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Getting to the Heart of the Matter

Occupational therapy and cardiac failure patients

Healthcare Professional Digest speaks with Interim HealthCare's national rehabilitation director, Jonna Borgdorff, PT

Occupational therapy. For many people -- including medical professionals -- it's a misunderstood term. After all, if it's occupational therapy, it's used just to get people back to work, isn't it? Definitely not.

Occupational therapists (OTs) help a variety of patient populations, including those who may not have worked for years. They employ tools and techniques unique to their field. And their goals differ from those of other therapists. Unfortunately, the confusion over what OTs do may, at times, be one reason for their underutilization, especially with cardiac failure patients.

To find out more about occupational therapy, what it's all about and how OTs can help cardiac failure patients live better, safer lives, Healthcare Professional Digest recently spoke with Interim HealthCare's national rehabilitation director Jonna Borgdorff, PT. The following is a summary of that interview.

Healthcare Professional Digest: What is the definition of occupational therapy?

Jonna Borgdorff: When many people are told they need occupational therapy, and they're retired or don't work outside the home, they say, "Why? I don't have a job."

But OTs do more than get people back to work. They help patients do what they used to, including the activities of daily living, by assisting them in the development of the physical and mental abilities to do these tasks.

HPD: What are the goals of occupational therapy?

Borgdorff: If the individual doesn't have a job, the primary goal is to enable the patient to resume daily living activities as safely and independently as possible. Physical therapists deal with musculoskeletal development. But OTs also consider the mental health of the individual. By that, I mean helping patients understand the sequence of necessary events to complete a task as well as develop problem-solving abilities and use the logic necessary to address safety issues. For instance, OTs help patients learn how to manage their medications, keep schedules, pay bills, dial 911 and more.

I know of one case where it was thought a patient was ready to be discharged from a nursing home, since she was walking well enough. But the OT had some concerns, so she sent the patient into a training kitchen and asked her to make some toast. Sure enough, the patient couldn't figure out the steps to do this task. So, while to the average person or family member it may have seemed the patient was ready because she was up and functioning again, thanks to the specialty focus of the OT, we were able to identify it was not safe for the patient to be discharged to her home alone just yet or without some additional home healthcare services.

HPD: What health conditions necessitate the use of occupational therapy?

Borgdorff: Typically, patients with brain dysfunction, whether from a stroke, early-onset Alzheimer's or medications, need occupational therapy. But patients who have recently had surgery or a heart attack can benefit greatly from occupational therapy too.

HPD: What are the primary concerns when OTs begin providing therapy to cardiac failure patients?

Borgdorff: First, OTs assess these patients' strength, balance, range of motion, and ability to plan and execute tasks. Energy conservation is another concern. Cardiac failure patients don't have the energy levels they used to, so OTs look at the way the home is set up and recommend changes to accommodate the lower energy levels. OTs work to get patients to a level where they can function better and more safely in their own environments.

HPD: What types of exercises/therapy do OTs provide cardiac failure patients?

Borgdorff: OTs teach basic strengthening exercises with weights and resistance bands and exercises using various equipment and items in the patient's environment, such as buttons or closures on clothing, to develop fine-motor skills. OTs also design creative programs so they can make therapy more fun while they are working on essential tasks like dressing and bathing.

HPD: How do OTs help these patients plan and execute tasks?

Borgdorff: OTs determine what the patients will be able to learn, and then they teach patients patterns and routines, such as when mealtimes are, what time the mail comes or when to take meds, so they won't be so scattered in daily activities. OTs also help make lists of activities like these that patients can refer to when they're on their own.

When it comes to executing tasks, many of these patients have had cardiac failure for some time and they have adapted to doing tasks unsafely. Other patients don't even function that well. For example, in some cases, if you give a cardiac failure patient a washcloth and soap, the patient can wash his or her face. But if you tell a patient to go into the bathroom and wash up, he or she may not be able to do it. OTs help progress patients from needing setup to completing a task to being able to complete the task as safely and independently as possible.

OTs help patients follow a path to get to the answers for how to complete a task. They help them see the steps necessary or cue them as necessary to get them back on track and train them to do tasks the right way.

HPD: Why is energy conservation an issue, and what can OTs do about it?

Borgdorff: Most cardiac failure patients don't have the energy levels they used to or when they first arranged their homes. Once, having the favorite chair next to a window was OK. But it may be at the farthest point from the bathroom, and now that's a problem. OTs look for things like this.

They make sure the bread-and-butter plates are near where the bread and butter are kept in the kitchen, that the towel hook is next to the tub and that the clothes most frequently worn are hung at a comfortable, accessible height in the bedroom closet.

It's a gift being in patients' homes, since OTs can see how patients really function. For instance, getting up from a chair in an office is very different from getting up from a sofa at home. OTs also determine what adaptive equipment, such as reachers and tub chairs, will be necessary to complete tasks safely.

HPD: How does an OT operate as part of a cardiac failure patient's care team?

Borgdorff: At Interim HealthCare, we have a cardiac failure pathway that includes nursing, social work, physical therapy and occupational therapy. Each of these professionals has specific tasks in the pathway. We also focus on what we call the High 5 Functions: get up, get clean, get dressed, get food and get out. OTs address the first four of these.

HPD: It's been said that occupational therapy is underutilized in the care of cardiac failure patients. Why do you think this is the case?

Borgdorff: Physicians have a general overview of what each discipline provides, but they frequently don't know everything occupational therapy can accomplish. Other medical professionals tend to forget about the value of occupational therapy for conditions other than work-related injuries. Plus, in some areas of the country, there's a shortage of OTs, so with time, people may forget to use them. However, occupational therapy is an integral part of healthcare and should be routinely ordered for any patient who could benefit from it -- and that includes cardiac failure patients.

Jonna Borgdorff, PT, has been Interim HealthCare's national rehabilitation director for two years. She has a clinical background that includes the treatment of a broad scope of patient populations, with a focus on elder care and delivery of therapies in the senior-living environment for the past 10 years.