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This article will explore both my professional and personal perspectives, beginning with the latter... Having a stroke, from my perspective... It was a normal day on 8th January 2026 - up around 4am, breakfast, then to the YMCA to practice my martial arts. Later that morning, walking down the hall in our house, I noticed my gait had changed and I was beginning to step more heavily onto my left heel. In the 39 years I have worked as an Occupational Therapist, I had occasionally wondered what the onset of a stroke might feel like. As I reached the bedroom, to my horror, I began to suspect I was learning this in real time, as my left hand was also demonstrating a loss of coordination. My wife and I drove to the emergency department (ED), at the US hospital where I had worked for the past twelve years. However, the medical worker there didn't seem to be quite comfortable with performing a neurological exam, diagnosing me with 'dizziness'. We left four hours later, without being seen by a physician. The next day, I found I was exhausted soon after starting my sword training, which convinced me I needed to visit another ED. The resident on duty quickly sent me for CAT scans and then ran me through a well-organised set of neurological assessments . Nothing appeared in the scans, but he strongly encouraged me to travel to a nearby hospital that offered MRI testing, as cerebrovascular accidents (CVAs) sometimes take some time to become visible.  Author Bill, engaging in sword training My sister (a retired nurse) was even more directive, with her "GET in the car!" - and we soon headed for a Veterans Administration hospital, thirty miles South. I won't bore you with all the details, but the professionals who make up this service were exemplary in their compassion, expertise - and ability to clearly explain findings to me and my support group (of spouse, daughter, sister and former co-workers). They were very much the 'third leg' of keeping my spirits up and giving me gentle nudges in those first few overwhelming hours. All these people made it possible for me to return home - and begin this article six days later, with the understanding that I had incurred two small CVAs on that first day. While in the VA Medical Center,   one of the first deficits I noted was not being able to use a fork in my left hand while eating. It seemed like meals took twice as long as they should, as I chased food around, and often off my plate... That night, part of what I did while in bed was to analyse the components of my left arm dysmetria . Dysmetria is a difficulty controlling the distance, speed and range of motion required for coordinated movements. In your occupational therapy classes, you will, at some point, have covered activity analysis . I well remember how much I disliked this class, as (for us) it involved analysing the motor, sensory, cognitive and psychological components of macramé ! Yet, were I to be completely honest, it has been one of the most useful life skills I have ever learnt - used in my occupational therapy treatments, leadership duties in the military and woodworking, to name but a few. Bill undertook an activity analysis of macramé I spent the initial days analysing my own activities of daily living (ADLs) and looking for how to use objects in my hospital room to address my dysmetria. Initially, I would reach to touch various body parts. As my ability to touch these improved, I moved to touching parts of my bed, followed by touching objects with a specific finger on the left hand. I was still able to completely extend the arm from supine or sitting positions, but it displayed a definite case of the 'wobbles'. As the ability to accurately point at a distant object improved, I began to concentrate on diminishing the wobbles. The day I could sit on the edge of the bed and not push food off the plate was definitely a thrill... One of the next challenges was being able to tie a hospital gown behind my neck. It was not a boring stay, to be sure! Thoughts for the acute care therapist All too often, a client will say "Well, I'm off to therapy now", meaning physiotherapy (physical therapy), following time with his or her Occupational Therapist. You may be left with the reaction of "What am I, chopped liver?" It is disappointing and will probably always exist as an artifact of our use of daily activities as our therapeutic tool . Not at all as impressive as the equipment found in the gym... Your client will likely want to focus on regaining mobility; that is of vital importance of course. But I recall the response of an Occupational Therapist, who replied something like: "I understand that mobility is vital to your future independence, but you will need to be able to use your hands when you arrive at your destination!" The Occupational Therapist as a teacher In a previous article, Are You Treating the 'Whole' Patient? (2024, on the Hub), I expressed my belief that one of the most important skills we have as Occupational Therapists is our ability to 'get to know' our patients . I cannot emphasise this more strongly or deeply. Take the time to learn your client's history; vocations, avocations (hobbies), interests, etc. In terms that your client/their family can understand, educate them on the physical and neurological components of what has happened to them . Stress to them how occupational therapy will positively impact their ability to return to independence. I cannot begin to recall the number of times a stroke survivor would tell me "I want to work on increasing the strength in my hand/arm." Physicians would remark on how strong my own arm was, even after the CVA. The issue was not with strength, but in my inability to control the limb. Spending acute care time educating your patients may not seem to be a top priority. But understand that your goal is to help build awareness of how to use everyday objects and activities to increase their ability to function post-discharge. You won't be there; if your client returns home and spends their day sitting in front of YouTube, the Occupational Therapist has failed them... The client returns home I believe the weakest leg of therapy occurs post-discharge and involves compliance - or rather a lack thereof, once they return home.  To create an effective home program you must explore how the client's daily routine may be used to help them in recovery . I don't think therapy works well when you simply provide a fixed home program; this likely goes out of date soon after they return to their home setting. In the 'old days', Physiotherapists and Occupational Therapists always performed a visitation as discharge approached. This doesn't consistently happen anymore - making helping the client to recognise home treatment opportunities more difficult. My own experience? Upon my own discharge back home, I used seemingly unrelated activities to work on retraining the arm and hand . Above is a wooden dachshund puzzle my wife had jigsawed years back. It sits beside my chair and gets taken apart and put back together multiple times each day: Can I hold the parts with the left hand? Can I assemble with fewer drops than yesterday? Do I see any perpetual deficits in recognising how they fit together? Imagine the thrill that I experienced, the first time I was able to hold a fork while cutting food with my right hand... Remember that you, the Occupational Therapist, are the expert in activity analysis . So use your skills to help your patient understand why putting a puzzle together can help his or her recovery. Encourage them to find other objects or challenges than those you suggest. Maybe one assignment can be to find or create a new activity. Your job is to teach them the skills to continue their own rehabilitation independently, as therapy time will always be too short. I don't practice for 'X' minutes per day; I stop and try multiple tasks throughout the day. Standing in the bathroom this morning, I looked around and discovered yet another set of possibilities. Could I accurately touch the objects on this shelf with the left hand? Could I do it with eyes closed? When I worked in the outpatient clinic, I commonly employed a strategy of having a client reach out and touch an object three times with eyes open, then do the same with eyes closed. Now at home, it was initially quite a challenge for me - but the arm soon began to accurately find the target. To make things more interesting, I made smaller objects in the nail grooming kit my targets (lower left of photo). Finally, I worked on picking up any three objects in front of me, with my eyes closed. One of the concepts this modification to the original task introduces is grading . As you read through this article you will have encountered other examples of grading. You are looking at offering your client a 'just-right challenge': Too easy and it's not really doing any good. Too difficult and the patient will grow frustrated and stop trying.  I constantly graded those initial tasks until I found what I could do with my hand, while still experiencing a challenge. In the clinic, once a patient could accurately reach out and touch my hand, I would tell them "Well no good deed goes unpunished, so we will make this a bit more challenging. Close your eyes; your target is now one inch up and one inch to the right of where it has been." Patients commonly expressed amazement that that they could soon find it. I would then encourage them to ask their spouse, or any visitor that came to the house, to join their 'therapy team'. While in bed at the hospital one night, I was sleeping poorly and recalled being a drummer in a band much earlier in life; see Of Swords, Paradiddles and Solitaire (2020, on the Hub). So I began to perform bilateral drumming sequences - some of which were no long possible. I found that I could still move my left wrist in time with the right, although finger motions were a mess... Let's look at that in more depth for a moment. (It helps if your roommate is as hard of hearing as I am, so you don't awaken them!) When my hands were close to midline , wrist motions - and the digits controlled by the median nerve - were relatively intact. But I could not perform tasks that required quick motions of the 4th and 5th fingers of my left (L) hand. Drummers learn various sequences, called rudiments, one of which involves alternatively performing a beat that goes RLRR LRLL with the drum sticks. The rehabilitation unit did not have drum sticks, but moving my wrists in this rhythm was possible. Initially I could not perform the motions quickly, so I forced myself to slow down (grading) until I reached a speed where I could. Once this was possible, I gradually increased speed. When the wrist was more accurate I moved distally to the fingers - again, gradually increasing speed. I doubt that you will often have a drummer as a client, but we are not trying to teach them drumming, are we? We are adopting the use of occupation as means ; our goal is to return function of a limb, or the ability to perform a cognitive task. During your acute treatments, teach your client how to analyse a task, how to break it down into sub-tasks and then to reassemble those sub-tasks into a whole.  But you must do your homework. Before you can teach this, you must perform activity analysis of the desired task on your own. Help them understand how their home treatment program will help them rebuild those skills. This is tremendously important. If your client doesn't see the relationship between the home program you give them and recovering their independence, they will discard your plan. I worked for a home heath agency for a number of years and enjoyed it, but I was allowed a limited number of visits. If you educate your patient in a limited version of activity analysis, so that they can use objects and activities at home to promote self-treatment, they will be greatly increasing their overall treatment times. However, treatment can easily go wrong if not organised well - as it did for my friend Joan. Joan was discharged home following surgery for appendiceal cancer. The surgeon ordered physiotherapy and occupational therapy, but the therapists did not contact her and came to see her too soon.  Pain control had not yet been well established, so both therapists came at a time when her pain levels prevented her participation in therapy. Essentially, Joan never received therapy... Returning back to my home treatment plan: Yesterday I added standing on the balls of my feet as I shaved, to improve balance. Then I wondered if I could shave with my left hand while doing this. Thankfully, I still have sufficiently functioning neurons to realise that, since I never did that pre-morbidly, it was not likely to end well! Give clients permission to laugh, cry and/or swear... As a client approaches discharge, consider bringing them and their significant other together in a private space. Ask them to talk about how the stroke has affected their lives and/or perception of themself . Long ago, I used to bring patients and spouses into my classroom. Although older, on e couple were newly weds, of just six months. I said, "You may not have even considered that one of you could experience an event like this just six months after you started your lives together." They were silent for a few minutes; my anxiety began to rise. Then they both began to cry. The patient's wife looked at me and said, "Nobody has ever invited us to talk about this." For a time, they drew their attention away from us, speaking with each other about their love and their desire to work together.  Recovering the use of an arm or the ability to walk is vital, but just as important is the ability to talk about these experiences. Believe me, I am so thankful that during my experience of stroke, my own 'team' was there to speak to. Closing thoughts Author Bill, engaging in his much-treasured occupation of drumming Take the time to learn what is important to a client, in terms of pre-morbid activities of daily living. Take the time to understand the mechanisms which resulted in those deficits in those areas. Teach and then challenge the client to perform their own activity analysis. Think about having their spouse, significant other or family member photograph rooms and objects at home, prior to discharge. Use those images to help the client select activities that will be part of that initial home program. Encourage breaks… Maybe a walk around the unit or their house, when frustration overwhelms. I did this frequently while hospitalised and was amazed when a nurse stopped me and said, "You are the only patient who walks, others just lie in bed most of the day.” Teach the client how to expand that home program out, beyond the initial one you give them. Therapy becomes life-long, but it can be tremendously rewarding as independence increases. Even failures along the way have the potential to bring on some serious laughter. References and further learning Cleveland Clinic (2023) Dysmetria (online). Available from: https://my.clevelandclinic.org/health/symptoms/25232-dysmetria . Accessed 21 April 2026. Croninger, W. (2020) Of Swords, Paradiddles and Solitaire. In Therapy Articles, on The Occupational Therapy Hub (online). Available from: https://www.theothub.com/article/of-swords-paradiddles-and-solitaire . Accessed 21 April 2026. Croninger, W. (2024) Are You Treating the 'Whole' Patient? In Therapy Articles, on The Occupational Therapy Hub (online). Available from: https://www.theothub.com/article/treating-the-whole-patient . Accessed 21 April 2026. The Occupational Therapy Hub (2022) Occupational Therapy - Activity Analysis (PDF document). Available from: https://www.theothub.com/product-page/occupational-therapy-activity-analysis . Accessed 21 April 2026.

The 'therapeutic use of self' is a term that is often used in occupational therapy and other therapies. However, many clinicians do not know what the therapeutic use of self is , or why it is so important. Read this concise article to find out more... Therapeutic use of self 'The thoughtful and deliberate use of one's personality, opinions and judgments as a component of the therapeutic process' ( Mosby’s Medical Dictionary , 2009) The term originates from philosophy and the theories of self . This demonstrates that researchers and practitioners acknowledge that, if you are asking a research question, completing research, running a business, or delivering care or a service, you will be influencing the outcome . What does this really mean though - and can therapy be delivered without considering the therapeutic use of self? - Why is therapeutic use of self important? - Asayand Lambert (1999) investigated what influenced change in psychotherapy clients, separating the possible influences for change into: therapeutic relationship, extra-therapeutic change (e.g. support, personality or 'ego strength'), placebo and technique. The results from their meta-analysis are as follows: This indicates that therapy cannot be delivered without considering how the therapist is influencing the outcome , through their therapeutic use of self. If the therapeutic use of self is so important, more so than technique, shouldn’t there be a general consensus about how therapists are going to influence change? - Techniques to consider if using therapeutic use of self - Carl Beuhner is quoted as saying "They may forget what you said - but they will never forget how you made them feel." Consequently, therapists and care providers need to consider how they are making their clients feel. Ask yourself: Are you rushing around and not giving clients the time they need when you are delivering care or treatment? We all do this at times because everyone is stretched, but if that feeling influences outcomes by 30%, then haven't you just ruined the opportunity for change, by letting the client know you don’t have time for them? "They may forget what you said - but they will never forget how you made them feel" - Carl Beuhner The first technique then is attunement . Attunement is the ability to be completely present with the client, developing a feeling of connectedness with them. The majority of the work around this is from psychotherapies however, as an occupational therapist , don’t you pride yourself as having origins in arts and crafts, psychology, architecture, nursing, social work, philosophy, teaching and psychiatry? Therefore, you should be considering all of these aspects within your work, both in everything you do and in what you recommend. Within attunement you should be considering what your body language is saying, how your tone of voice is delivering the message, if your facial expressions and body language (including eye contact) match what you are saying and if you need to mirror the client in order for them to recognise that they have your full attention. The second technique is providing the client with unconditional positive regard . Unconditional positive regard is the ability to accept that the client is trying their best and accepting where they are at that time. This does not mean you have to agree with their choices or even like them as a person. However, it does mean that you are providing client-centred care and treatment - whilst allowing the client to make mistakes, through their ability to make their own self-determined choices. Self-disclosure is the third technique. There are two types of self-disclosure; intra-session disclosure and extra-session disclosure . Intra-session refers to reflecting how something they have done or has happened during the session has made you feel. Extra-session disclosure is disclosing information about yourself, whether that be previous qualifications, family life or interests and events. Self-disclosure can be a positive experience for the client, building rapport with them and developing a therapeutic alliance. However, Leanne Hall states there are five golden rules to self-disclosure: Waiting Being brief Being clear that this is your opinion Considering the client’s values Considering the impact self-disclosure is going to have Waiting refers to the therapist considering why they are self-disclosing, whilst being brief is to ensure the client does not feel the therapist is hijacking their session. Therapists also need to ensure that when they are self-disclosing the client knows this is their opinion and is not part of their clinical expertise or experience, as the statement could be contrary to the client’s own beliefs and values. Additionally, if the statement is contrary to the client’s own beliefs and values, consider if this self-disclosure is going to jeopardise the therapeutic relationship and alienate the client? This then leads to the final factor of considering the impact that self-disclosure can have, as clients may be left feeling burdened by the self-disclosure rather than aligned with the therapist. Whilst these 'golden rules' ensure self-disclosure is used appropriately, it is important to remember that it can assist the client with humanising the therapist. The final technique is the ability to balance the power differential . Clients often believe that the therapist or professional has greater power than them. However, this belief can lead to self-helplessness , whereas a therapist should be promoting self-empowerment and self-help . Therefore, it is essential to understand the client's background and culture , whilst presenting yourself in an honest and congruent way. That means the power imbalance should be addressed during therapy or care. The acknowledgement that you may know more about a particular solution to their problem based on your training and experience should be made, whist acknowledging that they are the expert about themselves, their culture, their expectations and their own lives. The client and the therapist should then be working together to problem solve how the 'solution' that the therapist suggests can be integrated into the client's life, based on the information the client has about themselves. - Summary - In summary, based on my research and training, the therapeutic use of self encompasses four techniques: Attunement Unconditional positive regard Self-disclosure Balancing the power differential If therapists and care providers incorporate these techniques in a positive and helpful way for the client, without hijacking the client's treatment or care, then better outcomes should be gained.

Results are in, the votes have been counted and I am putting on a sparkly dress, to announce the Top 10 Occupational Therapy books that all Occupational Therapists (OTs) MUST read. I wanted to put this list together because I knew I hadn’t read widely enough in my own area. This has given me a few places to look, so thank you to everyone who took part in the 2020 survey. I was really interested to see what was nominated and absolutely delighted to see what wasn’t. We are going to do the top 9 in no order whatsoever and then the overall winner is at the bottom . Enjoy! [N.B. Clicking images takes you to Amazon; other shops and online stores are available] Diverse roles for Occupational Therapists Edited by Jane Clewes and Robert Kirkwood First up... I’m quite pleased this got through, not least because the chapter in it on ‘Personality Disorder’ is by me. This book has a range of occupational therapists in different mental health positions describing their roles; it’s a great resource for particular areas and for bringing innovation into places we haven’t been before. Colleagues of mine wrote about psychiatric intensive care units (PICUs), Prisons and Eating Disorders - I’m pretty sure at one point we were the most academic OT corridor in the UK. It’s probably due a sequel now, with even more novel roles emerging . Groupwork In Occupational Therapy By Linda Finlay 23 years old and still pulling in the votes, this is the oldest book in the list. Written primarily for occupational therapists, 'this text explores the range of group work activities used within occupational therapy practice. Discussing theoretical aspects and practical approaches , this book is an invaluable handbook to those working and studying occupational therapy.' Occupational Therapies Without Borders: Integrating Justice With Practice By Dikaios Sakellariou and Nick Pollard This is a book I hadn’t even heard of before. Apparently this builds on the previous two volumes, offering a window onto occupational therapy practice, theory and ideas, in different cultures and geographies . It emphasises the importance of critically deconstructing and engaging with the broader context of occupation, particularly around how occupational injustices are shaped through political, economic and historical factors. Centring on the wider social and political aspects of occupation and occupation-based practices, this textbook aims to inspire occupational therapy students and practitioners to include transformational elements into their practice. It also illustrates how occupational therapists from all over the world can affect positive changes , by engaging with political and historical contexts. It could probably do with a chapter on COVID-19, but then I’m sure most books could at the moment… An Occupational Perspective of Health By Ann Wilcock and Clare Hocking 4th on the list, another book I hadn’t come across before. Amazon says 'For nearly 20 years, An Occupational Perspective of Health has been a valuable text for health practitioners, with an interest in the impact of what people do throughout their lives. Now available in an updated and much-anticipated Third Edition, this unique text continues the intention of the original publication: it encourages wide-ranging recognition of occupation as a major contributor to all people’s experience of health or illness. It also promotes understanding of how, throughout the world, "population health" , as well as individual well-being, is dependent on occupation.' This sounds like a useful message for us to articulate. Creating Positive Futures: Solution Focused Recovery from Mental Distress By Lucie Duncan, Rayya Ghul and Sarah Mousley Coming in 5th (they are not in order), this is currently going for a much more modest price - and you can let me know whether the Wilcock book is 4 times better. With 5 stars on Amazon 'This is a valuable resource for anybody working in the fields of mental health and disability, regardless of professional discipline , not only occupational therapists but psychiatrists, psychologists, social workers and nurses.' It shows a respectful, structured and realistically optimistic way of talking with troubled people, so that their own strengths and resources are highlighted. This book introduces their Solution Focused Measure of Occupational Function . It is clearly written, almost jargon-free and contains many useful case-examples and suggestions for generative questions. The authors have avoided it becoming too much of a therapy-by-numbers ‘cook-book’. Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being & Justice Through Occupation By Elizabeth A. Townsend and Helene J. Polatajko For its price, I’d expect this book to assess my clients for me. It’s not easy to find a synopsis for this book (if someone sends me one I’ll add it to the article), but what I have learned is: 'As a practitioner, Section I provides you with the opportunity to reflect on the implications that embracing occupation as our core domain of concern has for your practice. The Section promotes an appreciation of the full breadth of human occupation and facilitates the adoption of an occupational perspective in viewing the world. With the Section, you are encouraged to adopt an occupational perspective to guide your practice - be it as a clinician, educator, researcher, administrator, manager, or consultant. You will immerse yourself in language frameworks and models , that will help to organise your thoughts and articulate your understanding of occupation and to explore the learnings that occupational science can shed on your understanding and appreciation of occupation.' Foundations for Practice in Occupational Therapy By Edward Duncan 7th on the list... Eddie was one of my first supervisors, back in the days when I was young and knew nothing. Now that I’m old and know less it’s good to see this scoring so well. 'The internationally acclaimed Foundations for Practice in Occupational Therapy continues to provide a practical reference tool, which is both an indispensable guide to undergraduates and a practical reference tool for clinicians , in the application of models and theories to practice. Underlining the importance and clinical relevance of theory to practice, the text provides an excellent introduction to the theoretical basis of occupational therapy.' Client-Centred Practice in Occupational Therapy: A Guide to Implementation Edited by Thelma Sumsion At 8th in the list, the editor is one of my undergraduate lecturers, who once chided me for napping during a talk. 'Directed primarily towards health care professionals outside of the United States, Client-Centered Practice in Occupational Therapy continues to be the only book that provides the reader with both the theoretical underpinnings of client-centred practice as well as guidance on the practical application of this approach.' Who knows what authoritarian practices will take place in the USA without a book like this to guide them? Kielhofner's Model of Human Occupation By Renee R. Taylor Nearly there… This book was one of the two that dominated the field. 'Updated throughout with new research, the 5th Edition of MOHO offers a complete presentation of the most widely used model in occupational therapy today. In the new edition, author Renee Taylor preserves Dr. Kielhofner's original voice and contributions, while updating MOHO concepts and their uses in today's practice environment . Throughout the book, readers will see a client-centred approach used to explore what motivates each individual, how they select occupations and establish everyday routines - and how environment influences occupational behaviour. The 5th Edition continues to deliver the latest in MOHO theory, research and application to practice and adds much that is new, including new case studies - that show how MOHO can address the real-life issues depicted - and expanded resources, that enhance teaching and learning.' This probably influences my OT clinical reasoning more than any other profession-specific book I’ve read. And the moment you have all been waiting for… ...will have to wait a little longer! I asked people what book wasn’t shortlisted but should have been ; I was told the missing gem was: Recovery Through Activity By Sue Parkinson It is 'underpinned by the conceptual framework of the Model of Human Occupation and will provide an invaluable tool to practitioners and also create a platform for research. Recovery Through Activity: enables service users to recognise the long-term benefits of occupational participation, by exploring the value of a range of activities provides occupational therapists with a valuable tool to support the use of their core skills provides comprehensive evidence regarding the value of activity, along with a wealth of resources to support implementation of an occupation-focused intervention helps to refocus the practice of occupational therapy in mental health on occupation supports occupational therapy practitioners to engage in their core skills and enhance the quality of service user care in mental health' Finally, we have the winner: Creek's Occupational Therapy and Mental Health Edited by Wendy Bryant With more votes than any other and five times the votes of the lowest scoring finalist, this is another ‘go-to' book for me. This 'seminal textbook for occupational therapy students and practitioners has retained the comprehensive detail of previous editions with significant updates, including the recovery approach informed by a social perspective . Emerging settings for practice are explored and many more service users have been involved as authors. Occupational Therapy and Mental Health is essential reading for students and practitioners across all areas of health and/or social care , in statutory, private or third (voluntary) sectors, and in institutional and community-based settings.' If you want to read a non-occupational therapy mental health book, The Body Keeps The Score annihilated the competition... And that is the result of the survey. You also told me you are interested in an occupational therapy TED-style event, so I might see if I can make that happen. Go forth and read these books! Very little is written about some of them, so add to the reviews and tell people what you thought. Before you smash out your money on hard copies of these, it might be worth considering joining your country's professional body; some of these are available as free e-books to members. If anyone wants to send me a copy of any of these, I’m happy to review it... I hope this was useful. Happy reading. Keir Harding Occupational Therapist Keir provides supervision and thinking space around mental health provision, particularly those viewed as being high risk. He is contactable via Beam Consultancy and is active on X/Twitter ( @keirwales ) and Facebook ( Keir Harding OT ).

