.
Definition & Scope of Occupational Therapy
Definition: Occupational therapy is a client-centered health profession
dedicated to promoting well-being through engagement in meaningful
“occupations” or everyday activities Wikipediaaota.org.
Scope: According to the American Occupational Therapy Association (AOTA),
OT involves clinical reasoning and judgement to evaluate occupational
challenges (e.g., client factors, performance skills), and to implement
occupation-based interventions. It includes habilitation, rehabilitation, and
promoting physical/mental health across populations at risk or experiencing
impairment aota.org.
A comprehensive state-level scope summary highlights OT responsibilities
such as:
þ Designing, fabricating, fitting, and training in orthotic and adaptive
devices;
þEnvironmental modifications (home, work, school);
þEnhancing functional mobility and feeding/swallowing
performance;
þApplying physical agent modalities and therapeutic procedures
aota.org.
2. Role of OT in Orthopedics
Focus: In orthopedics, OTs support functional recovery post-injury, fracture,
surgery, or with musculoskeletal conditions.
Device training: OTs assess and train adaptive aids—like prosthetics,
orthotics, mobility devices—to maximize performance and safety aota.org.
Functional mobility: They provide movement, strength, and endurance
training, plus instruct in ADLs (self-care, feeding, dressing) to restore
independence.
Modalities & positioning: OTs may use physical agent modalities (e.g.,
thermal, mechanical) and position management to control pain, swelling, and
preserve functional range aota.orgWikipedia.
OT Process:
Screening & Evaluation:
Screening collects essential information via history, client/family,
records to formulate an evaluation plan aota.org.
Evaluation includes gathering occupational profile (client’s meaningful
activities, limitations, context), selecting tools, and analyzing
performance skills and impairments Wikipediaaota.org.
Intervention:
Grounded in client-centered models and frames of reference,
interventions target improvements in occupational performance by
remediating impairments or adapting tasks and environment.
Outcome:
Outcomes focus on restored independence in occupations, client
satisfaction, enhanced participation, and quality of life. Outcome
measures might be standardized tools (e.g., Functional Independence
Measure, or occupation-based assessments).
Theoretical Frames of Reference in Orthopedic OT
Commonly used OT frames/models include:
Biomechanical Frame of Reference:
Remedial approach addressing motion, strength, endurance, and
prevention of structural issues (e.g., contractures, edema).
Interventions include ROM (passive/active), strengthening,
positioning, orthoses, nerve gliding, and ADL retraining ottheory.com.
Rehabilitative Frame of Reference:
Focuses on compensatory strategies when impairments are
permanent or remediation isn’t feasible. Emphasizes maximizing
function through adaptation ottheory.com.
Model of Human Occupation (MOHO):
An occupation-focused, client-centered, evidence-based conceptual
model. Emphasizes motivation, routines, skilled performance, and
environmental influences. Globally the most widely used OT model
Musculoskeletal Key.
Occupational Adaptation Frame of Reference:
Centers on a person’s adaptive processes when facing occupational
challenges. A study found this model can enhance patient satisfaction
and may lead to more efficient outcomes (when compared to
biomechanical-rehabilitative approaches), especially in cases like hip
fracture recovery PubMed.
Other models:
Canadian Model of Occupational Performance and Engagement
(CMOP-E): integrates person, environment, occupation and
spirituality as a core component Wikipedia.
Additional models include cognitive-behavioral, client-centered,
dynamic systems, PEO, etc. Wikipediaottheory.com.
ADL Training in Orthopedic Cases
In orthopedic rehab, ADL training targets self-care tasks (bathing, dressing,
toileting, feeding) by:
Building strength, endurance, joint mobility (via biomechanical
interventions).
Applying compensations or adaptive techniques (e.g., dressing aids).
Educating clients on safe movement and joint protection.
This aligns with OT's role in designing adaptive devices and context
modification to support self-care performance aota.org+1.
6. Adaptive Devices Commonly Used
OTs recommend and train in devices such as
Feeding aides (e.g., built-up utensils, plate guards, elastic shoelaces).
Toileting aids (e.g., raised toilet seats, grab bars, reachers).
Mobility aids (e.g., canes, walkers, wheelchairs, transfer benches).
Orthoses/splints (e.g., wrist splints, elbow orthoses), prosthetic training,
seating/positioning adaptations aota.org.
7. Precautions in Orthopedic Cases
Important orthopedic precautions (depending on the injury/surgery) include
● Weight-bearing restrictions (e.g., non-weight-bearing, partial WB).
● Range-of-motion limitations (e.g., avoid flexion beyond a threshold, no
rotation).
● Joint protection principles (avoiding stress on healing tissues, safe
movement patterns).
● Post-surgical precautions (e.g., no shoulder abduction, hip precautions like
no flex >90°).
Edema control and wound care.
Pain management, proper positioning, and avoiding contracture formation.
OTs must integrate medical/surgical guidelines into interventions to ensure safety
and optimize recovery.
