I recently sat down with Occupational Therapist, Arvinder Gaya, to learn about the role an OT has in helping injury victims following a serious injury or accident. The full episode can be seen on our YouTube channel or on the Podcast.
Read the Interview Below:
Andrew: Today we're joined by my guest Arvinder Gaya. She's an occupational therapist, and we're gonna talk about the role of an occupational therapist after an injury or accident.
Hi, I'm Andrew Iacobelli. I'm a personal injury lawyer with Iacobelli Law Firm, and on this show we talk about your rights if you've been injured, so you can make informed decisions for your future. Thanks for joining us, Arvinder.
Arvinder: Thank you for having me Andrew.
[00:00:28] Introduction to Arvinder Gaya and Personal Injury Occupation Therapy
Andrew: Can you tell us a little bit about yourself?
Arvinder: I've been an occupational therapist for almost 30 years now. I've owned my own occupational therapy company called Personal Injury Occupational Therapy for the last 10 years. We have about 20 OTs that work for us all over Ontario, and we've been working primarily with people who are injured in motor vehicle accidents over the last 10 years.
[00:00:51] What is an occupational therapist?
Andrew: So I think a lot of people watching this are probably wondering, because even me at one point, I didn't know what an occupational therapist was?
Arvinder: This is a common question that we get actually, and to be honest actually more people know what an OT is now than it did when I first graduated.
But when we think of occupational therapy, the word occupation, we wanna look at it from a broad sense. So occupation means what you. So the occupations that we do can include things like our work. It can include the day-to-day tasks that we do, like even something as simple as getting dressed and eating. It could be our leisure activities. So it has to do with any activities or tasks that we do in the roles that we play in our lives.
Occupational therapy is a profession that looks at when a person has an injury or illness that interrupts their ability to do their occupations. We would be looking at what is the, the issue or the barrier that's interrupting their ability to participate in those occupations and how can we get them back to doing those things again.
[00:01:58] How does an occupational therapist help with treatment after a personal injury?
Andrew: Is it treatment, or what does an occupational therapist do then?
Arvinder: Usually when we first meet a client we would do an assessment. So the first thing is to really determine, okay, what is the. Illness or injury that the person has and how it is interrupting their life, their occupations. And then we, we try to determine, we break the activity down in our minds because we, this is what we're trained to do. Is it due to psychological issues that they're having problems in the activity? Is it due to cognitive issues? Is it due to a physical impairment? And then from there, it helps us to determine how we need to treat the client to be able to get them back to doing those things.
After assessment, we usually will ask the client to rate how important all these different activities are in their life so that they can pick a few main goals where we can start working. But we're always looking at the parameters of their self-care, their work and it could be productive or volunteer work and leisure activities. So we make sure in our assessments that we address all of them, their activities in their life and how their illness has affected them.
What we would do in terms of treatment is based on what the issue is and what the activity is being affected. So for example, if the activity is you know, the person is not able to now get dressed because they have paralysis on one side, we will work in the realm of helping them to learn skills to be able to do that task. And if you're now trying to do this task with one hand, you're gonna have to do it differently.
Andrew: I see.
Arvinder: And then we would also work with the environment to say, okay, how is the environment supporting their ability to do this or impairing their ability to do this? So it could be, you know, now because of their paralysis, they have to be able to sit and they need a comfortable seat to be able to sit on that allows them to be able to do this, to make sure that they have those supports in the environment so that they can safely do the task with a modified method that we might teach. So we're always looking at the person, environment, fit.
[00:04:02] Who would need an occupational therapist?
Andrew: Who would need an occupational therapist or who would, who would you suggest get an occupational therapist involved in their care?
Arvinder: I mean, in the accident benefit cases specifically, or, or in the MVA cases, I would suggest that most people will need an occupational therapist if their injuries look like they're going to persist.
So, for example, if it's somebody. You know, has a fracture and now they've gone to an orthopedic surgeon, they had to have surgery, and they have a cast and the, and the prediction is they're gonna walk in six weeks. They may need an occupational therapist at the beginning to say, okay, well you can't put weight on that, so you might need a wheelchair. How are you gonna get around the house? How are you gonna get up and down the stairs to figure out those things? But they may not need an OT for the long term, so it may just be until they're back to walking again.
