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In each setting and specialism that I have worked as an Occupational Therapist (OT), 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... routine /ru: ˈti:n/ noun a sequence of actions regularly followed repeated behaviours that become second nature and require little conscious thought Personal practice experiences of utilising routine At an acute community 'rapid response' service By collaboratively adjusting medication timings, ensuring an appropriate frequency of welfare checks and structuring personal care support, older adults were kept 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 an inpatient brain injury rehabilitation unit Post-stroke routine was crucial to orientation (time and place) 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, orientation and social connection , within an appropriate physical environment. Early rehabilitation 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 addressing cognition - including working memory and executive functioning (divided attention, planning, sequencing, problem-solving, etc). * Occupation as Means vs Occupation as Ends: ​Occupation as Means ​U sing 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]  For young people struggling with their mental health "Many people don’t realise just how much their routine - sleep, eating, exercise, work, how you like to do things - impacts their mental health until they’ve had their routine disrupted." - Dr Gold (Gilbert, 2023) 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. Often linked to a reduced motivation to engage in normal daily routines, the self-care practices of those affected by mental ill health often break down. This potentially has knock-on effects to physical health, hygiene and self-esteem , among other domains. In turn, this may impact on an individual's social and/or work life. Factors are inter-connected, but routine intertwines all aspects of our lives. Adopting daily routines removes the stress of decision-making. For example, if your routine is to eat a bowl of cereal when you wake up, less valuable time is spent deciding what to have for breakfast. That frees up brain power for more important decisions as the day progresses, that deserve more of our energy and stress (Van Raalte, in Gilbert, 2023).  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.  In an outpatient neurorehabilitation centre I currently work with patients, often on intensive packages of rehabilitation, following a range of neurological conditions, including stroke, traumatic brain injury (TBI) and spinal cord injury (SCI). In neurologic rehabilitation, repetition is required to maximise levels of improvement and brain reorganisation, to facilitate an individual maintaining and making greater functional gains. Animal studies in neuroplasticity have shown that approximately 400-600 repetitions per day of a difficult functional task are needed before the brain reorganises. This means that... 'If an individual is working on a functional task such as grasping, it will take 400-600 repetitions of grasping per day to help drive neuroplasticity and cause changes in the brain' (Kimberly et al, 2010). And the link to routine? Well, whilst face-to-face occupational therapy and physiotherapy sessions might last two-to-three hours per day, how my clients engage in activity outside of the clinic will be just as key to their speed of progress and potential . Working with them on a functional home exercise programme (HEP), that fits realistically into their current routine, will help embed techniques, skills and abilities learnt in OT sessions. 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 throughout the coronavirus (COVID-19) pandemic. Regularised routines 'can buffer the adverse impact of stress exposure on mental health' (Hou et al, 2020), something that affected us all, to varying degrees. This relatively recent experience is highlighted in a piece by Megan Edgelow, who 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. Click the three statements 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 and rituals improve our sense of control over daily life , allowing us to take positive steps in managing our health. For example, making time for exercise can help meet recommended daily activity levels. The pandemic has played havoc with long-established routines and rituals; reflecting on how these might have changed might be a helpful first step to improved health. Routines can support our health in other ways, such as regular meal preparation , sleep hygiene and set bed times . These activities might sound simple but, with regular implementation, they can contribute to healthy ageing over our lifetime. Routines provide meaning Regular routines can stretch past daily task efficiency; they can ' add life to our days '. Evidence has shown that health-promoting activities, such as cycling or walking, offer chances to enjoy nature, explore new places and meaningfully connect with others. Research on the concept of flow - a state of full absorption in the present moment - shows that activities like arts, music, sports and games can be fulfilling and reinforcing (Nakamura and Csikszentmihalyi, 2009). Regularly taking part in meaningful, engaging occupations can also benefit our mental health. [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]. Gilbert, K. (2023) 3 Expert-Backed Tips for Building Mental Health Routines That Stick (online). Peloton: The Output . Available from: https://www.onepeloton.co.uk/blog/mental-health-routine/ [Accessed 8 August 2024]. Gray, J. (1998) Putting occupation into practice: Occupation as ends, occupation as means. American Journal of Occupational Therapy . 52(5)3, pp.354-364. Hou, W.K., Lai, F.T.T., Ben-Ezra, M. and Goodwin, R. (2020) Regularizing daily routines for mental health during and after the COVID-19 pandemic. Journal of Global Health . 2020; 10(2): 020315. doi:10.7189/jogh.10.020315. Kimberly, T.J., Samargia, S., Moore, L.G., Shakya, J.K. and Lang, C.E. (2010) Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke. Journal of Rehabilitation Research and Development. 2010; 47(9): 851-62. doi: 10.1682/jrrd.2010.02.0019. 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 .

