Give clients an extra minute to figure it out themselves…
As occupational therapists, we’re used to problem-solving and providing real solutions for clients. When we know how to solve a problem, it’s natural to want to jump in and resolve it right away. Sometimes, our clients only need a little cueing and the right adaptations to succeed.
For example, a client with visual-perceptual issues may not be turning a puzzle piece correctly, but instead of directly telling them to turn it, it’s helpful to give them some time to problem-solve.
Also, when you do intervene, ask a question that can promote their awareness (i.e.,“Is that piece turned the right way?”). This helps promote their sense of self-esteem and self-efficacy. This technique can be particularly useful with strong-willed clients who have difficulty asking for help or lack the opportunities to feel accomplished.
Go back to the original problem…
Why was your client referred in the first place? Sometimes it’s easy to get caught up in a whole process and your therapy agenda. Commonly, we see that many fine-motor issues are due to some hand weakness or that trouble buttoning is caused by poor finger dexterity. But after assessing the client’s deficits and treating accordingly, notice if you need to step back and re-evaluate. What was noticed as a problem that led them to seek your services?
What is it that they are mostly having trouble doing? It might help to go back and observe them completing this task to get a fresh perspective. It might not be poor hand dexterity after all- you may instead notice that your client is not even looking at their hands or the buttons when they’re attempting the task, which means the issue could be more visual or cognitive, for example.
…And know that new problems may arise
As an OT we are constantly reassessing our clients and patients. Their problems are not always static. What we were working on two months ago may not be the only thing we are working on with them right now. Their conditions are either improving or morphing as they grow older or recover.
Often we are treating more than just one issue and these issues can all impact each other. Take the child who has sensory processing issues and has trouble keeping her body still during class. As a result, the teacher may have to reprimand her to sit properly and pay attention.
Consequently, she may internalize this and begin unhealthy coping strategies, such as banging her fist on the table out of frustration and the need to move her body at a desk. She may feel embarrassed and inadequate compared to classmates, leading to socio-emotional issues and trouble focusing in class. Remain aware of the connection between multiple issues and stay open to making changes in your treatment.
Ask their preference
Bring 2 variations of activities, and ask them what color/method/game they prefer. If you’re having trouble motivating a patient, simply ask what their interests are. Whether it’s tennis, sci-fi movies, or painting, you’ll find ways to incorporate these while still addressing goals. A client may have trouble fully turning their forearm at the elbow, so you can combine this with a Wii tennis game, or producing brush strokes at an easel while encouraging specific forearm movements.
If you’re an OT, you’re already resourceful, so you’ll find a way to make it work!
Have any of these strategies applied to your work as an OT? What other helpful tips do you want to share with therapists in the field?