Author : Jamie Grant, Occupational Therapist; Director, The Occupational Therapy Hub Setting : Stroke early supportive discharge (ESD) community team, based in the UK Occupational therapy assessment and intervention I visited 'Pete' (name changed for confidentiality) regularly for 5 weeks, following and shaping his rehabilitative journey after a stroke. He engaged with an evidence-based constraint-induced movement therapy programme (CIMT). Multidisciplinary input included occupational therapy, physiotherapy, speech and language therapy and nursing. Background Diagnosis: Right Temporal ICH (intra-cerebral haemorrhage); left side affected Dominant hand : Right hand Relevant past medical history : Right ICH 3 years ago Physical environment : 2-storey house; 1 flight of stairs, 2 rails; upstairs toilet/mowbray; upstairs bathroom (shower over bath) Social environment : Lives with wife, children and grandchildren live elsewhere Meaningful occupations : Reading; shared cooking, gardening and walking with his wife Ward outcome measures : Montreal Cognitive Assessment (MoCA) = 23/30 Motor Assessment Scale (MAS) = 6/18 9-hole peg test = 29 secs (right hand); left hand unable to complete

Keywords : therapeutic expression, occupational therapy, artificial intelligence, creativity, psychiatry, prison - Abstract - Manual mediations, such as clay, painting and collage, have long facilitated projection and symbolisation in psychiatry. However, societal shifts toward image and digital media require adaptations in therapeutic practice . In prison settings, the use of music (e.g. via YouTube) has proven effective; selecting songs, identifying with lyrics and sharing them in groups fosters emotional expression, self-narration and personal validation. Emergence of artificial intelligence (AI) has introduced new tools. ChatGPT, sometimes used by patients, can provide occasional scaffolding, but carries risks of dependency. SunoAI, which generates musical compositions from text, opens unprecedented possibilities: shaping personal experiences, enabling projective exploration, confronting frustration and fostering validation, through creative output . These experiences demonstrate that, far from replacing traditional mediations, AI can function as a therapeutic third party. It extends the objectives of occupational therapy: supporting expression, structuring thought and reinforcing identity . The challenge remains to harness technological developments, while keeping the human at the centre of care.

Summary One of the major factors for developmental delay in children with autism spectrum disorder (ASD) is reduced capacity for sensory processing . Sensory integration therapy (SIT) addresses sensory processing challenges in children with autism, by providing controlled sensory experiences. Through tailored activities and exercises, such as movement, tactile stimulation and deep pressure, the therapy aims to improve sensory processing skills, self-regulation and participation in daily activities. Collaboration among parents, therapists and professionals is vital to develop a comprehensive treatment plan. SIT is just one aspect of a holistic approach and its effectiveness varies for each individual. It plays a role in promoting adaptive responses to sensory input and enhancing the overall well-being of children with autism. Introduction If you are a regular user of social media, or an avid reader in general, you are likely to have come across the terms ' neurotypical ' and ' neurodivergent ' at some point to describe individuals. Let’s dive deeper into their meaning... Neurotypical is a term that is generally used to describe a person who does not express neurologically atypical thoughts, mannerisms, or behaviours. Such a person thinks, perceives and behaves in ways that are considered 'normal' by society. In contrast, neurodivergence represents people who have an altered perception of their surroundings and general experiences, primarily by virtue of a difference in brain development .

By Rhiannon Crispe and Dr. Michelle Luken Co-Creators of The Burn In Model © Co-Founders of Embers™ Introducing The Burn In Model The Burn In Model is a nature-based occupational therapy model that uses the metaphor of a flame to help people understand alignment, misalignment and sustainable well-being . At its heart, it asks a simple question: Is your inner flame burning bright, or starting to fade? Born from the realities of burnout , yet reaching far beyond it, The Burn In Model has been described as a model for our era. It offers a practical and reflective way to understand what sustains us, what drains us and how to live in greater alignment. Because of this, The Burn In Model can be applied across diverse practice areas - from clinical work with individuals across the lifespan, to supporting families, groups and communities, as well as in supervision, leadership, coaching and education. Unlike many occupational therapy models developed primarily in academic settings, The Burn In Model was co-created by occupational therapists drawing on lived experience . It was shaped in community, through research, conversations and collective reflection - and refined through feedback from practitioners around the world. Burnout vs. Burn In The World Health Organization (WHO) defines burnout as a syndrome resulting from chronic workplace stress, that has not been successfully managed. While this definition captures an important aspect of burnout, it does not fully reflect how burnout is experienced real life. Burnout extends far beyond the workplace . It shows up in caregiving, parenting, activism, navigating systemic injustice and the unique pressures of neurodivergent living. It can emerge in any life role, whenever there is a deep and sustained misalignment between a person's being, doing and sense of belonging . In The Burn In Model, burnout is understood as a state of complex and ongoing misalignment between who we are (Being), what we do (Doing) and who or what we are connected to (Belonging) . When these elements remain out of sync over time , the Inner Flame dims and may eventually burn out. Burn In is the opposite. It is a state of strong and sustained alignment between Being, Doing and Belonging. Our Inner Flame burns bright, steady and strong when we are... showing up as our authentic self engaging in meaningful occupations connecting with people and places that foster belonging This experience is not limited to adults, or to any one group of people. Children, young people and older adults can all Burn In. Across every life stage and role, alignment supports vitality, connection and a sense of aliveness. Both burnout and Burn In can look and feel different from person to person. The Burn In Model recognises the dynamic and ever-evolving nature of life and alignment. No one Burns In every moment of every day. There will be days, weeks or seasons when alignment feels hard to reach - and that is part of being human. Regardless of the state of one's flame, The Burn In Model offers an invitation to notice it and tend to it. The Flame and Its Ecosystem At the centre of The Burn In Model is the flame. The flame has two parts: Inner Flame Reflecti ng the alignment between Being , Doing and Belonging . The greater the alignment, the stronger and steadier the flame. When these elements drift out of sync, the flame may dim or shrink. Outer Flame Representing growth and transformation , or Becoming . As alignment strengthens, the potential for authentic growth expands. No flame burns alone. It is always shaped by an ecosystem, made up of core elements, fuel and conditions that sustain or challenge it - and the ripple effects it creates. Together, the elements shape how our flame burns and how it impacts the world around us.  What Makes The Burn In Model Unique The Burn In Model stands on the shoulders of occupational therapy models and frameworks that came before it - including the Doing-Being-Becoming-Belonging framework, the Person-Environment-Occupation Model , the Kawa Model and the Occupational Therapy Practice Framework . These models have shaped how we understand occupation, identity and context. The Burn In Model honours this lineage, while extending it in new and necessary directions. I t brings into view aspects that have often remained unnamed in occupational therapy theory , such as: boundaries burnout signals gifts to the world lineage legacy These dimensions profoundly shape whether a person's Inner Flame flourishes or fades, yet they are rarely made explicit within existing models. When these experiences remain unnamed, they are easily overlooked by systems, practitioners and clients alike. By naming them, The Burn In Model gives language and legitimacy to what occupational therapists have long recognised in practice. While grounded in occupational therapy and occupational science, the relevance of The Burn In Model extends beyond the profession . It can be used by therapists, psychologists, coaches, teachers, leaders, parents and community groups - as a shared language to guide reflection, conversation and action, wherever people are seeking greater alignment and well-being. From Theory to Practice The Burn In Model is designed to be used in the real world. Its concepts are intuitive, metaphor-driven and adaptable, making them accessible for reflection, assessment and intervention. The Burn In Model is supported by a practical framework, that guides practitioners and clients from insight to action. This process supports people to map their flame , notice alignment and misalignment, identify supports and challenges and create pathways toward Burn In. Simple tools help open conversations and track change. A practitioner might invite a client to sketch their flame and surrounding ecosystem elements, to visualise their current state - then revisit the drawing later as a pre- and post-assessment comparison. A brief check-in such as, "On a scale of one to five, how is your flame burning today?" can serve as both a reflective prompt and a way to monitor progress. In this way, The Burn In Model becomes more than theory. It becomes a shared language , that helps people name what they feel, see what has often gone unseen and move toward alignment together. A Bold Vision The Burn In Model was never intended to be confined to academic literature or training manuals. Its vision is intentionally expansive. We see The Burn In Model being used across professions and settings... By therapists, teachers, leaders and caregivers. By schools checking in with children about their flame. By workplaces seeking to sustain their people, rather than drain them. By communities, ready to move beyond survival and into collective well-being. We envision books, workshops and conversations carrying The Burn In Model into homes, workplaces and communities worldwide. So when people tal k about their lives, their work and their well-being, they don't only name what's draining them; they have language for what keeps their flame alive. Next Steps You are invited to explore The Burn In Model in your own life and practice , in ways that feel right for you. You might start by using it for personal reflection, journaling or everyday conversations, then bring it into your work with clients, families or teams. If you would like further guidance, resources and shared language, you can explore our eBook , or connect with us here for ongoing learning and community. Together, we can Burn In, Not Out.

"If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process has ever made" - Allan Rechtschaffen Introduction Sleep is fundamental to health. We spend around one third of our lives sleeping (or trying to). Unsurprisingly, when sleep falters, the consequences ripple across daily life; mood, relationships, concentration, productivity, health and wellbeing all decline. Insomnia is one of the most common and often-overlooked clinical conditions. Around 10% of adults meet the criteria for insomnia disorder , 1 with even higher rates among those with long-term health conditions. 2 Occupational Therapists (OTs) are well-placed to support clients with insomnia. Their expertise bridges the biological, psychological and social components of sleep - from managing anxiety and supporting behaviour change, to understanding how the environment, daily routines and meaningful activities influence sleep quality. However, many Occupational Therapists receive little formal training in sleep and their interventions are often limited to sleep hygiene advice. This article introduces the CALMS   framework. A practical tool integrating evidence-based techniques, to help healthcare professionals confidently address insomnia in everyday practice. Understanding insomnia Insomnia is characterised by difficulty falling asleep , staying asleep or waking too early , despite adequate opportunity. While short-lived poor sleep during stressful periods is fairly common, insomnia disorder is diagnosed when these problems occur at least 3 nights per week for 3 months or longer, causing significant distress or daytime impairment. 3 Insomnia is now understood as a 24-hour disorder, marked by hyperarousal both day and night. Clients often describe being "tired but wired," exhausted but unable to switch off. Unlike sleep apnoea or insufficient sleep opportunity, insomnia rarely causes persistent daytime sleepiness. If this is the main complaint, other causes should be considered. Crucially, insomnia is not just a symptom of other conditions. Evidence shows it frequently persists unless treated directly, even if the co-morbid condition (such as pain or depression) improves. 2   How insomnia develops: The 3Ps model A helpful way to conceptualise insomnia and why it persists, is through Spielman's 3Ps model 4 : - Predisposing factors -  are characteristics that increase vulnerability, such as being a worrier, a perfectionist or female sex . Alone, they do not cause insomnia, but they raise the likelihood of developing it. - Precipitating factors -  are the triggers that initiate sleep disruption, such as stressful life events or illness . For many, sleep returns to baseline quickly, but in around 10% of people the insomnia evolves into a chronic problem. - Perpetuating factors -  explain why. These are the thoughts and behaviours people adopt in response to poor sleep, which inadvertently maintain insomnia. Perpetuating factors include: Cognitive C atastrophic thoughts, such as "If I don’t sleep, I won't cope tomorrow" Rigid beliefs, such as "I must get eight hours" Attentional bias - prioritising attention towards sleep-related thoughts/cues Sleep preoccupation - excessive rumination about sleep → These heighten anxiety, increase arousal and, paradoxically, reduce the chance of sleep. Behavioural Extending time in bed, such as early nights or lie-ins N apping W ithdrawing from daytime activities Lying awake in bed Attempts to force sleep (sleep effort) → These behaviours weaken sleep pressure and reinforce the bed-wakefulness association .  Together, these perpetuating factors create a vicious cycle , whereby worry fuels arousal, arousal disrupts sleep, coping strategies backfire and each poor night reinforces the cycle: The 3Ps model helps clinicians reframe insomnia as something that can change. Clients may feel their sleep is untreatable especially when associated with chronic challenges such as pain or depression. By highlighting how perpetuating cognitive and behavioural factors maintain insomnia, OTs can identify areas for improvement, even when other chronic conditions persist. CBT for Insomnia (CBT-I) CBT-I is the recommended first-line treatment, supported by decades of randomised control trials and meta-analyses. 5   CBT-I is a non-drug, multicomponent approach which, unlike CBT for anxiety or depression, specifically targets th e cognitive and behavioural factors that maintain insomnia. CBT-I integrates:  Behavioural strategies   S timulus control Sleep restriction R elaxation techniques Cognitive strategies P sycho-education Challenging dysfunctional beliefs R eframing catastrophic thinking R educing sleep effort While sleep hygiene forms part of psycho-education, it's rarely sufficient on its own to treat chronic insomnia - just as brushing teeth won't fix a cavity. Importantly, although CBT-I is traditionally delivered by those with specialist training, key CBT-I principles can be safely and effectively applied by Occupational Therapists in everyday practice. The CALMS framework This framework translates core CBT-I principles into a practical, memorable structure for addressing insomnia: - C - CAUSES - Consider factors contributing to poor sleep and address any quick wins.   Causes may include: Lifestyle factors  - irregular routines, noisy sleep environment, excessive caffeine or stress Medical factors  - pain, health conditions, or medication side effects Cognitive factors  - dysfunctional sleep beliefs, catastrophic thinking and sleep effort Key interventions: Use sleep diaries , such as that from the American Academy of Sleep Medicine , to help identify potential causes and sleep patterns. Address obvious contributors where possible , such as stress management, environmental adjustments, reviewing medication with a GP. Provide psycho-education on normal sleep - for example, "waking at night is normal" and "sleep need is individual" - to correct myths and reduce anxiety. Challenge catastrophic thoughts , such as "I won't cope tomorrow", whilst developing more balanced alternatives - for example "I've always got through before, even when I haven't felt my best" - to reduce sleep anxiety. Address sleep hygiene where relevant , framing it as supportive rather than curative. Instil hope and reassurance  that insomnia is treatable and that CBT for Insomnia goes far beyond generic sleep hygiene. Emphasise that sleep cannot be forced ; chasing it only backfires. Adopting a mindset of 'caring less' about sleep and resisting the urge to clock-watch both help reduce anxiety and sleep effort - paradoxically making sleep more likely. [Note] Not all causes can be identified or modified, therefore over-focusing on finding 'the cause' may divert attention from targeting perpetuating factors and keep clients stuck. - A - ALIGN body clock - Circadian rhythms are central to sleep. Irregular wake times, poorly timed light exposure and variable meal timing can perpetuate insomnia. Key interventions: Set a consistent wake time , ideally that suits your client's chronotype ( their natural biological tendency to feel sleepy and alert at certain times ). This anchors your body clock and supports regular sleep onset at night. Advise natural light within an hour of waking , like a short walk or coffee outside. Morning light helps shift your body clock earlier, supporting timely sleep onset. Conversely, reduce evening light exposure in the hours before bed, using dimmer switches, lamps and reduced screen brightness . Support   consistent meal times  and advise against late-night eating. Encourage meaningful daily activities and routines , to strengthen circadian cues. [Note] Focus on wake time as the primary anchor, rather than rigid bedtimes. Gradual changes may be needed for clients with disrupted schedules. - L - LINK bed and sleep - Repeatedly lying awake in bed will condition the brain to associate the bed with wakefulness . Clients might describe, "I'm nodding off on the sofa but, once in bed, it's like a light turns on." Key interventions: Advise only going to bed once genuinely sleepy  - not just tired. Limit bed use to sleep and intimacy , to reinforce the bed-sleep link. If awake for 20 minutes, advise "give up and get up" - i.e. leave the bed and do something calming and enjoyable. Return to bed once sleepy. [Note] For clients with mobility issues, recommend "give up and sit up" - i.e. engage in a calming activity while upright, rather than lying awake. - M - MAXIMISE sleep pressure - Sleep pressure (or sleep appetite) builds the longer we stay awake and is boosted by activity. Coping behaviours - such as naps, early bedtimes, lie-ins or avoiding exercise - reduce sleep pressure. Key interventions: Maintain consistent wake times  - even after poor nights. Discourage lie-ins and naps. Encourage engagement in meaningful daytime activities   and exercise , to build natural sleep pressure. If someone spends much longer in bed than they sleep, consider reducing time in bed  by ~60 minutes, via later bedtime or earlier wake time. This is to improve sleep efficiency . [Note]  CALMS does not use formal 'sleep restriction therapy', which requires specialist training. Instead, it applies a gentler approach to consolidate sleep and reduce wakefulness. Check for daytime sleepiness first, such as by using the   Epworth Sleepiness Scale and m onitor closely in clients with excessive daytime sleepiness. - S - SOOTHE body and mind - Reduce physiological and cognitive arousal in the day and at night. Key interventions: Teach relaxation techniques , such as progressive muscle relaxation, paced breathing or visualisation. Encourage daytime and evening practice - not as a way to force sleep, but to support winding down. Free apps, like Insight Timer , offer guided audio, which can help clients learn these techniques. Suggest cognitive strategies - such as constructive worry or journaling - to reduce mental arousal. Suggest paradoxical intention  (keeping eyes open) to reduce sleep-related performance anxiety. Establish a buffer zone between work/chores and bedtime, to signal winding down. [Note]  Like exercise, one session won't produce lasting change. Relaxation is a skill that improves with regular practice. Bringing CALMS into everyday practice   By using CALMS, Occupational Therapists can move beyond generic sleep hygiene, to deliver evidence-based interventions that address the core mechanisms of insomnia . CALMS can be incorporated into routine occupational therapy care as follows: Assessment Explore routines, beliefs and behaviours that perpetuate insomnia. Examples : Irregular sleep-wake times; catastrophic thoughts about sleep; excessive time-in-bed; sleep effort. Intervention planning Adjust schedules and encourage strategies that support sleep. Examples : Consistent wake times; morning light exposure; activity; relaxation strategies. Education Provide clear explanations about insomnia and its mechanisms. Reduce fear and instil hope . Examples : Normalising night waking; explaining how sleep-effort backfires. Follow-up S et collaborative goals and support gradual adjustments. Build confidence in natural sleep ability. Signpost to CBT-I with a trained provider, if needed. Limitations and onward referral The CALMS framework is designed for use by any healthcare professionals. For complex cases, such as suspected sleep apnoea, parasomnias, severe psychiatric comorbidity - or when CALMS is insufficient - refer to a sleep specialist , for further investigation or CBT-I. Conclusion Insomnia is common, chronic and often disabling - but highly treatable. When ignored, it causes unnecessary suffering and arguably limits the therapeutic benefit of other occupational therapy interventions. The CALMS framework provides a practical, evidence-based approach for Occupational Therapists to address insomnia - enabling them to tackle sleep directly as a vital occupation. By embedding these strategies into everyday practice, Occupational Therapists can improve clients' sleep, wellbeing and engagement in the occupations that give life meaning. Louise Berger leads the outpatient Insomnia Clinic within the Sleep Clinic at Royal Surrey County Hospital, one of only a few NHS insomnia clinics in the UK. This provides tailored, evidence-based care for individuals with chronic sleep difficulties (including insomnia), alongside co-morbid sleep conditions. Beyond her clinical work, Louise is passionate about translating sleep science into practice, improving access to care and shaping how insomnia treatment is delivered - through teaching, mentoring, speaking and contributing to professional and clinical guidelines. Louise also coaches clients in sleep globally, through BetterUp, serves as a trustee for the British Society of Pharmacy Sleep Services and co-edits the British Sleep Society newsletter. Louise welcomes connections with those passionate about sleep on LinkedIn: References Morin, C.M. and Buysse, D.J. (2024) Management of insomnia. New England Journal of Medicine , 391(3), pp.247-258. Morin, C.M. and Jarrin, D.C. (2022) Epidemiology of insomnia: prevalence, course, risk factors and public health burden. Sleep Medicine Clinics , 17(2), pp.173-191. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders . 5th ed. Washington, DC: American Psychiatric Publishing. Spielman, A.J., Caruso, L.S. and Glovinsky, P.B. (1987) A behavioral perspective on insomnia treatment. Psychiatric Clinics of North America , 10(4), pp.541-553. Van Straten, A., van der Zweerde, T., Kleiboer, A., Cuijpers, P., Morin, C.M. and Lancee, J. (2018) Cognitive and behavioral therapies in the treatment of insomnia: a meta-analysis.  Sleep medicine reviews ,  38 , pp.3-16. © 2025 Louise Berger. All rights reserved.

