Occupational Therapy in Acute Care
Occupational Therapy’s Role in Acute Care
Occupational Therapy with a stroke patient
- Acute care is an inpatient hospital setting for individuals with a critical medical condition.
- These patients may have experienced a sudden decline in their medical and functional status due to a traumatic event, a worsening of a progressive disease, or onset of a new condition.
Treatment Approaches
- Stroke- Intervention involves task-specific training to regain competency and body skills and hygiene, gaining strength and control, education concerning safety issues, home adaptation, social support and availability of community resources.
- Example of ADL intervention: Improve performance in feeding, grooming, and upper and lower body dressing.
- Dressing: Dress involved side first, then non involved side, suggest clothing such as t-shirts, elastic bands and velcro fasteners. Avoid buttons, snaps, zippers, belts when possible.
Future of Acute Care
History of Acute Care
- The primary goals for the future of acute care are facilitating early mobilization, restoring function, preventing further decline, and coordinating care, including transition and discharge planning.
- Looking to expand to bariatric care is also considered a future goal. Bariatrics is the branch of medicine that addresses the causes,prevention, and treatment of obesity.
- The occupational therapy approach in bariatrics would be to help individuals change their lifestyle, engage in meaningful activities and manage their weight.
- Occupational Therapy stemmed from the arts and crafts movement and the moral treatment movement.
- During World War 1, reconstruction aides rehabilitated disabled soilders and civilian patients. These women worked in military hospitals. Recostruction aides helped to recapture purpose in their lives.
- In the 1920s-1930s,early occupational therapists recognized the need to establish an identity and promote OT to the medical profession and to the public.
- During the 1940s-1960s, which was referred to as the "rehabilitation movement", occupational therapists were called upon to organize and run rehabilitation programs.
- By the 1960s-1970s the "rehabilitation movement", moved towards specialization,which allowed OT's/OTA's to branch out into different practice settings to further promote holistic care approaches.
- Acute care was one of these new practice settings. Knowledge of normal human development began to grow, from neonate through geriatrics, allowing occupational therapy practitioners to contribute a broad range of clinical skills to acute/critical care services
- Sheila Fowler-Davis, OTR at Coliseum Northside, Macon, GA
- www.aota.org:
- Occupational Therapy's Role in Acute Care. (2012, January 1). Retrieved September 15, 2014, from https://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/Acute-Care.pdf
- Getting Started in Acute Care Hospitals. (n.d.). Retrieved September 15, 2014, from http://www.asha.org/slp/healthcare/start_acute_care/
- Quick Reference to Occupational Therapy:
Reimbursement
- Heart disease is an umbrella term used to describe several problems related to plaque buildup in the walls of the arteries.
- About 600,000 people die of heart disease in the United States every year–that's 1 in every 4 deaths. Heart disease is the leading cause of death for both men and women. More than half of the deaths due to heart disease in 2009 were in men.
- OT's/OTA's focus largely on lifestyle changes that can help reduce or eliminate conditions that lead to heart failure.
- Reed, K. (2014). Cardiopulmonary Disorders. In Quick Reference to Occupational Therapy (3rd ed., pp. 401-403). Austin, Texas: Pro-ed.
- Reed, K. (2014). Nervous System Disorders. In Quick Reference to Occupational Therapy (3rd ed., pp. 370-373). Austin, Texas: Pro-ed.
- Reed, K. (2014). Injuries. In Quick reference to Occupational Therapy (3rd ed., pp. 545-556). Austin, Texas: Pro-ed.
http://www.heart.org/HEARTORG/Conditions/Conditions_UCM_001087_SubHomePage.jsp
What is traumatic brain injury?
- Traumatic brain injury (TBI), occurs when someone's head is severely hit or shaken, or when an object goes into the brain.
- Brain injuries range from mild to severe.
- People with TBI may have changes to their personality, trouble with memory, confusion, or poor judgement.
- These changes to the brain can affect people's ability to do daily activities, or occupations.
- An OT/OTA comes in to help people with TBI learn to live valued and productive lives.
- The goals are generally to compensate for functional limitations, maintain physical functioning for a long as possible and prevent future issues where possible.
- Example of ADL intervention:
- Assist person to organize a daily schedule that includes pacing (alternating cycles of activity and rest) and reduces reaching and standing time by placing items at shoulder to knee height and sitting whenever possible.
http://www.aota.org/en/About-Occupational-Therapy/Patients-Clients/DisabilityAndRehabilitation/TBI.aspx
- Stroke is the 4th leading cause of death in America and a leading cause of adult disability.
- A stroke occurs when a blood clot blocks an artery,or when a blood vessel breaks, interrupting blood flow to the brain.
- When either of those things happen, brain cells begin to die and brain damage occurs.
- Occupational therapy practitioners address the physical, cognitive, and emotional challenges brought on by a stroke, and they can help stroke survivors engage in the things they want and need to do.
- During the acute phase, treatment is used to establish the level of brain arousal by systematic observation, prevent deformity, promote good positioning, promote orientation with the environment, facilitate family involvement and offer support.
- Example of ADL intervention:
- Post-coma stage: promote familiar, meaningful activity and routines, such as performing basic self-care activities.
- Consider use of adaptive equipment as needed
Types of Patients Commonly Seen in Acute Care
- Once the patient is admitted, insurance in handled through admissions, which in return reimburses the OT/OTA.
- Main types of insurance:
- Medicare
- Commercial (Aetna, Blue Cross Blue Shield..)
- Medicaid
- If the patient has no insurance, this is called indigent care; patient/family make payment arrangements.
- Private insurance reimbursement varies according to what type of plan the patient has.
- Stroke
- Cardiac Issues
- Brain/Head Injuries
- Respiratory Disease (ex:pneumonia)
- Generalized weakness/fatigue
- Orthopedics-joint trauma and injury