Ron...did i understand you to say you don't take ROM measurements...why
not???? I do take measurements or approximate on every patient with Upper
extremity impairment affecting their function???? Lisa
----- Original Message ----
From: Ron Carson <[EMAIL PROTECTED]>
To: Kari Rogozinski <OTlist@OTnow.com>
Sent: Saturday, August 30, 2008 7:54:38 PM
Subject: Re: [OTlist] Elbow Break, Referral...
Call me think-headed, but I don't see how those goals are any
different than PT. When I read the goals I see the primary focus on
decreasing pain and increasing ROM and the "functional" stuff is just
thrown in. And that's primarily what PT does.
OT knows there's a lot more to dressing than just physical
dysfunction.. There's the environment, cognition, motivation, family
issues, etc. With your goals, what happens if ROM is increase so
the patient SHOULD be able to dress but they still can't because the
family doesn't feel they are safe? According to your goals, the
patient is d/c. Either that or you'll need some new goals!
I will also suggest that goals should not be written unless it has
been assessed. In other words, I don't write ROM goals, because I
don't take ROM measurements. I do assess occupation and those are the
goals that I write.
Again, what the therapists assess should be the goals. And conversely,
if it's not assessed then it shouldn't be a goal. Also, goals must be
measurable and progress must be made. How can a therapist measure
progress towards a goal that is not initially measured? And, what
measure is going to be used? I will say the "increase functional
performance with bilateral UE tasks" is not exactly a measurable goal?
Now, if you assessed that the patient required mod assist to donn
her bra and the goal was "Pt will independently donn/doff bra", then
that's an OT assessment and goal. However, can you see this ladies
face when I ask her about how much assistance she need to put on her
bra, or pull up her underwear? She's going to think I'm nuts because
she wants me to fix her arm, not worry about teaching her to get
dressed!
Gosh, I hate long messages.....
<Sorry for typos/graphos>
Ron
--
Ron Carson MHS, OT
----- Original Message -----
From: Kari Rogozinski <[EMAIL PROTECTED]>
Sent: Saturday, August 30, 2008
To: OTlist@OTnow.com <OTlist@OTnow.com>
Subj: [OTlist] Elbow Break, Referral...
KR> I agree with Chris, I would take this patient and right all 4
KR> goals. The only exception is i would state why i was going to
KR> decrease the pain or increase ROM. I would probably say something
KR> like: Pt. will increase active elbow extension to -20 degrees to
KR> allow for increased independence with upper body dressing or
KR> decrease reports or pain to increase functional performance with
KR> bilateral upper extremity tasks (grooming, bathing, dressing, etc.)
KR>
KR> Ron, you have now given us examples of 2 patients you would not
KR> treat, I too am wondering what kind of patient would you see?
KR>
KR>
KR> Kari, MOT, OTR/L
KR> Hollywood, Florida
KR> --- On Sat, 8/30/08, [EMAIL PROTECTED] <[EMAIL PROTECTED]> wrote:
KR> From: [EMAIL PROTECTED] <[EMAIL PROTECTED]>
KR> Subject: Re: [OTlist] Elbow Break, Referral...
KR> To: OTlist@OTnow.com
KR> Date: Saturday, August 30, 2008, 5:21 PM
KR> I would write all 4 goals.? Why in the world would you not take this
patient??
KR> "I shouldn't have taken it but I did."? What patient's do you
KR> take?
KR> Chris Nahrwold MS, OTR
KR> St. John's Hospital
KR> Anderson, Indiana
KR> -----Original Message-----
KR> From: Ron Carson <[EMAIL PROTECTED]>
KR> To: OTlist <OTlist@OTnow.com>
KR> Sent: Sat, 30 Aug 2008 2:48 pm
KR> Subject: [OTlist] Elbow Break, Referral...
KR> Received a new referral for a elbow fracture. I shouldn't have taken
KR> it but I did.
KR> And here is the dilemma facing our profession. The patient is 95,
KR> previously living independently. Fractured elbow in a fall. Now living
KR> with daughter. She is in a large amount of pain. Obviously, she is
KR> dependent for most of her occupations. She currently uses a cane but
KR> is not safe.
KR> The patient's immediate concerns are her elbow. When pressed, she of
KR> course wants to go back home, but that is not an immediate goal.
KR> So what do I write for goals? For example should I write:
KR> Patient will self-report pain as 3 out of 10
KR> Patient's will increase active elbow extension to -20 degrees
KR> These goals seem to direct the patients and doctor's concerns but are
KR> not occupationally oriented. So, should I write:
KR> Patient will safely and independently dress lower body
KR> Patient will safely and independently ambulate to the bathroom
KR> using the least restrictive mobility aid
KR> I like these goals but they don't address the immediate concerns.
KR> Ron
KR> --
KR> Ron Carson MHS, OT
KR> --
KR> Options?
KR> www.otnow.com/mailman/options/otlist_otnow.com
KR> Archive?
KR> www.mail-archive.com/otlist@otnow.com
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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