Occupational Therapy

Bespoke therapy based on patient occupation

Information provided by Ruth Garner

  • The first book on occupational therapy in this country was written by the head of OT at the Acci in 1948. (from Helen Norman, OT at the Acci 1948-1950)
  • Occupational therapy (OT) at the Birmingham Accident Hospital & Rehabilitation Centre was pioneered by Miss Alice Savage, MAOT, and she was instrumental is setting up services for patients across the hospital and across specialties.
  • Miss Savage retired in 1977 and was succeeded by Helena Bradshaw followed by Ruth Garner, Karen Lewis and, finally, Anne Stamps.
  • In the 1970’s the team consisted of a head OT, 3 senior OTs (one based in the Head Injuries Rehabilitation Centre), 2 basic grade OTs, 2 technical instructors and 2 OT assistants.
  • This staffing level remained until the hospital closed and services moved.
  • OTs worked very closely with other members of the multidisciplinary team and in particular Physiotherapy, Remedial Gymnasts and Social Workers.
  • The department was situated above the admin offices in the older building next to Davenports Brewery and we were often treated to the delightful smell of hops on warm summer days!

Outpatient Department

  • The OT outpatient department was a large area built around therapeutic activity for the rehabilitation of patients with upper and lower limb injuries.
  • It looked more like a workshop as it was set up with work benches, bicycles, lathes, foot operated saws, printing presses etc. each with a role in improving range of movement, strength, dexterity, co-ordination and tolerance.
  • Each patient was carefully assessed, and each activity broken down to create the correct level of exercise for the individual
  • Miss Savage wrote on the benefits of wrought iron work (note 1) and ankle rotator machines (note 2) etc. Patients could often be seen leaving the department with magazine racks, book cases, stools and rolling pins etc. made during the rehabilitation process.
  • The department had a kitchen where rehabilitation activities took place for inpatients preparing them for discharge home.

Traumatic Brain Injury

  • OTs were early adopters in the treatment of patients with severe brain injury.
  • They worked on sensory stimulation techniques in intensive care / early stages, progressing onto rehabilitation through to discharge and beyond.
  • The support of both patients and relatives was central to the success of the service. This was documented in 1990 (note 3)
  • A small unit near to H ward was used for patients with traumatic brain injury so that they could work on individual therapeutic activities in an environment with few distractions. This room took a bed and so we could work with patients in the very early stages of recovery.
  • Psychological tests were used to continually assess progress and identify areas of further need.
  • Relatives were welcome to take part in guided rehabilitation activities and, in doing so, could apply the techniques used during visiting times on the wards, thus providing consistency in approach. This would later help in the discharge planning and home visits.
  • The department was one of the first to trial the BBC computer for patients with traumatic brain injury.
  • It was a popular tool with patients, particularly younger ones, although the software we had access to was very basic by today’s standards. We had a touch sensitive screen that needed to be set up every time it was switched on and was used with programs developed for colour and number recognition, object recognition, following directions and hand-eye coordination etc.
  • Rehabilitation continued through discharge and into referral to other rehabilitation centres or back to work.
  • The Head Injuries Club, formed in 1962, was supported by OTs who attended the meetings in the Accident Hospital Social Club.
  • In the late 1970’s OTs supported the committee in fundraising and in planning a day centre to extend their activities and support within the local community.
  • Headway House was eventually established within the grounds of Moseley Hall Hospital and was, and still is, staffed by volunteers.
  • A second Headway House was opened in the grounds of Great Park, near Rubery and is known as Leighton House after the founder and very dedicated Stafford Leighton.
  • Around the same time as the Head Injuries Club was started, the multidisciplinary team identified a need for sheltered work for young people recovering from traumatic brain injury
  • A Rehabilitation Centre was established in Selly Oak, staffed by a manager and technical instructors, all with vocational experiences.
  • Work provided for attendees included constructing box files, sorting x-rays, Christmas cracker making, hair roller packing etc. This work generated an income for the centre.
  • In the mid 1970’s a senior OT was employed in order to assess, support and provide personalized therapeutic activities.
  • In 1980 the OT service took over the management of the centre, changing the focus from work to rehabilitation in all areas of life and moving some clients on to more appropriate sheltered workshops, vocational training or employment where possible.
  • The centre later moved to Mosely Hall Hospital where it still provides an essential rehabilitation service today.

Burns and Plastics

  • Within Burns and Plastics, OTs provided services to both in and out patients.
  • Splints were produced using a range of materials and techniques to increase and maintain range of movement, activities of daily living (ADL) to ensure independence on discharge, and emotional support to help cope with disfiguring injuries.
  • In 1978 the department started to make made-to-measure pressure garments to prevent and correct hypertrophic scarring.
  • This service grew significantly and by 1986 we were producing over 2,400 garments for over 140 patients a year (note 4).
  • These were made for all body parts, were worn for 23 hours a day and replaced every 6 months with great effect.

Elderly Care

  • Our main focus with older adults was discharge planning and through this we worked on activities of daily living (ADL) as soon as they were well enough to participate.
  • This meant dressing practice, making drinks and simple snacks, sitting to standing activities and walking practice etc.
  • Although patients and relatives were able to give details on home circumstances and objects to independent living, home visits often took place to assess their ability to do the required basics activities within their own home. Aids and adaptations were provided where necessary.
  • When patients needed more time before going home, they could be referred to Blackwell
  • Recovery Hospital for a period of respite.
  • This was an excellent service that gave patients a breathing space, and opportunities to do things under supervision thus increasing strength and confidence ready for independent living.
  • A lot of our work was about teaching new techniques within ADL and, of course, increasing confidence in their own abilities.

General Wards

  • A range of referrals came from all wards within the hospital, including the children’s ward.
  • Some of these were for splinting, ADL, diversionary activities, emotional support or discharge planning.
  • We had a car engine in the department which some of the patients would come down and work on, providing an opportunity to leave the ward and improve standing tolerance, hand-eye coordination, upper limb strength etc. Others could take advantage of other activities provided in the department.
  • This impacted on mental health and well-being for those who were inpatients for an extended period of time.

Note 1: Savage Alice E. M.A.O.T. (1959). Wrought Ironwork in the department. Sage Journals.
Note 2: Ankle Rotator Machine (Manual) Alice E Savage M.A.O.T.
Note 3: Garner R. (1990) Acute Head Injury; Practical management in Rehabilitation. Therapy in
Practice series edited by Jo Campling. Chapman & Hall.
Note 4: Garner R. (1987) Should ‘We’ put our patients under pressure?