Hello Joe:
I believe that for the most part, it is not the modality that make the
difference between OT/PT, it is the goal and the theory behind the goal.
If a therapist is standing in the kitchen stacking dishes, the could
very likely be either an OT or PT. Basically, it boils down to a simple
question of why is the therapist doing the treatment and what is the
goal.
If the treatment is to improve standing balance then it is more closely
aligned to physical dysfunction and thus physical therapy. If the
treatment is to improve meal preparation, then it is more closely
aligned to occupation and thus occupational therapy.
I try to put treatments on a continuum that looks something like this:
physical dysfn <--------------------------------> occupational dysfn
(NOTE: for non-US readers, 'dysfn' = dysfunction)
The more closely a therapist is working to improve physical dysfunction,
the more close they are working in the realm of PT. The same concept is
true for occupational dysfunction. As with all continuums, there is NO
clear cut delineation between the end points. However, for any
treatment, there comes a point in which one is primarily working to
improve physical dysfunction or occupational dysfunction.
Having said all of the above, I clearly understand that the two
endpoints are related, however, they ARE separate. Many times,
therapists have said something like "well, you can't have occupation
with out physical function". I believe that that statement is very
false. If it were true, then every person with an impairment would have
disability and handicap. And, we know that that isn't the case. For
example, just because you can't raise your arm due to a stroke
(impairment), that doesn't mean that you can't drive a car (disability).
Or, just because you can't move your legs due to MS (impairment),
doesn't mean that you can't prepare a meal (disability).
At some point, an OT working with clients having physical impairments
must accept that they are primarily concerned more with ameliorating the
physical dysfunction or more with decreasing the occupational
dysfunction. It will probably not surprise anyone to hear me say that by
definition, all OT's should be primarily concerned with decreasing
occupational dysfunction rather than physical dysfunction. Please bear
in mind, the decreasing occupational dysfunction certainly may include
working on physical impairment, but from an this perspective, physical
dysfunction is not the problem and thus it is not the issue to be
primarily addressed.
As far as OT's using physical agent modalities in preparation for
occupation, it think the concept is a bunch of hooey. Again, as a
therapist, you should be working on the person's occupation and in my
mind, that's how the treatment should be phrased. So, IF a client can't
brush their teeth because pain/stiffness is keeping them from holding
their toothbrush AND brushing their teeth is an client-identified
occupation AND a treatment goal, then an OT using physical agent
modalities is actually working to improve the occupation, not to
decrease pain/stiffness. In this case, if the treating therapist were
asked why the patient was receiving the physical agent treatment, they
could clearly say, "Mr Jones wants to brush his teeth but his pain and
stiffness is keeping him from doing so. So we are working to allow him
to brush his teeth".
I think all my rhetoric can be easily boiled down into one statement:
What is the specific goal for the patient. If the goal is to improve a
specific occupation that the client has identified as important, then,
regardless of the treatment modality, a person is doing OT.
Ron
=============================================
On 8/29/2003,[EMAIL PROTECTED] wrote:
JW> Hi Ron & others:
JW> What are your thoughts on PTs working on standing tolerance with the
JW> client's favorite leisure- a game of checkers, or, a homemaker
JW> working in PT stacking dishes in overhead cupboards working on
JW> standing balance post THR .... are they working on physical
JW> functions with an 'occupational' modality? What about OTs using
JW> contrast-bath treatments in preparation to self care, since it helps
JW> decrease stiffness/ pain in the clients hands before holding on to
JW> their toothbrush? 'Physical ' modalities for occupational purposes?
JW> Again, do or don't art/ music therapists use art/ music as an
JW> 'occupational' modality (ofcourse, not calling it that), even if it
JW> is mainly diversional in nature. I have heard of music therapists
JW> working with autistic, ADHD kids that helps 'occupy' the kids in a
JW> more constructive ways rather than their rather 'mis' or 'dis'
JW> occupation. I am not convinced that by law or, in actual practice we
JW> have a true domain that's not been shared by others. Again, I do not
JW> believe PTs have one either. At least, not in the US. Again, I do
JW> not believe that this con'fusion' leading to the 'fission' amongst
JW> the professionals is just limited to the US. I believe the OT
JW> product is undersold and under-recognized throughout the world, i.e,
JW> wherever it is.
JW> Our product is like a liquid, it takes the form of the container-
JW> the flexibility is what makes it an art to conform to the uniqueness
JW> of the individual that goes beyond the science of pathology. The
JW> product is holistic- aimed at health in terms of physical, mental,
JW> emotional and social well-being. I agree it is not a product that
JW> can be defined, rather it has several definitions based upon
JW> different settings. In fact, not too long ago there was an article
JW> in Advance or, OT Practice ( just not sure which) and, it depicted
JW> analogy of a few blind men describing an elephant with no one having
JW> ever seeing one before, and each described it based on what part
JW> they came in contact with. Each of them were right, just not
JW> complete....
