Occupational therapy (occupational therapy)

    Occupational therapy (treatment works) used in practice Russian clinicians Г.А. Mudrova, А.А. Zakharyin, A.A. Ostroumov etc. This is an active method of rehabilitation patients.  At the core of occupational therapy is the systematic training of domestic and industrial movements, recovery of lost motor skills. Occupational therapy normalizes the patient's psyche, and stimulates the function of the affected system (the body) and is an important component in the overall system rehabilitation.  In occupational therapists use a variety of activities: working in the garden and the garden (in winter in a greenhouse), cleaning, weaving, sewing, carpentry and plumbing work, modeling, etc.

  Currently, occupational therapy becomes important in the rehabilitation of patients. Occupational therapists are required to conduct a well-equipped special rooms. Due to the complex nature of occupational rehabilitation of classrooms should be located near the hall for gymnastics, swimming pool, massage, physiotherapy. In-patient occupational therapy is carried out both in the Chamber and in specially equipped rooms (workshops, etc.).

   Application of occupational therapy in the rehabilitation depends on the clinical features of disease, the dynamics of reparative processes and aims at preventing the development of secondary pathological changes in the tissues of the musculoskeletal system, limiting the motor function. The technique of using workflows is based on the physiology of labor movements. As a result of damage, and various orthopedic diseases, diseases of the central nervous system, spine, patients develop severe functional decline, breaking capacity for work, which often leads to disability. According to the medical-labor examination, the cause of decline and disability of patients is not only the severity of injuries and illnesses, but also the untimely and irregular of recuperation (restorative) treatment, as well as an incomplete use of all means of rehabilitation designed to restore and develop temporarily lost functions of the patient .

  Practice shows that the early application of occupational therapy and other rehabilitation facilities allows you to recover fully (or partially) disabled patient, to the acquisition of skills, labor and consumer self-service and helps to avoid disability.

  The problem of occupational therapy: restoring lost function through the use of differentiated types of labor, occupational rehabilitation and household skills (self-service, travel, etc.) and social reintegration (employment, material and social support, return to the labor collective), the provision of restorative and psychological impact on the patient's body .

  In the application of occupational therapy must take into account anatomical and physiological characteristics of the patient, and selection of movements should be based on the nature of the disease and the characteristics of its flow, which determines the dosage, the complexity and the initial position when the work processes (exercises). Exercises should be performed for a long time, systematically, with a gradually increasing load. You should avoid exercise (operations), which may lead to the consolidation cycle (unnecessary for this profession), the motor stereotype.

  The main factors (aspects) of occupational therapy (based on economic and social department of the UN), the following: recovery of motor functions, job skills training and daily activities; manufacturer (with prosthetic), the simplest devices that help develop skills in self, determination of the degree of restoration of occupational disability.

  Occupational therapy has two main areas: occupational activities and therapy work.

  Occupational activities - is filling free time a patient drawing, modeling, fabrication shop, improving psycho-emotional state of being in hospital.

  Therapy work - use for therapeutic purposes different labor processes, labor operations.

  There are three main forms of therapy work: replacement labor activities aimed at the prevention of movement disorders or restoration of disturbed functions, occupational therapy, aimed at the general strengthening, maintenance of functional status and disability in the event of a prolonged course of disease; industrial occupational therapy, prepares a patient for professional work (activity) carried out in close to production conditions (in the machine, exercise machines, benches, etc.).

  Given the clinic of the disease, the available functional changes (functional defect), is selected and the type of occupational therapy.  Rehabilitation for lost motor function in two ways: through the development of the lost motor function and adaptation (adaptation) of the patient to work.

There are three groups of labor operations (exercises): Occupational Therapy in lite mode (the cardboard work, winding yarn, toys manufacturer of foam, gauze masks, etc.), occupational therapy, produces some of the (developing) strength, muscle endurance hands (molding, paper plane, a file etc.); occupational therapy, which generates (developing) fine motor coordination of fingers, increase their sensitivity (knitting, weaving, printing and others).

  With a significant movement of motor function of hand (s) use special equipment to support it in carrying out the work (the strap, hanging, etc.).  Selection of exercises is based on the dynamic anatomy, physiology of labor. In addition, labor processes (exercises) assigned in view of the profession the patient, his age, functional impairment, etc.

  If persistent, irreversible defects of the locomotor apparatus (amputation, ankylosis, etc.), occupational therapy is aimed at developing a patient compensation (compensated) capabilities (functions) of the intact limb.

