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Archive for category: Occupational Therapy At Work

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Chronic Pain a Problem? Try OT

Co-written with Claire Hurd, Occupational Therapist

We have all, at some point, likely experienced pain.  A broken bone, sprained or strained joint, that killer headache, or even a long-term issue – pain prevents people from engaging in activities that are important to them, or at the least inhibits enjoyment and full participation in those things they want and need to do. It doesn’t matter if the cause of the pain is fully understood — the person’s experience of pain is what is important, and is what affects function.  As the role of an occupational therapist is to enable clients to engage in activities that they want, need, or are expected to do, OT’s have the capability to help individuals with chronic pain to better manage their lives. Occupational therapists have many tools they use to assist people in this regard.

Activities that require repetitive movements or a great deal of range of motion may exacerbate pain symptoms. Even if an occupational therapist cannot fix the source of pain, they can instead adapt how a person does an activity, or where they do it and with what equipment. Occupational Therapists know about different tools and devices that can be used to modified activities to improve comfort and prevent future disability, and we stay on top of the latest and greatest devices as these hit the market. Incorporating healthy body mechanics into an activity, whether or not this is assisted with equipment, may help to manage pain. Sometimes the order of steps in the activity can be changed to make it more comfortable. Making rest breaks part of the activity is also very important.

Fatigue often affects people with chronic pain and can be a barrier to planning or doing meaningful things. Occupational therapists are well-versed in energy conservation techniques and pacing strategies, which can not only improve fatigue but can also help to decrease pain symptoms. Energy conservation and pacing can sound simple, but it can be challenging to integrate new habits into one’s life; an occupational therapist can provide an individualized system and the support to stick to it and make it routine. Good sleep hygiene, which typically includes a bedtime routine as well as avoiding substances and activities which can interfere with sleep, is also important to prevent fatigue. What constitutes an effective sleep routine is also unique to each individual, and an occupational therapist can help you find what works best for you.

One of the most difficult consequences of chronic pain is often its’ effect on mental health. Occupational therapists trained in psychotherapy can provide counseling and teach emotional coping skills. They may also provide cognitive behavioural therapy, which helps clients to change their thoughts and behaviours, in this case related to their pain. Training in the skill of mindfulness can also allow individuals with chronic pain to change the way in which they are aware of their pain in the moment, and decrease an overall perception of it.

Chronic pain is best managed with prevention and early intervention. Occupational therapists can help you ensure that how you do your favourite activities does not cause or worsen pain and that you get to participate in those meaningful life roles (old or new) despite the pain. Everyone’s experience of pain is different, and you and your therapist will work collectively as you find solutions that help you manage your pain and work on the “solutions for living”.

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Financing Home Modifications

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

The foundation of the profession of Occupational Therapy is creating Person-Environment-Occupation fit.  We call this our PEO model.  What it means is that optimal function arises from the best interaction of the person, their environment, and those “occupations” that are the daily tasks they need to complete.

So, if you are struggling to complete daily activities, or are feeling that you need more support to manage at home, or are worried you might get injured falling in or around your house, perhaps you need to consider, or are considering, home modifications.

But before you get scared at the thought of a large-scale renovation, it is important to recognize that home modifications can be as small as changing some door handles to as large as installing an elevator.   There is a continuum, and your capabilities, needs, and current environment will dictate a custom approach.  So, what is the process for understanding how home modification can help, and how can you possibly fund these?  I am glad you asked…

Perhaps I am biased, but in my opinion, the process should start with an occupational therapy assessment.  If you call a contractor for a quote to say, renovate your bathroom, he will provide you with the estimate you want.  But what the contractor won’t understand is the PERSON or the OCCUPATIONS that person is struggling to complete.  For example, if there are larger issues, or bigger problems lurking, is the contractor the right person to advise you on this?  What if there are ways to improve your safety in the washroom without engaging in a full renovation of the space?  An occupational therapist will be able to problem solve your concerns with you, while recommending multiple options to consider – from inexpensive to more costly.  The few hundred dollars you will pay the OT may just save you thousands in unnecessary renovation costs.

