Over her 12 years with VNSNY, senior occupational therapist Gisele “Gigi” H. has come up with a ready answer for patients who say, “But the physical therapist was just here!” when she arrives at their front doors. Before getting down to business, she takes a few minutes to explain the difference between physical therapy (PT) and the occupational therapy (OT) that she provides. Physical therapists deal mainly with the legs, she’ll tell them, and their goal is to improve ambulation—walking and stair climbing. OTs, on the other hand, focus on helping patients with important everyday functions, which are typically centered on the upper body but can often involve the whole body as well.
Gigi didn’t need to spend much time explaining the difference to Pearl*, a woman in her early 60s who was recovering from a stroke that had affected her entire left side. “Her left arm was so weak she couldn’t even lift it, and her hand was locked in a fist and wouldn’t open,” says Gigi. Though Pearl was married, her husband had back issues and couldn’t help with much beyond bathroom tasks. In the initial session, Pearl cried because she felt so helpless and depressed. Once Gigi began focusing on specific goals with her, however, she lit up. Gigi designed a detailed treatment plan that spelled out the number of OT sessions she would conduct with Pearl over the next four weeks, what they were going to work on together, and what special devices or equipment (such as grab bars) might be required. She then submitted the plan to her interdisciplinary care team, which included Pearl’s doctor and her VNSNY nurse and PT.
Gigi’s two criteria for discharge were that Pearl be able to dress herself with just her strong arm, and be able to move from her power wheelchair to the toilet and to the tub, using a transfer bench. While helping Pearl relearn how to walk was primarily the focus of her PT, walking also requires upper body involvement, so the two therapists worked together to help Pearl achieve that goal as well.
Gigi grew up listening to her mother, a social worker, tell stories of her clients in the South Bronx. She always knew that she too wanted to work in a healing profession and “give back.” She was actually on another career track when the dean of the college she was attending told her that he thought she’d make a great occupational therapist. After completing her studies, Gigi deliberately chose to work in her home borough of the Bronx with folks like Pearl.
In sessions with her patients, Gigi starts by concentrating on activities of daily living (ADLs)—dressing, bathing, toileting tasks, grooming, and feeding. “I’ll ask, ‘How are you going to put your socks on? How are you going to take a shower or get in and out of bed?’” she says. She will also work with clients on tasks called instrumental activities of daily living (IADLs), such as cooking, shopping, getting the mail, and doing laundry.
One of the challenges in OT work is to help clients avoid getting discouraged, but this was never an issue with Pearl. The combination of her own fiery determination and the confidence that Gigi inspired motivated her to practice her exercises every day. By the time Gigi showed up for her third visit, Pearl was doing the prescribed movements by herself without being coached. She had gotten so good at them, in fact, that she could put on a blouse using just her right arm—putting her left arm in first and then maneuvering her way around with her left. She proudly showed Gigi how she could even handle a button-down blouse and a pullover!
Since then, Pearl has also graduated from her wheelchair and is now getting around with a walker. “She’s one of my star patients,” says Gigi, smiling. “She has what I call a good spirit. She likes to laugh and make jokes, and that helped her. She and her husband told me over and over how grateful they were to the physical therapist and me for everything we taught them. She did cry a few more times—but they were tears of joy.”
* The patient’s name has been changed for privacy.