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Hi Donna.
Coming from an outpatient perspective at this
point in my career (as well as from an OT perspective of 11 years, and highly
trained in modality use to supplement my OT treatment), e-stim would benefit him
greatly. Pain reduction has to be the #1 goal achieved, or he will not
feel well enough for rigorous exercise. I know this would drive many of
the OT's out there crazy, but in reality, he needs to strengthen that extremity
pretty quickly in order to care for his wife. Providing care for his wife
is what matters to him at this point in his life. I will bring home my
rotator cuff protocols tomorrow (didn't work today, sorry) and forward them to
you so that you can get some ideas for home rehab until he is ready for
outpatient. I think in sending him to outpatient, you are probably helping
him achieve mental as well as physical rehab.......obviously, he has the basic
self-care down pat, now he needs to use the muscles in his arm to care for his
wife. What could be more important and client centered
than that? (LOL-just keeping up with the latest argument).He is
probably feeling helpless in that he is now unable to return the care and love
that she has provided for him.
As far as home based and ADL goals, he can always utilize
compensatory dressing techniques for now to don his coat and an adaptive sponge
for showering. Laundry will be a bit harder, as again, he needs strength
for this. Have you considered a NMES unit for home to stimulate the
muscles(s) in question?
Thanks for the help, Lisa. Remarkably, he
is quite functional - Ind simple self care, Ind meal prep. His main
goal is to be well enough so he can care for his wife who was recently
transferred from acute care to SNF as he is unable to care for her. My
functional goals are certainly to reduce pain and maximize functional use of
his arm, as well as to decrease the difficulty he has with self=care and
home management.
Our Goals -
reduce
pain
maximize
functional use LUE
Ind
donning of coat
Ind
showering
Ind
laundry
Very LTG - be able to care for wife, assisting
with her minimal transfers and min self-care.
In spite of his pain, I was wondering about
sending him to outpatient a little sooner so that he can try ultrasound -
what do you think?
Thanks again, Donna
----- Original Message -----
Sent: Monday, February 26, 2001
5:03 PM
Subject: Re: UE treatment
HI Donna. What are your goals for
this patient? I am assuming pain control initially so that he may
participate in both rehab of his injury as well as ADL retraining.
Please forward me his goals, I will assist as able.
Lisa
I know this question will drive Ron
nuts, but I'm requesting help from those OTs who treat
UEs.
I work in home care and currently have
an 80 y.o. patient with a recent (2 weeks) torn rotator cuff from a
fall. Due to his age and cardiac status, he will not have this
tear surgically repaired. It was just diagnosed this week,
although I certainly suspected this diagnosis since I met this
patient a week ago. He is currently homebound, possibly for 2
weeks, due to his pain level - I will then refer him to
outpatient.
Current status - AROM - maybe 20
degrees flexion. PROM - difficult to fully ascertain due to
pain but I can get around 45 degrees flexion and he has minimal
rotation. AROM elbow flexion is only to 45 degrees due to
pain. His pain level is severe - 8/10. Please advise on
appropriate treatment.
Ron, I am a well-seasoned OT. I
certainly embrace and utilize an occupation-based approach with all
my patients and certainly hope you will give me and all the other
OTs who prescribe to this listing the respect that we deserve.
It is clear that you feel you are the only one to practice pure OT,
and that you envision yourself as the ultimate OT; however, believe
it or not, there are many of us out there who are also competent,
and leave our patients more capable (physically, emotionally,
psychologically) of living the life they want and fulfilling their
roles/occupations. I have found your postings over the past
few months to be very condenscending to other OTs and have been
personally insulted by you a number of times, in spite of the fact
that this is my first posting to the list and that you have never
written to me
directly.
Donna
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