Occupational Therapy and the Shoulder

Authors: Julie Upton DipCOT SROT

Occupational Therapy: an approach to healthcare that
focuses on the nature, balance, pattern and context of
occupations and activities in the lives of individuals,
family groups and communities.

The main aim of Occupational Therapy (OT) is to maintain,
restore or create a balance, beneficial to the individual,
between the abilities of the person, the demands of his/her
occupations in the area of self care, productivity and
leisure, and the demands of the environment.

The OT process begins with assessment. This includes their
physical state and an analysis of what daily demands on the shoulder are. Once the problems are identified and some treatment goals agreed with the patient we can begin a treatment program. The principles which guide the treatment of any shoulder problem are as follows; Pain relief should be maximised, range of movement needs to be optimum and appropriate scapular control is required for a functional shoulder. Sufficient strength and stamina to complete tasks throughout the day are also essential for function.

Unlike physiotherapists who would use exercises as a
treatment media, Occupational Therapists us activities. If
possible the manual activity that the patient wishes to
return to is used. If this is not practical, we find a way
to simulate the movements required. Gaining range of
movement and scapular control can both be aided by the use of a device called the OB help arm. This device supports
the arm in a sling and uses an adjustable counterbalance to give active assisted movement. It is useful in the early
stages of rehabilitation post-surgery when trying to regain
range and before full active movement can be done, for
example when protecting a rotator cuff repair. It also
allows therapist and patient to work together on gaining
scapular control and using optimum external rotation
elevation to prevent impingement. Having the arm supported by the device gives the therapist both hands free and the ability to move around the patient to monitor their movement pattern.

When considering helping a patient to return to activity,
assessing their abilities is only one half of the equation.
A careful activity analysis of their tasks is required to
establish what movements; postures, strength and stamina are needed to allow us to tailor the treatment to the
individual. Once we know what the patient needs to be able to do we can simulate this and practice to gain improvement in areas of weakness. This can be achieved in many different ways depending upon the task. It could be a
traditional low-tech option or a modern IT driven version.

In summary, if a patient wishes to gain a successful return
to activity without further injury, we need to help them to
achieve scapular control, appropriate movement patterns and then a sufficient level of strength and stamina. Using an Occupation Therapy task based treatment programme that complements the physiotherapy input provides a comprehensive rehabilitation service.

ShoulderDoc Commentary:

The roles of the Surgeon and Physiotherapist in the management of Shoulder injuries, diseases and surgery are well known. However, the Occupational Therapist has a lot to contribute to shoulder (and elbow) problems. They are becoming an essential part of the team. This article summarises their role succinctly.

Julie Upton DipCOT SROT – Head Occupational Therapist
Nottingham Shoulder and Elbow Unit, Nottingham City
Hospital, Hucknall Road, Great Britain

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