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    Website of the HIV Special Interest Group

    -as part of the College of Occupational Therapists Specialist Section - HIV/AIDs, Oncology & Palliative Care

Many people in the UK who require acute care secondary to their HIV health are admitted to general medical or infectious diseases wards at their local hospital, although specialist HIV wards are found in most larger teaching hospitals in regional centres and London. Some hospitals in the UK have specialist HIV posts including North Manchester General Hospital, Western General Hospital Edinburgh, North Glasgow University Hospital, Birmingham Heartlands Hospital, Chelsea / Westminster Hospital London, University College London Hospitals and Barts and the Royal London Hospitals, London.

The types of input provided by OT varies according to the trends locally as well as the local policy regarding length of stay and availability of rehabilitation facilities. For patients with complex needs long hospital stays are not uncommon and with multiple medical setbacks the therapist in the acute hospital might find themselves involved in more rehabilitation than their colleagues in general medical wards. This may also be complicated by social reasons such as housing and immigration matters delaying discharge.

Complex admissions - characterised by uncertain, mixed/multiple and changing pathologies - complicate the therapist's task of planning an appropriate  treatment. Moving backwards and forwards between rehabilitative, compensatory and palliative approaches is not uncommon.

Not all patients present with complex needs and many patients recovering from respiratory or general systemic illness require a straightforward rehabilitative approach addressing activity tolerance and strength / fitness goals. This patient group often appears to benefit greatly from a patient-focused programme with a strong emphasis on education, self-reliance and the "expert patient".

Below are the major treatment areas an OT might find themselves involved with in an acute centre (refer also to the section on this website on conditions):

Respiratory conditions and cardiomyopathies

(e.g. PCP, pulmonary TB) may require “pulmonary” approach e.g.

·         Work hardening / increasing activity tolerance

·         Energy conservation

·         Anxiety / stress management

·         Often recover well / fully

·         May need short term compensatory strategies at home e.g. perching stools, bath equipment, living downstairs, meals on wheels, care package etc.

·         May be left with residual scarring and need long term adaptations such as stair lifts

 Neurological impairment and HIV related Brain Impairment (HRBI)

·         In early part of epidemic many people died from neurological diseases e.g. PML, “AIDS Dementia Complex”

·         Until recently many of these illnesses have been better treated, thus avoided

·         The past few years have seen upsurge in numbers of neurological presentations

·         Common presentations include toxoplasmosis and Cryptococcyl meningitis, which can respond well to treatment. Primary CNS lymphomas and PML tend to fare less well.

Refer also to the section on this website that deals with this is more detail Neuro complications of HIV

Rheumatologic symptoms / joint pain

·         Assessment – time of day, severity, functional implications etc

·         Rest / activity balance

·         Orthoses

·         Joint preservation techniques

·         Compensatory equipment e.g. built up kitchen equipment

Pain management / peripheral neuropathies

·         Assessment – is it neuropathic pain, musculoskeletal pain, secondary to low body weight etc. Visual analogue scales.

·         “Hands on” treatments e.g. positioning, massage

·         Splinting / upper limb rehab

·         Relaxation / stress / anxiety management

·         Compensatory aspects e.g. built up pen grips, padded bathing equipment

Mental health

Issues include: dealing with a new HIV diagnosis, palliative care, stigma, related issues (sexuality, children, guilt, drug use, vulnerability, relationships / family), organic causes, dual diagnoses

Approaches / modalities include:

·    Active listening (the acute therapist is often well places to assess mental state and provide feedback to the multipdisciplinary team, and has often opportunities for informal counselling)

·    Risk assessment and safety – suicide and self harm

·    Patient centred practice – patient priorities in planning for return home, rehab or palliative care

·    Working with psychologists, mental health nurses, health advisors, drug and alcohol services etc

·    Stress and anxiety management,  relaxation etc

Low body weight and lipodystrophy / lipoatrophy

(secondary to illness states, poor appetite, side effects of medication, low mood, socio-economic factors)

·         Body image – types of patients

·         General health and wellbeing

·         Motivation

·         Use of kitchen activities

·         Working with the dietician, healthy eating

·         Work hardening / exercise tolerance

Compiled by:

Will Chegwidden, Specialist Senior Occupational Therapist

St. Bartholomew's Hospital

October 2005

Send mail to will.chegwidden@bartsandthelondon.nhs.uk with questions or comments about this web site.                           
Last modified: 16 May 2007