Occupational therapists believe that there is a relationship between occupation, health and well-being. Findings from studies over the years indicate that occupation has an important influence on health and well-being. Ranging from physiological to functional outcomes, it is clear that the performance in everyday occupations is an important part of everyday life. Withdrawal or changes in occupation for a person have a significant impact on a person’s self-perceived health and well-being.
Physical therapy and occupational therapy form an important pillar of complementary medicine that improves functional, muscular and structural stability in individuals; however, it is noteworthy that occupational therapy and physical therapy are entirely different and distinct tools of rehabilitation.
Physical therapy deals with improving the muscular and structural support of the tissues and tendons after an acute or chronic insult. The aim of physical therapy is to restore activity without affecting the normal healing process.
Occupational therapy deals with helping individuals in adapting to their injuries in order to maximize productivity and functional independence. An occupational therapist helps in optimizing the mobility with the help of equipments and devices after an injury that may lead to permanent disability. Occupational therapists also play a preventive role by guiding normal individuals to work with their bodies and not against their bodies that is a leading cause of aggravated wear and tear tissue damage and injuries.
Physical therapists utilize their vast knowledge of the human musculoskeletal system, anatomy and physiological functioning of muscles, joints and ligaments in order to restore mobility and full range of joint activity. At the same time, physical therapy exercises and maneuvers also decrease the risk of joint destruction and muscle injuries.
Occupational therapists help in enhancing coping skills in individuals after injuries. Occupational therapists work with family, relatives, friends and colleagues in order to make the transition less painful and more helpful for the recovering patient.
Physical therapist works soon after the injury in the initial recovery course after primary injury while the services of occupational therapists are generally needed in the rehabilitation course when the patient has fully recovered from the initial injury.
Provision of physical therapy may improve the situation and mobility of individuals. Physical therapists perform interventive therapies like massage, acupuncture, exercises and manual therapies to improve the functioning of the body.
Occupational therapy is performed when the patient has fully recovered and the sole purpose is to improve the quality of life by not letting the disability to affect the life of individuals. Occupational therapists modify the surroundings and the lifestyle mainly; instead of devising any treatment modalities.
Physical therapists mainly work with sports teams and athletes (since athletes are most vulnerable to musculoskeletal injuries and require the assistance of physical therapists most). In addition, physical therapists also work with surgical units, burn centers, nursing homes and trauma centers in order to attend to patients who are suffering from moderate to severe injuries involving joints (limb joints or spinal joints).
Occupational therapists are usually employed in rehabilitation centers to manage the patients who have suffered permanent damage and disabilities. Occupational therapists train patients to use special devices and equipment like hearing aids, walking aids, visual aids and other equipment that decrease the dependence on caregivers; thereby reduces economic and psychological dependence. Almost 48% of all occupational therapists work in the offices of speech and physical therapists (Bureau of Labor Statistics).
Physical therapists are mainly involved in the management of musculoskeletal stability while occupational therapists generally cover all aspects of a person’s life including social (by improving physical independence), psychological (by counseling), economic (by decreasing the caregiver dependence) and professional (by modification of work-environment or skill-set training).
Physical therapists require a Bachelors or Masters in Physical therapy followed by training in a physical therapy setting. Similarly in order to become an occupational therapist, individuals require a Bachelors or Masters in Occupational therapy; however no training or experience is generally needed in order to start the practice (according to the reports of Bureau of Labor Statistics).
At an average, there are almost twice as much job openings for physical therapists than occupational therapists (198,600 job openings in 2010 for physical therapists as compared to 108,800 job openings for occupational therapists).
To sum up, occupational therapy and physical therapy both constitute important tools of rehabilitation and recovery after moderate physical, musculoskeletal, vascular or neurological injuries. Although the primary functioning and aims of the therapies overlap significantly, it can be safely stated that in certain cases, individuals need both physical therapy and occupational therapy to obtain maximal benefits.
