special subjects
Occupational Therapy (OT)
Evaluation
OT can be initiated when a physician writes a referral for rehabilitation, which is similar to writing a prescription. The referral should be detailed, including a brief history of the problem (eg, type and duration of the disorder or injury) and establishing the goals of therapy (eg, training in IADLs). Lists of occupational therapists may be obtained from a patient’s insurance carrier, a local hospital, state occupational training organizations, or theAmerican Occupational Therapy Association. Patients are evaluated for limitations that require intervention and for strengths that can be used to compensate for weaknesses. Limitations may involve motor function, sensation, cognition, or psychosocial function. Examiners determine which activities (eg, work, leisure, social, learning) patients want or need help with. Patients may need help with a general type of activity (eg, social) or a specific activity (eg, attending church), or they may need to be motivated to do an activity. Therapists may use an assessment instrument to help in the evaluation. Several different functional measurement scales are available, and their use depends on the patient's condition, specific functional domains that need assessment, and the clinical setting. Examples include the Barthel Index, Katz Index, Functional Independence Measure (FIM), and Patient Reported Outcomes Measurement Information System (PROMIS). Patients are asked about their mobility; continence; ability to dress, toilet, transfer position, feed, walk, and communicate; social and family roles; habits; and social support systems. The availability of resources (eg, community programs and services, private attendants) should be determined. A higher score on the Barthel, Katz, FIM, or PROMIS indicates more independence. Occupational therapists may also assess the home for hazards and make recommendations to ensure home safety (eg, removing throw rugs, increasing hallway and kitchen lighting, moving a night table within reach of the bed, placing a family picture on a door to help patients recognize their room). (also see Overview of the Older Driver ). 