  Restorative occupational therapy is a means to improve physical performance. Under the influence of employment improves psycho-emotional condition of the patient and the function of the musculoskeletal system.

  With bedrest patients designate work on knitting, weaving, sculpting, sewing, painting, etc.

  Walking patient is able to fill the bed, clean room area, they may work in workshops, flower greenhouses, etc.

  Industrial occupational therapy is associated with work on various machines (weaving, woodworking, carpentry, cardboard, etc.). It provides an opportunity to orient the patient to work on the same field or getting a new specialty.

  In the course of occupational therapy patient gains a psychological and physical preparation for his career. For the patient, the conditions are close to production, to verify the residual capacity to work sick, his performance, is restored temporarily lost some sick skills (skills).

  Occupational therapy is used at various stages of rehabilitation, and includes several periods.

  The first period (2-4 weeks). - From the time of surgery to remove the plaster Longuet. With the 2-3 days recommended active and passive exercises are performed and facilitated the work process a healthy limb and fingers injured arm free of immobilization.

   The second period (3-4 weeks). - After the removal of sutures and plaster Longuet. Expanding range of gymnastics and work operations that require the active participation of the injured hand.

   The third period (6-12 months. And more) - after being discharged from the hospital throughout the period of restoration of the damaged nerve. Occupational therapy, exercise therapy and massage (self-massage, cryomassage) are held for a long time in the clinic and at home.

  Main in the complex movements are exercises that develop skills in self-service (washing, dressing, undressing, shaving, povyazyvanie handkerchief, etc.), cleaning, gardening (vegetable garden), and others are recommended as weaving, embroidery, sculpture, knitting, manufacturing cardboard toys, demolition of small parts, drawing, typing, carpentry work (work plane, polished wooden surfaces), etc.

  Occupational therapy should be differentiated in various stages of rehabilitation. The selection exercise and stress, it is divided by the load (the intensity of the manipulations), the selection of manipulation, etc.; for achievable development manipulation (movement), and localization effects on the musculoskeletal system.

   Load in the dosing of labor processes (skills) by choosing the weight of the working tool, the starting position (posture), duration of manipulations, the selection of the capture tool handles, special adaptations to tools and household appliances (spoon, razor, etc.).

   In occupational therapy, a gradual transition from the use of tools that facilitate the involvement of the patient limb work to the usual instruments. To hold hands in a comfortable position is used the base, means for fixing the forearm, tools, etc. In occupational therapists use various types of manipulation tools, stand, etc., contribute to the restoration of joint movement, strength, arm muscles, making the fine coordination of movements of fingers and increase their sensitivity.

  Dosing load in occupational therapy. We all stage of restorative treatment carried out monitoring of its effectiveness. This makes it possible to make adjustments in the work. Dosage loads on the state of health of the patient, the stage of rehabilitation, the volume of functional disorders, etc. One method of dosage in occupational therapy is time (duration) perform labor or manipulation of the volume of work, tool weight, mode of work, the nature of the work, working posture, etc .

  Occupational therapy should be combined with exercise therapy, massage, position correction (treatment position). Before delivering a package of occupational therapy and exercise therapy massage (self-massage), duration of 5-8 minutes, and occupational therapy itself takes 30-45 minutes daily or every other day.

  In formulating a correct stereotype workers' movements should do the following: To familiarize the patient with the labor operation (motion) technique to show the performance of job operations and to promote the mastery of work skills as a result of multiple repetitions of labor operations.

Types of work performed during the occupational therapy

  To carry out occupational therapy patients with sequelae of locomotor injuries and diseases of the upper extremities appoint the following works: knitting, weaving, sculpting, applied art works; typescript, sawing, hand joinery, burning, work on the sewing machine, hand bench work, work on the loom , on the machine for processing (grinding) of ceramic products; work on the assembly of various parts of instrumentation, working in the floral conservatory.

  From a psychological point of view of career is necessary to bring the work of type.  In the final selection occupational therapy, its nature, scope, careful analysis of the functionality of the patient's participation in this work the right and left hands, as well as to know which muscles are involved more in work, in which joints had the highest load.

   Occupational therapy is widely used in central nervous system damage, polio, stroke, mental illness, trauma musculoskeletal and other diseases.  Work therapy combined with physiotherapy and massage. Before occupational therapy are in active and passive exercises, massage (self-massage). Exercises should not cause pain. The range of exercise therapy to occupational therapy exercises include 8.10 in combination with massage (or self-massage) for the shoulder girdle muscles, joints, limbs and fingers in particular, IP standing, sitting.

