Other Health Services
Occupational Therapy
- Rehabilitation Services
Health Care Professionals
- Neuro/Musculoskeletal System
This large health
system includes a wide variety of inpatient and outpatient
programs with both acute and rehab components. In all clinical
areas, the Occupational Therapist’s primary goal is
to carry out a comprehensive assess-ment of a patient’s
ability to manage the activities of daily living, and provide
the appropriate interventions that will enable a patient to
reach his/her maximum potential. In all areas, Occupational
Therapists function within a multi-disciplinary team, comprised
of different discipline groups depending on the patient population
served and their needs as served by that particular clinical
area. Practising within a client centred approach, the teams
coordinate assessment, treatment and discharge goals/recommendations
so that a comprehensive and seamless approach to patient care
is provided.
Practising within
a client-centred approach, the teams coordinate assessment,
treatment and discharge goals/recommendations so that a comprehensive
and seamless approach to patient care is provided.
The following list
of clinical areas within the Neuro/Musculoskeletal Health
System outlines the uniqueness of Occupational Therapy activity
in each area.
Neurology
The primary patient
group are patients with Cerebral Vascular Accidents (CVA).
However, common admissions include patients with Multiple
Sclerosis, Parkinson’s disease, Guillain-Barre Syndrome
or an exacerbation/deterioration of a previously diagnosed
neurological condition. The Occupational Therapist’s
role in stroke rehabilitation is coordinated by the Care Path
as part of the Regional Stroke Centre program (see below).
Neurosurgery
The program in Neurosurgery
is a regional service. Most commonly seen are patients with
brain tumors, aneurysms, hydrocephalus, spinal fusions and
laminectomies, spinal cord tumors and some head injuries.
In both of these clinical areas, where
patients present with predominantly neuro-logical deficits,
the Occupational Therapist’s comprehensive assessment
includes not only the usual physical, social and functional
assessments, but must delve into the complicated areas of
a patient’s cognitive, perceptual and sensory-motor
abilities, any of which may significantly interfere with a
patient’s functional performance. At the acute level,
the therapist’s primary role is to complete the assessment
process and either provide discharge recommendations regarding
equipment and/or services at home or recommend further therapy
either on the inpatient rehabilitation unit, the Regional
ABI program or in an outpatient program.
Orthopaedics
The acute Orthopaedic
unit is a high volume, fast-paced area where skilled, post
surgical acute care is provided and rehabilitation activities
are initiated from an early date. Predominantly, the patient
groups include individuals with elective hip and knee replacement,
spinal fusion and instrumentation procedures, hip fractures
and a wide variety of orthopaedic injuries, any of which may
have a significant impact on a patient’s ability to
perform the activities of daily living.
Occupational Therapy
carries out a thorough assessment of a patient’s functional
abilities at the acute phase and begins the process of providing
the means by which a patient can maximize their independence,
safety or quality of life. Education with patients and families
regarding activity and movement precautions is provided along
with much discussion about the implications for ADLs.
The Occupational Therapist suggests
alternative strategies to accomplish activities within the
surgical restrictions, provides instruction in the use of
assistive equip-ment, provides recommendations regarding equipment
for home, reviews car transfer techniques and reviews strategies
for managing homemaking activities on discharge. As many of
the Orthopaedic population are elderly, special attention
is paid to their unique needs and problems. Cognitive evaluation,
particularly with respect to returning home alone, is an important
part of the Occupational Therapy assessment. These interventions
are provided in whole or in part depending upon whether a
patient transfers to the Orthopaedic Rehabilitation Unit.
Outpatient Services
Hand Program
Trillium offers a comprehensive Hand Therapy program comprised
of the Acute Service and a contracted Workplace Safety and
Insurance Board (WSIB) Hand Service. Both programs operate
collaboratively in an outpatient service. The patient population
includes those with bone, joint or soft tissue injuries or
diseases.
Occupational Therapist
assess hand function and provide appropriate interventions.
Assessment includes not only that of physical and sensory
status but a compre-hensive review of the client’s occupational
performance areas as well. Interventions may include the removal
of surgical dressings/sutures and wound debridement, the fabrication
of orthotic devices, therapeutic activities and exercises,
sensory education, provision of adaptive equipment and education.
The therapist is aware of the potential psychosocial impact
of injury and provides general support and information to
patients around these issues. Education regarding ergonomic
principles particularly as they relate to the workplace is
an integral part of both programs as so many of the injuries
are work related.
The Acute
Hand Service
The Acute Hand Service supports four hand surgeons and serves
the communities of Etobicoke and Mississauga. This highly
skilled interdisiplinary team provides services immediately
post-injury and/or post-operatively addressing the physical,
functional and psychosocial needs of each patient. In addition
to providing comprehensive, ongoing hand therapy services,
the team also provides expertise in the fabrication and
provision of both simple static and more complex dynamic
splints.