The purpose of this article is to explore the influence of GLP-1-type weight loss medications (such as Ozempic, Wegovy and Mounjaro) on occupation. Through personal reflection, it explores the individual occupational impacts of using such medications and the assumptions around obesity - drawing on links from experience working in the field of substance use.  Obesity Obesity rates have more than doubled in adults since 1990 , with now 1 in 8 (16%) of adults worldwide classed as obese (a body mass index of above 30). This trend is predicted to increase. Once associated with high income countries, this is no longer the case. The impacts of obesity can be tracked across the social gradient, meaning those who already experience socio-economic challenges, also experiencing the greatest health-related harms .  Obesity is associated with the leading causes of premature death worldwide, including: type 2 diabetes cardiovascular disease multiple cancers respiratory diseases many musculoskeletal conditions Those living with obesity are more likely to experience occupational disruption or a loss of occupation, through unemployment, stigma and discrimination. Such individuals also have an increased risk of hospitalisation, delayed recovery and reduced life expectancy. The social and economic costs are calculated at £126 billion annually for the UK , with further increases expected. The primary cause for obesity is an excess of caloric intake . However, it is a multifactorial disease, influenced by what is known as obesogenic environments , or the ' commercial determinants of health '. Recent policy has sought to address this, focusing on childhood obesity , reducing the sugar in soft drinks and efforts to limit the display of high fat, salt and sugar-containing foods at checkouts, or prominent areas in supermarkets. Evidence shows that up to 83% of such purchases are made on impulse, with promotions not saving money overall , as one might intend. Many factors can influence (or nudge) our choices, on different conscious levels.  It is within the scope of Occupational Therapists (OTs) to support people to take steps to reduce their weight, through diet and healthy lifestyle habits. Physical activity participation in early childhood has been found to be supportive of health behaviours being maintained into adulthood. Physical activity can be an occupation when meaningful. However, it is said to involve the complex interaction between psychological, social, environmental, and physical factors ( Hill et al, 2022 ). It is the continuation into adulthood of weight management through exercise that can be difficult - especially with genetic and environmental factors, that are difficult to control. This may be where current research has been exploring the use of medication as an adjunct to healthy lifestyle intervention. The 'weight loss jab': GLP-1 and GIP medications These medications are known by many forms, depending on the country and licences. Semaglutide ( Ozempic, Wegovy, Rybelsus ) and Tirzepatide ( Mounjaro and Zepbound ) are available throughout the US, many European countries, moving into new markets in China, India, Brazil and Mexico. Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists are a class of medication, initially developed for the treatment of type 2 diabetes. Self-administered via weekly subcutaneous injection, they function by increasing hormones known as 'incretins', which stimulate the secretion of insulin from the pancreas, regulating blood glucose levels. Some medications such as tirzepatide are referred to as a 'dual-agonist', containing an additional hormone known as gastric inhibitory polypeptide (GIP) . Functioning together, GLP-1 and GIP hormones can delay gastric emptying (how quickly food moves through our stomach and intestines), as well as improving sensitivity to insulin. Essentially, when you eat, you are satisfied quicker and you feel more full. This can result in weight loss, with clinical trials showing over 20% of starting weight lost . Many more medications, including oral preparations, are in clinical trials, due for release in the coming years. Their use has expanded from the originally-developed purpose, with studies highlighting their potential for a variety of uses beyond metabolic control, including: moderation or reduction of substance use and addictive disorders neuroprotective benefits  to those with type 2 diabetes individualised management of polycystic ovary syndrome playing a role in the management of persistent  pain Despite their prohibitively expensive cost if purchased via private healthcare, their use appears to already be disrupting the food industry .  