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Therapy Articles (124)

  • Using Yoga to complement Occupational Therapy

    N.B. A Hub collaborative partnership: Some marketing elements; no paid sponsorship If you are an occupational therapy (OT) practitioner or student, you will be familiar with the multifaceted challenges your patients and clients face. The intricate interplay between physical and mental health - intertwined with lifestyle and social factors - requires a holistic approach. OT assessment and intervention considers and seeks to address the whole person; sometimes there is a need for additional self-care practices, to help transform lives. Enter yoga - a versatile tool, offering a complement to OT intervention, with evidence that supports its physical and mental health benefits. A 2018 research paper (1) found that: 'Occupational therapists reported that yoga increased self-awareness, including the development of self-efficacy, self-regulation and self-care. Participants noted that the practice of yoga was motivating and elicited a sense of empowerment, that resulted in positive perceptions of health-related quality of life and overall well-being.' Yoga's versatility for Occupational Therapists Yoga provides occupational therapists with a set of invaluable skills applicable to a broad spectrum of individuals - both to patients and to fellow clinicians. Beyond the well-recognised physical benefits, yoga contributes significantly (2) to mental health and well-being. In a systematic review (3), discussing yoga therapy as a modality in occupational therapy practice for adults experiencing mood disorders, researchers concluded: 'Yoga therapy may be a promising method to integrate into care plans, to reduce the impact of mood disorders such as depressive symptomatology.' Yoga and yoga therapy is also cost-effective, compared with some other methods. As a healing modality, it can be adapted in most client-care settings, with approaches and techniques that are simple and easily translated to multiple populations, for both short and long-term management of chronic conditions. How can yoga practices be shared by Occupational Therapists in a real life setting? With suitable grading and positioning guidance, basic and fundamental yoga practices can be incorporated into daily routines. They can include breathing and relaxation techniques. With sufficient activity analysis, they can also be applied to specific conditions that Occupational Therapists handle on a regular basis. Two such conditions are irritable bowel syndrome (IBS) and fibromyalgia. One recent, interesting, state-of-the-art 2023 narrative review article (4) looked specifically at the benefits of mind-body techniques for these coexisting conditions. These conditions share common pathophysiological mechanisms; sensitisation of peripheral and central pain pathways and autonomic dysfunction. The review found that: 'On an individual basis, mind-body interventions have been reported to benefit both the conditions and influence central pain syndromes and autonomic dysregulation.' Such health conditions are also seen by Yoga Therapists, who undergo two years of training. You can read about the concept of yoga therapy here: What is Yoga Therapy? (7). Rising yoga practices - for both Occupational Therapists and patients As a busy clinician (with a non-work life to prioritise too), the likelihood is that you have no additional time on your hands to study yoga in-depth for two years. However, simple key postures - including standing poses, forward and back bends, twists, sun salutations and simple inversions - support healing and recovery on both physical and psychological levels. It is essential to apply specific techniques safely of course, emphasising the importance of postural alignment alongside breath awareness and mindfulness. These techniques can be learnt in a relatively short time frame. Specifically, there is a growing trend in the practice of chair yoga (8), which is a safe and accessible way to integrate yoga into a patient-Occupational Therapist relationship. Supporting patients with chair yoga gives an accessible practice, which can also be continued outside of traditional OT/clinical settings. A 2023 study (5) supported this rise, finding that: 'Chair yoga therapy can enable older adults with knee osteoarthritis to adopt and practice the therapy at home as part of their daily life, lessening the risk of their disease progressing to disability.' Chair yoga is designed to make yoga accessible to everyone, regardless of ability. The practice is one that many occupational therapists already use as a treatment adjunct with their patients. It is worth acknowledging the growing acceptance of chair yoga in healthcare settings, offering a practical solution for patients with varying physical capabilities. Accessibility of yoga instruction for Occupational Therapists? A recent study (6) found healthcare professionals are motivated to recommend yoga to patients, but face barriers, due to lack of information about how patients can access appropriate and affordable yoga instruction... In light of this, Liz Oppedijk - Yoga Therapy Educator at The Minded Institute and Founder/CEO of Accessible Chair Yoga - is offering a one-day online course: Basic Yoga Techniques for Health Professionals leaves participants with the ability to weave foundational yoga skills into their work immediately. As a valued Member of The Occupational Therapy Hub, you are entitled to a 10% discount on the full price of this course. Simply click the link above, add the course to your basket and enter the discount code OTHUB10 at checkout. Please contact marketing@themindedinstitute.com with any questions or queries. Empower yourself, empower your patients. Why not elevate your practice with yoga? References and further reading Graham, J. and Plummer, T. (2018) Perceptions of Occupational Therapists and Yoga Practitioners of the Effects of Yoga on Health and Wellness. Annals of International Occupational Therapy. 1 (3): 127-138. Available from: https://journals.healio.com/doi/10.3928/24761222-20180620-01. Bös, C., Gaiswinkler, L., Fuchshuber, J., Schwerdtfeger, A. and Unterrainer, H.F. (2023) Effect of Yoga involvement on mental health in times of crisis: A cross-sectional study. Frontiers in Psychology. 2023; 14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10074601/. Crooks, C., Toolsiedas, H., McDougall, A. and Nowrouzi-Kia, B. (2024) Systematic review protocol of yoga therapy as a modality in occupational therapy practice for adults experiencing mood disorders. British Medical Journal (Open). 14 (1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773392/. Majumdar, V. and Manjunath, N.K. (2023) Editorial: New insights into yoga and mental health. Frontiers in Human Neuroscience. 2023 (17). Available from: https://www.frontiersin.org/articles/10.3389/fnhum.2023.1239411/full. Yao, C.T., Lee, B.O., Hong, H. and Su, Y.C. (2023) Effect of Chair Yoga Therapy on Functional Fitness and Daily Life Activities among Older Female Adults with Knee Osteoarthritis in Taiwan: A Quasi-Experimental Study. Healthcare (Basel). 2023; 11 (7): 1024. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10094373/. Smit, C. and Cartwright, T. (2023) Recommending yoga for health: A survey of perceptions among healthcare practitioners in the UK. Complementary Therapies in Clinical Practice. 2023 (52): 101765. Available from: https://www.sciencedirect.com/science/article/pii/S1744388123000464. The Minded Institute (2024) What is Yoga Therapy? The Minded Institute (online). Available from: https://themindedinstitute.com/what-is-yoga-therapy-2. The Minded Institute (2023) Chair Yoga, Accessible to Everyone, from Simple to Profound. The Minded Institute (online). Available from: https://themindedinstitute.com/chair-yoga-accessible-to-everyone-from-intense-to-simple/.

