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Focus on: Occupational Therapy
By: MossRehab Admin
Sep 13 2015

(Living Beyond Disabilities - March 2014) - Lori Sledziewski, MS, OTR/L, an occupational therapist (OT) at MossRehab for over six years, is on a mission to raise awareness in the community of the key role played by her profession in rehabilitation. The spinal cord injury team leader for the MossRehab Occupational Therapy Department recently answered questions about the importance of OT for MossRehab.

Can you explain briefly what an occupational therapist does?
Occupational therapists address activities of daily living - things that people have to do in their everyday life. That can range from waking up and brushing their teeth to getting dressed and showered, eating breakfast, going to work, being a parent, enjoying leisure activities, driving. It really has a wide range. We address the activities that give people’s life meaning.

How is that different from a physical therapist?
We work closely with physical therapists. Physical therapists address strengthening, ambulation [walking], stretching, going up and down stairs, transfers like getting in and out of bed and getting in and out of a car. Our main focus is how are you going to get your shirt on, how are you going to get your pants on, how are you going to walk into your bathroom. There is always a functional goal with our activities.

You mentioned that you work with other therapists – physical, recreational, speech, etc. How is that work coordinated so the patient receives the best outcome?
Our patients have to have at least three hours of therapy a day in the inpatient unit. That is balanced among the specialties based on goals for the patient. For example, if the patient’s strength is good, but he or she needs more practice with getting in and out of the bathtub and getting dressed and cooking and cleaning, we may focus more on the OT. We are all trying to move the patient toward re-entry into the community. We are all working toward the same goal. We are just working towards it in different ways.

So there is a lot of conversation and coordinating of the care among the therapists and the physicians and nurses?
All of the OTs, PTs and recreational therapists are in the same office, and we have daily discussions. We are talking constantly in the gym or the office. We also have a weekly rounds meeting – where the treatment for each patient is discussed to educate everyone – so the doctor, the resident, the social worker, the psychologist, the nurse and all of the therapists are present. That’s where we formally discuss each case, talk about progress and any changes that might occur during the week, so we can better plan for discharge. Informally, we are speaking multiple times per day.

You work with spinal cord injury patients soon after their injury, when they are still in inpatient units. What are some of the toughest challenges you face?
Our patients are usually coming to us after a hospital stay. We are the first line of care that starts talking about what they are going to do when they go home. I initially rotated among all of the areas at MossRehab before settling on the inpatient spinal cord injury team. The challenge for me is figuring out how to start therapy with people that may be in denial or depressed or angry. A lot of our patients are not yet in the mindset of “I want to do this.” Getting patients to buy into that process early on – getting them to trust you that it is better for them to get out of bed, better for them to start getting dressed on their own rather than having someone do it for them - can be a challenge. It is a very emotional time that most patients are going through. We work very closely with our neuropsychologists.

Do any stories come to mind of patients that were particularly inspiring?
The most inspiring people that I have worked with are the people who are driven to accomplish everything. I had a patient who was determined to go back to work after being hit by a car while riding his bike. He wanted to do everything. It’s those people who – despite all of the bad things that have happened to them – they can still see the light at the end of the tunnel and they persevere through it. Sometimes you have families that visit every day and want to be part of therapy every day. When I see those people who just look at it as just another bump in the road in their life and they are going to overcome it, I just think that is amazing.

What is the most rewarding part of being an occupational therapist?
People come in, they are very dependent, they require help for everything, dressing, feeding themselves, going to the bathroom, getting out of bed. Through the process of occupational therapy they go out the door and they are independent, they can get themselves dressed, they can feed themselves, they can get their own food, they can cook their own meals. Sometimes we connect them with our driving school so they can drive again. Seeing people go from what is often the lowest point in their life and giving them back some amount of independence – having them feel better about the situation and themselves when they leave – is the most rewarding.

What sort of training is required to become an occupational therapist?
You need a master’s degree in occupational therapy to work anywhere now. As part of that degree, you have to go through two three-month internships where you are functioning as an OT under the supervision of a licensed therapist. You also put in many hours in observation. We have to renew our license every two years, and we are required to get continuing education units to maintain our license. One thing we pride ourselves on at MossRehab is mentorship. If you are a new graduate, you will have a mentor that helps you along the way with your treatment planning and decision making.

What drew you to occupational therapy?
I always wanted to be an art teacher, but I liked medicine as well. I felt that OT was a good blend of teaching, creativity and medicine. That was the perfect blend for me. I really, really love my job.

Looking ahead, what are you particularly excited about in terms of changes coming to OT?
The thing that I am most excited about is changes in technology. We use robotics here for upper extremity rehab. We have the Armeo® that we use very frequently. Trying to incorporate more technological things into care – patients get really excited about that and we do, too. There’s a lot of research for use of robotics with stroke, but we are finding that it is just as beneficial for spinal cord injuries. It is exciting to be on the forefront of that.

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