In other cases where we have a client with a brain injury, for example, you know, they've had significant injury in their brain and that's impacting their ability to remember, it's impacting their ability to concentrate, to be able to do all the tasks that they were doing before because they can't think the way they thought before. Now we're working with these clients in a long term basis and step by step. So at the beginning, it would really be just trying to make sure that they underst. What the issues were and what they should expect in terms of recovery.
We always start with their daily function first. So how are they gonna have a shower? How are they going to. You know, do their basic tasks. And it could be, again, we're always thinking, can we do something to get this person to be able to do it? So can, are there skills we can teach and how do we need to modify the environment so that we bring it again together to that person, environment, fit.
And so for someone like that, it may be that initially because they're so impaired and it's gonna take a while for that initial healing to happen, and they may have balance issues or things like that. We may just wanna bring in an assistant. So that's an environmental modification where we have a personal support worker. With memory, it could be that initially we're going to start to look at, okay, we know memory's impacting a lot of their things that they used to do before. Can we, would this person be able to learn? Like so we can tell that from the beginning, depending on where they are in their recovery and how they're taking, even the education that we're giving them, do they remember it the next time.
So we'll try to always improve, help the client to recover and also modify the environment and the, and the more we do that together, the quicker the client's able to participate. So our end goal is always participation. It involves the whole system, so we're not just looking at the client, we're looking at their home environment. How does everybody else interact with the client? What is their understanding about the client's illness and how can they support the person? So we're working with everyone in their environment as well.
[00:06:53] What are examples of achievable goals in occupational therapy?
Andrew: It sounds like it's a lot of goals like, like part of the treatment is setting goals and then the occupational therapist kind of takes a lead on, okay, what do we have to put in place to help this person achieve
Andrew: Achieve this goal? And is the goal. A goal specific for the, for the individual?
Arvinder: Absolutely. Okay. So initially when we do our assessment, we will outline, okay, this is where we see the issues are. So for example.
Arvinder: A goal would be to be able to safely walk using their walker in their home to be able to get to the washroom in their bedroom. We'll get a walker in place. We need to teach them how to safely walk, walk with it. We need to teach, teach 'em simple things like making sure they put the brake on before they sit on the seat of the walker. And if someone's really impaired, that could be something that requires a lot of queuing and repetition to teach.
Andrew: Okay, okay.
Arvinder: To make sure they're safe. So that's like a simple goal and we really have to do it step by step. Cuz as you can appreciate when someone's first injured, you know, there, there's acute injuries and those typically will resolve over time. And as they get better, they may get better at some things, but then, then we start to move on to more bigger issues like returning to work or like you know, getting back to parenting their children once they're past that acute stage and they're able to now walk and get up and participate in those activities.
[00:08:14] What should you consider when selecting an occupational therapist?
Andrew: What are some things that an individual or their family should look for in selecting an occupational therapist?
Arvinder: I think they should be asking, the number one question is if the occupational therapist has worked, here in Ontario, we work within the SABS and the treatment that we provide is within that litigation. So there's certain procedures and rules and forms and reports structure that we do just because we understand how the insurance company works and what's required to help a person in their case as well as their recovery.
If a person doesn't have that experience, that even though they may be a good occupational therapist, they may not be able to put it on paper the way that it's required in order for the lawyer and the insurer to understand what's happening with that person and what their needs are and for the person to be able to get the funding that they require.
[00:09:06] How do I get my personal injury treatment paid for by my insurance company or accident benefits?
Andrew: Okay. That's important. Yeah. So maybe some people watching are probably asking, why is that important? How do I pay for an occupational therapist is really what it comes down to, right?
Arvinder: If you've had a motor vehicle accident and you've got an active case, occupational therapy should be covered within your accident benefits as other treatment providers as well, as long as the adjuster approves it.
For example, if somebody asks us to see a client, a lawyer may say, you know what? I have this client and I think they need an occupational therapist, and we'll get involved. The first thing we do is we will do an interview with the person over the phone or if they're not able to meet with us, like a caregiver or their POA, to determine what their issues are and what their limitations are so we can determine what we need to do. And from that we fill out a specific form that's an insurance form. That's called an OCF 18. We fill that out and on there it's a request for funding. So it outlines why this client needs occupational therapy and what we're gonna be doing. And usually the first thing we do is an assessment and then how much it's gonna cost. And that goes to the insurance adjuster now, and then the insurance adjuster evaluates and decides. Based on the case and what they know about the case, if they're gonna approve it and deny it.
