation is all of that, and these things are addressed in occupational therapy.  If you can’t use the toilet, perhaps you need education, supplies or help to manage briefs, urinals, catherizations, bed pans, disimpaction, a colostomy, ileostomy, or suppositories.  Maybe you need a commode beside the bed because your bathroom is not accessible, or you don’t have a toilet on the level of the home you are required to sleep on due to limited mobility.  What if the commode you do have won’t fit over the toilet, or even through the bathroom door?  If you can get in the bathroom, but the toilet and sink are not usable for you, perhaps devices would help to correct this, or you need education on alternatives.  Perhaps your shower or bath needs some adjustments to help you transfer into / out, to sit to shower, or to reach the shower head.  Maybe the shampoo and soap bottles need to be changed or relocated.  A reacher may help you to access some of your clothing, or you need education and support to rearrange your things to promote your independence.  Education and equipment for dressing may help to reduce your need for assistance with dressing your upper and lower body.  No motivation to do these things in the first place?   Solutions can include cognitive, emotional and behavioral strategies and supports to change thinking patterns, reengage the psyche, and to restore normal routines.

Spoken quite simply – occupation is going to the washroom, grooming, showering and dressing, and if these things are a challenge for you, occupational therapists treat that.