I meant to add that just last week, a patient told me: "I've had lots of therapy in my life, but you are the only OT I ever met whose left hand knew what his right hand was doing".
I'm no great OT (I'm just an OT on a mission) so I don't say the above to toot my horn. Instead, I see it as a reflection on the other OT's who this lady had met. So, what might I do different from other OT's that inspired the comment? I'm not sure, but I suspect, that because I focus treatment on meeting patient occupational deficits and don't corner myself or patients into UE referrals, I learn a lot more about their needs and expectations. Focusing on occupation has so many advantages for OT and for our patients. But, even as good as OT can be, it obviously has it's limits. In fact, the person who said this to me was d/c after only one treatment session. Why? Because she and I agreed there was little that I could do to help her. But that conclusion was only reached after discussing her needs, providing suggestions and physically trying some things. But who knows, maybe if I would have seen her for more visits, she might say that I was the worst OT she ever met! But, talk about a narrow philosophy? The whole UE thing has us so backed into a corner that we can't even see beyond patient's belly buttons. Anyway, that's another discussion, right? Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Ron Carson <[EMAIL PROTECTED]> Sent: Wednesday, October 08, 2008 To: [EMAIL PROTECTED] <OTlist@OTnow.com> Subj: [OTlist] Best Practice RC> Chris, I'm not quite sure what solutions to discuss, but here's a RC> venture. RC> If the concern is that some OT's will lose their jobs, I believe that RC> many more OT positions will open up if OT's will change their practice RC> patterns. On the flip side, hand therapists might be best served if RC> they form their another profession. I truly think that hand therapy is RC> so specialized that much of the practice of "general" OT is lost. This RC> is similar to a brain surgeon. While he's been through med school, he RC> probably is not a good general practitioner, right? RC> Also, I take exception that my philosophy is narrow. In fact, adopting RC> an occupation-based approach to treatment significantly widens RC> treatment options and venues. An occupation-based approach moves OT RC> away from it's well-engrained pattern of UE therapy into a new an RC> wonderful world. RC> Ron RC> -- RC> Ron Carson MHS, OT RC> ----- Original Message ----- RC> From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> RC> Sent: Wednesday, October 08, 2008 RC> To: OTlist@OTnow.com <OTlist@OTnow.com> RC> Subj: [OTlist] Best Practice cac>> Any concrete solutions? cac>> Chris Nahrwold MS, OTR cac>> -----Original Message----- cac>> From: Ron Carson <[EMAIL PROTECTED]> cac>> To: [EMAIL PROTECTED] <OTlist@OTnow.com> cac>> Sent: Wed, 8 Oct 2008 8:31 pm cac>> Subject: Re: [OTlist] Best Practice cac>> I agree about the negativity of "contrived". But, I don't think cac>> "enabling" or "shaping" is what I'm talking about. cac>> I have never believed that hand therapy is occupational therapy. cac>> Ron cac>> -- cac>> Ron Carson MHS, OT cac>> ----- Original Message ----- cac>> From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> cac>> Sent: Wednesday, October 08, 2008 cac>> To: OTlist@OTnow.com <OTlist@OTnow.com> cac>> Subj: [OTlist] Best Practice cac>>> Ron, cac>>> I think the?phrase "contrived OT" is a very negative term to cac>>> describe what you are going for.? I think a better phrase could cac>>> be "shaping OT" or "enabling OT".? Your perspective of what OT is cac>>> is very narrow and boxed in.? Sure at it's worst a therapist can cac>>> take advantage of the system while having the patient perform cac>>> meaningless exercises and activities that will not have any cac>>> impact of the patient's daily occupations.? This as a result cac>>> makes our profession look horrible and uneducated.???But at its cac>>> best a highly skilled therapist can make a huge difference in an cac>>> individuals occupational needs?by means of "shaping or enabling cac>>> OT".? Lets not forget our highly skilled OTs that can make a cac>>> difference in the neuro population, burn patients, hand trauma, cac>>> etc etc.? You make it sound like these therapists are not OTs. cac>>> I think that you are good at identifying the problems in our cac>>> proffession, but can you offer?concrete solutions?? What do we do cac>>> with the therapists who help neuro patients regain function in cac>>> their UEs, or even?the typical hand therapists.? Some of us have cac>>> become experts in this relm of OT, and to pass the patients to cac>>> the PTs in this area would be a large