Then adaptation and education might be indicated. Joan, in using the approach I outlined, there isn't a difference between treating people with cog deficits and phy deficits. In fact, that's the beauty of the approach; The focus is occupational performance, not underlying issues. And because the focus is on the universal phenomena of occupation performance, it applies to all people having occupation deficits.
Of course, that does not mean we don't treat those underlying issues, it simply means that issues aren't our measure. For example, I don't take ROM or muscle strength measures. To be sure, I range limbs and do manual muscle testing, but I almost never record measurements. Why? Because improving these measurements is not my goal. However, I may assess range and strength because these may be barriers to occupation. In practice, however, I usually have patients attempt desired occupational goals or preliminary steps to those goals. My observation of the patient's occupational performance gives me a much better picture of occupation barriers than simple strength/rom measurements. In summary, using the outline I provided, really serves to unify OT across its diverse treatment spectrum. Peds, adults, gero, neuro, etc. can all use a similar approach. As I was typing this another example of this model popped into my head. I just started treating a man with what is essentially fatigue. He's had lots of medical issues and was hospitalized for a long time. He just came home and I picked him up on home health. During my eval, the patient presented with Parkinson's like symptoms; slow speech, tremors, flat affect, etc., however, there was no neuro diagnosis. I wanted a better idea of his cognitive status, so I whipped out my trusty MMSE. Surprisingly, he scored 27/30, which is normal. So, why did I do the MMSE? Simply put, I wanted to see if cognition was a possible barrier to his occupational performance. In this case it wasn't. But if it were, I would have probably use his goals as treatment. Again, the goal, and hence the measurement, is not remediating the underlying issue but improving occupation. So, an occupation-based approach applies to OT working in phys-dys, cognition, pediatrics, neuro, etc. But unlike other approaches, an OT using an occupation-based approach has one single purpose and reason for being, and that is improving occupational performance. Thanks, Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Joan Riches <[EMAIL PROTECTED]> Sent: Friday, October 10, 2008 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] Best Practice and OT expertise JR> .........and if cognition cannot be remediated? JR> Joan -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
