Well, it's artificial in the sense the occupation doesn't start and stop above the waist....
Finally, a short message... <<<smile>>> Ron -- Ron Carson MHS, OT ----- Original Message ----- From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Sent: Saturday, August 30, 2008 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] Elbow Break, Referral... cac> I don't thing the separation is artificial at all.? Just look at what we cac> learned in school during our orthopedic classes.? Not saying it is right, it is cac> just the experience of the professors at my class?and in the profession from what cac> I can tell. cac> -----Original Message----- cac> From: Ron Carson <[EMAIL PROTECTED]> cac> To: LRappap765 <OTlist@OTnow.com> cac> Sent: Sat, 30 Aug 2008 6:23 pm cac> Subject: Re: [OTlist] Elbow Break, Referral... cac> To follow the below logic, doesn't a patient need to increase ROM to cac> sit on the toilet? Doesn't the patient need to reduce pain to get into cac> the shower? cac> My point is that there is this artificially created separation where cac> OT expertise is ONLY above the waist. I think we either need to expand cac> our musculoskeltal expertise to include the whole body, or stop cac> focusing on the UE. cac> And it is up to the patient to understand what we are doing. For one, cac> it allows the patient to be part of the process, not a bystander. cac> Regarding need to increase elbow function to "hook a bra" or "reach cac> for a kettle", I don't know that the patient wears a bra or reaches cac> for a kettle. I understand that you don't mean these specific things, cac> but in a patient-centered approach to OT, when possible, the patient cac> drives the goal-making process, not the therapist. cac> IF this patient said, you know I really want put on my bra but this cac> dang elbow just won't let me, then I'd say 100% OT is the correct cac> profession. But if I say, "I'm going to increase your elbow function cac> so you can put on your bra", isn't that PT? cac> If I had an elbow fracture, and I did about 7 years ago, the VERY LAST cac> thing on my mind was fastening my bra (joke). Really though, it was cac> hard for me to zip my pants but that wasn't my concern. My concern was cac> the pain and the loss of ROM. If I went to a therapist and he said cac> what's your goals, I would say; 1. decrease my pain and 2. increase my cac> ROM. If they came out with questions about dressing I'd say, "yeah, cac> you meet the above goals and I'll be able to dress myself" cac> Making occupational goals when patients are not concerned about cac> occupation makes very little sense. What does make sense is fixing the cac> problem causing the occupational issues. And I believe that if that's cac> the case, and that's the focus and it's musculoskeltal issue, it cac> should go to the PT. cac> And, do you know of situations where is the ONLY provider when a cac> patient has a recent hip fracture or hip replacement? Or, wha cac> t about a cac> TKR, I've never seen OT being the only therapist. So, why is OT often cac> the only provider when an UE is injured? These are all situations cac> where a musculoskeltal issue impacts occupation, so why isn't OT cac> involved in the remediation of these issues? cac> Gosh, I hate long messages.......................... cac> Ron cac> -- cac> Ron Carson MHS, OT cac> ----- Original Message ----- cac> From: LRappap765 <[EMAIL PROTECTED]> cac> Sent: Saturday, August 30, 2008 cac> To: OTlist@OTnow.com <OTlist@OTnow.com> cac> 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, cac> [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 cac> 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 cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
