Occupation-Based Hand Therapy!

Integrating Occupation: Getting Started

 #1. Don’t discard the use of preparatory methods—try to link them more effectively to occupations in both explanation to your client and follow-up treatment.

#2. Choose purposeful activities very carefully.  Always opt for components of terminal occupations when feasible.  Always try to explain the connection between the preparatory methods / purposeful activities and terminal function.  Make sure to explain the difference between activities and occupations.

#3. From inception to treatment, incorporate the use of occupations (these may or may not be tasks that deal with the injury itself) and should be adapted to meet the immediate needs of the client.

#4. Use occupations not only to restore physical function but also to help clients return to psychosocial and/or vocational well-being while they wait for the tissues to heal.

#5. Occupations don’t take place in a clinical setting.  Consulting with the client about what he or she can and should not do outside of the clinical as well as providing them with “homework” can address occupational goals that exceed clinical staff and budgetary requirements. 

Holistic Assessments

COPM-Canadian Occupational Performance Measure
A tool that identifies problems in areas of occupational performance.  The COPM evaluates performance and satisfaction relative to identified problem areas.  It then measures changes over the course of hand therapy intervention.
The COPM increases a client’s involvement in therapy, can be used with all age groups and disabilities, and permits the evolution of occupation-based interventions
Client interview
Client identifies areas of concern
Rate importance of identified areas on 1-10 scale
Top 5 areas selected
Reassessment
Remind client of areas initially selected
Ask client to re-score performance and satisfaction
Compare new score to original score
Client may choose new areas of concern to become part of OT treatment plan

Disabilities of Arm, Shoulder and Hand (DASH)
A questionnaire in which the client rates symptoms and functional abilities in relation to 30 criteria areas. This tool works well with OBT because it assists with development of occupational profile through objective measure of clients functional abilities, and it does not focus on diagnosis per se, the focus is upon client function.
Available free on-line
www.dash.iwh.on.ca


Patient Rated Wrist/Hand Evaluation
A questionnaire in which the client rates pain and functional abilities by rating 15 areas.  The PRWE assists with development of occupational profile through objective measure of clients functional abilities.  Like the DASH, it does not focus on diagnosis per se, it focuses is upon client function.  Tool can also be used with optional “appearance” question to gain a sense of patient satisfaction with aesthetics of hand
Unfortunately, areas measured are pre-determined in questionnaire and may limit patient responses regarding areas of difficulty.  It does not address contextual issues, and beyond optional appearance question, does not address client satisfaction or provide insight into emotional state of client.

All information mentioned above provided by: Amini, Debbie. “Occupation-Based Hand Therapy: Applying Principles to Practice.” PowerPoint presentation. American Occupational Therapy Association national conference.  Long Beach, CA: April 19 2008.

My Own Tip: Sometimes it's easier to actually write a paragraph about your patient (brings you back to those school days, doesn't it?)!  For example, this is an excerpt from one of my lab assignments in school: "Mrs. Tillman has sustained a Colles fracture. This is the first injury/illness she's ever experienced, except for childbirth. She wants to return to work full-time as a factory worker.  She has been off for 3 months and has gained 20lbs.  Her job involves prolonged standing, reaching, and carrying light loads of 10lbs or less.  She is 5'3, weighs 175lbs.  She sits across from you during your initial eval in a slouched position, protruding abdomen, wearing sweats, and sighing frequently."
 
* Now that you have a brief paragraph about her, you can begin to brainstorm.  What muscles are strong/weak based on her history? What can you gather about her cardiopulm functioning? Why might reaching/carrying loads increase her pain? What things might you 'red flag' about her workplace (ergonomics-wise) after questioning her further about her set-up?  What priorities might you begin working on? What adaptive things can help her get around her ROM restrictions? Outside of work, what things might she have had to give up due to her injury?  How does she cope - does she have an attendant or avoidant personality?   ***These are all things to consider beyond the regular scope of physical hands-on hand therapy treatment.