Documenting Integrative Health in Occupational Therapy
Documentation is an essential component of occupational therapy (OT). Documentation allows the OT practitioner to monitor progress over time, create goals, and bill for services. Depending on an OT facility, integrative services may have the option to be billed to the insurance company by coding it as “neuromuscular re-education,” “Therapeutic exercise,” or “therapeutic activities.” (Thomas et al., 2021, p 4).
According to a survey many yoga or rehabilitation therapists included yoga under specific words or codes in the documentation.
Examples include: (*the words in bold are the most commonly used)
• Therapeutic exercise
• Therapeutic activities
• Neuromuscular control exercise
• Neuro re-education
• Patient or family education
• Dynamic balance or postural control
• Activity linked to functional tasks
• Description of the movement or pose (but not the name of the yoga pose).
• Use of or engagement in leisure activities
• Physical benefits of postures, education, and breathing
• Intervention for mental health symptoms
• As a coping mechanism used in mental health but also for people going through painful or stressful physical interventions after the stroke.
• Use of a physical intervention for weight bearing, balance, strengthening, gross motor control, etc.
• Core strength to increase the ability to transfer
• Stress management (Schmid & Van Puymbroeck, 2018).
The integrative health modalities approved by the American Occupational Therapy Association include:
Yoga: weight-bearing asana, self-range of motion asana, sequencing asana.
Tai Chi
Mindfulness: breathing exercises including alternate nostril breathing (connect both hemispheres) and equal belly breathing (creating balance within the body).
In occupational therapy, there are three key approaches to intervention planning:
Remedial: restoring a skill or ability that is impaired.
Compensatory: finding strategies or techniques that work around limitations.
Adaptation: modifying the setting or demands of a task to facilitate performance.
*It is important to note, occupational therapy goals are extremely client-centered and it is essential to create goals around function. These goals must be tailored to meet the individual needs of patients.
Examples of Goals for Stroke Rehabilitation Using Integrative Health Approaches:
Imaginary patient case study:
PMHx of right-sided Stroke presenting with functional deficits related to left-sided upper extremity hemiparesis, decreased sitting balance, and deficits related to memory and sequencing.
Neuromuscular Re-Education/ Therapeutic Activity Goal: To increase functional independence donning/doffing a shirt.
Integrative Health Modality: Weight-Bearing Asana (physical postures) including forward fold, Table Top, Quadruped, and Cat-Cow.
SMART Goal Example: “Patient will participate in four weight-bearing exercises, 2x daily for 4 weeks, to increase strength and control in affected upper extremity to increase functional independence in donning/doffing a shirt.”
Dynamic Sitting Balance Goal/ Functional Reach Goal: To increase balance and functional reach to increase functional independence and safety bathing and completing hygiene tasks.
Integrative Health Modality: Self-Range of Motion Asana (physical postures) including the Circle of Joy (Obtained from the website: Tumme).
SMART Goal Example: “Patient will engage in self-range of motion exercises, 2x daily for 4 weeks, to increase sitting balance and functional reach to improve safety and functional independence with bathing and hygiene tasks.”
Memory and Attention Goal: To increase cognitive skills including memory and attention and increase independence completing AM routine.
Integrative Health Modality: Sequencing Asana including a Seated Sun Salutation.
SMART Goal Example: “Patient will engage in sequencing exercise, and recall the sequence with no more than one verbal cue to improve cognitive skills relating to memory and attention in 2 weeks.”
Created by:
Julianne Madeline OTD, OTR/L, RYT-200
Additional references:
The American Journal of Occupational Therapy. (2023). Complementary health approaches and integrative health in occupational therapy. The American Journal of Occupational Therapy. 77(3). https://research.aota.org/ajot/article/77/Supplement%203/7713410200/25025/Complementary-Health-Approaches-and-Integrative
Schmid, A., Van Puymbroeck. (2019). Yoga therapy for stroke. A handbook for yoga therapists and healthcare professionals. Singing Dragon.
Schmid, A. A., Van Puymbroeck, M., Altenburger, P. A., Schalk, N. L., Dierks, T. A., Miller, K. K., Damush, T. M., Bravata, D. M., & Williams, L. S. (2012). Poststroke balance improves with yoga: a pilot study. Stroke, 43(9), 2402–2407. https://doi.org/10.1161/STROKEAHA.112.658211
Thomas, A., Kirschbaum, L., Crowe, B. M., Van Puymbroeck, M., & Schmid, A. A. (2021). The integration of yoga in physical therapy clinical practice. Complementary therapies in medicine, 59, 102712. https://doi.org/10.1016/j.ctim.2021.102712
Yang, I., Fahey, K. (2021). Adaptive Yoga: Designed for a variety of bodies and conditions. Human Kinetics.