Once you have considered all the available options, and have confirmed the scope of work, you will need to get estimates on the costs of the work involved.  It is important that you hire a vendor that has completed renovations for accessibility before, as not all contractors will have this knowledge and expertise.

Now you have your price – so how can you pay for it?  Here are some financing suggestions based on my years of experience in this field:

Insurance:

Extended Health – if you are still working, or still have access to extended health benefits, check your coverage.  Many plans have up to $10,000 in coverage for home modifications.  You will need to submit an estimate to them first for approval.

Motor Vehicle – if your disability has been the result of a motor vehicle accident, and you still have an open claim, you may be able to access funding through your insurance provider.

Veterans Affairs – if your disability has been the result of military service, Veterans Affairs may be able to provide funding.

Workplace Safety and Insurance Board – if your disability was the result of a workplace accident, and you still have an open claim, funding may be available through your WSIB.

Lenders:

Traditional Loan – if you are a homeowner with good credit, your bank may be able to provide you with a traditional loan for the monies you need.  As with all loans, there will be interested and a set repayment schedule so budgeting beforehand is important.

Line of Credit – often people borrow money using the equity in their home as collateral.  These are more flexible than a traditional loan and work more like a credit card.  However, it requires discipline to make sure you are paying off some of the principal with each payment, as only interest payments are required on a monthly basis.

Reverse Mortgage – According to the Financial Consumer Agency of Canada, a reverse mortgage “is a loan that is designed for homeowners 55 years of age and older.  Unlike an ordinary mortgage, you don’t have to make any regular or lump sum payments on a reverse mortgage. Instead, the interest on your reverse mortgage accumulates, and the equity that you have in your home decreases with time. If you sell your house or your home is no longer your principal residence, you must repay the loan and any interest that has accumulated” (Understanding Reverse Mortgages).  There are pros and cons to this arrangement, and not all lenders offer this.

Second Mortgage – A second mortgage is basically another mortgage against a property that already has a mortgage.  The second mortgage typically has a higher interest rate and is more risky for lenders and thus not all of them will offer this.

Talk to your lender or bank if you are looking to finance a renovation through one of these channels.

Government Programs:

March of Dimes – The March of Dimes Home Modification Program will provide $15,000 as a one-time home modification grant to people who qualify.  For information on this program, click here.

Ontario Renovates – Formerly the Regional Assistance Program (RAP), this is a municipally-based program for low-income homeowners.  The funding is provided to the municipalities to administer, but basically low-income homeowners apply based on modification needs related to a disability.  The proposed changes need to be prescribed by an occupational therapist and the funds are provided in a forgivable loan, and / or via grant.  The funding can even cover devices such as porch lifts, stair glides, etc.  Each municipality has different funding allotments and qualification criteria.  For the City of Hamilton, the program was just extended into 2019.  For more information about the program, click here or contact your municipality.

Healthy Homes Renovation Tax Credit – while not a loan or grant, this program does allow people to claim a taxable benefit for funds they spent on home modifications.   The maximum taxable return is 15% on $10,000 spent ($1500), and not all renovations are covered.  For more information on this grant, click here.

Remember, properly planned renovations or changes to your home can have a significant impact on how you manage, and can protect you from future injury.  You may not need one solution per problem as the best solutions are often ones that impact many areas of living in one foul swoop.  Seek the services of an Occupational Therapist so they can help you to find the best PERSON-ENVIRONMENT-OCCUPATION fit for your renovation project.

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Backpack Safety For Kids

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Backpacks are a staple for every student. They travel back and forth between home and school, lugging books and school supplies. They are put through the unavoidable daily abuse of being thrown on the ground, trampled on, stuffed into a cubby or locker, saving a spot in line, and become over-stretched and over-used with the necessities of school. They are a necessary part of your child’s education, yet how much thought do you really put into the backpack your child wears aside from maybe price or color?  Have you considered the health implications of an improperly worn, fitted, or poorly supportive backpack?