A personal relationship with food Food and related occupations have always been a passion of mine ; more so than the average person (I assume). This extends not just to the preparation, cooking and eating, but the shopping; hunting new and different ingredients, scouring social media, watching food categories on TV, making preserves for myself, gifting at special occasions; combining my favourite TV shows with my favourite food; deciding what I would make for the next special occasion (or just randomly send to a friend going through bad times). It was my go-to form of expression - a role I gained great satisfaction and competence from, having also come from two large food-orientated families. Always content to take all responsibility at home for the cooking and shopping, I also happily adopt the 'office feeder' identity at work. I was one of those Occupational Therapists who baked. Food is always a reliable conversation starter with colleagues and service users. It is essential to my identity , influencing occupational roles in different environments and contexts, at different times of my life. However, the only way I had ever truly been able to maintain anything resembling a healthy weight was through a lot of exercise and restriction, which fed obsession and damaged my mental health. I lived on the edge of losing control of my way of eating if I should stray. Many in my family experience obesity. I have always been big. My life has been marked by significant periods of weight loss and gain, for nearly 30 years . Therefore, I finally arrived at a decision to try Tirzepatide, bolstered by a close friend taking the positive decision around their health. My BMI was 35 at this point - well into the obese category, with my health increasingly at risk. A new start Within 24 hours of administering the first dose, the effects were profound . I spent the days at home working on university assignments. My mind would typically be full of food cognitions, battling just to get to lunch or dinnertime without snacking. Like the flick of a switch, my experience of hunger and cognitions around food vanished. I was no longer under the thrall of hunger. Managing my health increasingly influenced my time. Prioritising my work role, I took my dose on a Thursday to minimise the impact of any side effects. Peak blood concentration of the medication is 48 hours, with many Saturdays spent fatigued, hypotensive, unable to run beyond a few miles, or even at all. I no longer feel those butterflies in my stomach, when thinking I could indulge in my favourite meal later . My interest in cooking at home waned. I lost interest in the food programmes which once occupied my time. Food shopping was functional, with little desire to find new ingredients. The amount of time spent watching telly reduced - and the pleasure I gained diminished where I could no longer combine occupations. A little like those whom I support - when they are no longer under the influence of substances - some occupations just don't feel the same ; they lose their meaning, or the motivation to participate just isn't there. Why initiate something if you don't anticipate the reward?  Who would have thought that using medication to significantly influence your biology would lead to equally significant changes to the meaning of (and level of participation in) once-essential occupations? There was an initial sense of loss amongst the magic. The motivation for these occupations had dried up. It was all functional now... Was this closer to what normal people feel? It is tricky to tease out what is loss of an occupational role, or the anhedonic side effects of the medication . It is known to influence reward pathways in the brain. The medication had eliminated reward-based eating and the reward that comes with achievement and expression . I realise just how much food was a reward, in multiple personal contexts. Being on Tirzepatide has changed the meaning behind another of my daily occupations . Physical occupations have been essential to my health and mental wellbeing as an adult, having shied away from them as a child. In recent years, they have become less about enjoyment and more about paying it back for what I had or was going to eat. My joints didn't hurt anymore, possibly down to the anti-inflammatory effects of the medication, not just the weight loss. When you see the clear effects physical activity has, week after week, it supercharges self-efficacy and motivation for participation.  In the space of 9 months, I have shed 30kg and my BMI is of a normal weight for the first time in my adult life. This cost somewhere around £700 (US $935). The quality of my sleep has improved, as have my physical and cognitive energy levels. This loss has brought significant changes to my appearance. Greater confidence has led to participation in more leisure-based occupations away from home. Even the sensations of something as simple as getting ready in the morning is easier. It wasn't that long ago that my stomach made it effortful to tie my shoe laces... I'm now in what is referred to as 'maintenance'. This has proven more challenging than simply reducing the medication to a point where I eat enough to maintain my weight. This required conscious effort around food again , planning for and eating more. I was accustomed to feeling silence inside; increasing my food intake brought apprehension and some physical discomfort. I have become much more aware of how my body feels on the inside (known as ' interoception '). It has taken many weeks of reducing the medication and increasing my calorie intake to find a new balance. I've built confidence in my response to the increasing thoughts about food and the sensations of hunger. The medication has allowed me to take a moderated approach, learning that the sense of control is still there - as I gradually reintroduce some of the roles that food once played in my life .  