OT Interventions for Patients on Isolation Precautions
Patients are placed on isolation precautions to prevent the spread of infection to other patients and healthcare workers. When a patient is on isolation precautions, they will typically have to remain in their rooms with limited equipment available for you to use during your OT treatment times.
Working with adults in occupational therapy, even during “normal” times, you’ll likely work with patients on isolation precautions for various diagnoses, including, but not limited to, MRSA, C-diff, tuberculosis, and now, Covid-19.
This added difficulty can require OTs to bring some extra creativity to the treatment. This is why I’m really excited to share this guest post from inpatient rehab occupational therapist Stephanie Wade, OTR/L. She shares some creative OT treatment ideas for your patients on isolation based on her experience working on an isolation unit during Covid-19.
These interventions will work with any patients who are on isolation precautions in both hospital or rehab settings.
Covid-19 has taken our inpatient rehab unit through many waves of “new and unexpected.” At the beginning, the gym was closed, and the unit was nearly empty while we cleaned and strategized.
Then our unit filled up, but we completed all patient care in individual patient rooms. Ultimately, the first wave of Covid-19 patients made their way to us via the ICU, then from acute care units, so we established an isolated hallway on our acute rehab unit for their treatment.
You may find yourself, as I did, struggling to find creative ways to appropriately fill 5 hours of therapy time a day with patients who are newly ambulatory and regaining strength, but are stuck in their rooms on isolation precautions.
On days when they’re already bathed and dressed, and you’ve exhausted edge of bed dynamic reaching and Theraband activities, what else can you do with 8 square feet of floor space?
Here are some isolation treatment ideas I’ve found using only items that can be easily carried and sanitized, are disposable, or can be found in your unit’s supply closet. These interventions can work for your patients in acute care, inpatient rehab, or in skilled nursing facilities.
Fine Motor Treatment Ideas
Many of our patients recovering from Covid-19 have experienced poor perfusion and hyper-coagulation over the past weeks, often resulting in decreased sensation and dexterity in their distal extremities.
In other cases, your patient may have co-morbidities including diabetic neuropathy, recent neurological damage, or other conditions impacting their fine motor skills. Your favorite go-to activities will, more than likely, not be coming with you to an isolation unit. I hope these activity ideas will give you a creative boost to add versatility to your treatment sessions!
Surgical Tape Tearing
Starting with my all-time favorite, tearing tape has been a surprisingly versatile treatment activity. With the option to complete seated at the bedside table or standing at the wall, the patient can create a design or pattern as they feel compelled.
The act of tearing and peeling tape can build intrinsic digital strength and fine motor coordination. If your patient is able to tolerate standing, it can be a great way to build standing tolerance and dynamic balance as well.
Tic Tac Toe
A package of Pony Beads can go a long way for improving pincer grasp, but moving beads from one bowl to another can quickly become monotonous. A way I like to mix things up is to play a modified version of tic-tac-toe using medicine cups.
Each cup serves as a space on the “board” and each person chooses a color. Place your color bead in the cup as your “X” or “O”. The hunt for the right color in the bowl of beads can also serve as a sensory challenge for those with decreased sensation. This activity could be modified to use a spoon for lifting and placing beads to improve accuracy in self-feeding.
For a real challenge, use the same medicine cups to make a pyramid. Requiring a high degree of frustration tolerance to build the larger pyramids, this activity aims to build complex fine motor control and coordination.
While you may have grown accustomed to a collection of food containers in your rehab gym to develop opening skills, there are often many things in patient rooms that can serve the same purpose. Common items may include Ensure bottles, toothpaste, mouthwash, and soap containers.
Another favorite of mine is the pill crusher, as it typically has tabs allowing for an easier twist for lower-level patients.
Classic Card Games
Playing cards are a tried and true fine motor and in-hand manipulation leisure activity, however, they might not come to mind as an option for a isolation unit, as they cannot be sanitized. An easy solution is to buy 2-for-1 packs of cards at the Dollar Store and distribute them to appropriate patients to keep in their rooms for use during therapy or free time.
Standing and Balance Treatment Ideas
Decreased endurance and standing tolerance are benchmark deficits seen in survivors of Covid-19 as well as other patients undergoing a prolonged hospitalization. This is often accompanied by poor postural support and decreased upper extremity strength. These activities are great ways to address those deficits even when a patient is on isolation.
A common activity in the rehab gym with the help of an aid, balloon volleyball may seem unrealistic in a small patient room. I’ve found that having the patient hit the balloon against the wall continuously creates an opportunity to participate in dynamic reach to a variable target, leaving the therapist free to provide contact guard assist.
Depending on the configuration of the room, this activity may be completed sitting at the edge of the bed, in a chair, or in standing depending on the patient’s functional level.
Standing and dancing (with an assistive device, if needed) to music from the patient’s phone, has been one of the most fun ways to build balance and endurance. I always let patients choose their preferred genre and songs, however, the Cupid Shuffle, or similar line dances, can be great to encourage specific challenging movements for higher-level patients.
Dancing can be a great way to bring some brightness and fun to an often heavy and lonely part of the hospital.
Cone Obstacle Course
Bringing a set of colorful plastic cones to a patient’s room can help provide structure for dynamic standing balance activities including high forward and lateral steps, as well as reaching to the floor. They can also be used to mark stations for an in-room circuit workout.
Without access to our standard practice tub, simulating a tub transfer took some creativity. My most successful method was to turn the patient’s trash can upside down (with the trash removed, of course!) and use the wall for support for a lateral step over the “tub wall.” A Theraband tied between the bed and a chair can serve the same purpose.
There are lots of great resources available for chair yoga routines. I find this type of activity to be a great way to incorporate breathing techniques with focused postural support. I often use the opportunity to discuss mindful breathing and movements. Another added bonus is that these routines can be practiced in a small amount of floor space.
IADL Treatment Ideas
Instrumental Activities of Daily Living, or IADL, tasks are crucial for a safe and independent discharge home, but are very difficult to simulate without access to a kitchen or laundry room. These activities may require more preparation on the therapist’s part, but are invaluable for the higher-level patient.
Given that safely washing clothes from patients on isolation precautions is no small ordeal, I always try to coordinate bringing the clean clothes back during a treatment session, so the patient can practice standing to fold their own laundry.
I’ll admit, cooking is quite an undertaking on an isolation unit. For the right patient (high level, plans to return home without assistance, plans to return to cooking), though, I believe it’s worth the effort to be as true to this occupation as possible.
In this case, I purchased a cutting board, knife, and bowl from the dollar store and pre-washed all ingredients. My patient stood at a towel-covered bedside table to prepare chicken salad, chopping and mixing all ingredients.
I recommend scheduling a cooking session close to meal time, as there likely will not be a refrigerator available for leftovers.
When preparing an actual meal is not an option, you can always bring in a printed recipe and ask your patient to double it and/or write a grocery list to address functional cognitive skills.
While this activity may work best as a kit designated for isolation patients, it could all be sanitized and used elsewhere if need be. Remove labels from old pill bottles and fill with Pony beads. Create a new label with instructions for frequency and timing of taking medication. Ask your patient to fill pill sorter according to label instructions.
For more intervention ideas, check out The Note Ninjas ADL Guide! The guide provides you with tons of activities to address specific ADLs and the skills required for each ADL.
We hope these OT interventions for your patients on isolation spur your own creativity for working toward your patient’s goals in a way that is purposeful and occupation-based.
If you have any other favorite isolation treatment ideas that you’ve picked up along the way, please share them in the comments below!
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