  • Reflections on the Rebirth of an Artist

    This piece is dedicated to a remarkable individual I had the privilege of treating for approximately two weeks. 'S' - a young man in his early twenties, from a small village in Assam, India - arrived at our department in a wheelchair, due to the sequelae of a non-traumatic spinal cord injury (SCI). Despite his physical challenges, S displayed an exceptional level of positivity and resilience... S was an aspiring fashion designer, who moved to Delhi to follow his passion. The lack of funds for his higher education forced him to look for a part-time occupation, which led him to take a keen interest in the make-up and beauty industry. Soon, S realised that he had a talent for using knowledge of colour theory in applying make-up and started gathering a small clientele for himself. Tragedy struck with the advent of COVID-19 and, along with many others, S was also a victim of its atrocities. Within time, he was rendered paraplegic, requiring full use of a wheelchair and with 'no possibility of going back to work again'. Clinically, S presented with impairments in: trunk control upper limb strength functional skills wheelchair mobility Recognising his aspirations and potential for rehabilitation, I immediately initiated a comprehensive treatment plan, tailored to address these areas of concern. Our first target was to establish good trunk control and dynamic sitting balance, by engaging him in activities that challenged him in these areas. For example, overhead ball throwing and graded stooping in a high-seated position. Once that was established, we worked on improving upper limb strength and endurance, as it was essential for wheelchair mobility and transfers. Push-ups were a great option and his performance was evaluated based on clearance, endurance and level of assistance provided. Perfecting a static push-up was essential for relieving pressure during long sitting hours, to prevent pressure ulcers. Dynamic push-ups were necessary for independent transfers, from bed to wheelchair and vice-versa. During our therapy sessions, one of the main issues to address was how his current functional status affected his work, to a point of resigning as a make-up artist (MUA). He educated me on all the postural and technical difficulties a male MUA faced, while doing his job in a wheelchair. His biggest challenge was the lack of trunk stability. The other issue he faced was positioning the client to accommodate his wheelchair. He wasn’t comfortable with the idea of leaning over the client’s face with the risk of falling over them while he worked. Another problem he faced was engaging in bilateral activities like hair washing and setting, since it involved him moving all around the client while working. He wouldn’t be able to manoeuvre the wheelchair if his hands were coated in any hair-care products... In order to better understand these hurdles, we conducted a simulation with some modifications, to better suit his functional status. Two of my colleagues assisted as volunteers; we gathered all the basic tools and equipment needed for him to apply basic make-up over a client. We were immediately able to identify some factors that affected his activity performance: The quality of wheelchair used significantly affected his performance. The size, material, state of repair, presence of chest strap, quality of brakes and removable armrests were important aspects to take into account. Environmental factors, like accessibility and open space, were necessary to take into account. Using more handheld tools and gloves helped with prevention of cross-contamination. Having the client, in this case, the volunteer, seated at an inclination instead of lying supine also made a positive difference. A detachable lapboard to place all his tools on was also a better option than the trolley that was usually used by them. Throughout our sessions, S's determination and creativity shone brightly. Despite facing financial constraints and the devastating impact of COVID-19, he remained unwavering in his pursuit of regaining independence and pursuing his passions. With the support of his mother and close friends, S embarked on a journey of self-discovery and adaptation. Incorporating occupational therapy, vocational rehabilitation and physical therapy, our sessions focused on enhancing S's functional abilities, while exploring opportunities for him to re-engage in his interests. Despite initial scepticism, S embraced the idea of utilising his talents in the makeup and beauty industry - leveraging his knowledge of colour theory and artistic skills. Our therapy sessions evolved into a collaborative exploration, of adaptive techniques and strategies tailored to S's unique needs. From mastering wheelchair positioning for optimal makeup application, to implementing pressure relieving techniques during prolonged sessions, each session served as a learning opportunity for both S and myself. As our time together drew to a close, S's remarkable progress and unwavering optimism left a lasting impression on me. His resilience in the face of adversity serves as a testament to the human spirit's capacity for adaptation and growth. S's journey continues, as he undergoes long-term rehabilitation at another branch of our institute. While I may no longer be directly involved in his care, I remain inspired by his tenacity and consistent determination to overcome challenges and pursue his dreams. In conclusion... S's story exemplifies the transformative impact of rehabilitation and the strength of the human spirit. As healthcare professionals, it is both our privilege and responsibility to empower individuals like S, to reclaim their independence and pursue their passions - irrespective of the challenges they may face. Further reading and learning World Health Organization (WHO) (2013) Spinal cord injury (online). Available from: https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury. Accessed 13 April 2024. OT CPD Courses: Fundamentals of Posture, Pressure and Ergonomics (2022, The Occupational Therapy Hub). Plus+ Member access to participate and receive a certificate.