On reflection My dated attitudes were reflected by some of those around me. Unfiltered comments on my appearance and weight loss, pushing to confirm what they suspected. A bizarre entitlement to comment on my appearance. Living most of my adult life feeling uncomfortable for being bigger, this was the very first time in my life I'd felt self-conscious for having a smaller body. To my surprise, colleagues around me clung to dated beliefs around will power alone , despite being specialists in addiction. I wrestled with the decision to tell those around me, as someone who values honesty and authenticity. It took me many months to work through feelings of being a fraud , or cheating. I see this daily in those I support - a perceived stigma if you share what's really going on for you. Benefits to my physical and mental health became linked to a prescription... The power of (and access to) this life-changing intervention, in the hands of a distant pharmacist... For me, it was my first time being on this side of the power imbalance , something I go to great lengths of in practice to negate. There was obsessional checking around despatch and delivery, to ensure the cold-chain remained unbroken - and monitoring the fridge at home to ensure the medication remained within the effective temperature window. It was easier to notice the cognitions around food when I was under emotional duress, yet disconnected from the physical cravings and urges that came with it. In such a way, the behavioural chain was broken, allowing for new responses, structures and routines to be developed. You could draw some parallels between the approaches taken in substance use services; prescribing medications for a period of time to address the perpetuating factors and building supportive skills, structures and routines before reducing. From the outset, feeling like a 'fraud' or 'taking the shortcut', were causes of much internal disquiet. It is hard to counter long-held beliefs, that my failure to maintain a healthy weight was a moral failure from conscious choice. Much like the outdated moral models of addiction, I had internalised a lot of s hame around food growing up. This was an obvious example of how biology influences behaviour. Why should I have to live my life over-exercising and/or restricting calories, feeling constantly hungry and unfulfilled - when this comes naturally to others? Or have I just given up the fight for an easy option? Is this the stigma talking? Does it matter? Having gone on my first diet around the age of 14, I can say I have given my honest effort to all manner of approaches over the past 25 years... Different people produce varying amounts of GLP 1 hormone naturally . This is influenced by a myriad of factors, including that of obesogenic environments - with both conscious and unconscious influence on behaviour and psychology. It's a choice, thousands of small choices. But what is it that influences the choices? Where I'm at... A year on, I still find it remarkable - and in some ways uncomfortable - how profound an influence my biology has over my choices and participation in food-linked occupations. For me personally, the medication has proven far more than simply a 'weight loss jab' . How can making a huge positive change to your long-term health ever be a bad thing? Perhaps a closer look is needed at the attitudes towards obesity and our individual relationship with food. Obesity should be seen as a lifelong condition; the approaches and attitudes need to reflect this. My body, my mind and my occupations have gone through a transformation. I would encourage anyone to explore with curiosity the influence these medications may have on food and occupations - and how this understanding might be used for the better of that individual in your support.  About the author Jon Fisher Jon is an occupational therapist working in specialist NHS substance use services, in South Wales. He is also the coordinator of the UK Occupational Therapy and Substance Use Network. For comments/feedback, please feel free to contact him on jonathan.fisher2@wales.nhs.uk .

Shoulder impingement is one of the most common problems I see in the clinic. It doesn't just affect athletes who throw or lift weights; it shows up in people folding laundry, reaching into cabinets, or simply rolling over in bed. When the rotator cuff tendons and surrounding structures get pinched, pain becomes a barrier to everyday life. As occupational therapists, our role is to look beyond the anatomy. We connect the dots between movement patterns, posture, environment and function. With the right strategies, we can help clients not only reduce pain, but also restore independence and confidence in their daily routines. What Is Shoulder Impingement? Shoulder impingement happens when the space between the humeral head and the acromion narrows, compressing the rotator cuff tendons and bursa. Over time, this creates irritation and inflammation. [Diagram credit: Tom Morrison ] Poor posture, repetitive overhead reaching, muscular imbalances and sometimes structural differences in the acromion all play a role. Clients often report pain with overhead movements, weakness, or difficulty sleeping on the affected side. Diagnosis While occupational therapists (OTs) don't formally diagnose, we are