02 Feb 2012
By: NG WAN CHING
A year ago, a stroke turned businessman Lim Peng Min, 62, from an active person who travelled frequently to someone who could not even turn himself in bed.
Now, the father of two is able to do most things by himself, including going to the bathroom, walking up and down stairs, dressing himself and, yes, turning in bed.
But it has been a difficult road to recovery, one which he could not have gone on without the help of his occupational therapist, Mr David Zhang, as well as his wife and son.
Mr Zhang, a senior occupational therapist at Tan Tock Seng Hospital (TTSH), helped the Lims reconfigure their home and spent hours with Mr Lim to help him regain the functions he had lost.
Demand for services, such as those offered by Mr Zhang, is steadily rising as the population ages and develops more age-related conditions that affect people’s ability to function.
The number of referrals to occupational therapists in public hospitals has grown by around 10 to 15 per cent each year over the last five years.
For example, at the National University Hospital (NUH), the number of occupational therapy sessions for inpatients more than doubled between 2008 and last year.
This number is expected to continue to increase, with Singapore’s ageing population and the increasing awareness of the occupational therapist’s role in rehabilitation, said a spokesman for NUH.
At TTSH, the number of referrals has gone up from 17,686 in 2007 to 23,581 last year.
Most of these are for patients who have had a stroke or suffer from other conditions such as high blood pressure and diabetes.
Ms Florence Cheong, a manager in occupational therapy at TTSH, said: “When they come in, some of them are in a weakened condition and they may need some help to get back to where they were.”
Occupational therapists work closely with physiotherapists to treat these patients.
While physiotherapists help patients with physical rehabilitation, occupational therapists focus more on their ability to carry out the activities that they were doing prior to the injury or medical condition.
“If they cannot return to doing those activities, then we can help them to optimise their abilities as much as possible,” said Ms Cheong, who is also the president of the Singapore Association of Occupational Therapists (SOAT).
This is done by assessing and analysing how patients engage in activities, said Ms Jo Chen, senior occupational therapist at the KK Women’s and Children’s Hospital rehabilitation centre.
TTSH, like other hospitals, has refined its programmes to offer more targeted therapy for patients, Ms Cheong said.
Its MindFit programme, for instance, is a new programme set up a year ago which has occupational therapists working with the psychology department and memory clinic in a cognitive training session for patients who have mild cognitive impairment. Patients are taught memory strategies in six sessions that last two hours each.
For example, in a session on remembering telephone numbers, psychologists will teach the patients how to remember a telephone number by dividing it up in chunks.
Then occupational therapists will help them practise what they have learnt.
Patients will also have homework, which will be reviewed during the following sessions.
This programme has been quite well-received and sessions are now also held in Mandarin.
KKH has opened new clinics, including a mental health clinic, a feeding clinic (run jointly by occupational, speech and language therapists) and an orthopaedic walk-in clinic, to provide therapy for women and children up to 18 years old. It has also recruited more occupational therapists.
In the last five years, TTSH occupational therapists have become more involved with other organisations in community and in preventive programmes in the community such as fall prevention programmes, Ms Cheong said.
For example, under TTSH’s maintenance group exercise therapy programme, its occupational therapists train the staff of day-care centres in facilitating therapeutic exercises for the elderly.
In another programme, the occupational therapists visit residents’ homes to assess home safety levels and advise them on home modifications if needed.
This helps to equip residents with skills and knowledge that keep them healthy.
At the Singapore General Hospital (SGH), services are reviewed regularly in order to ensure quality of care for all the patients, said Ms Anna Tan, head of the department of occupational therapy.
The workload of its occupational therapists has increased by about 10 per cent yearly for its financial years of 2008 to 2010.
The number of occupational therapists in SGH has doubled between 2008 and last year.
To cope with increasing demand at SGH, manpower will be deployed to areas that require more occupational therapy services.
SGH conducts ongoing updates and training programmes to ensure that its occupational therapists are updated in their knowledge and skills to manage the changing demands in patient care.
Most of the time, education is also provided for patients’ caregivers, to help them help patients practise techniques at home.
Mr Zhang, who spent about seven to eight one-hour sessions helping Mr Lim, said: “It took a lot of practice and hard work on Mr Lim’s part, as well as on his caregivers’ part, for him to get to where he is today.”
He visited Mr Lim’s home to help his family sort out their living arrangement.
This included the clearing of clutter in the living room and the installation of grab bars along the walls to help Mr Lim navigate his home environment safely.
Mr Lim, a businessman dealing in car spare parts, also had problems reading after his stroke.
He said in Mandarin: “The stroke affected my vision on my left side. When I went back to the office two to three months later, I read bills wrongly. What was a five-figure bill, I would read as a three-figure one.”
Mr Zhang advised him to turn his head more to the left when he was reading so that he could see everything on a page.
Mr Lim’s fine motor movements were also affected by the stroke. To get his motor skills back, he had to do exercises including turning a small, flat object, such as a coin, repeatedly from side to side.
He also practised turning in bed. He could turn well on his right side but had problems when it came to turning on his left side.
His wife, Mrs Lim Siew Kheng, 52, a pharmacy technician, said: “I ended up with very little space in bed, which was frustrating.”
Now that Mr Lim has done some training to help strengthen his left side, his ability to turn his body has improved.
So has his ability to walk up and down stairs.
“He’s talking about going to London in May to visit our daughter who lives there,” said Mrs Lim.
This is exactly what his occupational therapist has been working with him to achieve – a return to his normal activities before his stroke.
Email: wanching@sph.com.sg
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