Hi Ron Yes you're right and what I was probably thinking was 'some of you' shy away from only setting one goal. In my example I only have one measurable goal and I find that it really helps clients to have one thing that they want, can watch and see progress with. Then they are open to setting further goals. What kind of rules do you have regarding discharge once goals are met? Is this a reason why some therapists want to have multiple goals initially?
Joan Riches B.Sc.O.T., OT(C) Specialist in Cognitive Disability Riches Consulting High River, Alberta, Canada 403 652 7928 -----Original Message----- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: February 17, 2009 8:11 PM To: Joan Riches Subject: Re: [OTlist] purposeful activity Hello Joan: Thanks for your personal and professional insight. I hate to only comment on ONE thing, but something really struck me. You said: "Any deficit affects so much in present or future occupational performance that I think some of us shy away from limiting the reason for working on something to one goal." I think this is SO true! I don't know why therapist feel the need to write multiple goals. I frequently have only ONE goal. I'm curious to read others' comments on the topic of one goal! Thanks again!! Ron -- Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: Joan Riches <jric...@telusplanet.net> Sent: Tuesday, February 17, 2009 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] purposeful activity JR> Greetings to all JR> I couldn't resist this one. JR> In my opinion (like Ron's) all activity has purpose for someone or JR> something (witness the reproduction of plants) . The OT question re the JR> activities we use as treatment interventions is: Does this activity have JR> purpose and therefore meaning for this client in terms of their explicit JR> and implicit occupational goals? JR> I absolutely agree with Ron's goal formulation where the only goal is JR> some form of OCCUPATIONAL performance. JR> (In the presence of cognitive deficits this becomes a much more JR> difficult question.) JR> Below is my personal physical and OT/PT case example. JR> I've been thinking about it a lot in my present situation and how it JR> plays out. I am still after 14 months working on the stability of the JR> hip that was pinned and the range and strength in the shoulder with a JR> nondisplaced fracture. Although I am determined not to walk or run with JR> the typical 'hip' gait or to limit my reach and ability with my arm I JR> find it very difficult to persist in activities that are not useful and JR> meaningful 'at the time'. Especially now that the physical limitations JR> are only apparent when I'm challenged - trying to walk a distance across JR> a large parking lot quickly to keep an appointment for instance or JR> helping to unload plywood from the truck or screwing a light bulb into a JR> ceiling fixture - it is easy to have 'life' push out the daily JR> excercises. I am not of the generation the 'works out for the sake of'. JR> I have a brilliant and understanding PT. He knows the 30 to 45 straight JR> minutes a day will just not get done. He knows that I want to recover JR> not adapt. So he knows what I need to do and collaborates with me to JR> find ways to incorporate the movements into my regular activities such JR> as mindfully using the stairs, varying pace, not using the railings to JR> pull myself up etc. The stairs themselves cue me as do the top shelves JR> in the kitchen where I store at least three things that I use for JR> breakfast each morning. JR> My morning routine now includes an exercise where I need a significant JR> break between sets. So I do a set and then clean my teeth etc. thus JR> being purposeful with the 'dead' time. There is an exercise for my JR> shoulder for which I need help. This has been tacked on to my husband's JR> regular morning care. I do his compression stockings and he does my JR> shoulder. Bob checks my style and is available if I have questions but JR> my next visit will be in eight weeks - down from six the last time - JR> down from 3X/week when we started. JR> I have no doubt at all that what Bob does for me is PT. His purpose is JR> directed to foundation abilities and what else affects my occupational JR> performance is not his concern. Over time he sees my delighted reporting JR> of the things I can do as evidence that his treatment of the foundation JR> skill is effective. I have a good team with a PT and an OT(me). JR> My occupational goals include all the things that I need to walk or run, JR> reach, carry or support including the effective use of my hands to be JR> able to do - however measureable goals are demanded from us. So for the JR> shoulder I have picked one daily activity - doing up my bra that is a JR> measureable goal to monitor progress. (can now do effectively but with JR> some discomfort). JR> So PT goal - to increase shoulder range and strength to facilitate JR> dressing. JR> OT goal - to fasten bra with both hands behind the back without JR> discomfort. This is a good fit and focus for me - what would work for JR> someone else in a similar situation will depend on whether it is an JR> important thing to be able to do. Many women adapt by doing it up in JR> front and twisting it around. JR> Conclusion JR> Any deficit affects so much in present or future occupational JR> performance that I think some of us shy away from limiting the reason JR> for working on something to one goal. The progress in the physical JR> foundational skill is so easy to measure but it leaves out all the other JR> the factors that also affect occupational performance. JR> Thanks for reading this far. It has been a joy to see all the new JR> members coming on. I haven't been at all active on the list lately JR> partly because to say everything I want to takes me so long to type. I JR> would very much appreciate your comments and feedback. JR> So many topics to wade into - the discussions are bearing great fruit, I JR> think. JR> Soft theory - so important. JR> Blessings, Joan JR> Joan Riches B.Sc.O.T., OT(C) JR> Specialist in Cognitive Disability JR> Riches Consulting JR> High River, Alberta, Canada JR> 403 652 7928 JR> JR> -----Original Message----- JR> From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On JR> Behalf Of Ron Carson JR> Sent: February 17, 2009 4:16 AM JR> To: Diane Randall JR> Subject: Re: [OTlist] purposeful activity JR> In my opinion, all activity has purpose. Lifting weights, pulling pegs, JR> making cupcakes, bowling, etc. I truly can't think of any activity that JR> doesn't have a purpose. I think OT's often want to "claim" purposeful JR> activity as our mantra, but all profession have purposeful activity, JR> don't they? JR> Interestingly, when I was teaching a Human Occupation class, there were JR> 3 words student's could not use in class, the "a" word, the "p" word and JR> "f" word". JR> <a> = activity <p> = purposeful <f> = function JR> Thanks, JR> Ron JR> -- JR> Ron Carson MHS, OT JR> www.OTnow.com JR> ----- Original Message ----- JR> From: Diane Randall <spark...@rcn.com> JR> Sent: Tuesday, February 17, 2009 JR> To: otlist@otnow.com <otlist@otnow.com> JR> Subj: [OTlist] purposeful activity DR>> In your opinion, what makes an activity purposeful and how would you JR> go DR>> about making a non-ADL actvity purposeful? Thanks Diane OTAS JR> -- JR> Options? JR> www.otnow.com/mailman/options/otlist_otnow.com JR> Archive? JR> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.0.237 / Virus Database: 270.10.25/1957 - Release Date: 02/17/09 07:07:00 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
