By Jaclyn Butensky, MS, OTR/L
Occupational Therapist, Brooklyn, NY

Occupational therapists are skilled at enhancing patient engagement in meaningful activities. My favorite part of my role involves getting creative in the process. Although clinicians intend to make sessions as engaging as possible, most of us have experienced a monotonous treatment session. This could look like a patient sighing when asked to complete an exercise, demonstrating a lack of motivation, or realizing that an activity is no longer providing enough of a challenge. 

As home visit therapists, we are fortunate to see patients interact within their normal environments. We often work with patients for weeks or months continuously and have the opportunity to build rapport. And as we spend more time with our patients, there’s a level of comfort and routine that can follow. This is not always a bad thing, however sometimes routine can translate to a feeling that progress is stalling. 

So, how can clinicians freshen up their treatment sessions if they are becoming tedious to ensure that patients are continuing to progress toward their goals? Here are three tips any OT can incorporate. 

1. Re-evaluate Your Approach

Therapists frequently monitor, re-evaluate, and modify treatment plans. This is important because it helps us ensure that the patient’s plan of care is on track. If I ever feel like progress is stalling or sessions are becoming too routine, I like to do treatment session “check-ins”. 

For example, I’ll ask myself if these activities align with my patient’s goals. Is my patient engaged in therapy or are they increasingly disengaged, and why? How can I get my patient more involved in their therapy?

2. Talk to Other Clinicians

Therapists in the home care setting are not observing other clinicians as often as they would in a rehabilitation facility or clinic. It’s easy to fall into a habit of providing the same activities that we know and are familiar with. 

If you are in a therapy rut, I suggest reaching out to coworkers to help stir up some new ideas. Sometimes adding a few new tools to your therapy “toolbox” can make the world of a difference in your treatment sessions!

3. “Tweak” Your Treatment Sessions

I’ve found that making small changes to the materials, activities, or usual therapy routine can spark new interest and motivation in patients. So don’t be afraid to incorporate new activities in your treatment. You might be surprised by the positive effect it has on your session! 

I’ve made a list below of some common household items I like to use during my treatment sessions and what body functions can be addressed.

Pillows

• Use as a “ball” to play catch (balance, standing tolerance, endurance)
• Squeeze foam pillow (grip strengthening) 

Post-it notes

• Guess the word – write a letter on each Post-it note and ask your patient to form a word (attention, problem-solving, vision) 
• Stick post-it notes to a vertical surface (reaching the outside base of support, wrist extension)

Cans or Water Bottles

• Use in place of dumbbells (strengthening)
  
• Stacking at various heights in the pantry (upper extremity range of motion, balance) 

Paper Towel Roll

• Dip a paper towel roll into paint (grasp in hand and use pronation/supination to create circles on paper)
  
• Paint with Q-tips (grasp pattern) 

Floor Prints

If your patient has a patterned floor or a very large secure area rug, use the patterns for balance exercises. 

• Rug with circles – step onto dots using a narrow base of support, step-over dots, walk around the dots, etc.
  
• Rug with lines – tandem walking on straight lines

Bags

• Simulate a shopping experience using bags around the house
• Collect fruits, cereal boxes, etc. from around the kitchen and place them into bags, try carrying a certain distance (endurance, strengthening)

Laptop or iPad

• Use the touch-screen to draw/trace/copy lines (vision, finger isolation), write with a stylus (grasp/wrist extension)

Games

• Bean-bag basketball – toss bean bags or any other small items lying around into a basket (standing balance, endurance, hand-eye coordination)
  
• Alexa – ask Alexa to play games, for example, “song quiz” (attention, memory)
  
• Set a timer – write down the amount of time it takes for your patient to walk from point A to point B, challenge them to improve their “score” 

Many of the activities listed can be used to prepare for an occupation-based activity. For example, if a patient has a goal to walk to the grocery store, you might start your treatment session with a stepping balance exercise to prepare for functional mobility on an uneven sidewalk to get to the grocery store. 

Know What to Tweak and What Not to Tweak

Keep in mind, not every intervention has the flexibility to be “unique” because there are some skills that need to be repeated for carry-over. For example, a client who is relearning the skill of putting on a t-shirt might need to practice this in a specific way to be successful. Another example could be a home exercise program that needs to be repeated multiple times for the patient to be able to complete it independently. 

There are many activities that clinicians can get creative with that address cognition, balance, strength, endurance, and other body functions that are relevant to a patient’s goals! Increasing engagement in meaningful occupations is at the core of what Occupational Therapists do. The best way to get patients engaged is by understanding what activities are important to the patient and learning what sparks their interest. When patients are motivated by what they are doing during therapy, this can lead to better treatment outcomes.