A poem and accompanying reflection. By Debbie Mace, Occupational Therapist, UK. - A Carer's Voice: Poem - I am a carer, don't see past me, I am a carer, don't see through me. I am a carer, I'm here because I care, I'm here because I care, not because I'm being paid.   This isn't a job I'd choose to take on; no way, not on any day. I'm here because they mean the world to me. Their heart and mine weave in time. They are such a huge part of my life; I'm not just their child, parent, friend, husband or wife.   I'm their carer, don't see through me, I'm their carer, please see me. You have no idea how their life weaves with mine, Or what it means to our family time.   It changes everything you see, It's changed our lives, completely. It changes every part of your everyday, Our lives have changed, in so many ways. Nothing is as it was before.   We've learnt a lot, them and me, We've loved, cried, laughed and grown a lot. Together! And we're stronger now than ever, because, We walk together through every door.   Because this happened, it's changed who we are. We count our blessings more, Than we ever did before. We count our blessings every day, Somehow, we've made it through, together!   We count our blessings every day, because we’re still together. We count our blessings every day, in deep, deep gratitude, Knowing love is forever.   I'm their carer, I'm here because I care, My love for them runs deeper than words can say. You know it's true, I’m here, in front of you today.   So, when you meet me, please be kind, Be respectful, Hear this voice that's mine. I'm here because I choose to be, But this isn't a job I'd choose to take willingly.   If I could choose a carefree life for them, I'd do it now and not hesitate. I'd set them free and go back to being me, I wouldn't choose to be their carer at all.   But this isn't the life we have now, or A choice we get to make. I'm their carer, please hear me, I'm their carer, please see our family. By Debbie Mace, April 2025 © All rights reserved - A Carer's Voice: Reflection - In recent years I have taken on a carer role for three of my closest family members. It's a hugely rewarding, enlightening and humbling experience, although it does have its challenges. Before this experience I didn't realise that, collectively, carers effectively create a 'second NHS' [the UK's National Health Service]. As an Occupational Therapist (OT) working with carers, I hadn't understood the challenges - and last year an opportunity arose for me to participate in a carer wellbeing project . Initially I was reluctant but, after encouragement from my family, I stepped into the experience. This helped me reflect on my carer journey so far and hear the stories and experiences of other carers; together we found a deeper appreciation of hope and creativity in life .  It also helped me to appreciate the Occupational Therapy lens of purposeful and meaningful occupation, that can light up the darkest spaces. Culture and Nature Carer Wellbeing project The 'Culture and Nature Carer Wellbeing' project ran from the Summer of 2024, until the Summer of 2025, at Doddington Hall in Lincolnshire (UK). It began with an exploration day, to help us shape the delivery of the project. There were three of these sessions across the summer months, in the hope that this approach could maximise participant engagement...   The nature and culture-based activities took place monthly, between Autumn and Spring 2025 - which felt like a long time initially, but soon passed quickly. During the engagement sessions, a suggestion was made to include a 'Celebration Event' at the end of the project, which was included with the mindfulness, wreath making, sketching, mono-printing, flower arranging and floral garden sculpture activities. Carers were encouraged to try things out; to be 'playful' and experimental during these sessions, in the hope we could continue with some of the activities when the project ended.   In the Winter, I was asked to join the project steering group - a role I enjoyed, because it enabled me to share ideas from the larger group of carers, ensuring their perspectives could be clearly heard. The steering group supported the production of resources and training sessions, to enable sessions to continue in the community , outside of the project.   Along with family and friends, carers were invited to bring their cared-for person to the Celebration Event - to view an exhibition of their creations and co-creations during the project. These consisted of poetry, film, photographs and prints (see example below):    During the project I had an opportunity to (more deeply) experience the value of meaningful and purposeful nature and culture-based activities . Everyone respectfully validated each other in the sessions, as our unique circumstances and experiences emerged in a supportive space.  The focus on activity within a shared learning environment facilitated nurturing conversations, that were compassionate and supportive.  Friendships formed and genuine feedback was given.  One person described the sessions as a refreshing change from previous 'moan fests' that they'd attended in other carer settings. Hope and Creativity In the Winter of 2025 I met with the project's researcher, Dr Rob Dean. Our discussion soon became focused on hope and creativity. These emerged as significant themes throughout the wellbeing project.  As a carer, it's important to have hope for a better tomorrow ; this extends beyond ourselves and includes our cared-for person, as well as other family members or friends.  Without hope, life becomes hopeless, which can feel very isolating.  Many years ago, I had the opportunity to benchmark hope alongside a day treatment service project in the West Midlands. I recall colleagues commenting that it was an impossible task to undertake. But it wasn't. Listening to the voices of those who came to share their experiences and views of hope (and what it meant to them), it soon became clear: Hope has to be something real and tangible for us; it has to be part of our everyday lives (and that's why hope and creativity are so important). Our hopes are woven into our relationships, our roles and our connections with the natural world.  All of our connections benefit from our hopes. It is part of everything that makes life worthwhile. But to feel hopeless - to feel truly without hope - is to feel lost and alone. Hope can be found in our human occupations; it's what makes life purposeful and meaningful. It comes in many forms, but it lives within us. Hope becomes part of our identity and our creativity can keep it alive or revive it - in the darkest of times, when we need it the most. An Occupational Therapy Lens Occupational Therapists appreciate the importance of both hope and creativity for people's wellbeing, as part of everyday life. Whenever we ask people about their goals, we are exploring hopes for the future and ways to creatively support recovery and help people embrace change.   As OTs, we can ignite hope and creativity in others through our understanding and appreciation of meaningful and purposeful activity - and the hope that brings. We do this collaboratively, in truly unique and co-creative ways that inspire. This is what makes our practice truly holistic and person centred.    Our unique occupational therapy lens must be a guiding inspiration in our health and social care systems, now and into the future. Never underestimate the unique potential and importance of occupation - because it shines a light in the dark, like nothing else can.  During a webinar hosted by the Royal College of Occupational Therapists last year, Professor Iwama said this best when he reminded us of the following: "Occupational therapy is the only allied health profession that sees the whole person, for the whole of their day - and then focuses on what's important to them, in their life."   People who receive the benefits of occupational therapy intervention can appreciate the value it brings and the difference it makes to their lives; this isn't always appreciated or well understood by members of the wider systems that we navigate. Occupational therapy is often undervalued, but we can all be advocates for change and proud of the potential that occupation offers, to everyone.

Occupational therapy (OT) is a practice that can assist older individuals with living a more comfortable and productive life. It majors in the areas that help enhance quality of life. There are a number of rehab facilities providing occupational therapy to older adults. They take in individuals with certain medical conditions and injuries, with the drive and ambition of giving comfort and professional assistance. OT teaches life skills, which helps overcome many obstacles in the latter phases of life journeys. It's more of improving the self-reliance techniques devoid of the physical challenges.

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.

Client confidentiality To protect identities, names and other details have been changed. Images, including those of individuals, are from a stock library. The information below was submitted by an occupational therapist (OT) to a local government housing department, following their specialist assessment at the child's home. The Occupational Therapy Re-housing Report supported the family to move to a property more suited to the son's needs. This provided improved access and safety , greater independence and ease of occupational engagement within the home. Service: A community-based children's team, run by a UK council, supporting individuals with disabilities, up to the age of 18 years old. Client name: 'Max' Age: 16 Assessment date: May 2022 Health and Functional Status Max lives with his loving and supportive mum Julie and his sister. He attends a special school. In his leisure time, he enjoys his food, water play, swimming and loves to be outside. Max has the following medical diagnoses:

One of the fundamental skillsets that preschoolers need to master are 'pre-writing skills'. These are pre-academic abilities, that become a foundation at school age. Pre-writing skills are part of the motor learning that preschoolers experience in early education settings. Motor learning is the study of the movement processes associated with the practice, such as experience, motivation, reinforcement, motor skills and developmental progress, that lead to a relatively permanent change in a person’s capability for skilled action (Schmidt and Lee, 2005)

An experienced Occupational Therapist, the author of this article once knew little about her ancestry, with no real interest in it. She describes having 'lived in a silo' - disconnected from the past and unconnected to the future - with little appreciation of a life being lived as part of an eternal timeline ( living in connection to everyone, everywhere ). This was until she became a licensed 'Wayapa Wuurrk' (Earth Connection) practitioner*. * Wayapa® Wuurrk means 'connect to the Earth', in the languages of the Maara and GunaiKurnai First Nation People of Australia. Wayapa is a unique approach to our collective wellbeing as planet and people . It offers Earth, Mind, Body Spirit Wellness, to anyone of any age and ability, through movement and mindfulness. It is the first Indigenous Wellbeing modality to be accredited by the International Institute for Complementary Therapies (IICT) . The author's journey of learning and connection has enabled her to perceive the value of the Kawa Model as a group intervention . To incorporate Kawa into you occupational therapy practice in this manner, follow the steps illustrated below... We are not silos. We are all connected to each other and to our Earth. We are nature! Introducing Kawa as a Group Intervention The Kawa (River) provides a great opportunity for high-quality reflection and co-created group experiences within occupational therapy practice . Kawa enables the exploration of complex issues, within groups or communities that share roles, goals, or interests. Kawa Model illustration - interacting features impacting flow "You can't solve a problem from the same thinking that created it" - Albert Einstein This is exactly how Kawa facilitates problem-solving for us as individuals and in groups. It enables us to create a different perspective , through the unique reflective and emergent process that is Kawa. In a group setting, this occurs through group discussion, as participants identify their shared ' common themes ' from their individual Kawa Rivers. Through the value and validation a group experience participants can then be empowered to co-create their  Collective Wellbeing Action Plan (CWAP) which becomes the focus of OT intervention. Whether this group approach with Kawa is used in a single exploratory session, or as the foundation for an ongoing course of intervention, the fact is that the agenda has been identified and set by the group, through a genuine and relevant co-creation process from their shared experience as a group.  As a group they may share a common role, such as a particular discipline within a multidisciplinary team (MDT). The group could consist of carers or individuals experiencing a shared difficulty or disability. Whatever the common ground participants share, this becomes the focus of their Kawa River within the group session, and the CWAP they co-create with this process. It is worth noting that participants can benefit from the unique insights this process provides for them within their individual river and the collective group experience too. As a group intervention, this genuinely empowers participants to identify their priorities and to take ownership of their plan. Furthermore, any action inspired as a result of this process will be meaningful and relevant to them and their lives. As a group intervention this has potential to inspire hope , both for each individual member and the collective group. Individual members of the group will be more aware of their own life journey and gain valuable wellbeing insights into their unique river landscape through this process. They will obviously choose what to do with these insights; depending on the setting, the OT facilitating the process can ensure appropriate support is available for them if necessary (see the process Preparation below). Kawa session at Wolverhampton University, UK [photo credit: Lianne Sealey] Group participants have a shared experience or intention that they focus on whilst creating their individual Kawa River. This is prepared in advance and brought to the group session.  During a meaningful group discussion, participants can share these insights and 'common themes' will emerge, relating to their shared experience and space within the group.    Using Kawa in groups in this way taps into this shared space, without a pre-determined agenda. It facilitates meaningful discussions and produces genuine co-creation opportunities for participants to explore their shared space. Just as Einstein encouraged, we can explore problems together, from a different perspective . This methodology enables us to co-create another level of consciousness, through Kawa's reflective and emergent process. In this way, we can tackle complex issues, outside of agendas and systems . Imagine the potential this holds for everyone - for communities, organisations and the global problems facing humanity now! Reviewing Kawa in group sessions The following step-by-step guidelines are intended to empower you to create your own Kawa group work session(s) - and complete a review with your group. Without a review, we do not know if the group intervention has had any meaningful impact for the participants . Reviews provide an opportunity for OTs to showcase their skills, knowledge - and the uniquely inclusive, holistic and inter-generational perspective that OT offers everyone. Please try to schedule a review when booking the group session, or before the end of the session. It is more likely to happen when it is valued and a clear commitment is made to engage. Otherwise it is likely to be lost. It is recommended that the initial review is with the same facilitator, to provide consistency.  However, once everyone is familiar with the process (including the review), they can identify their facilitator; this is ideally someone external to the group. The Process: A) Preparation Ask all the group participants to prepare their individual Kawa (River) before the session (ideally one-to-two weeks in advance). The focus of these rivers is their shared experience within the group .  However , it is likely that it will include their personal journey too. Kawa grows meaningful insights for participants. In a shared space, these will become their 'common themes'. These then provide the focus for their session and the co-creation of a shared action plan, as well as potential future sessions and review(s). You may choose to run a separate introductory/preparation session in advance - to introduce the Model and for everyone to begin creating their rivers. This is time consuming, but the preparation has to be done in advance of the group session. Alternatively, with sufficient understanding of the Model and process, participants can prepare independently in advance. You can create a resource to support this - or contact this article's author Debbie (details below) , for a template that you can use . Kawa (River) example from author   Kawa creates a reflective and emergent process that, with time, allows otherwise unconscious elements in life to come to light. This is why it is important to allow time for people to experience this insightful part of the process. B) The Group Session During the group session, encourage participants to discuss their individual Kawa rivers and share the 'common themes' that emerged for them. Then encourage them to identify their shared goals . Incorporating a goal-setting approach, such as SMART (Specific, Measurable, Achievable, Realistic, Time-bound) facilitates the co-production of the CWAP and provides a structure for the follow-up review. Finally, participants can prioritise their goals to co-create their CWAP, which becomes the focus of intervention. Using this process within a reflective and active learning approach enables the continual development of meaningful insights and strategies .  This is equally relevant to individuals and collectively to the group, team or organisation. C) The Review The CWAP can be regularly reviewed, within timeframes to meet the needs of the group and maintain momentum. In this way, participants can continually update their learning, growth and wellbeing strategies - whilst ensuring that the focus of the CWAP remains meaningful and relevant for everyone in the group. Now feel free to have a go yourself!  Feedback can be offered through The Occupational Therapy Hub , or by contacting article author Debbie ( theCelticOT@outlook.com ). Further reading: To join the journey to 'Collective Wellbeing' now, for Planet and People, visit the Wayapa Wuurrk (Earth Connection) website . Watch this space for developments, including a Wayapa Cognitive Behavioural Therapy Course, being co-created with Professor Melissa O'Shea and her psychology team at Deakin University in Melbourne. For more information about the Kawa (River) Model, visit the official website Read ' Use of the Kawa Model in a school setting ' via the Hub's Therapy Forum A note of gratitude Thank you Professor Iwama - and co-creators of Wayapa Wuurrk, Jamie Marloo Thomas and Sara Jones . Thank you for your encouragement and support on this journey, developing this group 'wuurrk' approach with Kawa, through a Wayapa lens. It is with much gratitude and humility that I can share this within the OT community now. As you may be aware, Professor Iwama has gifted the Kawa Model to the profession of Occupational Therapy, and his wishes are for it not to be monetised.  Wayapa Wuurrk (Earth Connection) Group set up

