OCCUPATIONAL THERAPY IN COPD
Teaching Patients to Reorganize Their Lives
By Claudia Stahl
A PULMONARY REHAB PROGRAM IS not the most likely place to find an occupational therapist, but Carolyn Costello, OTR/L, believes it should be.
What happens when a patient is too winded to brush her hair? How can a person lead an active lifestyle when a simple walk down the hall feels like a five-mile jog? When he lacks the endurance to carry groceries from car to cabinet?
Costello's job is to make these common activities surmountable to patients with chronic obstructive pulmonary disease (COPD). She leads the pulmonary rehab program at HealthSouth Rehabilitation Hospital of Virginia in Richmond "to help these people to make the lifestyle changes necessary to continue the things they want to do," she said.
According to Costello, an inpatient rehabilitation program dedicated solely to pulmonary patents is a novelty these days. Most facilities offer these services on an outpatient basis, where the majority of patients are highly motivated to get well. But Healthsouth's comprehensive program is aimed at the patient whose COPD has led to a downward spiral of inactivity and, often, depression.
Costello sees as many as 20 patients per day, most of them aged 60 and up. Occupational therapy begins with a group stretch that she "choreographs" to motivate the patients. It is not unusual for swing music or "the chicken dance" to make its way into the program.
The stretch conditions and motivates patients for the day's remaining activities, which are focused on educating patients to manage when they experience shortness of breath. Patients attend daily, hour-long educational seminars led by different professionals. Costello's seminar focuses on breathing techniques, relaxation, discharge planning, in-home safety and energy conservation.
Asked about Costello, her patients have said, "she doesn't let any grass grow under your feet." The activities in her program are designed to increase patients' independent participation in self-care and ADL, increase tolerance for standing and walking and increase upper-body strength and endurance through use of gravity-resisted exercises.
For people with COPD, fatigue and shortness of breath preclude their ability to brush their teeth, dress and groom. Bathing activities become laborious due not only to fatigue, but the hot, damp air from the bath or shower. Home activities like shopping, cooking, and washing clothes require too much endurance to be performed routinely or completely.
Inevitably, these people phase out social and leisure pursuits like playing with grandchildren and traveling.
And all of these complications are exacerbated if a patient is using oxygen equipment, which raises safety concerns, as well.
Costello educates patients about proper body mechanics, energy conservation techniques, safety and fall prevention, relaxation, and management of anxiety and panic attacks, and breathing techniques. Patients practice these skills while performing functional activities (e.g., self-care, homemaking, gardening, carrying packages, cooking or shopping), with or without oxygen equipment.
"Occupational therapy is a good bridge between PT, where patients use exercise machines to increase strength, and real life," Costello explained. "A treadmill paces you, and you don't have to think about it. But if you're walking around halls with a walker, you have to use a different pace and adjust your breathing accordingly."
By carefully organizing their time and environments, people with COPD often learn to manage life's activities by slowing their pace and alternating rest and activity. Sitting whenever possible (e.g., for dressing and cooking) conserves energy, as does using the microwave, grocery-prepared foods, and low-maintenance clothing.
For people with COPD, even the most mundane activities are a breath of fresh air when they are manageable. Costello's fun, up-beat approach to therapy has meant newfound independence for patients who too often fall through the cracks. "I've seen incredible improvements, day by day in these patients. They find they are able to do things, and they love it," Costello said.
Claudia Stahl is an ADVANCE associate editor.