injustice to the patient.? cac>>> In fact we would probably work ourselves out of a job if we cac>>> followed your narrow philisophy.? In fact there would be no more cac>>> hand therapists.? What would happen to all of those therapists?? cac>>> Would they all go back to school and become PTs??I believe that cac>>> would cause a bunch of problems in our profession. cac>>> Chris cac>> Nahrwold MS, OTR cac>>> St. John's Hospital cac>>> Anderson, Indiana cac>>> -----Original Message----- cac>>> From: Ron Carson <[EMAIL PROTECTED]> cac>>> To: Neal Luther <OTlist@OTnow.com> cac>>> Sent: Wed, 8 Oct 2008 8:03 am cac>>> Subject: Re: [OTlist] Best Practice cac>>> Thanks Neal. cac>>> I want to "pick apart" the below two statements: cac>>> ================================= RC>>>> "Is it so the patient will regain function? Is it so the patient RC>>>> can move their arm with less pain so that they can get dressed? RC>>>> Or is it because the treatments are DIRECTLY addressing a SPECIFIC RC>>>> barrier to a SPECIFIC occupation? NL>>>> [the above] seems to be saying the same thing. If the barrier is NL>>>> pain then one would address as appropriate. cac>>> ================================== cac>>> I think these statements can be explained using a continuum. Draw a cac>>> line and place opposing statements at each end: cac>>> X <------------------------------------> X cac>>> Tx to regain function Tx to regain specific occupation cac>>> [contrived OT] [pure OT} cac>>> For me, the hallmark of OT, and what separates us from other cac>>> professions, is occupation. To the best of my knowledge, we are the cac>>> only profession that claims occupation as an outcome and as treatment. cac>>> On an unrelated side note, while claiming occupation sounds good, it's cac>>> essentially meaningless because other professions have no knowledge of cac>>> occupation. None, the less, I believe that occupation is our claim to cac>>> fame. As such, it's my opinion that "pure OT" occurs when: cac>>> 1. Goals are written as occupational measures, (i.e. "By d/c cac>>> patient will safely and independently ambulate and transfer to cac>>> standard toilet and perform all toileting tasks"). cac>>> 2. Treatment is given to specific barriers which inhibit the cac>>> specific occupational measure. In this case, ALL treatment is cac>>> given with the assumption that improvement cac>> in the treated area cac>>> results in improved occupational performance. In this approach, cac>>> success is measured NOT in the treated area but in occupational cac>>> performance. cac>>> The other end of the continuum is "treatment to regain function" or cac>>> "contrived" OT. First, I think we must recognize that OT does not own cac>>> function. Other therapy professions provide treatme cac>>> nt to "regain cac>>> function" and function is a nebulous term that is hard to define. cac>>> Secondly, I use the word "contrived" because: cac>>> In this approach, OT treatment is not DIRECTLY connected to cac>>> specific occupation. The OT has NOT drawn a direct line between cac>>> stated occupational deficits and the treatment to improve these cac>>> deficits. In this approach, the OT may do e-stim and then have the cac>>> patient pickup cones, pegs, or do something like fold clothes. cac>>> This is "contrived" because it may not address the "real world" cac>>> demands of the patient's specific occupational demands. cac>>> At its worst, "contrived" OT is a "joke" because patients are cac>>> engaged in essentially meaningless and child-like games that are cac>>> an embarrassment to patients and our profession. cac>>> In theroy, the differences between "contrived OT" and "pure OT" are cac>>> clear-cut. However, in practice, the differences can be harder to cac>>> tease apart. cac>>> Thanks, cac>>> Ron cac>>> -- cac>>> Ron Carson MHS, OT cac>>> ----- Original Message ----- cac>>> From: Neal Luther <[EMAIL PROTECTED]> cac>>> Sent: Monday, October 06, 2008 cac>>> To: OTlist@OTnow.com <OTlist@OTnow.com> cac>>> Subj: [OTlist] Best Practice NL>>>> Your statement "Is it so the patient will regain function? Is it NL>>>> so the patient can move their arm with less pain so that they can NL>>>> get dressed? Or is it because the treatments are DIRECTLY NL>>>> addressing a SPECIFIC barrier to a SPECIFIC occupation? If it's NL>>>> anything but the later, I su cac>> ggest that something other than NL>>>> best-practice is being applied to your patients"...seems to be NL>>>> saying the same thing. If the barrier is pain then one would NL>>>> address as appropriate. cac>>> -- cac>>> Options? cac>>> www.otnow.com/mailman/options/otlist_otnow.com cac>>> Archive? cac>>> 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