A reflective article by Jane I., LCSW Assisted by a professional, William Croninger, OTR [Jane's words] Pain. It is now my constant companion.  Sometimes I can keep it at bay, other times it is all-encompassing and controls my every waking moments. But let's step away from that for a few moments...   My friend suggested that I use my house as the centre point of this final journey: I rather like that. The house is sited on a pleasant street, just West of the city of Portland in the US state of Maine. My family has been in this area since the late 1700s and this house is a very special place for me. My father built the home upon his return from service in the Pacific during WWII - and I was most likely conceived in one of these rooms. It contains so many memories for me... As a young girl, I remember walking by the kitchen at times and seeing my parents in an embrace. So many memories of growing up with sister and brother, the generations of deer and other small creatures, that always seemed to wander into the back yard in the morning.   There is another set of feet walking the path around the small pond now, enjoying the flowers that fill that space. The new feet? Well, that is the granddaughter that my son and his partner brought into this world, back in 2023. Unfortunately, I do not have the strength to lift my granddaughter onto my lap . She is approaching two years old now; she is becoming her own person, adopting her own characteristic demeanour, finding things that attract and excite her.   I've been a licensed clinical social worker (LCSW) for over 40 years. Initially in medical facilities and, up until my retirement - just before the onset of COVID - in public schools. After I retired, I would occasionally see clients in an office I shared with another LCSW, but more often online via Zoom, where I maintained a full load of clients.  I took much pride in my ability to continue to be productive , learning to use new digital tools to work with my people.    The diagnosis - and mortality In March of 2022, I began to notice unrelenting right abdominal pain after bending over to clean up a spill. Surgery followed in April and, when I woke, I had a diagnosis of  appendiceal cancer . It's pretty rare and, similar to  pancreatic cancer, tends not to be found until it has metastasised body-wide. Mine was no different.  What was my reaction? I made up my mind that it would not beat me; I would certainly beat it. Following surgery, I just did not seem to be recovering as fast as I would have thought. Two weeks after surgery, a physiotherapist and occupational therapist called to set up my appointments. At that time I could barely get out of bed, secondary to weakness and pain. Neither the physician nor the therapists had spoken with me regarding how I was doing and when I wanted to begin my therapies.  Bottom line was that therapy ended prior to me being able to engage purposefully in them.  Sadly, neither the occupational or physical therapist asked me how this had affected me.   They seemed more interested in talking about their own upcoming retirements.  I would ask you to think how losing your independence would affect you. Not just the actual physical changes in your ability to perform your  activities, but in your concept of yourself... At that time of the initial diagnosis, I was a proud 65-year-old woman, known for her vigour and engagement in the community.  I was completely independent and enjoyed working in the garden, the book club and frequent outings with "the girls" . All that had changed; changed completely, following one trip to the doctors. I changed physicians and underwent a six-month course of physical therapy. I learned a great amount about my condition, as well as new ways to move and live - whilst facing my mortality. At some point, I was told that there was "nothing else that could be done" for me, as the cancer had metastasised throughout my body. No build up - pretty much out of the proverbial 'blue'. It was estimated that I could live 6-12 months...  It was devastating. My immediate reaction was sheer terror. "What will I do?" I could barely get out of bed, I couldn't cook for myself, couldn't do laundry, or even shop - due to my weakened immune system. The home I had lived in and loved for so many years now had places I could not get to (just no energy, or too much pain).    I was the person that helped others - professionally, but also cared for my mother, my father after his stroke and my husband, as cancer killed him. I had held their hands; figuratively and literally when they needed assistance.   With one conversation, I moved from being a caregiver to a seemingly helpless sick lady. I know, I kind of sound like I was whining, but the shock was overwhelming - particularly when I had initially been told I would recover and go on with my life. It particularly bothers me when friends say things like "Oh, you will beat this." I am NOT going to spend my final days and months battling cancer. In the end, cancer is going to kill me. I can accept that. The other thing some people tell me is: "You don't need to do anything; just stay in bed, pull the covers up and go to sleep." At least initially, friends and former co-workers were helpful. "If you need anything, just call", they would say. But after decades as a social worker, it became quickly apparent how uncomfortable they were talking to someone with terminal cancer. Gradually, they have drifted away. Some of those people still remain, but the numbers continue to diminish... A Professional's Thoughts [William's words] I found Jane's experience of contact with therapists deeply upsetting when we talked. None of the professionals seemed to have sat down and asked, "How are you feeling? What are you thinking?" We are occupational therapists, we pride ourselves in 'treating the whole person'. This was certainly not done in Jane's case. I once had an order on a new patient from a physician, who stated he wanted 'aggressive ADL training'. Reading over the medical record, it was pretty clear that her condition was terminal. I read the order to her and asked "Is this what you want to do?" Her answer was an emphatic 'NO!' "I know when I next leave this room it will likely be feet first on a gurney." I asked "What do you want to do?" Her reply was that she wanted someone to listen to her, as she told her life story. So we collaborated on what she would be willing to do and that I would then listen to that story. Everyone has a life story; nobody wants to just fade away into oblivion. Ask what your client is feeling - not just physically, but in their 'soul'.  - What is important? - What can they no longer do? - What do they want to do? What will continue to give their life meaning? - What is keeping them from that? And, as an Occupational Therapist, how can we help them continue in those vital areas, that will give life meaning?   I think most of us feel this; the panic of not knowing what to say . The need to say something 'helpful', or to raise a friend or patient's spirits. The fear of saying the 'wrong thing'.  Prior to becoming an occupational therapist, I worked in public schools here in the US, as a guidance counsellor. Over the years I spent in that setting, I gradually came to feel more comfortable 'opening closed doors', behind which dwelt fear and pain. People often want to talk - and if you are frightened, imagine what the person in the hospital bed feels! Watch your client . How do they seem to be feeling? What are their hands doing? Here, you are looking for covert signs of what may be distress, in facial expression and hand activity. Try an open-ended question , like "Do you want to talk about what may lie ahead?" If the response is negative, drop it and move on. Realise that how the client feels is their own right. We aren't there to 'make the m feel better'... A young woman entered my office years back, with a particularly distressing situation at home. I was completely at a loss as to how to help her , as the issue was not going away regardless of what I did or said. In the end, we stood and I asked her if she would accept a hug. She did and then left. I felt terrible - like I had done nothing for her. Her situation was no better than when she walked in. A few hours later I returned to the office, to find a note on my desk: "Mr C, I knew there was nothing you could do for my situation. Your listening and the hug was the perfect response. If you had tried to do anything else at the end, I'd have known you were just being phony."  Jane knows what lies ahead. I am not going to be able to diminish her pain, or even quell her fears of the unknown. But I can sure listen   to her, as she processes the experience. As Occupational Therapists, we cannot solve all our patient's issues. But we can demonstrate humanity and that we value their words. In that first interview, concentrate on how the disease process has affected your client: - How does he/she define themselves? - What is important to them? - What can they no longer do - and how can we problem solve, in order to help them return to that activity? The diagnosis is really unimportant. We are Occupational Therapists - we help people maximise their independence and quality of life. A Patient's Thoughts (continued) [Let's now return to Jane and her words...] I want to go on living the parts of my life that are important to me : Cooking meals when I can; ordering food that will be delivered; talking on the phone with my gardener, to get the place looking beautiful. I even talked to the representative of the firm that will carve my mortuary bench. I picked it out last week - and it felt great.   I will close the business officially in September of this year [2025]. I had some goals around how I would spend my life during retirement. These goals no longer seem possible, but I've developed new goals - and will pursue them... Texts from Jane [24/07/2025]: "In an hour I'm opening the window in this bedroom, so I can hear the birdsong." [30/07/2025]: "I got to the state park an hour later than planned, but feeling better all over. Before I even sat down on the bench, the waterworks came. Slow and sweet, trickling. My thought was that finally I had got back there. It's been so long that I truly cannot place when I'd been there last! I let all my thoughts go wherever they wanted... I cried and stopped - and cried again for a long time. So much pain, loss, disappointment. But also, in the last weeks: Pain relief, moments of meaningful connection (some deep!), clarity (both mental and emotional) and the basic success in ridding my life of bad juju! Corrective emotional experiences abound! The tears streamed... my shoulders shook... I sat. It was beautiful. I did it! I can go again, anytime I want. Another freedom before I'm gone. I bought the car pass for my son to use too. Tidal pools are great for our busy toddler!"   A Professionals Thoughts (co ntinued) Jane (in the image below) wanted to go to one of the state parks. She has pretty much stayed inside these past months. But I learned that, with the new meds, she is in a period where she is feeling quite a bit less pain - and so has been 'sneaking out' in her car, to increase her tolerance for driving! Please, take the time to get to know your clients - regardless of how they will leave the facility. I would often ask my clients if they would like to 'breathe fresh air' and none of them ever said no. So, if ever possible, we would wheel them outside, to this place where they could feel a breeze and we could be alone and talk... When I taught occupational therapy, I frequently told my students how working with a client was essentially like dancing. At times we lead, at times they do - and we are there for support. Try it! I am amazed at how many have written to me since I left the university - to tell me that they remember that challenge: To try to 'dance' with their clients. By William Croninger, OTR

Occupational deprivation is often believed to only affect those experiencing extreme situations, whose opportunity to complete desired occupations is restricted and limited . These extreme situations allude to those who are refugees, those currently experiencing imprisonment or even those experiencing domestic abuse, for example. So what is 'occupational deprivation' and why should we all be aware of it? What is occupational deprivation? The definition of occupational deprivation is ' prolonged restriction from participation in necessary or meaningful activities due to circumstances outside the individual’s control ' ( Occupational Therapy Australia , 2016). This means that hobbies and activities that people choose to do for their own well-being or as part of cultural norms are being limited. Consequently, rather than occupational deprivation affecting only those in 'extreme situations', it can affect those who are disabled, have mental illness, are homeless, have been hospitalised for prolonged periods, those experiencing racial discrimination, plus many more. Considering this, occupational deprivation is experienced by much more of the population than most people believe.  The table below shows the number of some of those potentially experiencing occupational deprivation due to their current circumstances: As these figures show a year-on-year increase, it is likely then that occupational deprivation is also on the rise.  Why is occupational deprivation so important? As stated in an earlier article “What is occupational therapy?” the word 'occupation' refers to things that occupy your time and bring meaning to your life. The World Federation of Occupational Therapy (WFOT) states that engagement in occupations are not only a right, but also a need . Consequently, occupational deprivation results in having a  lack of meaning or purpose in your life and  creates or prolongs mental and physical illnesses . This is due to prolonged  occupational deprivation leading to despair, erosion of skills, poverty, poor health and social isolation. Whiteford (2011) suggests occupational deprivation is in part due to social exclusion, with  political dossiers playing a key role . This is due to these dossiers potentially influencing social opinion, often resulting in negative media portrayal, which continues the cycle.  Social division is then ensued , potentially  leading to social unrest .   How can we prevent occupational deprivation? Occupational Therapy Australia position paper states that occupational therapists play a key role in raising awareness and bringing communities together, with the aim of reducing occupational deprivation (or occupational injustice). The paper also suggests occupational therapists should remove environmental barriers to facilitate occupation, whilst designing programmes that enable engagement. Providing information to policy makers is another way to prevent possible unintended occupational deprivation and  increase social cohesion and inclusion . Additionally, Hocking (2017), suggests that  continued research to increase understanding of occupational injustice is required. However, to adjust social thinking around those who experience occupational deprivation or injustice, acknowledgement of difference, with a focus on ability rather than what they may be receiving is required.  Summary Occupational deprivation is a far-reaching challenge affecting mental and physical well-being. Social cohesion is also affected by occupational balance, which is all influenced by political dossiers presented at that time. Consequently, in order to ensure a cohesive, social and skilled society, a focus on ability in all is required, as is further research and increased awareness. Occupational Therapists play a key role in this through the services offered, information provided and training in environmental adaptations.

- N.B. A Hub collaborative partnership: marketing aspects, no paid advertising - Referencing: Footnote and in-text throughout The relevance of yoga therapy to healthcare? "Yoga therapy consists of the application of yogic principles, methods and techniques to specific human ailments. In its ideal application, yoga therapy is preventive in nature (as is yoga itself) - but it is also restorative in many instances, palliative in others and curative in many others." - Art Brownstein, MD, International Association of Yoga Therapists ( IAYT ) Yoga therapy's offerings can benefit healthcare practitioners, both professionally and personally. This article will discuss both aspects . Across domains, from reducing depression, anxiety and chronic pain, to improving self-care habits and quality of life, yoga therapy has emerged as a valuable complementary modality in healthcare settings. With an expanded scope of practice including yoga therapy skills, healthcare professionals can champion wellbeing for their patients, their colleagues - and themselves.  Potential benefits of yoga and yoga therapy in healthcare By tailoring yoga's tools of posture, breathing, mindfulness, meditation, and reflection to an individual, yoga therapy can affect physical functioning and nervous system regulation - and can leverage neuroplasticity and mind-body bi-directionality toward whole-person improvements in wellbeing and quality of life. Bringing person-centred, bio-psycho-social approaches to numerous conditions Reducing demand on healthcare systems , by helping people manage stress and make habit changes, to prevent or remediate lifestyle-related diseases Providing health professionals with yoga skills to care for themselves and each other, as well as patients

As a Specialist Occupational Therapist (OT) working in neurological rehabilitation, there are two words which arise frequently in conversation - with other clinicians and with the patients we support: ' Neuroplasticity ' and the concept of the recovery ' plateau ' ... - Neuroplasticity - As rehab therapists, we are passionately driven by this! - Plateau - This concept - that progress can tail off completely after a period of time - is arguable, usually unhelpful and very often not due to the patient themselves. This article will explain why we 'love and loathe' these two words respectively. It will cover: So what is Neuroplasticity?   Common Constraints of Rehab Why is Recovery Plateau an Unfair Disservice to Patients? Summing Up and Final Food-for-thought... References and Further Reading So what is Neuroplasticity? Neuroplasticity refers to the brain's ability to change, reorganise, or grow neural networks, in order to adapt from experiences . Neurons (nerve cells) - and their nervous system connections - alter as a consequence of new information received, such as when processing sensory inputs, practising targeted movements, or from damage or dysfunction (Britannica Academic, 2022; in Brown, 2022). The process can involve functional changes due to brain injury, or structural changes due to learning; '- plasticity' refers to the brain's malleability, or its ability to change (Cherry, 2024). N europlasticity is actually an on-going process in everyone's lives , as the brain is constantly shaped and rewired. The occupations (activities) that we engage in contribute to either establishing new synaptic connections between neurons, or altering of the strength of existing synapses... ...This impacts how our physiology and body systems work, as well as the behaviours and skills we exhibit and possess. It is important to note that neuroplasticity has the potential to be both supportive and damaging to our health and well-being . Negative consequences of this process include the ingrained adoption of unhealthy eating habits and the pain and dysfunction of organs controlled by the autonomic nervous system ( Brown and Weaver, 2012 ). However, this article discusses its key benefit. Healthcare professionals (HCPs) in the neuro rehab world - including occupational therapists, physiotherapists and psychologists - draw on neuroplasticity, to facilitate recovery of a patient/client's body and/or brain . This could be after an ischaemic or haemorrhagic stroke, a spinal cord injury (SCI), traumatic brain injury (TBI), hypoxic brain injury (when cells are starved of oxygen), or a brain tumour. An example of this in my personal work is supporting an individual with h emiparesis  ( one-sided muscle weakness). Through both conventional, hands-on rehabilitation approaches and the use of neurotechnology, I can assist the return of strength and functional range of movement of the upper limb. In doing so, that person can aim to return to engagement in everyday life and their activities of daily living (ADLs) - such as brushing their teeth, preparing a meal, using a computer or playing the piano. Image: Cleveland Clinic (2023) Common Constraints of Rehab Firstly, the benefit: In animal models and human trials, it has been found that high-repetition, task-specific training drives cortical reorganisation , improving motor outcomes. So s cience dictates that repetition and duration are fundamental. Person-centric factors are, of course, influential in the recovery trajectory. These include: nature and severity of the injury speed and type of treatment received in the acute phase past medical history general health and fitness levels executive functioning and wider cognitive levels post-injury - e.g. ability to sustain attention, process and retain information and plan/sequence activities level of motivation to engage in recovery social support structures around the individual - e.g. an encouraging partner or friends Factors affecting post-stroke motor recovery: Implications on neurotherapy after brain injury ( Alawieh, Zhao and Feng, 2018) Despite the wonders of neuroplasticity, a breadth of factors and variables mean that improving skills and abilities can be highly challenging, or sometimes not possible. This article explores the argument that this is largely due to external limitations - in time, staffing, resources and/or funding  (these factors are usually interlinked). '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; in Grant, 2022a). To reiterate, evidence dictates that we need to give patients sufficient time and frequency for neuroplastic change to occur - but the systems and settings we work within often do not allow enough of this. For example, Page (2025) states that, in outpatient settings, it is common for stroke survivors to perform just 30 to 40 upper limb movements in an entire session. Clearly, if such individuals have just one therapy session in a day, it is highly unlikely they will reach the number of repetitions recommended above. The limitations raised - which are largely outside of the patient's control - then directly contribute to that other frequently-used word in recovery: Plateau. Why is Recovery Plateau an Unfair Disservice to Patients? Plateau noun plural: plateaus, plateaux a period or state of little or no growth, or decline Psychology: a period of little or no apparent progress in an individual's learning, marked by an inability to increase speed, reduce number of errors, etc., and indicated by a horizontal stretch in a learning curve or graph. ( Dictionary.com, 2025) I'll start here by prefacing that the organisation I work for is very research-informed and benefits from the use of neurotechnology, maximising the number of functional repetitions a patient can make in a block of treatment. Unfortunately, in many other therapy services worldwide, the aforementioned limitations (time, staffing, resources, funding) mean that patients are unable to perform the necessary intensity and frequency of movements needed to trigger neuroplastic change . This often then leads HCPs to deduce that a person's scope for further recovery has slowed - or worse, no longer exists. In their eyes, it has plateaued. In turn, the clinician de-prioritises the patient on their caseload, refers them to a step-down service, or discharges them completely. This is arguably an injustice to that individual's rehab potential. 'Imagine telling a marathon runner to train by jogging for 3 minutes twice a week. And then acting surprised when they don't improve.' (Page, 2025) Image: TactusTherapy (2025) Demain et al (2006) argue that the concept of plateau is ambiguous. They point out that recovery has been considered to plateau within the first six months, yet studies indicate that later recovery is possible . This rings true from my personal experience as a neurological OT, currently in an outpatient setting in the UK. I see progress sometimes years after the injury has occurred. There is nuance and obvious variation here; the nature of the progress might be motor (physical), sensory (improved sensory feedback, or reduced hypersensitivity), cognitive, mood-related (affect), or a mixture of these elements. Yes, it is likely to be slower than during the initial six months - but it can still be both functionally significant and highly meaningful to the individual. A significant number of people engaging in rehabilitation will, at some point, ask a therapist how long they think their recovery could take . The answer can never be accurately forecast, due to the myriad of personal, social and institutional factors unique to each individual. Fundamentally though... 'The one thing the answer should not  be is "That's as good as your recovery will get." Many medical providers used to say this in the past, but published research has since proven that brain injury and stroke survivors can push past a supposed "progress plateau" and improve with effective and continuous brain rehabilitation - even years after the initial event' (Constant Therapy, 2025). Summing Up and Final Food-for-thought... With months and potentially years following injury, many barriers can prevent a patient's further focused recovery - not least the constraints and pressures of the healthcare organisation supporting them. As a clinician, you may be limited by the time or resources you can offer those coming through your door. And, as an occupational therapist, there is a time to convey optimism and a time to be realistic with what you might achieve... Nonetheless - as Page (2025) argues - the problem with progressing rehab in most cases is neither the patient's effort, nor the adaptability of his/her nervous system. It is decisions made by the therapist and/or the system in which the patient is being treated. You may not have the power to change the service - but make sure you are the clinician fighting your patient's corner, every step of the way! References and Further Reading Alawieh, A., Zhao, J. and Feng, W. (2018) Factors affecting post-stroke motor recovery: Implications on neurotherapy after brain injury. Behavioural Brain Research . 2018, 340: 94-101. Available from: https://doi.org/10.1016/j.bbr.2016.08.029 . ISSN 0166-4328. Brown, A. (2022) Neuroplasticity . Therapy Articles on The Occupational Therapy Hub (online). Available from: https://www.theothub.com/article/neuroplasticity . Brown, A. and Weaver, L.C. (2012) The dark side of neuroplasticity. Experimental Neurology . 2012, 235 (1): 133-141. Available from: https://doi.org/10.1016/j.expneurol.2011.11.004 . ISSN 0014-4886. Cherry, K. (2024) How Neuroplasticity Works . Verywell Mind (online). Available from: https://www.verywellmind.com/what-is-brain-plasticity-2794886 . Cleveland Clinic (2023) Hemiparesis (image). Available from: https://my.clevelandclinic.org/health/symptoms/24952-hemiparesis . Constant Therapy (2025) Debunking the myths about the brain injury "recovery plateau"  (online). Available from: https://constanttherapyhealth.com/brainwire/debunking-the-myths-about-the-brain-injury-recovery-plateau-infographic/ . Demain, S., Wiles, R., Roberts, L. and McPherson, K. (2006) Recovery plateau following stroke: fact or fiction? Disability and Rehabilitation . 2006 Jul 15-30;28 (13-14): 815-21. doi: 10.1080/09638280500534796. PMID: 16777768. Dictionary.com (2025) Plateau (definition) . Available from: https://www.dictionary.com/browse/plateau . Grant, J. (2022) Occupational Therapy and Neurology . e-document on The Occupational Therapy Hub (online). Available from:   https://www.theothub.com/product-page/occupational-therapy-and-neurology . Grant, J. (2022a) The Power of Routine . Therapy Articles on The Occupational Therapy Hub (online). Available from: https://www.theothub.com/article/the-power-of-routine . Page, Dr. S. (2025) Sometimes It’s The Therapist Who Plateaus; Not The Stroke Survivor . StevePRehab (online). Available from: https://www.steveprehab.com/post/plateau . TactusTherapy (2025) The Truth about the Plateau in Stroke Recovery (image). Available from: https://tactustherapy.com/stroke-recovery-plateau-truth-myth/ .

