ANN ARBOR, MI - Seventy million Americans have some form of arthritis, a leading cause of disability in the United States. While medication relieves symptoms of pain and stiffness in the joints, it is occupational therapy that is helping people regain mobility and independence by changing harmful habits and further protecting the joints during everyday life activities.

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Occupational therapy focuses on teaching techniques to enable people with arthritis to be more independent at home or at work. Therapists look into what is difficult for the person with arthritis to do and how the disease may be interfering in daily life.

Geraldine Barlage was first diagnosed with rheumatoid arthritis in 1981. Losing much of her mobility cost Barlage most of her independence.

“It was four years after being diagnosed that it became very evident to me that if I didn’t start doing everything I could, I was going to give up a lot,” says Barlage. “My rheumatologist referred me to occupational therapy.”

Soon, Barlage learned how to change her habits and use simple tools and techniques to regain her mobility and independence.

“When I am at work, I can’t grab books by the spine. Instead, I grab the whole book using my entire hand. I went through a lot of training as far as being taught to always use the largest joint,” says Barlage.

She also began using tools, such as knives with bigger handles in the kitchen so she doesn’t have to grip as tightly. She also wears custom designed resting splints during the night.

“The statistics say that 10 years into this disease a lot of people become disabled. Because I have been taking advantage of the things that have been presented to me, I am functioning at a pretty high level still,” says Barlage.

Treatment for people with arthritis in terms of occupational therapy is situational. Joint inflammation and deterioration is localized in different joints and lifestyles are affected differently––so it is up to the therapist and patient to custom-design splints and problem solve in a way for the patient to function most independently.

Here’s a look at some common techniques:

Strategizing for the future with joint protection

Teaching joint protection techniques to reduce stress on involved joints helps the arthritis patient to rethink those harmful habits that wear on joints.

Joint protection principles:

• Use the largest and strongest joint possible to do a task, such as the shoulder and hip to shut the door.
• Avoid beginning an activity that cannot be stopped immediately if it proves to be exhausting or beyond ability to complete, such as taking the turkey out of the oven on Thanksgiving Day.
• Use good posture.
• Control weight to reduce stress on joints. Use tools with enlarged grips.

Dodge also advises to “respect your pain;” to stop those painful activities such as grasping, bending or reaching and take a few minutes to brainstorm any alternative methods that will help protect the joints and not invoke pain.

Simplifying to conserve energy

The overuse and abuse of joints leads to deterioration of the joints, which severely affects independence and mobility. With the use of energy conservation, those with arthritis can decrease fatigue by limiting the amount of energy used on daily tasks and save it for activities they truly enjoy.

Energy conservation practices include:

• Plan and schedule daily tasks and activities, spreading out heavy and light tasks throughout the day.
• Avoid rushing
• Organize to eliminate unnecessary tasks such as reaching or carrying – slide pots and pans from oven to sink or use a cart to clear the dinner table.
• Try to sit and perform activities such as washing dishes and ironing.
• Rest before fatigue hits, so you need less time to fully recuperate.
• Get rid of cast iron or ceramic bowls and pans — plastic or aluminum is much lighter.
• Use electric appliances
• Use large-handled brushes, utensils or pens to avoid having to tightly grasp objects.

Exercise to gain flexibility, strength and endurance

Occupational therapists favor exercises such as swimming, walking and biking to enhance and strengthen arthritis patients.

“We provide exercise programs so that we can make sure people are gaining flexibility, strength and endurance rather than losing it because of the disease,” says Dodge.

Splinting

Splinting is essential for many people with arthritis because it prevents deformity, rests the joints, stabilizes the joints during activity and relieves nerve entrapment.
Splinting at night rests the joints and decreases swelling. A wrist splint can be very effective because it supports any lifting or stress on a particular joint. Also, splinting helps reduce pressure on nerves, which is important for people who have symptoms from Carpel Tunnel syndrome, says Dodge.

“Everything we do in occupational therapy is with the goal of helping patients retain their independence as long as possible,” says Dodge. “There is so much that can be done to work through those difficulties in a very positive matter. No one should ever give up.”

What is arthritis?

Arthritis is a disease that involves the joints or any structure of the joint. It causes joints to become swollen and ligaments and tendons to become overstretched, which then decreases the strength and stability of the joint needed to perform the task.

The number of different types of arthritis reach into the hundreds and range from very mild short-term pain and stiffness to very debilitating effects such that the person cannot get out of bed because he or she has so much pain, inflammation and stiffness.

The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. Osteoarthritis results from degenerative changes in the joints and occurs in most people over age 60. It usually affects the weight-bearing joints and hands. Rheumatoid arthritis causes inflammation, stiffness and deformity of the joints, especially joints in the hands, arms and feet because of an abnormal inflammatory response occurring in the immune system.

Facts about arthritis:

• Both osteoarthritis and rheumatoid arthritis are three times more common in women than in men.
• Arthritis occurs in one out of three people in the United States.
• By age 65, more than half of all people have X-ray evidence of osteoarthritis in at least one joint.

Learn more on the World Wide Web:

U-M Health Topics A-Z: Arthritis
http://www.med.umich.edu/1libr/aha/aha_arthrito_sha.htm

U-M Health Topics A-Z: Coping with Arthritis
http://www.med.umich.edu/1libr/aha/umhs/aha_copearth_sha.htm

Arthritis Foundation
http://www.arthritis.org/ 1-800-283-7800

American Occupational Therapy Association
www.aota.org (301) 652-2682

Written by: Erin Block

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