Joey Wahler (Host): It's an important yet sometimes misunderstood field. So we're discussing occupational therapy. Our guests from Silver Cross Hospital, Lindsay Heidrich, senior occupational therapist for the inpatient rehab unit. Deborah Jacob, senior occupational therapist for outpatient care, and Lauren Nale, senior occupational therapist specializing in acute therapy. This is Silver Cross Hospital's I Matter Health Podcast, where medical experts bring you the latest information on health topics that matter most to you and your family. Thanks so much for joining us. I am Joey Wahler. Hi there, ladies.

Welcome.

Deborah Jacob, OTR/L, CEAS: Thank you.

Lindsay Heidrich, OTR/L: Thank you. Thank you for having us.

Joey Wahler (Host): We appreciate the time. First Lauren, in a nutshell, for those unfamiliar, what is occupational therapy?

Lauren Nale, OTL, CSRS: Yes, that's a very good question. People are typically introduced to occupational therapy when they have an injury or a disease or a condition that makes it difficult for them to just participate in their basic day-to-day activities. The goal of occupational therapy is to get people as independent as possible, doing the things that they want and need to do in their daily life.

And we call these everyday life activities, occupations. We use them to promote health, wellbeing, and a person's ability to participate in those specific activities. This can mean addressing a variety of things, including brushing your teeth, dressing, cooking, taking out the garbage, driving, computer use.

Or also splinting the armor of the hand to help with these activities. Occupational therapists can address physical, cognitive, visual, or even psychosocial impairments that can impact these activities. And they include restorative interventions such as strengthening, compensatory training, such as instructing patients on how to do tasks a little differently than normal.

Instructing patients on how to use adaptive equipment such as different hand controls while driving, equipment for feeding or setting reminders on their phone if they're forgetful. And we also include a lot of caregiver training so that they can instruct someone else on how to assist that patient.

Occupational therapy practitioners work across the lifespan. We work in a variety of settings. This includes hospitals, schools, clinics, skilled nursing facilities. We come to the home. And at Silver Cross Hospital specifically, we work mostly with the adult population, but we do sometimes see pediatrics here at Silver Cross.

Host: Lindsay, sometimes, people, as you know confuse occupational and physical therapy. So what would you say the main differences are between the two?

Lindsay Heidrich, OTR/L: Absolutely. So there is some overlap between the two disciplines, such as both work towards improving the patient's overall level of function and assisting them return to their prior level before coming into the hospital. OT however, mainly focuses on increasing a person's independence and safety with activities of daily living and instrumental activities of daily living.

We also focus primarily on the upper extremity function, pinch grasp strength, fine motor coordination, visual perceptual skills and sensation. While we do include some short distance ambulation, the PTs are primarily responsible for choosing an appropriate assistive device such as a cane or a walker, and safely mobilizing the patient.

Host: When we talk about the different levels of occupational therapy, Lauren, what should we know about acute care?

Lauren Nale, OTL, CSRS: Yeah, so we see patients for occupational therapy in acute care usually when a new onset of illness or injury or an exacerbation of a chronic condition happens, and that might cause a patient to lose their ability to do these daily activities we're talking about. So in acute care, essentially doctors put in orders for us, when they believe that our services might be warranted due to one of these new issues.

So this could be something like a new stroke, maybe a patient with a car accident, cardiac surgery, a fall with maybe a fracture or even an infection. We typically evaluate and assess the patient and then either we recommend continued therapy at maybe a different level of care, like home health, skilled nursing, inpatient rehab, or outpatient.

Or if a patient is doing really well, we might recommend that they discharge from our services, and continue on with their hospital stay and get better with other services.

Host: Lindsay, what are some examples of inpatient treatment?

Lindsay Heidrich, OTR/L: Patients are brought to the inpatient rehab side typically after being evaluated by a physiatrist and an acute care OT PT, when on the medical floors, to ensure that they meet criteria and are appropriate to participate. Patients must be medically stable to participate in an intense three hour a day program consisting of occupational therapy, physical therapy and speech therapy when warranted. Length of stay is individualized and correlates to the patient's medical complexity with typical stays, usually between seven and 21 days.

Patients are rounded weekly to ensure goals are being met and to properly plan for discharge to home. We collaborate with family throughout the stay to provide education and hands-on training as well as resources for caregivers, medical equipment, and discharging to the appropriate next level of care.

Our primary goal is for the patient to discharge home at or close to their prior level of function.

Host: Speaking of going home, Deborah, what does outpatient therapy involve?