  By the nature of occupational therapy produced movement applies and the mastery of everyday skills. Exercises for development of domestic skills (eg, use an electric, valves, switches, combing, doing up and undoing buttons, eating, washing dishes, etc.) prepare the patient for labor operations.

  During the training on mastering the skills of everyday patient gradually developed a fine motor coordination required to perform various labor operations.

  In a specially-equipped rooms with a set of household appliances, stands on which they are mounted and reinforced, patients develop skills in self-service, as well as train with the capture of an artificial hand prosthesis. On the wall stands have handles of different shapes and sizes, switches, plugs, locks, keys, faucets, etc. for work benches mounted bolts, circuit breakers, switches, etc.

  Occupational Therapy in Traumatology and Orthopedics. When a cast has to perform self-care good hand with the fingers partially injured arm.  After removing the plaster cast the problem of rehabilitation - increased range of motion in the joints of the upper extremity. As for pain relief used occupational therapy, massage, cryomassage to increase strength and range of motion in the shoulder joint.

 Occupational therapy involves ironing, sizing envelopes for storage of X-rays, making paper toys, sorting of small parts in shape and size.  Duration of employment for 10-15 minutes 2-3 times a day.

  As we strengthen muscles, increase range of motion the processes of occupational therapy complicate. Include work with the plane, sand, various kinds of cardboard works (gluing envelopes, boxes), weaving, sewing work, etc. The duration of 20-30 minutes 2-3 times a day in between - massage (self-massage, cryomassage).

  At a later stage of rehabilitation (in 1-1,5 months. After injury) using occupational therapy, require more dynamic and static effort. These include carpentry, wiping glasses, locksmithing, etc. 2-3 times a day for 30-40 minutes with breaks for rest and massage (self-massage).

Occupational therapy in injuries of brachial plexus and peripheral nerves of upper limb. Fractures of the humerus, clavicle, shoulder dislocation is often accompanied by peripheral nerve injuries (mostly radial, ulnar or median nerve), while there are certain movement disorders. In the comprehensive rehabilitation of a significant role belongs to occupational therapy. At the beginning of recommended simple movements and then a more active and with the subjects in the gym, etc.

Occupational therapy for motor disorders of the upper limbs as a result of various injuries: with bone fractures shoulder girdle (clavicle, scapula, etc.), damage-acromial clavicular joint, dislocation of humeral head and damage the proximal end of humerus fractures of the diaphysis of the humerus, fractures of the elbow joint, fractures of the forearm, wrist, fingers injuries and traumatic brachial plexus paresis of peripheral nerves of upper limb (limbs); contractures. Treatment difficulty and shown with injuries of the lower extremities (fractures, neurological damage, contractures, etc.).

Occupational therapy for injuries of the lower extremities. It is used for bone fractures, damage to the ankle, Achilles tendon injuries, peripheral nervous system and other pathologies. Of particular note is a bad adaptation of elderly patients, they require more than an early and active start occupational therapy.

Occupational therapy, gymnastics and massage (self-massage) are used comprehensively in the early stages of injury. Occupational therapy in the early stages of rehabilitation in the elderly has a purely diversionary, psychological. Showing the most labor operations for the manufacture of tampons and napkins from gauze, knitting, simple cardboard work, etc.

  With the expansion of the motor ill treatment, able to sit up, charge bonding boxes, envelopes, sewing work, typing, etc. At the end of the lower limb immobilization (cast removal) rehabilitation aims to restore motor function, and then the support function (using exercise therapy, exercise in water, cryomassage, training on simulators). All this serves as a preparation for the application of occupational therapy, which includes sewing on the sewing machine, carpentry and plumbing work, and later - on grinding and looms with the treadle. To train the support limb function (various squats, riding a bicycle, jogging on a treadmill, etc.).

Occupational therapy and training on special simulators are preparing for productive activities, rehabilitation physical condition of patients after trauma (surgery), lower extremity (limbs).

Occupational therapy in orthopedics. At deformations of musculoskeletal system (clubfoot, hip dislocation and habitual, etc.), paralysis (polio, cerebral palsy, etc.) is greatly disturbed the function of limbs.  Occupational therapy is of great importance in the restoration, correction, motor function, especially the upper extremities.

Poliomyelitis. Displaying a complex treatment in the rehabilitative and residual periods. Apply occupational therapy, exercise therapy, massage, orthopedic appliances and other Occupational Therapy is selected using labor operations adequately pathological changes in muscles, joints, location and nature of injuries. In the implementation of occupational therapists play an important role starting position when the limb movements (manipulation) for this use hammocks, suspension with brackets or special vehicles, tires, etc. The use of special equipment ensures stable performance of limb movements. Before occupational therapy is carried out MH and massage (or self-massage). Duration of occupational therapy - 10-30 minutes from outdoor activity, and in between - with massage.