That process usually takes two business weeks, by the time it's submitted to when it gets approved. Once it's approved, then we're able to go in and work with a client.
[00:10:34] Is occupational therapy done in your home?
Andrew: And the treatment from an occupational therapist typically in their home?
Andrew: Or in their own environment?
Arvinder: Yes. Most of the time the treatment would be in their home. And that's because again, we're working on their occupation. So their activities that they do, and a lot of the things they would initially be doing are mostly in their home. Once they're, you know, able to start engaging in the community, doing things like going grocery shopping or going to the bank. I mean, now a lot of people do online banking, but...
Arvinder: Things that they need to do in the community, then treatment will end up being in those environments. It may also be in the workplace. So if we're looking at somebody transitioning back to work, oftentimes the occupational therapist will work with the client and the employer if they have a job to go back to and look at doing assessments in the workplace to understand what's required from that job, and to also determine if this person's gonna be able to meet the requirements of the job based on their limitations and strengths. So it could be in any environment that the person participates in.
[00:11:33] How often do you need to see an occupational therapist?
Andrew: If someone's wondering, now they're gonna get an occupational therapist. They're wondering, okay, how often will I see the OT?
Arvinder: When it's a brand new accident, we'll typically see the person once a week to start, because there's usually a lot of things to put in place at the beginning. And that could be equipment, that could be like other services that we need to put in place. Because a lot of the time the occupational therapist is the first person on the case, working with that client and our assessment, it covers the whole person. And because it does, we're able to identify issues in all areas, which could be physical, cognitive, communication issues, mental health issues.
We're able to see where treatment is required. From our initial assessment, we typically will make referrals out to other service providers that we think are required to help this client.
Andrew: So usually it's the, the occupational therapist will have a role in identifying some other, yes, resources.
Arvinder: Yeah. And sometimes, you know, like if the client has a preference, like say they've already worked with a certain physio and they really like working with that physio right. Then, you know, there's no reason why we can't bring that physiotherapist on the team.
Arvinder: As long as we know they understand the process and are able to work with the insurance process as well.
[00:12:49] Seeing an occupational therapist after being discharged from the hospital
Andrew: Okay. And let's talk a little bit about the situation. I think it's another common situation with OTs, but people probably don't know. Where someone is admitted in the hospital.
Andrew: And they're getting ready to be discharged.
Andrew: So let's share with us a little bit about the role of the occupational therapist in that.
Arvinder: So actually this is very ideal for occupational therapy because if a lawyer retains a client while the client is still in hospital, so they've just sustained the injury, they're still in hospital. Oftentimes they will ask the occupational therapist to see the client in the hospital. And the reason is because the hospital staff and therapy staff in the hospital are not they do not have the scope to work with a client in the community. Their job is to work with a client in the hospital. And their job is to get the client prepared the best that they can to be able to discharge.
But they don't know anything about the environment that the client is going back to except for what the client might tell them or the family might tell them, but they haven't assessed it. So they don't really understand, and the client may not understand what issues they're gonna have in their own environment, depending on their limitations.
When we get involved in the hospital, our job is to go. to assess the client, work with the treatment team in the hospital to understand what they feel the person continues to require.
Arvinder: Because they've usually already assessed them and maybe are already working with them in the hospital. So we have a collaborative approach. And then the second thing we do is actually go into the client's home. So usually a family member will organize an appointment where we go into the client's home to see the home environment. So now we know the client, we know their limit. Now we can see the home and we can know, okay, well they're gonna have problems here and here and here, and then we can try to see if there's equipment that's required to mitigate those issues.
So the issues we're really looking at, at that point, are around safety and, and accessibility into the home. And the other thing is around what is the assistance the person's gonna require when they get home? In terms of being able to take care of themself on a day-to-day basis. So our assessment in hospital would include an attending care assessment, which looks at what kinds of assistance the person's going to require. When we're able to do this while the client's still in hospital, we're able to submit that paperwork to the insurance company and get approval from them to get those services and equipment in place before the person even goes home. And that makes it a lot better for the client because the transition is a lot smoother.
Andrew: And you mentioned attendant care, and so that's a, that's sort of a term of art for, you know, used in the legislation.