Backpacks are meant to be worn over both shoulders so that the weight can be evenly distributed across some of the largest and strongest muscles in the body. Due to this, backpacks are preferable to shoulder bags, however they must be worn properly in order to avoid postural issues and injuries to the back, shoulder, and/or neck (1). Additionally, backpacks that are too heavy or large increase a child’s risk of injury due to falling or tripping (2). The following are some simple tips to help ensure your child’s backpack is fitted properly in order to avoid any negative health implications.

First of all, when choosing a backpack look for the following features (1,3):

1.    Make sure the backpack is made of a lightweight material. Sure, some trendy materials may look cool, but these can also add unnecessary weight.

2.    The backpack should have two wide, padded shoulder straps that are adjustable. Thin, narrow straps can cut off circulation resulting in pain, tingling, and numbness.  Straps with a clip to secure them across the chest are best.

3.    Look for a padded back to increase comfort and also to protect your child from being poked by items inside the bag.

4.    Backpacks with a waist strap help distribute the weight more evenly and can protect the neck and shoulders from carrying the weight independently.

5.    Check out backpacks that have a roller option if allowed in your child’s school. This allows freedom to switch between wearing on the back (for example on snowy days when rolling is not practical) and rolling the bag on the ground to take stress off of the neck and shoulders.

6.    Ensure the backpack has multiple compartments as this helps to distribute the weight more evenly, and keeps things organized and separated.

Once you have found the perfect backpack, ensure the backpack is worn properly by following some of these general guidelines:

1.    The American Academy of Pediatrics suggests that backpack load should never exceed 10-20% of your child’s body weight. Make sure unnecessary items aren’t traveling back and forth – leave heavy items at home or school if possible.

2.    When putting on a backpack, ensure your child bends at the knees (not the waist!) and uses both hands to lift it onto their shoulders. Watch for signs of strain or difficulty when putting it on – if any are present consider reducing the load in the bag by having your child carry a few items.

3.    ALWAYS use both of the shoulder straps. No matter how “cool” your child thinks using one shoulder strap looks, it can cause muscle, spine and orthopedic injury down the road.

4.    Tighten the shoulder straps and use the strap around the waist (if available). This helps to ensure even weight distribution. The bag should sit in the center of the back, about two inches above the waist (not down near the buttocks!).

5.    When packing, ensure heavy items are near the center / back of the bag. Use all of the available compartments to help distribute the weight more evenly.

6.    Talk to your child about making frequent trips to their locker, desk or cubby to avoid carrying extra weight around all day.

7.    Consider the backpack as a possible culprit if your child starts complaining of back pain, numbness or tingling in the shoulders or arms, or discomfort in the upper body or lower back.  If so, consult with a professional about how to correct the issues, and prevent these from getting worse.  Core, back, or strengthening exercises might be needed if your child is having difficultly lugging around their school stuff – and consult a professional to have any exercises prescribed.

Then, make it fun!  Give your child a list of things to look for when picking out their backpack, and comment on the different features of the ones at the store.  Once purchased, load this up with different things so you can show them the difference when weight is distributed evenly, unevenly and gets too heavy.  Have them try the straps at different lengths so they can comment on what is most comfortable.  Encourage them to leave things at school that should stay there (like indoor shoes) and consider having a double set of school supplies at home so these don’t need to travel back and forth.  Make Friday “clean out your backpack day” for a special treat.

Remember that you get what you pay for.  A $10.00 backpack chosen on style or color may cost you a lot more in the long run.  Backpacks are not an item you should cheap out on!

For more informative articles on kids health check out our OT For Kids page.

1)      American Academy of Orthopedic Surgeons (2013).
2)      KidsHealth (2013)
3)      American Academy of Pediatrics (2014)

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“Stressed or Depressed” – Man Therapy

Is it me, or is there a rise in gender discussions of recent? The ongoing, and now vastly publicized, fight for work equality between men and women, gender in sport, mom-preneurs, daddy day cares.   It is no secret that women and men look, think, act, behave, communicate, and logic differently.  So how do these gender differences relate to mental health and the processing of mental health problems?  Consider the following:

Husband comes home from another long work day.  Deadlines are looming, the boss is out of town, promotional opportunities are forthcoming, and someone called in sick.  His wife expects him to do a few dishes, play with the kids, maybe get the dog out.  She asks for his help with a few things, and he explodes (or retreats, or grumbles, or will begrudgingly oblige).  “I had another long day, I just want to…(go to bed, watch the game, zone out in the basement, eat in peace..).”  She probably had a long day too – working or home, the demands and tasks don’t seem to end.  Both go to bed frustrated, sad, angry or feeling isolated and alone.  The next day the cycle repeats and onward things go…she might ask about how he is doing, and he might respond with “I am just stressed”.

