Occupational therapist working with patient writing
Occupational therapists help patients re-learn or modify functional tasks that are most meaningful, such as handwriting. (Photo: iStock)

October is Occupational Therapy Month

October marks OT Month, when we celebrate and promote the role that Occupational Therapists and Occupational Therapy Assistants (OTAs) play within our multidisciplinary teams across UHN. Are you aware of the impact that this profession makes every day? Test your OT savvy below.

True or False?: The goal of occupational therapy is to get patients prepared to go back to work.

False. The term "occupational" broadly refers to the tasks we need or want to do every day, says Debbie Hebert, Occupational Therapy Practice Lead for Toronto Rehab. From dressing themselves after a spinal cord injury to practicing their golf swing after a stroke, OTs help patients re-learn or modify functional tasks that are most meaningful.

"Self-care, productivity, and leisure are the three main baskets of occupations we focus on, but it's individualized for each person," says Debbie.

Not surprisingly, many patients approach their first appointment with an OT with some skepticism explaining that they're not ready to go back to work.

"We start by explaining our role and asking questions such as, 'what would your daily routine look like? What kinds of things are challenging for you right now that you would like to work on?'" says Debbie. "They'll then tell us, 'I can't put my coat on by myself,' or 'I can't pull my hands through my gloves because I can't separate my fingers.'"

How does an OT's role fit within the larger multidisciplinary team? A patient's goals often cross professions. For example, the patient who wants to perfect her golf swing again may also have balance problems that her physiotherapist (PT) can then tackle.

"If a patient is learning how to dress himself but has balance issues we would work with his nurse to develop a strategy that we both will practice with a patient so that he is able to receive consistent practice," says Debbie.

"We all want to help our patients achieve their goals and together we can all help each other get there."

True or False?: You'll only find OTs in a clinical setting 

False. OTs bring their expertise to research settings by identifying where gaps exist, conducting studies, and enabling end users to engage in research.

Dr. Rosalie Wang is an occupational therapist and affiliate scientist with Toronto Rehab's Artificial Intelligence and Robotics in Rehab Research Team. She is also an Assistant Professor at the University of Toronto where she, along with Debbie Hebert, is part of a collaboration with George Brown College.

The team is developing a line of fashionable, functional clothing for working-age women who are experiencing weakness on one side of their bodies from experiencing a stroke.

"There is a significant proportion of people living with residual disabilities, even after their course of rehab," she explains.

Sleeves can be a challenge for people without optimal shoulder movement while zippers, buttons and snaps require fine motor control that is sometimes lacking.

While adaptive clothing exists, it's often made for seniors, is loose-fitting, and is designed with function – not fashion – in mind.

"We have identified a need among this population of women to be able to dress themselves without frustration in clothing they like that represents who they are," says Dr. Wang.

The team is focused on upper body clothing, such as winter coats, blouses and bras.

"For our winter coat, we're looking at designs that lend themselves to ease in putting them on, aren't loose or lacking in shape, and can even create the appearance of body symmetry, which can sometimes be impacted by a stroke."

As an OT, Dr. Wang's role includes looking at women's existing dressing and undressing abilities and strategies after stroke, understanding how they go about selecting clothes, and how they interact with the environment while wearing them.

"We're not just asking, 'can you put on your shirt,'" she explains. "We're asking 'what does this clothing mean to you, and how can we make it easier, while still keeping your personal values intact?'"

"It's a very integrated way of looking at function and fashion."

Number of OTs and OTAs by site across UHN

  • Toronto Rehab: 136
  • Toronto Western: 39
  • Toronto General: 20
  • Princess Margaret: 9​​

True or False?: OTs play a pivotal role in cancer care.

True. "OTs teach patients how to self-manage the side effects of their treatment," says Patrice de Peiza, an OT within Toronto Rehab's Outpatient Musculoskeletal Rehab Program.

Cancer rehab is a growing field, as cancer survivorship increases and treatments continue to progress that allow patients to live longer.

Scars following mastectomy can become stuck to the chest wall, making it hard for a person to raise their arms up or reach back to fasten a bra from behind.

Radiation for cancers of the head and neck can make the site feel tight and dry, limiting a person's ability to turn their neck to do a shoulder check while driving.

Chemo can contribute to fatigue or "chemo fog," which impacts memory and clarity of thought.

"From teaching stretches that loosen scars and increase range of motion to introducing memory books so a person doesn't forget important ideas at work, we empower patients by giving them tools to live their lives more fully," says Patrice.

"With cancer patients we often see Survivor's Guilt – 'even if it hurts to lift my arm, at least I'm alive and I shouldn't complain,'" says Patrice. "While they are willing to accept feeling less than optimal, we take them further and give them hope."

Though most patients referred to an OT receive therapy within one to two years of completing their medical treatments, therapy can still have some benefit years after treatment is completed, Patrice says.

"A woman came to see me nine years after undergoing a mastectomy. Every night she would have muscle spasms in her chest that would wake her up. But after just three sessions of scar release she came back and said, 'I had the first full night sleep in nine years.' It's those moments that make our work feel rewarding."

"Cancer rehab is a relatively uncharted territory and Toronto Rehab is proud to be part of it."

True or False?: OTs teach patients tricks, like popping wheelies, to help navigate their environments.

True. "Teaching a patient how to pop a wheelie isn't a fancy party trick," says Jennifer Holmes, an OT and practice based educator in Toronto Rehab's Brain & Spinal Cord Rehab program. "It's a basic and essential wheelchair skill for practical, outdoor mobility."

Whether it's an elevated curb at the end of a crosswalk, or a gap between the subway and platform, if the small wheels at the front of a chair get stuck, a person can pitch forward and fall out.

"Learning how to pop a wheelie gives a person the ability to take those front castors off the ground, and stay relatively balanced while they're moving," says Jennifer.

"Because so many of our environments aren't enabling people need to learn these advanced skills so they can access all the different places they need to be."

But an OT's role extends far beyond teaching skills. It starts with helping to prescribe the right wheelchair.

While people tend to think of a wheelchair as a basic piece of equipment, an OT looks at the fit between a person, the wheelchair, the environments they'll be in and the occupations they need or want to do.

From lightweight options that are easy to propel to motorized models that can bring a person into a standing position, to different armrests, backrests, cushions, tires and footplates, when you're using a chair every day, it needs to be the perfect fit – for comfort and function.

"Society's perception is that someone is 'confined' to a wheelchair, but most people who require one look at their wheelchair as 'freedom'," says Jennifer.

"Once a person realizes what a wheelchair can do for them it becomes an enabling device that allows them to go places and do the things they need and want to do."​

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