OT Treatment Ideas

(Casey, 2021; Holm, 2017)

Think basic! Treatment activities don’t have to be complex. OT’s role is multifaceted for this patient population. Prior to initiating treatment, it is important to first ensure the patient is set up and positioned for success. Do they need their arms “freed” or repositioned? Do they need assistance wiping their face or using the Yankauer? Activity ideas include, but are not limited to:

 

    • Perform tasks in varied positions (in bed, edge of bed, standing) utilizing positioning aids or adaptive equipment

    • It is ok to repeat activities across sessions. You brush your teeth and wash your face every day, even more than once a day!

      • Build up grooming items or utensils. Be creative here!

      • Upper body bathing in supported sitting or long sitting positions

      • Folding towels, brushing teeth, combing hair while seated edge of bed to facilitate functional UE use while addressing balance, endurance, posture, and coordination.

      • Pre-feeding/Self-feeding: adapting utensils, hand to mouth pattern. Picking meal items from the menu

      • Encouraging participation and independent in typical grooming tasks: shaving, applying makeup, nails/manicure

    • Think about the patient’s position to encourage participation.

      • Can you elevate the upper extremity to decrease the distance required to move?

      • If they are unable to get into a chair or the bed doesn’t go into chair position. Can you elevate the HOB to increase upright sitting and facilitate chair like position?

    • Grade the task and increase the challenge by changing the patient’s position (i.e., supported long sitting > supported sitting in bedside chair > unsupported sitting EOB > standing at the sink)

    • Incorporate the use of meaningful occupations and activities as able

      • Sitting edge of bed for the length of the patient’s favorite song

      • Modify favorite task/activity (as able) to allow as much participation as possible

    • Encouraging functional upper extremity use

      • Provide training on adaptive and durable medical equipment for ADL to improve coordination and motor planning skills

    • Progress activity and person tasks in varied positions utilizing positioning aids or adaptive equipment as needed

      • From bed or long sitting, to edge of bed, to out of bed to chair/commode, to standing, and then mobilizing using appropriate adaptive equipment as needed

  • Neglect/Inattention

    • Position items and encourage patient to attend to neglectful side

    Tracking/Scanning

    • Have the patient track photos of family members

    • Enhancing cognitive skills for orientation, attention, concentration, executive functioning, memory, and visual-perceptual ability

      • Reorienting throughout the session

    • Delirium prevention and management

      • Speak clearly and use simple words/phrases

      • Repeat cues

      • Orient patients and have them verbalize correct orientation 3 times

      • Talk about familiar topics and family members/friends

      • Decorate the room with familiar items and photos

    • Coping strategies

    • Encouraging sleep protocols

    • Be sure to grade the challenge: think about initiation, sequence, termination

      Other Activity ideas

    • Folding laundry/towels: can they sequence and attend to the task

    • Ordering Meal: Can the Patient pick meal items from the menu and order? Targets command following, initiation, attention, memory

    • Set up a white board with Velcro. Laminate small card in which you can write tasks and have the patient sequence/order (i.e., steps in an activity, order of tasks for the day)

    • On a laminated sheet simple cognitive activities

      • Analog clock: What time is on the cloak

      • Quarter & nickel: How much money?

      • Photo of a famous person: Who is the man in the photo?

      • Connect the dot drawing: Finish the photo

    • Optimize normal sensory input

      • Ensure appropriate lighting, noise management, and provision of visual/hearing aids

    • Address range of motion deficits, positioning needs, and contracture management

    • Can use pre-fab splints (soft vs orthoplast) or custom fabricated splints

    • Ideal to position hands into intrinsic plus position

    • Stretching & exercise programs

      • Stretches for the head, neck, upper extremities, and trunk to facilitate movement against gravity, with neuromuscular reeducation as neede

      • Incorporate exercises including movement against gravity, isometrics, weight-bearing, and core/trunk to prepare patients for participation in ADL/IADL

      • Train family members and caregivers to assist the patient with their exercise program

    • Positioning to increase tolerance for upright posture and promote breathing techniques

    • Educate Patient/family on the benefits of therapy and the consequences of prolonged immobility/bed rest

References

Casey, K. (2021, November 5). Occupational therapy interventions in the ICU [PowerPoint Slides]. Johns Hopkins Critical Care Rehabilitation Conference, Johns Hopkins Medical Center.

Holm, S. (2017). Early Mobility and Rehabilitation. In H. Smith-Gabai & S. E. Holm (Eds.), Occupational Therapy in Acute Care (2nd ed., pp. 663–672). AOTA Press. https://library.aota.org/OT_in_Acute_Care_2e/134?highlightText=intensive%20care%20unit