The Role of Occupational Therapy in Scleroderma
Presented at the Society AGM by Phoung Quach Royal Free Hospital London
What is Occupational Therapy?
• We work with people of all ages who have physical, mental and / or social problems, either from birth or as a result of accident, illness or ageing.
• Our aim is to enable people to achieve as much as they can for themselves in order to get the most out of life.
• We work closely with the individual and with his / her family in order to achieve client centred goals.
Areas of assessments
The occupational therapist determines the person's functional level or areas of difficulty by assessing the person in the areas of;
Self Care — Bathing / dressing, eating / drinking
Mobility — Walking in & outdoor, using stairs
Transfers — In/out of bath/car, on/off toilet/bed/chair.
Domestic — Food preparation, cleaning and laundry
Work / Leisure — Correct seating and work space
Type of intervention
Once the occupational therapist has completed the assessment, he / she will discuss with the patient their priorities and goals in order to determine the type of intervention or treatment.
Intervention in particular for a patient with scleroderma may include;
Advice on;
A person with scleroderma may experience mild aching in a few joints and / or swelling and stiffness of the joints. When the person performs daily activities stress can be placed on these joints and this can increase the pain and inflammation.
The principles of joint protection encompass how to perform daily activities with the minimal amount of stress on the affected joints.
The aim is to
• Reduce pain by minimising strain.
• Preserve the joint structure / prevent deformity.
• Maintain function.
• Conserve energy.
An example is to use the strongest or largest joints instead of smaller joints i.e. by using your entire body instead of using your fingers when opening or shutting doors.
When a joint is inflamed or is stiff to move, a lot of energy is being exerted therefore the person may find that they feel tired more easily.
By applying the principles of energy conservation the person learns to use the least amount of energy in the most efficient way and hence conserve energy for activities that the person enjoys.
An example is to break down a task into little components and identify which steps can be omitted or simplified.
At times, as a result of symptoms of scleroderma especially relating to the hand and wrist, the person may find doing daily activities such as washing and dressing, feeding and drinking difficult. The person may require assistance to achieve this. Using assistive devices or alternative methods the person maybe able to maximise their independence and can also help with energy conservation and joint protection.
Samples of aids;
Sock aid - used to put socks on without having to stretch down to the feet.
Button hooks – can be used if the person has difficulty with managing buttons.
Tap turners or tap levers – can make turning taps easier.
Adapted cutlery - built up or padded handles can increase the grip on the cutlery.
Bottle / jar openers.
Kettle tipper- allows pouring water without having to lift the kettle and helps to reduce the risk of scalding.
It is possible however to over adapt by making the task too easy and prevent exercise or muscle stretches and in turn increase joint stiffness. It is therefore important that the person compromises as to when they should use aids. For example on work days for speed in the morning the person can use the sock aid to put on socks, but at other times when less rushed the person should stretch to reach the feet.
This usually includes advice on hand exercise and provision of a thermoplastic splint.
The aim is to maintain joint movements and to prevent further deformity of the hand.
General advice on hand care i.e. how to keep the hands warm and moisturised and avoid harsh detergents is also given.
This requires liaison between the hospital and the community occupational therapist. Major adaptation may include stair lift, installation of a shower or ramp. The level and type of adaptation depends on the severity of the difficulty and it usually involves an assessment by the social services occupational therapist, a financial assessment and application for a disability facilities grant to provide funding.