Hello Lisa: Why take measurements if they aren't part of the goal? I do document when a patient has limited ROM, but I don't measure it.
Don't you measure ROM when a patient has a lower extremity impairment affecting function? Why not???? Ron -- Ron Carson MHS, OT ----- Original Message ----- From: L Sloan <[EMAIL PROTECTED]> Sent: Saturday, August 30, 2008 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] Elbow Break, Referral... LS> Ron...did i understand you to say you don't take ROM LS> measurements...why not???? I do take measurements or approximate LS> on every patient with Upper extremity impairment affecting their function???? Lisa LS> ----- Original Message ---- LS> From: Ron Carson <[EMAIL PROTECTED]> LS> To: Kari Rogozinski <OTlist@OTnow.com> LS> Sent: Saturday, August 30, 2008 7:54:38 PM LS> Subject: Re: [OTlist] Elbow Break, Referral... LS> Call me think-headed, but I don't see how those goals are any LS> different than PT. When I read the goals I see the primary focus on LS> decreasing pain and increasing ROM and the "functional" stuff is just LS> thrown in. And that's primarily what PT does. LS> OT knows there's a lot more to dressing than just physical LS> dysfunction.. There's the environment, cognition, motivation, family LS> issues, etc. With your goals, what happens if ROM is increase so LS> the patient SHOULD be able to dress but they still can't because the LS> family doesn't feel they are safe? According to your goals, the LS> patient is d/c. Either that or you'll need some new goals! LS> I will also suggest that goals should not be written unless it has LS> been assessed. In other words, I don't write ROM goals, because I LS> don't take ROM measurements. I do assess occupation and those are the LS> goals that I write. LS> Again, what the therapists assess should be the goals. And conversely, LS> if it's not assessed then it shouldn't be a goal. Also, goals must be LS> measurable and progress must be made. How can a therapist measure LS> progress towards a goal that is not initially measured? And, what LS> measure is going to be used? I will say the "increase functional LS> performance with bilateral UE tasks" is not exactly a measurable goal? LS> Now, if you assessed that the patient required mod assist to donn LS> her bra and the goal was "Pt will independently donn/doff bra", then LS> that's an OT assessment and goal. However, can you see this ladies LS> face when I ask her about how much assistance she need to put on her LS> bra, or pull up her underwear? She's going to think I'm nuts because LS> she wants me to fix her arm, not worry about teaching her to get LS> dressed! LS> Gosh, I hate long messages..... LS> <Sorry for typos/graphos> LS> Ron LS> -- LS> Ron Carson MHS, OT LS> ----- Original Message ----- LS> From: Kari Rogozinski <[EMAIL PROTECTED]> LS> Sent: Saturday, August 30, 2008 LS> To: OTlist@OTnow.com <OTlist@OTnow.com> LS> 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>> LS> -- LS> Options? LS> www.otnow.com/mailman/options/otlist_otnow.com LS> Archive? LS> www.mail-archive.com/otlist@otnow.com LS> -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