The WSIB
Hand Service
This service is a private, contracted service provided in
partnership with the University Health Network – The
Toronto Western Hospital. Workers from across Ontario with
complex hand injuries, needing a second opinion or specialized
treatment plans attend the Assessment Clinics and Treatment
Programs. Specialty services include dominance screening,
glove and gauntlet service, writing and keyboard assessment,
functional abilities evaluations, cosmetic prothesis assessments
and psychosocial services (Occupational Therapy, Psychology
and Psychiatry). These specialty services are provided on
an as needed basis.
Outpatient Neurology
The outpatient neurology services are staffed with a full
time Occupational Therapist and part-time Occupational Therapy
Assistant, Physiotherapist and Speech-Language Pathologist.
The inclusion criteria for outpatient Occupational Therapy
services includes:
- Clients diagnosed with acquired brain injury (i.e. stroke)
or degenerative neurological disorder (i.e. Parkinson’s
disease or multiple sclerosis)
- Clients who are independent or have support with toileting
and medication regimes
- Clients who can tolerate one hour of therapy with rest
periods
- Clients with minimal need for emotional support
- Clients who can access the program
- Clients who would benefit from a single stream service
- Clients able to work on an individualized treatment program
at home and have support for reintegrating within their
community
The goals of the
Occupational Therapy service are to:
- Develop or restore function affected by a neurological
disease or injury
- Explore adaptive interventions and modifications to the
environment to facilitate independence in activities of
daily living (i.e. assistive devices, wheelchairs)
- Prevent dysfunction in the areas of self-care, productivity
and leisure
- Educate the client and caregivers regarding their experiences
and condition and to provide health promotion strategies
- Link the client and caregivers to community services that
address prevention, intervention and support
- Liaise with other disciplines responsible for the client’s
care
The role of the
Occcupational Therapist is to facilitate the assessment and
intervention process. The Occupational Therapist assesses
clients and their caregivers using a client-centred, holistic
model of practice. Throughout the assessment process, areas
of difficulty (i.e. moving, thinking, perceiving or social/emotional
coping abilities) and environmental conditions contributing
to the client’s ability to carry out everyday tasks
are identified. Also, the client’s strengths are recognized
and built on.
An individualized
treatment program outlining target goals, outcomes and action
plans is developed with the client. This plan is consistently
monitored and re-evaluated to ensure treatment and intervention
is in keeping with the client’s desired outcome.
Treatment is a collaborative
process. The client is a partner in the process as he/she
obtains treatment in sessions as well as works on treatment
goals at home. Working closely with the Occupational Therapist
is the Occupational Therapy Assistant (OTA). The OTA helps
to implement the treatment plan and monitor the client.
Referrals are received
from physicians (family practitioners, neurologists and neurosurgeons)
based at Trillium and from all levels of the care continuum.
Prevocational
Program
The Prevocational Program has two services: (1) prevocational
evaluation and readiness to return to work and (2) work conditioning.
These services are provided solely by the Occupational Therapist
and Occupational Therapy Assistant in Rehabilitation Services,
on a part-time basis.
Prevocational
evaluation/readiness to return to work
The goal of the prevocational evaluation is determine a
person’s work skills and potential for work or vocational
rehabilitation when they have not worked for an extended
period of time, or not at all because of a medical or psychiatric
disease or illness. When a person has been absent from work
for a short time due to an acute illness or accident, the
goal is to determine if the person is ready to return to
their pre-injury/illness job and if any modifications are
necessary to support their return to work. The Occupational
Therapist uses standardized tests, observation and interview
skills, simulated work tasks and activities, analysis of
workplace/job demands, and work stations to assess physical
and psychosocial capacities, identify areas of function
and dysfunction that will affect work performance, help
clients develop realistic work goals and/or facilitate a
smooth and successful return to work. Referrals are received
from services and physicians within Trillium Health Centre,
community agencies and insurance companies (fee for service).
Work Conditioning
The goal of this service is to help a client improve his/her
general work tolerance towards return to work or vocational
rehabilitation. The Occupational Therapist provides the
client with activities and a graded work schedule to upgrade
his/her work tolerance. The Occupational Therapist closely
monitors the client’s progress. Job stations throughout
the hospital may be used to provide more realistic work
tasks and environments for upgrading skills and/or tolerances.
Rehabilitation
Three levels of
rehabilitation exist at Trillium Health Centre. In all areas,
Occupational Therapists work closely with other members of
the interdisciplinary team and the client to set goals for
discharge home or to a supported setting. Occupational Therapists
and Physiotherapists are paired up in teams for collaborative
client-centred care. Occupational Therapy Assistants provide
a wide variety of interventions for these clients.
