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Occupational Therapy

Occupational Therapist’s enhance an individual’s quality of life through promoting independence and participation in daily activities. They assist in this process by working in collaboration with clients, carers and families towards individualised goals, recognising and utilising strengths and abilities to overcome the barriers identified.

TOTAL REHAB™ is dedicated to providing client-centred therapy aimed at enabling participation in the daily tasks an individual wants to, needs to, or is expected to engage in. To achieve this, therapists complete a variety of assessments pending the reason for the referral, plan interventions and implement therapy as required, liaising with all involved to ensure client-specific goals can be achieved and maintained in an effective and efficient manner.

As part of their role as an Occupational Therapist, TOTAL REHAB™ provides:

Initial Needs Assessment (INA)

An INA is a comprehensive assessment of an individual’s functional abilities and challenges across biomechanical, sensorimotor, cognitive, interpersonal and intrapersonal aspects of their lives in the context of their environment and culture. It provides a framework for the establishment and prioritisation of meaningful rehabilitation goals and recommendations which help to enhance function and facilitate reengagement in activities of daily living.

Functional Independence Measure (FIM)

The FIM instrument is a basic indicator of severity of disability. The functional ability of a patient changes during rehabilitation and the FIM instrument is used to track those changes. Functional change is a key outcome measure of rehabilitation episodes. TOTAL REHAB™ has an AROC trained FIM credentialed clinician able to complete FIM assessments as required.

Activities of Daily Living (ADL) Assessment

An ADL assessment involves a therapist observing and assessing an individual’s ability to perform the standard activities of daily living they participate in such as personal care tasks, home and garden maintenance and domestic tasks as well as driving, shopping and participation in leisure activities.

The aim of the ADL Assessment is to determine where strengths and challenges in participation lie so functional limitations preventing participation can be identified and recommendations provided to either improve engagement in meaningful daily activities or identify the degree of assistance an individual requires to ensure they can remain supported in their home.

When completing ADL assessments for the purposes of identifying the level of care an individual requires, TOTAL REHAB™ utilises the NSW MAA and LTCS Guidelines for Levels of Attendant Care for People with Spinal Cord Injury as a reference tool, taking into account an individual’s circumstances when providing any recommendations.

Home Safety and Modification Assessment

Common to the role of an Occupational Therapist is an assessment of an individual’s home to identify potential personal and environmental risk factors that could increase a person’s chance of falling. As the risk of falling increases with the number of risk factors present, identifying and modifying the risk factors individuals are exposed to can reduce the risk of falls.

During a home safety assessment, an Occupational Therapist observes the mobility of an individual within the context of their home environment to identify falls risks and provide solutions to minimise the risks. Should there be the potential to modify the environment so safety at home can be increased, the therapist will complete a home modifications request.

Home modifications are changes made to the home environment that aim to increase an individual’s level of independence and safety in their own home. Modifications to the home can include installation of assistive devices such as grab rails, hand rails, chair raisers, flick mixers and wedge ramps, of changes to the structure of the house such as fabricating ramps, removing baths and hobs or widening doorframes.

When providing recommendations, TOTAL REHAB™ utilises AS1428.1 – Design for Access and Mobility as a guide on aspects of physical accessibility relevant to design outcomes. This Australian Standard provides minimum design requirements for new building work, to enable access for people with disabilities and can be used as a legal reference to provide access in existing buildings and private dwellings.

Cognitive Assessments (DLOTCA)

Individuals who have sustained a Traumatic Brain Injury as a result of an accident often have increased difficulty with areas of executive functioning and cognition such as memory, problem solving, orientation, perception, planning and organisation. In order to determine a person’s social of cognitive level and in turn identify areas of concern to aid intervention and progress, conducting an assessment that provides valid, reliable and predictable information is important.

The Dynamic Lowenstein Occupational Therapy Cognitive Assessment (DLOTCA) is battery commonly used to assess adults with neurological deficits. It is not only valid and reliable but has standards of performances available for people with and without a brain injury. The DLOTCA enables therapists to obtain a detailed cognitive profile and evaluation of neurological deficits whilst also having the capacity to identify the level of awareness an individual has regarding their own condition and cognitive disability.

DVA

The Department of Veteran Affairs (DVA) provides a Rehabilitation Appliances Program (RAP) service for eligible return service men and women and their partners which enables access to therapeutic aids and appliances, home modifications and falls prevention products that aim to enhance quality of life.

The RAP helps eligible members of the veteran community to be independent and self-reliant in their own homes. Occupational Therapy assessments are able to identify areas where safety and independence can be improved through the provision of aids and appliances which help to minimise the impact of disabilities and dysfunction.

The RAP provides products according to each persons assessed clinical need as part of the overall management of their health care.

  • Examples of products available through the RAP assessment include:
  • Shower chairs and over toilet aids to increase safety whilst completing personal care tasks;
  • Long handled reachers and shoe horns to minimise the need to bend down low;
  • Bed and chair raisers, height adjustable day chairs, bed sticks, and electric beds or recliner chairs for those who have difficulty getting in and out of lower heights;
  • Wheelchairs, wheeled walkers and walking sticks if mobility is a concern;
  • Home modifications including grab rails in showers, toilets, and entrances, hand rails, ramps, wedges and half steps, all measured to suit each individual’s home environment, ensuring safe and suitable accessibility.

All Gold Card holders are eligible for appliances under this program, while White Card holders are eligible when the appliance is necessary for the management of an accepted disability only.

Seating Assessment

The effective prescription and use of a wheelchair enables and empowers individuals to participate in life and interact in their community. A correctly prescribed wheelchair and seating system will optimise function, address the impact of environmental factors, correct and prevent postural and pressure issues and meet a client’s home and community participation needs. The short and long term consequences of an incorrectly prescribed system can be profound, as are the safety issues associated with wheelchair use. It is equally important to consider how a client perceives their wheelchair, and the psychological issues of self- and societal perception of wheelchair use when working with the client in setting goals (NSW Agency for Clinical Innovation).

The therapist associated with TOTAL REHAB™ has a high degree of experience working with and prescribing wheelchairs for people with spinal injuries, brain injuries and amputations. Essential to this is the ability to effectively complete a MAT assessment to identify postural issues that may impact on a person’s pressure, support, control, sensation and functional ability.

TOTAL REHAB™ incorporates the Enable NSW and LTCS Guidelines for the Prescription of a Seated Wheelchair or Mobility Scooter for people with a Traumatic Brain Injury or Spinal Cord Injury when completing a seating assessment to ensure best practice guidelines are followed throughout the process.

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