often the first to catch functional red flags . Things I look for include: - Painful arc -   Pain between 60-120 degrees of shoulder abduction. - Functional difficulties -  Reaching overhead, dressing, grooming, or lifting. - Observation -  Rounded shoulders, forward head posture, scapular winging or poor control. - Client report -  Sharp pain with reach, night pain, or fatigue with overhead tasks. - Provocative tests - Commonly used to identify impingement patterns: Neer Test  (pain with passive forward flexion) Hawkins-Kennedy Test  (pain with internal rotation in 90° flexion) Empty Can Test  (pain or weakness in resisted abduction) Treatment - Exercises - 1) Scapular Retraction Strengthens rhomboids and middle trapezius, to stabilise the shoulder blade and protect the subacromial space. Sit or stand tall. Pull shoulder blades back and down, avoiding shrugging. Hold 5-10 seconds, 2-3 sets of 10-15 reps. Upgrade: Add bands or cables, then progress to one-sided work. 2) Rows Builds the posterior chain (rhomboids, traps, lats) for scapular stability. Use a band, dumbbells, or cable. Pull toward your torso while keeping your elbows close and your spine neutral. 3 sets of 10-12 reps. Upgrade: Remove chest support or perform single-arm rows for core activation. 3) Horizontal Abduction (T raises) Targets the posterior deltoid, infraspinatus, and teres minor. From a prone or bent-forward position, raise arms straight out into a 'T'. 2-3 sets of 10-12 reps. Upgrade: Add light dumbbells or bands. 4) Open Book (Half Kneel) Improves thoracic mobility and scapular control. In a half-kneel, 'open' arms apart like a book, rotating through the thoracic spine. 2-3 sets of 10 per side. Upgrade: Add a resistance band or do it from quadruped. 5) External Rotation with Band Strengthens infraspinatus and teres minor for joint stability. Keep elbow at side, rotate forearm outward against the band. 3 sets of 12-15 reps. Upgrade: Progress to side-lying dumbbell external rotation, then side plank version. 6) Prone Y-T-W-L Activates the lower traps, serratus anterior, and scapular stabilisers. Lie prone, move arms through Y, T, W, L positions. 2-3 sets of 8-10 per letter. Upgrade: Add light weights (3–5 lbs). 7) Serratus Anterior Punch Essential for scapular protraction and upward rotation. Supine, punch a dumbbell toward the ceiling by protracting the shoulder blade. 2-3 sets of 10-15 reps. Upgrade: Progress to plank or bear plank punches. 8) Scaption Works the supraspinatus in a safe plane of motion. Raise your arms in a 'V' (30° forward of abduction) with dumbbells, stopping just below the nipple line. 2-3 sets of 12-15 reps. Upgrade: Use an incline bench or slightly lean forward with weights. - Stretches - Subscapularis Release Manual release (with thumb, broomstick corner, or tool) to reduce anterior shoulder tightness. Pectoralis Minor Stretch Doorway or wall stretch, to open the chest and reduce scapular anterior tilt. Cross-Body Stretch Pull the arm gently across the chest to lengthen the posterior capsule and deltoid. Thoracic Spine Extensions Use a foam roller for repeated extensions to improve posture and overhead mechanics. - Therapeutic Approach - Professional guidance Early assessment and form correction by an OT, PT, or trainer is critical. Manual therapy Scapular mobilisations, soft tissue release, or IASTM (Instrument Assisted Soft Tissue Mobilisation) can restore mobility. Technique cues 'Elbows in your pockets' helps avoid shoulder hiking; slow, controlled motion prevents compensation. Programming Start by limiting pushing and overhead exercises for 2-4 weeks. Reintroduce gradually with a pull-to-push ratio of 3:1 or 4:1. Lifestyle changes Address the habits that created the imbalance , such as posture at work, lifting form, or repetitive overhead tasks. Pacing and patience Shoulder impingement improves with consistency, not force. Clients who commit to daily corrective work usually make steady progress without setbacks. Conclusion In my experience, shoulder impingement responds really well to a combination of strengthening, stretching and small daily habit changes . The clients who get better fastest are the ones who stay consistent with their exercises and adjust their environment so they are not constantly aggravating the shoulder. I've seen people go from not being able to wash their hair without pain, to lifting, swimming, or playing catch with their kids again. The earlier we catch it, the easier it is to treat. About the author: Brian Comly, M.S., OTR/L Brian is a husband, father of two, full-time occupational therapist, certified nutrition coach - and the founder of MindBodyDad and The Growth Kit . Since 2009, he has worked in Philadelphia with patients recovering from spinal cord injuries, traumatic brain injuries, strokes, orthopaedic injuries and progressive neurological disorders. Brian blends his clinical experience with his passion for performance, health and parenting to provide evidence-based strategies that help people live stronger, healthier and more intentional lives.

This is a helpful short course if you wish to learn more about trauma - and how early adversity impacts one's development and mental health needs. Questions will follow content, to help test your knowledge and provide evidence of learning.