Familiar? But when you look at how men and women process emotion differently, “stressed” for men, might actually mean “depressed”.

When you imagine a person who is depressed you may think of them as tired or sad, maybe they are neglecting their hygiene, have a reduced appetite or poor sleep, and these are all very valid symptoms of depression. However the American Psychological Association reports that depression signs can differ greatly between men and women, and the reason for this remains unexplained. Many professionals speculate it could be from our ‘macho-man-ideal’ society, in which men are encouraged to ‘suck it up’ and to show their ‘strength’ or self-control by not expressing emotions. This ideal is unfortunately also rubbing off on Canadian children, and boys between the ages of 13-17 are severely underrepresented in the statistics of youth that call the Kids Help Phone, and when they do call they rarely talk about mental health.

Symptoms that are often not recognized as depression, especially in men, include:

●     Being irritable, short-tempered, or inappropriately angry
●     Spending a lot of time on work (they may be trying to escape their feelings by keeping busy)
●     Reckless driving, extreme sports, or other risky behaviour
●     Excessive controlling behavior
●     Alcohol or substance abuse (men are far more likely to abuse substances)

These behaviours are untraditional of typical depressive symptoms, but mean that men who may benefit from emotional aid are often slipping under the radar for health professionals, and this can lead to disastrous consequences including poor quality of life and higher rates of suicide.

Recent studies by organizations that specialize in mental health say that they need to approach the topic of depression differently with men. Often men will not admit any possible feelings of ‘depression’, but will quickly agree to feeling ‘stressed.’

Women, on the other hand, might use the word “stress” differently.  Women may use stress to describe a point in time, a set of demands, or something that is expected to pass, while men may relate this to a state of being, a new “normal”.

Based on these revelations, men may require a different marketing strategy for addressing mental health than women. Mental health agencies including the Colorado Office of Suicide Prevention and Carson J. Spencer Foundation collaborated with Cactus to come up with a unique way to entice men to explore their mental wellness.  According to Dr. Spencer-Thomas and J. Hindman (MS):

“The goal of Man Therapy is to show working age men that talking about their problems, getting help and fixing themselves is masculine. The campaign strength is its innovative and humorous approach through a fictional “therapist” named Dr. Rich Mahogany, who is a no-nonsense man’s-man that lets men know honest talk about life’s problems is how they will start to solve them. At the center of the campaign is a web portal that allows men to interact with Dr. Mahogany, do a “head inspection” (self-assessment), and get “manly mental health tips.” When men indicate high levels of distress, Dr. Mahogany refers them to the National Suicide Prevention Lifeline or “the Pros.” Check out this resource for Man Therapy.

The bottom line is that depression can manifest itself differently in different people, and men are constantly under-represented in the list of people seeking help. Occupational Therapists assess and treat people with mental health problems, and some even have the additional training and experience necessary to provide Psychotherapy.  The core approach of the OT profession is to encourage successful function in all life roles regardless of the reasons why function is impaired.  OT intervention may help the men in our lives to reduce some of that “stress” (aka depression), so they can resume enjoyment in life roles.

 

Resources

CTV News, www.ctvnews.ca/video?clipId=454539
Mayo Clinic, http://www.mayoclinic.org/diseases-conditions/depression/in-depth/male-depression/art-20046216

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Accessibility In The Community

In this episode of our popular OT-V series we are discussing community accessibility. The following video discusses the important things to consider when someone with a mobility impairment arrives to a home or building to realize that they may need help to enter.

The following items to consider will help to ensure a safer and easier entrance.

