Questions - What To Consider

The word occupation within occupational therapy is used as a noun to describe an activity. It comes from the Crimean war when therapists used activity to occupy the time of the wounded during recovery.

We are all occupational beings in that we engage in activity and generally want to be as independent and successful as we can be.  This can be taken for granted until something inhibits our ability to be independently active, whether through physical or mental ill-health.  Occupational therapist support people at those times to solve the problems caused by ill-health and indeed the ill-health itself to maximise potential. This increased self-esteem helps the person to remain a productive and active member of society, reducing care needs and positively impacting on society and the economy.

Clinical reasoning in any health profession is the process by which decisions or recommendations are rationalised and justified.  Without clearly documenting or evidencing clinical reasoning the recommendation is without credibility.

Outcome measures are important to identify whether interventions have been successful so that they can be justified to the client and the commissioner.  Without outcome measures it is difficult to truly reflect on interventions to demonstrate impact and improve practice.

Activity analysis is a core skill of occupational therapy and it’s what makes an Occupational Therapist unique.  It is the detailed deconstruction of an activity to determine abilities of the performer.  This then highlights very specific areas of focus within the intervention strategy to support client centred goals.

Without an awareness of the most up-to-date and relevant evidence base an occupational therapists clinical reasoning cannot be articulated effectively.  For example, there might be a recommendation for a healthcare chair with specific backrest to support postural needs.  Without knowing what the evidence suggests regarding postural support the ‘why?’ question could not be effectively answered.

A standardised assessment is simply an assessment tool that has been formally written and approved that can be universally applied.

In the UK you can contact your local authority (council) to request an assessment, ask your GP or look at RCOTSS-IP for a list of occupational therapists practicing in the private sector.

A contracture is a shortening and hardening of a muscle, tendon, ligament or other connective tissue which results in deformity and rigidity of joints.

Firstly, it is important to remember that not everyone’s posture is the same and although there are examples of ‘universally good posture’ this might not be appropriate for someone with a kyphosis for example.  It is important to know whether the spinal deformity is fixed or flexible (correctable) as this helps to determine whether the seat needs to help correct the posture or manage it.  Using techniques with back cushions and mechanism types it is relatively simple to support even the most complex deformities.  See the Clinical Posture Guide for more support.

All seating assessments need to take account of the following measurements:

  • Hip width
  • Seat Depth
  • Seat height
  • Lumbar support height
  • Back height
  • Armrest height
  • Shoulder width

Guidance on taking measurements and how best to record/communicate these can be found in the Clinical Posture Guide and the Client Assessment Form.  These can be found in the Posture and Assessment sections.

Although you are not expected to perform an in-depth tissue viability or pressure care risk assessment you can use other elements of your assessment to determine how ‘at risk’ your client is.  For example, are they able to facilitate positional changes independently and/or mobilise?  Do they have current pressure areas? With this information our product specialists will be able to offer advice.  It might also be good practice to complete a multi-disciplinary assessment to ensure that holistic needs can be met.

By using a combination of lateral support back cushion, headrest and tilt-in-space mechanisms alongside accurate measurements (particularly width) this client’s postural and functional needs can be met whilst also supporting their holistic health and well-being.

The most common transfer that any carer supports is sitting to standing.  The rising feature on the mechanisms is there to support independence where possible and reduction in carer support when independence is not possible.  This may result in a carer needing to provide minimal assistance when previously physically supporting the stand or may also mean only one carer is needed when previously two were required.  The benefit of the rising element is that it takes the strain from agonist muscle groups (quads and triceps in this instance) and allows the client to focus on the transition from standing to mobilising which reduces risks of falls and maximises independence.

Most seating assessment documents are quite similar and cover relevant aspects such as measurements, pressure and postural needs as well as client goals leading to recommendations for provision.  An example Client Assessment Form can be found in the Assessment Section.

Repose offer over 30 categories of fabric across the domestic and healthcare ranges.  Each of the categories has a vast number of colours and styles so there should always be something that fits in.  We also offer complimentary furniture on some ranges so if the client was considering a complete suite change, they can purchase other matching items.

The new EU Medical Device Regulations come into effect on 25th May 2020 and it is unclear whether the UK will align themselves with this regulation when they leave the EU.  However, if they do there are a few points you need to be aware of:

  • The new regulation covers 4 times the amount of equipment than it previously did meaning that more of what you recommend might be considered a medical device.
  • Manufacturers will need to provide more detailed data regarding safety and effectiveness of their products to prove performance claims.
  • Unique Device Identification will be enforced to ensure devices can be tracked through their manufacturing and procurement process.

The regulations are therefore more likely to impact on manufacturers than the clinician and you are unlikely to notice any day-to-day difference.

The Care Act (2014) states that local authorities have a duty of care to promote an individual’s well-being (physical and mental).  It describes how eligibility criteria for provision is met and the rights of the person or carer with needs.  This took over from/enveloped FAC criteria in 2014 but they are still worth looking at to give an understanding of how need may be determined, and criteria met.  For children the CSPD Act remains relevant.