Hello Diane:
Thanks for writing.
I want to encourage you to try and see things a little differently.
You said:
"Instead of timing someone with a stopwatch for standing
balance, I find out what table top activities are meaningful
to them and have them stand while engaging in those
activities. "
Unless a particular activity is a patient's stated goal, I suggest NOT
having patients standing at table doing activities. Instead, engage
patients in those occupations which are impeded by decreased standing
balance, endurance, etc. For example, if a patient can't get their
clothes from the closet because they can't stand with their walker,
then work on standing with a walker. If a patient can't ambulate to
get their clothes, then work on mobility with a walker. Get away from
the table top and move out into the "real world"! <smile>
I also think that using a stop watch has merit because it gives the
patient tangible and visual feedback on improvement. While standing
for a certain amount of time should NEVER be a goal, patients can be
highly motivated by seeing improvement in standing endurance. I
recently d/c a home health patient whose had a goal to ambulate from
her bed to her toilet. Treatment started with standing bedside. Her
initial standing tolerance was 10 secs. I recorded this time and every
time there after, not because they were goals, but because they were a
measurement of progress towards her goal.
Ron
--
Ron Carson MHS, OT
----- Original Message -----
From: Diane Randall <[EMAIL PROTECTED]>
Sent: Saturday, November 29, 2008
To: OTlist@OTnow.com <OTlist@OTnow.com>
Subj: [OTlist] AARGH!
DR> Ron, I am a COTA student. I believe part of he problem is that media is not
DR> being taught in OT school. There are two programs in our area. Our program
DR> requires two media classes where we have to learn everything from knitting
DR> to ceramics. Our teacher frowns upon "clothespins" and "cones" and makes us
DR> up come up with a ideas that are functional and creative and meaningful to
DR> the patient when we are treatment planning. The other program in the area
DR> offers no media classes. At first, I could not understand why we were
DR> learning so many crafts and why we were constantly forced to think outside
DR> the box. Now that I am ready for my internship program, I see the benefit. I
DR> have been taught to have a "bag of tricks" when I treat patients. Instead of
DR> timing someone with a stopwatch for standing balance, I find out what table
DR> top activities are meaningful to them and have them stand while engaging in
DR> those activities. It is about taking the time to know your patients, however
DR> briefly, and engaging them in activity that will sustain their attention and
DR> interest. I know emphasis has been placed on productivity and profit seem to
DR> have taken over some facilities. I think we can do both if we create our own
DR> "bag of tricks" for our patients. It does have to be time consuming.Diane
DR> -----Original Message-----
DR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
DR> Behalf Of Ron Carson
DR> Sent: Saturday, November 29, 2008 04:36
DR> To: Deann Bayerl, MS OTR/l
DR> Subject: Re: [OTlist] AARGH!
DR> I sort of struggle to understand how OT's who set up patients on
DR> simple, redundant and often inappropriate activities are not "bad". I
DR> understand the productivity push, but I don't understand being so lazy
DR> that the best a therapist can do is clothespins, pegs, etc.
DR> And I don't think it's that so many OT's are physically lazy as they
DR> are mentally lazy. OT's have allowed themselves to be backed into a
DR> corner of meaningless and silly activity that is often more
DR> diversional than therapeutic. It seems that some OT's are quite
DR> comfortable in the back seat of the rehab. In my opinion, these OT's
DR> should be ashamed of their practice patterns.
DR> Ron
DR> --
DR> Ron Carson MHS, OT
DR> ----- Original Message -----
DR> From: Deann Bayerl, MS OTR/l <[EMAIL PROTECTED]>
DR> Sent: Friday, November 28, 2008
DR> To: otlist@otnow.com <otlist@otnow.com>
DR> Subj: [OTlist] AARGH!
