Creative Ideas for Simulating Occupations in Your OT Treatments

There are scenes many of us have experienced as occupational therapy practitioners at least once in our careers, no matter what setting you work in. You open up the supply closet and see the same old uninspiring materials. You find out a surprise discharge barrier and have to assess it ASAP. Your mind is drawing a blank and you still have to come up with your OT treatments to fill up a 30-minute session.

Even well-equipped facilities can get crowded during therapy hours, and you can’t always access the areas you need. With productivity standards, it’s not feasible to keep moving around the building. After I position my client’s wheelchair just right, gather my papers, and place my laptop in the quickest WiFi zone, there is no way I can move again. Looks like we have to practice tub transfers right here in this corner!

We are expected to address a wide range of goals in very little time, especially in subacute rehab. One way to do this is to simulate a full occupation using whatever surroundings you have. You can mimic an activity, without actually doing it, and still target the skills involved. You probably already do this with medication management, using colored beads to mimic pills.

We should obviously advocate for the most realistic OT treatments, and shouldn’t base an entire discharge on one activity. But using “the next best thing” is helpful for building up skills along the way. Below are some simulation OT interventions to try when you do not have the time, resources, or ability to do the real thing:

Housekeeping

Housekeeping is a legitimate goal that deserves attention, but it is also hard to replicate or perform in the clinic. It’s not realistic to ask the environmental staff for cleaning supplies every time, or to bust out a vacuum in the middle of the unit. Instead, I found a quick stand-in for sweeping, mopping, and raking.

Tie a weight to the end of a Swiffer, yardstick, or any kind of pole. Walk this tool around the room, pushing or dragging it over the floor in functional directions. This seems safer than having the patient actually get the floor wet, or using real appliances with cords in a gym.

I would also have patients tie or untie knots on a Theraband. This was to mimic managing cords and various household duties. The Theraband texture was easier to grasp for some people, and the resistive force turned it into a strengthening exercise.

AOTA has cool suggestions for creating your own fake laundry machines. They suggest wrapping a sheet around the outside of a walker so the top is clear like a top-loading washing machine. For front-loading dryers, you can drape a sheet over a tray table so the center is clear.

You can work on laundry skills without having to lug a suitcase of adult clothes around. Swap them for doll’s clothes or children’s outfits. The patient can sort them by category or weather appropriateness. One client drew me some clothing shapes on paper and I had them laminated. We used these to hang up on a tabletop clothesline like real laundry.

Transfers

If you have to practice community transfers, you do not need a car, a tub, and a curb all in one place to do so. You can use upside down buckets or hospital basins on the floor to simulate thresholds. Almost anything can be used for the patient to step over, as long as it is a realistic height. (A strip of Theraband on the ground would be too low.)

I’ve used wooden blocks and toy bricks stacked up as needed as the patient progressed. This is perfect for simulating walk-in showers with a small entry ledge. You can perform this inside the parallel bars for more security.

If you position a chair facing the wall, you can wrap a string of yarn around its legs and tape the ends to the wall. This will create a rough outline of a vehicle entry or a tub chair. Have the patient reproduce getting into these types of seats by raising their legs high enough over the yarn.

Cooking

Meal prep is a staple of OT culture. However, you may not be able to reserve the cooking room or have any ingredients on hand. An easy substitute is using Play-Doh or Theraputty. Don’t just stop at pinching and rolling- you can use utensils to manipulate it (knives, forks, scissors).

Try following an actual recipe for holiday cookies or “pigs in a blanket.” Use a spatula to flip your creations and engage some upper extremity mobility. Therapy bean bags come in handy here, too. The heavier the item, the more challenge to forearm pronation.

If you have to work on kitchen demands but are limited to a standard room, you can still replicate the motions required. Use your typical weight equipment (dumbbells, dowels, wrist weights) and have the client perform the acts of bending over to an oven, unloading a dishwasher, or transporting a pan. They will be gesturing in functional movement patterns while improving strength.

IADLs

Most OTs would love to have grocery items or a storefront available to assess discharge function. You might have to substitute groceries with things found around the rehab, instead. Make a list of things to find and have the patient go “shopping.” The list can include things like pencils, large cups, white towels, etc.

Scavenger hunts are not new to therapy. A common go-to is hiding cones around the room for the patient to retrieve. With the addition of a shopping list, the challenge is increased and allows for dual tasking- a mobility demand combined with cognitive demand.

