
Module 3: Diverse skills and roles
3.4 Occupational therapy
Now you have explored the key roles of physiotherapy and speech and language therapy, this next section focuses on what occupational therapy (OT) can do for people with prolonged disorders of consciousness.
In the films below listen to Therapy Lead Hilary Rose and Senior OT Susie Wilford talk about the core roles of Occupational Therapists working with PDoC patients in a hyperacute and rehabilitation setting.
Then listen to Senior OTs, Suzi Kerrell-Vaughan and Kirsty Page, reflect what they feel they can do for people with a disorder of consciousness in long-term care.
These experienced PDoC practitioners highlight that much of their work with patients is multi and interdisciplinary and at times it’s difficult to define a purely occupational therapy role. However they explain that there are key traditional OT areas of treatment and care which they conduct with this patient group, namely 24 hour positioning, seating, spasticity management, splinting, sensory assessment and environmental management. Each of these interventions are explored in more detail below.
Occupational therapy technician
Alongside OTs work Occupational therapy technicians (OTT) and assistants (OTA). Experienced OTT Andrea Powell descibes the key roles of OTT’s and her own experience of working with this patient group.
Pressure care
Along with nursing colleagues Occupational Therapists play a significant role in providing pressure care for people with a PDoC. Listen to Susie Wilford discuss the work of OT’s in providing pressure care and 24 hour postural management programmes.
Splinting
Splinting is an intervention used in the prevention and correction of contracture in adults with a neurological condition. Splinting is defined as the ‘application of external devices designed to apply, distribute or remove forces to or from the body in a controlled manner, to perform one or both functions of control of body motion and alteration or prevention in the shape of the body tissue’ (Rose 1986).
This means that the production and application of splints which support arms and legs in neutral positions or resting splints to achieve the ‘perfect’ position are often out of the question with this patient group (unless you are treating them in ITU before the long term affects of tonal changes have taken effect). Suzi spoke about how one of her challenges as an OT with this client group is fabricating splints with these abnormalities already present.

Click on the film below to hear more about splinting. As you listen, write down some notes, what is the point and the aims of splinting a patient in a disorder of consciousness?
KEY DOCUMENT
The College of Occupational Therapists and Association for Chartered Physiotherapists Interested in Neurology (2014). Splinting for the prevention and correction of contractures in adults with neurological dysfunction: practice guidelines for occupational therapists and physiotherapists.
Seating and positioning
In the film clips earlier, Suzi and Kirsty also talked about positioning and seating. Click below to listen to what they have to say about seating. Listen out for what can affect these patients position day to day.
Click through the cards in the sway presentation below to see the extent and range of factors affecting the seating and positioning of people in a PDoC.
KEY DOCUMENT
Recent guidelines on the physical management of people in a disorder of consciousness provide nineteen specific recommendations about physical management programmes f
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- The guidelines are an annex to the Royal College of Physicians PDoC Clinical Guidelines. You can find them as Annex 3C here.
- There is also a useful poster about the development of the guidelines here.
Transferable skills
This course focusses on the difference and the specifics of caring and treating PDoC patients. Health professionals who have not treated a person with a disorder of consciousness however have many of the skills to do so. This is because the skills required to treat this patient group come from the core aspects of professional training, clinical and interpersonal skills.
In the first film below Kirsty Page, a Senior Occupational Therapist reflects on the skills she gained in other clinical areas and how these skills help her work with people in a disorder of consciousness. In the second film, Susie Wilford reflects on all the core skills Occupational Therapists already have that provide the base for being able to work with PDoC patients and highlights the skills that can only be learned through working with this group.
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Is anything missing in this section about the work occupational therapists do with this patient group?
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It would be beneficial to have some mention of the OT’s core skill in the assessment of cognition, this is an invaluable skill when observing and as someone starts to emerge.
Thanks for this suggestion. I am wondering about adding a section on emergence as we don’t really say much about it here at all … but we are also trying to stop the course growing ever longer…but of course it is a key skill area…what do others think?
A lot of key information. I now understand OT roll properly .
Be good to reflect on the role of OT in enrichment on the unit also (one video mentioned adapting the formal assessments to ensure they are more person centred) but also general enrichment on the unit (showering the PDOC patient, taking the PDOC patient off the ward and into different environments, music etc…)
Informative for seating balance of patients.