These are purposeful activities including arts, crafts, recreation, sports, leisure, self–care, home management and work activities which help to
- Develop or maintain strength, endurance and range of motion.
- Provide the use of voluntary, automatic movements in goal–directed tasks.
- Exercise affected parts of the body.
- Identify vocation potential and work training.
- Improve sensation, perception and cognition.
- Develop social skills.
- These are tasks of self–maintenance, mobility, communication and home management.
- Self–care includes dressing, feeding, toileting, bathing and grooming activities.
- Mobility includes movement in bed, wheelchairs, public and private transportation.
- Assisting devices are frequently used.
- Communication includes the ability to write, read, use telephones, and computers.
An orthosis is a device added to a person’s body to support a position, immobilize a part, correct deformities, assist weak muscles and restore function. Temporary splints are made of thermoplastic materials. Splints for long–term use to treat permanent conditions are made of metal or steel.
There are two types of splints
Static splints have no moving parts, prevent motion and provide rest or rigid support to the affected part. Dynamic splints have moving parts to permit, control or restore movements. Movements are managed intrinsically by another body part or extrinsically by elastic, springs and motors.
Prosthesis
Limb loss may result from accident, injury or congenital causes. Congenital amputees and those who lose a limb early in life develop sensorimotor skills without the amputated part. Those who lose limbs later in life have greater difficulty adjusting to the loss of a part that was well integrated into the body scheme.
Occupational therapy is useful in developing functional use, tolerance and training of prosthetic devices. Psychological adjustment is also addressed.
Wheelchairs and wheelchair transfers
A wheelchair provides a comfortable and efficient mode of ambulation for those persons whose physical dysfunction makes walking impossible or impractical. In a sense, the wheelchair becomes the extension of self or body. The user must learn to manage the wheelchair.
An occupational therapist measures the client for a wheelchair, recommends the style and accessories. Wheelchair safety and mobility is also taught.
Biofeedback as adjunct therapy
Biofeedback is a therapeutic technique that attempts to produce in a client the ability to control certain physiological processes by using instrumentation. The client assumes the responsibility and becomes an active participant in his/her own improvement. In addition to improve the specific problem, the client increases his/her feelings of self–control and personal mastery. It is important to note that in biofeedback only the client can actually produce the desired changes by following the therapist’s instructions and regular practice.
Electronic biofeedback offers information quantitatively, consistently and immediately. The instruments for measurement include a transducer, the processing unit and output display. The transducer detects the change in the parameter being measured, the processing unit contains electrical circuits that amplify, rectify, filter and integrate the signals in preparation for display, the various types of display units are computer monitors, buzzers, lights or meters.
Biofeedback can make a person aware of the state of contraction of voluntary and involuntary muscles, blood pressure levels, heart rate and brain activity.
Movement Therapy
The Brunstrom approach to the treatment of hemiplegia is based on the use of motor patterns available to the patient in the recovery process. It enhances progress through the stages of recovery toward more normal and complex movement patterns. Synergies, reflexes and abnormal movement patterns are considered normal patterns occurring in the process of normal voluntary movements.
Neuro–developmental treatment – Bobath approach
The primary goal of neuro–developmental treatment is to re–learn normal movements. The techniques used are positioning, weight bearing, rotation of trunk and encouraging the use of both sides of the body. Associated movements, associated reactions, key points of control (for example the shoulder and pelvic girdles), and reflex inhibiting patterns are used.
The Rood approach to treatment of neuro–muscular dysfunction
Margaret Rood combined controlled sensory stimulation and orthogenetic sequences of motor behavior to achieve a purposeful muscular response for children with brain damage. Tactile stimulation is offered by fast brushing, light stroking, quick icing, heavy joint compression.
Inhibition methods are light joint compression and slow rhythmic movements. These methods are used for patients with hypotonia, hypertonia and hyperkinesis.
The Proprioceptive Neuromuscular Facilitation (PNF) approach
Proprioceptive Neuromuscular Facilitation has been described as a method of promoting or hastening the response of the neuromuscular mechanism through stimulation of proprioceptors to treat neurological disorders. Techniques for facilitation and inhibition include stretching, tractions, approximation, maximal resistance, repeated contractions, rotation. This approach is used with patients who have quadriplegia, CVA, ataxia and limited shoulder movements as in arthritis.
