Terrianne, Home care can be such a rewarding venue to work. It is a wonder that OT doesn't get more respect as part of the home care team. It all stems, at least I think, from the not being a qualifier thing. Jimmie
Terrianne Jones <[EMAIL PROTECTED]> wrote: Jimmie, you make some very good points about the use of exercise in the bigger picture of OT practice. If only most OT's actually practiced as you described, there would be no problem. Unfortunately, in my experience--I currently work in home care and SNF's trans care-rote exercise is the rule rather than the exception. OTR's are routinely observed in my SNF setting to be sitting with clients going through graded exercise programs day after day, for almost all of the clients therapy minutes. In fact, it got so bad last year that the rehab director, a PT (!), had to put up signs in the therapy area reminding the OT's that they must adress functional goals related to self care--apparently an audit of this facility revelaed that OT was using the therapeutic exercise code nearly to the exclusion of the other codes. This company is loaded with new grads who don't know any other way to practice. I theorize that many therapists do not really posess a good understanding of occupation and the theoretical underpinnings of our profession, so out of professional insecurity they grab onto things that look "legitimate" so they don't have to try to explain something they don't understand. I personally refuse to write goals related to exercises, though it is standard in both of my practice settings that OT writes a goal for upper extremity home exercise programs regardless of the clients situation. I write many home programs which focus on increasing engagement in occupation, and I find that in home care anyway, my clients are pretty motivated to participate, because the programs are created to support the occuaptions they value. Terrianne Jim Arceneaux wrote: One caveat though: Please don't get stuck in the ADL/function thing as well. OTs are too often identified as the ADL guys. This places us, in the eyes of non-rehab. disciplines, as glorified aides. Plus, the PT practice framework, or whatever they call it, states that PT's address ADL and function. OT is more complex than ADL or function. Also, in the "rants," as people called them, several individuals mentioned OTs need to stop doing exercise. I argue that exercise is no worse than doing mindless activities like bouncing around a balloon or digging pennies out of therapy putty. Neither is truly OT. But, we must understand that OT practice must utilize occupation as its treatment medium of choice while also employing other learned techniques to facilitate return to the patient's desired occupation. It is not a sin against the OT gods to do an exercise, but it is also not OT if your primary focus is exercise. If you had a patient that couldn't put his sock on because of hip capsular tightness following an ORIF (that had the potential to do this without a sock aid) would you run to the PT to ask them to improve the range for you so you can meet your goal. I hope not! It would be best to find a way through participation in an occupational task to improve this range, but if necessary why can't you provide service to meet an establihed OT goal. AS Chuck stated, there is nothing in my practice act that says I can't and the practice framework from AOTA supports the addressing of client factors (i.e. ROM) in meeting occupational goals. I'm not certain why so often fellow OTs will look at another OT performing an exercise as something akin to a PT, but state another OT is a fine example while watching them play balloon volleyball as I mentioned above. You also don't here OTs often stating that NDT is not OT. Well, really it isn't, but it can be utilized by an OT to facilitate participaton in occupation. The NDT is no different than an exercise. Another rant...Wow! Jimmie Chris Smith wrote: bHalleujah--so many PT wannabees in the field. I have only worked in one LTC facility out of five that addressed Adls in an appropriate manner and by only one of the COTA not the other two. Where I am now the OT who does the majority of the evals and writes an obligatory ADL goal rarely addresses them herself. I do home health for a company owned by the LTC facility and work both in house and in HH. After I complained to the rehab director (a PTA of course) that by pts coming out of the facility couldn't do ADLS she told everyone they had to do one adl "run through" before DCing--what an attitude. If all we ever bill is 97110 why do they need us? They can just hire PTs. Sorry for the rant. Chris _______________________________________________ Join Excite! - http://www.excite.com The most personalized portal on the Web! -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ************************************************************************************** --------------------------------- Everyone is raving about the all-new Yahoo! Mail beta. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ************************************************************************************** --------------------------------- Never Miss an Email Stay connected with Yahoo! Mail on your mobile. Get started! -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ************************************************************************************** --------------------------------- Access over 1 million songs - Yahoo! Music Unlimited. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **************************************************************************************
