Occupational Therapy: Reawakening Movement, Restoring Daily Life
Think about what you did this morning. Made coffee. Brushed your teeth. Got dressed. Drove to work. When illness or injury takes away the ability to do those things, occupational therapy is the discipline that helps people find their way back—or find a new way through.
“‘Occupation’ in the OT sense is anything that occupies your time,” explains Andrea Sullivan-Lassner, OT/L, Clinical Manager for Occupational Therapy, Outpatient Services, at Burke Rehabilitation®. “Whether it’s getting up and brushing your teeth and making your coffee, returning to work after a traumatic injury, or doing things a little differently while recovering from an injury, we’re going to teach you how to get that task done.”
At Burke, OT spans inpatient and outpatient care and includes restoring arm and hand function after stroke, brain injury, spinal cord injury, or orthopedic injury; addressing the cognitive effects of neurological conditions and helping patients, including those going through chemotherapy, organize their day and work on memory; and treating the vision deficits associated with conditions such as stroke.
April is Occupational Therapy Month, an opportunity to look at a fast-evolving field that touches every phase of the physical rehabilitation journey. “Our knowledge area is very vast,” Andrea says of occupational therapists. “We need to be prepared for any number of life conditions patients face.”
From Crafts to Cutting Edge
Occupational therapy has roots in early 20th-century medicine, when engaging patients in hands-on activities—crafts among them—supported recovery in psychiatric and rehabilitation settings. Science has advanced well beyond those origins, and Andrea describes a field that is evolving quickly to capitalize on what research reveals about how the brain and spinal cord actually work.
As scientists have mapped the neural pathways that govern movement—and identified ways to stimulate dormant or damaged ones—occupational therapy has developed tools that work with those pathways directly. Augmenting patients’ exercising a weakened limb, these technologies help reconnect the brain or spine to the muscles that have gone dormant, reactivating the signals that drive movement and reinforcing them through repetition. The result is recovery that wasn’t possible even a decade ago, particularly for patients with chronic conditions where the window for improvement had seemed to close.
For stroke survivors, the arm’s complexity of small muscles and fine motor demands can leave it impaired for years. At Burke, the OT team has spent a few years working with Vivistim, an FDA-approved implantable vagus nerve stimulator. A small device is placed just beneath the skin below the collarbone, with a lead that wraps around the vagus nerve—a pathway originally associated with epilepsy treatment, and found to have a meaningful effect on motor recovery after stroke. When a patient works through high repetitions of a functional task (turning a jar lid, reaching for an object, typing simulated cooking tasks), a therapist uses a handheld device to pair vagus nerve stimulation at precisely the moment a movement is performed, briefly firing a signal that reinforces the brain-to-muscle connection.
The results have been striking. One patient opened a car door with his previously immobile right arm after seven years without movement in that limb. Another regained enough hand control to cook and stir his oatmeal. A third returned to fishing. “You could have had a stroke eight years ago,” Sullivan says, “and all of a sudden you’re starting to move your hand in ways that you haven’t moved it for eight years.”
The RT Xcite, a multi-channel electrical stimulation device, takes a related approach, although without an implant. Electrode pads placed along the arm initiate movement in the shoulder, elbow, wrist and hand. When a patient begins to feel and see movement—say, their hand opening—they use that feedback to continue the movement on their own, Stimulation and volition work together to recreate the motor pathway, lighting up the signal in the brain responsible for that movement
For patients with a spinal cord injury, Burke recently introduced ARC-EX, an FDA-approved non-invasive spinal cord stimulator device that delivers electrical impulses over the dormant nerve pathways in the injured spine. The company describes the device as a “hearing aid for the spine.” Individuals with cervical levels of injury have demonstrated improved hand sensation and strength using the device in conjunction with skilled therapy says Andrea.
The Clinician Behind the Technology
Technology, Andrea is quick to point out, is only part of the equation. “These technologies work with skilled clinicians to fast-track whatever we can get from the spine, the brain, or the muscle,” says Andrea, who has been an OT for more than 25 years. “It just helps connect everything again.”
That expertise includes something that’s always been fundamental to OT: analyzing how the body moves and strategizing around what isn't working. When a patient raises their arm and the shoulder hikes toward the ear instead of staying stable, a trained OT sees it, names it, and adjusts—perhaps moving to a side-lying position to remove gravity from the equation while the right muscles build strength.
OT is often thought of alongside physical therapy; at Burke, the two, together with speech, language and swallowing therapy, form an integrated team-approach to physical rehabilitation. Andrea explains how closely the teams work together. When PT achieves a milestone—a patient standing independently, for instance—OT might incorporate standing during upper-body work or functional tasks. Similarly, if in OT a patient is able to move their hand to their mouth for the first time, for example, PT reinforces the movement in their sessions.
Occupational therapy itself has grown in reach and possibility — more people, in more places, with more pathways to improvement than existed even a decade ago. At Burke, that expansion is tangible. When Andrea arrived at the main outpatient campus in 2013, she had one full-time colleague and one other outpatient clinic. Today, 20 occupational therapists work across eight outpatient sites in Westchester, the Bronx and surrounding communities.
The growth tracks a shift in healthcare broadly: the length of inpatient stays has decreased sharply, and patients arrive as outpatients faster and at higher clinical complexity than they once did. Burke's OT programs now include certified hand therapy, driving evaluations for community members facing or recovering from impairment (close to 400 assessments across four sites), a new program to help people with low vision live safely and independently, and a clinic to help new wheelchair users with seating and positioning.
“People trust that Burke is there for them throughout their lifetime,” Andrea says. “Whether it’s getting them back to dressing themselves, back work, back to driving—or sometimes saying it’s time to stop driving. Whatever it might be, they know we’re here for them.”
