Sensory Input

Providing sensory input to help a client resume functional movement is considered a preparatory activity. For example, the OT practitioner may stimulate a muscle through vibration in an attempt to activate muscle fibers for contraction and subsequent movement. Using sensory input such as deep pressure may help inhibit abnormal muscle tone in order for the client to engage in purposeful movement.¹⁵ Many of these techniques were originated by Margaret Rood, and they help clients prior to the actual activity. Thus, providing sensory input to change muscle tone or sensory sensitivity are considered preparatory activities.

Sensory input may be provided as a technique to help clients relearn movements that may be lost due to illness, disease, or trauma. Although the goal of sensory input is improved function, the techniques do not require the client engage in activity. Generally, the sensory input is provided to the muscle fibers directly. Therefore, OT practitioners use sensory input as an adjunct to purposeful and occupation-based activity.

Therapeutic Exercise

Therapeutic exercise, a modality from the biomechanical frame of reference, is the “scientific supervision of exercise for the purpose of preventing muscular atrophy, restoring joint and muscle function, and improving efficiency of cardiovascular and pulmonary function.”¹⁴ By understanding the principles of therapeutic exercise, the practi- tioner is able to apply biomechanical principles to purposeful activity. Therapeutic exercise is most effectively used as an intervention for lower motor neuron disorders that result in weakness and flaccidity (e.g., spinal cord injuries, poliomyelitis, Guillain-Barré syndrome), or orthopedic conditions such as arthritis.⁸

The general goals of therapeutic exercise are to (1) in-crease muscle strength, (2) maintain or increase joint range of motion and flexibility, (3) improve muscle endurance, (4) improve physical conditioning and cardiovascular fitness, and (5) improve coordination. The OT practitioner selects an appropriate therapeutic exercise from available options on the basis of the client’s needs, goals, capabilities, and precautions related to his or her condition.⁸ Although a description of each therapeutic exercise is beyond the scope of this entry-level text, Table 15-1 provides a summary of the types of therapeutic exercise used for each of the general goals.

The advantage of therapeutic exercise is that the practitioner can target specific muscle groups and motor movements by asking the client to perform particular exercises. The amount of resistance and number of repetitions can be controlled. Therapeutic exercise should not be used exclusively in occupational therapy practice, but it may be used to prepare a client for purposeful activity and occupational performance.

Physical Agent Modalities

Physical agent modalities (PAMs) are also considered preparatory methods. PAMs are used to bring about a response in soft tissue and are most commonly used by OT practitioners for treating hand and arm injuries or disorders. PAMs use light, sound, water, electricity, temperature, and mechanical devices to promote changes in function.¹ Thermal modalities that involve heat transfer to an injured area (i.e., warm paraffin baths, hot packs, whirlpools, or ultrasound) are used to decrease pain and joint stiffness, increase motion, increase blood flow, reduce muscle spasms, and reduce edema.⁸ Another thermal modality is the use of cold transfer (i.e., cold packs and ice). Cold transfer is used in the treatment of pain, inflammation, and edema. Electrical modalities include media such as transcutaneous electrical nerve stimulation (TENS), functional electrical stimulation (FES), and neuromuscular electrical stimulation devices (NMES), and are used to reduce edema, decrease pain, increase motion, and re-educate muscles.⁸

The use of PAMs in occupational therapy is controversial.^1,2,8,10 After debate and discussion, the American Occupational Therapy Association (AOTA) developed a position statement on the use of PAMs that states, “Physical agent modalities may be used by occupational therapists (OTs) and occupational therapy assistants (OTAs) as an adjunct to or in preparation for intervention that ultimately enhances engagement in occupation.” The use of PAMs solely as intervention without application to occupational performance is not considered occupational therapy.^1,2 PAMs are not to be used by entry-level practitioners; rather, the practitioner needs to complete specialized post professional training and provide evidence that he or she has the theoretical background and technical skills needed to use PAMs. With proper application, the use of PAMs in occupational therapy allows the practitioner to provide a comprehensive treatment program for the client.⁸

Orthotics

Any “apparatus used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body”⁴ is considered an orthotic device, or orthosis. Orthotic devices can be prefabricated or custom made and involve assessing the client, determining the most appropriate orthotic device, designing the device, and evaluating the fit. Orthoses were previously referred to as splints and some practitioners continue to use this term although orthotic is more current and accurately reflects billing codes. OT practitioners train clients in the use of the orthosis, monitor the wearing schedule, and evaluate the client’s response.

Orthoses also include braces made for the lower ex-tremities and trunk. These types of orthoses are usually made from high-temperature thermoplastic materials that are molded over a plaster model of the body part. These materials are very strong and durable, and they require special tools for cutting and shaping. Typically, orthoses made from these types of materials are fabricated by an orthotist. Seating and positioning systems, which support, align, and help to prevent deformities, are also considered orthoses. OT practitioners may be involved with other team members in the evaluation of a client and the fabrication of a seating and positioning system. However, the subject of seating and positioning is beyond the scope of this text.

Upper extremity orthoses commonly made by OT practitioners (and previously referred to as splints) are “orthopedic devices for immobilization, restraint, or support of any part of the body.”⁴ They may be rigid or flexible. Three primary purposes of an orthotic device are to (1) restrict movement, (2) immobilize, or (3) mobilize a body part.⁵ The OT practitioner is expected to recognize when there is a need for an orthosis, select a design that is correct for the problem, fabricate the orthosis, and educate the client in its proper use and care.

There are two main classifications of orthoses—static and dynamic. The static orthosis has no moving components; as the name implies, it remains in a fixed position. Static orthoses are used to protect or rest a joint, diminish pain, or prevent shortening of the muscle.⁵ Figure 15-1, A, shows an example of one type of static orthosis. The dynamic orthosis has one or more flexible components that move. The purpose of the dynamic orthosis is to increase passive motion, enhance active motion, or replace lost motion.⁵ The movable components (elastic, rubber band, or spring) are attached to a static base. Figure 15-1, B, shows an example of a dynamic orthosis.

Stay updated, free articles. Join our Telegram channel

Join