Deborah Jacob, OTR/L, CEAS: So once patients are medically stable, they're safe to be at home and that they're able to be transported to and from their appointments, they'll receive an order for outpatient occupational therapy, and typically they're seen one to two times a week for treatments. And that consists of a lot of patient, family caregiver education, training, and encouragement to foster success and independence to reengage these patients in their life roles such as the dressing, bathing, grooming, hygiene, cooking, cleaning, laundry, yard work, hobbies, driving, return to work activities with the goal in mind of returning the patient as close to that prior level of function as possible.

Host: And Deborah patients don't always experience all three of those levels of treatment, but they do sometimes, right?

Deborah Jacob, OTR/L, CEAS: That's correct. Sometimes they don't need the outpatient occupational therapy, or all three levels because they're independent and safe. But if they do have deficits that continue to impede their safety or their independence with their function, they could continue with the outpatient occupational therapy.

Host: Gotcha. Lauren, as OT in a hospital setting, what kinds of patients do you typically treat most commonly?

Lauren Nale, OTL, CSRS: Yeah, so again, occupational therapists work with a variety of patient conditions across the lifespan. Specifically in the hospital setting, at Silver Cross, we primarily work with 18 plus or people that we consider adults. We see patients who maybe have had a recent stroke, an exacerbation of a progressive neurological disorder, such as multiple sclerosis or Parkinson's.

Sometimes we see patients that are status post a cardiac procedure or people with chronic conditions of the heart and lungs, cancer, amputations, fractures, infections, traumatic injuries. So it's a very wide range. And then we also see patients that might just be here for general immobility or deconditioning.

Host: Lindsay, can you walk us through what a first OT session might typically look like?

Lindsay Heidrich, OTR/L: Once a patient is admitted to the rehab unit, the occupational therapist will complete an initial assessment that includes a shower, if safe and dressing in clothes brought from home to identify their deficits with activities of daily living. We also assess their range of motion, their upper extremity strength, visual perceptual skills, coordination, and sensation in order to identify other areas that need to be addressed in therapy sessions.

We will then develop a plan of care to address those deficits and provide intervention specific to increasing patient safety and independence. Mostly with things like activities of daily living, functional transfers, and higher level instrumental activities of daily living, such as laundry, cleaning, and cooking.

Host: Deborah, do all physical therapy patients need occupational therapy at some point, and how is that determined?

Deborah Jacob, OTR/L, CEAS: Good question. No, they don't always require the OT services with PT services. It depends on if there are still deficits that present themselves and those deficits could be picked up by the physical therapist treating the patient, could be the physician. It could even be the family or the patient that has verbalized some concerns about some deficits in their areas of safety with their self-care, dressing, bathing, grooming, hygiene, cooking, cleaning, and that laundry, or even driving or returning to work activities.

Host: And Deborah, is there a misconception about what you do that you'd like to clear up right now here?

Deborah Jacob, OTR/L, CEAS: So occupational therapy is often thought of as getting your occupation back. So a lot of times people say, I don't need occupational therapy. I'm retired. Well, their occupation is actually taking care of themselves or doing that laundry. So their occupation becomes different at different stages in their life.

So that is one big misconception. Another one is they think OTs only work in the school system with kids or only in pediatrics. Or they only work with fine motor coordination or pegs. Some of them just really don't know what OT is and they always often refer to OT as pT or physical therapy. And then sometimes they think that if they get OT, they're also going to have to get PT at the same time.

So those are just some that pop into my head.

Host: Lauren, what about a particularly rewarding case, sort of a light bulb moment with a patient that really sums up what you do and why you do it.

Lauren Nale, OTL, CSRS: Yeah, that's a great question. I think that's why we're all OTs is to see that end result. I think all of us have probably had some experience working with patients that were once also working themselves full-time. And so I think having the experience of helping a patient get back to a full-time or part-time working environment with accommodations and helping them navigate that, is such a rewarding experience because job fulfillment is so important to people.

I've also had patients who are able to return to caregiving, like being a mother or a father to young children after like a major cardiac event, being able to pick up their kid for the first time because they didn't have the balance or the strength to do so. Extremely rewarding. And then I think on the acute care side, in the actual hospital setting, I've had patients where I'm the first person to get them up and walk them to the bathroom and use the toilet. And for people using the toilet for the first time, as silly as it sounds, after a major medical event, makes them super happy and helps them feel like less of a burden to their caregivers or family members.

Host: I am sure. So Lindsay, how do you and yours collaborate with other care team members, physical therapists, nurses, and doctors, to ensure that great holistic care?

