A while back on an AOTA forum, I was "criticized" for working on mobility when there were not obvious occupational forms present (i.e. toilet, shower, chairs, etc). At least one person's contention was that working on mobility in the absence of an occupational form is not OT. I want to share a quick case study which highlights why I take exception with the person's comments.
For the sake of brevity, I'll keep "Jane's" case study as simple as possible. #################################################################### Jane has a spinal condition leaving her with partial lower extremity paralysis. The patient's initial goals are of course to walk but also to transfer to her toilet, shower, etc. Again for brevity, she wants to learn "skills for the job of living". Initially, the patient was unable to stand, so we began working on standing. This required maximum, and I mean max, assistance x1. At this early stage, the patient was unable to use a walker. After a week or so, I progressed the patient to a walker, but she still required knee blocking to stand. Eventually, the patient was able to stand without knee blocking and finally began taking steps. After she was able to walk 10-15 feet with a rolling walker, we tried transfers from wheelchair to wheelchair. This was very difficult and required continuing practice. After approximately 6 weeks of almost daily OT, TODAY, the patient transferred from her w/c to her toilet using a walker. She required assistance with sit to stand and cuing with the transfer but it was essentially her doing the transfer. This is a huge milestone for this patient and made her VERY happy and optimistic that her life was going to again have some semblance of "normal". ################################################################## Now, in my opinion, I have been working on occupation from day ONE! The patient had occupation-related deficits, her barriers were identified I was competent to address those barriers and the patient had good potential to make significant progress towards her goals. So what do you think? Should OT work on mobility/ambulation in the immediate absence of occupational forms? Should OT address mobility from the very beginning, if mobility is a barrier to occupational goals? I'm interested to hear what other's say! Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
