Long term conditions

Occupational therapists help people with long term conditions get the most from life

Long term conditions include:

• Stroke, traumatic brain injury and other neurological conditions
• Dementia
• Limb loss, arthritis and other musculo-skeletal disorders
• Cancer, HIV and AIDS
• Cardiac and pulmonary conditions
   

When working with people with long term conditions occupational therapists focus on:

• how they can enable clients to function at an optimal level, despite impairments
• how activities which the person needs or wants to do can be modified or adapted to make them easier
• how clients  feel about themselves and their ability to tackle problems
• how the physical and social environment can be altered so that restrictions are reduced 
   

Occupational therapists work in a variety of settings, such as hospital wards, care homes, specialised rehabilitation services and social service departments. They help people with long term conditions:

• carry out activities of daily living, such as dressing, cooking or using public transport
• remain in employment through vocational rehabilitation programmes 
• access information, advice and services
• manage their own conditions effectively
• remain living in their own homes through home adaptations
• use specialist equipment or develop ‘coping strategies’
• participate in group activities
• manage fatigue
• prevent falls 
• practice functional skills in order to promote independence
• use orthotics, prosthetics  and wheelchairs to help with physical function and mobility 
• move safely in his or her own environment despite severe mobility problems 
• set realistic and achievable personal goals
• come to terms with a situation if it cannot be changed or improved.
• enjoy leisure time
   

Annie was a young woman who sustained a brain injury following a car accident 

Before the injury, Annie had been working as a financial assistant and living with one of her friends. Her hobbies included seeing friends, socialising, long distance running and going to the gym. Following the injury, Annie had a moderate right hemiplegia and was unable to stand or walk without assistance. She had limited attention span, difficulty remembering basic information, and grew tired easily. She had lost confidence, became fearful if she was by herself, and no longer had contact with many of her previous friends. 
 
Initially the occupational therapist worked with Annie to help her improve her mobility, attention span and tolerance to activity. Annie was asked to keep a diary (assisted by her relatives), and to answer basic orientation questions every day. She was asked to participate in activities which she enjoyed such as painting and remedial games. These could be done in a standing position, so the activities helped her to transfer weight on to her affected side, to improve her standing balance and to increase her tolerance to activity. Annie was also helped to increase her independence in basic mobility and self care.
 
As Annie progressed and her attention, memory, mobility and activity tolerance improved, much more complicated activities were used. Annie worked with the occupational therapist to set herself realistic goals. The activities she chose included cooking a meal, going to the swimming pool (with help), buying a list of items from a shop, keeping an appointment and catching a bus. Annie’s confidence improved daily as she was able to do more things for herself and she gradually became aware of how much progress she had made. Annie was discharged to a community team for further rehabilitation.