JW> Think of gasoline- it has no form of its own, yet it makes different
JW> cars run from concept to vintages, luxury to economy....the power
JW> behind the drive! To me that is OT or, that could be. Human bodies
JW> are the vehicles- life the journey! (...disregard my bad poetry) :-)
JW> p.s: In the above analogy (bad poetry), the tires of the car is PT,
JW> as the body of the car is borne on it and, it helps to move/ run it.
JW> Just kidding!!!!!
JW> Everybody have a great labor day weekend.
JW> Joe
JW> ----- Original Message ----- From: "Ron Carson" <[EMAIL PROTECTED]>
JW> To: "Joe Wells" <[EMAIL PROTECTED]> Sent: Friday, August 29, 2003
JW> 7:31 PM Subject: Re[2]: [OTlist] PT does it all!!
>> Hello Joe:
>> The OT's profession true and unique domain is that of occupation. In
>> my little world, it's as simple as that.
>> You also mention that we have an excellent product. I believe that
>> our 'product' is so laterally flattened by different practice
>> patterns and theories that is hard to even define our product.
>> Ron
>> =============================================
>> On 8/28/2003,[EMAIL PROTECTED] wrote:
>> JW> Re: [OTlist] PT does it all!!Amanda:
>> JW> I agree. We have an excellent product, just have a lesser brand
>> JW> name. A few weeks ago, I had posted how a show on Discovery
>> channel JW> kept showing OTs and called everything PT. Although, both
>> JW> professions developed almost side by side, it is interesting to
>> see JW> the difference in the public perception and acceptance that
>> comes JW> from it.
>> JW> Ron, it is a reality. Though not all PTs practice what we OTs JW>
>> thought or still think is our domain, but more and more are, JW>
>> especially since it's been published under their practice acts by JW>
>> APTA. The PT profession does aim at being a wholesome 'rehab/ JW>
>> therapy' provider. And, it is highly endorsed by APTA. Although, JW>
>> AOTA endorses a similar stance, I just don't see enough enthusiasm/
>> JW> confidence within the profession, let alone public education.
>> Would JW> we be phased out of public image further with PT's expanded
>> scope? JW> Is it truly an expansion of PT's scope now, or as they
>> claim, just JW> given the right words for what they have always been
>> doing? What is JW> our true unique domain then, something that only
>> we can and only we JW> are allowed to do ( restricted acts)? Or, is
>> there one? What is PT's JW> compared to ours? These questions are
>> hopefully being answered by JW> someone at APTA and AOTA as these
>> professions are heading towards a JW> very interesting decade or two
>> ahead of us. I expect some major JW> changes not only in how the way
>> we practice and our professions end JW> up by 2020, but also how the
>> outside world perceives us as we JW> struggle in this interesting
>> healthcare market. Joe
>> JW> ----- Original Message ----- From: Amanda K. Dobyns To: JW>
>> [EMAIL PROTECTED] Sent: Thursday, August 28, 2003 8:00 PM Subject: JW>
>> Re: [OTlist] PT does it all!!
>> JW> Unfortunately, the young girl who was quoted in the story
>> probably JW> did not understand the difference between the two types
>> of therapy JW> she received during her rehabilitation. In my limited
>> clinical JW> experience, I have been called a PT more times than you
>> would JW> believe. I think it goes to show that more client education
>> is JW> necessary if our profession is to be better understood.
>> JW> Amanda
>> JW> on 8/28/03 7:20 PM, Ron Carson at [EMAIL PROTECTED] wrote:
>> JW> > Hello:
>> JW> > Today, at a medical supply company, I picked up the Spring 2003
>> JW> edition > of a magazine called "FAAST Access". The magazine has
>> JW> something to do > with assistive technology. On page 19 there's a
>> JW> story line about a young > girl with a spinal cord injury and how
>> JW> her life was made better by a > piece of technology. Now, here's
>> JW> the really unfortunate part of the > story.
>> JW> > I quote:
>> JW> > "As soon as I was able, I started physical therapy to improve
>> my JW> > independence with daily activities. The therapists were able
>> to JW> teach me > how to dress and perform all of my daily
>> activities, JW> except getting in > and out of my chair from the
>> floor."
>> JW> > So, not only is the PT profession saying that they teach JW>
>> self-care, > magazine articles are doing it as well. By the way, JW>
>> this is not the > first time I read about PT teaching daily JW>
>> activity.
>> JW> > Ron
>> JW> > JW>
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