Trigger warning: Self-harm and abuse A Mental Health Act tribunal is where people who are detained in hospital against their wishes get the chance to appeal their detention. They get legal representation and while staff argue why they need to remain detained, the solicitor picks apart their statements to show that the detention is unjust. Watching this are a panel of three people: a psychiatrist, a judge and a lay person - and at the end of the merry process they get to decide whether the detention is required. In the UK, this is how we make sure people aren’t deprived of their liberty without good reason. This bit was a bit dull, but it gets more interesting from now on… I was at a mental health tribunal once where I was asked this question: "If self harm is what keeps them in hospital and they really want to get out, why don’t they just stop doing it?" I relished answering this but my heart sank a bit as well. This was the medical expert on the panel and it is so frustrating that people in such a position of power hold the view that self harm can simply be 'turned off'. I’m not a fan of diagnosis but, using a medical model, self harm is one of the symptoms of borderline personality disorder . In what other area would we suggest people just stop the symptoms of their illness? "Why don’t they just stop hearing voices?" Or even "Why don’t the manic people just calm down?" Obviously, any action that someone takes has an element of choice involved, but in mental health we work with many things that people do that cause them harm. I’m going to suggest that, if the attitude we take into our work is that people should just stop doing what they are doing, it is going to be absolutely impossible for us to help them. It also conveys the idea that people who could just stop are unworthy of help. If you feel that alcoholics should just stop drinking, agoraphobics should just go out more or anorexics should just have a McDonalds, this probably isn’t the article for you. If you’re interested, I’m going to try and explain how to make sense of why people do things that aren’t obviously in their best interests. I’ll probably focus on self harm, but you can use this process for understanding most things . I’ll give it to you in a couple of steps, but the order doesn’t really matter... The things people do make sense Nobody self harms for the sake of it. Nobody self harms because of their diagnosis. The only reason someone self harms is because, in that moment, it’s better than not doing it. You’re not that important There’s a good chance that the reason someone self harms is nothing to do with you. Yes, its painful to see someone you’re supposed to care for hurting themselves. Yes, it’s frightening to think you’ll be blamed for what they do... and yes, it can feel personal. Despite your initial reaction, you will be much more useful if you can start in a non-judgemental and curious manner . If you have to make an assumption, work hard to make sure it is the most empathic one you can think of. Be curious The best source of information about why someone does something is the person themselves. I once read 'She spent time in her bedroom and self harmed due to her diagnosis', which I thought was one of the worst things ever written in somebody’s notes - and the winner of my 'Utter Lack of Interest' award.  We need to ask questions: "Can you help me understand why you do that? I want to understand how it’s useful to you." "How does it help?" These are all things we can say to help people talk about why they do things; as a bonus, it gives them a sense that we are interested in them. It does something for them Everyone’s reason for self harming will be different, but it's likely that they get something positive out of it. It might allow them to feel something (because feeling nothing is terrifying). It might ground them and help them focus. It might validate their sense that they need to be punished. It might... well, anything really. Whether it affects their physiology, thoughts or feelings, there is likely to be some result that is worthwhile. It does something to other people It’s very easy for us to start thinking of ‘attention seeking’ at this point. Let's throw that term out of the window and just think about what happens in the environment once someone has hurt themselves. It might mean that people spend time with you . It might mean that people don’t abandon you . It might mean that people keep you away from something that terrifies you. It might mean that people care for you in ways that they wouldn’t otherwise. I remember one person who had always been neglected by his parents. They only showed they cared when he was physically unwell. Later in life, the only time he could accept people being nice to him without a crushing sense that he didn’t deserve it was after he had poisoned himself. If we ask, we can find out why it makes sense. But they could just ask us! But you won’t ask for things you don’t think you deserve. Many people have lived lives where they were never given what they asked for. Even if they did ask, let’s have a think about who is given the clearest message that people care about them. Is it the person who asks politely for support, or is it the person in their room turning blue, with a team ensuring they stay alive in that moment then watching them for the night?  In mental health services we are very good at conveying the message that the amount of care you receive is related to how dangerous you are. It’s weird that we then get annoyed when people respond to that. We can’t see the choice they’re making If we don’t ask, we are in danger of thinking people self harm for the sake of it. It’s very hard to sympathise with that. If we can see a choice, between cutting and another night of staying awake replaying the most traumatic experiences in 3D IMAX in their brain, it makes a lot more sense. If we can see a choice , between overdosing and feeling that your head is going to explode, it makes a lot more sense. If we can see a choice - between head banging and listening to the voice of the person who hurt you telling you how awful you are and that you deserved it and that no one likes you and it will never get any better, ever – again, it makes perfect sense. We won’t know what is going on for someone until we ask them. We need to make sure we do that. So all of the above are just some ideas. To make it a bit more MOHO , people only do things because they want or need to do them. Other ideas are available, so feel free to dismiss this. I’m going to suggest that if you can do the above you’ll be much more effective at helping people. It might even mean that you work on the problems that lead to people hurting themselves, rather than just trying to stop the self harm itself. Don’t be the person with a deciding vote in someone’s liberty thinking that they should just pack it in. Be curious, be empathic... and honestly, if stopping was easy, people would do it. Keir is a Lead Therapist in an NHS Specialist Service and provides training, consultation, supervision and therapy around complex mental health problems through Beam Consultancy . It is the height of arrogance for me to be writing about this; people who experience these difficulties do it much better. I highly recommend reading this by @hoppypelican. There are more articles like this here Follow Keir on Facebook: Keir Harding OT ; Instagram: Keirhardingot ; X (where he is busiest): @keirwales

- Introduction - Falls and fall-related injuries in older individuals are common; one in three people aged over 65 have at least one fall every year. Occupational therapists (OTs) play a key role in assessing risk, improving safety at home and reducing falls by older people  (Clarke, 2019). Home fall-hazard reduction interventions by OTs successfully reduce fall rates in older people by around 26%, a Cochrane review reveals (Lewis and Griffin, 2023). Relevant members of this cohort should be supported to modify and make their homes safer. In doing so, they are more able to live meaningful and independent lives... N.B. In relation to falls, the terms ' prevention ' and ' reduction ' are both used within literature. The latter is preferable and arguably more accurate, since risk can be reduced but never completely eliminated . Home fall-hazard reduction interventions by OTs successfully reduce fall rates in older people by around 26% (Lewis and Griffin, 2023)

An update to the 2022 article by Jon Fisher Having been on a journey of vast professional development over the past 18 months since writing the original article , I felt compelled to share my learning and reflections from developing the role of occupational therapy within an established substance use service. It is my hope that service users, somewhere, may benefit from sharing my experience with like-minded therapists. I’m not here to make any judgments around the use of substances. Contained below, I seek to share knowledge, experience and advice for Occupational Therapists, who may be in a position to support people with needs arising from their use of substances - regardless of practice setting, as addiction does not discriminate . Defining the problem Substance use remains ubiquitous throughout society, deeply embedded in culture and social norms . The unintended consequences (addiction and dependency) continue to present a significant and pressing public health concern. They have a ripple effect - not just for the individual, but those around them - in the form of relationship breakdown, loss of employment and housing, poorer physical and mental health outcomes, premature death and contact with the criminal justice system (UK Gov, 2017). Consider the occupational impacts within even just one of these areas... It is estimated that, in England alone, there are over 600,00 dependent drinkers - and only 18% of them are currently in treatment (Alcohol Change UK, 2021). Think about waking up every day, needing a drink of alcohol just to feel well enough to function and to alleviate withdrawal symptoms. There are a great deal more ' harmful and hazardous drinkers '. In England alone, there were nearly 8,000 alcohol-specific deaths, over 20,000 alcohol-related deaths and nearly 350,000 alcohol-spe cific hospital admissions in 2021 (UK Gov, 2023). There are approximately 276,000 adults in treatment each year (UK Gov, 2021) across all substances. The UK Government estimates the total socioeconomic cost of alcohol-related harms to society totals £21.5 billion. The use of illicit substances is thought to cost society around £10.7 billion (UK Gov, 2018). Cannabis remains the most commonly used substance in the UK , used by around 7.4% of 16-59 year-olds (DrugWise, 2023). See the person, hear their story We are all familiar with the term ' stigma ', a horrible concept for bringing shame, not just to what you do, but to who you are as a person. High levels of stigma have been shown to be a barrier to seeking help and treatment (WHO, 2001). You may have heard the myth about someone needing to hit 'rock bottom' before they are ready to make changes. We wouldn't apply this to any other forms of health and social care, so why substance use? What we know is that individuals seek treatment when their personal capacity and resources to manage their problems have been utterly exhausted. This is often reflected in the many and complex challenges someone may have when they do finally enter treatment. But what actually is stigma? What makes something more stigmatised than something else? Why are there levels of stigma? Amehdani's (2011) study of stigma in mental health sheds light on these questions. The perceptions of how dangerous, unpredictable or strange something seems; perceptions of whether you should be able to control what you do, or be able to sort it out ("you're not trying hard enough!"); the visibility of symptoms makes something more stigmatising; how disruptive a condition or behaviour is in society and whether you can realistically recover, or you’re deserving of 'pity' . It is easily seen how someone injecting heroin is more stigmatised than a dependent drinker, despite both potentially responding to past traumas. So how can we challenge the stigma associated with substance use, beyond just changing our words and awkwardly correcting our colleagues during meetings? We can have an impact by directly challenging the self (or internalised) stigma of those who use services. We can educate individuals around the effects of substance use and the addiction process on the brain . We can focus specifically around the effects on executive functioning and how this will influence thoughts, feelings and behaviours. Relapse , whilst always distressing, is a natural part of the process of recovery . Attempts should be made to frame it as such - and plan in advance, to reduce both the physical and psychological harms this can cause. We wouldn't be occupational therapists if we did not also consider the social environment . By association, stigma can also be a barrier for those we support and those closest to them. We can extend this education and knowledge to family and carers - in an attempt to modify the social environment around the individual, into something more supportive of recovery and occupational participation . Another way occupational therapists can challenge stigma with more than just words is by applying the 'occupational perspective' to addiction . We have our models of practice (I use MOHO), we view things holistically, we have many frames of reference and specialities ( sensory integration anyone?) We h ave deep and meaningful ways of understanding the link between participation in occupation and health, our sense of identity, connection and belonging. It is often too easy to label someone as 'not motivated' or 'not ready'. We can apply our occupational lens to highlight unseen occupational needs (that might present as a barrier to treatment) and seek to resolve them . High levels of distress from internalised stigma are known to be a predictor for someone disengaging from treatment, so we should make this a priority . The narratives a round recovery can seem all too narrow at times. Morris and Cox (2022) highlight the lack of available narratives for those recovering from alcohol use disorder, limited to the disease model of 'alcoholism' or positive new sobriety . They argue that these don't capture the wide range of motivations and narratives around drinking. As occupational therapists, we can play our part in helping to diversify the narratives around recovery . Someone may be more receptive in recognising they have a problematic relationship with alcohol or drugs if focusing on the nuanced occupational impacts, rather than calculating their weekly units. And of course, participation in occupations has its role to play in helping someone moderate their use of substances during their recovery, if abstinence isn’t the intended goal. Many of us were drawn to the profession due to our connection with the wonderful values, philosophy and ethos of Occupational Therapy. Naturally, we are going to validate our service users' experiences on multiple levels. Our intentional relationship - and curiosity for what makes an individual who they are - is an integral part of therapy, which nurtures the essence of change . Having worked alongside some amazing peer mentors, nothing can ever replicate their knowledge from experience, the validation or presence of which quells the shame those entering treatment feel. If you haven’t already, connect with your local peer mentors, or lived-with and living-experience advocates. The 'occupational perspective' of addiction and dependency The occupational perspective on addiction and dependency may seem a recent focus, further brought into the light by Twinley's umbrella concept, ' the dark side of occupation ' (2020). So very much has been written about the role of occupational therapy in substance use, exploring the concept of ' addiction as occupation ' (Guyonnet, Stewart and David, 2023; Dogu and Ozkan, 2023; Ryan and Boland, 2021; Rojo-Mota, Pedero-Perez and Huertas-Hoyas, 2017; Wasmuth, Crabtree and Scott, 2014). It is already in the light and we have the tools and knowledge to understand and address it. We just need to be talking about it more and integrating it into training , so that any therapist, regardless of setting, feels confident to explore and intervene. Exploring the phenomenon of addiction, it is clear that in order to support someone in recovery, it takes more than replacing the occupations like-for-like (Wasmuth, Crabtree and Scott, 2014). Opportunities to engage in new occupations geared specifically towards reshaping social lives, identities, roles and routines are required . In Wasmuth, Brandon-Freidman and Olesek's conceptualisation (2016), they found that individuals experienced a lack of purpose, direction or occupations to organise their daily life; they experienced a complete 'breakdown of self', posing serious threats to their mental health . By acknowledging addiction as an occupation and then focusing on this occupation's gains and harms , occupational therapists may be in a position to gain trust of clients and help them make adjustments to their occupational lives, that are personally beneficial (Wasmith, Crabtree and Scott, 2014). Helping to bring forth personal realisation of the benefits of using substances can sometimes pose a challenge to therapists. To be truly person-centred, we recognise that service users have hopes and aspirations beyond the cessation of substance use. Often the hope is that, by providing other opportunities to experience a genuine sense of self - connection with others, learning alternative methods for regulating emotions, having someone to help you see things differently - the use of substances will become less appealing. Occupational therapy interventions for substance use disorder The evidence for what occupational therapists are doing to meet the needs of those using substances is laid clear in Ryan and Boland's (2021) scoping review of interventions for people with substance use disorder. They organised interventions into three themes: Single occupation-focused interventions Skills training, including daily living and vocational Establishing community-based sober routines They highlighted th at creativity was a strong element of practice and that the neurological process of addiction should inform treatment approaches. Work is a critical component of recovery; occupational task engagement and achievement was important in building self-esteem, restoring self-concept and routines . They described a 'chain reaction' when service users are supported to make one influential positive chance, dispersing to other areas of life. Wasmuth, Outcult and Buck (2015) described the unique contribution of occupational therapy to this setting was to foster a sense of 'mastery' ; pulling together all the skills, knowledge, courses and interventions service users had received - and structuring them into real-life situations, related to occupational participation. A great deal of occupation-based intervention is already offered in substance use services, just not by occupational therapists! The occupational challenges of those in early recovery are best described by Kitzinger et al's (2023) exploratory study of habits and routines... 'Individuals have engaged a great deal of time in obtaining substances, using substances and recovering from their effects. Thereby limiting or eliminating certain occupations, or valued daily activities.' They isolated challenges to sustaining recovery, arising from: stigma anhedonia [ inability to experience pleasure, often from activities one used to enjoy ] sleep disturbances mental health co-morbidities negative social support networks Their study found that the most difficult time of day related to patterns of unused time . When there was a lack of structure, or unoccupied time, individuals returned to previously established positive supports. Yeah, but it’s still a choice to continue using, right? A systematic review of relapse factors in alcohol use disorder from the past 20 years (Sliedretch et al, 2020), framed around the bio-psycho-social-spiritual model , found a number of trends which may light the way for occupational therapy interventions. The review found that contributory biological factors to relapse included poor physical health and difficulties with sleep, amongst others. Psychological factors contributing to relapse included the presence of co-occurring mental health issues, emotional dysregulation and life events associated with psychological trauma . Unsurprisingly, low quality social support was highlighted in the social factors. Concluding with the spiritual, they found that spiritual beliefs and practices were protective (think Alcoholics Anonymous) - but incorporated a broad definition of spirituality to include the perception of life 'purpose'. Having a purpose in life, doing meaningful things, in meaningful roles, having a sense of identity and connection. If this doesn't scream occupational therapy then I don't know what does? Occupational therapy has been shown to be effective in promoting self-management o f aforementioned physical and mental health conditions (Bevan Commission, 2021; RCOT, 2018). In order to alleviate the losses felt in early recovery (which are often associated with relapse), priority should be given to developing new patterns of occupation - in the form of roles, routines and connections that are congruent with the construction of newfound occupational identities (Vegereis and Brookes, 2022). Owing to the distressing nature of addiction and dependency, one can easily be drawn to the behavioural or social impacts. This draws attention from the neurological aspects of addiction . In an article written for occupational therapists, Gutman (2006) outlines the process of addiction and how i ndividuals are neurologically primed to relapse from changes in the brain . Therapists can intervene to challenge distorted thinking that has arisen from these changes, supporting relapse prevention by modifying responses to drug-related sensory stimuli. Evidence shows that substances have an impact on different executive functions and can persist beyond cessation (Canales et al, 2022; Maharjan et al, 2022; Valdes and Lunsford, 2021). Executive functioning (or cognitive process skills) involves using self-control to facilitate goal-directed behaviour, manipulating current information in working memory, and shifting between different tasks or cognitive states (Miyake et al., 2000). It falls within our professional domain to understand the implications of this on occupation. We have the core skills and knowledge to identify and intervene in these challenges - such as via activity analysis, environmental adaptation, grading, problem solving and the therapeutic use of occupation (RCOT, 2019). Drawing specific attention to Alcohol Related Brain Damage (ARBD) or Alcohol Related Cognitive Impairment (ARCI): You may have heard of 'alcohol dementia', Wernicks-Korsakoff syndrome or other variations; ARBD is the umbrella term. As a profession, we have a great deal to offer those experiencing this life-altering (but potentially reversible) condition (ARBD Network, 2023). ARBD has a pronounced effect on executive function, that impacts on one’s ability to successfully participate in all occupational domains over time. As occupational therapists, we support the (re)engagement in occupations, that provide a meaningful alternative or moderating influence on alcohol consumption. We can support and educate carers to modify the social environment and grade occupations accordingly. We can provide evidence and guidance around potential care arrangements, or placements to support individua ls to live more meaningful and independent lives. To put it briefly The strength and value of occupational therapy presence in substance use services comes from our understanding of the effects of conditions on occupational participation. Our core skills help to elucidate the challenges, and to formulate interventions to protect or restore participation in meaningful occupations. No other profession in this field does what we do. We are principally concerned with the connection between occupation and health, which becomes more nuanced and complex with substance use. Through being better informed about the impacts of addiction on the mind - and the pervasive effects of stigma - we might better equip ourselves to support individuals to be the agents of their own change. About the author Jon Fisher is an Occupational Therapist working in Aneurin Bevan Specialist Drug and Alcohol Service (ABSDAS) in South Wales, UK. Jon accrued years of experience working in substance use services around the UK prior to training as an Occupational Therapist; he worked in various mental health roles, before combining his knowledge, skills and experience to develop the new role in Aneurin Bevan UHB. Jon is facilitator for the UK and Ireland’s ' Occupational Therapy and Substance Use Network '. The professional network brings together occupational therapy colleagues from around the UK and Ireland for practice support, sharing of knowledge and resources and to pursue the development of evidence and recognition with the RCOT. For responses or further information, contact Jon: via email - jonathan.fisher2@wales.nhs.uk or via X (formerly Twitter) - @Fisheraddiction . References Alcohol Change UK (2019) Alcohol statistics. Available online: https://alcoholchange.org.uk/alcohol-facts/fact-sheets/alcohol-statistics . Ahmedani, B.K. Mental Health Stigma: Society, Individuals and the Profession. J Soc Work Values Ethics . 2011 Fall; 8(2): 41416. PM ID: 22211117; PMCID: PMC3248273. ARBD Network (2023) What is ARBD? Available online: https://arbd.net/what-is-arbd/ . Bevan Commission (2021) Evaluating the value and impact of occupational therapy in primary care . Available online: https://bevancommission.org/programmes/bevan-exemplars/ Canales, J.J., Williams, R., Sahoo, S., Crivelli, D., Balconi, M., Losasso, D. and Balena, A. (2022). Neurocognitive impairment in addiction: A digital tool for executive function assessment. Neurocognitive and EF impairment in psychopathology: A focus on addiction . Doğu, S.E. and Özkan, E. (2023). The role of occupational therapy in substance use. NAD Nordic Studies on Alcohol and Drugs . 40(4), 406-413. https://doi.org/10.1177/14550725221149472 . Fisher, J. (2022) Exploring the value of occupational therapy in substance use settings. Therapy Articles - The Occupational Therapy Hub . Available online: https://www.theothub.com/article/exploring-the-value-of-occupational-therapy-in-substance-use-settings . Gutman, S. A. (2006). Why addiction has a chronic, relapsing course. The neurobiology of addiction: Implications for occupational therapy practice. Occupational Therapy in Mental Health. 22 (2), 1-29. https://doi.org/10.1300/J004v22n02_01 . Kitzinger, R.H., Gardner, J.A., Moran, M., Celkos, C., Fasano, N., Linares, E., Muthee, J. and Royzner, G. (2023). Habits and Routines of Adults in Early Recovery From Substance Use Disorder: Clinical and Research Implications From a Mixed Methodology Exploratory Study. Substance Abuse: Research and Treatment . 17 , 117822182311538. https://doi.org/10.1177/11782218231153843 . Maharjan, S., Amjad, Z., Abaza, A., Vasavada, A.M., Sadhu, A., Valencia, C., Fatima, H., Nwankwo, I., Anam, M. and Mohammed, L. (2022) Executive Dysfunction in Patients With Alcohol Use Disorder: A Systematic Review. Cureus . https://doi.org/10.7759/cureus.29207 Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., Howerter, A. and Wager, T.D. (2000) The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology. 41(1), 49-100. https://doi.org/10.1006/cogp.1999.0734 PMID:10945922 Morris, J. and Cox, S. (2022) Drinkers like us? The availability of relatable drinking reduction narratives for people with alcohol use disorders. Royal College of Occupational Therapists (2019) Learning and development standards for pre-registration education . Available online. Royal College of Occupational Therapists (2018) Getting my life back . Available online: https://www.rcot.co.uk/sites/default/files/Getting-my-life-back_England.pdf . Rojo-Mota, G., Pedrero-Ṕerez, E.J. and Huertas-Hoyas, E. (2017). Systematic review of occupational therapy in the treatment of addiction: Models, practice, and qualitative and quantitative research. In American Journal of Occupational Therapy (Vol. 71, Issue 5). American Occupational Therapy Association, Inc. https://doi.org/10.5014/ajot.2017.022061 . Ryan, D.A. and Boland, P. (2021). A scoping review of occupational therapy interventions in the treatment of people with substance use disorders. In Irish Journal of Occupational Therapy (Vol. 49, Issue 2, pp.104-114). Emerald Group Holdings Ltd. https://doi.org/10.1108/IJOT-11-2020-0017 Sliedrecht, W., de Waart, R., Witkiewitz, K. and Roozen, H.G. (2019). Alcohol use disorder relapse factors: A systematic review. In Psychiatry Research (Vol. 278, pp. 97-115). Elsevier Ireland Ltd. https://doi.org/10.1016/j.psychres.2019.05.038 . Twinley, R. (2020). Illuminating the dark side of occupation: International perspectives from occupational therapy and occupational science . Abingdon, Oxon; New York, NY: Routledge. UK Government (2021) Adult substance misuse treatment statistics 2020 to 2021: report. Available online: https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2020-to-2021/adult-substance-misuse-treatment-statistics-2020-to-2021-report . UK Government (2023) Local alcohol profile for England: short statistical commentary, March 2023 . Available online: https://www.gov.uk/government/statistics/local-alcohol-profiles-for-england-lape-march-2023-update/local-alcohol-profiles-for-england-short-statistical-commentary-march-2023 . UK Government (2021) National Statistics. Adult substance misuse treatment statistics 2020 to 2021: report . Available from: www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2020-to-2021/adult-substance-misuse-treatment-statistics-2020-to-2021-report Valdes, K. and Lunsford, D. (2021). Executive Functioning of Individuals With Substance Use Disorder. Annals of International Occupational Therapy . 4(4). https://doi.org/10.3928/24761222 2021092101. Vegeris, E.L. and Brooks, R. (2022). Occupational Lives in Sustained Recovery From Alcohol Dependency: An Interpretive Phenomenological Analysis. OTJR Occupation, Participation and Health , 42 (1), 22-29. https://doi.org/10.1177/15394492211042265 . Wasmuth, S., Brandon Friedman, R.A. and Olesek, K. (2016). A grounded theory of veterans’ experiences of addiction as occupation. Journal of Occupational Science, 23 (1), 128-141. https://doi.org/10.1080/14427591.2015.1070782 . Wasmuth, S.L., Outcalt, J., Buck, K., Leonhardt, B.L., Vohs, J. and Lysaker, P. H. (2015) Metacognition in persons with substance abuse: Findings and implications for occupational therapists. Canadian Journal of Occupational Therapy . 82(3), 150-159. https://doi.org/10.1177/0008417414564865 . Wasmuth, S., Crabtree J.L. and Scott, P.J. (2014) Exploring Addiction as Occupation. British Journal of Occupational Therapy . 2014; 77(12): 605-613. doi:10.4276/030802214X14176260335264. World Health Organization (2001) WHO. World Health Report 2001. Mental health: new understanding, new hope . WHO: Geneva, Switzerland; 2001.