Lindsay Heidrich, OTR/L: So one of the things that I love most about the inpatient rehab setting is the interdisciplinary aspect of it. So meaning all of the disciplines work together as a team with the common goal of improving the patient's independence and function, but also facilitating a safe discharge to the next level of care or home.

I rely heavily on the speech language pathologist for how to best communicate with patients who have cognitive impairments and their recommendations for swallowing, diet and liquids. We collaborate with social work, social workers for discharge planning, family training, and ordering equipment. We collaborate with the nurses and doctors regarding areas such as medical status changes and how patients are tolerating certain medications.

Nursing will also practice recommended methods of transferring outside of therapy hours. So for example, using a sliding board to, a patient to transfer to a drop arm commode who's not allowed to put weight through their leg, something like that, that's very new and scary. When appropriate, OT and PT will collaborate and provide a co-treat session in order to safely mobilize and progress patients that are of high medical complexity.

Host: Deborah, how would you say the field of OT has evolved most in recent years? Where do you see it heading in the near future? Especially in a hospital setting where you all work?

Deborah Jacob, OTR/L, CEAS: Well, I feel it's definitely become more personalized and we've implemented outcome measures which assess the effectiveness of our services that we provide. We have to definitely be more mindful of insurance restrictions. They limit numbers of visits and they'll also put expiration dates on the visits for patient care.

So we have to encourage patients to be more diligent and consistent with their home exercise programs and allow patients to have more supervised independence with engaging in their home activities of daily living. And with that being said, we also make more referrals to community services. And one service that I think is well worth mentioning is the Silver Cross Hospital Stroke Support group, which meets every third Wednesday of the month at four o'clock in the cafeteria.

And they are just a wonderful bunch of people. It's a free event, very engaging. They have different events and speakers and activities, and it's just a really, a wonderful bunch of folks in that group. So if you haven't already, please look into that, and see what that's about, because that's a great resource.

Also we have actually more access to durable medical equipment and adaptive equipment via lending closets. And of course, Amazon, you know, therapists can just look up something that the patient's going to be needing to help to improve their safety or independence and print that off and give it to the patients to order that from Amazon and other sites.

But definitely Amazon has made things more cost effective and easy for patients to get. And there's also has been a big trend towards technology as well. I know we have our smart watches, our smartphones, our smart TVs. These really help patients to control their environments. You have Alexa, Alexa, turn the lights on, turn the lights off.

You have the robotic vacuums and mops and just so many devices that you have, the watches that help you to remember when to take your medications, when your appointments are to keep you oriented. So there's some really, really great technology that's out there that's come about and that's more accessible and more affordable for patients.

And I think in the future, I think you're going to see, again, a lot more, wearables and technology that's going to interface with the computers to help patients to be more motivated and more consistent with doing their home exercise programs, and it'll also track their progress. So I think that's a big trend we're going to see in the near future, and hopefully they'll become more affordable.

Host: In summary for each of you, what's your best piece of advice to those joining us to make the most of their occupational therapy experience? Lauren?

Lauren Nale, OTL, CSRS: Yeah, so my biggest piece of advice in, and really outside of occupational therapy would just be to advocate for yourself, to be as independent as possible in your day-to-day activities. If you have a major medical event, keep that in mind. And even at home, if you have a caregiver or somebody that's willing to help you, that's a lovely thing, but try and just stay as independent as you can and ask for what you need when you need it.

Host: Great advice. How about you, Lindsay?

Lindsay Heidrich, OTR/L: For patients to stay mobile and active, just keep swimming.

Host: So keep swimming, and of course you mean that sometimes literally, but

Lindsay Heidrich, OTR/L: but also figuratively. Yes.

Host: And Deborah, how about you?

Deborah Jacob, OTR/L, CEAS: Oh, my biggest piece of advice is to get a hobby. Get something that sparks joy and helps to get you outta bed in the morning. Very, very important to have hobbies. Most people do not have hobbies, and it's very important.

Host: Really great feedback from all of you. Lauren, Lindsay, Deborah, a pleasure. Keep up all your great work and thanks so much again.

Lauren Nale, OTL, CSRS: Thanks Joey.

Lindsay Heidrich, OTR/L: Thank you, so much for having us.

Deborah Jacob, OTR/L, CEAS: Thank you, Joey.

Host: For more information, please visit silvercross.org/rehabilitation. Now, if you enjoyed this podcast, please do share it on your social media and be sure to check out all the other podcasts of the entire library for topics that are of interest to you. Thanks so much again for being part of Silver Cross Hospital's I Matter Health Podcast.