Hello Rebecca: Thanks for "stepping up" and writing. Here's my "simple" approach to OT.
Evaluate the patient to determine their "problems". Isolate the cause of the problems. Identify those problems having the greatest chance for correction. Once you determine that a problem can't be corrected, work on adaptation. If adaptation isn't successful, then discharge! As I said, it's simple but it's generally how I approach most of my therapy. Here's case in point. I evaluated a patient 3 weeks ago. She lives in an ALF. She has multiple orthopedic problems including: 1. Left torn rotator cuff - s/p three years 2. Right shoulder OA 3. Bi-lateral knee OA 4. Depressed mood. She currently depends on a manual w/c and mod assistance for her mobility related living skills. But, the manual w/c is not effective secondary to her ortho problems. OK, so, what and who cares, right! Well, during the eval she was able to identify that she wants to be able to eat without spilling her food/drink and she wants to be able to walk to her bathroom. So, I writ the plan of treatment, including goals of feeding herself without spilling and using a rolling walker to access her bathroom/dining room. So, off to work I go! My manual therapy has not been successful for remediating the patients right shoulder problems and she has not been able to tolerate using a walker to safely and effectively access her bathroom/dining room. I've attempted adapting her eating style but it has not been effective. I've recommended a referral to a ortho doctor to better isolate her shoulder dysfunction. Just today, I did a power wheel chair eval. She needs additional training before I can recommend the power w/c. If she is unable to safely use the w/c and the ortho report comes back negative, then I will d/c her. But, through ALL of this, the patient just told me yesterday that I had really helped her. I suspect that our relationship has been the biggest help! And, I NEVER underestimate the power of SELF to effect change in patients! OK, that was quickly written so disregard typos, OK? Does this help? Every patient is unique and different but the process is basically the same. I should also point out that about the same time I was seeing this patient, I got a referral for another patient down the hall. The patient's primary complaint was depressed mood and debilitation s/p a long hospital stay. Well, despite several visits with this lady (whom I'd previously seen), I was unable to establish treatment goals. So, I checked in on her every couple of days, but I did NOT pick her up as a patient. No goals = no therapy!! I don't know if any of this helps but for me, the MOST liberating thing that I discovered about being an OT is that I can actually address the most important things in my patient's lives!! Here's a word of caution. If you evaluate people with mobility problems, with very few exceptions, they will want you to address their mobility issues. Since I work alone, I don't worry about boundary issues with PT but I understand that most OT's work alongside PT and that PT addresses mobility. But, that does not mean that as an OT, you also can't address mobility. For example, my experience is that most PT's work primarily with gait. What you can do, is take patient's gait and apply to their daily lives. For example, just because a patient can walk across the gym, that doesn't mean that they can go into the bathroom, turn on the light, position themselves near the toilet, lower their pants, etc.... As an OT, you should make sure that client's are able to safely use their mobility aide to allow them to complete their daily living. If they can't (maybe because it's too big, or not sturdy enough), you can consult with the PT and say something like: "You know, that patient's doing well with that standard walker, but they are fatiguing too quickly while dressing. They will benefit from a rolling walker to reduce their fatigue." In this manner, OT and PT are truly working to betterment of the patient, and they are not duplicating services and stepping on each other's toes (at least, not too much) <smile> OK, I'm done! Ron ----- Original Message ----- From: Rebecca Holloway <[EMAIL PROTECTED]> Sent: Wednesday, February 21, 2007 To: otlist@otnow.com <otlist@otnow.com> Subj: [OTlist] don't tell me what NOT to do, tell me what TO do... RH> Hello, RH> I am an older, newish OT and I understand why using pegs, RH> cones and loops are not functional activities. RH> I have used peg boards before to play a solitaire type game RH> when someone is standing statically and for a couple of low RH> functioning dementia patients after falls injuring shoulders. For RH> some reason these types of activities engage the dementia patients RH> more than actual ADL or exercise. RH> Anyway, I am sure I am not the only newish OT on this list RH> and I would like to know suggestions of functional activities that RH> can be performed instead of using the old methods that seem to be RH> in every OT dept. I can surely think of some, but I think another RH> opinion is helpful and may be helpful to more people than just RH> myself. RH> Rebecca, OTR/L RH> Minneapolis MN RH> --------------------------------- RH> Need a quick answer? Get one in minutes from people who know. RH> Ask your question on Yahoo! Answers. -- 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 **************************************************************************************
