Falls, brain damage from strokes, and other major events can cause people to become more susceptible to trauma as they age. Yet, depending on the intensity of their injuries, some level of recovery is usually achievable, and the occupational therapist (OT) is a vital partner in that effort.
No matter how old they may be or what mobility impairment they cope with, humans have a remarkable ability to adapt. OTs facilitate adaptation by tapping into that resilience and helping restore vitality and hope. A client’s motivation is a core component of the rehabilitation process; trained and experienced OTs will develop sets of personalized tools and methods for gauging and inspiring a client’s motivation to relearn life skills.
Assessment of the Impairment
The most important motivational tool OTs can have is the ability to understand what a client faces and where he most needs help. This begins with a physical assessment. The goal of the physical assessment is to determine a client’s safety, balance and risk of falls, strength, endurance, coordination, sensory functions, and problem-solving and communication skills. Much of the required information is obtained after reviewing his medical history. Among the information needed from the medical record, the OT explores the history of the mobility impairment, which includes:
- The circumstances of the client’s injury, what part of the body is affected, and how severely
- The assessments, treatment plans, and progress notes of any physicians, nurses, and speech and/or physical therapists
- What medications the client is taking
- The client’s mental status
- Any previous history of work with an OT
In addition to the physical aspects of mobility impairment, to understand a client’s level of motivation the OT must explore his psychosocial status. It is important to know, for example, if the patient describes himself as lazy so that the therapist can explore what he means by it. Interviewing is an essential tool for discovering this information, and good listening skills are thus imperative.
OTs often take a holistic approach in order to learn the full range of a client’s strengths and weaknesses and how they will affect specific treatments. Along with a mental status check, the OT visualizes from the client’s perspective, seeking to understand his:
- Perception of the mobility impairment
- Current emotional state
- Home environment — the purpose of this being to conceptualize the physical environment, its hazards, and ways to improve safety
- Routine activities of daily living — including dressing, bathing, eating, and other personal care tasks — how well he carried them out before the impairment, and what challenges exist to retraining any of these lost skills
- Safety issues, fears, and concerns
- Initial level of motivation
- His caregiver’s perspective on the situation
- Occupations, hobbies, and other important activities
The Treatment Plan
The information that an OT gleans from interviewing his clients and reviewing their medical histories will guide him in developing a treatment plan. This highly individualized plan clarifies the client’s current physical status, identifies barriers to treatment, and lays out goals. It specifies where the client needs to be at different stages and at the end of treatment. The client and caregivers (if the senior wants to have them involved) are involved throughout the process and should take part in developing the plan. The therapist helps the client actually visualize each goal and see how, no matter how slightly, achieving each one can improve her life.
One of the most important characteristics of a treatment plan is its flexibility. As a person progresses through treatment, new problems and solutions invariably develop. Goals and modalities change, and OTs adapt to the evolving needs, barriers, and motivation level of their clients. Contingencies for a wide variety of potential scenarios are already built into good treatment plans.
For example, an early assessment might reveal that a client is highly motivated to get better because she is eager to get home and take care of her pet dogs. A stroke has rendered her dominant hand unable to open a can of food or hold a grooming brush or a leash. Over time, her initial high level of motivation plummets as she realizes how much time and work is involved and how long it might be before she is safe to go home. Along with the client, the plan and therapist must adapt to this newly stunted level of motivation.