Occupation-Based Intervention in SNFs

April 17th, 2019 in  Allied Health
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Everyday objects and tools can help to model routines and provide occupation-based therapy even if time or other resources are limited.
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Occupational therapists working in skilled nursing facilities (SNFs) often have limited time with patients in a busy rehab gym. As a new grad trying to manage productivity demands, it can be hard to cover all activities of daily living (ADLs). While actually bathing and dressing is the most occupation-based a session can be, there may not be the time or resources to do them consistently. Using these tools and tricks can help to more closely address ADL skills when time is running short, or if you are outside of the privacy of the patient's room!

Clothespins

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Clothespins aren't just for finger strength! Grab some and attach them to your patient’s clothing! You can strategically place them:

  • At the waist line
  • At the bottom of their pant leg
  • Along their button-up shirt
  • Behind their lower back
  • On their collar
  • This list goes on!

All of these areas will encourage the range of motion (ROM) needed during ADLs. You can even use them in more discreet places like the armpit area to mimic shaving or applying deodorant or clipping them onto a headband or ponytail to simulate grooming. Patients can apply or remove the clothespins while standing to further challenge dynamic balance. Plus, timing their standing tolerance will make documentation easier and covers multiple goals. You can also have them follow a full sequence using the clips to mimic their morning routine!

If you don't have any clothespins readily available or you want to add another layer of challenge, this method can also be used with stickers. With stickers, you can incorporate visual scanning or hand sensation by having patients search for hidden stickers on their clothing.

Rings or Horseshoes

Instead of using those colorful rings or horseshoes in a throwing activity, use them to simulate lower body dressing. Have the patient stack them onto their feet or over their ankles (if they’ll fit). This task will promote trunk flexion, endurance, hand-eye coordination, and working in one’s own bodily space rather than stacking them onto a pole.

Having your patient cross a leg over the opposite knee (“figure 4 sitting”) while reaching for the rings can work on hip flexibility. All the while it teaches an alternative way to don and doff shoes if the patient is unable to bend forward. And it goes beyond the legs! The rings can also be placed onto arms to practice entering a sleeve or pulling up a shirt.

Therabands

Getting dressed

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Sometimes getting fully dressed or undressed isn't an option. Maybe the patient declines or their room is being mopped or they have guests. One way to make the session occupation-based is to employ a Theraband as something other than an exercise device. Tie it together to make a circle big enough to fit around your patient and have them step into it like pants or pull it over their head like a shirt.

It can even be used to simulate a backpack or a bra, or you can use smaller Theraband circles as socks. Just using Therabands, your patients will be demonstrating the motions needed to don and doff all articles of clothing without having to fully dress or undress.

You can have patients practice with long-handled reachers or dressing sticks as well that will model behaviors that they can carry over into their morning routine with actual clothes. This helps bridge the gap for patients who are resistant to using adaptive equipment. They can “experiment” with the tools in a gym setting before adopting them into their more intimate ADLs. This also helps as a grading tool because you can gradually increase the challenge from a large, loose Theraband to a regular size pair of jeans!

Sit-to-Stands

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Most OTs in SNFs can recite the verbal cue “nose over toes” in their sleep. When a patient doesn’t follow this rule, and tends to lean backwards while trying to stand up, most of their ADLs become unsafe. Keep in mind that retropulsion in this fashion is commonly seen in Parkinson’s disease (here are some tips for treating retropulsion in your patients). Try hanging a piece of Theraband around the patient’s neck like a scarf (pictured above) and ensure it is long enough to pass their hips.

From there, you can attach items to each end of the band to slightly weigh it down. The weights themselves aren’t important, and you can find some household options here! As the patient stands, instruct them to keep the band ends (or the hanging items) in front of them. If they lean backwards, they will now see and feel what they are doing wrong during the transfer. Using this intervention, you can add a visual and tactile cue to the process!

Resourcefulness is a key part of treatments in SNFs with productivity pressures. Being creative with what your facility has can ensure you maintain occupation-based sessions no matter what. Share your own ideas below and let’s keep the list growing!