Vocational Rehabilitation in practice: Simon's story
by Anthony Yuill
The principles of vocational rehabilitation and occupational therapy are exactly aligned, and aim at maximising independent living through vocational participation and thereby dramatically enhancing quality of life. Simon’s story is one example of how this happens in practice.
Background
Simon, 34, is a builder, husband and father with no significant prior medical history. He was involved in a workplace incident on a building site, suffering major trauma including fractures to his pelvis and ankle, and significant lacerations to his right knee. Spending a significant period in hospital afterwards, he was then discharged home to the care of his partner and children.
Initial rehabilitation
Simon benefited from rehabilitation through statutory services, but this was severely limited once he was discharged from hospital. He became withdrawn and avoided social situations, while his relationship with his partner became strained.
Since he was unable to return to his place of employment, Simon suffered significant financial hardship. He was subsequently diagnosed with depression and prescribed anti-depressants. He continued to receive fortnightly physiotherapy from a private physiotherapist, and was referred for an occupational therapy assessment by his Case Manager.
Occupational therapist intervention
The occupational therapy assessment covered every aspects of Simon’s life. Although returning to work was among his main goals, the assessment identified many areas which needed to be addressed before this became a realistic possibility. These included reduced concentration levels, fatigue, anxiety, disrupted sleep patterns and the cessation of all his previous leisure pursuits. He lacked any productive daily routine, and physical recovery from his injuries remained slow. Continued psychological trauma (including flashbacks) associated with the incident at work led him to avoid any activity requiring vigorous or sustained physical movement.
Following the provision of basic aids to everyday tasks - including a “helping hand”, trolley, bath-board and hand rails - the OT then began an activity-based, psychological programme with Simon. This explored the relationship between his inactivity and prior psychological trauma, and also his goal of returning to work.
With emotional support from his OT, Simon was able to establish habits of positive behaviour which broke his depressive cycle, building these into a structured, weekly programme of activities. With his improved mood and motivation, he began to re-engage with community activities which also boosted his physical recovery.
After a period working with the OT, learning to manage his anxiety through positive activities, Simon was finally able to realistically consider a return to work. In collaboration with his family, employer and physiotherapist, the OT established a phased return-to-work programme. Although he was unable to work on-site initially, he was able to secure an office-based position with a phased return to full-time work over a period of time. The OT was also able to provide support and advice to Simon’s employers to ensure his smooth transition back into work.
Future
By engaging in OT-based rehabilitation Simon now has a much improved quality of life, part of which has been his re-engagement with his professional vocation. At work, he still routinely uses coping strategies taught him by the OT, and his relationship with his partner has hugely improved in the meantime as his self-respect and confidence has continued to grow.
Simon remains motivated and continues to engage in his physical recovery programme. His long-term professional goal remains returning to the building-site - a goal which he finally has a realistic prospect of achieving.
