The Compensatory Approach vs Remedial Approach in Occupational Therapy

As occupational therapy students, we all learn about the different therapeutic approaches that can be used, and the compensatory approach as well as the remedial approach in occupational therapy are ones that are learned and then often applied once we’re practicing OTs.

If you feel that you do not fully understand what the remedial approach or compensatory approaches are yet, then you’ve come to the right place!

This article will explain these two approaches and how they apply to occupational therapy, as well as how they differ from each other. We will also include some examples of these approaches, and cover if there is a “best” approach to use. 

What is the remedial approach in occupational therapy?

Definition: Remediation focuses on the restoration of a lost function. Simply put, this approach targets improving underlying impairments. There is emphasis on changing the person’s underlying skill, as opposed to targeting the activity demands or context (1).

• Example: targeting the strength of an affected upper limb after a stroke.
• Also can be referred to as ‘remediation’. 
• Depending on which country you are receiving occupational therapy training in, you may know this approach as the “rehabilitative approach” or rehabilitation. 

When is the remedial approach used?

• When your patient has an impairment that can improve. For example: upper extremity weakness, attention difficulties, and visual-perceptual difficulties.
• It is more commonly used when the medical condition has happened more recently. 
• In saying that: it can be used at any stage in the occupational therapy intervention, from day 1 to the last day of OT treatment. This will be further explained later in the article. 

What is the compensatory approach in occupational therapy?

Definition: The compensatory approach involves compensation for the lost function. It involves learning adaptive, compensatory methods to perform a task. 

• Example: the affected upper extremity is flaccid and has not regained any strength, so a one-handed adapted dressing technique is taught to the patient to compensate for their upper limb that has no strength. 

When is the compensatory approach used?

• The compensatory approach is often used when the remedial approach has been attempted but unfortunately, function has not been restored. This allows the patient to gain more independence, regardless of whether the underlying impairment has improved. 
• It is used in conditions with irreversible impairments or degenerative conditions. This would include conditions such as blindness, ALS and dementia. 
• It is used when there is limited access to occupational therapy sessions. For example, I sometimes have patients come for occupational therapy from a neighboring country, and they can only attend 1-2 sessions. I try to teach them compensatory strategies, as this will lead to a fast improvement in functional independence, whereas the remedial approach often requires more time and intensive therapy before seeing results. 
• This approach is more effective when the person has an awareness of an impairment, and through this they are able to identify when they need to employ a strategy or use of an assistive device to assist them. If they have a severe cognitive impairment, they may be less aware of when they need to implement a compensatory strategy.
• However, most importantly, this approach can also be used with every patient in every session, irrespective of how recently their condition changed. I will elaborate further on this below. 

So, which approach is better?

These approaches should be used interchangeably and in conjunction with one another throughout your patient’s journey. It is true that at different stages of the journey, you may use one approach more than the other, however, both approaches should always be considered. Here are some examples of what this may look like:

Example 1:

Lisa is a 35-year-old mother with a 9-month-old baby who suffered a mild brain injury in a car accident. She presents with hemiparesis in her left upper extremity and is struggling with the child care tasks she needs to do for her son. 

Remedial approach:

Upper extremity strengthening exercises are taught to Lisa to help her eventually be able to use bilateral upper extremities in child care tasks, such as changing a diaper. Stretches are taught to her to help her maintain range in all the joints in her left upper extremity. Sensory re-education is done to help her improve her sensation in her affected upper limb. 

Compensatory approach:

You realize that Lisa’s left upper extremity has good potential to regain a lot of strength, but this will take time, and she still has to look after her baby. You teach her compensatory strategies like how to hold her baby and feed him with a bottle at the same time, or how to change his diaper one handed.

You show her assistive devices she can incorporate into child care tasks so that she can still achieve them independently. You educate her on her reduced sensation in the left upper extremity and the importance of checking the bottle’s temperature or the bath water on her unaffected upper extremity. 

A combination of both approaches will help her be more independent in caring for her baby. 

Example 2:

Jonas is a 55-year-old male who works as an accountant. He had an acute stroke and, as a result, has a short-term memory impairment. He wants to be able to return to work, and has come to occupational therapy to help him with this. 

Remedial approach:

You target visual and auditory memory exercises with him in every session to improve his short-term memory. 

Compensatory approach:

You teach him internal and external compensatory strategies that he can use to assist him at work. An example of an internal compensatory strategy would be teaching him association strategy to assist him in recalling new colleagues’ names.

An example of external compensatory strategies would involve: keeping a notebook to write down important information, taking minutes in meetings, setting alarm reminders for tasks he needs to do, writing to-do lists and keeping deadlines and other important tasks written in a journal. You can also use work-simulated tasks to practice the compensatory strategies taught. 

A combination of both approaches will help him return to work with a decreased risk of forgetting to do on the job tasks. 

It is interesting to note that Dirette, Hinojosa, and Carnevale decided to compare the compensatory and remedial approaches and actually found no significant difference between the two approaches. This signifies that one approach is not superior to the other (1).

_______________

In conclusion, the remedial approach aims to improve impairments, whereas the compensatory approach in occupational therapy involves the implementation of an aid or strategy to improve occupational performance. It is advantageous to use a combination of both strategies with your patients.

We hope that you now have a greater understanding of the compensatory approach and the remedial approach in occupational therapy, and when it is most beneficial to use either strategy. 

If you have any specific examples of either one of these approaches, please share them in the comments!

Reference:

1. Golisz KM, Toglia JP. Evaluation of perception and cognition. In Neidstadt ME, Crepeau EB, editors. Willard and Spackman’s Occupational Therapy. Philadelphia: Lippincott-Raven; 1998. p.747.