Occupational Therapy and what it actually does has become a topic for me lately. The name is genuinely misleading. Despite “occupational” suggesting job-related work (big shudder from the retirement community…especially Gary), the term uses occupation in its broader sense… any meaningful activity that occupies your time and gives your life structure and purpose. That includes self-care, work, leisure, social participation, and everything in between. The core purpose of occupational therapy (OT) is to help people participate in the activities of daily life that matter to them — when illness, injury, disability, aging, developmental challenges, or mental health conditions make those activities difficult or impossible. The fundamental question an OT asks is: what do you want or need to do, and what is getting in the way of doing it? The intervention is then designed around closing that gap, either by rehabilitating the underlying limitation, adapting the activity, or modifying the environment. My Stretch-U team always has at least one OT in training onsite, so most of what I know about it comes from them.
What OTs actually work on is physical rehabilitation like recovery from stroke, orthopedic surgery, traumatic brain injury, spinal cord injury, or chronic conditions like arthritis. OTs help restore fine motor skills, hand strength and coordination, upper extremity function, and the practical ability to dress, cook, bathe, and manage a home independently. They also help with neurological conditions like multiple sclerosis, Parkinson’s disease, and ALS. OTs develop strategies and adaptations to maintain function and independence as conditions progress, and train caregivers in safe assistance techniques.
While OT works on critical things like cognitive rehabilitation, pediatric development (children with sensory processing disorders like autism spectrum conditions, etc.), other mental health issues requiring daily routines, and aging and fall prevention (something to take note of for potential future use…long time forward I hope…), 20% of OT antidote is focused on hand therapy. In fact, 18% of OTs have what is called a Certified Hand Therapist (CHT) credential. Hand therapy is a specialized OT subspecialty focused on injuries and conditions affecting the hand, wrist, and forearm — fractures, tendon repairs, nerve injuries, repetitive strain, and very often, carpal tunnel syndrome. Custom splinting and progressive exercise protocols are core tools.
OT differs from Physical Therapy in ways that are distinct but overlapping. Physical therapy (PT) focuses primarily on movement, strength, pain, and biomechanics — restoring the physical body’s capacity to move. Occupational therapy focuses on functional performance — what you can actually do with your body in the context of real life activities. OTs are more concerned with whether you can button your shirt, prepare a meal, or return to work than with isolated measures of strength or range of motion. In practice the two disciplines work closely together and their scope overlaps significantly, particularly in upper extremity rehabilitation and neurological recovery. OT has strong evidence for specific applications like stroke rehabilitation, hip fracture recovery, dementia care, pediatric sensory processing, hand therapy, and fall prevention in older adults. The field is more heterogeneous in other areas, and like many rehabilitation disciplines the evidence base is better for some interventions than others. What makes OT distinctive is its activity-centered, person-centered approach. The goal is never abstract restoration of function for its own sake but rather it is always tethered to what the specific person needs and wants to do in their actual life. OT is designed to be responsive to the specificity of the person’s needs in a way that purely biomedical approaches often are not.
I have noticed all of these differences in the last few weeks while I have been trying to figure out how to compensate for my funny left hand/thumb issue. To begin with, my hand has made very good progress and is perhaps 75% recovered from my minor league trauma that sent me running to the ER with my hands waving in the air. I know exactly what they are talking about with the difference between OT and PT in the simplest of tasks. I use my left hand to squeeze toothpaste on my toothbrush. That used to involve my thumb and was pretty much an activity I took for granted. After my thumbalina moment, it became impossible to do that with my thumb and I started squeezing it with my palm and four fingers of my left hand. That worked fine and really was no bother at all. But as my hand/thumb have gotten stronger (for instance, I can now touch my left thumb to all four fingers and I can hold a water glass comfortably in the left hand), I started to want to squeeze my toothpaste the old fashioned way with my thumb. It still doesn’t work easily and takes extra effort versus just doing what I trained myself to do with the palm and four fingers. I’m thinking a PT trainer would tell me that I needed to work on my left thumb strength until I can easily squeeze the toothpaste. But my OT trainer would say that if it works and it doesn’t impede my life, move on to other tasks to fix and leave well enough alone. I see the merits of both approaches and while I want to regain 100% of my hand capabilities, pragmatically, life is too short to worry about why I can’t do something that I really don’t have to do any more. I never could curl my tongue upside down the way some can and yet I can curl my tongue upwards and am the envy of those who can’t even do that. So what?
My homemade OT workout studio no consists of a big bowl of raw rice that I leave on the kitchen counter so that I can squeeze it with my left hand during lunch. It allows me to stretch out and alternately narrow the fingers with the resistance of the rise. It’s a good hand workout. If course, the rice has also served to dry out my left hand and its now starting to get cracked and peeling skin, particularly on my thumb…I can’t win.
I also went online to Amazon and have been amazed at the array of hand exercise devices that exist for people like me who have suddenly come upon a hand malady and need strengthening therapy. I bought a bundle that has grip n’bend sticks, hand squeeze rings, jelly squeezable eggs (very Needoh-like) and fingertip webbing that looks like its from Torquemada’s collection, intended to force stretching and squeezing. I keep a set by my TV chair and in my garage gym. They all come in three or four different color-coded strength levels, measured in pounds (so 30-60 pounds), so you can graduate your training. I feel like they really do help strengthen the hand and increase thumb functionality.
Arthritis of the hand is the largest single contributor by far to this world of the hand injured. Osteoarthritis affects the hands of roughly 25–30% of adults over 60, and hand OA is one of the most common joint problems in the general population. Rheumatoid arthritis affects about 1% of the adult population, with hands being the primary affected site in most cases. Carpal tunnel syndrome is the most common entrapment neuropathy, with prevalence in the general adult population ranging from 2.7 to 5.8 percent. Hand pain and disability in older adults is also a very real thing. For adults aged 55 and over in a one-month period, the prevalence of hand pain is 16.9%, and a prevalence of hand disability is 13.6%. There is a condition called Dupuytren’s contracture which is a progressive fibrotic condition of the hand in which the palmar fascia thickens, tightens, and eventually contracts, pulling one or more fingers into a permanently bent position toward the palm that cannot be straightened. Dupuytren’s contracture affects roughly 3–6% of the US population overall, rising sharply with age. Approximately 20% of men over 65 in Northern European ancestry populations get it. Trigger finger afflicts approximately 2–3% of the general population lifetime prevalence, rising to around 10% in diabetics. Stroke-related hand weakness connects with roughly 800,000 strokes per year in the US, with upper extremity weakness being the most common residual deficit, affecting an estimated 75–80% of survivors to some degree. Traumatic hand injuries — one of the most common reasons for emergency department visits, causes approximately 1.5 million hand injuries treated annually in the US alone.
At any given time: roughly 15–20% of the adult population has some clinically meaningful hand pain, weakness, or functional limitation. Over a lifetime, the proportion who experience a significant hand condition at some point is substantially higher — likely 40–50% or more when age-related decline and acute injuries are included. In adults over 65: prevalence of hand impairment of some kind is close to 50%, with arthritis being the dominant driver. Age is the most important variable. Hand conditions are dramatically age-skewed. Forget about programming as a career, young people should go into OT since the population is aging and hand issues are rising. What does all this say…hands down, I ain’t so special after all…