  • 'Drawing back the covers' on the OT role in sleep: An article and podcast

    Every now and then, the ambience in our office is disturbed by a member of the public roaring with laughter in the corridor, whilst reading the 'Sleep Office' sign on our door. We prick our ears with a sense of familiarity, anticipating what is coming next. "Sleep Office. Ha ha! What do you think they do in there then, sleep?" While the idea of sleeping on the job sounds amusing to some, to our patients, sleep at any time has often become a living nightmare. Night after night, for years or decades - stuck in a seemingly inescapable cycle of desperately wanting to sleep, yet spending much of the night exhausted and awake. We call this insomnia, which is one of the many sleep disorders we deal with at our sleep clinic. To those who have never struggled with sleep, it is hard to understand the profound impact that sleep disorders have on a person’s life. While they may be seen as a nighttime problem, they have a significant impact - across the full 24-hour spectrum - on: health emotions cognition productivity quality of life You might call me biased, but I think that sleep is the ultimate occupation! Every other occupation is affected by how well we sleep, and similarly, sleep is affected by all our occupations. At the Royal Surrey County Hospital (in the UK), we are a team of three Occupational Therapists, working within an outpatient National Health Service (NHS) sleep clinic to provide assessment and behavioural treatment for sleep disorders. While our respiratory nurse and physiotherapy colleagues provide the sleep disordered breathing service, our primary focus is on delivering treatment for insomnia. We also support patients with circadian rhythm disorders, concurrent insomnia and sleep apnoea (COMISA), nightmare disorder and parasomnias. Our patients range in age from 16-90 years and, unsurprisingly, many have complex medical or mental health issues in addition to their sleep disorder. A day in the life... Today, my day started with a remote clinic. Due to there only being a few NHS Insomnia services in the UK, many of our patients are not local and prefer remote treatment, to avoid long journeys. My first patient was a 45-year-old lady who, for the last 10 years, has taken several hours to fall asleep and then woken for another hour or two overnight. At first assessment, she estimated sleeping around 5 hours on a good night and was feeling desperate. Despite describing herself as a naturally positive person, her life had become a battle. She felt exhausted all the time, had been pulled up for mistakes at work and her relationship with her husband was deteriorating - not helped by their recent 'sleep divorce' (separate bedrooms). We initiated cognitive behavioural therapy (CBT) for Insomnia, which is misleadingly named, as it is nothing like regular CBT. After only a few weeks, her sleep is improving. CBT for Insomnia (CBT-I) is the recommended first line treatment for people with chronic insomnia - although sadly few services exist, which means that most sufferers are fobbed off with no help, or ineffective sleep hygiene. CBT-I has a robust evidence base, demonstrating efficacy in primary and co-morbid insomnia (references 1,2). It is a multi-component intervention, addressing cognitive and behavioural factors that perpetuate sleep disturbance. We deliver our programme in an innovative way, through a combination of treatment videos (which I created, after we were forced to close our service during covid-19) and one-to-one support (to tailor, troubleshoot and top-up video content). While the principles of CBT-I are quite simple, in reality they can be challenging, both to deliver as a healthcare professional and to implement as a patient. For example, techniques such as sleep scheduling can be very daunting. This requires an already-sleep-deprived individual to sacrifice catch-up sleep, get up at a consistent time and temporarily reduce their overall time in bed, in order to increase sleep efficiency. Not surprisingly, occupational therapy coaching skills are extensively employed, including: evaluating motivation explaining rationale instilling hope compassionately