Occupational therapy is conducted in the initial sitting position and begins with a simple manipulation. It includes: the selection and sorting of material to work; manufacturer of various paper products (napkins, flowers, etc.), balls (gauze and wool), cardboard paper (glued envelopes, boxes, etc.), binding, sculpting plasticine , clay, etc., sewing work, burning, cutting, carpentry work (planing, sawing, etc.) work at home and work benches (use a key, a crane, the inclusion of light, dressing and undressing, using a spoon, razor, etc. ).

When performing this or that work is training of muscles, restore limb function, etc., while important to the restoration of the finger grip while reducing flexor muscle strength.

Postpartum plexites (paresis) occur in children as a result of birth trauma. The disease is accompanied by the appearance of contractures in the joints of the upper extremities. Use conservative treatments (physiotherapy, massage, orthopedic facilities, occupational therapy, physiotherapy, etc.). Occupational therapy sessions are built in accordance with the nature of the strain, age. Working with children should be held in the form of games and simulate the labor manipulation.  Occupational therapy includes sorting colors, buttons, folding cubes, mosaics, sculpting plasticine, making gifts of paper, cardboard, etc., painting, sewing clothes for dolls, etc., as well as bookbinding, wood carving, cutting, twisting screws, use of cranes on the school bench, painting and other children were taught domestic skills and self-service.

Cerebral Palsy (CP). For the disease characterized by spastic paresis (toning specific muscle groups, the formation of contractures).

Used for the rehabilitation of occupational therapy, exercise everyday skills, gymnastics in the water, walking, training and other means.

Objectives Occupational Therapy for Cerebral Palsy: normalization of muscle tone, improve coordination, training of walking, correct posture in a sitting position, a reduction of contractures.

Important in rehabilitation of children with cerebral palsy - an implementation of occupational therapy.  For patients with cerebral palsy is very important to develop a correct working posture, relaxes spastic muscles, as well as training techniques work skills (showing ways of performing work operations, the explanation of labor tasks, passive listening basic workers' movement, etc.).

Initially, patients with cerebral palsy have a rudimentary labor operations that require equally easy work of both hands, then work to improve coordination of movements. In addition, to allow more time to perform labor operations. Kind of occupational therapy is defined as psychological characteristics of children's age, while preserving the work of a particular posture.

The main activities are recommended for children with cerebral palsy: drawing, painting simple drawings, etc.; making dresses for dolls made of paper, dressing and undressing dolls, disassembly and reassembly of toys, weaving, sculpting, gluing boxes, envelopes, carpentry (planing, sanding, etc.), hand sewing work, winding a spool of thread, etc.

Nonspecific polyarthritis. Polyarthritis observed in both adults and children and is accompanied by limitation of motion in joints, the presence of contractures and ankylosis, all of which drastically reduces the physical work capacity and work capacity of patients.

For lower limbs is characterized by flexion contractures, and in the upper limb arise limitation of movements and contractions in the shoulder (shoulder), elbow joints, and typical strain the hand and fingers, flexion contractures in the interphalangeal joints and extensor - in the metacarpophalangeal joints.

In the subacute period and during the exacerbation of applying treatment provision (bus, dressings), exercise therapy, massage (cryomassage), medications, occupational therapy and other means.

Occupational therapy is used to reduce existing functional impairment limb muscles regain their strength necessary to perform the work by hand, self-development of skills.

If the patient is working, then the exercise therapy, massage and occupational therapy designed to maintain a professional working capacity and prevention of disease progression.

Kinds of therapy, recommended fever patients: cardboard, Finishing work, woodwork, metalwork, sewing work, sculpture, painting, etc.

To develop the correct finger grip and development functions of flexion in the metacarpophalangeal joints using the following types of occupational therapy: modeling from clay, work on the sewing machine, typing, weaving, unwinding and winding the yarn into a ball, "kneading" foam rubber sponge in a bucket of warm water; bite a tennis ball; manufacture of gauze tampons, napkins and paper envelopes, boxes, sorting buttons, etc.

Before occupational therapy held physiotherapy and massage, preparing to perform manipulations. Training of various adaptive motions (functions) for Self-Service (combing, brushing teeth, using faucets, ironing, etc.), as well as perform obschetrudovyh processes (cleaning, light yard work, garden, conservatory).

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