.jpg)
In each setting and specialism that I have worked as an Occupational Therapist, the adoption of routine has been key to the recovery, rehabilitation or general maintenance of an individual's health and/or well-being. In this article, I encourage you to consider, reflect on, or be reminded of the value of routines and rituals, for both you and those you support in practice...
My experiences of using routine
At an acute community 'rapid response' service
Adapting medication timings, welfare checks and personal care support structures kept older adults safely in their home environment, rather than admitting them to hospital unnecessarily. By making (often minor) adjustments to how they went about their day, rates of falls and medication errors would reduce and clinical observations could be increasingly stabilised. This might also rely on the provision of adaptive equipment to carry out activities of daily living (ADLs), but it would ultimately make engaging in necessary occupations safer and easier.
At a brain injury rehabilitation unit
Post-stroke routine was crucial to orientation and to restoring patient's cognitive abilities. Devised by a multidisciplinary team of therapists, a daily timetable incorporated occupation both as a means and an end*. This included set breakfast periods, when patients were encouraged to eat and drink in the dining room - providing context and orientation in an appropriate physical environment.
It also involved gathering information from friends and family about the person's usual personal care routine, then accommodating for and encouraging these preferred methods and orders of task completion.
In doing this, interventions exercised social and communication skills, as well as rehabilitation of executive functioning, such as memory, divided attention, planning and problem-solving.
For young people struggling with their mental health
Incorporating meaningful activity and social opportunity into daily routines provided a much-needed volition-boost, distraction from negative or unhelpful thought cycles and a chance to re-connect. The community-based mental health charity facilitated peer support, allowing teenagers to learn resilience tools and tips from others going through similar experiences. Planned meaningful activity, in a safe, after-school environment, included fortnightly art classes, evening discussion groups and weekly yoga sessions.
Within a paediatric disability service
I have explored elements of routine management with parents of children, including those with autism spectrum disorder (ASD), where behaviour that challenges can also impact on the wider family's daily life. Adapting showering or bathing methods, attending after-school clubs and staggering mealtimes are just a few examples of how triggering behaviours might be avoided or reduced. This often involves liaising with family members and other healthcare professionals, to establish if a child is sensory-seeking or sensory-avoidant, then making minor adjustments to the execution of ADL(s). Alongside referring to a sensory advice service - and sometimes making home adaptations - parents can be empowered to support their child's daily routine. Goals might focus on engagement in an activity with greater ease, independence and/or safety.
* Occupation as Means vs Occupation as Ends:
Occupation as Means | Using the engagement and performance of occupations as intervention. |
Occupation as Ends | The outcome of the intervention or goal is the ability to perform or engage in occupation. It does not necessarily mean the use of occupation was used directly as an intervention. |
[Gray, 1998]
Away from clinical practice, I am sure you are more than aware of the power of routine (or a lack of it), as we coped with change, to varying degrees, throughout the coronavirus pandemic. This recent experience is highlighted in a piece on The Conversation, where Megan Edgelow explores the influence of 'doing' on the quality of daily life - a concept that every occupational therapy professional holds close to their heart!
I reference Megan (Assistant Professor at Queen's University) at the end of this article, but I would like to share her main points with you below:
Routines support cognitive function
A daily routine and regular habits support cognition. They can even free people up to be more creative. According to research, regular work processes allow us to spend less cognitive energy on recurring tasks; in turn, this supports focus and creativity for more complex tasks. Researchers found that many influential artists have well-defined work routines, which might support their creativity, rather than constrain it.
Research on the subject of memory has shown that regular habits and routines can support older adults' functioning in their home environments. For example, if taking medication at the same time and putting house keys in a particular place is part of a daily routine, less energy is used looking for lost objects and worrying about maintaining health. This frees up time in the day to do other things.
Routines promote health
Routines provide meaning
[Edgelow, 2022]
How could you build on your own routines?
Do you think you - or those you support in occupational therapy practice - could do with improved or adjusted routines? Take a look at these small steps, that might help cognitive functioning, promote better health and/or provide greater meaning in daily life:
Decide on a regular time to wake in the morning and go to sleep at night; aim to keep to this most days of the week. Choose a familiar, low-stimulation 'wind-down' activity to precede going to bed (avoid screen time!)
Organise your day with a timer or smart phone app; put tasks you want to do into your schedule.
Start a new leisure occupation or hobby, or take up an old one. Need ideas? Consider playing an in/outdoor sport, engaging in arts and crafts, playing a musical instrument or singing in a choir.
Make physical activity manageable, with local walks or bike rides a few times a week. Or consider walking or cycling your commute to work, rather than driving or getting the bus (if this is realistic for you).
In summary...
Routines are powerful tools! Whilst the notion can sound mundane, research shows that implementing them can support better physical and psychological health, as well as social connection and wellbeing.
Occupational therapists and therapy assistants can use routine to support patients and clients in their recovery, or to maintain a level of health and/or cognitive functioning. As occupational deprivation and disruption of the coronavirus pandemic passes, we all have the chance to evaluate routines that we want to keep and the meaningful occupations we need in our daily lives, to stay happy, healthy and productive.
References
Edgelow, M. (2022) What you do every day matters: The power of routines. The Conversation. Available from: https://theconversation.com/what-you-do-every-day-matters-the-power-of-routines-178592 [Accessed 23 March 2022].
Gray, J. (1998) Putting occupation into practice: Occupation as ends, occupation as means. American Journal of Occupational Therapy. 52(5)3, pp.354-364.
Nakamura, J. and Csikszentmihalyi, M. (2009) Flow Theory and Research. The Oxford Handbook of Positive Psychology. 2 ed. July 2009. DOI: https://doi.org/10.1093/oxfordhb/9780195187243.013.0018.