I am writing this article from two points of view, as an experienced fitness trainer / strength coach who has studied health issues for many years and as a patient who suffers with lymphedema of the leg daily. I have been able to maintain my lymphedema pretty well, but that is because I have done extensive reading on the subject, I listened to my doctors, and I have extensive knowledge of exercise. It is on my mind every day, at almost every moment because it takes great effort to maintain properly. I have included the description of lymphedema below.
Lymphedema is a difficult thing to deal with and must be maintained all day long, every day. There is no cure for lymphedema. I have had lymphedema in my leg since my 1991 cancer surgery. I went from being a gymnastics coach and fitness trainer who exercised daily to being bedridden after my surgery as a result of the lymph nodes being removed along with the cancer. My life changed drastically, but I went back to work and learned how to maintain it as soon as possible. Several doctors told me that I would be bedridden for the rest of my life and that I would never work again. That was in 1991.
So, what is lymphedema? Here is the definition by the National Lymphedema Network…
“Lymphedema is an accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in the arm(s) and/or leg(s), and occasionally in other parts of the body. Lymphedema can develop when lymphatic vessels are missing or impaired (primary), or when lymph vessels are damaged or lymph nodes removed (secondary).
When the impairment becomes so great that the lymphatic fluid exceeds the lymphatic transport capacity, an abnormal amount of protein-rich fluid collects in the tissues of the affected area. Left untreated, this stagnant, protein-rich fluid not only causes tissue channels to increase in size and number, but also reduces oxygen availability in the transport system, interferes with wound healing, and provides a culture medium for bacteria that can result in lymphangitis (infection).”
So, what types of exercise can a lymphedema patient perform? That depends on the patient and whether they have medical clearance to exercise. Once cleared for exercise, the best exercise to reduce the leg swelling is swimming because the person is horizontal, in motion, and performing a non-impact movement. The second best exercise for a person with leg lymphedema is riding a recumbent bike. It is also non-impact, it’s a steady motion, and the legs are elevated slightly.
If the patient is in good physical condition otherwise and they have the lymphedema under control (as much as possible) they can use the elliptical machine. That is, if they can tolerate it from a fitness and medical standpoint. Make sure the lymphedema patient has permission from their doctor to perform exercise, especially an intense exercise such as the elliptical. Keep the person with lymphedema OFF THE TREADMILL. Walking and running cause the leg swelling to become MUCH worse because they are high impact. Picture someone putting ice cream into an ice cream cone and then packing it in. The swelling becomes dense, packed in if not maintained properly. The more severe, the more difficult it is to deal with.
In my experience, it can take an hour with the leg elevated before the swelling even BEGINS to go down and several days or weeks for it to completely drain. People with lymphedema should be wearing their compression stocking if their doctor prescribed it and sleeping with her legs elevated every night, unless their doctor has told them otherwise. It is important to stay in motion and to only perform non-impact exercises. For example, squats are often better than walking lunges for someone with lymphedema. The walking lunge is an impact exercise. Do NOT encourage a person with leg lymphedema to participate any exercise classes that include impact exercises. If they are in good shape the spin classes will keep the circulation going and help will lose or maintain a healthy body weight. It’s all about keeping the body in motion without ANY impact exercises.
Keep in mind that of the lymphedema is from a new surgery the patient MUST be cleared to begin exercise because if they begin to exercise before the doctors allow them to exercise they will cause problems with the lymphatic system. My doctors told me the swelling from the surgery would never go down if I started to exercise too soon and that I would cause permanent damage. I was told to wait one full year after my surgery before I was allowed to exercise my legs. I waited 10 months and couldn’t stand it any longer. I HAD to return to exercise because it was what I enjoyed and it was my life. Not being allowed to exercise my legs was extremely difficult for me because I spent a lifetime in the gym. Again, make sure the lymphedema patient has FULL medical clearance to exercise.