[00:15:28] What is an assessment of attendant care needs?
Andrew: In terms of what, what funding is available. Just explain briefly, if you don't mind, what attendant care is in the role, the occupational therapist has a large role in assessing attendant care needs.
Arvinder: Again, this is where you have to be aware of the legislation because if you're not, you wouldn't know that this is required. But an attendant care assessment involves an occupational therapist, and it can also be done by a nurse looking at the client's abilities in all areas of function.
So it starts with things like, can the person get dressed and undressed? And if they can't, what assistance do they require? If they require an orthotic, can they put on the orthotic and take it off? And if not, what assistance do they require? So there's a lot of different areas that are assessed, those are some examples.
What this assessment does is, is we go through all these areas and we're able to put a time value on them. So if we say, okay, this client's not gonna be able to dress themself, and they really are gonna be fully dependent, because we can know that from our assessment. We know we need a personal support worker to help the person get dressed in the morning every morning, so we can anticipate how long that's going to take. Depending on their needs and their abilities, right? If the person can help a bit, it might be a little faster. If they're completely in a vegetative state, that might take longer. So, based on our assessment, we're gonna decide, okay, yes, maybe for this task it's gonna require 10 minutes of assistance.
The insurance company has a formula in the form that determines how much or how they value each, they have different levels in the attending care form. So some tasks are at a certain expertise level and other ones require more expertise. So based on that, they have a dollar figure that they feel equates to that number of minutes that we allocate in the different areas.
And that at the end will come up with a calculation of time that the person, according to our assessment, should be allowed to have a P S W. And it comes out to time and then it equates to money. It could be that we say the client requires, you know, five hours of assistance during the day, and based on what areas they require assistance, it's gonna form into like a number figure. And say for example, it's a thousand dollars.
Once that's submitted to the adjuster and they say, okay, we agree, we approve it, then we're able to help the client to hire a personal support worker. And this assessment is really a perfect area for occupational therapy to be involved because it is about function and that's what we really have our expertise in.
[00:18:06] After a car accident case, what kinds of injuries require occupational therapy aftercare?
Andrew: Yes. In a car accident case, what kinds of injuries do you usually see that the occupational therapist would be involved in?
Arvinder: Well, the injuries vary a lot. So they could be physical injuries like a fracture or like soft tissue injuries or nerve and tendon injuries. And we also will see pain related issues. So they usually stem from the other injuries, so they end up in, some people will end up with chronic pain and that's like an ongoing condition that requires treatment?
Arvinder: Brain injury is very common just because of the way accidents happen in the contrecoup effect in the brain. We will often see people develop anxiety and depression depending on how they recover or how they, if they don't recover well.
A therapist who knows what they're doing, who has experience working with people over time will be able to anticipate this. Right. So we know right from the get go. And we also can anticipate that if we're seeing a client that has a history of mental health illness, so they've had difficulty already with depression or anxiety and now they have a concussion, they're at a much higher risk for developing this if it's not treated right.
[00:19:21] Occupational therapy in conjunction with mental health factors
Andrew: So what would you tell, like family members or people or lawyers even that might have a client that has that that has a concussion, overlay on you know, some prior mental health or depression.
Arvinder: We've actually developed an acute concussion program. Sure. Specific occupational therapy specific. And we did this in collaboration with a physio clinic because they were identifying that they're getting these clients that come in to see them with concussion. Right. Early. Okay. So now these clients are still considered in the MIG because there hasn't been medical imaging showing, but they end up at this physio clinic that has an expertise in concussion and they're finding when people have a preexisting history of mental health, they just do not recover as well.
Now the physio clinic can get us involved right at the beginning, and we start to work with the client around developing tools and techniques to manage their anxiety and their, and their mood and some of those can include things like meditation. We do biofeedback with it. So we use a system that's called Inner Balance and it can monitor the heart variances and so the client can know that they're kind of tapping in and regulating their heart and their brain so they'll know that they're being effective.
So when the client can learn these techniques and know that they're being effective. They're regulating their body to go into a rest and repair state, and they're doing this very early. So typically concussion clients don't get this. This is not a part of normal protocol.
