Opinion: we should never underestimate the rehabilitative and transformative power of actually doing something

By Daniel HarteSouthern Care and Social Care Trust

Those of a certain age may fondly recall the 1980s' movie The Karate Kid. The new boy in town, Daniel LaRusso, struggles to fit in and becomes the brute focus of the school bullies. I remember as a 12 year old initially being disappointed with a film that was small on fight yet big on melodrama.

But while the film was not what I expected it to be, it is one of my favourites from that era, iconic scenes that I have been able to connect to my role as an occupational therapist. To defend himself, Daniel learns karate from his mentor, Mr Miyagi. Miyagi appears to embrace the philosophy of occupational therapy by engaging Daniel in various chores such as sanding, painting fences and buffing vintage cars ("wax on, wax off" anyone?). Miyagi’s deeper motive was to develop Daniel’s strength, coordination, resilience and discipline for combat. 

The Karate Kid's "wax on, wax off" scene

In occupational therapy jargon, this is referred to as "purposeful activity". Most of my career has been in hand rehabilitation. It is not until we are limited by our hands that we appreciate how much we rely on them in all our activities, using them to explore the world and even to communicate.

Probably due to my focus on hand therapy I became intrigued how magicians effortlessly perform sleight of hand. Magic tricks need to be practised obsessively to perfect sleight of hand. A few years ago, I collaborated with illusionist and academic Kevin Spencer to publish a research paper that presented magic tricks as a therapeutic tool and purposeful activity that can be used in rehabilitation to engage people. The gross and fine motor skills developed in this fun activity can be transferred into important everyday activities such as getting washed and dressed. 

Another example of this is a study by Dido Green from Oxford Brookes University who reported that 23 children with upper limb hemiplegia (weakness) who attended a two-week magic camp significantly incorporated their affected side into everyday activities.

Kevin Spencer showing how small magic tricks can be used as a form of physical therapy 

In practice, I have used magic tricks to great effect. I recall a child who would not look at their hand, never mind use it, after losing part of a digit. The bargaining chip was I would teach them a trick if they agreed to try it. Bingo! Straight away, the idea of mastering a cool trick had that particular child attempting to use both hands. 

Creative endeavours can also benefit people who do not have a disability. While purposeful activity is used as a tool to engage and to rehearse motor skills (along with physical, cognitive, and psychosocial skills) essential for everyday living, meaningful activities are those that are particularly important to the individual. Research by neuroscientists at the University of Richmond show that we change the neurochemistry of our brains and making ourselves happier when we use our hands to engage in activities. 

Think of the artist, musician or wood-turner who will spend hours absorbed in their hobby or livelihood. This may be what is referred to as a state of flow or being "in the zone" whereby they are energised and rewarded by the process as much as the end product. 

With people living longer than ever before, health services are clearly embracing activity to promote health and well-being

Many of us may never have got around to pursuing activities we would love to do, but the reason why we procrastinate is an emotion management issue and not a time management one. The Procrastination Research Group says that the main reasons why we procrastinate are because the task is seen as boring, too difficult or there is a fear of failure. To overcome this, it is recommended that we identify how to start the task and just make that tiny step forward. A low-threshold entry point is more effective as it reduces the emotional response connected to the task that can become the barrier. 

With people living longer than ever before, health services are clearly embracing activity to promote health and well-being. Think of social prescribing by GPs or the Parkrun revolution which has helped many overcome social isolation and manage depression, obesity and cardiac health. The value of activity has always been at the core of occupational therapy. In hand therapy, the mantra "if you don't use it, you lose it" is very much true: brain MRIs show that the cortex changes when a hand is immobilised in a cast. As such, we should never underestimate the rehabilitative and transformative power of doing.

Daniel Harte is an occupational therapist and researcher at the Southern Care and Social Care Trust which is a Queen's University Belfast teaching hospital


The views expressed here are those of the author and do not represent or reflect the views of RTÉ