Introduction

Occupational therapy (OT) is a healthcare profession that 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 collaboratively with the client, so that they may become as functionally independent as possible in the activities of daily living (ADLs), as well as in the use of self-management strategies.

The occupational therapist working with a person who has systemic lupus erythematosus (SLE) will provide a holistic approach, during both the evaluation and treatment phases of the therapy.

Occupational therapists believe that sound health depends on a rhythmically balanced life of work, play, and rest, and all these areas will be addressed in the treatment plan of care. Therefore, the focus of OT interventions is on productive and meaningful activities (occupations) addressing both the psychosocial and physical aspects of how the client performs work, home, and leisure roles.

Psychosocial health

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 clients how to evaluate their personal strengths and resources.

For example, an ADL analysis or inventory may be done to determine what life areas require immediate interventions. To enhance the self-efficacy belief of that client, the occupational therapist will then introduce the strategy of goal-setting. This means that the client will be responsible for creating realistic, achievable, intrinsically motivating goals, focusing on areas needing immediate attention.

One such 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 client and the family when a flare-up occurs.

The stress of a chronic illness such as SLE will require the OT practitioner to educate the client 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, at work, or in any situation where the client finds them helpful.

Physical health

The occupational therapist, in collaboration with the client, also will address 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) .

It appears that those individuals who make an uninterrupted 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, clients may be referred to and/or asked to participate in a community exercise program. Some of these programs are offered through the Arthritis Foundation and co-sponsoring institutions, while other appropriate programs are available in the community. Exercise prescription programs for individuals with SLE are highly desirable.

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.

Self-management

The occupational therapist will facilitate the process of self-management for each individuals he or she works with. 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 client 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 empower clients to become active in their own health care, and promote a wellness approach to living with SLE.

Summary

Occupational therapists are healthcare professionals and providers who employ a holistic and functional approach to evaluation and treatment. This approach can be valuable to people with SLE who need to optimize their ability to function independently in all areas of daily life. Client participation in community programs following the completion of OT services will provide the social support and networking necessary for continued success and compliance with self-management. In my experience, the major benefit of the occupational therapy experience for the person with SLE is that the client regains a sense of control over the disease arid reclaims independence in the activities of daily living.

For more information on Occupational Therapy, contact the American Occupational Therapy Association (AOTA) at 4720 Montgomery Lane, Bethesda, MD 20827-1220; (301) 652-2682 or (800) 668-8255; www.aota.org.

Mario Francisco Canelón is manager of the Occupational Therapy Hand Center at McLeod Regional Medical Center in Florence, SC. He is an Arthritis Foundation-certified trainer and leader for the Systemic Lupus Erythematosus Self-Help Course (SLESHC), the Fibromyalgia Self-Help Course (FSHC), and the Arthritis Self-Help Course (ASHC). He also serves on the Board of Directors for the Carolinas Chapter of the Arthritis Foundation.

 © 2000 Lupus Foundation of America, Inc.

Disclaimer: The opinions and statements expressed by the authors or contributors to this publication do not necessarily reflect the opinions or positions of the Lupus Foundation of America, Inc.

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