occupational therapy
An OT is concerned with the ordinary activities of daily life—washing, dressing, cooking, cleaning—the things that ‘occupy’ our time. Occupational therapy is what helps us readjust to the world after things like surgery, stroke and hip fractures, or any progressive disease. Its earliest evidence can be found in ancient Greece, when massage, exercise and therapeutic baths were used to ease the distress of mental illness. The profession became more formally recognized in the 1900s when crafts and activities—used initially to help wounded World War soldiers pass the time—became ways to detect and address problems with fine motor skills.
Rhonda Powell is lead hand therapist at Milliken Hand Center, part of Washington University School of Medicine. Hand therapy is a subspecialty of both OT and PT, and covers the mechanisms from shoulders to fingers. Powell treats everything from acute trauma injuries (wound care and splinting) to chronic conditions like arthritis, tendonitis and nerve compression (carpal tunnel) and says that compromised hand function can be particularly hard to deal with on an emotional level. “You lose your identity when you can’t use your hands,” she says. “And if you are a musician or artist who depends on your hands for your livelihood, it can be devastating.”
Julia Henderson Kalb, an instructor within Saint Louis University’s department of occupational science and occupational therapy, adds, “There is more art to OT than you may think. Not just in terms of how art and craft can be used, but in how the therapy is tailored creatively to the individual.” Kalb, who works at SLU’s ALS Clinic, explains that OT can be particularly beneficial to people with degenerative diseases or the elderly who are continually having to adjust to new limitations. Ideally, she says, treatment is centered around activities that are meaningful or enjoyable to the patient—throwing a ball or hoola-hooping for the sporty person, for example, or gardening activities that employ upper extremity strength for the horticulturalist. An injury like a hip fracture might need treatment for a few weeks, Kalb says, while getting over a stroke could take months. “Occupational therapists also are concerned with psychological well-being, so the more natural the treatment setting, the better,” she adds.
Powell agrees that treatment tailored to the individual usually will be more successful. “As much as possible, occupational therapists try to find activities for a patient to do rather than just rote exercises,” she explains. With OT, she adds, treatment can happen almost without a patient knowing it. “We find activities that engage the muscles that need to be engaged—turning a screwdriver, picking up checkers, rooting for an object through a bowl of rice.” And always, the goal is to make treatment as pain-free as possible. “We certainly don’t adhere to the ‘no pain, no gain’ philosophy!” Powell says.
physical therapy
The main difference between occupational and physical therapy is that a physical therapist treats the source of the injury rather than the fallout from it. PTs focus on strength and balance, flexibility and posture. They use weights, parallel bars and other equipment to treat ailments that affect the muscular, skeletal and nervous systems.
Andy d’Aquila, certified manual physical therapist at St. Louis Physical Therapy, says there is a larger role for PTs these days a.) because of the enormous number of aging baby boomers and their aches and pains and b.) because of our more sedentary lifestyles. Desk work and automation mean we move less. “But we are built to move,” d’Aquila says.
To be a certified manual therapist, additional training is required beyond what is usual for an entry-level PT qualification, and involves joint manipulation and soft tissue massage. “We treat any soft tissue or joint from jaw to toes,” d’Aquila explains. “Any sprain, strain, joint injury or arthritic pain.” He says studies have shown that manual therapy combined with PT exercises can alleviate lower back pain more effectively than any other treatment. PT also is particularly effective for easing inflammation in the temporomandibular jaw joint (TMJ), which can cause pain while eating, talking and breathing.
Although medication may be needed immediately following an injury, d’Aquila says a PT’s goal is to decrease, if not eliminate, the need to medicate. In that regard, he says PT can be considered naturopathic, meaning ‘alternative’ or self-healing. He stresses, however, that there is an educational component to PT and a commitment on the part of the patient to keep up with the home program. “A person needs to take ownership of their own care and not fall back on old bad habits,” d’Aquila stresses.
Nancy Hammond, postural restoration therapist and owner of Integrate 360 Physical Therapy, says it’s often our body’s anatomical asymmetry that can cause imbalance in these areas, and over time adversely affect simple functions like standing, walking, sitting and reaching. Even breathing the wrong way can cause postural problems. “If you can’t breathe correctly, you can’t move correctly,” Hammond explains. “Incorrect use of the diaphragm kicks in accessory muscles and causes dysfunction.” She notes that the diaphragm, our ‘breathing muscle,’ contracts 20,000 to 24,000 times a day, which can exacerbate asymmetry, creating an imbalanced pattern. “Injury and poor habits lead to changes in posture through repetition of undesirable movements, leading to muscle disuse, misuse or overuse,” Hammond explains. “If we can get people breathing and moving correctly, muscles work better and a person has more power.”
speech therapy
One of life’s simple joys—chatting to friends over a meal—isn’t simple for someone who can’t swallow, or find the words to say what they mean. Both eating and communicating are essential to life, which is why the field of speech therapy (or speech- language pathology) is so important. Sara Karpman, speech-language pathologist at Mercy Rehabilitation Hospital, says this particular branch of rehabilitation encompasses a broad spectrum of disorders. “If there’s a problem anywhere from the neck up, it usually can be addressed by a speech therapist,” she says.
“Yes, it’s a lot more than lisps and stutters,” says Sue Owens, speech-language pathologist with the Voice & Swallowing Center, a division of Soundhealth Services. Owens specializes in voice resonance issues—hoarseness and changes in voice quality due to illness (head and neck cancers, for example) or mis/overuse. “Without one’s voice, a person can feel very isolated,” Owens explains. “Even if your voice can be heard, but isn’t functioning well, it can have a big impact on your life.”
Owens also notes that voice problems can manifest during times of stress. “There’s a strong link between mind and body, and sometimes the physiological symptom manifests in the voice,” she says. In any event, taking a thorough patient history and working alongside a physician helps the therapist determine the best course of treatment. “Therapy can look very different depending on the disorder,” Owens explains. “But we use the best assessment methods and develop treatment plans to optimize the level of function.” Speech-language pathologists also address language/cognition disorders and memory issues for patients with dementia. Often, people who have experienced an acquired brain injury or stroke encounter changes in their thinking skills, in their abilities to use and understand language, and to speak.
One of Karpman’s main roles at Mercy is to determine whether a patient’s swallow mechanism is safe for eating. She says there are four different phases of swallowing, and any or all can be affected because of certain diseases and surgical interventions. A speech-language pathologist, she says, will look at the strength and movement of the muscles involved in swallowing, as well as the coordination and timing of breathing and swallowing. Treatment may involve exercises to improve muscle movement, as well as suggested positions or strategies to help the patient swallow safely and more effectively.
Owens says her patients often are people who rely on their voices for a living—opera singers, say, and even those who work at call centers. And Karpman notes that speech therapists can be helpful in transitioning transgender patients as well.