Working as an OT, with individual’s who may have physical, sensory, cognitive, emotional and behavioural difficulties, can vary hugely from day to day. 

I liaise closely with other therapists within our centre, particularly in Physiotherapy and Speech and Language therapy on a daily basis. The team and I also have strong relationships with other community teams/resources and various local NHS hospital based therapy teams. This helps us here at The Bridge to be able to offer trulyholistic support to our patients, from preparing for their arrival to after they leave; and it means a lot of work goes on beyond the boundaries of the traditional core function of OTs.

Christine’s* story offers a prime example of this. Christine came to us having had a stroke in her early fifties which had had a serious impact on her function in multiple ways.

At the time Christine was living in a house which was wholly unsuitable to meet her complex needs moving forward.

Christine was around 18 months post-stroke when she arrived, so was unlikely to make many significant functional improvements. However, there was still much work to be done in enabling her to be as independent as possible.

Christine’s main goal was to go home. This was her sole focus and we kept that at the forefront of our work throughout her time here. A plan, to be delivered via a multidisciplinary approach, was put in place built around this goal, plotting the way ahead and mitigating the risks.

We also focused on providing an environment in which she could feel safe. One difficulty she faced was hemianopia, a common visual impairment post-stroke where the eyes are still technically working but there is a problem with the visual processing within the brain. When we first met Christine, she couldn’t see past the mid line of her visual field – the rest of the environment on her right hand side simply did not exist in her world. Now, she is blind to less than a quarter of the normal field of vision.

To help achieve this progress, we used scanning techniques with basic repetition during functional tasks like washing and dressing, or when moving in her wheelchair up and down the corridors on the unit. For example, I would put post-it notes along the corridor and she had to find them all, turning her head to compensate for her visual deficit. Similarly with washing and dressing, we would place the items she needed in different areas of the room. This strategy meant she had to move and turn her head to locate the objects, an important action in preparing for a more independent life.

As the goal we were working towards was allowing Christine to live in her own home, I worked very closely with her allocated social worker and housing provider to firstly assess her current property, which was deemed not suitable for her to return to. I then assessed a further property jointly with the local housing provider and identified that this new bungalow was better suited to Christine’s needs but required some adaptations to be fully meet Christine’s longer term needs.

After a Disabled Facilities Grant was made on my recommendation, we implemented adaptations to the bathroom and installed a ramp to allow wheelchair access. Kitchen counters were also lowered to make them more accessible, enabling Christine to make a cold drink. Hot drinks were not possible due to the risks involved, but being able to make cold drinks was another step towards independence.  

There was a lot of work between all parties to put the right equipment into the house and to devise and implement the strategies to best manage Christine’s cognitive and behavioural difficulties. Great effort was required in securing her a larger then standard package of care to support her needs on discharge home, but we achieved that and Christine was able to return to a much more suitable home environment with the appropriate level of care to support her needs.

Today she has support from her family and a package of care through which she is visited four times per day with additional carer input overnight which will be reviewed and hopefully reduced over time once Christine settles further into her new home environment.

This is a vast improvement on her situation compared to when Christine first came to us needing close monitoring by staff every few minutes and significant periods of one to one care to ensure her safety. If not for the aforementioned interventions, people like Christine all too often end up in nursing homes, with none of the independence she enjoys today. 

Crucial to this outcome, alongside the care and rehabilitation Christine received whilst at the Bridge, was the close collaboration we were able to foster between our team and the various community partners.

Pauline Matthews is an occupational therapist at The Bridge Neurological Centre in Middlesbrough, which is operated by Elysium Healthcare.

*Name changed for anonymity.