Occupational therapy

Occupational therapy provides support to people whose health prevents them doing the activities that matter to them.

An occupational therapist can identify strengths and difficulties you may have in everyday life, such as dressing or getting to the shops, and will help you work out practical solutions.

They can work with you to identify goals that can help you maintain, regain, or improve your independence by using different techniques, changing your environment, and using new equipment.

Who can benefit from occupational therapy?

Occupational therapy is used when someone is having difficulty with everyday tasks. This could be because they have a:

• medical condition – for example, rheumatoid arthritis
• learning disability
• mental health condition – for example, bipolar disorder

Occupational therapists work with people of all ages and can look at all aspects of daily life, from the home to the school or workplace.

Read more about when occupational therapy is used.

Occupational therapy techniques

After identifying the difficulties a person has with everyday tasks, occupational therapists can help by either:

• practising the activity in manageable stages
• teaching a different way to complete the activity
• recommending changes that will make the activity easier
• providing devices that make activities easier

For example, after a hip replacement, someone may find it difficult to get in and out of the bath. Grab rails could be fitted in the bathroom to make this easier.

Someone with rheumatoid arthritis – a condition that causes pain and swelling in the joints – may find it hard to lift small objects. Special equipment, such as a wide-handled vegetable peeler, may be made available to make tasks easier.

Read more about occupational therapy techniques and equipment.

The aim of these changes is to allow you to maintain and improve your ability to do everyday tasks. This can include both work and leisure activities.

Read more about occupational therapy rehabilitation.

How is it accessed?

Ask your GP, nurse, or another health or social care professional for a referral to see an occupational therapist.

You can also go through your local clinical commissioning group (CCG) or local authority social services department.

If you do not want to go through the NHS or local authority, you can contact an occupational therapist directly.

Read more about accessing occupational therapy.

The professional body for occupational therapists working in a wide range of areas in the UK is the Royal College of Occupational Therapy (RCOT).

If you decide to see a private occupational therapist, make sure they are fully qualified and a member of a recognised body. You can see if your occupational therapist is registered by checking the HCPC online register.

The Royal College of Occupational Therapists (RCOT), has published several helpful patient information leaflets that explain how their work can help.

Occupational therapy is used to treat and manage a wide range of conditions and needs.

Some of these conditions include those that:

• are present from birth
• develop with age
• are the result of an accident

Occupational therapy is also used as part of a rehabilitation programme (a treatment programme designed to help someone recover from illness or injury) – for example, after surgery or to treat depression.

Health conditions

Occupational therapy may be used to treat conditions including:

• arthritis – a condition that causes pain and inflammation of the joints and bones, which can make handling objects difficult
• depression – when you have feelings of extreme sadness that can last for a long time and interfere with your daily life
• multiple sclerosis (MS) – a condition of the central nervous system (the brain and spinal cord) that affects the body's actions, such as movement and balance
• Parkinson's disease – a condition that affects the way the brain co-ordinates body movements, including walking, talking and writing
• schizophrenia – a mental health condition that causes psychological symptoms, such as hallucinations (hearing or seeing things that do not exist)
• dyspraxia (developmental co-ordination disorder) – a condition characterised by difficulty in planning smooth, co-ordinated movements
• chronic pain – constant pain
• chronic fatigue syndrome – when you have constant exhaustion that doesn't go away after sleep and rest

Conditions in children

Occupational therapists may also work with children whose participation in everyday activities is affected by conditions such as:

• cerebral palsy – a set of neurological conditions caused by a problem with the brain that occurs before, during or soon after birth that affects movement and coordination
• developmental coordination disorder/dyspraxia – a condition affecting physical coordination and the quality of movements, meaning that a young person performs daily activities less well than expected
• Down's syndrome – a genetic condition that causes mild to moderate learning disability and affects physical development
• learning disability – can be caused by problems before, during or after birth following an illness, accident or seizures
• autism – a developmental disorder affecting social interaction, communication and behaviour

Ageing

Occupational therapy may be used to address problems that develop as a result of getting older. For example, you may find certain movements are not as easy as they used to be, such as getting out of bed in the morning. An occupational therapist can suggest equipment and adaptations to your home, or new techniques that may be helpful.

Occupational therapy also includes providing devices and helping devise strategies to aid memory and improve function in people with conditions associated with ageing, such as dementia (an ongoing decline of the brain and its abilities) and Alzheimer's disease (the most common form of dementia).

Rehabilitation and recovery

Occupational therapy can be used after an accident, illness or operation to help you recover and regain as much independence as possible. For example, occupational therapy may be used after:

• a hip fracture – this usually requires surgery followed by a rehabilitation programme to help you regain full mobility
• a severe head injury – after a severe head injury, you may find everyday activities at work or home difficult, and occupational therapy may help you recover
• a stroke – you may have some weakness on one side of your body and need to learn new ways of carrying out daily activities
• an addiction – this can make it hard to stay in work

Many different techniques and equipment can be used as part of occupational therapy, depending on the difficulties you are having.

