Hi Joan and thanks for your insight! May I ask what you would want an OT to work on with you though before you had sufficient range to fasten your bra behind your back, if increasing the range of motion or adapting the task (i.e fastening int he front) were not options you would want?
IMO, when therapists resort to cones, etc, it is not because they are lazy, it is because they don't know what else to do, either because they only have experience in work settings where cones and pegs were used, or they are in a subactute setting where they are seeing multiple people at once. Of course that is not ideal, but it is reality. I for one would like to move into this more ideal realm and change the way I practice, but there is precious little practical "how to's" for doing this, especially in settings like mine, where there is no kitchen, ADL suite, etc, and it is impossible to see everyone one on one for ADL's. There is no course that I can find on taking OT back to the functional in today's money-driven practice settings, in fact I have never seen a shoulder course for OT that doesn't focus on increasing range and other medically-based PT-type interventions. Even here, many people say "do this" but very few say specifically HOW or offer any practical ideas for the therapists stuck in peg/cone world who want to be more functional but are up against a practice world that just wants numbers. If you or anyone can offer any practical advice, point to a book or course to help therapists work more functionally with patients (who often, in a nursing home setting, can't even come up with goals of their own or answer "nothing" or "watch TV" when asked what they would like to be able to resume doing) I would be most appreciative. Thanks, Ilene Rosenthal, OTR/L Message: 1 Date: Tue, 17 Feb 2009 11:30:40 -0700 From: "Joan Riches" <jric...@telusplanet.net> Subject: Re: [OTlist] purposeful activity To: <OTlist@OTnow.com> Message-ID: <!~!uenerkvcmdkaaqacaaaaaaaaaaaaaaaaabgaaaaaaaaaqpieeyoaqeeuzxp6qay++8kaaaaqaaaa8ulnq9shyumb39sehxogoqeaa...@telusplanet.net> Content-Type: text/plain; charset="US-ASCII" Greetings to all I couldn't resist this one. In my opinion (like Ron's) all activity has purpose for someone or something (witness the reproduction of plants) . The OT question re the activities we use as treatment interventions is: Does this activity have purpose and therefore meaning for this client in terms of their explicit and implicit occupational goals? I absolutely agree with Ron's goal formulation where the only goal is some form of OCCUPATIONAL performance. (In the presence of cognitive deficits this becomes a much more difficult question.) Below is my personal physical and OT/PT case example. I've been thinking about it a lot in my present situation and how it plays out. I am still after 14 months working on the stability of the hip that was pinned and the range and strength in the shoulder with a nondisplaced fracture. Although I am determined not to walk or run with the typical 'hip' gait or to limit my reach and ability with my arm I find it very difficult to persist in activities that are not useful and meaningful 'at the time'. Especially now that the physical limitations are only apparent when I'm challenged - trying to walk a distance across a large parking lot quickly to keep an appointment for instance or helping to unload plywood from the truck or screwing a light bulb into a ceiling fixture - it is easy to have 'life' push out the daily excercises. I am not of the generation the 'works out for the sake of'. I have a brilliant and understanding PT. He knows the 30 to 45 straight minutes a day will just not get done. He knows that I want to recover not adapt. So he knows what I need to do and collaborates with me to find ways to incorporate the movements into my regular activities such as mindfully using the stairs, varying pace, not using the railings to pull myself up etc. The stairs themselves cue me as do the top shelves in the kitchen where I store at least three things that I use for breakfast each morning. My morning routine now includes an exercise where I need a significant break between sets. So I do a set and then clean my teeth etc. thus being purposeful with the 'dead' time. There is an exercise for my shoulder for which I need help. This has been tacked on to my husband's regular morning care. I do his compression stockings and he does my shoulder. Bob checks my style and is available if I have questions but my next visit will be in eight weeks - down from six the last time - down from 3X/week when we started. I have no doubt at all that what Bob does for me is PT. His purpose is directed to foundation abilities and what else affects my occupational performance is not his concern. Over time he sees my delighted reporting of the things I can do as evidence that his treatment of the foundation skill is effective. I have a good team with a PT and an OT(me). My occupational goals include all the things that I need to walk or run, reach, carry or support including the effective use of my hands to be able to do - however measureable goals are demanded from us. So for the shoulder I have picked one daily activity - doing up my bra that is a measureable goal to monitor progress. (can now do effectively but with some discomfort). So PT goal - to increase shoulder range and strength to facilitate dressing. OT goal - to fasten bra with both hands behind the back without discomfort. This is a good fit and focus for me - what would work for someone else in a similar situation will depend on whether it is an important thing to be able to do. Many women adapt by doing it up in front and twisting it around. Conclusion 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. The progress in the physical foundational skill is so easy to measure but it leaves out all the other the factors that also affect occupational performance. Thanks for reading this far. It has been a joy to see all the new members coming on. I haven't been at all active on the list lately partly because to say everything I want to takes me so long to type. I would very much appreciate your comments and feedback. So many topics to wade into - the discussions are bearing great fruit, I think. Soft theory - so important. Blessings, Joan 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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
