Occupational therapists (OTs) have been in the spotlight this month after the National Disability Insurance Agency (NDIA) froze NDIS payments for these services at $193.99 per hour for the sixth year.

The NDIA also cut travel payments for OTs who visit people in their home and community by 50%.

Health Minister Mark Bulter says it’s important people on the NDIS aren’t paying more for therapy and support than they would pay in the health or aged care system.

But OTs are concerned this could affect therapists’ viability, including their ability to support people with disability in their homes and communities.

But what can OTs actually do? And why is it often better to do this in a person’s home and community?

Who might see an OT?

Imagine trying to get back to your daily life after a major health setback, such as a car accident or stroke, or an episode of a long-term condition or disability, such as depression or arthritis. The things you used to do with ease can become difficult and exhausting.

After such a setback, your home or community can also feel like an obstacle course. Maybe you can’t carry the laundry basket out to the line anymore, or you’re struggling to keep up with your children.

This is where occupational therapy can make a real difference. OTs are health professionals that enable people to do the things they need, want and love to do in daily life, from getting dressed to cooking dinner, gardening to driving.

Occupational therapists work with people of all ages. They overcome barriers by changing the environments and objects we use, teaching new skills, rehabilitating old ones and tweaking the way we tackle tasks.

What can OTs do in the home and community?

Seeing people in their own homes and communities allows the therapist to get a more accurate picture of a person’s strengths and abilities, which can be difficult to understand in a clinic.

OTs use their skills and creativity to provide personalised care, tailored to individual needs and circumstances.

An older person with dementia might, for example, cause alarm by putting a plastic kettle on the stove of a hospital kitchen. But they could make their cup of tea perfectly safely at home with their stove top kettle.

OTs can support home and community mobility, such as checking a wheelchair passes smoothly through doorways and can manoeuvre in tight spaces such as bathrooms.

But they can also advise on kitchen aids and seating to save energy for people with conditions such as multiple sclerosis, to support them continuing to cook family meals.

In their work with neurodivergent people of different ages, an OT might help an autistic teen develop sensory strategies to deal with their busy and noisy school day.

For other people, OT support might help them navigate their local public transport system. Learning and practising skills where they’re used makes it easier to carry them over into everyday life.

What does the research say?

Research shows home and community OT can lead to better activity and participation than clinic-based therapy. It’s also cost-effective.

For stroke survivors, OT makes everyday tasks like showering or getting dressed easier.

OT at home eases burden and stress for the parents of children with cerebral palsy and carers of people with dementia.

OT at home helps older people with ongoing health issues to be more actively involved in their communities.

Community OT is also effective in supporting recovery for people with mental health problems, enabling them to enjoy community and leisure activities, seek and maintain employment and enhance physical activity.

OT focuses on helping you do the things that keep you well and independent, which means fewer trips back to the hospital. OTs can spot and solve trip hazards within homes, for example, before a frail person has a fall.

People who get OT at home soon after leaving hospital are less likely to be readmitted. Emerging research also suggests OT can work jointly with paramedics when someone falls at home by visiting and offering immediate treatment that prevent avoidable hospital stays.

There are some downsides, such as limited access in disadvantaged communities. While telehealth can address some barriers, it is not suitable in every case.

How do Australians access OTs?

There are many pathways to access OT services, but the complexity of the health-care system means the process is challenging to navigate.

OT services can also be costly, due to severely limited funding, equipment and transport costs.

OT is available as part of Home Care Packages and the Commonwealth Home Support Programme for older people.

OT has also played a key role in supporting NDIS participants since the scheme’s inception. However, waiting lists often stretch for many months and not everyone knows about what OT can offer.

You can also access community OT through Medicare Chronic Disease Management plans, local community health centres and councils and through private health insurance rebates.

Thanks to Lana O’Neil (Occupational Therapist at Western Health in Victoria) and Sarah McCann (Senior Occupational Therapist at Western Health) for sharing their clinical expertise for this article.

Danielle Hitch, Senior Lecturer in Occupational Therapy, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

You may have heard high-impact activity – exercise such as running, jumping, football and basketball – is good at building bone density and strength. But what about when you’re standing still, lifting weights at the gym?

The good news is weight training is great for bone health. But some exercises are more effective than others. Here’s what the science says.

What is bone density?

Bone density, also known as bone mineral density, is essentially a measure of how many minerals (such as calcium and phosphorus) are packed into your bones.

It gives you an indication of how solid your bones are, which is important because denser bones are generally less likely to break.

However, bone density is not quite the same as bone strength.

Bones also rely on a range of other compounds (such as collagen) to provide support and structure. So, even dense bones can become brittle if they are lacking these key structural components.

However, bone mineral density (measured with a bone scan) is still considered one of the best indicators of bone health because it is strongly linked to fracture risk.

While there is likely a genetic component to bone health, your daily choices can have a big impact.

What affects your bone health?

Research shows a few factors can influence how strong and dense your bones are:

Getting older: As we age, our bone mineral density tends to decrease. This decline is generally greater in women after menopause, but it occurs in everyone.

Nutrition: Eating calcium-rich foods – dairy in particular, but also many vegetables, nuts, legumes, eggs and meat – has been shown to have a small impact on bone density (although the extent to which this reduces fracture risk is unclear).

Exposure to sun: Sunlight helps your body make vitamin D, which helps you absorb calcium, and has been linked to better bone density.

Exercise: It is well established that people who do high-impact and high-load exercise (such as sprinting and weight training) tend to have denser and stronger bones than those who don’t.

Smoking: Older people who smoke tend to have lower bone density than those who don’t smoke.

Why does movement improve bone density?

In the same way that your muscles get stronger when you expose them to stress, your bones get stronger when they’re asked to handle more load. This is why exercise is so important for bone health – because it tells your bones to adapt and become stronger.

Many of us know that people at risk for bone loss – post-menopausal women and older adults – should be focused on exercising for bone health.

However, everyone can benefit from targeted exercise, and it’s arguably just as important to prevent declines in bone health.

In fact, whether you are male or female, the younger you start, the more likely you are to have denser bones into your older life. This is crucial for long-term bone health.

Do weights improve bone density?

Yes. One of the most effective exercises for bone health is lifting weights.

When you lift weights, your muscles pull on your bones, sending signals that encourage new bone formation. There is a large body of evidence showing weight training can improve bone density in adults, including in post-menopausal women.

But not all exercises are created equal. For example, some evidence suggests large compound exercises that place more load on the skeleton – such as squats and deadlifts – are particularly effective at increasing density in the spine and hips, two areas prone to fractures.

What type of weight training is best?

Lifting heavier weights is thought to produce better results than lifting lighter ones. This means doing sets of three to eight repetitions using heavy weights is likely to have a greater impact on your bones than doing many repetitions with lighter ones.

Similarly, it takes a long time for your bones to adapt and become denser – usually six months or more. This means for healthy bones, it’s better to integrate weight training into your weekly routine rather than do it in bursts for a few weeks at a time.

Exercises that use body weight, such as yoga and pilates, have many health benefits. However they are unlikely to have a significant impact on bone density, as they tend to put only light stress on your bones.

If you are new to weight training, you might need to start a bit lighter and get used to the movements before adding weight. And if you need help, finding an exercise professional in your local area might be a great first step.

Exercising for bone health is not complex. Just a couple of (heavy) weight training sessions per week can make a big difference.

If you’re concerned you have low bone density, speak to your doctor. They can assess whether you need to go for a scan.

Hunter Bennett, Lecturer in Exercise Science, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.