Saturday, April 2, 2011

OT A to Z: B is for Balance

After consulting my OT colleagues on Twitter (thanks, @kirstyes!), it was decided that B is for Balance...occupational balance that is!
Image by cogdogblog and used under a Creative Commons License.

The concept of balance is certainly one that garners media and public press attention. Usually this is the form of discussions surrounding work-life balance. So I think there is at least a general acceptance of the notion that it is healthy to balance the activity demands and roles in our lives. And while many people may agree with the concept, this is probably one of those areas where knowing and doing may not always coincide.

But how do OTs view balance? OTs readily state that there needs to be a balance in our occupations - often thought of in general terms or self-care, work, and leisure. OTs would also assert that occupational balance and health are interdependent. Changes in health may impact occupational balance - either in the short-term or long-term, but occupational imbalance certainly may impact health.

First, how may health impact occupational balance? Let's think of two clients - perhaps one who underwent a total hip replacement due to osteoarthritis and another who had a spinal cord injury (SCI). The person with the total hip replacement will certainly experience occupational imbalance - he or she will initially have difficulty performing activities of daily living (ADLs) such as dressing, bathing, and toileting and much effort will be focused on completing self-care tasks. However, she or she will also have difficulty performing instrumental ADLs such as driving, meal preparation, and home management and most likely is temporarily not going to participate in work or leisure activities. But with the assistance of an OT, he or she will be able to adapt (our "A" word) some activities and perform them in a different way - such as dressing his or her lower extremities using adaptive equipment. And we can also assume that in a fairly short period of time, his or her ability to perform the range of occupations - from self-care to work and leisure - will be improved with recovery from the surgery and increased strength.

However, if we think of a client with SCI, it is easy to recognize that not only may they have difficulty performing many occupations but the time required to perform them leads to an imbalance. Early in my OT career, I worked with a college student who sustained a cervical SCI. He made terrific progress in his rehabilitation and achieved his goal of returning to school in a matter of months. However, he did not stay away at school for long. In talking to him some time later, he shared with me that while at college he could do everything he needed to do himself, it took him so long to do everything that tending to much beyond his self-care and making it to classes was not realistic. So when friends called to go out, he quickly grew frustrated with the time that it took him to get ready and felt that he missed many social activities because of this. So because his self-care activities took such as large portion of his time, he had difficulty achieving occupational balance.

What are some ways that occupational balance affect health? I think one area where this is truly evident is the occupational imbalance experienced by caregivers. Hunt and Smith (2004) studied the experiences of caregivers of people with stroke and found that many reported changes in their activities, their roles, and their routines. While this is probably not a surprise, it certainly warrants increased attention as reports of studies indicate that caregivers also sustain decreased health status.

Furthermore, this is really an area where OTs have the expertise to contribute to the public discourse on health. It is an interesting prospect to consider how many public health challenges could be improved at least if more attention were focused on occupational balance.

What do you think?
  • Do OTs have a role in addressing the occupational balance in a public forum? If so, how might this be accomplished?
  • What about in working with clients - do you address the occupational balance of their caregivers?
  • How do you strive to achieve occupational balance in your own life?


Hunt, D. & Smith, J. (2004) The personal experience of carers of stroke

survivors: an interpretative phenomenological analysis. Disability and Rehabilitation, 26 (16), 1000- 1011.


  1. Hi I think blog posts like this and opening up debate about our ideas and philosophy is one way to start addressing it. I suppose one thing to mention is that balance does not mean an automatic three way split but is different for everyone. Some people are happiest on the go and dont like time out 'alone' dor themselves. Perhaps balance is the outcome more than the process. So for example with the SCI example perhaps getting some help with personal care so that he had time to go out and engage socially might have provided a more satisfying balance.
    I know when I was in practice I always talked to carers about their needs and suggested respite for them so that they could engage in leisure or study/work opportunities. The opportunities for respite were often limited due to funding though.
    Now when it comes to balance in my own life let's just say I'm trying to work out where that lies. I know I've been spending far too much time working and have tried to reduce that but being single when I'm not working I end up just vegging in front of the tv or computer. Balance can be so interlinked with your physical and social environments.
    I think for us in the West it will be an ongoing issue, wonder whether there are any cultures out there or people that feel they've for it just right.

    Enjoyed this one again.



  2. You are definitely right - balance is also a matter of personal perspective. We have all known people who spent the majority of their time working to the exclusion of other occupations. While the health aspects of this could be discussed, the person cannot imagine living another way.