The Occupational Therapy Hub is your global community platform, championing the profession and passionately empowering clinicians, students and those they support. We do this via connection, education and continuing professional development (CPD) resources. Free and Plus+ Memberships are available to everyone. Join today! Networking and Connections Education and CPD Resources Your global occupational therapy community Free Membership Membership Plus+ The platform and app run by practising Occupational Therapists. News and Latest Grown and shaped by 25,000+ Members , in 195 countries . Member Directory Established 2017 Passionately empowering clinicians, students and those they support The Mission To share knowledge and resources, across an international network. To provide an open community of practice - reducing geographical and financial barriers to education. To show the world the value of our health and social care profession . 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Latest on the Hub Free OT Circles → Career Development and Leadership: Leadership traits "For occupational therapists in a leadership or management position, what is THE most important aspect of leadership?" Freely share your views with Simone and many others, within this dedicated OT Circle... Great for networking, for reflection and for your wider continuing professional development (CPD)! Join and engage with the informative, supportive community right here, or via The OT Hub app . 26/10/2025 OT Circles Plus+ New OT CPD Course: Discover Sensory Processing and Integration We are very proud to bring you a new and engaging OT CPD Course , in collaboration with Sensory Integration Education (SIE): Enter the fascinating world of sensory processing and integration! You will learn about the eight sensory systems and how sensory processing differences can shape behaviour and everyday experiences. Deepen your understanding of sensory challenges and their impact on people's daily lives. Developed by highly experienced occupational therapists, this introductory course is a vailable free to all of our Plus+ Members . 23/10/2025 OT CPD Courses Plus+ New research: Challenges and supports for ageing well with spinal cord injury The number of people ageing with spinal cord injury (SCI) is increasing - and they are living longer. A lifelong multidisciplinary approach is needed to support this cohort, to maintain health, quality of life and participation in meaningful roles - and facilitate ageing well. 'Disparities between disability and aged-care funding systems must also be addressed.' Plus+ Members can read this 2025 scoping review within the Development and Ageing theme of the Research Portal. 21/10/2025 Research Portal Free A personal, occupational perspective of more than just a 'weight loss jab' "Why should I have to live my life over-exercising and restricting calories, constantly hungry and unfulfilled - when this comes naturally to others? Have I given up the fight for an easy option? Is this the stigma talking? Does it matter?" This article explores the influence of GLP1-type weight loss medications (e.g. Ozempic, Mounjaro) on occupation. It candidly explores their occupational impacts and the assumptions around obesity - drawing on experience working in the field of substance use. Read it here - or on-the-go, via The OT Hub app . 12/10/2025 Therapy Articles Plus+ Model-making classes 'helping veterans manage mental health issues' Model building enables 'health, well-being and independence for veterans' if they find it meaningful' (BJOT study). "Veterans were talking about their shared interest in the vehicles, talking about their service, training they had received... things they'd not spoken about in some time… with anyone before. The small models gave them a sense of completism once finished and a tangible trophy to show for their time in recovery." Upgraded to Plus+ ? Get updated on this and other OT news and stories, from around the world. 11/10/2025 OT Updates Free New to watch: Sensory activities for kids On television in the United States, Occupational Therapist Trisha Crone demonstrates simple, fun and edible activities. These target all eight sensory systems, to support healthy development! Head over to Therapy Videos now, to explore this topic - alongside a library of wider curated material. Also available to watch via The OT Hub app . 02/10/2025 Therapy Videos On-demand education: OT CPD Courses Discover Sensory Processing and Integration 2 Plans Available More info / Join Game On! Overcoming Sports Injuries 2 Plans Available More info / Join Moving and Handling: A Dignified Approach 2 Plans Available More info / Join ADHD and Occupational Therapy 2 Plans Available More info / Join Improve Client Outcomes with Positive Psychology 2 Plans Available More info / Join Sleep: An Occupational Therapy Domain 2 Plans Available More info / Join Networking and learning: OT Circles Circles Career Development & Leadership Public · 97 members Join Mental Health Public · 511 members Join OT and Adapted Parenting Public · 42 members Join Neurology Public · 550 members Join OT Books: Buy & Sell Public · 59 members Join The OT Journal Club Public · 309 members Join Show More Your eyes into OT: Therapy Articles Impacts of GLP-1 medications: A personal, occupational perspective of more than just a 'weight loss jab' Reflective Journals Oct 12 Shoulder Impingement: What Occupational Therapists Need to Know Clinical Reference Oct 5 Facing My Mortality: A Patient's Thoughts Reflective Journals Aug 24 We believe in the power of for health and wellbeing occupation

