Occupational therapy helps restore one's essential abilities

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

Occupational therapists make a difference in the lives of their patients every day. Here to explain how and to tell us about the profession are Upstate occupational therapists Alexis Antoniou and Paige Courbat.

Welcome to "The Informed Patient," both of you.

Alexis Antoniou: Thank you.

Paige Courbat: Hi.

Host Amber Smith: Now let's start with the definition. What is occupational therapy?

Alexis Antoniou: Occupational therapy: now, we work with individuals across the lifespan, so that means anywhere from birth, really, up through pretty much 100-plus. So here, specifically at Upstate, we would probably moreso work with babies, children and then also the elderly.

Our focus is to have individuals regain independence in what we call "occupations." A lot of the times, people hear "occupations," and they think, "Oh, are you going to help me get a job?" Or something along those lines. When we say "occupations," we mean anything that really occupies your time in your daily life.

So that can be anything simple from getting dressed, making a meal or returning to work, returning to a leisure activity, things like that.

Host Amber Smith: I'm glad you clarified that because I was going to ask, "Is it plumbing, is it the building trades?" But it's pretty much how you spend your time.

Alexis Antoniou: Yes, it is.

Host Amber Smith: So people may have heard of physical therapy.

Is this part of physical therapy, or is it totally separate from that?

Alexis Antoniou: So it is totally separate, although we do work very closely together. Where it differs: I would say physical therapy focuses on skills such as movement, gait, strength training, things like this, biomechanical.

Occupational therapy focus is toward those occupations and function focused, so we would focus more on that mobility, doing the task at hand rather than just the mobility piece itself.

Host Amber Smith: I see. Well now, which types of patients may need occupational therapy?

Paige Courbat: With Upstate being a Level 1 trauma center, burn center, comprehensive stroke center, we commonly treat multi-traumas. That can include anything from internal and orthopedic injuries, brain injuries, of course, strokes, burns, but other diagnoses seen can fall under the category of things like general medicine, which might include a sepsis diagnosis or a respiratory illness, an infection. We treat spinal cord injuries, elective spine surgeries or joint replacements, impairments caused by cancer and even amputations. That's unique to this setting.

But otherwise you can see occupational therapists working in schools, in early intervention with young children. geriatrics. We also have outpatient settings that are still under that Upstate umbrella, but they focus on even those higher-level things once the people we treat here end up at home.

Host Amber Smith: It sounds like a wide array of types of conditions that you work with, and it sounds, too, like it's very individualized.

Paige Courbat: Yeah, we try to be, as in this setting, we might say "patient centered," but really just "person centered."

So we're always focusing on when we see someone, what is your goal? Of course, I am assessing what you're doing, and I know what it might take to get you home, but what is meaningful to you, and how can we implement that in our goals of therapy?

Host Amber Smith: So are the goals of occupational therapy going to be different for every patient?

Alexis Antoniou: Yes, absolutely. Specifically, I work in acute care. Paige works in acute rehab therapy here. Now we will have very common goals, but up on the acute-care floors, like right in the hospital, I'm assessing, again, what are you able to do at what level in order to return home, at either a completely independent level or the amount of assistance that you have available to you at home in order to create a safe discharge plan. And then that might entail going to rehab if the answer is they're not safe at this point to go home.

So we're continuing to work on those basic skills like getting dressed, making a meal, doing the things that you would routinely do around the house at home.

Host Amber Smith: So they may have occupational therapy while they're in the hospital, but it may continue even when they're discharged.

Alexis Antoniou: Yeah, it might. Like I said, they could go off to rehab, whether that be acute rehab or subacute rehab, and then even after, if they were to go to rehab and discharge home, they may continue on with home occupational therapy or outpatient.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with two occupational therapists from Upstate, Alexis Antoniou and Paige Courbat.

Now, what sorts of treatments might you do with patients? Can you give us sort of an overview?

Alexis Antoniou: So on acute care, we are looking, first and foremost, at how the individuals are able to care for themselves. So this can be assisting them with feeding themselves, grooming tasks, bathing, dressing and generalized mobility, to be able to safely get around their environment once home.

And then that continues on in the rehab process, which I'll let Paige speak to a little bit more.

Paige Courbat: So in rehab, again, we are looking to maximize that functional independence, particularly because some of our patients have to be independent at home. They live alone, and they have to be able to do all the daily tasks, which include higher-level things like money management, household management tasks, doing their own laundry, cleaning.

So we best try to simulate that when they are here with the tools we have, so anything functional like that we incorporate into our therapy to the best of our abilities. But we have some really cool tools accessible to us on rehab, too, so I'd just like to speak to those.

Like I said earlier, some of the conditions we treat include those spinal cord injuries, stroke patients. In those cases, a lot of folks have significant loss of function or ability to use a certain part of their body.

We have wearable upper-extremity electronical stimulation devices called Bioness H200. That would be something that almost looks like a robot arm, goes on their upper extremity, and it provides impulses to make their muscles basically do the thing that we want them to do, elicit that motion, so they can reengage with the support of this tool in those functional tasks and hope to regain function.

We also have a system called the Bioness Integrated Therapy System. This is like a big TV screen that's interactive. It focuses on those cognitive pieces, visual motor pieces, which will affect your performance and your daily skills, but it's focusing on all those other things, too. You need to be able to reach, stand, balance, but everything we use is super modifiable to meet that patient where they're at.

We also have a functional electrical stimulation system that almost simulates the movement of a bicycle, and we can attach that to a person's lower extremities, their upper extremities, and it's providing that same electrical stimulation that I was mentioning with that Bioness wearable arm device, but now across multiple muscle groups, so it's really amplifying the benefit across the body.