Arvinder: So usually they'll go to a physio clinic and they'll get the physical rehab. Maybe they'll get looked at for balance, but they don't normally get the mental health piece. So that's one thing we do. The other thing we'll do as OTs in early concussion treatment. If we get to be involved, cuz you know, people need to know to involve us, right. We will work with the clients right from the beginning to determine their limits around activity.
A really important thing with concussion clients is that they need to continue to do activity, including exercise from the beginning. So if we can intervene a lot sooner then we likely can prevent them from developing consistent concussion symptoms that are prolonged over time.
Andrew: So if someone's watching this and they're wondering, do, do I need that or... like how do, how do they self-identify as somebody that would benefit from this?
Arvinder: I think if they know that they've had mental health issues from before, right, if you know you're already at that risk, then being able to intervene on these things quickly and even from a physical perspective, getting into a clinic that has people who specialize with concussion is very important because how you treat it is very different than just a typical, a typical injury. And if you end up at the wrong place, you may get the wrong information. And then these symptoms will not get that early intervention that can prevent them from becoming prolonged issues.
[00:22:14] What are the differences between different therapy options after a personal injury?
Andrew: I see. So some people just hear therapy and they kind of, they don't know the difference. There's so many therapies. Right. A lot of clients ask us what's the difference between, you know, I'm already seeing a physiotherapy, why do I need to see an occupational therapy?
And I try to explain there's a difference, but maybe you can shed some light on the, the, the major differences.
Arvinder: Ok. A Physiotherapist's role is really looking at the physical aspect of a client's abilities, right? So that could include their movement, their range of motion, or their strength or impairments in the physical realm, right?
And from an occupational therapy standpoint, we're looking at every activity the client does. Our goal is to start with activity. So we look at the impairment, but we apply it to activity and we're looking at things like, how does their injuries affect their ability to drive their child to school? A physio will not look at that. They'll just look at, okay, yes, this client has a fracture and we, they're impaired in their movement and we know they're gonna need, you know, some exercises afterwards once the cast comes off. But an OT will look at like, okay, they're impaired, in that leg, they can't press the pedal of the car. So how are we gonna get this kid to school?
That's a very big difference because we're looking at the overall function of the client's entire life.
Andrew: So it's important for, I think, people involved in car accidents that have injuries to know you're, they're not choosing one therapy over another. This is all part of the team.
Arvinder: Yeah. And you know, as a team, we work very closely. When there is a physio and an OT involved, we'll be talking to the physio. Like if there isn't anything specific around, say, mobility in the house and the physios working with them, I'll prob, I'll probably give the physio a call and say, you know, is there things that we should be avoiding at the house or is there ways that we can work on this or that? And that way we're working together so now I can apply what they're learning there into their everyday environment.
[00:24:08] What is the process when an occupational therapist gets involved in an accident benefits claim?
Andrew: So sometimes when we get a client that we think may benefit from an assessment by an occupational therapist, we make that suggestion. Just tell us about the process from that point on when the lawyer asks you to be involved with a client.
Arvinder: Usually what happens is the lawyer will send us information, of course, after they get permission from the client to go ahead. That'll include information about the client as well as their case and their adjuster and insurance information. So the typical process would be that our intake coordinator at our company will give the client a call and we will do an interview with the client over the phone. And again, if the client is not the one we would know who the contact person is or the POA.
After that point, our intake coordinator completes the OCF 18, and that's usually done within a day or two. And then that OCF 18 is sent to the client for signature. Typically at our company, we'll send it by some kind of an electronic format where they can sign it electronically. We review the form with the client and then if they have any questions, they can get back to us. We can clarify anything that is not correct as originally written. From the day that the insurance company receives that form, which is done electronically, so it's immediate when we submit it, they have 10 business days to respond.
So usually I would say that in most cases, if it's somebody who's not in an urgent situation, it would probably take about three weeks by the time we have an approval, and then the OT would call the client to set up an appointment. Sometimes we have cases that are really urgent, like these clients that are in hospital.
Arvinder: We know they're gonna be discharged in a week. In those cases, we will just go in. We typically will ask the lawyer about the injuries, and so we have some understanding about the injuries, and we'll usually call the insurance company if we already have the insurance information and talk to the adjuster and let them know that we're, you know, this is a rush for these reasons. And, ideally if we can get a verbal approval for them. So those would be the two different scenarios that we would work with.