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Why choose occupational therapy (OT) as a profession? If you are considering or developing your career, read our frequently asked questions, information, videos and articles. A Career in Occupational Therapy Considering or developing occupational therapy as a career? Read on. Can't find what you're looking for? Visit OT Circles , or contact us . There are many reasons to choose to become an occupational therapy practitioner. A key few: Make a genuine difference to people's everyday lives - ability, meaning, roles, confidence Work with varied groups of people - children, teenagers, adults, older people; cultural and socio-economic contrasts Work in varied settings - hospitals, schools, the community, charities, prisons; statutory and private services Career flexibility - to retrain and specialise within other areas of practice This is our kind of anatomy lesson! A great advocacy image, highlighting key skills and qualities of an occupational therapy practitioner. Graphic created by student OT Maddy Bell ( @happylittleot on Instagram) in 2022. OT Career FAQ Why choose occupational therapy as a career? There are a breadth of reasons to choose to become an occupational therapist. Below are a key few: Making a genuine difference to people's everyday lives - meaning, roles, confidence, ability Working with varied groups of people - children, teenagers, adults, the elderly; cultural and socio-economic contrasts Working in varied settings - hospitals, schools, the community, charities, prisons; statutory and private services Having career flexibility , to retrain and specialise within other areas of practice This video provides insights into why others chose this career path: [Source: Royal College of Occupational Therapists] The Occupational Therapy Africa Regional Group (OTARG) share this short video clip. It highlights that, to be truly fulfilled and successful in the world of occupational therapy, you must have a passion for the work you are doing : [Credit: OTARG ] OTARG is a non-profit professional organisation for occupational therapists, occupational therapy assistants, occupational therapy technicians and students in Africa, aiming to promote OT in Africa. In universities across Canada, occupational therapy students took part in the 'gOT Spirit Challenge', an annual competition to promote the profession. Watch this lighthearted, lively entry from Queen's University: [Source: Queen's University 2016; YouTube - Dustin Thatcher ] What makes a successful occupational therapy practitioner? Key skills, abilities and knowledge A warm bedside manner Excellent rapport-building Excellent communication skills Knowledge of psychology Sensitivity and understanding Ability to use your initiative Flexible and open to change Knowledge of teaching and the ability to design courses Patience and the ability to remain calm in stressful situations Ability to design and develop individual treatment programmes Ability to form good working relationships with a wide variety of people Ability to motivate patients/clients who may be disappointed or frustrated Counselling skills, including active listening and a non-judgemental approach Competent use of computer and main software packages [Source: National Careers Service ] Source: RCOT [ YouTube ] Useful articles 10 Reasons Why You Will Succeed as an Occupational Therapist: OT Career Path Career Advice Articles: American Occupational Therapy Association Source: icould Career Stories [ YouTube ] 13 Essential Characteristics of Occupational Therapists and Occupational Therapy Assistants Exceptional communication skills While working with the patients, occupational therapists need to listen and explain them the situations and tasks. If they are working with a child patient, they must be capable of converting the complex terms into simpler ones so that the child can understand it. Besides this, they also need to communicate with other team members and doctors. So, it is necessary for them to be clear, efficient, and confident while listening and speaking at the time of such discussions. Outstanding personal skills These professionals work with the patients of all age groups undergoing any physical, mental or emotional disability. Also, the basic nature of the patients varies a lot. Some may be very calm while others may be rude, frustrated or impatient. Thus, they must know the way to deal with all of them and help them get the desired results faster. Problem solving abilities Problem solving skills play a vital role in the jobs related to occupational therapy. Different clients may have different problems. For the success of the cases, you must make a strategy on how to solve all these distinctive issues effectively, without any major failure. Physical strength Physical strength is quite a major requisite for the occupational therapists and related job titles. They have to serve the clients throughout the day, travel from one area to another and stand by the side of the patients irrespective of the time and duration. Thus, if you want to be an OT, you must have a great physical strength to manage such a busy and hectic schedule. Possess a helpful nature An occupational therapist should be very helpful as this is all that they have to show in their profile. It is one of the most important qualities they must possess otherwise they can’t give their best to the patients. All day long, they should be ready to assist the clients for every type of help they want. From helping them in moving around to guiding them through some money related problems, an occupational therapist has to be the guardian angel to their client. Organisation skills For being a proficient occupational therapist, one must be a good organiser. Along with their own schedule, they also need to manage the client’s timetable. Also, they have to properly maintain all the documented records, appointments, meetings with other team members and professionals, etc. Only an organised occupational therapist can provide a well-planned treatment and high-quality care to the patients, so its a must that s/he must have management skills. Boast patience It is easier to write “Keep Patience” to a patient’s ward, but it is not so easy to implement the same. Patience is believed to be the most important attribute that one must have to be in this profession. Sometimes, occupational therapists might have to face rude, impatient, frustrated, depressed or stubborn patients. So, they must keep their patience to tread through these everyday situations. Some clients may achieve success in their condition in a few months or weeks while some may take years. So, you just need to keep hold of the case to be an efficient occupational therapist. Compassion and empathy One should opt occupational therapy as a career only if s/he is empathetic and compassionate. Most of the clients of