- Lymphoedema: Definition and Prevalence - Did you know that over 150 million people worldwide suffer from lymphoedema (US 'lymphedema'), a condition that can severely impact daily life?    Our lymphatic system complements the immune and circulatory systems. It consists of a series of one-way channels that transport lymphatic fluid ('lymph') from the tissues to the bloodstream. Functions of lymph include fluid balance, immunity and fat absorption. Lymphoedema is an accumulation of protein-rich fluid in the interstitial space, that causes reactive inflammation and fibrosis.  It occurs when lymph builds up in tissues, instead of returning to the circulatory system. Protein molecules accumulate, which causes thick, hard tissue; this protein build-up draws more water into the tissues and leads to a heavy, painful and potentially immobile limb. Physiology of lymphoedema Lymphoedema affects approximately 15% of all cancer survivors and 30% of all those treated for breast cancer (Manrique et al., 2022) Lymphoedema can be further classified as primary or secondary: Primary lymphoedema is inherited; it may occur at birth but more often later in life Secondary lymphoedema is due to a known trauma or injury to the lymphatic system, such as surgical removal of lymph nodes, or radiation therapy (Showalter et al., 2013) - Lymphoedema: The Signs - Swelling in the trunk Increased limb size Heaviness or tightness in a limb Aching or discomfort Erythema - redness of the skin Pitting of the skin when pressed Lymphorrhea - an abnormal lymph fluid flow that occurs when the pressure from swelling inside of the tissue is too high for the skin to contain, or there is an opening to the skin's surface Positive Stemmer's sign - the inability to pick up a fold of skin at the base of the second toe or middle finger   - Stages of Lymphoedema - Stage 0 The latent stage, in which the lymphatic system is functioning inadequately, but it is coping by means of compensatory mechanisms. No oedema is present. Stage 1 The reversible stage . The lymphatic system is overburdened at this point. Protein-rich, soft swelling develops. When the affected limb is elevated, the swelling reduces on its own. Stage 2 The spontaneously irreversible stage. Excessive connective tissue has formed and begins to harden. Elevating the limb no longer reduces the swelling, due to the fluid becoming richer in protein. Stage 3 Considered elephantiasis . At this stage, extreme swelling is present, the skin is hardened, wart-like growths develop and cellulitis is commonly correlated.  Stages of Lymphoedema - CDT: A Gold-standard Process - Complete Decongestive Therapy (CDT)  is the gold-standard process for lymphoedema management. It consists of two phases: Decongestion and reduction Maintenance Both phases consist of four elements and must be applied together for effectiveness: Skin care Manual Lymph Drainage (MLD) Compression therapy Therapeutic exercise The treatment phase commences with meticulous skin care. Secondly, it includes MLD - a hands-on technique that uses skin stretching to encourage fluid to move out of an area where there is swelling and into healthy lymph nodes. This allows the body to reabsorb the protein-rich fluid accumulation and move it into the bloodstream. Phases of the CDT Process   Third, compression bandaging is donned. The affected limb is wrapped with short-stretch compression bandages, to encourage fluid to move up and out of that limb and to prevent re-accumulation of fluid. The expectation is to wear compression bandages for approximately 23 hours per day - until the next treatment session - to reduce the size of the swollen limb. Fourth, therapeutic exercise encourages muscle movement , that helps to move lymph out of an affected limb. It is completed with the compression bandages donned.    The maintenance phase entails the patient being responsible for self-management . It involves continuation of skin care, self-MLD, therapeutic exercise, hydration and monitoring of symptoms that were taught to the patient in the treatment phase. Instead of donning short-stretch compression bandages, it involves the use of prescribed, custom-fitted compression garments (NLN Medical Advisory Committee, 2010). Short-Stretch Compression Bandaging of the Arm  - The Role of Occupational Therapy - As a result of lymphoedema, quality of life, functional mobility, range of movement and activities of daily living (ADLs) are negatively impacted. Occupational therapists (OTs) provide lymphoedema management in a holistic manner, within acute care, inpatient rehabilitation and outpatient settings. This ensures that services are based on the person's goals and preferences, in order to support his or her activities of daily living (Occupational Therapy Board of Australia, 2015). OTs are best skilled at exploring the impact of swelling and fatigue on one's ability to perform activities of daily living (ADLs) , such as showering and dressing (AOTA, 2014). Additionally, instrumental activities of daily living (iADLs) - which involve household chores, driving and social engagement - are more complex. They are based on the interplay between one's physical and social environments , which leads to an overall sense of self-worth (AOTA, 2014). Occupational therapists provide patients with knowledge regarding lymphoedema - and any potential, corresponding complications, as lymphoedema is complex and multi-faceted. The aim of this education is to empower patients to self-manage their swelling and be aware of any changes to their symptoms. OTs facilitate problem-solving strategies, to allow patients to increase their independence in their daily routine. One of the biggest things that I have learned as a Certified Lymphoedema Therapist is that occupational therapists play a key role in enabling patients to advocate for themselves. Many of my patients come to me after years of experiencing lymphoedema; they have not received the treatment they need and have given up. Thus, occupational therapists have the important role of giving patients hope , while utilising evidence-based practice and allowing them to engage in their meaningful occupations again. The extent of the impact of lymphoedema on patients' daily routines can be quantified by the Lymphoedema Quality of Life Study . This written questionnaire includes a rating scale of 'not at all' to 'a lot', in relation to the impact of lymphoedema on items such as   appearance, donning clothing, mobility, social participation and mental health: Lymphoedema Quality of Life Tool (Arm) - How to Become a Certified Lymphoedema Therapist - The first step to becoming a Certified Lymphoedema Therapist (CLT) is to attend a certification course, entailing 135 hours of education. This course includes education on anatomy, physiology, prevalence, case studies and hands-on practice with completing MLD and donning the short-stretch compression bandages. Upon completion of the training course, therapists earn the credentials 'CLT'. To additionally earn the full credentials of 'CLT-LANA' (Certified Lymphoedema Therapist - Lymphology Association of North America), therapists must pass a standardised, 130-question exam. - Conclusion - Lymphoedema is a build-up of lymph fluid in the fatty tissue just under the skin. As a result, mobility, quality of life and independence are reduced.  Whilst better treatments for cancer have been developed, the prevalence of lymphoedema has risen by over 30% over the past 10 years . Thus, lymphoedema currently affects approximately five million Americans (Armer et al., 2011). The efficacy of CDT supports its use in improving oedema, range of motion, quality of life and activities of daily living in patients. However, patients' compliance and carryover of home care recommendations are imperative for successful lymphoedema management. Support groups and online resources provide valuable information for patients. Organisations such as the National Lymphedema Network offer educational materials and advocacy efforts. A career as a CLT is rewarding to consider, as it combines science and creativity. It also yields great objective feedback, in the form of circumferential measurements, to quantify the reduction in the size of patients' limbs.   Submitted by: Chelsea Laur, MSOT, OTR/L, CLT-LANA, CWT  Certified Lymphedema Therapist - Lymphology Association of North America (CLT-LANA)   Certified Wound Therapist (CWT) - References and Further Resources - American Occupational Therapy Association (AOTA) (2014) Occupational therapy practice framework: Domain and process (3rd ed). American Journal of Occupational Therapy . 68, S1-S48. Available from: https://doi.org/10.5014/ajot.2014.682006 . Armer, J.M., Brooks, C.W. and Stewart, B.R. (2011) Limitations of self-care in reducing the risk of lymphedema: Supportive-educative systems.  Nursing Science Quarterly , 24(1), 57-63. Available from: https://doi.org/10.1177/0894318410389058 . Keeley, V., Crooks, S., Locke, J., Veigas, D., Riches, K. and Hilliam, R. (2010) Lymphoedema Quality of Life Tool. Journal of Lymphoedema . 2010, 5 (1). Available from: https://lymphoedemaeducation.com.au/wp-content/uploads/2019/03/JoL_Quality_of_Life_Measures1.pdf . Manrique, O.J., Bustos, S.S., Ciudad, P., Adabi, K., Chen, W.F., Forte, A.J., Cheville, A.L., Jakub, J.W., McLaughlin, S.A. and Chen, H.C. Overview of Lymphedema for Physicians and Other Clinicians: A Review of Fundamental Concepts. Mayo Clinic Proceedings . 2022, 97(10): 1920-1935. Available from: https://www.mayoclinicproceedings.org/article/S0025-6196(20)30033-1/fulltext .  PMID: 32829905. National Lymphedema Network (2025) What is Lymphedema? (online). Available from: https://lymphnet.org/page/what-is-lymphedema . NLN Medical Advisory Committee (2010) Lymphedema risk reduction practices. Position Statement of the National Lymphedema Network. Occupational Therapy Board of Australia (2015) Position statement: Occupational therapy in oncology. Australian Occupational Therapy Journal . 62, 462-464. doi:10.1111/1440-1630.12265.   Showalter, S.L., Brown, J.C., Cheville, A.L., Fisher, C.S., Sataloff, D. and Schmitz, K.H. (2013) Lifestyle risk factors associated with arm swelling among women with breast cancer.  Annals of Surgical Oncology . 20(3), 842-849. Available from: https://doi.org/10.1245/s10434-012-2631-9 .

Sexual activity and intimate social participation are often considered meaningful occupations . Healthy intimate relationships and satisfaction with one’s self as a sexual being have the potential to contribute to quality of life and wellness. While sexuality and intimacy can play a very positive role in individuals lives, there is also the potential for sexuality to have grave consequences and be used as a vessel of power. Considering the powerful impact of sexuality on individuals' lived experiences, occupational therapy professionals should be prepared to address sexuality and intimate occupations with their clients. Occupational therapy professionals are perfectly situated to address sexuality and intimacy occupations , due to our training in activity analysis, therapeutic use of self, cultural competency and trauma informed care.

The article explores the benefits of a therapeutic drumming group in inpatient rehabilitation, delivered as an occupational therapy (OT) intervention. What are the benefits of therapeutic drumming? The functional benefits of therapeutic drumming are broad and include: Facilitation of pain management Social connection Cognitive processing Perceptual-motor function Short-term memory Coordination skills Therapeutic drumming can help to control chronic pain, by serving as a distraction ; it also promotes the production of endorphins and endogenous opioids... "The endogenous opioid system is widely distributed throughout the central and peripheral nervous systems and plays an important role in various physiological functions, including regulation of pain, emotion and the response to stress" (Drolet et al. 2001). The group also facilitates social connectedness . Following group participation, patients often comment that they feel better about their current situation in the hospital, after hearing other patients' stories. Patients from the group have even decided to meet for dinner in the hospital's dining room - versus eating alone in their rooms - which promotes improved mental health and social connection. This can also lead to an increase in patients' motivation to partake in their therapy sessions. In addition, the sound of drumming generates new neuronal connections in various parts of the brain: " Integrating drumming as a mind-body activity of purposeful rhythmic movement to music may stimulate neuroplasticity in several cognitive functions, such as learning and memory, to learn new movement patterns, attention to follow instructions, executive functions to execute complex movement patterns, and social cognition to connect movement with meaning and emotional expression amid social interactions" - Toader et al. (2023) Furthermore, the use of therapeutic drumming can be beneficial to improve perceptual motor function , as part of rehabilitation for people with various diagnoses, including Parkinson's disease. Taking part in physically active and socially integrated activities, such as drumming, may help to maintain or improve cognitive function and lower the risk of acquiring dementia over time (Toader, et al., 2023). Short-term memory loss impacts daily routines, including functional sequencing of activities of daily living (ADLs). In the therapeutic drumming group, I verbalise an interesting fact regarding the band or artist of the subsequent drumming song. At the end of the song, whoever recalls that fact earns a prize, as an extrinsic motivation to improve their memory recall.  Lastly, the therapeutic drumming patterns that I facilitate involve unilateral, bilateral, alternating upper and lower body movements. This develops Proprioceptive Neuromuscular Facilitation (PNF) patterns , to facilitate improved coordination and motor planning skills. Therapeutic drumming allows patients to set their own pace and improve their coordination through repetition. Every Friday, I lead at the hospital where I work. I will detail here the session plan, to support other occupational therapists to consider the use of drumming in their practice... - Group Structure - The group commences with patients introducing themselves and answering an icebreaker question.  Next, the benefit and structure of the group are explained. I then share an interesting fact about the band or artist to which the group will be drumming. Lastly, I verbalise and demonstrate a movement pattern with the drumsticks to start the song - and the group follows along. Throughout each song, the movement patterns are graded , to be progressively more complex, facilitating a just-right challenge for the group participants. - Supplies - The group of approximately 12 patients per week sits in a large circle. As program supplies, I have:- Drumsticks 5-gallon buckets Yoga balls Built-up foam tubing 10-gallon water jugs, with handles Wrist weights The yoga balls are placed on top of the 5-gallon buckets, with the opening of the buckets facing upwards, for stabilisation of the yoga balls. The foam tubing is an optional modification, for patients with decreased functional grasping skills to grasp the drumsticks. The 10-gallon water jug is an alternative instrument for patients with decreased unilateral upper extremity strength, coordination or hemiparesis ; it allows the patient to stabilise the empty water jug with his or her affected arm and utilise the unaffected arm to grasp a drumstick. Furthermore, the wrist weights serve as an optional challenge, for patients to put on their wrists or biceps for increased strength-building . My musical playlist includes bands and artists such as:- Aretha Franklin, The Beatles, Twisted Sister, Elvis Presley, Jackson 5, Credence Clearwater Revival, Queen, Johnny Cash, Van Halen, Michael Jackson, Kiss and Journey. Of course, you could select any songs that you feel patients would enjoy participating to!   Conclusion Therapeutic drumming is a holistic intervention that can be adapted to patients with a variety of diagnoses and clinical presentations . You do not need specialised equipment or extensive set up to participate. It can be conducted as an individual, concurrent, or group activity session. Regardless of patients' coordination and rhythm, creating a sound is therapeutic, as it serves as a powerful form of self-expression . If you are looking for a new group idea, or a creative intervention approach, I encourage you to try therapeutic drumming with your patients!   Submitted by: Chelsea Laur, MSOT, OTR/L, CLT-LANA, CWT Certified Lymphedema Therapist (CLT) - Lymphology Association of North America (LANA) Certified Wound Therapist (CWT) References   Drolet , G., Dumont , É.C., Gosselin , I., Kinkead , R., Laforest , S. and Trottier, J-F. (2001) Role of endogenous opioid system in the regulation of the stress response.  Progress in Neuro-Psychopharmacology and Biological Psychiatry.  Vol. 25, 4: 729-41. https://doi.org/10.1016/S0278-5846(01)00161-0   Toader, C., Tataru, C.P., Florian, I.A., Covache-Busuioc, R.A., Bratu, B.G., Glavan, L.A., Bordeianu, A., Dumitrascu, D.I. and Ciurea, A.V. (2023) Cognitive Crescendo: How Music Shapes the Brain’s Structure and Function .  Brain Sciences. Vol. 13, 10. doi: 10.3390/brainsci13101390.

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. The insomnia team: (Left to right) Susan Hayes (OT), Louise Berger (OT), Helen McNamara (OT) 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. [Stock image; not actual patient] 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. [Stock image; not actual patient] 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! Louise Berger OT - Article and podcast author 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. C reated 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.

By Ali Sutani, OT Reg. (Ont.) What do a smart vest , augmented reality (AR) goggles and a simple ergonomic chair have in common? On the surface, they may seem like everyday tools. But... ...through the lens of occupational science - the study of how we engage in meaningful activities - they represent the future of what I like to call occupational 'products'. These are not just tools - they are evolving systems , designed to enhance how we live and work. As an occupational therapist (OT), I've spent my career exploring the fascinating relationship between people, their environments and the tools they use. The emergence of occupational products marks a pivotal shift in this relationship - pushing us to rethink how technology and design can meet human needs. Whether it is helping someone regain independence at home or optimising workflows in high-stakes industries, these products are transforming the way we perform, connect and thrive . What Are Occupational Products? At their core, occupational products are tools or systems that support how people engage in daily activities. They go beyond mere functionality; they are designed to integrate seamlessly into our routines, adapt to our needs and even anticipate challenges we might face. Think about a connected smartwatch that tracks your stress levels and nudges you to take a mindful break. Or consider an exoskeleton that supports a warehouse worker's back, enabling heavy lifting without strain. These innovations aren't just techy gadgets - they are part of a broader movement to create products that align with what matters most: human well-being, autonomy and connection . People, Places and Things That Shape Us Occupational science teaches us that meaningful activity is never isolated - it happens at the intersection of three elements : the person, the place and the thing. The Person : Each of us brings our unique goals, abilities and challenges to the table. Occupational products must honour this individuality . For example, an augmented reality headset might help a surgeon perform intricate procedures by projecting real-time instructions onto their field of vision, reducing cognitive load and enhancing focus. For someone recovering at home, a wearable might offer gentle reminders to stretch or hydrate. The Place : Our environments profoundly influence how we engage with the world . Well-designed occupational products adapt to these environments, whether it is a crowded hospital, a quiet library, or a chaotic construction site. Take the example of collaborative digital platforms that allow remote teams to work together seamlessly, creating a sense of shared purpose, even across distances. The Thing : And, of course, there is the tool itself - the occupational product. These tools are evolving, from static objects to dynamic ecosystems. Modern occupational products, powered by artificial intelligence (AI) and advanced materials, don't just react to us - they interact with us . They guide, protect and even grow with us, enabling not just performance, but empowerment. Why do Occupational Products Matter? The global workforce is facing profound changes. Automation, hybrid work models and the growing importance of mental health have reshaped what 'work' means. Occupational products are uniquely positioned to address these challenges, by fostering autonomy, competence and relatedness - three key pillars of human motivation, identified in Self-Determination Theory . Autonomy : Empowering people to take control of their tasks and environments. Competence : Supporting skill development and confidence, through intuitive design and feedback. Relatedness : Strengthening connections by facilitating collaboration and shared goals. For example, a simple app that gamifies daily chores can transform a mundane task into a family bonding experience. Or a virtual reality module that simulates real-world challenges can prepare workers for high-pressure situations, enhancing their confidence and resilience. Occupational Products in Action Imagine this: You are in a bustling hospital, where nurses use smart wearables that monitor patient observations/vitals, while also tracking their own well-being. The devices send reminders to take breaks, reducing burnout, while ensuring high-quality care. Or consider a small business, where employees use a shared task app to assign and track responsibilities . Tasks like 'organise inventory' or 'prep for meeting' are gamified with points and badges, making the workday more engaging. These aren't just hypothetical scenarios - they are real-world examples of how occupational products are reshaping daily life. The Road Ahead Occupational products are still in their early stages, but their potential is vast. From AI-driven personal assistants that anticipate needs, to AR overlays that make learning new skills intuitive, the possibilities are endless. As these tools become more integrated into our lives, the role of occupational therapists will expand. We will be at the forefront of ensuring that these innovations remain human-centred, accessible and ethical . As someone passionate about blending human care with intelligent design, I believe this is just the beginning... Whether you are a healthcare provider, a designer, or a curious consumer, I invite you to explore this exciting intersection of technology and occupational science. Let's work together to create tools that don't just solve problems, but enrich lives . Occupational products aren’t about replacing human effort - they are about enhancing it. They are not about controlling our actions - they are about empowering us to live and work with greater meaning and ease. After all, every tool we create tells a story about who we are and who we aspire to be. Let's make that story one of connection, innovation and progress. Watch Further learning Revolutionising Healthcare and AI's Transformation [Video credit: BioTech Whisperer ] OT and Artificial Intelligence: OT CEU Course with Sarah Brzeszkiewicz [Video credit: OT Potential]

Ramadan is known as the fasting month for Muslims around the world. They will fast from fajr (dawn) to maghrib (twilight). There is no eating and drinking permitted during that period. Parents will encourage their children to learn fasting as part of the ritual this month, including families with neurodiverse children, before they reach adulthood. Ramadan means adopting a new routine to the other months of the year. It can be challenging for children to start a new routine for just a month - and then go back to the previous daily routine. As a Muslim occupational therapist, who works with neurodiverse children, I have personal and professional experience of supporting these activities. Here are several tips that parents can use to introduce fasting to their children - or occupational therapists can suggest to families they work with: Before Ramadan Storytelling. Read a book about fasting during Ramadan. A social story book from Carol Gray is very useful to introduce a new routine. Use visual aids to help them visualise it. Pictures or videos are welcome. a) Suhoor : Eating in the very early morning (before dawn) b) Fasting : No eating and drinking from dawn to twilight c) Iftar : Break the fast at twilight time Use a countdown approaching the first day of Ramadan. Include when it starts and ends. During Ramadan Set the exact time for a child to wake up for suhoor every day. Please refer to prayer time to make enough time for a child to have a meal. Prepare the child’s favourite meal during suhoor and break the fast to make them more excited. Display the prayer schedule during Ramadan, so children know what time fasting starts (fajr time) and ends (maghrib time). Use the iftar to celebrate the fasting of the day. A graded approach! Set fasting duration time for several hours and gradually extend the time toward maghrib. It’s OK if the child wants to break the fast in the middle of the day, then continue fasting towards maghrib. Use an analog clock to help the child understand that time has passed by and they are getting close to breaking the fast time. Use the Ramadan calendar to track the days passing by. The child can mark off the day by crossing it, or putting a sticker on it. Be ready to be the child’s co-regulator during the process. They have to deal with an unfamiliar and new routine - and sometimes it may cause negative emotions to come up. Set expectations lower because it is a learning time; making mistakes or not achieving goals is part of the process! Be ready to be the child’s co-regulator during the process. They have to deal with an unfamiliar and new routine - and sometimes it may cause negative emotions to come up. Reference Carol Gray Social Stories (online). Available from: https://carolgraysocialstories.com/ . Accessed 5 March 2023. Further reading Birmingham Live (2022) Ramadan on the spectrum - 'how autism affects how I celebrate the holy month' (online). Available from: https://www.birminghammail.co.uk/news/midlands-news/ramadan-spectrum-how-autism-affects-23570286# . Accessed 5 March 2023.

