Years ago, Novant Health occupational therapist Claire Salmond was working in a nursing home. One resident refused to meet with Salmond. A physical therapist finally asked the resident: Why won’t you work with Claire? She responded: I’m retired; I don’t want to go back to work.
“The title is a bit misleading,” Salmond concedes in a British accent that has faithfully stayed with her after living in the U.S. for more than 20 years. “A lot of people think the occupational therapist is looking at return to work. In some ways, for some people, we are. But what we’re really looking at is a level of independence for someone who’s lost function after an accident or illness.
“Most everybody knows what a physical therapist does,” Salmond continued. “But occupational therapy is not as well-known. We are sometimes known as ‘the other therapists,’ but we often work closely with other disciplines including physical and speech therapists. We do different things, but our focus is the same – to try and make people as independent and safe as possible.”
In simple terms, occupational therapists focus on helping patients regain their abilities to perform daily tasks after an injury, surgery or other conditions that have changed their level of independence, while physical therapists focus on how the body moves and recovers from surgeries and injuries. There’s crossover between the two jobs, and they often work together to help a patient recover.
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Many of Salmond’s patients have had accidents and lost some use of their hands. “We have a lot of wrist fractures, wrist sprains, arthritis,” she said. “We may be treating somebody who’s in a lot of pain, or who has a lot of stiffness.”
‘A lot of trauma’
That was the case with Heather Beeson, a counselor at East Forsyth High School in Kernersville, North Carolina, who came to Salmond last August after having her middle fingertip on her left hand amputated after a serious boating accident that happened when her boat was docking.
“Heather’s hand was so swollen,” Salmond recalled. “It was really enlarged, and there was a lack of movement. She couldn’t come close to making a fist. She had little grip strength. There’s a lot of work to do on a hand when it’s really, really stiff. Even though she had an amputation on the fingertip, there was a whole lot of trauma that went on in the hand, which is why she had so much swelling.”
Beeson’s dominant hand – her right – wasn’t impacted. But it hardly mattered. She discovered just how much she relied on that non-dominant hand.
Beeson couldn’t type, text, open a bottle of water, get dressed easily or dry and style her hair as she normally would. She developed ways to compensate in some areas (“You learn to be resourceful”), but none of it was easy.
“When I came to Claire, I was just so discouraged,” she said. “I had had other surgeries before, but never something that affected my daily life. It was frustrating. I couldn't type with both hands, but that didn’t stop me from working.”
“My orthopedist kept saying, ‘You have to move your hand.’ And I’m thinking: It hurts to move it. It’s too painful. He sent me to Claire, who was pretty close to being a savior. I ended up enjoying going to her. I didn’t want to stop. It was such a great experience that, if I weren’t so dedicated to my profession and close to retiring, I would consider going back to school to learn occupational therapy.”
Salmond said Beeson was an ideal patient; she did everything asked of her. “I’m a competitive person,” Beeson said. “In this case, I was competing against myself.” Beeson would do timed exercises in Salmond’s office and rejoiced to see her time improve as she progressed within therapy.
Beeson had something else going for her. “A positive attitude goes a long way,” Salmond said. “When I ask a patient, ‘Have you done your home exercises, and they say, ‘No,’ it’s like: If you’re not buying into this, what’s the point? I try and make these exercises part of their daily activity. Gripping a steering wheel tightly while you’re at a stoplight is an exercise.”
‘We’ll make it work’
The amount of time Salmond spends with a patient depends on the individual and the extent of the illness or injury. “It could be anywhere from three treatments to 12 weeks or beyond,” she said. “I always want the patient to feel they’re getting benefit from our sessions. We reassess the goals at least every month. Sometimes, we upgrade the goals we set initially. And sometimes, it’s like, ‘This is where we’re going to be. At this point, I want you to continue with your home program.’”
Occasionally, Salmond treats patients with career-ending injuries. “You can get two people with the same injury, and one person can go back to the job and the other can’t,” she said. “You never know how somebody is going to respond to treatment.”
Injured maintenance people have an especially tough time. “Maintenance guys do everything,” Salmond said. “They bend down, crawl, lie on their backs, pick up heavy objects. If I treat an administrative assistant who’s got a bad wrist, they’ll probably be fine after therapy, which also includes review of their workstation setup and education. If I’ve got a laborer with a serious injury, that could be a problem.”
Salmond found her calling when she was just 14. She went to a career fair with a friend who wanted to be a physical therapist: “Somebody asked me, ‘Have you heard of occupational therapy?’ Of course, I never had. But I went to the hospital and visited with an OT and thought: This looks really cool. So, my path has been straight ever since.”
Salmond does help people return to work. But her job entails more than her title implies. “Our goal is to help someone figure out how to cook, how to clean, how to get themselves washed and dressed. Returning someone to independence is always our aim.”