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Lisa - thanks for the information on rotator cuff
tx so far - and thanks in advance for the protocols you'll be sending. I
agree that e-stim is probably the route to go - we don't have any where I work -
another reason to get him to outpatient asap.
Donna
----- Original Message -----
Sent: Tuesday, February 27, 2001 4:32
PM
Subject: Re: UE treatment
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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