Specific exercises can be set by a therapist as part of a home exercise programme. Can the same approach be used for activities of daily living?
Occupational therapists qualify from their training able to work with all ages and with both mental and physical health conditions. We are holistic in our approach and use the context of the environment to assist our client interventions. The perceptions, values and beliefs of our clients are key to the driving forces we seek to engage with in order to influence their participation and performance within everyday activities. In order to tap into their motivations, we seek to ensure our interventions are bespoke, client centred, meaningful, relevant and contextual.
When working with overwhelmed, complex or demotivated clients it can be hard to establish what is meaningful for them, what they value, and what activities are acceptable and accessible to them in their new found status of reduced independence. In my experience, timely engagement in everyday activities for therapeutic gain is beneficial and can empower a client to take ownership of their participation and long term goals.
A Home Activity Programme educates a client about the importance of actively engaging in everyday tasks accessible within their home and local community. It provides a structure of suitable activities within which a client can practice their skills each day in order to develop skills, understanding and independence. This places an expectation on the client and their family and provides a platform for action. Participation in this type of programme can bring about a sense of achievement, clarity of perspective and experiential understanding of their abilities and limitations. Repetition, in vast quantity, is required to activate the brain and relearn movement and skills. This approach provides a timely journey into action and participation and emphasises the need for repetition, placing a therapeutic value on everyday tasks and an onus on the client to participate.
The Home Activity Programme is set up for the client to carry out independently and with their family or support network in a self directed way. It involves completion of specific tasks every day. Supervision is provided by the occupational therapist who will educate and equip the client when setting up the programme and then coach and progress the client with weekly review sessions. A written agreement may be useful to reinforce the expectations of the client to take ownership of the programme. It is important that activity participation is logged, any difficulties or barriers are discussed and problem solved and that challenges are progressed as abilities improve. Therapists understand the important role that family involvement plays in rehabilitation so it is crucial to include the family in the programme as much as possible.
Skill and creativity are required on the occupational therapists part in order to set up an activity programme which is acceptable to the client and provides the right level of challenge and opportunity for success. There may be a need to focus on activities carried out in a more supported way initially to load on range of movement, strength and weight bearing. As progression is made, there may be opportunity to load on more co-ordinated movement and dexterity and increased mobility and stamina. When working with clients following brain injury, there are often cognitive difficulties reducing independence. This can be incorporated into the Activity Programme to focus on attention, concentration, organisation, following instructions or more executive skills such as self monitoring, problem solving and multitasking. The programme should incorporate self care, leisure and productive tasks and be appropriate to the environment and time of day.
Therapy contact time is front loaded for this approach in order to set up the environment, provide resources and education and ensure the client understands how to carry out each task however, once the programme is running, the review sessions should be less time demanding. You may be able to follow up some clients by video call or telephone. Using more frequent video calls at different times of the day can be more beneficial than a face to face visit at times in terms of developing an understanding of how clients work at different times of the day and the impact of fatigue. The duration of a programme can vary depending on the needs and goals of the client however a 6 week programme is usually a minimum.
A Home Activity Programme is a semi-formalised structure for clients to repeatedly participate in activities of daily living in a (supported) self directed way as part of their rehabilitation intervention. It offers a simplified, accessible way to identify participation opportunities and engage the client in the therapeutic value of everyday activities. It can offer clients an opportunity for skill acquisition, application of adaptive or compensatory strategies, increased activity tolerance and stamina, and increased knowledge and understanding of their condition and associated abilities. It will not be suitable for all clients but can be transferred in to a residential or in-patient environment and the concept can be applied to higher level tasks including retuning to work preparation. It is an essential concept in an occupational therapists tool box and can be implemented remotely.
For further information or if you have a client who could benefit from this approach please get in touch.
Independence Found Ltd provides Occupational Therapy Assessment and Rehabilitation services. Based in the Midlands, Independence Found Ltd is led by Hayley Green, Occupational Therapist who has specialised in rehabilitation following acquired brain injury or multiple trauma.
www.independencefound.co.uk email@example.com 07807816997