by Carol Milano

Hospitalized for a month after knee replacement surgery, Naomi Maye had daily 30-minute sessions in SUNY Downstate Medical Center's Rehab Orthopedic Surgery Occupational Therapy (OT) Department. "They gave me exercises to do on my own: bend my knees; raise my hands backwards, forwards, upward. Whenever I did, I had less pain. Now I get around much better. OT definitely helped," she declares.

For all types of arthritis, OT helps manage pain or inflammation, by prevention (strengthening muscles around joints) and training (exercises to increase fine motor coordination and joint movement), explains Ray Cooper, Coordinator, Outpatient Rehabilitation Services, Mercy Medical Center in Baltimore.

OT can avert injury or the worsening of existing conditions, keep health care costs down, and maximize quality of life, reports the American Occupational Therapy Association (AOTA). "We look at the whole person, not just an injury. If a physical problem interferes with a task, OT finds an alternative way to perform it," says Cooper.

Tactics include environmental redesign or adaptive devices to facilitate arthritis-impeded activities. "We have special shoelaces, button hooks you use in either hand, pens you hold in a new way and L-shaped knives to cut meat and bread--all custom-fitted. A creative therapist can help a patient achieve the basics of independence," Cooper believes.

Darryl Eversole saw an occupational therapist for several months after each of his 13 hand surgeries to replace knuckles and wrists. "She customizes devices to each patient's needs. When I couldn't handle the handle on my razor anymore, she built me a gripper so I could shave. She made one for my toothbrush, too," recalls the Los Angeles oldies d.j.

Cooper's program teaches energy conservation, body mechanics, and joint protection. "For very inflamed joints, we break a task into several stages so a patient can do it safely and more easily. For people with hand arthritis, OT identifies the biomechanics to allow an activity without damage to joints." Mercy's staff helps systemic arthritis patients do everything from button a shirt to perform a job.

In severe cases, customized splinting positions a joint to avoid further degeneration or correct a problem. "Worn either day or night, splints maintain joint alignment and integrity. Small splints keep fingers highly functional and mobile. Managing effectively in early stages can prevent many deformities," advises Cooper.

Eversole's therapist makes him splints he wears for a month or two after a procedure, taking them off at home to do the exercises she prescribes. "Sometimes I have three or four different size splints to do different things for a certain joint or finger. I have a box full of splints," he laughs.

Who should consider OT? "If you're diagnosed with lupus or arthritis, have any joint pain, or notice your joints changing, ask your doctor for a referral to a rheumatologist. In most states, you need to be referred [to OT] by a physician," notes Cooper.

Before treatment, get approval from your insurance company and make sure the OT program provides patient education. (If you have an HMO you may have to use the OT program they recommend.) Hospital programs usually cost more than private outpatient clinics. At Mercy Medical Center, typical fees are $150 for initial visits, then $120 for subsequent appointments. In cases caught early, two or three visits may suffice; severe inflammations can require 10 or 12. Patient education may be in small groups, but treatment is individual--each case is unique.

Who provides the service? The USA has over 60,000 certified Occupational Therapists or Assistants, credentialed at the professional or technician level after a 4-year Bachelor's or 2-year Associate's degree at one of 300 US programs accredited by AOTA. After completing supervised fieldwork programs, they pass a national certification exam. All 50 states regulate OT practice; many also require ongoing continuing education. (See for more details.)

Distinctions between OT and PT can be subtle. PT's focus is on gross motor activities, OT's on fine motor work (often involving the hands, used in many functions). For joint replacement, the two therapies work in tandem: PT helps with weight-bearing activities and physical rehabilitation of the joint. OT concentrates on how to perform needed tasks.

Two years after knee surgery, Naomi Maye's OT sessions are still helping. "When I get up in the morning, my hands are so stiff I can't move them. So I do my exercises first thing in order to get going," she reports.


TIP: To avoid stiff hands in the morning, wear isotoner gloves while you sleep, so your body heats up the inside of the glove and keeps your hands warm. It operates like a hot pack, and works like a hot bath, says Ray Cooper.





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