occupational therapy are not only physically disabled but also, mentally and emotionally sensitive. In that phase of life, they need a genuinely warm-hearted and sympathetic occupational therapist who understands them and treats them accordingly. Acquire creativity No one can learn to be creative as it is an inherent characteristic of human beings. Being an occupational therapist, many times you have to modify the tasks and schedule of the patients. For example, you can take a desolate kid to have fun at an amusement park, instead of taking him to a general rehabilitation centre. Your creative methods can help the clients come out of the dilemma and it may result into their active participation in the healthcare programs organised by you. Good writing skills Akin to communication skills, writing qualities are also quite important to became a highly efficient occupational therapist. It is because you need to keep the detailed files and records of all the clients in order to assist them, their family, and your team. You should state the exact condition of the patients on the papers so that it is easier for you and the medical staff to understand what you are doing and exactly how you are doing it. Keeping the details documented will not only help you and the healthcare staff but also the caretakers when you are not around. 'Cheerleading' skills Being an occupational therapist, your words must have the power to motivate your patients and ignite the passion in them to make their life normal once again. Motivation is very important for such depressed, frustrated and troubled people. An enthusiastic OT with great cheerleading skills can make the patients do the things that seem impossible. A good observer Besides being a good listener, a successful occupational therapist must also be a good observer and analytical. S/he should have the ability to analyse the situation and needs of the patients along with handling their complaints. An OT must observe and evaluate the things and procedures that are suitable for their clients and must act accordingly. For example, if a patient moves abnormally, a good OT would recognise the reason for it and would plan the course of the patient accordingly. Flexibility You never know what kind of client you are going to deal with, as disorders can happen to anyone and they may need your assistance. Thus, being an occupational therapist, you should be flexible enough to work with a wide variety of people. You must have the ability to establish a good inter-relationship bond with them, irrespective of their religion, race or nationality. [Source: Top Occupational Therapy Schools ] Working environment, hours and salary? You will usually work standard office hours, Monday to Friday. Some services, such as within community physical health and inpatient mental health, work on a shift basis. This can include working early, late or weekend shifts. You could work with clients at a variety of settings , including: hospitals health centres residential or nursing homes GP surgeries schools prisons in the community at a client's home or workplace You will need mental and physical stamina, as this is a very practical job. [Source: National Careers Service ] Salary? The average salary of an Occupational Therapist varies significantly internationally . Salary rates can also vary between private and and public health services. If you are seeking to become an Occupational Therapist to make a fortune, you are looking at the wrong career. Occupational Therapists generally earn equivalent salaries to other health professionals, such as Nurses and Social Workers. An Occupational Therapist's salary will generally increase with years of service and level of experience. Source: Health Careers (October 2019) What are the entry requirements to the profession? Depending on your country and proposed university of study, entry level to occupational therapy can be at apprenticeship, diploma, bachelor, masters or doctoral level . To be accepted into an occupational therapy educational program you will need to meet its specific admission requirements and prerequisites. Once graduated you will likely need to be registered with a health registration board and will be subject to background checks and annual registration requirements, such as continuing professional development (CPD). As an example, in the UK, you will need: an apprenticeship, degree or postgraduate qualification in occupational therapy, approved by the Health and Care Professions Council (HCPC) professional registration with the HCPC to pass enhanced background checks, as you may be working with children and vulnerable adults To do a postgraduate course in occupational therapy, you will usually need a degree in a related subject and some relevant paid or voluntary work experience. [Source: National Careers Service ] How do I go about finding and applying to a university? You can search for approved entry level occupational therapy educational programs worldwide, on the World Federation of Occupational Therapists (WFOT)'s website . Some countries may allow programs that are not WFOT approved, but this may this may restrict you working in certain countries or access to further study (Source: WFOT ). The tertiary admissions process is likely to be slightly different between countries, so we recommend that you make contact with the university directly to check their admissions process. It is often recommended that you visit at least one occupational therapy service for job shadowing , prior to university interviews. Universities need to know you have some insight into what the career involves! Can I work as an Occupational Therapist in another country? Yes! If you are a qualified Occupational Therapist you can work in different countries. Every country has slightly different requirements , regarding a working visa, professional indemnity insurance, occupational therapy registration, association membership, etc. Some countries, such as the United States of America, also require you to pass a certification exam. If you are wanting more information about working overseas, read this useful publication: Occupational Therapy International Practice Guide 2020 (WFOT) . 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