Ron, I find myself in a very similar situation currently with a gentleman who
is s/p humeral fracture. He went to an urgent care clinic wear they x-rayed
him, gave him a sling and told him to wear it for 4 weeks, then wrote an order
for OT. I am seeing him under Medicare part B in his ALF facility. He is
reporting minimal pain, and even though it is his right (dominant arm), he
totally figured out how to compensate and was very functional during his
recuperation when he had limitation on weightlifting, etc. I debated back and
forth what to do--turf to PT or attempt to do what I hate to do (straight
exercises for the entire visit). Logistics prevailed and it was easier early
on for me to come to the man than for him to get to a PT, so I proceeded,
setting him up on graded range of motion programs. I have progressed him now
to the point where we are using occupation based interventions during our
sessions. But I will confess that I felt a
bit like a "fraud" during the early weeks when I was doing straight exercise
with him, because I wanted him to have the benefit of a skilled PT versus me, a
generalist who is not a fan of exercise as a main modality for OT. In fact,
now his main complaint is continued decreased ROM. It has gotten better, and he
is quite functional, but he wants 100% return. I am going to refer him to PT
and D/C him as I think I have maxed out what I can offer. Had this man been
status post surery, or a rotator cuff repair, I woud have turfed him
immediatley to the PT's.
I have enjoyed great realtionships with the PT's I've worked with over the
years and I think its becasue I let them do what they are experts at, and I do
that at which I am an expert (facilitating engagement in occupation). In fact,
more than once I have been thanked for acknowledging my limitations,
especially in the ortho category--I am very aware of the potential for trouble
because I saw first hand a bad outcome due to negligence on the part of the OT
. The OT thought she knew what she was doing in regard to shoulder rehab and
repeatedly put a client with a rotator cuff injury on the arm bike and
re-injured the man. Needless to say, that did not help our pofessional
credibilty one bit.
Terrianne
--- On Tue, 8/26/08, [EMAIL PROTECTED] <[EMAIL PROTECTED]> wrote:
From: [EMAIL PROTECTED] <[EMAIL PROTECTED]>
Subject: Re: [OTlist] Would You Treat For Refer to PT?
To: OTlist@OTnow.com
Date: Tuesday, August 26, 2008, 9:36 PM
Does she?not lift?with her right shoulder because of the high pain level?? If
she lives alone how will she take her trash out?? How will she load and unload
her groceries from her car?? How will she carry her laundry basket to her room
to put her clothes away?? Unless this lady has a fulltime maid, her life is a
little difficult right now.? Perhaps prompting the lady's memory isn't
such a bad idea, considering that her mind is probably focused on her high pain
level, and she is probably thinking to herself "Why does this guy have to
know that information, I just want him to work on my arm", and she is
giving you short answers, probably unaware that you were going to DC her. ?I
would start on goal oriented compensation techniques to get her through her
typical IADLs and a restorative program for her shoulder involving modalities,
soft tissue mobilization around the coracoid process, relaxation facilitation
techniques for?the shoulder,?and a graded therapeutic exercise program.? Based
on AOTAs position papers over the years, this is certainly an
appropriate?approach.? What is wrong with a bottom up approach starting with
body functions and gradually improving to graded functional activities when the
pain and the AROM improves significantly.? There is no way a patient like this
would improve based on a top down approach.? She would learn to compensate, but
from your evaluation it sounds like she wants her pain to improve, and for her
shoulder to improve to her normal baseline.? Why in the world wouldn't a
skilled OT with orthopedic shoulder?experience take this case?
As OTs it is in our scope of practice to treat shoulders, knees, backs, hips,
whatever, from a compensation and a restorative approach depending on the state
in which you practice.? Now based on our level of education I would not suggest
diving into restorative techniques for these areas unless you have had?extensive
training, and if your PT partner on the other side of the clinic is working on
the same thing.? Team work and communication is the key for those situations.
-----Original Message-----
From: Ron Carson <[EMAIL PROTECTED]>
To: Kari Rogozinski <OTlist@OTnow.com>
Sent: Tue, 26 Aug 2008 7:03 pm
Subject: Re: [OTlist] Would You Treat For Refer to PT?
Oops, I failed to mention that I my referral to PT was s/p my OT eval.
Everything the patient stated matched my observation of her movement.
Yes, it is her dominant side. She does not do much lifting with her
right arm, because of the pain. She does close in work with her right
arm, such as crocheting, eating, turning book pages, etc. But she does
no lifting with her right shoulder.
I also think that within the course of an evaluation, it's difficult
to assess ALL daily living tasks, (i.e. driving, washing dishes,
shampooing hair). What I do is extrapolate my observations and the
patient's reports to form a basis of "all" daily living.
However, it
is best to not say "all" when I don't really know that to be a
fact!
Ron
----- Original Message -----
From: Kari Rogozinski <[EMAIL PROTECTED]>
Sent: Tuesday, August 26, 2008
To: OTlist@OTnow.com <OTlist@OTnow.com>
Subj: [OTlist] Would You Treat For Refer to PT?
KR> Ron,
KR> ?
KR> I noticed that you said you asked the patient.? I find that
KR> usually when i have them perform specific tasks instead of asking,
KR> the findings don't match what is reported.? Don't you think she
is
KR> entitled to an evaluation at least and then decide which way to
KR> go.? It is hard for me to believe that she is safe and Independent
KR> with all daily living tasks.? If her dominant side is affected(
KR> I'm assuming she is right dominant), it makes me wonder how she is
KR> lifting things or carrying things with that side.? Is she using
KR> proper compensatory techniques or is she going to cause damage
elsewhere??
KR> --- On Tue, 8/26/08, Ron Carson <[EMAIL PROTECTED]> wrote:
KR> From: Ron Carson <[EMAIL PROTECTED]>
KR> Subject: [OTlist] Would You Treat For Refer to PT?
KR> To: "OTlist" <OTlist@OTnow.com>
KR> Date: Tuesday, August 26, 2008, 4:15 PM
KR> Received a new home health referral. Patient's diagnosis is
right
KR> shoulder pain. Patient presents with bicep tendon pain during AROM,
KR> PROM and palpation. She lives alone and is independent
with all her
KR> daily living tasks.
KR> I referred the patient to PT for the shoulder pain. Would you, as an
KR> OT, treat this patient?
KR> Thanks,
KR> Ron
KR> --
KR> Options?
KR> www.otnow.com/mailman/options/otlist_otnow.com
KR> Archive?
KR> www.mail-archive.com/otlist@otnow.com
KR>
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