Some of these techniques are explained below.

Thinking about activities differently

A key aim of occupational therapy is to help you develop or maintain a satisfying routine of meaningful everyday activities that can give you a sense of direction and purpose.

This can include help with budgeting, domestic or personal care routines, leisure activities, and involvement in work or voluntary activities.

An occupational therapist will look at the activity you are finding difficult and see if there is another way it can be completed.

For example, if you are finding it difficult to:

• peel and chop vegetables – perhaps you could buy vegetables that are already prepared
• walk to your local shop – perhaps there is a bus that runs past your house, or you may be able to do your shopping on the internet
• do the ironing – perhaps you could sit down while you iron

An occupational therapist will also help find new ways to carry out an activity by breaking it down into small individual movements, and will then practise the stages with you.

For example, if you cannot get up from a chair without assistance, an occupational therapist will go through each stage of the movement with you until you can confidently get up on your own.

If appropriate, the occupational therapist may suggest a special chair.

For children, an occupational therapist may develop a game or activity that they can complete each day.

This could be aimed at improving your child's:

• hand strength
• concentration
• social skills

Focusing on a small goal, such as improved hand strength, may eventually help your child to hold a spoon, a pencil or dress themselves.

Adapting your environment

Part of occupational therapy may involve making an environment suitable for your needs.

This could be your home, workplace or where you are studying, and may involve changes such as:

• putting in ramps, so an area can be accessed in a wheelchair
• fitting a stairlift
• installing grab rails – for example, by the stairs or beside the bed
• providing a raised toilet seat, bath lift or shower seat to make the bathroom easier to use
• clearing up clutter, reorganising cupboards or providing visual cues so you can safely move around and reach what you need

Using special equipment

Occupational therapists can also advise about what special tools or pieces of equipment you may find helpful. For example:

• a walking stick, walking frame or a wheelchair
• electric can openers or electric toothbrushes
• knives with large handles and chunky pens (if you have difficulty holding small objects)
• a non-slip mat for the bath
• a special keyboard or mouse to help you use a computer
• voice-controlled lights or voice-controlled software on a computer

You should mention any difficulties to your occupational therapist, no matter how small they seem, as there may be all kinds of adapted equipment that can help.

For example, you could have a special comb to style your hair more easily, or a device to turn the pages of a book.

Rehabilitation aims to improve your ability to carry out the everyday activities that have been affected by illness, injury or surgery.

Occupational therapy attempts to help you get the most out of life. As well as being able to complete everyday activities, there are other areas of your life that should also be included in your rehabilitation programme, particularly work and leisure.

Workplace rehabilitation

Workplace rehabilitation, or vocational rehabilitation, means helping someone with a health condition return to work or start working, or enabling them to carry on working. "Work" does not have to mean a paid role – you could be a full-time parent or a volunteer.

An occupational therapist could help by:

• assessing your workplace
• assessing your role at work
• assessing your ability to complete work activities, and finding ways to assist you if necessary
• finding ways to manage your condition while at work
• providing additional training
• finding a way to cope with problems like discrimination and prejudice
• helping your employers manage your return to work and increasing awareness of your condition
• monitoring your progress

Leisure rehabilitation

Leisure rehabilitation could cover any fun activity, such as taking up a hobby or attending social events.

Taking part in leisure activities can prevent people feeling isolated because of their condition, and improve their quality of life. While you need to be able to care for yourself and work, being able to take part in activities for fun is also important.

An occupational therapist may discuss what activities you enjoy, and find practical ways that may not always seem obvious, so that you can continue those activities.

For example, if you like going out to the shops but find it tiring, so an occupational therapist may suggest a wheeled walker with a seat and basket. If you enjoy gardening but find some tasks difficult, an occupational therapist can identify easier ways of carrying out those tasks using different techniques and specially adapted gardening tools.

Activity grading and graded exposure

One way your occupational therapist may encourage you to return to work or resume your hobbies is with activity grading.

Activity grading is a way of breaking down an activity you want to complete into stages that become increasingly more difficult.

For example, if your goal is to walk to work, but it is too far for you to do at once, this can be broken down.

On your first day, you can get the bus most of the way and then walk the last part. Each week, you could get off the bus a stop earlier and increase the distance you walk.

The activity becomes increasingly difficult as you gradually reach your goal of walking to work.

As you become more confident with an activity, you can progress to the next stage and eventually reach your goal.

Graded exposure is similar to activity grading, but is more focused on dealing with the emotional and psychological element of rehabilitation. It is used to help gradually build your confidence and establish meaningful routines that you may have otherwise avoided.

