PT care settings

PATIENT CARE SETTINGS IN PHYSICAL AND OCCUPATIONAL THERAPY

Intro to OT/PT

  • Focuses on the environments where Occupational Therapy (OT) and Physical Therapy (PT) practitioners work.

Where Do OT’s, OTAs, PTs, and PTAs Work?

  • Common work environments include:

    • Hospitals

    • Inpatient Rehabilitation Facilities (IRF)

    • Home Health

    • Skilled Nursing Facilities (SNF) / Long-Term Care

    • Outpatient Clinics

    • Schools

  • Additional settings for OTs and OTAs:

    • Psychiatric Facilities

Acute Settings: HOSPITALS

  • Patient Population:

    • Varied diagnoses, ages, and acuity levels.

    • Specific population depends on the hospital's level (e.g., trauma center, community hospital).

  • Typical Length of Stay (LOS):

    • Approximately 3-5 days.

  • Therapy Goals:

    • Early mobilization.

    • Prepare the patient for the next level of care.

  • Typical Treatment Strategies:

    • Physical Therapy:

    • In-bed or edge of bed (EOB) exercises.

    • Basic mobility and transfer training.

    • Occupational Therapy:

    • Focus on basic Activities of Daily Living (ADLs).

Post-Acute Settings: Acute Rehab (IRF)

  • Patient Population:

    • Various diagnoses and age groups.

    • Common conditions treated include:

    • Cerebrovascular Accident (CVA)

    • Spinal Cord Injury (SCI)

    • Congenital deformities

    • Amputations

    • Major multiple traumas

    • Femur fractures

    • Traumatic Brain Injury (TBI)

    • Neurological disorders

    • Burns

    • Active rheumatic joint diseases

    • Severe or advanced osteoarthritis or degenerative joint diseases affecting two or more weight-bearing joints.

    • Knee or hip joint replacements.

  • Typical Length of Stay (LOS):

    • 1-3 weeks.

    • Patients must tolerate a minimum of 3 hours of treatment/day.

  • Therapy Goals:

    • Maximize improvement in performance skills.

    • Facilitate return to prior skill level.

  • Typical Treatment Strategies:

    • Physical Therapy:

    • More complex mobility and transfers.

    • Balance and strength training.

    • Endurance exercises.

    • Occupational Therapy:

    • More complex ADLs progressing to Instrumental ADLs (IADLs).

    • Patient and caregiver education (both PT and OT).

Post-Acute Settings: Skilled Nursing Facilities (SNF) / Long-Term Care

  • Patient Population:

    • Variety of diagnoses, primarily adult age groups.

    • Patients often have more medically complex conditions requiring longer care.

  • Typical Length of Stay (LOS):

    • 14-25 days or longer, depending on long-term care needs.

  • Therapy Goals:

    • Improve functional activity tolerance and endurance to return to prior skill levels.

  • Typical Treatment Strategies:

    • Physical Therapy:

    • Focus on lower extremity strength.

    • Endurance and balance exercises.

    • Motor control related to mobility (gait and transfers).

    • Occupational Therapy:

    • Focus on upper body strength and endurance.

    • Mobility exercises and cognitive skills enhancement related to ADLs and IADLs (actual or simulated).

Post-Acute Settings: Home Health

  • Patient Population:

    • Varied diagnoses and age groups.

    • Patients must be under care of a physician and deemed "homebound" (having considerable difficulty leaving home).

  • Typical Length of Stay (LOS):

    • Therapy sessions 1-5 times/week; sessions typically last 60-90 minutes over 30-60 days.

  • Therapy Goals:

    • Address performance skills and tasks to maintain home living as long as possible.

  • Typical Treatment Strategies:

    • Physical Therapy:

    • Focus on lower extremity strength, endurance, and balance related to mobility (gait and transfers) in and around the home.

    • Occupational Therapy:

    • Upper body strength and endurance training.

    • Mobility exercise and cognitive skill enhancement supporting ADLs and IADLs in a natural context.

Post-Acute Settings: Outpatient

  • Patient Population:

    • Varied diagnoses and age groups, dependent on clinic specialties.

    • Services may include vocational rehabilitation, general orthopedic conditions, cardiac rehabilitation, ergonomics, pre-employment assessment, aquatic therapy (PT), and specialized therapies like hand therapy (OT) and pelvic floor health (PT).

  • Typical Length of Stay (LOS):

    • Patients may attend therapy 1 time/week up to multiple times/week; sessions last 30-60 minutes.

  • Therapy Goals:

    • Restore function.

    • Adapt to provide compensatory training.

    • Prevent further complications associated with conditions.

  • Typical Treatment Strategies:

    • Therapeutic exercise and manual skill techniques (including soft tissue and joint mobilization).

    • Therapeutic activities and neurological re-education.

    • Patient training and education.

    • Use of physical agent modalities (PAMs) such as ultrasound and electrical nerve stimulation, and fabrication of orthoses.

Outpatient Pediatric Clinics

  • Patient Population:

    • Varied diagnoses from birth to age 21.

    • Focus areas include:

    • Fine motor coordination, sensory processing, feeding/eating issues, emotional regulation, pre-vocational and social participation skills (OT).

    • Strength, balance, coordination, gait, gross motor skills, range of motion, and mobility (PT).

  • Typical Length of Stay (LOS):

    • Patients may attend therapy 1X/week up to multiple times/week; sessions last 45-60 minutes, often leading to long-term treatment.

  • Therapy Goals:

    • Acquire new skills and restore function.

    • Adapt and provide compensatory training.

    • Prevent further complications associated with conditions.

  • Typical Treatment Strategies:

    • Physical Therapy:

    • Focus on strength, endurance, balance, and coordination exercises.

    • Occupational Therapy:

    • Use of compensatory strategies and adaptations, psychosocial approaches, and sensory processing interventions.

School-Based Settings

  • Patient Population:

    • School-aged children.

  • Typical Length of Stay (LOS):

    • Determined as needed by the Director of Special Education and the Individualized Education Program (IEP) team, usually aligns with the school year.

  • Therapy Goals:

    • Services must be planned according to the goals set by the IEP team, which should enhance educational and academic participation.

  • Typical Treatment Strategies:

    • Physical Therapy:

    • Focus on strength, endurance, balance exercises related to mobility (gait and transfers) impacting educational participation.

    • Occupational Therapy:

    • Strength, endurance, mobility exercises, improvement in coordination, as well as vision and visual perception related to increasing participation in all educational activities such as fine and gross motor coordination, handwriting, sensory processing, and attention skills.

Psychiatric Hospital - (OT)

  • Patient Population:

    • Varied diagnoses, ages, and acuity levels depending on hospital type and severity of conditions.

    • Common psychiatric conditions include mood disorders, anxiety disorders, substance-related disorders, and schizophrenia (and other psychotic disorders).

  • Typical Length of Stay (LOS):

    • Typically involves 5-14 days but may extend longer depending on individual circumstances.

  • Therapy Goals:

    • Improve overall functional status tailored to individual diagnoses and primary symptoms.

  • Typical Treatment Strategies:

    • Conduct group therapy sessions to provide structure throughout the patient’s day.

    • Each group session specifically addresses coping and life skills aimed at achieving functional independence, including goal-setting skills, social skills, and time management skills.