Regaining your independence: how occupational therapists help patients to return to their life outside hospital
Forming a close connection with her patients is central to the success of their rehabilitation, according to Fazeela Chharawala, a senior occupational therapist (OT) whose patients have complex neurological conditions. Here Fazeela talks about how helping patients regain their independence needs a team approach.
As an occupational therapist specialising in neurosciences, I typically work with patients who have experienced traumatic brain injury, a brain tumour or an infection in the brain. Most therapists like me are based on one or two wards and make up part of a multidisciplinary team. This means we are many different professionals working together as one team from doctors and surgeons to nurses, pharmacists and other therapists. Every member of our team contributes unique knowledge and skills and together we really can do a huge amount for each individual patient and their circumstances.
That’s actually why I wanted to become a therapist – to have an impact on the lives of patients after brain injury. My role allows me to work closely with every patient and understand the person beneath the condition. Alongside the patient’s family, we design the best rehabilitation programme for them and track progress and goals together.
When I first see a patient they are often in a coma or a low-awareness state with severe physical injuries. In those cases, my colleagues and I determine what we can do to help them start to wake up and move within their limitations. This could mean simply sitting upright. Often there are “hidden injuries” – a patient may look physically well, be able to move around in a wheelchair or even walk, but they are struggling with issues like fatigue, memory loss, balance problems or emotional challenges. Other patients have lost the ability to multitask and the easiest way to test this is to see whether they can walk and talk at the same time.
I like to get to know every patient I meet and understand what their home situation is like and what support networks are in place. I assess their physical and cognitive state alongside their understanding of their own condition. I sit with the patient and their family and talk through what the impact of their condition is likely to be and a typical path to recovery.
A key aim of an OT’s work is to support patients to regain enough independence to make it safe and appropriate for them to leave hospital. The process of planning for a patient’s discharge from hospital starts long before they are ready to go home. Initially we identify what physical barriers to recovery exist in their home life. This might be lots of stairs in their house or a challenging commute to work. Together with the family we establish how we can overcome these barriers.
"My role allows me to work closely with every patient"
Establishing targets and goals
After injury or a neurological condition, many patients’ physical limitations have changed. Before being discharged from hospital we practice everyday tasks for example washing and dressing or tasks the patient has identified are important to them such as using the computer.. We work with the patient, other therapists and nurses on the wards to practice each of the steps involved, from moving out of the chair to undressing, accessing the shower or typing on the keyboard. We identify helpful adjustments to the way a patient moves, for example, we may decide to work on developing their upper-body strength.
Cooking is a common task patients want to do for themselves when they return home. On the ward we have an ‘adapted kitchen’ where we run through simple actions and recipes with our patients until they feel able to tackle making their own meals without support or supervision.
One of the biggest challenges for my patients is doing more than one thing at a time. Consider the cognitive effort required to do your food shopping: you need to make a list, go to the shop, keep an eye out for other shoppers, keep track of what you’ve put in your basket, look out for labels and prices, and search for your next item. We take these things for granted, but for a lot of people who’ve had a head injury, a stroke or who suffer from MS, it’s an incredibly complex experience. So preparing our patients for this kind of everyday life experience is extremely important. It might be we take them out of hospital and to the shops – we’ll walk down the street together, cross the road, work out what to buy, how to pay and how to get back to the hospital safely. We develop strategies so patients feel able to cope when they are faced with doing it alone.
Returning to work often seems onerous for patients. We usually try and involve their family and their employer to work out what kind of intervention or modifications are needed to help them begin working again with the least difficulty.
When the time comes to leave hospital we absolutely have to ensure all the right support is in place in the community so patients can manage their own recovery safely. We develop a package of care specific to the individual patient that might involve community therapists, social services or organisations like the Stroke Association.
Opportunities and challenges
For all the rewards being an OT brings, it can also be very emotionally taxing. Working closely with patients and their families is intimate and personal in nature and can be challenging. As a team we take the time to debrief and share our experiences so no-one becomes individually overwhelmed.
I’ve had some really unique opportunities as a result of being an OT at Imperial. For example, I recently worked in theatre with a neurosurgeon who removed a tumour from a patient’s brain while they were awake. I was tasked with performing continuous assessments with the patient to ensure their healthy brain tissue was not being affected to allow the surgeon to remove the maximum amount of tumour. It was a truly extraordinary experience for me and felt very cutting edge.
All my work is ultimately about allowing patients to take back their independence and embrace life after illness or injury. I honestly couldn’t imagine doing anything else.