Emma Barteau, OTS When I arrived on the island of Curaçao for the first time, I had little idea of what was to come from the culture, the people, or the healthcare system. Having only left the US once before, this was a bit of a leap : finishing my occupational therapy (OT) schooling with a capstone experience in a foreign country. Though, yes, I did plenty of research, Google searching - and even joined Facebook groups before arriving - there is no way to grasp the fullness of a new place without stepping foot in it! Once there, it didn't take long to fall into the rhythm of life on the island, figuring out how to navigate the busy streets and finding the local shops in the area. The site of my capstone project - the physical rehabilitation centre for the island - also became familiar, following days of observation, interviews and asking plenty of questions. It became evident that OT here was not an alien profession; many treatments and activities echoed those I had seen in the US. T he island of Curaçao - location for this OT capstone project As my understanding of the facility and the OTs grew, it also became clear that there was a need for the project I hoped to enact. I arrived with the purpose of advocating for mental health care to be provided from the perspective of OT - which I quickly learned would require a multifaceted approach to balance the influencing factors... Physical and Mental Health (the 'mind-body connection') This rehabilitation facility, like most, provides care for a variety of people needing inpatient services, following major changes in health: strokes, amputations, spinal cord injuries , etc. could be expected to be seen in the patient population. Just by following along with patient treatments and conversations among practitioners, I could see very early on that depression and anxiety were not uncommon and often had influence on the course of treatment . Diving into the literature further confirmed this, as I learned that physical disorders are highly associated with changes in mental health, including mental distress (Cree et al., 2020; Damsbo et al., 2020; Kang et al., 2015; Terrill et al., 2018). Interestingly, this relationship appears to work both ways , as other sources identified mental distress as a contributor to disability (Rai et al., 2011). This relationship of the body and mind paints a picture of a patient population in a vulnerable situation, with increases in mental health risks. At this facility, there is a psychology team, who work with patients who demonstrate the need for psychological intervention. This is a great service to have available, sure, but there is a distinct isolation of the mind and body in this structure . Psychology addresses the mind, OT addresses the upper body, physiotherapy (/physical therapy, PT) addresses the lower body, that kind of thing. Instead, our profession has been rooted in holism ; several models and frameworks describe the interwoven relationship of the personal and environmental factors, as well as the mind-body connection. In our education to become OTs, we don't only cover pathologies and treatments of the upper extremity, but learn to assess the whole person.  Role of Culture Curaçao is a constituent island country within the Kingdom of the Netherlands, in the southern Caribbean Sea, about 65 km (40 miles) north of Venezuela When talking about the whole person, culture must also be considered - especially in the circumstances of this project. Curaçao, a Caribbean melting pot , contains Dutch, Portuguese, South American, Indian and African influences, with additional visitors to the island year-round. In this blend, there are attitudes and beliefs of health and illness which influence the help-seeking and treatment of mental health conditions. Unfortunately, there are reports of stigmatisation of physical and mental illness in Curaçao, which impact individuals' participation in society. Due to the cultural diversity of the island, though, it is impossible to identify a single belief system by which the population operates, requiring more emphasis to be placed on a person's individual background, experiences and values. The benefit for patients in the rehabilitation facility is that mental health needs are commonly identified by staff who spend time with the patients every day, such as the OTs. The ultimate willingness to discuss mental health and receive treatment still remains the patient's prerogative.  The Project The final design of the project reflects a balance of the factors discussed: Adjoining the assessment and treatment of the mind and body Working inter-professionally with psychology and other professions Maintaining cultural respect, while exploring beliefs To do this, three strategies are being employed: Staff education : As there appears to be some general confusion about the scope of OT assessment and treatment, advocacy will be provided for the profession among the facility staff, through a presentation. Then, mental health basics will be introduced, with an emphasis on what OT can do in this sphere.  Development of a screening tool : A short screening tool has been written to meet the needs of the site population, while maintaining OT scope and cultural needs. This tool will be piloted among the site population and OTs will receive training on its use.  Development of a resource library : Based on the outcome of the screening tool, a practitioner can then employ use of this library, by locating relevant handout and activity materials for a patient. These educational and interventional materials have been designed to provide a brief but effective mode of addressing mental health skills.  All materials are also being translated into the prominent local languages: Papiamento and Dutch.  Reflecting Although I am still in the midst of this project, I already feel as though I have gained invaluable experience, both as a future practitioner and as a person . I have grown a passion for unifying mental and physical health services - a need I know exists in the US as well. I hope that my gained awareness of cultural influences on health and illness will help me as I assess and treat future clients, refraining from making assumptions of their experiences. I am more than thankful for the time I have in Curaçao - and for the holistic and client-centred spirit of occupational therapy . References Cree, R.A., Okoro, C.A., Zack, M.M. and Carbone, E. (2020) Frequent mental distress among adults, by disability status, disability type and selected characteristics - United States, 2018. MMWR. Morbidity and Mortality Weekly Report , 69 (36), 1238-1243. https://doi.org/10.15585/mmwr.mm6936a2 Damsbo, A.G., Kraglund, K.L., Buttenschøn, H.N., Johnsen, S.P., Andersen, G. and Mortensen, J.K. (2020) Predictors for wellbeing and characteristics of mental health after stroke. Journal of Affective Disorders , 264 (264), 358-364. https://doi.org/10.1016/j.jad.2019.12.032 Kang, H.-J., Kim, S.-Y., Bae, K.-Y., Kim, S.-W., Shin, I.-S., Yoon, J.-S. and Kim, J.-M. (2015) Comorbidity of depression with physical disorders: Research and clinical implications. Chonnam Medical Journal , 51 (1), 8-18. https://doi.org/10.4068/cmj.2015.51.1.8 Rai, D., Kosidou, K., Lundberg, M., Araya, R., Lewis, G. and Magnusson, C. (2011) Psychological distress and risk of long-term disability: Population-based longitudinal study. Journal of Epidemiology and Community Health , 66 (7), 586-592. https://doi.org/10.1136/jech.2010.119644 Terrill, A.L., Schwartz, J.K. and Belagaje, S.R. (2018). Best practices for the interdisciplinary rehabilitation team: A review of mental health issues in mild stroke survivors. Stroke Research and Treatment , 2018 , 1-8. https://doi.org/10.1155/2018/6187328

Introduction I am currently doing a sensory integration module and I have chosen to develop an article to help my learning. Neuroplasticity is a core concept which I will explore further during this article. I will summarise some of the key learning points to consolidate my knowledge. This feels highly relevant to my role, in relation to trauma and mental health . The brain can change Neuroplasticity refers to the ability of neurons and neural networks to alter and adapt behaviour as a consequence of new information, such as sensory messages, damage or dysfunction (Britannica Academic, 2022). This can take place throughout the human lifespan, but is particularly prominent at key developmental milestones , such as early childhood or puberty (Erikson, 1982). Throughout the lifespan, synapses strengthen or weaken neural connections and we are able to update our knowledge and adapt our behaviour in context to the environment. There are many different theories of development, including the nature vs nurture debate (Bundy et al., 2020). However... Recent literature suggests that gene expression is based upon the specific environment within which one lives, which ultimately influences brain function and behaviour (Nelson et al, 2006). Research suggests that we maintain the neuronal connections and pathways that are most useful to us - and lose those that are less helpful. If someone experiences early adversity, their cortisol levels increase and act as a way to self-protect. Instinctive ways of behaving, such as fight or flight reactions, are formed in the amygdala and hypothalamus (Gerhardt, 2011). This results in the strengthening of neuronal pathways and synapse connections in these areas. Consequently, young children who live in an environment with angry or aggressive people will keep pathways that help them become alert to anger and danger (Gerhardt, 2011). This function also serves to impede the development in other areas of the brain, that relate to social, emotional, sensory and cognitive connections (Ward, 2017). Even when the threat has reduced, a child can maintain higher levels of stress/cortisol into later years, which impacts the parasympathetic system and immune functioning (e.g. rest and digest). It can also impede social and emotional learning, as the brain is preoccupied with managing stress. Scientific research highlights the key role of the social brain in controlling our emotions and determining behaviour. Neural pathways are formed as a result of environmental factors and situational experiences (Barker et al., 2018). The brain develops in response to social experiences and learned behaviour, a good example being emotional control. It is the primary caregiver who provides initial experiences of emotions being managed, before the baby can learn to self-soothe and manage her own feelings well (Gerhardt, 2014). My Practice I have always been interested in the impact of the environment on early development, due to my role in mental health . However, I had not realised the relevance to neuroplasticity. It has been helpful to review the evidence, to better support my practice. I was interested in some of the benefits of calorie restriction and intermittent fasting, due to a reduction in inflammation and oxidative damage (Zhu et al., 2012). From a neuroscience perspective, reducing calorie intake seems to improve synaptic resilience to damage and modify the number, architecture and performance of synapses. There were also noted improvements in sleep (Fusco and Pani, 2013) and verbal memory (Witte et al., 2009). This challenges our current perceptions on the importance of promoting regular meals. However, the authors did recognise that calorie restriction remains poorly understood, recommending more research before making conclusions. I was also interested in the value of promoting 'newness' and challenge , due to the benefits of environmental stimulation on cognitive function. A study found that music enhanced activation of the dorsolateral prefrontal cortex, to support retrieval of information and memory functioning (Ferreri et al., 2013). I think that the value of occupation on memory is rarely promoted in my area of practice (mental health), although perhaps more so in others (e.g. stroke or rehabilitation). We tend to promote diet, music and learning opportunities, but it is helpful to see the evidence here to support that. This research provides good evidence to support the role of neuroplasticity in everyday practice. Summary of importance This learning has helped developed my knowledge beyond a superficial level. The latest research explores the use of neuroplasticity and for promoting lifestyle changes (diet, sleep, relationships, exercise, etc) and improving general health, even in the later years. It is through enriching environments (e.g. learning opportunities), that neuroplasticity can occur. References Barker, Roger A., et al. (2018) Neuroanatomy and Neuroscience at a Glance. John Wiley and Sons. Britannica Academic (2022) 'Neuroplasticity'. Britannica Academic, Encyclopaedia Britannica. 3 September 2020. academic-eb-com.hallam.idm.oclc.org/levels/collegiate/article/neuroplasticity/442801 . Accessed 3 February 2022. Bundy, Anita C., et al. (2020) Sensory Integration: Theory and Practice . F. A. Davis. Erikson, E. H. (1982) The life cycle completed . New York, NY: WW Norton. Ferrarelli F., Smith R., Dentico D., Riedner B.A., Zennig C., Benca R.M., et al. (2013). Experienced mindfulness meditators exhibit higher parietal-occipital EEG gamma activity during NREM sleep. PLoS ONE Fusco S. and Pani P. (2013) Brain response to calorie restriction. Cell. Mol. Life Sci . 70 3157–3170 Gerhardt, S. (2011) Why Love Matters: How Affection Shapes a Baby’s Brain. Psychoanalytic Psychotherapist and Author of ‘Why Love Matters’ and ‘The Selfish Society’ . https://files.cdn.thinkific.com/file_uploads/472793/attachments/366/abf/b8e/QOC10Gerhard.pdf . Accessed 3 February 2022. Gerhardt, S., 2014. Why love matters: How affection shapes a baby's brain . Routledge Nelson, C., Johnson, M., Thomas, K. and de Hann, M. (2006) Brain development and neural plasticity. In Nelson, C., de Hann, M. and Thomas, K. (Eds.), Neuroscience of cognitive development . New Jersey: John Wiley and Sons Inc. Ward, J. (2017) The Student's Guide to Social Neuroscience . Psychology Press. Shaffer, J. (2016) Neuroplasticity and Clinical Practice: Building Brain Power for Health. Front Psychology . 7: 1118. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960264/ . Accessed 14 September 2022. Zhu B., Dong Y., Xu Z., Gompf, H.S., Ward S.A., Xue Z., et al. (2012). Sleep disturbance induces neuroinflammation and impairment of learning and memory. Neurobiology . 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Grabbing a cup of coffee, hailing a bus, using a computer, holding a phone to your ear, or simply scratching your head… Most of our daily actions involve our arms. But in many situations, when living with a muscular weakness, moving the arm can be challenging or even impossible.  This significantly impacts our ability to engage in daily activities and meaningful occupations, be they within domains of self-care, productivity or leisure. Occupational Therapists (OTs) can benefit from a deeper understanding of upper limb assistive technology and environmental adaption, to maximise potential for occupational engagement. Various devices exist to assist arm movement, such as arm supports, robotic arms and gripping aids. These devices help people maintain autonomy , by enabling them to manipulate objects for essential home tasks, work, or leisure activities. They also facilitate interaction with others and help keep muscles active. Causes of reduced arm mobility Many conditions can lead to loss of arm mobility due to motor or sensory effects, such as neuromuscular disease, or nervous system damage and lesions. Among the neuromuscular pathologies that affect arm mobility, examples include Duchenne Muscular Dystrophy, Infantile Spinal Amyotrophy, Limb-Girdle Muscular Dystrophy, Myotonic Dystrophy type 1, and Charcot-Marie-Tooth disease. In these types of pathologies, the loss of strength can be caused by muscular deterioration at the neuromuscular, nerve or motor neuron junction. Symptoms vary depending on the individual, the disease and its stage of progression. They can affect different parts of the arm, with: muscle weakness in the upper part of the arm (proximal muscles) muscle weakness in the forearm (distal muscles) impairment in the fingers and hand (fine dexterity, e.g. grip and pinch strength) In the case of Duchenne muscular dystrophy for example, muscle weakness is functionally apparent earlier in the lower limbs; it becomes more noticeable in the upper limbs following the loss of the ability to walk. Clinical and radiological studies show that motor deficits in these patients first affect the shoulders and progressively reach the muscles of the arms and forearms, especially those acting as extensors of the elbow and wrist. In the case of neuromuscular diseases, the reduction in muscle strength in patients generally leads to a loss of range of motion. This limitation in movement subsequently causes tendon contractures or osteo-articular stiffness. The resulting pain, which further limits movement and the ability to perform activities, creates a vicious circle. Lesions or injuries of the central nervous system (such as stroke, traumatic brain injury, cerebral palsy and spinal cord injuries)   can lead to highly variable motor deficits in the upper limbs.  In the case of a spinal cord injury (SCI), the higher the lesion in the spinal cord, the more the muscles of the upper arm (proximal muscles) will be affected. Depending on the degree of the lesion, the patient will retain more or less arm function. A complete lesion will result in a complete absence of movement below the lesion; an incomplete lesion will allow for arm movement, but with reduced strength. Patients who have experienced a stroke often display impaired reach and grasp functions. In this case, movements can be slower, less fluid and/or have a shorter range. The difficulty these patients have adapting the force used to grasp, manipulate and release objects appropriately is of a different nature to that presented by individuals with a spinal cord injury or a neuromuscular disease . Hence, many individuals living with a neuromuscular condition or a lesion of the central nervous system can benefit from the use of an assistive device for arm or hand function. Existing upper limb assistive technology Five types of assistive devices for the arm and hand are available. These devices assist or perform movements for the user. Each type meets a specific need: - Mechanical Arm Supports - Suitable where the person can perform the movement, but where repetitive actions cause fatigue. - Electric Arm Supports - Suitable where lifting the arm is difficult or impossible, but where bending the elbow and shoulder rotation are possible. - Robotic Arms with Gripping Devices - Suitable where arm and hand movements are severely limited or non-existent. - Gripping Aids for the Hand -  Suitable where it is possible to close the hand, but where maintaining the grip is challenging. - Electric Meal Aids - Suitable where lifting the hand to the mouth is difficult or impossible. These devices are adaptable to a variety of joint mobility situations, accommodating different levels in the shoulder, elbow and hand. Several clinical scales have been designed to measure the arm mobility, such as the Brooke Upper Extremity Rating Scale . Assessment methods for the fitting of an upper limb assistive device Assessing for the recommendation of an assistive device For this type of assistive device, there is an increasing tendency to use a top-down approach, starting with the individual's activities, lifestyle habits and preferences. Integrating users' feedback into the recommendation process and adopting an ecological perspective, rather than focusing on physical limitations, helps reduce the abandonment rate of these assistive devices (Hocking, 1999). - 1) Usage - Assessing needs in terms of particular uses allows for: Prioritisation :   For example, for one patient, using a computer might be more important than eating. These choices will impact the direction of the assistive device. Gathering indicators for post-fitting assessment,   by targeting the most important activities . For example, if an individual wants to use the device for fishing three times a year, the well-being associated with this activity might take precedence over the frequency of use criteria. → Clinical scales for evaluating usage: COPM, MOHOST, LIFE-H - 2) Environment - Here, the specific conditions of the distant environment (flat, hilly, etc.) and the immediate environment (specifics of the wheelchair, etc.) are determined. These elements will affect the functionalities of the assistive device. For example, a person living in a very hilly area will need greater ability to lock their arm support. → Environmental assessment tools: Assessment can be multimodal; photos, sketches, videos, tracking movements at home or places of use, etc. - 3) Motor abilities - These abilities should be related to usage. Even if object manipulation is limited, the ability to take and give an object may be very important. The objective is to assess the arm as a whole: Potential pain Possible contractions or joint limitations Skin issues (possible allergies to contact with materials) Sensitivity (feeling at different points of support) Movements (ability to move, manipulate objects, etc) → Clinical scales for evaluating motor abilities:- Functional assessment of the upper limb; Orthopaedic assessment; 400 point assessment; Box and Blocks Test; Jamar: dynamo + pinch; FIM; Minnesota; MFM; Nine Hole Peg Test; Perdue Pegboard Test; Brooke Upper Extremity Rating Scale; CUE-T; Pain (VAS); Barthel ADL Index; Myotools; Nepsy; Ecological situation observations; Preston; PUL; RULM. This assessment of usage, environment and motor abilities results in the definition of functional specifications. Based on these specifications, the occupational therapist can then match the needs with existing devices on the market. Assessment of the assistive device - after fitting The evaluation of the assistive device can occur at various points in time, depending on usage and how the patient is monitored; one week, three months or one year following fitting. This step evaluates the progress in performing activities with the assistive device (as opposed to without), the satisfaction level, or improvement in quality of life. The 2007 report by the National Authority for Health in France suggests that assessments should take place in environments where the device can be expected to be used. In this way, the device’s effectiveness can be assessed in relation to the individual’s primary activities. → Clinical scales for assistive device assessment: QUEST (Demers, 1999), Goal Attainment Scale (GAS) (Krasny Pacini, 2013), COPM, PIADS. A guidebook to explore this topic further The best way to learn about upper limb assistive devices is to try them! This allows you to have a sense of how the device works, experience the sensation of assisted arm movement and determine in which situations it may be suitable. To discover more about upper-limb assistive devices, you can freely download the guidebook 'Assistive Technology for Arm Mobility in Europe' (Orthopus, 2024): This resource was co-written by healthcare professionals, associations, equipment installers and researchers. It also includes testimonials from the true experts: the users themselves. Other resources Global indicators of assistive technology use amongst occupational therapists - Report of WFOT's Global Surveys (World Federation of Occupational Therapists, 2019) Global report on assistive technology (World Health Organization, 2022) Clinical scales for upper-limb (Orthopus)  - for before and after the fitting Assistive devices for arms (Orthopus) Bergsma, A., Janssen, M.M.H.P., Geurts, A.C.H., Cup, E.H.C. and de Groot, I.J.M. Different profiles of upper limb function in four types of neuromuscular disorders. Neuromuscular Disorders . December 2017; 27 (12): 1115-1122. doi: 10.1016/j.nmd.2017.09.003. Epub 2017 Sep 15. PMID: 29033278.