We also have other devices, and I'm sorry it's long-winded, but like the Armeo Spring, the stable arm supports, which, again, are compensating for people's weakness at that time to help them reengage in some of those functional tasks, but also have, like, a fun game element to it because people just want a little bit of escape when they have, some long-term stays here, which I see more of, once people get down on rehab. So we are making it as fun as we can, as functional as we can, and hopefully that, as patient-centered as we can.

Host Amber Smith: Can you tell us about some specific initiatives that occupational therapists are participating in at Upstate?

Alexis Antoniou: Yes. So occupational therapists here have a part in some things in the community, such as balance screens. They've taken a part in co-leading, with physical therapy, performing these balance screens at community events like the runs that we've had recently.

We also here, specifically for staff, take part in specialized or higher education to keep on top of the most up-to-date, evidence-based practice. And that's included specifically for OT (occupational therapy) things like upper-extremity mobilization following stroke, vision rehab, as well as cognition and dementia care.

Additionally, we have a very big role in psychiatric care, which is where OT was founded, back in the early 1900s. That was our bread and butter.

So specifically here at Upstate, the occupational therapists really take the lead role in regards to therapy when we're talking about OT, PT and speech in the traditional sense. And they will do individualized sessions as well as group sessions with multiple patients.

Host Amber Smith: In psychiatry?

Alexis Antoniou: That's right.

Host Amber Smith: Interesting. I wouldn't have thought of that being in psychiatry.

Alexis Antoniou: Yeah. So we run groups, and this can be in sensory integration, cognitive behavioral therapy-based groups and things like emotional regulation.

Host Amber Smith: Let me ask you, how would you want a patient in the hospital to prepare for their first visit seeing an occupational therapist? Are there things they should think about ahead of time, goals that they're trying for? Or do you help them with that?

Paige Courbat: We try to facilitate that process. I think it's difficult in this particular setting, being hospital-based. Many times it is due to an unexpected injury or illness, so it might not be even something they have heard of, and this is their first introduction to what occupational therapy is.

Other times, and not so much I would say for our discipline, but other times with elective surgeries, the surgeons might be saying, "It's very possible, post-surgery, you will experience weakness, making it more difficult to participate in your activities of daily living." And in that case, they may want to consider what would facilitate their progress home. Maybe that's home modifications.

But all of that comes into discussion when we do do initial assessment for a patient after receiving consult orders from a doctor. And then we try to, again, incorporate that into their goals. And we know, your home has to be accessible to get there. So we like to play a part in making recommendations for post-discharge, even including some of those modifications, equipment you might need and stuff of that nature.

Host Amber Smith: I'm interested in what drew each of you to this field. Can you talk a little about what the education is like and how you got where you are?

Alexis Antoniou: Sure. Currently, to be an occupational therapist, you have to have a master's degree, so I went to the University at Buffalo, and they had a combined program there, so it will take anywhere from five to six years to get a degree for occupational therapy. This involves a lot of science courses, so that's typically the beginning of it, is a lot of science-based courses. And then as you move toward the graduate aspect of it, is where they focus on more of, like, the therapeutic-type classes, how to refine our skills when we're working with patients.

Now, what drew me to this, I don't have a very particular story, but when I was thinking about what I wanted to do as a profession, as I was getting toward the end of high school, I knew I wanted to go somewhere in the health care field.

I did consider physical therapy. I did consider psychology. But it didn't feel like quite a right fit. Then one of my best friends got into an occupational therapy program and said, "Hey, I really think you should check this out," because I did not know what it was at that point. And then once I looked up what it was, it finally clicked.

Host Amber Smith: Ms. Courbat?

Paige Courbat: For me, I always knew I wanted to be in health care, I just didn't know what avenue. I loved watching, like, surgery shows, but wow, was that an undertaking to commit to that much school.

So my mom did a Google search and said, "Hey, Paige, you like helping people. What about occupational therapy?"

And I said, "Well, let's look into it."

And way back when, we were able to set up a time for me to shadow an OT. And at that point it was actually here at Upstate on the rehab unit, so things have come really full circle in my part, and from there, I stuck with it, applied to school, and to touch on that schooling note, too, if anyone is interested in OT, they also have the doctorate program as well. Like Alexis said, it's not required. It's more post-professional management, research theory-focused, but it's nice to have that option of higher education if this is something people are passionate about.

Host Amber Smith: What do you like the most about your job?

Paige Courbat: For me, I've worked in a couple settings. I've worked in early intervention, and now I've worked here both on the acute floors and now in rehab. I just find it so satisfying that you can see the progress with patients on a week-to-week basis.

And for the most part, people are so grateful to do the bare-minimum basics of life. They are just so happy to have the means to do it, even if that's compensating for where they're at right now with tools. It's just really satisfying to play a role in that.

Alexis Antoniou: Yeah, I would have to agree.

Definitely, the patients are what make everything worthwhile, even on the more difficult days. Like Paige said, most of the time people are very appreciative to do the basics. And to be able to help facilitate them regaining their independence and meeting their goals is very satisfying.

Host Amber Smith: Well, it does sound like a very interesting career. I want to thank both of you for taking the time to tell us about it.

Alexis Antoniou: Thank you so much.

Paige Courbat: Thank you.

Host Amber Smith: My guests have been Alexis Antoniou and Paige Courbat. They're both occupational therapists from Upstate Medical University.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

Find our archive of previous episodes at upstate.edu/informed.

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