Occupational Therapy in Pokhara: Regaining Independence After Illness or Injury

Occupational therapy (OT) is the health profession concerned with enabling people to perform the activities that matter to them — daily self-care, work, and participation in family and community life. It is distinct from physiotherapy, which focuses primarily on movement and physical function. The occupational therapist’s lens is the activity: can this person dress themselves, cook a meal, manage their finances, return to their work? If not, what is limiting them, and what can be done about it?

How Is Occupational Therapy Different From Physiotherapy?

Physiotherapy and occupational therapy are complementary and often overlap, but they approach the same patient from different directions. The physiotherapist asks: what is wrong with this person’s movement and how do we improve it? The occupational therapist asks: what activities can this person not do, why not, and how do we get them doing those activities again?

For a stroke patient, the physiotherapist focuses on mobility, balance, and motor recovery. The occupational therapist focuses on whether the person can dress, bathe, use cutlery, write, manage their medication, and navigate their home safely. Both perspectives are essential; neither replaces the other.

OT also has a specific expertise in upper limb and hand function that goes beyond what standard physiotherapy encompasses — including fine motor retraining, splint fabrication, tendon rehabilitation, and sensory re-education.

What Conditions Require Occupational Therapy?

Stroke is the most common condition driving OT referrals at A&B. After stroke, patients may have difficulty with all self-care tasks due to hemiplegia, spasticity, perceptual problems, or cognitive impairment. OT systematically addresses each limitation, using a combination of retraining the impaired function and adapting the task using compensatory strategies or assistive equipment.

Traumatic brain injury (TBI) — from road traffic accidents, falls from height, or blast injuries in veterans — produces complex combinations of physical, cognitive, and behavioural deficits. OT addresses cognitive rehabilitation (attention, memory, executive function), functional independence, and return to work or school.

Hand injuries — tendon lacerations, crush injuries, fractures, and replantation cases — require specialised hand therapy. The hand is an extraordinarily complex structure, and hand therapy is a specialist area within OT combining splinting, scar management, range-of-motion exercises, tendon gliding protocols, and sensory re-education.

Arthritis — both rheumatoid and osteoarthritis — benefits from OT through joint protection education, adaptive equipment (jar openers, angled cutlery, key turners) that reduces joint stress, and hand exercises tailored to the patient’s specific limitations.

Children with developmental delay, cerebral palsy, and autism spectrum disorder receive OT to address participation in daily activities — dressing, feeding, writing, and play — and to develop the sensory processing and fine motor skills these activities require.

What Does an OT Assessment Involve?

The OT assessment begins with understanding what the patient identifies as most important to them — which activities they want to return to and are currently unable to perform. This is formalised using tools such as the COPM (Canadian Occupational Performance Measure), which scores both performance and satisfaction on self-identified priority activities.

The assessment then examines the component skills that these activities require: upper limb strength and coordination, fine motor function, cognitive function (attention, memory, problem-solving, sequencing), perceptual skills (spatial awareness, body perception), and sensory function.

For patients who have had stroke or TBI, cognitive assessment tools — including standardised tests of attention, memory, and executive function — are used to characterise the cognitive profile, because cognitive limitations often have more impact on daily function than physical ones.

The assessment concludes with a goal-setting conversation, establishing realistic, time-bound, meaningful goals for therapy.

What Adaptive Equipment Does OT Prescribe?

Adaptive equipment reduces the demand on impaired systems so that the person can still perform the activity. Examples include: long-handled dressing aids for patients who cannot bend to reach their feet; non-slip mats for bathing; raised toilet seats and grab rails for patients with hip or knee problems; angled cutlery for patients with tremor or limited wrist movement; rocker knives for patients with one functional hand.

For communication, tablets and communication apps benefit patients with aphasia or limited hand function. For writing, pencil grips and modified pens assist patients with fine motor limitations.

Prescription of equipment is based on individual assessment — the same piece of equipment may be appropriate for one patient and counterproductive for another. The OT selects equipment based on what the assessment shows and trains the patient and family in its correct use.

What Are Home Modification Recommendations in Nepali Homes?

Home visits are an essential OT service for patients with significant disability, enabling the therapist to assess the actual home environment and recommend practical modifications. In a typical Nepali home, common issues include: uneven outdoor surfaces creating fall risk, high door thresholds, absence of handrails on stairs, toilet style (low floor-level toilets are extremely difficult for people with knee or hip problems or weakness), and narrow doorways incompatible with wheelchairs.

Low-cost modifications with high impact include: grab bars beside the toilet and in the shower, non-slip bathroom mats, rearranging the bedroom to give the hemiplegic side space, removing loose rugs that cause tripping, and if stairs cannot be safely managed, a ground-floor room for sleeping.

What Is Hand Therapy and Why Is It Specialised?

The hand contains 27 bones, 29 joints, over 30 muscles (intrinsic and extrinsic), and a complex tendon system where a millimetre of scar tissue can eliminate function. Tendon rehabilitation after surgical repair follows strict protocol-based rehabilitation — moving the tendon through specific ranges at specific times post-operatively to prevent adhesion formation without disrupting the repair.

Custom thermoplastic splints — moulded to the individual patient’s hand in the OT department — protect healing structures, position joints correctly, and in the case of dynamic splints, apply gentle sustained force to improve range of motion.

Scar management after hand injury involves silicone gel sheets, compression, and massage to reduce hypertrophic scarring that restricts tendon gliding.

Sensory re-education is used after nerve injury to the hand, using graded textural and temperature stimuli to retrain the brain’s representation of the hand after peripheral nerve repair.

A&B International Hospital

Pokhara-02, Bindhyaabasini Way to Sarangkot

Phone: +977 061-412512

Website: abinthospital.com

For stroke recovery, hand injuries, TBI, arthritis, or children with developmental delay in Pokhara, A&B International Hospital’s occupational therapy team provides personalised assessment and goal-centred rehabilitation. ECHS polycards accepted for eligible veterans and their families.