• Understand the type of device you are using and its abilities and limitations

• Understand your own physical abilities

• Identify and assess the help you have available

• Seek out all available entrances and entrance types to select which one best suits your mobility aid or device

• Assess the size of the door you need to enter and what you will encounter upon entry

Watch the video to learn more about accessibility and the solutions available.

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Occupational Therapy and Aging in Place

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Being proactive with your health is one of the best strategies for preventing future problems.  This is in contrast to being reactive which would involve trying to address a problem AFTER it has happened.  Much like putting a grab bar in the bathroom AFTER a fall caused hip fracture, the better strategy would have been putting in the bar BEFORE, while you are well, to prevent the fracture in the first place. This is what “aging in place” is all about.

As the population continues to age, more and more people are opting to stay in their homes.  In fact, in Ontario, 60% of people over 75 still own a home.

Harvard Health Publications compiled a list of “6 Ways You Can Prepare to Age Well” and in reading this we identified that 5 of the 6 strategies related to occupational therapy!  So, we have adapted this to show the top 5 ways occupational therapy can be involved in the aging well and aging in place process:

1.       Space Modification:  An occupational therapist is trained to provide solutions for the “occupations” of daily living.  The home you occupy may need to be slightly adapted, or more extensively modified, in order to ensure it will meet your needs as your physical abilities change.  An occupational therapist can help by assessing your current space, your physical concerns, and will develop a plan for any current or future adaptations you may require.  Common areas OT’s consider in the home include the bathroom, kitchen, flooring, entry ways and stairs.

2.       Fall Prevention:  As people age, the dangers of falling become heightened.  An occupational therapist can help by assessing your home to look for any existing dangers that may lead to falls.  Common areas considered include flooring, transitions, layout and home organization.  Check out our video on “fall prevention” to learn more about how OT can help to reduce your risk.

3.       Is a Move Necessary:  Although many are hoping to live in their current home as long as possible, at some point people often have to make the difficult decision to relocate.  If the layout of your home is not suitable for your aging in place plan, it may be necessary to look to move to a more suitable home, such as something that is one level or has less maintenance.  Alternatively, many seniors look to downsize into senior friendly neighbourhoods or villages where care might be onsite if needed.

4.       Plan Ahead for Assistance:  Do you have someone reliable who is willing to assist and care for you in your later years?  An occupational therapist can help you to plan for the assistance you may need – such as help with activities of daily living, finances, meal preparation, transportation and home maintenance.  It’s best to discuss with loved ones early on if they are able to help with any of these tasks, and if not, an OT can help you to find this assistance in the community.

5.       Emergency Preparation:  As you age, the likelihood of an emergency is heightened.  Emergencies could include a fall, health crisis, problem with your home, or medical condition that worsens overtime causing you to need 24 hour care.  An occupational therapist can help you to develop an emergency plan, or to have the supports in place so you can get support when it is needed.

It is important to remember that people will age differently, and no two people will have the same experience with the changes that occur as we all get older.  I know a lady at my gym who is 75 and can run circles around most 30 year olds.  A unique and custom approach is the best strategy for ensuring that you get the help you need, based on your own abilities and the environment in which you live.   It is just important to develop your plans early and proactively, instead of reactively trying to develop solutions after something has happened.  Seek the services of an occupational therapist for input on how to “age well” and “age in place”.

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Head Injuries In Sports

We talk a lot about concussions on our blog.  Why?  Concussions are a serious brain injury that should not be left untreated and are one of the main reasons to seek the services of an Occupational Therapist.  Sports-related concussions are estimated at 30 000 per year in Canada with many occurring in popular contact sports such as hockey, football, and soccer.  It is important for coaches, athletes and parents to recognize the signs of a concussion and follow strict guidelines if a head injury occurs.  The following from Parachute Canada provides “Concussion Guidelines for the Athlete.”  Check it out and be sure you are aware.  If you suffer a head injury make sure you see a doctor and always remember “when it doubt, sit it out!”

Parachute Canada:  Concussion Guidelines for the Athlete

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Mind your Mouth – the Language of Disability

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Have you ever been in that uncomfortable place of wondering what to say to someone with a disability?  That cognitive and emotional process of wanting to offer support, but not wanting to offend?  Or worrying about offending by offering support?  Or worrying about offending by not offering support?  It can be a conundrum.