DBMOl>> Ron,
DBMOl>> I do understand your frustration, even more so from having spent some
DR> time
DBMOl>> in IP rehab. Here are two of the problems outside of lack of
DBMOl>> creativity....productivity and required IP pt rehab hours. Although I
DBMOl>> preferred to work with pts on ADLs in the am, b/c they were the most
DBMOl>> relevant, some of those pts had to be down to pt at an early hour &
DR> you just
DBMOl>> can't get to all of them (although you CAN shift your schedule around
DR> from
DBMOl>> day to day, but in my experience this was not often done). Thus the
DR> next
DBMOl>> part of the day was often working with pts in the rehab room, where
DR> there
DBMOl>> was a considerable push for working with more than one pt at a time.
DBMOl>> Instead of working with them together, they were often set up a
DR> separate
DBMOl>> 'stations' and given a task that they could do without 1:1...thus the
DBMOl>> towels, clothespins, bead sorting, etc. It takes thinking outside the
DR> box to
DBMOl>> set up a session that is both meaningful and therapeutic; which is
DR> often not
DBMOl>> the case on a day to day basis. It's not that these are not good
DR> OT/OTAs,
DBMOl>> they just are not creative. I've seen this in OT and I also saw this
DR> for
DBMOl>> many years in my previous profession as a teacher. There are those
DR> truly
DBMOl>> dedicated to the profession and those that see it as a job that pays
DR> the
DBMOl>> bills. No matter where you work, there will be people of both types.
DR> The
DBMOl>> best we can do is be the former and put in the extra effort to
DR> provide
DBMOl>> meaningful therapies and explain to our clients why and how the
DR> particular
DBMOl>> activities we choose are therapeutic and pivotal to OT.
DBMOl>> d
DBMOl>> -----Original Message-----
DBMOl>> From: [EMAIL PROTECTED]
DBMOl>> [mailto:[EMAIL PROTECTED] On Behalf
DBMOl>> Of [EMAIL PROTECTED]
DBMOl>> Sent: Thursday, November 27, 2008 3:00 PM
DBMOl>> To: otlist@otnow.com
DBMOl>> Subject: OTlist Digest, Vol 48, Issue 2
DBMOl>> Send OTlist mailing list submissions to
DBMOl>> otlist@otnow.com
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DBMOl>> or, via email, send a message with subject or body 'help' to
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DBMOl>> Today's Topics:
DBMOl>> 1. AARGH! (Ron Carson)
DBMOl>> 2. Re: AARGH! (Lehman, David)
DBMOl>> ---------------------------------------------------------------------
DR> -
DBMOl>> Message: 1
DBMOl>> Date: Thu, 27 Nov 2008 06:37:53 -0500
DBMOl>> From: Ron Carson <[EMAIL PROTECTED]>
DBMOl>> Subject: [OTlist] AARGH!
DBMOl>> To: OTlist@OTnow.com
DBMOl>> Message-ID: <[EMAIL PROTECTED]>
DBMOl>> Content-Type: text/plain; charset=windows-1252
DBMOl>> I evaluated a home health patient who was just out of rehab
DR> secondary
DBMOl>> to a total hip replacement. This is a 55 y/o who was
DR> previously
DBMOl>> independent.
DBMOl>> During the eval, I asked her if she receive OT in rehab. She
DR> rolled
DBMOl>> her eyes and explained that the OT's had her folding towels at a
DR> table
DBMOl>> and standing at a table playing cards.
DBMOl>> I will NEVER, EVER understand why so many OT's have client's
DR> doing
DBMOl>> essentially meaningless activity when there are so many other
DR> NEEDS
DBMOl>> and DESIRES.
DBMOl>> Why do OT's stand with patients at a table playing cards? It makes
DR> NO
DBMOl>> sense because it's contextually incorrect. Who plays cards
DR> standing?
DBMOl>> And why will OT's stand with patients but won't take the initiative
DR> to
DBMOl>> address mobility issues such as getting clothes from the
DR> closet,
DBMOl>> ambulating to the toilet, etc?
DBMOl>> On that happy note <smile>, HAPPY THANKSGIVING!!!
DBMOl>> Ron
DR> --
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