Andrew: So in, in addition, we talked a lot about the treatment side from occupational therapists. But in Ontario, as you know, the coverage amount that's available through a person's own insurance company is gonna be dependent on the nature and severity of the injuries.
[00:26:28] What is the role of an occupational therapist in assessing injuries and getting benefits approved?
Andrew: And so specifically with a catastrophic injury. Can you touch upon the role that occupational therapists play in the assessment and ultimately the determination on whether the person qualifies for that higher level of benefits.
Arvinder: So occupational therapists are typically involved in the determination of catastrophic in most cases because the catastrophic determination is always based on how the client has recovered from the injury and their ability to get back to doing the functional tasks that they did before. And the level of impairment that they continue to suffer at the time that they're being evaluated.
The occupational therapist would be involved in that functional test, which has to meet a threshold in order for the client to be classified as catastrophic when it's somebody who has a brain injury, there's a specific test that we do that is called the GCS so this is something that's required in the insurance legislation to determine if a person is impaired. And that test in particular relates to the brain injury, relates to the cognitive dysfunction that the person is having and how it impairs their ability to do different functional tasks.
So this test could be done at the six month mark or at the year mark, and it really depends on the client's level of impairment. So OTs are typically involved in doing the GCS, depending on what type of injuries the person has, the evaluation may be slightly different. But typically what the occupational therapist will do is a situational assessment and a situational assessment is typically a two day assessment where the therapist will go in and see the client for four to six hours, two consecutive days. The first day we'll be seeing them in the home and evaluating their ability to do things at home, and also deal with emergency situations at home. And then the second day will be in the community and their ability to do activities in the community and deal with, again, emergency situations that may come up in the community.
And so depending on the injury, the occupational therapist will set up situations so we'll, we wanna make it as real life as possible. So if we know the client has a mental health issue, we wanna make sure that if they get overly stressed, like for example, they live in an apartment and a fire drill goes off, can the person safely navigate that situation to be able to get out of that apartment safely.
In the situational assessment, we're looking for what happens as the client's going through different activities in a whole day, which would simulate a work day or something like that, right?
Arvinder: Because we're working eight hours. So can they tolerate doing that if they were doing it before? If they did it on one day, what happens to them the next day? Like if we're required to work in a full-time job five days a week, we have to be able to consistently do that.
Andrew: That's right.
Arvinder: So we'll look at the next day and see, okay now after that one day of testing, what happens the next day? Are they able to participate? Did their symptoms get worse? Did their concentration get worse? And so we can really identify if there's any decompensations that happen over that period of time.
Arvinder: So occupational therapists are really key in catastrophic assessments. But ideally they should be trained specifically for doing the catastrophic assessment.
Andrew: And that's a service your company provides as well?
Arvinder: Yes. Yes, we do.
[00:30:00] What should you do if you think you need to get an occupational therapist involved in your personal injury case?
Andrew: Okay. What happens if someone already has a lawyer and they're going through the process and they're, they're getting physiotherapy and maybe some other therapies, but they're listening to this and thinking, I might benefit, I think what Arvinder's talking about what might benefit me or my loved one?
Andrew: Who was involved in a car accident? What's the suggestion for them?
Arvinder: What I would suggest is to first go back to their lawyer and talk about what they heard so that the lawyer understands. And you know, of course they can always reach out to us and get more information if they're not sure. And we're happy to talk to their law firm as well if they want us to talk to their law firm after having a conversation with them about how we can help.
But I would suggest they talk to their legal team first so that you know, their legal team may have a person that they feel is well suited to work with them as well.
But of course we're happy to help at any time.
Andrew: That was great Arvinder, thank you for joining us. It was really informative. I think everyone learned a lot about occupational therapists and the role they play in car accident claims.
Arvinder: And thank you so much for having me, Andrew. I really enjoyed being here.
Andrew: So if anyone wants to reach Arvinder, how, how can they reach you or your company if they need some help?
[00:31:14] Have Questions? Contact PIOT Today!
Arvinder: They can find us directly on our website, which is www.piot.ca. Or they can, if they go to that website, they can find our number, they can give us a call. There's also inquiry pages on the website that they could just write about their situation, we'll call them back usually within 24 hours.
Andrew: Thanks for joining us today. We hope you found this episode informative, and if you have any other questions, feel free to reach out to us at any time or visit our website and request a free consultation.
We'll see you in the next episode.