You can get a referral for free occupational therapy through your GP surgery, local council or local clinical commissioning group, or you can go private.

The duration and severity of your condition determines whether you can access care through your local council or the NHS. In general:

• for short-term conditions, such as after an operation, occupational therapy is usually accessed through the NHS
• for long-term conditions, such as a permanent physical disability, occupational therapy is usually accessed through your local council

If you are not sure how to access occupational therapy, you can contact your local council and ask if they provide occupational therapy to someone in your situation. You can search for your local council on the GOV.UK website. If they cannot help you, they may suggest that you speak to your GP.

Private occupational therapy

If you do not want to access occupational therapy through the NHS or your local council, you could contact an occupational therapist directly. If you decide to see a private occupational therapist, make sure they are fully qualified and a member of a recognised body, such as the Royal College of Occupational Therapists (RCOT).

Only healthcare professionals registered with the Health and Care Professions Council (HCPC) are allowed to use the title of "occupational therapist". You can see if your occupational therapist is registered by checking the HCPC online register.

If you choose to access occupational therapy privately, heed the below advice about buying your own equipment.

Short-term conditions

If you require occupational therapy because of a short-term condition, it is usually the responsibility of the NHS to provide this.

Speak to one of the healthcare professionals treating you. They will discuss your needs and decide if you would benefit from occupational therapy.

If it is decided you would benefit from occupational therapy, an assessment with an occupational therapist can be arranged as part of your care.

At your assessment, your occupational therapist will decide if you need any equipment or training.

It may be provided free of charge by the NHS, although this could depend on what is available from your local clinical commissioning group (CCG).

Long-term conditions

If you have a long-term condition affecting your ability to carry out most everyday activities, you may be able to access occupational therapy through your local council or Health and Social Care Partnership (HSCP).

Local councils usually provide occupational therapy as part of their social care services. They may work with local NHS providers and organisations, and other councils to run these.

Councils have eligibility criteria to determine whether someone can receive social care services such as occupational therapy. This is largely based on the Care and Support (Eligibility Criteria) Regulations 2014.

The criteria may vary slightly between councils, but should include the following points:

• your needs arise from or are related to a physical or mental impairment or illness
• you're unable to carry out certain necessary tasks as a result of your needs, such as washing yourself, getting dressed or going to the toilet
• being unable to complete these tasks has a significant impact on your wellbeing

You can contact the social services department of your local council to arrange an assessment or your needs, or you can be referred for an assessment by:

• your GP or consultant (specialist doctor)
• a nurse
• another healthcare professional
• a social care professional

Assessing your needs

An assessor can carry out a health and social assessment to identify what areas of your everyday life are causing problems. They will discuss your needs with you and explain what help is available. An assessment and any advice or information should be free.

Read more about assessments.

Accessing equipment

An occupational therapist can make decisions about what equipment would be most useful to help you live independently. These decisions are made as part of your health and social care assessment (see above).

Equipment might include items such as:

• two-handled cups, tap turners and kettle tippers for the kitchen
• grab rails and raised toilet seats in the bathroom
• bed raisers and hoists in the bedroom

Read more about occupational therapy techniques and equipment.

Equipment cost

If an assessment has concluded you need equipment, it can usually be provided free of charge on a long-term loan. However, different local authorities may charge for some pieces of equipment.

You may need adaptations made to your house. These changes may be carried out free of charge, but this will depend on your local authority.

Larger, more expensive items and major adaptations may be the responsibility of the housing department. You may need to contribute towards the cost of these items, or you may be able to apply for a Disabled Facilities Grant to help with the cost.

A Disabled Facilities Grant (in England) is a grant from your local council to pay for changes to your home so you can continue to live there. Similar grants are available in Scotland, but each local authority should be contacted to establish what their criteria is.

The amount paid through the grant will depend on your income and outgoings. Visit the GOV.UK website for more information on Disabled Facilities Grants.

Equipment for employment

If you need equipment to help you carry out your work, the Access to Work scheme may be able to provide funding. Contact the disability employment adviser at your local Jobcentre Plus for advice and assistance, or see the GOV.UK website for information about Access to Work.

Buying your own equipment

You may choose to buy your own equipment rather than use the equipment provided by your local council. If you are going to buy your own equipment, it is still a good idea to have an assessment by an occupational therapist. They can provide guidance on what equipment is most suitable and advise you on what is available.

Sources of advice

Rica is a consumer research charity that produces information for disabled and older consumers. All reports are based on independent research carried out by Rica. This includes user trials, technical tests and survey work.

Help is also available from the Disabled Living Foundation. This national charity provides free, impartial advice about all types of home adaptation and mobility products for disabled adults and children, and older people.

Equipment loans

If you need some equipment on a short-term basis – for example, because someone with a disability is visiting you – your local British Red Cross can often lend you wheelchairs and other equipment for short periods of time.