Occupational therapy considerations
![Picture](/uploads/1/9/2/9/19293441/9265971.jpg?316)
According to the American Academy of Orthopaedic Surgeons, rotator cuff disease is one of the most prevalent musculoskeletal disorders. The cardinal symptoms are pain, weakness, and decreased active range of motion of the affected shoulder joint. These symptoms may have detrimental impacts on one's engagement in meaningful occupations that are integral to daily functioning in the domains of: self-care, work, and leisure.
Self-care: Activities that activate the shoulder joint include over-head and above the shoulder activities. This includes reaching for items, putting on upper extremity clothing, and personal hygiene activities. According to the American Academy of Family Physicians, a prevalent symptom is night pain and sleep disturbance. This may lead to fatigue and weakness, and impact an individual's ability to complete activities of daily living (ADLs) such as transferring out of bed or instrumental ADLs such as meal preparation and driving.
Leisure: The pain, weakness, and limited shoulder mobility may prevent an individual from enjoying their desired leisure occupations, such as involvement in sports and physical activities with their loved ones.
Work: Loss of productive occupations such as work may be the most debilitating impact of rotator cuff pathology, especially for individuals who are employed in "blue-collar" occupations such as construction work and manufacturing. Even for those who work in an office setting with limited physical demands, the pain and weakness associated with this condition may impact their focus, alertness, and other cognitive functions.
Self-care: Activities that activate the shoulder joint include over-head and above the shoulder activities. This includes reaching for items, putting on upper extremity clothing, and personal hygiene activities. According to the American Academy of Family Physicians, a prevalent symptom is night pain and sleep disturbance. This may lead to fatigue and weakness, and impact an individual's ability to complete activities of daily living (ADLs) such as transferring out of bed or instrumental ADLs such as meal preparation and driving.
Leisure: The pain, weakness, and limited shoulder mobility may prevent an individual from enjoying their desired leisure occupations, such as involvement in sports and physical activities with their loved ones.
Work: Loss of productive occupations such as work may be the most debilitating impact of rotator cuff pathology, especially for individuals who are employed in "blue-collar" occupations such as construction work and manufacturing. Even for those who work in an office setting with limited physical demands, the pain and weakness associated with this condition may impact their focus, alertness, and other cognitive functions.
![Picture](/uploads/1/9/2/9/19293441/3230027.jpg?250)
Given the monumental impact on daily functioning, occupational therapy intervention is essential for individuals who have incurred an injury to the rotator cuff. These interventions may need to be both compensatory and remedial. In compensatory interventions, the occupational therapist teaches the client techniques that compensate for their functional deficits, with the aim of fostering independence. An example of this is teaching the client new ways to perform a task that would ordinarily require significant shoulder movement such as moving essential items from the top cupboard to a lower cupboard. This would restrict any overhead shoulder movements and thus "compensate" for the client's injury, while enabling independence.
Remedial techniques involve efforts to improve the client's functional deficits, such as a physical rehabilitation program involving strengthening exercises. Remedial techniques will be discussed more thoroughly in the "treatment" section, as it is the gold standard for shoulder rehabilitation.
Fongemie, A., Buss, D., & Rolnick, S. (1998). Management of shoulder impingement syndrome and rotator cuff tears. American Family Physician,57(4), 667-674. Retrieved from http://www.aafp.org/afp/1998/0215/p667.htmlhttp://www.webmd.com/pain-
management/picture-of-the-rotator-cuff
Hoffmann, T., Bennett, S., Koh, C., & McKenna, K. (2010). Occupational therapy for cognitive impairment in stroke patients (review). The Cochrane Library, (9), Retrieved from http://www.update-software.com/BCP/WileyPDF/EN/CD006430.pdf
Shoulder Treatment [Web Photo]. Retrieved from http://www.physioplushurstville.com.au/shoulder-pain.aspx
Son on shoulder [Web Photo]. Retrieved from http://matrixtherapysolutions.com/?page_id=511
Yamaguchi, K. (2011). New guideline on rotator cuff problems. American Academy of Orthopaedic Surgeons, Retrieved from http://www.aaos.org/news/aaosnow/jan11/cover1.asp
management/picture-of-the-rotator-cuff
Hoffmann, T., Bennett, S., Koh, C., & McKenna, K. (2010). Occupational therapy for cognitive impairment in stroke patients (review). The Cochrane Library, (9), Retrieved from http://www.update-software.com/BCP/WileyPDF/EN/CD006430.pdf
Shoulder Treatment [Web Photo]. Retrieved from http://www.physioplushurstville.com.au/shoulder-pain.aspx
Son on shoulder [Web Photo]. Retrieved from http://matrixtherapysolutions.com/?page_id=511
Yamaguchi, K. (2011). New guideline on rotator cuff problems. American Academy of Orthopaedic Surgeons, Retrieved from http://www.aaos.org/news/aaosnow/jan11/cover1.asp