I recently left a client meeting and one of the other providers was a wheelchair user.  As we ventured to the parking lot we stopped at her car.  As we were finishing our conversation she proceeded to engage in the process of transferring into her vehicle.  Not wanting to provide help without her request or permission, and not really knowing if she needed it in the first place, I simply said “I know you do this all the time but if you need a hand please let me know”.  I figured it was the best way for me to acknowledge that I could help if she needed or wanted it, but that I didn’t want to assume she could not be independent.

I have had many clients tell me about situations in the community where people have made comments, or engaged in actions that are blatantly disrespectful.  I had one client enter Walmart in his wheelchair and the “Greeter” put a sticker on him saying “I am special”.  He was livid.  Or, at a recent course we watched a video of a client with quadriplegia trying a community outing for the first time since his injury.  As he struggled to manage his wallet and bank card the cashier was visibly annoyed.  Granted she was young, but clearly had no patience for this man that was struggling and her actions were clearly not going to make him feel any better.  On top of being compassionless, she didn’t offer him any assistance either.

Ontario has made some great strides in the domain of customer service.  Not only are commercial buildings to be accessible to people with mobility impairments, but now employers are responsible for training their staff on how to appropriately and effectively provide service to people of all abilities.  This is a great step in the direction of helping all people know how to manage service situations that require compassion, patience and understanding.  We have previously blogged about the Accessibility Legislature in Ontario and you can find that information here:  “Accessibility In Ontario.”

So, have you ever wondered how to navigate those waters?  Have you ever used the words “confined to a wheelchair” or “wheelchair bound”?  Do you understand the difference between handicap and disability?  Do you know how use of words like “cripple, invalid and retard” have changed over time to now be generally unacceptable ways to reference someone with a disability?  For people in wheelchairs, the wheelchair actually allows them freedom of movement.  It returns to them a level of function they lost when their legs stopped working.  For many of them, the ability to be independently mobile is not “confining” and does not make them “bound”.  It is now proper practice to put the “person” before the “disability” and to describe their situation as you would their hair color.  For example, “Julie has brown hair” has the same application as “Julie uses a wheelchair”.  How could I be offended by such a statement of fact?  I recently came across the following resource called “Watch Your Language” and find this is an excellent tool to help people that may not have regular contact or training speaking to or about people with disabilities to understand the nuances of language surrounding this topic.

But I think the most important thing to remember here is that not all disability is visible.  It is never good practice to speak negatively, disrespectfully or rudely about anyone.  Doing so just reflects poorly on you.  Remember that everyone has a story and the one you might make in your head about that person or their situation may not be accurate.  As Stephen Covey always said “talk about people like they are present”.  In the current movie Cinderella, I love the advice she gets from her dying mother: “have courage and be kind”.  Words to live by.

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Solutions for A Sore Neck

Sitting at a desk, staring at a screen, reading a book, working on a laptop or tablet, texting, daily commuting… these are all activities that can lead to pain and soreness in the neck and shoulders.

The Institute of Work and Health reported that neck pain related to work is one of the most common complaints of working aged adults and in 2006 it was reported that injuries to the upper extremity account for 30% of lost-time claims in Ontario.

The following handout provides you with some simple and cost effective solutions to reduce neck pain while at work.

NECK PAIN -- ergo doc one pager

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What Is OT?

A common question I am asked is “what is occupational therapy?”

Most people think occupational therapy is about getting people back to work following an injury, or designing functional work spaces and workstations because of the word “occupation” in the term.  While this is an important part of what occupational therapists do, their scope is actually much broader.

Here are some other examples of areas where an occupational therapist can help:

– Dressing and grooming

– Bathing and showering

– Making and eating meals

– Being social

– Returning to work, school, or volunteering activities

– Engaging in leisure activities

The following video from our OT-V series provides an indepth look at what occupational therapy is and how occupational therapists can help people with physical, emotional, or cognitive disabilities.

We hope our video provides you with a great explanation and answers the frequently asked question:  “What IS OT?”