Occupational therapy is about ‘looking at how someone can be included and participate in what matters to them'

When Christine Nesbitt won the gold medal for the 1,000 metre women’s speed skating, she purposely sought out a flag that had been signed by students.

Years ago, occupational therapist (OT) Shannon Harvey was working in a classroom, helping the students work on their printing. As part of the exercise, “Everyone got to sign a Canadian flag,” Harvey said. The flag was subsequently sent with Team Canada to the Vancouver 2010 Olympics.

Harvey said that when she saw the news coverage of Christine Nesbitt's gold medal win for the 1,000 metre women’s speed skating, and saw Nesbitt “holding this flag (that) had all these little kids’ signatures on it … it was really cool, because there were some kids on my caseload that were non-verbal, but in that one moment in time,

it was like their voices were being heard and they were cheering for Canada, and they were so proud.”

That’s the heart of occupational therapy.

“It's looking at how someone can be included and participate in what matters to them,”

Harvey said.

This board book is adapted to allow for easier page turns.

It’s almost impossible to count how many different ways that inclusion can happen, which was a big part of what drew Harvey to the profession in the first place.

“OT got my attention because of how dynamic the profession is, and that it’s a helping healthcare profession. You’re working in a very broad, broad realm,” she said. Harvey noted that her own graduating class is a testament to this; she ended up in pediatrics, but she has friends who are working in mental health, community roles, the emergency department of a level one trauma centre, etc.

Some occupational therapists will work with babies, while others have older patients.

 “There are so many roles for OT;

it's a profession that I thought I would never get bored of and could always find a challenge,” she said.

While Harvey has been working in the occupational therapy field for many years, she started working at Lansdowne Children's Centre in May 2024. She works in the organization’s two portfolios: CBRS (Community-Based Rehabilitation Services) and SBRS (School-Based Rehabilitation Services).

Harvey noted that within occupational therapy, “The profession recently rewrote its practice guidelines. So, it's an exciting time for OT. Where historically, OT would be focused on self-care (which could encompass things like bathing and getting dressed), productivity (helping an individual with their participation in education, volunteering or employment), or participating in leisure occupations, now, instead of working directly with clients, OTs are reaching out at system and population levels. You can see OTs within SBRS and CBRS, advocating for change and accessibility needs.”

The tiered model of occupational therapy service is being rolled out in schools across Ontario.

“As part of that service, teachers from Kindergarten through Grade 2 classes can sign up for tier one universal strategy education sessions in their classroom, so the teachers can learn new tips and tricks to support their students with everything from pencil grasp to printing, dressing, and even just having appropriate body breaks in the class,” Harvey explained.

In the past, a child would have to be referred for occupational therapy, and they would be removed from the classroom environment to work on a skill. Now, an occupational therapist (and possibly occupational therapy assistants) will come to a classroom and share universal strategies with the teacher and students at the same time, as well as giving the teacher further instruction as to some of the fine motor and printing strategies that could be integrated into the existing curriculum.  There is a greater focus on meeting students’ needs within the classroom.

This approach has several benefits. Not only does it mean that the classroom will have

“universal strategies that all children could benefit from,”

but also, by coming to the classroom and working with all the students in their familiar environment, it’s easier for the occupational therapist in supporting the teacher to identify which students might need some additional support in a smaller group or one-on-one.

Sometimes, an occupational therapist needs to adapt the individual components required to do a task – so that the task still gets done, but maybe not in the same way by everyone.

For an example, Harvey spoke about rowing, drawing on her experience with the Canadian Paralympic Committee, which included serving as the occupational therapist and coach with the National Para Rowing team, including for the 2008 Paralympic Games in Beijing.

Shannon Harvey has served as the occupational therapist and coach with Canada’s National Para Rowing team, including for the 2008 Paralympic Games in Beijing.

“Most people would assume that (when rowing) the athletes use their legs to push and then use their strong core, and pull the oar with their arms to move the boat,” she said.

But in fact, “A rower would use every muscle they have available to move the boat as fast as they can,” she said.

Since some of the athletes she was coaching had spinal cord injuries, the muscles available to them were those in their arms and shoulders, which meant part of Harvey’s job was helping the athletes utilize those muscles optimally as well as working with the athlete and other support staff to ensure that their seating, boat and oars were customized to help them to perform at their best.

“It’s looking at changing the definition of how something is defined and how someone can be included,”

she said.

The most important thing, though, is to make sure that the goals being worked towards are ones that matter to the client.

“If there's no buy-in, you're not getting anywhere,” Harvey said. “That’s where occupational therapists will always start; we want to know, what is important to the child? What do they want? What is tricky? And how could we help?

It’s not an OT telling anyone what to do; it’s a collaboration with the child and their family to come up with a plan to support their participation in what is meaningful to them.”

Once a goal is determined and the plan is in place, “It can be really exciting to work with families and their children to help them meet their goals, whatever they may be,” Harvey said.

Sometimes that means changing how a person is moving so that they can participate, but other times, it’s about changing the equipment, the environment, etc.

Occupational therapists will use a variety of tools, including splints and restraints, to help their patients.

The tools of adaption and accommodation can vary widely, and might fall anywhere on a spectrum between high and low tech.

Harvey shared that she’s been able to create a functional adaptation for a client by cutting up a pool noodle.

Finding bespoke solutions is par for the course for occupational therapists, Harvey said.

“I find that OTs are a very creative bunch that are good at problem solving.”