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The Occupational Therapist

What is an Occupational Therapist?

A lot of patients have very little understanding of the work of an occupational therapist (OT).

The most common misconceptions are that they are either solely involved in helping people get back to work or that they are there to pick up the bits and pieces of work that none of the other specialists deal with.

Both are wrong! Occupational therapy is a profession in its own right.

Perhaps the best way to define occupational therapy is to broaden the commonly understood meaning of the word "occupational" to include all activities of daily living. So add in things like leisure activities, self care, domestic chores and community activities. Each of these will be affected by your hip surgery and the role of your therapist is to help you maintain your involvement in all these areas and to provide support for those where you are likely to have difficulty.

So how does this all work out in practice?

Furniture

The first contact with your occupational therapist is probably going to be a request for you to make an assessment of your home furniture. If you are not already aware of the various hip precautions that you will need to follow post-surgery, this might come as a surprise.

Raised Chair One of the precautions that most hip patients must follow is the rule of 90 which is that you mustn't close the gap between your body and your leg by more than 90 degrees - the risk being that you will dislocate your new hip. The problem is that many types of furniture mean that you will inevitably breach the rule either because the seat is so low that you are forced to sit at the wrong angle or that the process of getting in and out it means you must bend your body in a risky way.

The loo seat is a classic. They are all built too low.

Beds are a further hazard and you will need advice on which side to get in and out - which may involve re-arranging your bedroom for the duration of your recuperation. You will also receive essential advice on how to sleep without risking dislocating your hip. Many hip replacement patients have problems sleeping after surgery.

In rare cases the occupational therapist will visit your home herself and make a thorogh assessment of what is needed. More likely she will send you a chart to fill which will ist the height of various bits of furniture. You'll need to send the results back to the OT department a few weeks before your surgery so that there is time to make any necessary alterations.

One word of caution - do not include office type chairs as potential seats (unless they have brakes) - the last thing you need is to have your chair vanish from under you as you attempt to sit down.

If you are unable to measure the furniture yourself an occupational therapy assistant may be available to help.

During your preoperative assessment meeting with your OT, you will jointly decide which bits of furniture need alteration and dates and times fixed for the assistant to visit your home. The alterations normally involve raising the furniture to the correct height.

Aids

In addition to the furniture your occupational therapist will also discuss the different types of aids available. A perching stool is useful for washing yourself and washing the dishes, a sock-putter-on'er is essential as it will be a while before you can reach your feet again. A grabber is great for picking up light objects. They often come with a hook at the end which can be used to drag objects towards you. I also had a special trolley which was very stable and which I could weight bear on it.

Raised toilet seat The commode for my bedroom and the toilet raiser were crucial bits of kit.

The OT will arrange for all this equipment to be in your house before you are discharged. The delivery people will ensure that it is all adjusted and installed correctly and will show you how to use it.

Although your occupational therapist will be able to supply you with all the essential items - normally at no cost to yourself - there are other aids coming on the market you might find useful and I will be talking more about these later on.

Admission to Discharge

Your occupational therapist is also responsible for ensuring you understand the whole process of your surgery from admission through to postoperative rehabilitation. You might be shown a video.

The important points they will stress are about the arrival time, finding the correct place to go, what to bring with you and fasting before the operation.

They will also ask about your transport plans particularly post-op: getting into a car after the operation can be tricky but using a black cab is not permitted as simply getting into it will break the rule of 90! In some cases ambulance transport can be arranged but this is becoming increasingly rare.

Support after surgery

The OT will try to understand how best they can help you with your day-to-day life following your return home. Showering They will probably talk you through a round of your daily activities and point out how a hip replacement will impact on these in the first few weeks post-operatively. It will really help if you've already given some thought to this. To do so you will need to become very aware of what you do every day. Getting up, washing, dressing, making breakfast, for instance, all involve a range of movements which you may find are limited, for a while, after your hip replacement.

The OT will explain how some activities can be adapted to suit your temporary limitations and, if problem areas are identified, they will discuss support options for you.

Finally they may talk about the long term impact of the operation in terms of leisure activities, returning to work and other aspects of your long term function.




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