Short Term
Rehabilitation Unit
This unit primarily provides service to clients who have
undergone elective joint replacement (hip or knee), elective
back surgery and surgical repair of hips. The unit also
admits those with patients with significant medical illness
who require a period of intensive therapy. The Neurological
Rehabilitation Unit provides services to clients who have
had a CVA, cerebral hemorrhage, aneurysm, spinal surgeries
with neurological sequelae, or neurological disorder, and
to a lesser extent, clients recuperating from a medical
illness or cardiac surgery. The length of stay ranges from
5 days to 6 weeks.
Along the continuum
of care, following acute care, the rehabilitation Occupational
Therapists provide assessments and interventions in the
areas of personal care, home management and other essential
daily tasks. Further assessment may be carried out in the
areas of cognition (i.e. attention, memory, problem solving),
motor skills, perception, psychosocial status (i.e. mood,
coping skills) and the client’s resources and supports.
Interventions
include teaching in the use of assistive devices for personal
care and equipment for managing daily tasks, energy conservation,
training in organizing and completing personal care tasks,
activities for visual, cognitive and perceptual retraining
or compensation, transfer training, wheelchair and seating
prescriptions, facilitation of motor recovery through therapeutic
activities, and family education and training. Involvement
can be both one to one and within a group setting. The physical
environment and the supports available are carefully assessed
and enhanced where possible, to promote greater independence
for return home. Weekend passes are used by the Occupational
Therapist and Physiotherapist to refine goals and facilitate
the client’s reintegration into his or her home environment.
On occasion, in-home assessments are done in collaboration
with the Community Care Access Centres.
Rehabilitation
Unit (Medium Term)
The majority of patients admitted to this rehabilitation
unit are those who have suffered a neurological event or
have had neurosurgery. To a lesser extent, patients are
admitted for a period of intensive therapy following medical
illness or cardiac surgery. Length of stay can be up to
6 weeks.
Occupational Therapists
work closely with other members of the interdisciplinary
team and the patient to set goals for discharge home or
to a supported setting. Assessments and interventions are
provided in the areas of personal care, home management,
functional mobility, visual perception and cognition, seating/wheelchair
prescriptions, to name a few. The clinician is involved
in formal education sessions, organized for the CVA patient
and his family. Feedback from weekend passes are used to
refine goals and facilitate the client’s integration
into his home environment. Occupational Therapy Assistants
are an integral part of the unit in the provision of service
to the patient.
Long Term
Rehabilitation
The Long Term Inpatient Rehabilitation Program is designed
for the treatment of individuals referred from the Medical
and Neuroscience/Musculoskeletal services at Trillium Health
Centre who are expected to require an extended rehabilitation
program to enable them to return to a community setting.
Treatment is goal-oriented, focused on cognitive and physical
recovery and is provided by an interdisciplinary health
care team consisting of Nursing, Physiotherapists, Occupational
Therapists, Physiotherapy Assistants, Occupational Therapy
Assistants, Speech Language Pathologist, Communication Disorders
Assistant, Home Care Coordinator, a Physician and a Dietitian.
A typical patient
is one who has experienced a significant illness/injury
or who has a complex medical history, but whose condition
has stabilized and has begun to experience positive return
of function.
Rehabilitation
Day Hospital (Physical Medicine)
The Rehabilitation
Day Hospital is an outpatient program providing occupational
therapy, physiotherapy, speech and language pathology, therapeutic
recreation, social work and nursing interventions for clients
whose health problems have resulted in functional disability
or whose health status requires weekly monitoring or further
diagnostic, investigative or consultative services. Programs
offered include: Stroke Rehabilitation, General Neurological
Rehabilitation and Brain Injury Rehabilitation. Referrals
to the program are received from the inpatient acute medical
and surgical units, the inpatient rehabilitation units and
the community.
The Occupational
Therapist participates in all initial assessments of referred
clients to help determine their needs and potential for rehabilitation,
as well as those of the family or primary caregiver. The Occupational
Therapist assesses each client accepted on the program and
deemed to have difficulties with their life tasks (i.e. hygiene/grooming,
dressing, eating, cleaning, shopping, banking, driving, working,
etc.) to determine what specific problems are interfering
with the client’s abilities (i.e. motor, sensory, perceptual,
cognitive and/or behaviour/emotion problems). Together with
the client, the Occupational Therapist designs individual
treatment programs aimed at improving the client’s performance
of their daily tasks. The Occupational Therapist supervises
and assigns responsibilities to the Occupational Therapist
Assistant for the provision of individual and group treatment.
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