Here is something that many people do not know. When a person with lymphedema is not in motion and does not have compression stocking on their leg, they must keep their legs elevated in order to prevent swelling. Something as simple as waiting in line at the grocery store could cause enough swelling to keep a person in bed the next day. The swelling begins in less than a minute, literally, when standing still or sitting without the leg elevated. It is truly a challenge every minute of the day to keep the leg from swelling and those around lymphedema patients must be patient and considerate.
There is plenty of information on lymphedema. It is either primary or secondary. Secondary lymphedema would be caused from something such as a cancer surgery. Mine is secondary because my lymph nodes were removed from my upper thigh on one leg during my cancer surgery. If the lymphedema is not controlled it can end up being elephantitis. Yes, it is a real medical condition and it is very serious. There are lymphedema support groups throughout the USA. The National Lymphedema Network has plenty of information.
The right wheelchair is extremely important to the overall health of a wheelchair user, but often over looked. Information and measurements are essential to a proper fitting wheelchair.
Your first two questions should be: Does the individual use his/her arms to propel, foot propel or a combination? How do they transfer to and from the wheelchair? Both of these questions affect the floor to seat height that the chair would need to be set at. If a wheelchair seat is too high, the user will slide down in the seat in order to touch the floor creating poor posture. This can cause long term damage to the spine. A more immediate problem is shallow breathing as a result of folding your diaphragm in half. If the seat to floor height is too low, it will make transfers difficult or unsafe. Individuals who foot propel will want a seat to floor height that keeps their knee and hip even and still allows the foot to strike the floor heel first.
The type of transfer someone does will also indicate the arm type required on the chair. If you or your client is able to do a standing pivot transfer, full length arms will be required. This will keep your body standing straighter as you gain your balance. Individuals who are unable to stand may perform a sliding transfer. This activity will require removable or swing away arms on the chair. When transferring is not an issue, a shorter arm length will allow for closer access to a desk or table. Wheelchairs also have the option of having adjustable height arms. This is an important feature that assures your shoulders aren’t pushed up too high, nor would you have to lean over to rest your arm. A proper height will leave your shoulders level and arms resting in place.
If you are taller or shorter than average, an adjustable height back may be required depending on your/clients upper body strength. The correct height in most cases in just below the scapula.
Wheelchairs come in a variety of styles and weights. If person using the wheelchair has poor upper body strength, they would need a lighter weight wheelchair. Common sense would indicate the lighter the wheelchair the less effort the user has to exert to push/pull the wheelchair along.
You must keep in mind, when deciding on the weight of the wheelchair, that wheelchairs have maximum weight ratings. Most wheelchairs are rated to handle a client up to 250 pounds. A number of manufacturers specialize in bariatric wheelchairs for patients weighing 300-700 pounds. Wheelchairs can be custom built to meet almost any weight or size requirement.
Wheelchairs are readily available in standard seat sizes. They begin at 14″ wide and increase in two inch increments up to 30″ wide. They also come in a variety of seat depths. This is the measurement from the back of the seat to the front. Most stock chairs are 16″ deep. They also increase in two inch increments up to 20″ deep. Anything wider or deeper would fall into the custom category.
To determine the seat size, you need two measurements. The width of the seat is determined by measuring a straight line from one hip to the other. Do not measure around the mid section, but straight through it, then add 1 inch. Then you measure from the back of the hip to the back of the knee. This must be done with the patient in the seated position. This measurement, minus 1 inch, is the depth of the seat.
Next, you will need to decide which type of footrest will best fill the need. There are two basic types of footrests. The standard footrest is adjustable in length from your foot to the knee. The other type is referred to as elevating leg rests. This type allows you to elevate the foot pad, raising the leg up. It is often required when someone has edema /swelling in the legs. Elevating leg rests add weight to the chair over the front wheels, making it more difficult to propel and steer.
In future articles I will be covering cushions, back supports and other positioning products that promote proper posture and wheelchair health. Be sure the medical store or healthcare provider you choose has the experience to guide you through the process. Education is important, but nothing can replace experience.