How to Get the Best Occupational Therapy

By Jane Farrell

Occupational therapists (OTs) and occupational therapy assistants (OTAs) help people of all ages and abilities take part in what they need and want to do through the therapeutic use of everyday activities (or “occupations”). They consider each person’s physical and mental health and abilities (and barriers), along with their environment, to create an individual treatment plan. Occupational therapy’s effectiveness comes from using activities that are personally meaningful to each client during therapy to help the client meet their goals.

Common things occupational therapy addresses include:

1. Helping children with disabilities learn, play, and make friends.
2. Helping people recovering from an accident or injury get back to doing what they want to do in their daily lives.
3. Helping older adults safely stay as independent as possible, including managing medications, dressing, cooking, and driving.

“It is important that the therapy you receive is efficient and works,” said Sherry Keramidas, PhD, FASAE, CAE, Executive Director for American Occupational Therapy Association (AOTA). Some treatments might not be provided in the best way or might be the wrong approach for clients. As part of its campaign Choosing Wisely®, the AOTA has identified the following five treatments that should be questioned by clients. (Clients who have questions about the process should ask for clarification. If the OT or OTA is not focusing on the occupations wanted and needed, clients can start a conversation about their needs and the current treatments).

1. Non-Purposeful Activities

Helping the client regain his or her valued activities is at the core of occupational therapy. Meaningful activities are encouraging, build endurance, and increase attention. One-size-fits-all activities are repetitive and boring, so clients may not attend therapy, and their results will not be as good as they could be.

For example, an adult is recovering from a stroke and is able to stand and balance well in a clinic gym. However, that person still may not be able to cook at home because she cannot reach overhead into the cabinets. Because she enjoys cooking and needs to be able to prepare food by herself, occupational therapy that includes cooking would be more motivating and practical than a non-purposeful activity, such as stacking or reaching for cones. Occupational therapy sessions that focus on a client preparing a meal will highlight which skills and changes need to be addressed for her to cook and take care of herself in other ways. These sessions may also uncover new problems—and show the client ways to solve them.

2. Sensory Interventions Without a Diagnosis

Occupational therapy practitioners often help people, especially children with autism, accept sensations (e.g., light, noises, jostling, textures, tastes) that are present in their everyday environment. However, the OT must first assess and document each client’s specific sensory difficulties before providing a sensory-based intervention. Sensory issues are complex, and an intervention that does not address the correct problem can be ineffective or even harmful.

An example might be the use of a weighted vest. This approach is popular, but it is not the best solution for everyone. The OT needs to assess each client to be sure a weighted vest is the best solution. If a weighted vest is not used the right way, the client could have sensory overload, leading to a bad outcome.

3. Physical Agent Modalities (PAMs) Without Purposeful Activity

Using heat, cold, electrotherapy, mechanical devices, and similar tools on their own without purposeful activity is not occupational therapy. However, an OT can use PAMs to reduce pain or other discomfort before or during an occupational therapy session, if doing so will help the client participate.

For example, a client recovering from shoulder surgery may be in too much pain to participate in therapy that focuses on dressing. The OT could begin the session with PAMs so the client is comfortable enough to try dressing. It would not be appropriate for the OT to use only PAMs without including an everyday activity.

4. Overhead Pulleys

After a stroke, or because of another condition, some people have hemiplegia, or weakness on one side. Exercise, particularly of the weak side, is often part of the recovery process. However, overhead pulleys often lead to shoulder injury or pain among clients with hemiplegia and weakness, making recovery more difficult.

Gentler, controlled range-of-motion exercises and activities are preferred, such as the OT or OTA guiding a client’s arm movement, or reaching for items in a medicine cabinet while getting ready in the morning.

5. Cognitive-Based Interventions Not Tied to Occupational Performance

OTs and OTAs often address cognition, or the way a person’s brain uses information. Occupational therapy related to cognitive issues (e.g. attention, memory, executive functions) must use an activity that is important to that person.

For example, an adult with a brain injury who wants to buy his own groceries should have occupational therapy that focuses on choosing meals, creating a list, managing money, and getting around the store. Activities such as workbooks and computer training do not allow the person to actually do any of the steps needed to buy groceries, so nothing is learned that will transfer to a real-life setting. OTs who use meaningful activities are able to assess the person’s strengths and challenges and design a plan that considers self-awareness, practical strategies, environmental changes, and assistive technology.

Physicians may refer patients to an OT, but patients may also choose one on their own. All OTs and OTAs must practice under federal and state law. Currently all 50 states, the District of Columbia, Puerto Rico, and Guam have laws regulating the practice of occupational therapy. Insurance sold through Affordable Care Act marketplaces are required to cover occupational therapy services. Occupational therapy is also covered under Medicare and many other insurers.

For more information about occupational therapy, visit www.aota.org/consumers.

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