Q&A: Physical Dysfunction with Distinguished Senior Lecturer Janet Brooks

By: Maisie O'Brien

1. What is “physical dysfunction?”

Physical dysfunction is a temporary or permanent physical problem that limits a person's ability to perform physical activities. Occupational therapists that work in the area of physical dysfunction, like all OTs, are interested in maximizing a person's ability to participate in their life. Using conceptual models to guide their practice, OTs work one-on-one with clients to determine what roles they want to perform and what activities make up that role. Then, the OT evaluates whether the client has the physical, cognitive, visual, perceptual, and sensory skills to engage in those activities.

There are two basic routes an OT can take to support a client. First, an OT can try to maximize the client’s ability to participate in a given activity, supporting their physical, cognitive, and perceptual skills. If these skills cannot be improved upon, the OT would go the second route, which involves decreasing the complexity or the physical, cognitive, and perceptual demands of the activity. In the first route, the client gets better physically or cognitively. In the second route, the client may or may not get better, but the OT is going to make the task more accessible given the client’s current level of functioning.

Here is a straightforward example demonstrating the two routes: picture an OT trying to help a client use a shower. If an OT can teach the client how to get in and out of a shower safely, then the client can perform this activity in lots of different settings. The first route works. But if the client cannot develop the strength, balance, and range of motion required to use the shower, then the OT would opt for the second route. They may help the client install a shower chair, so the client can sit to take a shower. Now this is more cumbersome because the client can't rely on having a suitable shower chair in every bathroom they visit. OTs generally try to maximize restraint-free performance, then provide adaptations as necessary.

2. Describe your work treating physical dysfunction as an occupational therapist.

After I finished occupational therapy school, I joined a private practice that focused on treating clients experiencing physical dysfunction. We worked in a variety of settings, including acute hospitals, outpatient rehabilitation centers, skilled nursing facilities, and home care. It was so rewarding to see clients move from being acutely ill in a hospital to being home and regaining their strength. I loved seeing clients’ abilities change over time, and being a part of that process. Today, my work in physical dysfunction is primarily in the area of adaptive sports. I specialize in teaching adaptive skiing in the winter, and paddleboard, kayaking, pickleball, golf, and cycling in the summer.

3. What are some challenges that practitioners specializing in physical dysfunction face today?

One significant challenge in the United States is that bodies and physiology sometimes require more time for healing than insurance companies are willing to pay for. Access to good quality health care and therapeutic intervention is highly varied. Due to these limitations, occupational therapists have to figure out how to empower clients to take charge of their rehabilitation process.

Although it's always been up to the client to continue their exercises and home program between sessions with OTs, the time between sessions has increased. Lengths of stay in acute hospitals, rehabilitation hospitals, and skilled nursing facilities have also been reduced. Sometimes this can work well. It allows the client to return to their home environment and function in a comfortable, familiar setting. However, unless the client has a lot of social support, it can be hard for them to access continued care and attend to their physical improvement.

4. What is innovative in the area of physical dysfunction?

Technology is becoming a larger part of the rehabilitation process. Wearable devices, supportive devices, and technology-based modifications are becoming more effective and widespread. Although my focus at Tufts is helping students understand the body in order to support clients’ physical recovery, sometimes we can only take clients so far. Technology like prosthetics and mobility devices can really step in and enhance a client’s physical functioning and quality of life.

Another positive change is that there is increased visibility, acceptance, and community for people with atypical bodies. A great example of this is last summer’s Paralympics, which was broadcast on television right after the Olympics. It was wonderful to see these athletes being given representation, respect, and endorsement opportunities in a mainstream forum. Seeing people with atypical bodies maximizing their participation in activities they love is empowering to others with atypical bodies. There is so much meaning and purpose to the Paralympic Games.