In the previous installments, I have provided a brief history about the Occupational Therapy Profession, the philosophy of treating THE WHOLE PERSON by using meaningful activities that improve function and performance of self-care tasks from infancy to final stages of life. This a wholistic approach, the opposite is reductionistic, and unfortunately, the latter is the most typical practice model. Reductionism does not promote lasting results because our bodies are a part of a complex system that is interdependent. Additionally, we are also interconnected with our environment and other people in our lives.
Occupational Therapy views wholeness as a choice people make toward whole-person wellness that leads to living a healthy and productive life, free of dependency in self-care due to illness or as a result of injuries. Wholeness is proactive in action using wellness-directed goals established by the individual (referred to as “client-centered” therapy). It is dynamic and evolves throughout the stages of recovery and growth (in the case of children with disabilities). No other individual physical or mental rehabilitation discipline addresses all aspects of human potential involving the physical, mental, and psycho-social well-being of a patient in a self-directed plan of care for achieving a person’s full potential by overcoming limited capacity for rehabilitation due to a pre-existing condition.
Patients who have a limited capacity for wholeness are often people with one or many pre-existing conditions (co-morbidities) that inhibit the success of therapy when only addressing one specific condition. For example, when a person who has Parkinson’s is referred to physical rehabilitation for movement correction has a rotator cuff injury, peripheral neuropathy (numbness) in their feet, or bunions. All these dysfunctions will affect arm swing and impair walking. When therapists address movement retraining without mitigating the other issues, this reductionist approach limits the patient’s capacity for achieving their rehabilitation goals because it does not take into account the contributing or underlying causes.
When I hear from people who have Parkinson’s, who have had movement retraining therapy and tell me, “it did not work” I ask what other conditions they are dealing with. In my own practice, once dyskinesia is prominent, or when a patient has transitioned to a wheelchair for mobility, the capacity for restoration is nearly impossible. Not because rehabilitation is limited, but because in that person’s mind, their drive and support system is challenged by the high level of commitment and daily follow-through on changing postural habits, doing their home exercises, and changing their nutrition.
There is no overnight remedy for the dysfunctional lifestyle habits that took a lifetime to develop before the disease revealed itself, so changing for the better is the long game plan and requires perseverance. Understanding the psychology underlying a patient’s health crisis or disease progression, and taking into account their caregiver’s disposition for the level of commitment required to facilitate compliance with a daily home exercise program is also an OT strength because of our psycho-social education and training.
Ideally, what Occupational Therapy (OT) is designed to do is to address all aspects of a person who has experienced an event that has fractured the wholeness of inter-connectedness within their body, environment, and has affected the dynamics of relationships in their support system. When a person does not feel well because of a headache after an accident, they tend to isolate, they can be irritable, may not be able to work or go to school. When one considers all the ramifications of whiplash, concussion, or a childhood sensory integration dysfunction, it becomes clear that the patient is not the only one suffering.
The OT assessment process must be inclusive of all health conditions, support system, and the complementary clinical skills of the support team, but the MVP is the PATIENT. Ultimately, it is up to the patient to be diligent to do the work between therapy sessions. Often, patients need the support of their family or caregivers to help them get started and to watch that the exercises are done safely and appropriately. At Integrative Therapeutic Solutions, we are part of that support system because we want to see our patients succeed. Therapy does not provide cures, only opportunities for wholeness. Don’t wait to Integrate your life, we are here to help you achieve your maximum rehab potential!