18/01/2023
Understanding the role of occupational therapy in healthcare services (Zimbabwe)
Occupational Therapy (OT) is a profession that has been around for a about 100 years now. In Zimbabwe OT has been practiced since before independence but at that time it was mainly provided for the white community. After Independence in 1980, OT was made available to all, and in 1986 Zimbabwe started training Occupational Therapists at the University of Zimbabwe. It is offered as Bachelor of Science Honours degree with 4 years of training at the School of Health Sciences. The OT course equips professionals with knowledge of human anatomy, physiology, psychology, sociology, physics, occupational treatment techniques for physical, psychiatric conditions, home adaptations, aids and appliances fabrication, disability issues and the integration of people with disabilities into the community and much more. It is a diverse profession that is rarely understood in Zimbabwe and often confused or likened to Physiotherapy. This writeup seeks to clarify what Occupational Therapy is so that appropriate referrals are made and that our people of Zimbabwe benefit from this useful medical rehabilitation profession.
By way of definition Occupational therapy is: A client-centred health profession concerned with promoting health and well being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement. (WFOT 2012).
This could be a mouthful for people who are not in the profession. What this means is Occupational Therapists work with people (adults and children) who have suffered either physical, psychological, emotional and social problems to help them go back to their “normal” lives using activities/occupations that are in line with what the client/patient usually does on a daily basis. This entails that the OT should be able to understand the client/patient in terms of their daily activities such as, Activities of Daily Living (ADLs), work and play/leisure activities. ADLs are activities that include personal or self care. This include but not limited to bathing, dressing grooming, cooking, feeding, shopping, paying bills etc. Work occupations are activities that one does to earn a living. This includes ones job or volunteer activities. Leisure occupations are activities one does to relax and enjoy themselves in their free time (hobbies). This involves one engaging in playing a game of they are interested in or engaging in hobby of their choice. The aim of occupational therapy is enable people who have suffered physical, emotional, psychological or social dysfunction to go back to doing their ADLs, work and leisure activities, either independently or with assistance.
To enable understanding lets use an example of a 50 year old man who has suffered a stroke and is a bank manager. The client is referred for occupational therapy management and the OT will use activities that the manager does daily for therapy. The OT will do a thorough assessment of how the patient/client is performing his ADLs, work and Leisure occupations. This is called an occupational/activity analysis, it analyses the physical, psychological, social and emotional components of an activity/occupation. For ADLs the analysis involves how the patient is performing personal selfcare activities such as bathing, dressing, grooming, feeding etc. An analysis of how they perform instrumental activities of daily living such as planning their home budget, paying bills, shopping for groceries, pay school fees for their kids etc is done. How they perform work activities such as managing people at work, write work documents, attend meetings, is analysed. How they also perform leisure activities such as playing golf, swimming, watching TV, playing card games with friends and family, reading books is incorporated in the analysis. For each activity the physical, psychological, emotional and social components are analysed. Equipped with this information the OT will then analyse to see which ones are affected and why are they affected. In the case of the guy with the stroke inability to bath himself might be because they are unable to lift his arm or leg due to the physical problem emanating the paralysis from the stroke, or unable to plan the activity in his head due to perceptual or cognitive problems that come as result of the brain being affected by the stroke. The OT will then understand from the client which activities/occupations are important to them so that they can develop a treatment plan that will address the identified problems. The OT treatment will then incorporate several techniques to improve either the physical, perceptual, or cognitive ability to enable the patient to bath themselves. The OT uses occupations/activities that are purposeful and of interest to the client. Going back to the stroke guy, instead of asking the patient to lift their hand 10 times the OT will give the patient an activity such as stacking cones up, removing and placing items on shelves, incorporate the affected arm in bathing, lift the arm to put on clothes, use the upper limb to turn on an off their computer, sit and plan for a meeting, prepare a budget for the family, transferring from the bed or chair independently, mobilise to the toilet, take their clothes off to use the toilet, able to sit on and off the toilet seat, clean themselves after the using the toilet, don their clothing after using the toilet. At each step the OT is noting and recording the difficulties and understanding the cause so that they address whatever physical, perceptual or cognitive issues that could be limiting the performance of an activity/occupation. So an OT assessment is detailed to this extend and the treatment plan and ex*****on uses this information. That’s why the profession is called Occupational Therapy, using occupations as a means as well as an end goal.
Now how is OT appropriate in acute and chronic care settings. In the acute care setting the role of OT is to ensure from the beginning the client/patient is already tuned to recovery and going back to their “normal” functional level. OT begins as early as the life-threatening period is over and the doctors are happy the client is out of medical danger. If the patient is not yet able to perform occupations due to temporary functional problems, activities/occupations are prescribed that are graded according to ability at the time, temporary aids and appliances are given and temporary environmental adjustments are done to enable function. If the client does not return to full function and their condition is deemed chronic, or now have a permanent disability, the OT will now look at permanent environmental adjustments at home and at work if the client is still able to return to work. Home environmental assessments are done and recommendations for adjustments are made. For instance, the guy with the stroke might need to have their bathtub fitted with aids to assist with getting in and out of the bathtub as a temporal measure. If their condition is chronic or permanent and unable to go in and out of the bathtub and if they so wish the bathtub can be removed and replaced with a walk-in shower. At work there will also be other adjustments recommended like access to the building, and workstation to enable them to be to perform their work duties. This OT process can be applied to all conditions in which a client/patient has suffered physical, psychological, emotional, and social dysfunction. It is recommended that OT should be considered in surgical, orthopaedics, medical, and mental health conditions. The OT process is client centred, because what applies to one client does not apply to another as they have different personal and environmental circumstances and needs.
The World Health Organisation is advocating Rehabilitation 2030 and Occupational Therapy has been deemed an important rehabilitation service such that by 2030 most healthcare institutions should be offering rehabilitation which includes Occupational Therapy. It will be a noble thing that as doctors and other healthcare professionals offer surgical and medical treatments also consider the after care of these clients especially in terms of function. After all isn’t that clients normally also cite in addition to physical complaints functional problems when they go see a doctor. They might say ‘I am in pain such that I am not able to bath myself or drive my car or go the field and work in the field’. It is therefore upon us as healthcare professionals to now ensure that those functional problems are attended to. For instance, the pain will go away but the patient might have residual muscle strength problems which affect their ability to perform their ADLs, work and leisure activities. If the patient is referred for occupational therapy management the OT will ensure that the patient is meeting all their functional needs either by themselves, with assistance of others or with the assistance of equipment at home and at work.
As a point of clarification, there may be areas of overlap with Physiotherapy and Psychology. However always remember for function in ADLs, work and leisure an OT consultation is important as it addresses physical, cognitive and perceptual problems that might hinder function. In Zimbabwe occupational therapy is not fully utilised and due to this, patients might be suffering a lot of functional problems in their homes and at work and with no one to assist. Some end up finding their own ways of coping which might be dangerous or does not help them progress functionally and they remain needing care when they could be independent and live functional lives with improved quality of life. Occupational Therapy enables patients to experience life fully with or without a physical, psychological, emotional or social dysfunction.
For further clarifications please contact:
Tsitsi Murove
Occupational Therapist
+263776137135
tsmurove@outlook.com
Thank you.