A retrospective piece, sharing an intervention idea from an occupational therapy placement I was given the chance to work with a UK mental health charity, supporting young people in a variety of role-emerging OT settings . Experiences included designing and facilitating group sessions on resilience, to a secondary school for deaf and hard-of-hearing children . I know from experience how stressful teenage life can be, but communication and engagement with the wider social environment is clearly an additional barrier for this community. Although a sign-language facilitator was present, this provided an extra layer of challenge, as I'm sure you can imagine. Frankie and I were keen to rise to this and we loved our time at the school. We brought the Five Ways to Wellbeing to pupils, via a variety of weekly classes. These were designed to be fun, engaging and mindful of the stressors faced - both by those with hearing impairments and by teenagers in general.

By Alice McGarvie - Occupational Therapist, From the Harp Occupational therapy celebrated 100 years in the USA in 2017 and 100 years in the UK in 2019.   I’m from the UK and look forward to learning more about the history of occupational therapy in my country and celebrating all we’ve achieved and our vision for the future. I urge you to find out your country’s occupational therapy history and vision for the future, promote this and celebrate! Even if occupational therapy is fairly new in your country, your country will have an interesting occupational therapy history.

Autistic, Lesbian, Gay, Dyslexic, Transgender, Bisexual, Schizophrenic... These are a few of the many common words we may use in clinical settings (and now also social media) when we address people we work with in the field and communities. For decades now, there have been vicious arguments about person first vs. identity-first language across different types of communities across the globe. In occupational therapy education and academic publications, person first language is the preferred choice. However, when out in the field, this really boils down to what each individual or family would prefer. And as a profession that is known for its client-centred and family-centred practices, this is a question we need to ask as soon as possible so that we can get this right from the start... not after treatment #5, #10, or when the series of treatments are all finished.

This paper is a keynote address delivered at the RCOT annual conference in 2017 Occupational therapy emerged from social movements that were flourishing in the UK and the US towards the end of the 19th and beginning of the 20th centuries, including: women’s suffrage, socialism and the settlement movement. From the beginning, occupational therapy was essentially a women’s profession, dedicated to helping people experiencing marginalisation and deprivation. In this paper, I discuss the terminology of the margins and the key features of marginal spaces and places that are of interest to occupational therapists. I write about the British Empire, which, at the time occupational therapy was founded, extended around the globe; showing how a colonial worldview influenced the new profession. Great Britain was the centre of the Empire and the colonies were the margins. I explore the two-way traffic of ideas and practices between centre and margins, applying this to both the British Empire and the occupational therapy profession. Occupational therapy, which began on the social margins in Britain and America, became integrated into the mainstream during the 20th century, losing some of its pioneering spirit in the process. I argue that we have much to learn from occupational therapy theory and practice on the margins, where creativity and innovation are thriving. I conclude that mainstream occupational therapy services can be improved by the adoption of ideas, skills and practices from the margins.

The start of 2020 saw many masters students across the UK completing their two-year pre-registration Occupational Therapy programme. Throughout the course, students will have gained an insight into the importance of continuing professional development, including management of change within health and social care settings . With health services and the role of Occupational Therapists ever changing, there is great emphasis placed upon service development .

The profession of occupational therapy emerged in North America and northern Europe at the beginning of the twentieth century. The first professional occupational therapy association was founded in the USA in 1917 (Paterson 2010); the Canadian Association of Occupational Therapists in 1926 (Friedland 2011) and the Scottish Association of Occupational Therapy in 1932 (Paterson 2010). A meeting to establish an international association was held in England in 1952, when the World Federation of Occupational Therapists was inaugurated. The founder members of the new international body were: Australia, Canada, Denmark, India, Israel, New Zealand, South Africa, Sweden, the United Kingdom and the United States of America. Seven of these founding countries were Anglophone . The first president of the Federation was Scottish (Paterson 2010). At the time when occupational therapy was emerging as a profession, the UK still had the remnants of an Empire that once stretched all around the world, and the USA also had influence across the globe. It was inevitable that the international language of the new profession of occupational therapy would be English.

Through a global health pandemic, COVID-19 times are definitely trying. Many occupational therapists (OTs) have transitioned to telehealth practice, with populations ranging from paediatrics to adult home health services, while academic programs have shifted to distance learning . We know that health professionals are at the forefront of this public health crisis. But what else can OTs do to contribute during this time, in addition to providing services to our clients? Discussions have taken place between OTs globally, on educating the public and our clients to be equipped to navigate the current situation. Here are some of the ways that occupational therapy can contribute...

I was shocked to see the worldwide prevalence of COVID-19 in such a short timespan. So many have been severely affected, both mentally and physically. I quickly realised that outpatient services could not see patients face-to-face ; instead, we could conduct telephone consultations, to ensure the safety of patients and their families. Everyday I used to call our patient’s families, checking on their well-being and providing strategies and advice over the phone. It worked well for a few weeks, but families were not as satisfied as they could be... Challenging behaviour and sensory difficulties were getting worse among children, likely due to being kept at home and feeling helpless . Parents were struggling to effectively motivate their kids at home, stressed out with many other responsibilities.

"We don't have to do it alone. We were never meant to." - Bren é Brown As Occupational Therapists, we look within and around, constantly deliberating on what and how to add purpose and meaning to anything we do - and advocate for anything that speaks to us; this is what an ideal situation of symbolic interaction looks like for our profession. Symbolic interaction is a very grounded, practical and everyday approach to social life and social understanding. According to this concept, any entity that has been created or obtained as a symbol - for example, human rights, cultures, humanities, etc. - can never follow one particular meaning for eternity. The ambiguity in which they exist and have been created needs to be contested and renewed, according to the time and population they interact with.

Co-author: MaryBeth Gallagher PhD, OTR/L BCMH 'This paper offers targeted strategies you can use to address the impact of occupational disruption in your own setting.' Introduction Occupational disruption has been defined as a transient or temporary condition of restriction from participation in necessary or meaningful occupations. This interruption often, but not always, resolves itself as the human adapts (Whiteford, 2010). The arrival of the COVID-19 virus and the subsequent pandemic has had a tremendous impact on our daily habits and routines. It has meant that people have become socially distanced, unemployed and ‘repurposed.’ This is certainly true in the healthcare organization in which we are employed, where employee wellness has the potential to be eroded by these additional stressors. If as occupational therapists, the situation described here is something you recognize within yourself and your work environment, this paper offers targeted strategies you can use to address the impact of occupational disruption in your own setting. This article presents the response of a small team of occupational therapists to the challenges posed to employee wellness in the face of unmitigated occupational disruption from the COVID-19 virus. The article also describes the processes and practices that were developed to support our colleagues. It concludes with recommendations to replicate and or adapt our approach to nurturing employee wellness.

This is a shortened version of the first Hanneke van Bruggen lecture, presented by the author at the 17th Annual Meeting of ENOTHE in Ghent, Belgium (2011). Introduction As an enthusiastic traveller, I observe that occupational therapy is recognisably the same profession in every country I have visited, but it also differs in the ways that it is taught and practised, reflecting diverse cultural norms and expectations. Through discussions with colleagues around the world, I have learned to appreciate just how flexible and adaptable occupational therapy can be, when we have the skills and confidence to set goals and deliver our services in ways that are culturally and socially relevant to diverse settings. What is diversity? Diversity means difference, variety and being unlike each other (Shorter Oxford English Dictionary 2002). For example, the term biological diversity , or biodiversity , means 'the variability among living organisms from all sources… and the ecological complexes of which they are part; this includes diversity within species, between species and of ecosystems’ (UN 1992). We know that biodiversity is essential to life on earth because: It is the combination of life forms and their interactions with each other and with the rest of the environment that has made Earth a uniquely habitable place for humans. Biodiversity provides a large number of goods and services that sustain our lives. (Secretariat of the Convention on Biodiversity 2000)

There is a lot of information out there. How do we as Occupational Therapists (OTs) find what we need for our specific clients, in a time-sensitive way? This process of putting research into practice is complex and there are some strategies you can use to make it a little bit easier and fit into your busy OT day.

Occupational therapy is a very established profession in many areas of rehabilitation: Paediatric, neurological, orthopaedic, professional, to name some examples. I think that most Occupational Therapists (OTs), throughout their professional trajectory, experience many areas, until the moment when they can choose one to call their ' specialty '. It happened to me and many colleagues. I started my career attending to people with burns-related injuries, because of a great internship at my college. But, to tell the truth, there are not many places to work as a specialist in burns rehabilitation in the city I live. So I decided to go to a larger field of action and work with traumatic upper limb injuries. That's why I became a hand therapist. Nowadays, I work as an independent consultant in ergonomics and quality of life in workplaces . Of course, in this latter specialism, thinking about my quality of life was the predominant factor.

October 12th is World Arthritis Day Many may not know this, but occupational therapists play a key role in prevention, education, and intervention for this condition that affects children and adults around the world. I am an advocate for those who have any form of arthritis, as it is a condition that has affected me for the entirety of my young adulthood and will continue to affect me for the rest of my life. The purpose of today's post is to raise awareness and to encourage others to share their stories about how arthritis has affected their lives-whether it is related to yourself, a family member, or a close friend. Arthritis Facts There are so many types of arthritis & they can affect more than just your joints. Arthritis is an informal way of referring to more than 100 types of joint diseases that can affect any individual at any age, yes, even small children can have it! Some types consist of Ankylosing Spondylitis, Inflammatory Arthritis, Juvenile Arthritis, Rheumatoid Arthritis, Lupus, Osteoarthritis, Psoriatic Arthritis, and the list goes on. Arthritis is the leading cause of disability in the United States It can be difficult to understand arthritis pain and fatigue (two of the most common and troublesome symptoms of arthritis). Stigma In my experience and observations, I have noticed that arthritis symptoms can often be minimized by friends, family, and among other individuals. I have found that by sharing my story, I have been able to educate others about the real-life implications that arthritis has had on my life and the lives of millions of people around the world. Many organizations around the world, such as The Arthritis Foundation seek to end stigma surrounding arthritis by providing education and support for those diagnosed and their families. The more we talk about it and share stories, the more people will understand that it is not a condition to be taken lightly. The Reality Arthritis is no joke. I have known children who have had to take off a year or more from school to get intense treatments for conditions such as juvenile rheumatoid arthritis (JRA). I have known adult friends who have had to discontinue working or have a change in career due to the chronic pain that often comes along with a diagnosis of arthritis. In my experience, I have had people who told me that I could never become an occupational therapist. I have had to plan extra time in my day to use methods to loosen up my joints in the morning and to take naps to rest after a long day due to chronic fatigue. The reality is that arthritis is a serious condition and we need to empower ourselves, our families, and our clients to feel that they are cared about and supported. If you know someone with any form of arthritis, be there for them. Make sure that they feel validated and let them know that there are resources and support. If you have arthritis, just know that you are not alone. Many days can be a struggle, but we have to continue to educate others and advocate for health services such as occupational therapy that can increase the quality of life for those experiencing arthritis. Happy World Arthritis Day! For more information and support please visit https://www.arthritis.org. I encourage you to post a comment below, if you have a story to share about arthritis. Thank you! Sue Ram

I know what you're thinking. It's too expensive to travel for a conference, find affordable accommodation and pay for the conference registration itself, especially as a student or new grad. Although attending occupational therapy conferences can leave a hole in your wallet, you most definitely won't come back empty-handed. What I mean is that there are many benefits to attending OT conferences and here are five reasons why you should consider attending an OT conference near you (or far if you're feeling adventurous!) 1) Networking Yes, networking can seem like a daunting task, but conferences are a great way to meet both like-minded individuals and also those who can offer a perspective you hadn't thought of before. Are you interested in a pediatric specialty area? Mental health? Technology? Well, there will be many others there who share the same interests as you. It is a good idea to connect with others at a conference who are interested in the same specialty areas as yourself so that you can learn what other professionals are using in practice or are researching. Perhaps you are seeking a mentor or a supervisor, networking at a conference is a great way to do this. Networking at conferences is a great way to also meet people who you can call friends. You can make connections with people all around the globe and have a new reason to attend the next conference so that you can meet up with all of your new professional friends! 2) Endless learning opportunities Conferences are a great way to increase your knowledge on all of the up-and-coming research in our profession. From poster presentations to short courses and keynote speeches, there is something for everyone. Have you been wanting to learn about the role of occupational therapy in oncology or learning disabilities? Go to a poster presentation about a topic you didn't have the opportunity to learn about yet. Sit down at a short course and ask other attendees what they think about the topic. Conferences allow attendees to learn so much in just a few days and there is nothing more valuable than knowledge! 3) Get mOTivated and inspired Sometimes our daily routines can become a little too "routine". Attending a conference can allow you to remember why you became a part of the profession in the first place. From being around so many positive people ready to move the profession forward, you too will feel motivated and refreshed. Many conferences include a keynote speaker, sometimes this individual is someone who belongs to the profession or someone who has had personal experiences as a client who was positively impacted by occupational therapy. Hearing stories from others are a great way to get inspired and gives us an opportunity to see how much we are helping people across the lifespan with being able to function in their daily lives. It is always a good idea to step back and think about why we chose occupational therapy so that we can go back to the classroom or the clinic refreshed and ready to help those who need it most. 4) A mini vacation Conferences are a great way to get away for a little. Whether you attend a conference in your town or you fly out of the country, it provides for an awesome getaway. Conferences allow an opportunity to explore a new city with fresh faces and a chance to sleep in a cozy hotel or get to spend time at a friends home who lives in the area you are visiting. It is always refreshing to get away for a bit and attending a conference allows for that. We all need a break (hello occupational balance!) and this is a great way to learn and relax all in one trip. 5) Share ideas and research Have you been working on a research project that you want others to know about? Have you been thinking of an idea you have been wanting to try in practice, but want to know if there are others out there already trying what you want to do? A conference is a great way to showcase the hard work you have been doing throughout the year. Students and practitioners are all trying to contribute to the body of knowledge related to our profession, you can as well! You can visit a poster session related to a topic you have been thinking about researching. Ask the presenter if they have any advice for you or if they are willing to work with you on something in the future. The opportunities are endless when it comes to sharing ideas. Another perk is that for some conferences, registration fees can be lower if you are presenting! I do hope these reasons may have convinced you to consider attending a conference soon. The benefits are endless and there is nothing more refreshing and motivating than increasing your knowledge on something you are passionate about. I do recommend to at least try it out once when the opportunity arises, as conferences can be a great deal of fun. Hope to see some of you soon!

This year marks 15 years since I completed my first coach training and started to coach occupational therapists (OTs). It has been a fascinating journey. It is worth reflecting on what coaching is, what it offers OT, how OTs are using coaching in different settings, how coaching helps OTs themselves and how coaching could support OT in the future. Back in 2005, whilst I was still breastfeeding, I fell in love with coaching. It felt so natural to work this way; much less stressful than my OT work had been and more empowering for both parties. I immediately wanted to coach OTs who seemed stressed, burnt out, bullied, or wanted a change of direction. However, most of the OTs who got in touch wanted to learn to coach, rather than be coached themselves! Part of me was frustrated, but my coaching skills for OTs workshop went down so well that I let go of it and just went with the flow. Fifteen years later, that one-day workshop has been taken by hundreds of UK OTs and hundreds more worldwide, online. I don’t mind admitting that I fell out of love with OT for a couple of years . I was entranced by the coaching world, its positivity and can-do attitude and was a bit fed up with 'problem lists' and deficit thinking, which seemed to abound in OT practice (well, in the settings I had worked in). I also felt less responsible for the outcomes as a coach, rather than as an OT – it wasn’t all up to me whether something was effective, or there was a good outcome. As time went on, I started to see how coaching could really enhance OT practice, not merely be an additional tool in our already adequate toolbox. I started to see how putting coaching philosophy at the heart of my OT practice changed me as an OT. In this way, coaching was much more than just asking questions and setting goals. To date, I have used coaching in various ways: as an occupational coach in a return-to-work service; as a private coach, mostly with OTs but also corporate clients; I have set up the coaching element for a cancer vocational rehab programme; I have specialised in coaching creativity and published the first book of its kind; set up a coaching party programme with full training; taught coaching to undergraduate OTs; and many other things too! I am in the privileged position of seeing how other OTs use coaching too. Along with the leading work by Fi Graham and others in New Zealand, many OTs who work with children and families now use occupational performance coaching (OPC) in their work. Many OTs are setting up their own wellbeing businesses, combining OT and coaching; the Lifestyle Redesign Programme at USC is at the forefront of using coaching and OT; coaching is now often used within vocational rehabilitation, helping people to overcome internal and external barriers to work. In mental health OTs and many other professionals see the value of coaching in recovery but also in prevention; a coaching approach is used in many other ways, including fatigue management and conditional management programmes. I could go on, but I think you are starting to get the picture. Coaching within OT has really come a long way. To me, there are many reasons why coaching has become so popular and why so many OTs are looking to how coaching can strengthen their practice: The notion of client choice/person-centred practice is very difficult in services which are so tightly controlled. To me, coaching is a way of ensuring at least some of what we do has the person and their world at the core. Coaching helps shift the power away from the OT , into the hands of the client/patient. Not only does this grow responsibility and self-efficacy, but it should also help the OT too. In services where OT contact is limited, coaching can sow seeds , which grow long after the OT intervention has ended. Coaching helps people see how interconnected their world is, shifting away from 'I' to 'We'. An OT who coaches effectively helps people make conscious occupational choices and supports positive change. So why is all this important right now? There has been a drive, in recent years, to empower people and make them less dependent on healthcare services . Certainly, this has been seen in the UK and the Covid situation has expedited this change; access to GP services has changed and reliance on online support has increased. Covid, lockdown and the subsequent societal changes, have also shed light on how OT is such an important profession for the future. People are having their occupational lives turned upside down: staying at home more, working from home, less social contact or physical contact, with many hobbies and recreational activities stopped. Now is the time for OT to be seen in broader society and to shine. Coaching can support OTs to work in this way. Climate change, preventing further climate damage - and managing the impact that is now inevitable - all depend on changing our occupational lives. How we live, work, feed ourselves, socialise, travel, etc; all our occupations must change. Our daily 'doing' has caused climate change, so we need to change our daily doing – our occupations. Coaching helps raise awareness of the broader impact of our actions and behaviours and highlights our personal responsibilities. I am also hoping that those OTs who are interested in working in this arena will support themselves, through coaching. I know this may sound like coaching as a panacea for all the worlds ills, but if you understand what coaching can do, you will start to see its power and potential. We all need to be listened to, to have our deepest concerns and desires heard. We all need to understand our impact on our immediate and broader environment. We all need to have hope. That is why I love coaching! 😊 Jen Gash Occupational Therapist Start coaching now Click on this link and use the code 20csot for a 20% discount (to users of the Hub!) at the checkout.

Occupational therapy in Tanzania, East Africa, was first established in the year 2000, at the Kilimanjaro Christian Medical College . It is the only school in Tanzania offering occupational therapy (OT) studies. The course is offered at a diploma level. In total there are a little over 300 occupational therapists under the Tanzania Occupational Therapy Association ( TOTA ) umbrella. Only recently has the government of Tanzania acknowledged the importance of occupational therapy, which is why it has started employing occupational therapists to public hospitals. Very few occupational therapists own rehabilitation centres. Unfortunately, there are no occupational therapists working in private hospitals in Tanzania. Occupational therapy is still not well known. People find it hard to differentiate it from physiotherapy. I think it is mostly because we (OT professionals) have not taken the responsibility of making the profession as known as it should be . Another reason is the expense of using occupational therapy services, since it is not included in the health insurance fund. In view of these challenges, occupational therapists have decided to take a step in tackling these challenges. One way they do this is by using brochures that have information about occupational therapy. They spread these brochures in hospitals, schools and through WhatsApp groups . Also, they use local radio stations to talk about certain health conditions and the importance of occupational therapy for individuals. The association of occupational therapists in Tanzania (TOTA), has also been working on establishing a degree programme in the country, so as to upgrade the level of education of occupational therapists to meet the required standards. One particular center in Dar es Salaam uses a different approach. It is a group of occupational therapists from Maisha Bora Clinic/Good Life Clinic. They work with children with autism and cerebral palsy. They provide a hands-on approach at the centre and at clients' homes. Those in need of services who cannot reach the centre are approached at home. An assessment follows. This involves physical, cognitive and environment assessments . Parents/guardians who can afford to pay do so, but those who cannot pay incur costs when buying locally made adaptive tools, such as a special sitting chair, splints or a standing frame. We realise that we have a long way to go to achieve our goal of being recognised and fully utilised to our maximum potential, but we are still glad of the efforts we put in everyday. Vanessa Dallaris Occupational Therapist, Tanzania Africa Lead, The Occupational Therapy Hub