Holistic OT: Evidence and Tips for Reimbursement

Holistic OT: Evidence and tips for reimbursement 

I was drawn to occupational therapy because it is a "holistic" profession. But, looking back I do not know what exactly holistic meant to me. Through school I remember encountering this concept, but didn’t have a firm grasp of how holistic techniques could influence my everyday practice. 

I’ve been witnessing a growing movement to more discretely define holistic occupational therapy as well as to collect and disseminate research backing these interventions. 

Emmy Vadnais, OTR/L is at the forefront of this charge. No matter where you stand on holistic care you should be paying attention, because it is going to continue to influence healthcare. I recommend you check out her site, subscribe to her mailing list, check out her courses and follow her on Facebook

Applying holistic OT to your pracitce

I caught up with Emmy recently to ask her some of the specific questions that I had about applying holistic OT. 

Sarah: In a SNF setting, what is one holistic approach that I could incorporate into my practice? What is the evidence for it?  

Emmy: Guided imagery is a great tool to use with all ages and any setting. It can be used in a skilled nursing facility to assist people lower stress, anxiety, pain, depression, access their inner wisdom, and bridge the communication between the mind, the body, and the spirit. It occurs in a relaxed, meditative state, and may also be referred to as creative visualization, mental imagery, therapeutic imagery, interactive guided imagery, guided meditation, active imagination, or intuition.  

Guided Imagery can be used to assist a person to participate in activities during a session, or it can be the full intervention for that session. It can assist a person to get into a relaxation response state that has many healing and preventative benefits, help get to the root of what is behind a particular challenge, and positively affect how DNA expresses health. Intuition or inner wisdom is a key component that can guide a person to creative insights, understandings, and awareness of solutions to the most burdensome of problems. Your clients can learn how to incorporate Guided Imagery to manage their stress, anxiety, pain, and emotional state to support functioning and be successful in all aspects of their daily lives.

Research shows that guided imagery can give a person a greater sense of control, increase self confidence, assist with fear, panic, anxiety, helplessness, uncertainty, trauma, loss, and grief, increase relaxation, decrease depression, decrease stress, decrease pain, decrease nausea, decrease blood pressure, prepare for medical procedures, decrease respiratory difficulties, decrease medication side effects, improve immune system, improve healing and recovery time, decrease hospital length of stay, enhance sleep, strengthen connection to spirituality, meaning, and purpose in life, improve functional outcomes, and improve quality of life. 

Sarah: In an acute care setting, what is one holistic approach that I could incorporate into my practice? What is the evidence for it?  

Emmy: Reflexology is a wonderful tool that can easily be incorporated into OT practice, because the feet and hands are often accessible. It is easy to provide in an acute setting or anywhere where the feet and hands may be accessed. If a person is lying in bed, it's easy to remove socks or shoes and provide reflexology even if they're connected to various tubes. 

Reflexology can help a person connect to their body, relax, lower pain, and align their energy to assist participation in ADLs or other therapeutic activity to be successful in reaching their goals. A definition of reflexology is that it is the physical act of applying pressure to the feet with specific thumb, finger, and hand techniques without the use of oil or lotion, based on a system of zones and areas that reflect an image of the body on the feet and hands, with a premise that such work affects a physical change in the body.

While receiving reflexology, your client may feel more cared for by you, and you may feel more calm. This may create a greater rapport and a healing relationship between you and your client. Empathy and compassion studies have found that if a person feels they are taken care of, they will have better health outcomes. In addition, simple reflexology techniques can be taught to caregivers and loved ones so they have tools for providing caring, therapeutic touch, and healing presence. 

Researched benefits of Reflexology include inducing the relaxation response, lowering stress, anxiety, cortisol levels, heart rate, and blood pressure, increasing lymph movement, improving the immune system and healing recovery time, lowering physical and emotional pain, improving range of motion, increasing circulation to body parts and organ systems, increasing respiration and oxygenation in the blood, improving neuropathy, plantar fasciitis, arthritis, joint mobility, edema, muscle tone, motor reflexes, depression, mood, emotional regulation, communication, social skills, insomnia, headaches, and nausea, decreasing use of medications, improving digestion, decreasing constipation, and improving reproduction, proprioception, and body awareness. 

Sarah: In school based pediatrics, what is one holistic approach that I could incorporate into my practice? What is the evidence for it?

Emmy: Yoga is wonderful to use in any setting and can be great for children. Yoga philosophy includes “asanas” or postures or poses, breathing techniques, and meditation which have wonderful restorative, healing, and preventative qualities. Yoga may improve children's mental and emotional functioning, cognitive development, assist with physical development, and stress management.  

Yoga can easily be adapted to the environment and the individual with the use of modification of poses or the person. It can be done sitting, standing, or lying down. B.K.S. Iyengar devoted his life to the study and practice of Yoga as it healed him from illness. From his experience he developed ways to adapt the postures so they can be done by anyone. 

Many children enjoy doing Yoga as it allows them to move their bodies in fun ways and it has many health benefits including allowing healthy ways to express and balance emotions, promotes a relaxation and brings students into the present moment (mindfulness) which can assist with focus, attention, memory, and listening skills for learning, encourages community and connectedness within the classroom, helps to create an atmosphere of confidence, enthusiasm and non-competitiveness where everyone can succeed, provides opportunities for beneficial motor breaks throughout the day, eases anxiety and tension, reduces impulsivity and reactivity, supports social and emotional learning, enhances organizational and communication skills, can assist with creativity, improves posture assisting students to sit comfortably, musculoskeletal strength, coordination, motor skills and balance, improves mind/body awareness and connection, improves confidence and self-esteem, encourages respect for oneself and others, and can create a calm and harmonious classroom.

Sarah: Could you give an example of reimbursable documentation?

Emmy: An example of reimbursable documentation is to assess stress, anxiety, pain, and/or emotional state prior to the Holistic intervention. Ask the client to rate their experience of one or more these states on a scale from 0 – 10, where 0 represents no problem and 10 is at its worst. Provide the therapeutic service and then ask the person where they rate their pain, stress, anxiety, and/or emotional state on a scale from 0 – 10. In my experience, 90%+ of the time the person will report a decrease on the scale which indicates there was benefit received. Document how scores and how the stress, anxiety, pain, and/or emotional state lowered and from what intervention. This may be enough documentation for the session or you could state how the person was then able to perform in activities due to the intervention. Be sure to relate the holistic intervention back to the treatment goals. An example of how to bill for Guided Imagery is to use treatment codes for Therapeutic Activity or ADL. Many forms of Holistic intervention can help improve a person’s functioning mentally, emotionally, physically, and spiritually and can greatly enhance OT practice.