acknowledging concerns adapting guidance to overcome barriers or resistance In spite of patients’ initial scepticism, CBT-I literally changes lives within a matter of weeks. That was the case for my first patient. Only four weeks after first seeing me, she was surprised to find that she was falling asleep within 30 minutes - and getting back to sleep quickly during the night. Her average sleep duration had already increased to 6.5-7 hours a night. I explained the next steps and congratulated her on the positive spiral she was creating - where increased sleep consistency produces greater confidence, which in-turn promotes calm at bedtime and consequently promotes more sleep! My next patient was a 62-year-old man, whom I was speaking to for the first time. He explained that his sleep had been poor for years; as is the case for many of our patients, his physical and mental health was suffering. After initially describing symptoms suggestive of insomnia, he flippantly disclosed violent dreams associated with thrashing around and dream-related movement. Further questioning revealed a history consistent with REM Behaviour Disorder (RBD). Sadly, around 70% of those with RBD develop Parkinson’s Disease within 12 years (reference 3). RBD is not something that can be treated behaviourally and a formal diagnosis requires a laboratory sleep study, which we do not have available at our hospital. So I inform the gentleman on good sleep practices, recommend safety measures to avoid injury overnight, advise the GP to remain vigilant to other prodromal Parkinson’s symptoms and refer him to a London clinic, for a formal diagnosis. Other activities during the day include setting up a respiratory sleep study for a lady with insomnia - but whom I suspect has sleep apnoea too. Plus talking to a young woman with a severely delayed sleep rhythm (4am - 1pm) about light therapy. That and wading through an endless stream of admin, triaging referrals, attending a multidisciplinary (MDT) meeting and cursing the new electronic records system that isn’t cooperating... As my day draws to an end, I am left utterly convinced that when we help our patients sleep, we help them live. If this article has inspired you to think more deeply about sleep, I would encourage you to start building your knowledge of sleep, through reading or training. From there, your most powerful tool is to ask your patients about their sleep. In the words of Jane, a former patient and former insomniac: "Life feels so much brighter, better and happier when you’ve slept well!" Struggling to sleep? Listen up! This free 30-minute one-off podcast will provide insights and evidence-based techniques, to help you and your clients sleep better tonight! If you are struggling to fall asleep or stay asleep, please listen in below. Created by article author Louise Berger, the talk will cover: How you are not alone and there is hope What to do when you are having a few bad nights The difference between a few bad nights and full-blown insomnia How insomnia develops The vicious cycle of trying too hard to sleep The two systems that determine how well you sleep - sleep drive and hyper-arousal The difference between being sleepy and tired Practical ways to increase sleep drive, so you can fall (and stay) asleep more easily Ways to reduce alertness and anxiety at bedtime and overnight Why you don’t have to sleep 7-8 hours every night Why your insomnia isn’t going to take you to an early grave References Trauer, J.M., Qian, M.Y., Doyle, J.S., Rajaratnam, S.M.W. and Cunnington, D. (2015) Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Annals of Internal Medicine. 163 (3): 191-204. doi: 10.7326/M14-2841. Edinger, J.D., Arnedt, J.T., Bertisch, S.M. et al. (2021) Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine. 17 (2): 263-298. Roguski, A., Rayment, D., Whone, A.L., Jones, M.W. and Rolinski, M. (2020) A neurologist's guide to REM sleep behavior disorder. Frontiers in Neurology. Jul 8; 11:610. Berger, L. (2024) Say Goodnight to Insomnia Podcast. Royal Surrey NHS Foundation Trust: Occupational Therapy > Insomnia Clinic. Available online: https://www.royalsurrey.nhs.uk/saygoodnight. Accessed 15 February 2024.

