Hi everyone sorry it has been a long time since posting on the blog so many good things to read which I need to blog at some stage. This is part 2 to the original article written by occupational therapist, Jason Lomond on what is occupational therapy. I will let Jason explain more to you about today’s second article that he has written. Here’s Jason.
In part 1 of this two part series I described the functional and systematic occupational therapy assessment as it relates to dealing with pain and movement dysfunction. Having identified all the factors contributing to the occupational performance issue, this article will review the actual methods used to enable peak performance in everyday activities for those living with pain and movement dysfunction.
Occupational Therapy Intervention for Pain and Movement Dysfunction
by Jason Lomond, Occupational Therapist
Within occupational therapy practice any or all of the assessment findings from the three constructs, person, environment and occupation, may be of interest to enable a successful outcome. The targets of treatment may be impairment reduction, adaptation, accommodation and skill acquisition.
To clarify this terminology, impairments include factors like strength, range of motion, sleep, pain, etc… So intervention would be directed towards improving those factors. Essentially we fix the underlying problem related to the person construct. This is as opposed to adaptation and accommodation, whereby we change the environment or the occupation to enable a successful outcome. And lastly, skill acquisition assumes that the individual is obviously lacking a skill that would enable a successful outcome.
To clarify the above targets of treatment some concrete examples are given. For instance, an individual breaks a leg at work and ends up with panic attacks related to the event. In this example, the cast and exercises for the opposite limb are examples of impairment reduction, crutches would be an example of adapting the activity and moving the individual to a different position is an accommodation. And finally due to the anxiety the individual may be taught skills to manage the stress. The strategies may be used independently or combined according to the goals of the individual and the assessment results.
Occupational therapists have a number of enablement skills to support the client’s occupational goals. These include consultation, coach, advocate, design, education, engagement, collaboration, coordination, adaptation and specialized techniques.¹
One of the specialized, impairment reduction approaches that I use as an occupational therapist is neurofunctional acupuncture.² Unlike traditional Chinese acupuncture a contemporary approach makes use of a thin needle to stimulate peripheral nerves. The insertion sites are anatomically defined and stimulated manually or with electricity with the purpose of altering abnormal activity of the nervous system and/or the hormones, and immune systems. In the treatment of pain and movement dysfunction neurofunctional acupuncture can immediately restore weak muscles and improve blood flow, thereby improving function.
Specific exercises to strengthen a weak muscle are also useful as an impairment reduction approach but, in my opinion, should only be prescribed following restoration of motor function. Otherwise other tissues will compensate to complete the motion. That being said, cardiovascular exercise is an excellent tool to improve blood flow and the metabolism.
In addition to neurofunctional acupuncture and exercise, the use of soft tissue manual techniques are a preferred method to assist muscles to reorganize their tension, thus facilitating smooth and painless motion.
As mentioned above, in addition to reducing impairments related to the person, treatment targets such as adaptation, accommodation and skill acquisition are used to enable occupational performance. This implies that the therapist moves away from the role of specialist to use alternative skills such as coach, consultant, educator or collaborator.
Some examples of these interventions may include worksite modifications by changing the demands of the occupation or changing the occupation completely, educating the client on proper biomechanics or lifestyle choices, coaching the client and client’s family to make lifestyle changes and teaching the client techniques to control sympathetic arousal (i.e. cognitive behavioral strategies, proper breathing).
In my experience, the more central the pain problem the greater the need of the treatment targets of adaptation, accommodation and skill acquisition. Of course other forms of therapy, such as mirror therapy, can play a role to enhance occupational performance in these cases.
To illustrate the treatment approach outlined in this article I will review the case of the female marathon runner from Part 1 of the series.
The Female Marathon Runner Example
To summarize the assessment results, the athlete complains of right knee pain of several months in duration.
She rates her current performance as 5/10, with 10 being the best performance possible. Her goal is to reach 10/10 in 2 months time at the Olympics. The athlete reports that the pain is worse with running and NSAIDs provide some relief. Anxiety was noted.
The athlete also reported visceral dysfunction (infrequent bowel movements followed by periods of diarrhea), low energy and difficulty in maintaining her target heart rate zones during the runs. The Exstore assessment identifies limitations in right passive internal hip rotation and restriction in the right proximal tibiofibular joint.³ The muscles that abduct the right hip, trunk rotation and hip flexion bilaterally all test 3/5 in manual muscle testing. Trophic tissue changes are noted throughout the lower extremity.
Based on the assessment findings it is concluded that the athlete is likely suffering from parasympathetic overtraining and the pain mechanism is partially inflammatory in nature.
Using the treatment targets mentioned in the article it is decided that impairment reduction, adaptation and skill acquisition strategies are used. The athlete’s training is adapted in the short-term by significantly decreasing volume and intensity. Low intensity, low impact aerobic activity (i.e. rowing) is added to assist with recovery from primary sessions. The athlete is taught cognitive behavioural, visualization and relaxation strategies to manage anxiety. Neurofunctional acupuncture is used to restore sensory-motor function and assist with nervous system recovery. For example, electro-acupuncture is used to target the nerves related to the gluteal muscles, hip flexion and trunk rotation. And finally manual soft tissue techniques are used to improve biomechanics by targeting restricted areas such as the tibiofibular joint.
If you have questions or comments please feel to contact me at www.performancetherapy.ca I will be updating the site soon with new pictures and video to provide a visual to the concepts mentioned in this article.
Jason Lomond is Registered Occupational Therapist, certified in Contemporary Medical Acupuncture from McMaster University. Occupational Therapist specializing in the treatment of pain and movement dysfunction. Connect with Jason on Twitter or call 902-521-4467
- Townsend, E., Polatajko H. Enabling Occupation: Advancing Occupational Therapy Vision for Health, Well-Being and Justice Through Human Occupation. Ottawa, Ontario. CAOT Publications ACE, 2007.
- Lombardi, A. EXSTORE: Simplified Assessment of Musculoskeletal Injuries, unpublished manuscript. 2011.