Occupational therapy for SLE
Most lupus patients are young women who expect - and are expected by others - to lead active lives. It is important that patients and their families understand the limitations that lupus may impose. An active full life is a goal that can be reached, but all must realize that periods of fatigue and depression are common even in mild cases. Patients may need time to themselves on some days to obtain both physical and emotional rest. Also, some patients feel isolated and alone with their disease. They can benefit from participation in a support group for lupus patients. The support group should be led by a leader who stresses the positive; otherwise, the group becomes a forum for complaints and negativity. Patients should try to achieve a balance between exercise and rest. Flare-ups of disease activity require increased rest, including daytime naps. Too much rest, though, can cause loss of muscle mass and muscle tone resulting in weakness, fatigue and further reduction in activity. This can lead to feelings of depression. As a patient feels better, therefore, a regularly scheduled exercise program should be undertaken to increase strength, endurance and muscle tone. A physical and/or occupational therapist can often be helpful in teaching the patient a proper exercise program. A program of physical and occupational therapy will include: - range of motion exercises Occupational therapy facilitates the rehabilitation process for those with an injury, illness or disability, whether acute or chronic. The ultimate goal of the occupational therapist is to solve problems so that the patient may become as functionally independent as possible in the activities of daily living (ADLs), as well as in the use of self-management strategies.
Occupational therapists believe that sound health depends on a balanced life of work, play, and rest. The focus of OT interventions is on productive and meaningful activities (occupations) addressing both the psychosocial and physical aspects of how the patient performs work, home, and leisure roles. The occupational therapist will need to address psychosocial issues related to anger or depression, uncertainty, guilt, fear and/or loss of control that often are associated with SLE. In addition, the OT practitioner will educate and teach patients how to evaluate their own strengths and resources. As an example, an ADL analysis or inventory may be done to determine what life areas require interventions. To help the patient, the occupational therapist will then introduce a strategy of goal-setting. This means that the patient will be responsible for creating realistic, achievable, intrinsically motivating goals, focusing on areas needing immediate attention.
One area that often is not addressed by individuals with SLE is "a flare-up plan." The OT practitioner can help the client to develop a flare-up plan that meets his or her needs. This intervention helps the individual maintain a sense of control and will minimize the added stress felt by the patient and their family when a flare-up occurs.
The stress of a chronic illness such as SLE will require the OT to educate the patient in coping techniques. These stress reduction techniques include: deep, abdominal breathing; relaxation techniques (guided imagery, progressive muscle relaxation); exercises; work simplification; and energy conservation strategies. All of these tools may be used at home or at work.
The occupational therapist addresses issues related to fatigue, musculoskeletal discomfort/pain, mobility, strength, skin care, and sleep challenges, and will educate and provide interventions to address all of these issues. This can be accomplished by developing an exercise program (i.e., dancing, swimming, tennis, gardening, Tai-Chi, and others) tailored to the needs, function and interests of each individual. An exercise program is important for four reasons: minimizing the deconditioning process; maintaining optimal physical function level for ADLs; improving fitness; and having a positive impact on factors related to quality of life (daily activities, mood, pain, sleep, stress, fatigue, and disease status). Individuals who make an effective transition from supervised to self-directed exercise are more likely to maintain exercise over the long-term. Therefore, to optimize compliance with the exercise program after completion of occupational therapy, patients may be referred to and/or asked to participate in a community exercise program. Some of these programs are offered through the Arthritis Foundation or other community organizations. The occupational therapist also can provide strategies for work, home, and/or leisure environments in which the individual with SLE participates. OT practitioners may conduct on-site job and/or home analyses to assist the person with SLE in adapting the workplace or home to accommodate the need for optimal function. Additionally, occupational therapists may conduct a motor vehicle driving evaluation with the client, in order to make suggestions for continued driving safety.
The occupational therapist will facilitate the process of self-management for the patient. This is important, because ownership and responsibility of any chronic condition means a more satisfactory outcome in the long-term. This concept of self-management means that the patient will be willing to learn about and assume responsibility for the daily care of SLE.
Being responsible for SLE means: (a) keeping informed about one's status by asking questions; (b) taking part in planning and implementing the treatment program by telling the health care team about preferences and goals; and (c) trying out different treatments-under the guidance of the health care team-until the best treatment program is designed. Life-style changes such as these help the patient to become active in their own health care, and promote a wellness approach to living with SLE.
The major benefit of occupational therapy for the patient with SLE is that he or she regains a sense of control over the disease arid reclaims independence in the activities of daily living.
|
