I don't thing the separation is artificial at all.? Just look at what we learned in school during our orthopedic classes.? Not saying it is right, it is just the experience of the professors at my class?and in the profession from what I can tell.
-----Original Message----- From: Ron Carson <[EMAIL PROTECTED]> To: LRappap765 <OTlist@OTnow.com> Sent: Sat, 30 Aug 2008 6:23 pm Subject: Re: [OTlist] Elbow Break, Referral... To follow the below logic, doesn't a patient need to increase ROM to sit on the toilet? Doesn't the patient need to reduce pain to get into the shower? My point is that there is this artificially created separation where OT expertise is ONLY above the waist. I think we either need to expand our musculoskeltal expertise to include the whole body, or stop focusing on the UE. And it is up to the patient to understand what we are doing. For one, it allows the patient to be part of the process, not a bystander. Regarding need to increase elbow function to "hook a bra" or "reach for a kettle", I don't know that the patient wears a bra or reaches for a kettle. I understand that you don't mean these specific things, but in a patient-centered approach to OT, when possible, the patient drives the goal-making process, not the therapist. IF this patient said, you know I really want put on my bra but this dang elbow just won't let me, then I'd say 100% OT is the correct profession. But if I say, "I'm going to increase your elbow function so you can put on your bra", isn't that PT? If I had an elbow fracture, and I did about 7 years ago, the VERY LAST thing on my mind was fastening my bra (joke). Really though, it was hard for me to zip my pants but that wasn't my concern. My concern was the pain and the loss of ROM. If I went to a therapist and he said what's your goals, I would say; 1. decrease my pain and 2. increase my ROM. If they came out with questions about dressing I'd say, "yeah, you meet the above goals and I'll be able to dress myself" Making occupational goals when patients are not concerned about occupation makes very little sense. What does make sense is fixing the problem causing the occupational issues. And I believe that if that's the case, and that's the focus and it's musculoskeltal issue, it should go to the PT. And, do you know of situations where is the ONLY provider when a patient has a recent hip fracture or hip replacement? Or, wha t about a TKR, I've never seen OT being the only therapist. So, why is OT often the only provider when an UE is injured? These are all situations where a musculoskeltal issue impacts occupation, so why isn't OT involved in the remediation of these issues? Gosh, I hate long messages.......................... Ron -- Ron Carson MHS, OT ----- Original Message ----- From: LRappap765 <[EMAIL PROTECTED]> Sent: Saturday, August 30, 2008 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] Elbow Break, Referral... L> Hi, L> I don't think it's so unusual for a patient to focus on L> eliminating pain. I don't think it means they are not interested L> in occupations. Aren't we doing both things? Doesn't she need to L> increase active elbow extension to hook her bra on, or L> reach for the kettle to make tea. Just because she doesn't L> articulate these things doesn't mean that' L> s not the goal, does it? Isn't it really up to the OT to see the L> link and make the connection and Maybe impart an understanding to L> the patient. It's really up to us to understand what we do and L> why, not the patient. Also, Using a cane safely also seems like L> it falls in our domain. Just my 2 cents... L> Linda Rappaport, MS, OTR/L L> In a message dated 08/30/08 15:49:07 Eastern Daylight Time, [EMAIL PROTECTED] writes: L> Received a new referral for a elbow fracture. I shouldn't have taken L> it but I did. L> And here is the dilemma facing our profession. The patient is 95, L> previously living independently. Fractured elbow in a fall. Now living L> with daughter. She is in a large amount of pain. Obviously, she is L> dependent for most of her occupations. She currently uses a cane but L> is not safe. L> The patient's immediate concerns are her elbow. When pressed, she of L> course wants to go back home, but that is not an immediate goal. L> So what do I write for goals? For example should I write: L> Patient will self-report pain as 3 out of 10 L> Patient's will increase active elbow extension to -20 degrees L> These goals seem to direct the patients and doctor's concerns but are L> not occupationally oriented. So, should I write: L> Patient will safely and independently dress lower body L> Patient will safely and independently ambulate to the bathroom L> using the least restrictive mobility aid L> I like these goals but they don't address the immediate concerns. L> Ron L> -- L> Ron Carson MHS, OT L> -- L> Options? L> www.otnow.com/mailman/options/otlist_otnow.com L> Archive? L> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
