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Programs & Services

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.