by Prof Dr Ramli Musa under Patient Education March 5 2009
Rehabilitation has been defined broadly as a process of minimizing psychiatric impairments, social disadvantages and adverse personal reactions, so that the disabled person is helped to use his or her talents and to acquire confidence and self-esteem through experiencing success in social roles. The purpose of this visit is to learn about the role of occupational therapy and rehabilitation centre in psychiatric department, Hospital Tengku Ampuan Afzan (HTAA) with regard to management of psychiatric patients. There were 21 patients at the time of visit with 2 occupational therapists and 2 medical attendants. Both in-patient and out-patient were involved in this program.
The aims for this occupational and rehabilitation program are as following:
1) To encourage patients’ social interactions
2) To improve patients’ concentration and learning ability
3) To increase patients’ confidence level
4) To encourage healthy physical activity among patients
In order to achieve these objectives, several activities were planned by occupational therapist. Stable patients assessed by doctors were chosen to join the program. During our visit, the activities conducted were as following:
§ Session started with physical exercise, warming up followed by aerobic exercise. Medical students and staffs were also involved to encourage patient’s involvement.
§ After physical exercise, reinforcement of daily activities such as grooming and dressing were done by checking patients’ hygiene and instructing them to do basic activities such as clipping nails, brushing teeth and combing their hair. The facility was equipped with self-care corner for this purpose.
§ Next, cognitive activity was conducted. Crossword puzzles were distributed to each patient and they were given 15 minutes to complete the task. Some patients had difficulties in completing the task. However, the medical students and the staffs were available to guide them through the process. The answers were discussed and individual patient was asked to write the answer on the board.
§ Other than cognitive therapy, it has been informed that among other aspects being focused on include occupational training skills, social training skills, art therapy and psychoeducation. These activities were conducted in alternate weeks when appropriate.
§ Patients’ motivation and involvements were assessed by the occupational therapist. Their motivation plays an integral part in determining patients’ improvement.
1. There were only 2 trained occupational therapists for a total of about 20 patients at a time. Hence there was lack of individual attention for the patient which is necessary to assess individual performance, involvement and encourage self-esteem. The objectives of this program would be better met with a smaller therapist-to-patient ratio.
2. The activities were not specific to patient’s disorders and severity as all of them were grouped together and made to do the same activities. Such conditions do not address specific individual needs as per their illness/ disabilities. For example, a mentally retarded patient was made to be involved in a cross-word puzzle; due to his disability, he was unable to fully appreciate the benefits of the cognitive exercise. Our suggestion would be to have smaller therapy groups each focusing on specific disorders or disabilities.
Medications are necessary to help patients gain a better insight to their illnesses, which is imperative in ensuring therapy and rehabilitation to take effect. Rehabilitation program and therapy aim at improving patients’ social and occupational functions in a sheltered environment that would encourage self-confidence in preparation for them to return to the community.