Occupational therapy

Occupational therapy is a therapeutic service. It seeks to enable people with health impairments to manage their life independently and to participate in society. OT therefore aims to help people improve or regain impaired bodily functions, independence, and quality of life in general. The things that people do enable participation and quality of life. Participation is unique to the individual and may differ considerably from one person to the next. OT seeks, in particular, to provide support with daily tasks such as dressing, eating, and household chores. The therapy may include, for example, training in specific daily activities, the use of medical aids, or working on sensory input. Occupational therapy may also involve promoting cooperation and communication.

Occupational therapy can be used for various health impairments and conditions. The basic premise and starting point for all OT, regardless of the patient’s diagnosis, is the activities they want to perform on a daily basis but are no longer able to.

OT is used, for example, in cases where illness or injury causes the functioning of the muscles, joints, or nerves to be restricted. This can, for example, limit a person’s movement, perception, or cognitive functions, and impact daily activities. OT can help people to live their lives with greater independence and self-determination.

It can also be beneficial for people with mental illnesses. Anxiety disorders, obsessive-compulsive disorders, depression, behavioral disorders, and addictions can negatively impact a person’s quality of life and make living day to day more difficult. Occupational therapy can, for example, help people to manage their illness and deal more effectively with acute crises if they arise.

In older people, OT can be used to help individuals cope better with the physical or cognitive limitations that come with aging and to stay mobile. In this case, relatives are usually also involved in the therapy.

Occupational therapy can support a child’s psychological and physical development as well as their functional competence. For example, it can promote gross motor skills, fine motor skills, and the development of social competence in individuals with developmental disorders. As a result, they should be able to take part in school and playtime activities. In some cases, childhood illnesses or injuries can have health impacts years later. These late effects can be prevented by occupational therapy.

Being able to resume working roles is a common objective for adults attending OT. They benefit from being able to practice work-related tasks or from working with occupational therapists employed directly as job coaches in their workplace. One OT approach used in this case is to assess and improve the person’s work environment.

The methods available are as diverse as the areas in which OT is used. The methods used depend not only on the patient’s health impairments, but also on the tasks and activities that they want to maintain, improve, or (re)learn. For example, if someone wants to be able to dress themselves or open water bottles independently again, the occupational therapist will use suitable exercises, aids, or other approaches to facilitate this. Occupational therapy always begins by looking at the activities that the person wants or needs to perform on a daily basis but is no longer able to.

Motor functional therapy, for example, serves to relieve pain and enable the movements needed on a daily basis. If mobility is restricted, the patient can do exercises such as putting on a sock using a medical aid, practice getting about safely on a daily basis with or without a walking aid, or learn to prepare meals independently.

Sensory motor perceptive treatment focuses on the senses or sensory awareness. For example, the patient may practice climbing stairs safely or work to improve manual dexterity. If a patient has impairments that impact daily tasks, they can learn how to compensate for these so that they can, for example, manage household chores unassisted or return to working life.    

Psycho-functional treatment may, for example, involve the therapist helping the patient develop a useful daily routine and supporting them in its implementation. The goal of this type of treatment is to improve social, emotion, and psychological competence in general.

Brain performance training can be used, for example, to improve perception, memory, and concentration. Training programs on a computer may be used for this purpose. In addition, daily strategies can be developed and external aids chosen. Brain performance training seeks, for example, to help patients plan activities and solve problems as effectively as they once did. The ultimate goal, as with all occupational therapy, is to enable patients to lead a self-determined life.

An individual can receive occupational therapy if it is prescribed by a doctor or medical psychotherapist. In this case, the costs are covered by the person’s health insurance provider.

Occupational therapy starts with an introductory meeting at which the patient and therapist get to know one another. This meeting and further tests help the therapist to determine which problems the patient is encountering in daily life. The needs and concerns of the patient are of central importance when designing a course of occupational therapy for them. The therapist will therefore put together an initial set of objectives based on these. The patient is also involved in deciding which methods are to be used to achieve their objectives.

The frequency and duration of the therapy depends on the severity of the patient’s impairments and on the prescription. One therapy session usually lasts between 30 and 60 minutes. 

Over the course of the therapy, the current situation and the progress that has been made are reflected upon and documented at regular intervals, and the treatment adapted if necessary. Documentation helps keep track of goal achievement and outstanding therapy objectives.

Where does occupational therapy take place?

Occupational therapy can take place in any healthcare setting, and is most commonly provided at an inpatient facility or at an occupational therapy practice. Inpatient facilities include hospitals, day hospitals, rehab centers, and nursing homes, for example.

OT practices may facilitate home visits. The advantage offered by home visits is that they allow therapists to work with patients who are unable to attend the practice for health reasons. They also give the therapist insight into the patient’s home and daily environment. This simplifies the process of planning specific adjustments to make everyday life easier. In addition, the patient’s home and patient’s daily environment provide a more realistic setting than the practice in which to work on daily tasks.

Occupational therapy is one of the services offered at inpatient healthcare facilities. In this case, there are no additional costs for patients.
Occupational therapy provided on an outpatient basis must be prescribed in order for statutory health insurance funds to cover the costs. The therapeutic services directive (“Heilmittel-Richtlinie”) issued by the Joint Federal Committee (Gemeinsamer Bundesausschuss, G-BA) specifies the precise costs that are covered. 

However, those with statutory health insurance are required to contribute co-payments towards the costs. For occupational therapy, a co-payment of 10 percent of the costs must be contributed. There is also a charge of 10 euros per prescription. Children and adolescents under the age of 18 are exempt from co-payments for occupational therapy.

Co-payments are not required for occupational therapy that is covered by statutory accident insurance.

Different rules apply to people with private health insurance. The level of cover specified in your individual insurance policy determines whether and what proportion of OT costs are covered by your private health insurance provider. 

For more information about the specific conditions that apply to the prescription of occupational therapy, see our article about therapeutic services.

Finding a suitable occupational therapist is something you need to do for yourself. Your family doctor or hospital staff when you are being discharged may be able to help you find a therapist located near where you live.

An overview of occupational therapy practices operated by members of the German Occupational Therapy Association (“Deutscher Verband Ergotherapie”, DVE) is provided on the DVE website.

The National Association of Statutory Health Insurance Funds (“GKV-Spitzenverband”) also offers an overview of OT practices in its list of therapeutic service providers.