I hate that question, "Why do want to improve ROM, etc". It's an obvious question with an obvious answer. Can you imagine a surgeon asking, why do you want me to fix your elbow?
Your strategy is different than mine. I asked the patient to drink, eat, etc with her affected extremity. She couldn't do any of them without compensation and pain. Being the "great" UE OT that I am, I told her to keep using her affected arm as much as possible to allow her to do the things she needed to do. I then suggest PT to help with her elbow function. The correlation between range/pain and function only provides a LIMITED view. It does not include several other factors such as motivation, environment, cognitions. In fact David and with due respect, your example is exactly how I think a good PT should look at function. But, and as I've said a millions times, my OT job is not restoring function, it's restoring occupation. David, regarding why the PT said they couldn't help, my only guess is because of the UE/LE divide... Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Lehman, David <[EMAIL PROTECTED]> Sent: Tuesday, October 21, 2008 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] UE Evauation Yesterday... LD> I first have to agree with Chris....but, my question is did you LD> ask the patient, "Why do you want the range of motion to improve, LD> and why do you want the pain to go away?" I emphasis a LD> movement-strategy-impairment approach to examination. I first LD> observe the patient perform functional tasks, decide if the LD> strategy is faulty, and then hypothesize why (i.e. what LD> impairments cause the faulty strategy in fu8nctional movements). LD> If the patient demonstrates for you particular functional LD> activites and the limitations of the strategy are evident, then LD> you can correlate for her how the range and pain affect function. LD> Secondly, I don't get it, Ron. Why did the PT say he/she could LD> not do anything for this patient? LD> David A. Lehman, PhD, PT LD> Associate Professor LD> Tennessee State University LD> Department of Physical Therapy LD> 3500 John A. Merritt Blvd. LD> Nashville, TN 37209 LD> 615-963-5946 LD> [EMAIL PROTECTED] LD> Visit my website: http://www.tnstate.edu/interior.asp?mid=2410&ptid=1 LD> This email and any files transmitted with it may contain LD> confidential information and is intended solely for use by the LD> individual to whom it is addressed. If you receive this LD> correspondence in error, please notify the sender and delete the LD> email from your system. Do not disclose its contents with others. LD> -----Original Message----- LD> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] LD> Sent: Tuesday, October 21, 2008 11:30 AM LD> To: OTlist@OTnow.com LD> Subject: Re: [OTlist] UE Evauation Yesterday... LD> Ron said: LD> "For sure,?? improving?? her?? elbow? function? will? improve? occupational LD> performance, but the patient's concern is NOT occupation." LD> If the patient is not concerned about her occupations why does LD> she want her elbow to improve in function? And the record player continues! LD> Chris Nahrwold MS, OTR LD> -----Original Message----- LD> From: Ron Carson <[EMAIL PROTECTED]> LD> To: OTlist@OTnow.com LD> Sent: Tue, 21 Oct 2008 9:19 am LD> Subject: [OTlist] UE Evauation Yesterday... LD> Hello Everyone: LD> Yesterday, I received a home health referral for a humeral LD> fracture/tricpes tendon reattachement. By now, I'm sure most regular LD> readers are aware of my stance on OT's NOT being UE experts. LD> Interestingly, PT had already evaled the patient and said they LD> couldn't do anything. LD> So, as I'm sitting there talking with the patient, I'm encouraging her LD> to use her affected UE for daily activity such as eating, dressing, LD> toileting. During this time, I'm thinking there just isn't much role LD> for OT. The patient's concern is ROM and pain, not occupation. For LD> sure, improving her elbow function will improve occupational LD> performance, but the patient's concern is NOT occupation. LD> As I'm sitting there pondering doing ROM, exercises and strengthening LD> the patient tells me that her doctor ordered outpatient PT. Since LD> patients can not be on home health while going to outpatient therapy, LD> I discharged the patient. LD> It was an awkward situation. The family and I discussed the LD> differences between OT and PT and how some OT's treat UE injuries. LD> Ron LD> -- LD> Ron Carson MHS, OT LD> -- LD> Options? LD> www.otnow.com/mailman/options/otlist_otnow.com LD> Archive? LD> www.mail-archive.com/otlist@otnow.com LD> -- LD> Options? LD> www.otnow.com/mailman/options/otlist_otnow.com LD> Archive? LD> www.mail-archive.com/otlist@otnow.com LD> -- LD> Options? LD> www.otnow.com/mailman/options/otlist_otnow.com LD> Archive? LD> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
