Occupational Therapist in the Multidisciplinary Team
Rehabilitation for individuals with neuromuscular disease requires a multidisciplinary team. The specific needs for occupational therapy may change as the disease progresses. The roles of occupational therapists may also vary in terms of the settings (e.g. acute hospital versus day rehabilitation center).
Despite these, the common goals of occupational therapy include:
- monitoring and surveillance to prevent complications.
- maximizing health and functional capacities.
- promoting access and full integration into the community to optimize quality of life.
Occupational Therapy Assessment
The followings are different assessments performed by the Occupational Therapists:
Occupational therapists would perform comprehensive assessment covering different aspects such as musculoskeletal, neurological, cardiopulmonary, functional and psychological. The information gathered would assist the team in diagnosis, management and developing short- and long-term care plan. The assessment data would guide the occupational therapy intervention. In some settings occupational therapists may be required to perform focused assessment and intervention for specific purposes such as splinting for positioning after corrective surgeries for contractures; special seating for pressure relief.
Occupational Therapy Management
Below is a general description of how occupational therapists can assist in the rehabilitation of Neuromuscular Disorders:
- Prevention – management of contractures/deformities with activities, splinting and adapted seating
Limb contracture is a common impairment in neuromuscular diseases. This leads to decreased motor performance, mobility limitations, loss of function for activities of daily living, and increased pain. The pathogenesis of contractures is multifactorial. Although the evidence is still accumulating, there are generally accepted principles with regard to splinting, bracing and stretching that help minimize the impact or disability from contractures.
Occupational therapists may use the following strategies:
i) use of physical activities to maintain functional mobility and range of motion.
ii) introduce self-stretching techniques.
iii) use of night splint, prone board and flexi-stand to prevent knee and hip contractures. An adapted seating system is also useful for the prevention and management for spinal deformities, which in turn help preserve a better cardiopulmonary function. In addition to proper seating adaptation, various cushion and/or a tilt-in-space system can also provide comfort, pressure relief and improve function.
Learning to live with the chronic symptoms (e.g. fatigue, chronic pain, atrophy) requires self-management. This will help to minimize the impact of these symptoms on the individual’s emotion and life role functions. Occupational therapists works with the individuals to set priorities and develop action plan for energy conservation and work simplification. Avoiding over-use of muscles is another strategy that is commonly shared; research evidence suggests that overloading or excessive mechanical stress may accelerate deterioration of muscle cells.
- Prescription of assistive technology
Prescription of assistive devices (e.g. power-mobility device) is another important aspect for the treatment of patients with neuromuscular diseases. The type of assistive device varies from simple gadgets such as buttoning aid, enlarged handle for keys, transfer boards, hoist for transfer to sophisticated devices such as mobility-assistive device, augmentative and alternative communication aids, computer access aids, automatic self-feeding device, and even environment control systems. Mobility-assistive technologies are essential to allow individuals with neuromuscular diseases to interact with peers and the community, especially when they lose the ability to walk. Individuals who rely on respiratory equipment to breath, would need the input of occupational therapists to integrate the respiratory equipment into their power-mobility device
- Home modification
Environmental modification may be required in some individuals to promote independence in daily life. This can be simple modifications such as removing environmental obstacles to facilitate use of adaptive device like wheelchair at home or major changes such as resizing bathroom door for wheelchair access, removing the bathtub to create a level platform for mobile shower chair access.
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