Activity Grading

Sometimes an Occupational Therapist may use activity grading to enable their patient to take part in an occupation important to them.

Grading is a planned approach to increasing the level of activity. It should not make fatigue worse. If you know your patient's baseline then you can guide them to increase their level of activity in several ways by:

• Educating the patient on the concept of activity grading and the benefits of this approach. 

• Breaking down the activity into small, manageable chunks which can be gradually increased.

• Establishing how much of the activity can be completed at their baseline level of functions. 

• Starting with one small component, gradually encourage your patient to complete parts of the activity. 

• Once the patient is confident they are able to complete this component without an increase to their fatigue, another can be added

• Continue to review, if things become too difficult you can always go back to a previous grade and practice this for longer before moving on.
  
  

For example, if your patient's goal is to walk to work, but it is too far for them to be able to manage at once, this can be broken down.

On the first day, your patient could get the bus most of the way and then walk the last 100 metres. Each week, they could get off the bus a stop earlier and increase the distance they walk. The activity becomes increasingly difficult as they gradually reach their goal of walking to work.

Graded exposure is similar to activity grading but is more focused on dealing with the emotional and psychological element of rehabilitation. It’s used to help gradually build your confidence and establish meaningful routines that you may have otherwise avoided.

For example, a patient who has developed fatigue as a result of a car accident may be extremely anxious around cars. They may start by sitting in a car which is turned off with a close friend...