COVID-19 OTCOVID-19 is having a significant impact on the opportunity, type, and delivery of occupational therapy (OT) services across practice settings and populations. Yet the inherent value of the OT profession is to allow clients, groups, and communities the opportunity to improvise with their life regardless of an acute or chronic physical, cognitive or social/emotional condition. OT professionals are the masters of facilitating adaptation to support the improvisation of living one’s best life.

Supporting OT Patient Progress During COVID-19

In most cases, occupational therapists can and are shifting their monitoring of progress and plans of care using technology, specifically telehealth practices and technology. Under the umbrella of telehealth, OTs are: 

  • providing direct intervention 
  • checking in on the status of clients with their home programming 
  • assessing the home environment to support safety, independence, and engagement in activities that are purposeful, meaningful, and promote quality of life 

The most impactful strategy that clients and their families can do to help maintain progress with occupational therapy focused plans of care, goals, and levels of independence is to obtain and follow-through with home programming. Home programming may include: 

  • precautions to protect and prevent injury or further disability 
  • activities to maintain participation and performance in meaningful activities that might consist of activities of daily living 
  • instrumental activities of daily living 
  • leisure exploration 
  • productivity with employment, volunteering tasks, etc.

OT Barriers and Adaptation

Though the delivery of OT services may have some barriers based upon physical contact, OT professionals, their clients, and families can utilize the current communication technologies (phone, video conferencing, email communications) to connect to monitor progress, provide feedback, and/or provide additional education that promotes health and wellbeing. Caregivers, caregiver supports, and families can reach out to their OT professionals to seek additional support through education and training, home programming, and then regular implementation of those recommendations. 

Foundation to OT practice is to encourage people to engage in the activities where one finds purpose, meaning, and productivity. This might mean something as simple as helping a child participating in routine morning activities that simulate their academic roles or an aging family member to allow them to assist with chores, cooking, or gardening. Philosophically “doing” is healing, especially when we might experience the deprivation of such. “Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health.” (AOTA, 1962, p. 81).

OT Teletherapy Options During COVID-19

Telehealth as a practice setting is no different when providing skilled therapeutic service to a client, group, or population in a school classroom or playground, community-based setting (daycare), hospital, assistive living setting, etc. All settings have limitations on what may be accomplished due to the barriers inherent in the physical, social, or additional environments. 

The primary concerns with telehealth practice are how OT professionals and their clients engage with therapeutic interventions that are psychomotor based. These types of interventions require direct physical contact to provide direct and indirect support for goal-directed movement and/or the use of tools, utensils, adaptive equipment, durable medical devices, clothing, furniture, etc. However, in some cases, this can be mitigated through the use of caregivers or other health providers in the home.

Telehealth practice affords OT professionals many opportunities to continue the provision of skilled therapy but also has its limitations that need to be acknowledged and barriers that need to be navigated. The American Occupational Therapy Association and other professional groups have provided ongoing resources and solutions for occupational therapy professionals implementing telehealth, such as OT and Telehealth, OT and Telehealth in the Age of COVID-19, and International Journal of Telerehabilitation.

As with any setting, it requires the OT professional and their client to be skillful with creativity and improvisation. These essential clinical reasoning skills are foundational of OT’s approach addressing the human condition. 

COVID-19 Impact on Moving Forward

During this time states, healthcare companies, hospital groups, private practices, and schools have had to proactively or reactively develop and implement their policies and procedures related to how habilitation and rehabilitation services are delivered. These new policies and procedures are being created to protect the therapy consumer and also support the health and wellbeing of their organizations and employees. These entities will be more adept at planning and implementing contingency plans or alternative mechanisms to anticipate unprecedented events like COVID-19 in the future. 

There is an opportunity for healthcare providers to explore, innovate, adapt, and improvise how rehabilitative care is being delivered in very diverse settings and populations. Though COVID 19 is a significant event that is temporarily altering daily life, there are natural and reluctant leaders within the rehabilitation community that are stepping forward to facilitating creativity and improvisation, specifically through the use of technology to see what is possible despite the current barriers. 

The current situation where you live may be limiting your ability to engage in those activities that you find meaningful and healing. There are some that we can modify and adapt to find some semblance of engagement. There are others that we cannot, yet we have the opportunity to explore lost or new activities that could provide some sustaining help. As an occupational therapist and educator, I am always reminding clients and students to adapt. This advice works for all, including me. My hope is out of the uncertainty, tragedy, and unprecedented experience, we value what we have lost, what we have, and what we are discovering about ourselves and what we can do!

Author: Bryan M. Gee, PhD, OTD, OTR/L, BCP

Dr. Bryan Gee is Director of the Post-Professional Doctor of Occupational Therapy Program and Continuing Education/Online Learning Community Support at Rocky Mountain University of Health Professions.

 

References

American Occupational Therapy Associational. OT and Telehealth in the Age of COVID-19. Retrieved from https://www.aota.org/Practice/Manage/telehealth/coronavirus.aspx 

American Occupational Therapy Associational. OT Telehealth Resources. Retrieved from https://www.aota.org/Practice/Manage/telehealth.aspx

International Journal of Telerehabilitation. Retrieved from https://telerehab.pitt.edu/ojs/index.php/Telerehab/index

Reilly, M. (1962). Occupational therapy can be one of the great ideas of 20th century medicine. American Journal of Occupational Therapy, 16(1), 1-9.