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OT CPD Courses (32)

  • Therapeutic Benefits of Gardening for Depression

    As Occupational Therapists, we are always trying to identify activities that a client might connect with. Gardening is an accessible, adaptable pastime, that many clients have experienced and which an intervention can be built around. However, barriers exist with many mental health conditions, such as volition and fatigue, that need to be overcome in order to engage. Take this short course to explore these themes further. Questions and self-reflection will follow content, to help test your knowledge and provide evidence of learning.

  • Learning Section

    Introduction As Occupational Therapists, we are always trying to identify activities that a patient or client might connect with. Gardening is an accessible, adaptable pastime, that many clients have experienced and which an intervention can be built around. However, for many mental health conditions, there are barriers such as volition and fatigue, that need to be overcome in order to engage. These can be minimised by using techniques to encourage engagement, predominantly appropriate for Occupational Therapists, but also Social and Therapeutic Horticulturists. A brief overview of depression Depression (also known as major depression, major depressive disorder, or clinical depression) is a debilitating mood disorder and mental health condition. It can affect people of all ages, races, ethnicities and genders, often presenting itself with low mood and cognitive distortion (Gonzalez et al, 2009). Characteristics often impact the ability to engage with others and in daily life activities, such as sleeping, eating, or working. Although men, women and people of all genders can feel depressed, how they express symptoms - and the behaviours used to cope with them - may differ. An individual with depression is likely to experience some (but not all) of the following signs and symptoms, most of the day, nearly every day: Persistent sad, anxious, or 'empty' mood Feelings of guilt, worthlessness or helplessness Feelings of irritability, frustration or restlessness Decreased energy, fatigue or feeling slowed down Difficulty concentrating, remembering, or making decisions Difficulty sleeping, waking early in the morning, or oversleeping Becoming withdrawn and detached; isolating from family and friends Loss of interest or pleasure in hobbies and activities Problems with sexual desire and performance Changes in appetite or unplanned weight changes Physical aches or pains, headaches, cramps, or digestive problems (no clear physical cause) Thoughts of death or suicide, or suicide attempts [National Institute of Mental Health, 2023] Depression interferes with day-to-day functioning and causes significant distress for the person experiencing it. Statistically, 4-10% of people in England (for example) will have depression at some time (NICE, 2011), with 7.8% being diagnosed alongside anxiety (HSCIC, 2009). The World Health Organisation (WHO, 2008) predicted that depressive conditions would be the second major cause of disability in the world by 2020. As symptom severity is highly variable, any effective intervention should be appropriate to the degree of depression. Evidence that gardening is beneficial for depression Soga, Gaston and Yamaura (2016) carried out a statistical quantitative research review of the health benefits of gardening and concluded it can provide a reduction in depression. This supports many of the qualitative experiences of the benefits of gardening with depression. "Gardening is a constant boost to my consciously nurtured optimism, as I am surrounded by the natural world, which pursues life with eager enthusiasm." (Mind, 2017) Gonzalez et al (2009) evaluated the impact of therapeutic horticulture on clinical depression, by measuring changes in the severity of the depression and the participants' perceived capacity for attention. They found a correlation between the extent to which attention was captured and the reduction in depression. They deduce that this was a result of the disruption to the participant’s rumination and the effortless attention involved in engaging in gardening. Berg and Custers (2011) demonstrated that gardening increased positive mood, reducing cortisol levels and enabled participants to handle acute stress better (Kings Fund, 2016). Rostami et al (2014) noted that visitors of gardens felt that the experience reduced their depression by 94%. Providing access to a garden environment - even visiting public areas - can have positive effects on well-being, evoking a sense of identity, meaning and reducing stress. The MIND charity and University of Essex (UK) have developed an eco-therapy project - including gardening and food growing - to support mental health conditions, including depression. They found 69% of people experienced significant increases in wellbeing by the time they left the Ecominds project. Their survey of GPs stated that the eco-therapy was a valid and suitable treatment for anxiety (52%) and depression (51%) (University of Essex, 2013). Thrive (2017) suggest that gardening is an activity that enables a person to often connect with their past, while developing personally through their growing horticultural knowledge. It provides essential physical exercise, social connectedness and environmental connectedness (Sempik et al, 2005).

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