Another idea is to write out numbers 1-10 on separate sticky notes and place them randomly around the room. The patient will have to collect them in proper 1 to 10 order. This can offer a better look at their distractibility and attention during their home routines.

Use old calendars and planners (recycled!) to practice appointment management. I write down a list of fake appointments and have the client transfer them over onto the correct dates. This works on organization, handwriting, and even memory.

You can ask them to recall certain dates or events from the list. They can count days ahead or behind to practice time awareness and planning. They can add in birthdays or anniversaries to make the treatment more personal and motivating.

In almost every skilled nursing facility I’ve worked in there has been a kit of large beads and string. The idea is to grip and grasp your way to a fully beaded necklace. Once the fine motor component gets addressed over and over, I add to it and make it more functional.

Grab paper and write a list of colors for the patient to follow and recreate. Following a pattern can translate over into sewing, hobbies, or basic assembling. This now works on multitasking, working memory, and following directions. If they miss colors or skip sections, you get to also work on problem solving.

ADLs

When trying to assess an ADL routine, there are numerous things that could impede your plans. The patient could already be dressed for the day, they could be missing items, or they are in a foreign space that doesn’t match their usual layout. You can still simulate the demands of their morning routine.

Place clothes and grooming supplies around the room at different heights. You can try to replicate their tall dressers, low drawers, deep closets, etc. As they collect items you can assess for proper sequencing and safety awareness.

Dressing can be simulated by donning materials over the body or limbs. Materials include: therapy rings, tied washcloths, large rubber bands, Theraband loops, infinity scarves, or beaded necklaces. It has been easy to stack colored rings over people’s shoes to work on seated bending.

Dressing-related ROM can also be reproduced by other activities. You can pass cones hand-to-hand behind the back or behind the neck. You can clip clothespins to various spots on their current outfit and have them unclip each one. To isolate toilet hygiene you can pass cones between the legs in standing.

For a seated wiping motion, the patient can slide a sheet of paper under their body from front to back while leaning off of one hip (easiest on a mat table). You can stack cones in front near their lap and have the patient transfer them to behind their back near the tailbone.

Fine Motor

You may have a patient who needs to improve fine motor skills to open packages, manage medical devices, or remove wrappings. Grab a roll of any tape. Picking at the edge and peeling back the tape is very similar to opening up new bottles or sealed items (like Ensure, lotion, or eyedrops).

Working on shoe tying can be cumbersome in some sessions. The donning and doffing process may take longer than you have, or it can fatigue the patient unnecessarily. You don’t want to handle the shoe or place it on their lap for hygiene’s sake.

To target tying and keep it realistic, you can repurpose some cardboard to serve as the shoe. I have saved plastic inserts from new shoes, cut holes into them, and threaded shoestring to simulate a real shoe. You could also use an empty tissue box.

Final Tips for Simulated OT Treatments

Substitutions don’t have to be complicated in order to be relevant. To work on hair grooming without any supplies around you can lift a wrist weight overhead in a brushing motion. This makes exercise more task-oriented.

We’re told to remain occupation-based and functional, but that is tricky if all you have is a sea of exercise equipment. To blend the idea of function with the reality of what’s available, you can guide patients in exercise that has specific and dynamic movement patterns.

I recently had a client goal for transporting dishes up into the cupboard. I only had a red Theraband. I tied the band into a loop and had the client lift one end up towards a shelf, copying the act of lifting dishes. It felt better than just repeating biceps curls, and this is good for an OT who feels the pressure of always having to justify treatments and be creative. Theraband can be used this way with hand-to-mouth motions to improve feeding, or step-ups with the feet to improve placement into pant legs.

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We know the frustration of seeing a client barrier but not being able to perform it, not quite “scratching the therapy itch.” Playing with the elements of the task may lead you to some great occupational therapy treatment ideas. Breaking down bigger activities into manageable chunks is the heart of occupational therapy!

What other occupation-based simulations would you add to this list? Let us know your favorite treatment ideas in the comments below!

Reference

“Creative Solutions for Implementing Occupation-Centered Practice in Skilled Nursing Facilities” (AOTA, 2019)
https://www.aota.org/~/media/Corporate/Files/Publications/CE-Articles/CEA-June-2019