April is OT Month!

Demystifying OT and Celebrating its Distinct Value

By: Melinda Butler, OTD, Director, www.therapystrategiesplus.com

Occupational Therapy

Occupational Therapy is a unique profession that is often misunderstood. This is in-part due to the fact that the role of the OT can vary significantly among treatment populations and settings. But it is also because many OTs don’t have a concise “30 second elevator speech” that clearly defines the profession. Case in point: Whether working with children, adults, or geriatric populations, the primary role of Physical Therapy is to address movement including gait/ambulation, strength, balance, pain management and tissue healing through physical means. This role remains fairly consistent across treatment settings whether home, school, hospital, inpatient or outpatient clinics.

However, when we consider OT across the lifespan and treatment settings, the focus can greatly differ. While the overarching theme is activities of daily living (ADL), this manifests differently for babies, children, adults and geriatric populations. Throughout the lifespan, the ADL focus shifts from reflexes to developmental skills, play, learning bathing/dressing, toileting, community integration to cognition. Simply describing OT as activities of daily living could mean almost anything, including the areas of focus for PT. After all, aren’t bed mobility, transferring and walking all activities of daily living? Therefore, “ADL” does not entirely identify the unique role of OT. So how do we define OT with one definition that fits all patient populations and treatment settings?

Let’s start by clarifying what OT is not:

  1. OT is not PT for the upper body…both PT and OT address the whole body
  1. OT is not a service that helps people find jobs…job skills is a component of OT but not job finding
  1. OT is not simply fine motor skills…fine motor skills development can be a component of OT but hardly satisfies a definition

Consider the analogy of an athlete. Whether the sport is basketball, football, swimming, tennis or golf, most athletes who compete in physical sports undergo two types of training: 1) Cardiovascular endurance and strength training and 2) Sport specific training. The cardiovascular endurance and strength training would be very similar regardless of the sport. Most athletes will typically do some running, cycling or some elliptical work. They will also do resistance training either with weights or closed chain activities. This type of training can be compared to PT. Sport specific training on the other hand would be very different for every type of athlete. A tennis player might work on serving, a swimmer might work on breathing technique, and a basketball player might work on free throws. All are examples of sport specific training, and all are very different. This can be compared to OT.

So what is OT?

Therapy focused on overcoming dysfunction by acquiring or rehabilitating specific skills or tasks that allows a person to engage or participate in activities of daily living. This definition is general, but it differentiates OT from other disciplines.

Now that we have helped to demystify OT, let’s consider OTs unique value within the medical model. OTs who provide services to Medicare recipients, may experience that OT is viewed as an ancillary service and not as a stand-alone discipline. OTs are typically not allowed to initiate an Oasis in Home Health and Medicare will often deny claims involving inpatient OT services if PT is not also involved. Gait distance tends to be a primary consideration for coverage for adult, inpatient therapy services. However, gait training is often achieved with the use of a device. There is often little consideration made for activities that require letting go of the device with one or both hands to engage in everyday activities like toileting or item retrieval from floor, closet, drawer or cabinet. Many of these basic tasks can mean the difference between a person eating a nutritious meal, maintaining hygiene and skin integrity, making an important phone call, or even retrieving life-saving medication from inside a medicine cabinet.

Through thorough documentation, advocacy and enlightenment, these barriers can be overcome. As OT practitioners who witness the day to day challenges of our patients, we can be change agents who lobby for the needs and rights of our patients. A basketball player will never achieve greatness by running and strength training alone. Shooting, passing, dribbling and playing the game is necessary for true mastery of the sport. OT allows patients to “play the game” and master the sport of living!

So let’s celebrate OT Month by taking a moment to educate others on the unique value of Occupational Therapy.