Dear Listserve,
In my 13 years as an OT, I've never been confronted with this situation. I have worked with adults and geriatric patients throughout my career. In my best attempt to cover for a pediatric OT several days this week, I have a treatment plan for a 15 year old girl that involves bathing. I'm a guy, a guy that feels uncomfortable working on this activity with a girl of that age group, where modesty is even more of an issue than is in for older females. It goes without saying that I would have a female present throughout the entire treatment involving bathing. But in this situation, no other OT's are any more experienced in pediatrics than I am and this patient has been assigned to me. Would I defer the bathing to a non-OT? In so doing, I would not be following the treatment plan and I would be deferring the training to a non-skilled professional. I would appreciate any timely guidance that anyone could offer me. Thank you, Curtis -----Original Message----- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of otlist-requ...@otnow.com Sent: Tuesday, April 21, 2009 7:23 PM To: otlist@otnow.com Subject: OTlist Digest, Vol 65, Issue 1 Send OTlist mailing list submissions to otlist@otnow.com To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com or, via email, send a message with subject or body 'help' to otlist-requ...@otnow.com You can reach the person managing the list at otlist-ow...@otnow.com When replying, please edit your Subject line so it is more specific than "Re: Contents of OTlist digest..." Today's Topics: 1. Re: A Typical Day, Is this Normal? (Carmen Aguirre) 2. promoting OT (Alayna Adams) 3. Welcome to Our Newest Member(s) (Ron Carson) 4. Breaking the Bonds of Upper Extremity OT; Is it even Possible? (Ron Carson) 5. Re: Breaking the Bonds of Upper Extremity OT; Is it even Possible? (Audra Ray) 6. Re: Breaking the Bonds of Upper Extremity OT; Is it even Possible? (Lucy Simpson) 7. Re: Breaking the Bonds of Upper Extremity OT; Is it even Possible? (Ron Carson) 8. Re: Breaking the Bonds of Upper Extremity OT; Is it even Possible? (Carmen Aguirre) 9. Re: Breaking the Bonds of Upper Extremity OT; Is it even Possible? (cmnahrw...@aol.com) 10. Re: Breaking the Bonds of Upper Extremity OT; Is it even Possible? (Ron Carson) ---------------------------------------------------------------------- Message: 1 Date: Thu, 16 Apr 2009 01:53:51 +0000 From: Carmen Aguirre <caguirr...@msn.com> Subject: Re: [OTlist] A Typical Day, Is this Normal? To: <otlist@otnow.com> Message-ID: <col112-w28babcbc1f6f7e57418af8dd...@phx.gbl> Content-Type: text/plain; charset="iso-8859-1" If you are expected to be at 90% , 435 minutes will do it. It is possible to do it if you do some indiv tx in am, for instance, and some concurrent with some in the afternoon on certain days. On the other days concur some of the others or designate those appropriate for a group session. The extra time may help gain some "quiet" time for some uninterrupted notes... Not easy though... Carmen > To: OTlist@OTnow.com > Date: Wed, 15 Apr 2009 12:54:42 -0400 > From: cmnahrw...@aol.com > Subject: Re: [OTlist] A Typical Day, Is this Normal? > > Sounds like some overtime to me. Not appropriate to complete within a > 8 hour work day with time for notes and conferences. > > -----Original Message----- > From: Brent Cheyne <brentche...@yahoo.com> > To: Ron Carson <otlist@otnow.com> > Sent: Wed, 15 Apr 2009 6:53 am > Subject: [OTlist] A Typical Day, Is this Normal? > > There have been some very excellent and insightful posts recently and I > need to go back and read them a second time before I respond..very > thought provoking.... > Over the past "busy season" at my place of work I've been having a very > challenging caseload. Please review the circumstances and decide if it > is a normal/comfortable work condition > > > In an 8 hour day I have to treat and do daily notes, 1 weekly note, > attend 1 weekly staff meeting and attend 1-2 care plan meetings. > > 1. 91 yo female, femur fx nwb-max assist ADL, wants to go home > alone-60min > 2 91 yo female, sternal fx max assist ADL, want to go home alone-60 min > (Eval today) > 3 85 yo female, total knee replacement ADL with supervision but > encouragement 45min > 4 82 yo female, distal radial fracture-ADL with minimal assit-home > alone-60 min > 5 81 yo male, total hip revision-ADL with minimal assist and encourge- > to live alone 60 min > 6 77 you female, CVA Aphasic right hemi- max assist self care- to live > with spouse -60 min > 7 63 yo female, Multiple sclerosis, max assist ADL, home with spouse, > 60 min > 8 74 yo fe > mal, CVA right hemi-max assist ADL, r/oSNF placement , 60 > minutes > 9 65 yo male, Parkinson stand by assist ADL, home with spouse who > works, 60 min > > So I'm scheduled to see these people today... about 465 minutes of > treatment,5/9 patiens are maximal assist, all this week, did this all > last week > Does this sound like a reasonable and appropriate schedule? > Am I going to be able to get through it and still provide that > meaningful and effective, individualized treatment that will create a > great public relations image? > Give me some feedback > Brent > > > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/otlist@otnow.com > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/otlist@otnow.com _________________________________________________________________ Rediscover Hotmail?: Get quick friend updates right in your inbox. http://windowslive.com/RediscoverHotmail?ocid=TXT_TAGLM_WL_HM_Rediscover _Updates1_042009 ------------------------------ Message: 2 Date: Sun, 19 Apr 2009 18:51:30 -0700 (PDT) From: Alayna Adams <powrpufgurl_...@yahoo.com> Subject: [OTlist] promoting OT To: OTlist@OTnow.com Message-ID: <537522.36451...@web50405.mail.re2.yahoo.com> Content-Type: text/plain; charset=iso-8859-1 Hi everyone,I am going to write a letter to the editor of my local newspaper to promote OT for OT month. I would appreciate any feedback. Sorry about the format being off.?To celebrate Occupational Therapy (OT) month, I would like to inform our community on what OT is and how it benefits residents. OT is a type of rehabilitation that aims to help people with a physical, developmental, or cognitive disability increase independence with everyday occupations including but not limited to dressing, cooking, bathing and leisure. Occupational therapists work in hospitals, nursing homes, schools, rehabilitation facilities, mental health facilities and a variety of other settings with people of all ages and abilities.??????????? OT benefits patients and family members by improving their ability to take care of themselves and live more independently. OT treatment consists of adapting the environment and recommending equipment such as tub benches, reachers and magnifiers to enable a person to complete activities of daily living. OT will work with patients to improve moibility, cognition, and activity tolerance to regain function in order to live as independently as possible. ??????????? Many of our elderly community members have received OT and are able to return home without services or significant help from family or caregivers. Occupational Therapists can complete home evaluations and recommend adaptations as necessary. OT will train and educate caregivers to enable them to help their loved ones live a life with dignity and independence. ??????????? Infants and children are able to reach developmental milestones and perform better in school with the skilled treatment of OT. People with a mental illness can learn new habits and roles to enable them to contribute to society. A teenager with a spinal cord injury could learn of adaptations to allow them to go to college and complete self care. ??????????? Many people are unaware of what occupational therapy is because of the title. Occupation is what we do everyday of our lives, what makes our life meaningful to us. Occupational Therapy is a profession that can help people regain function to live life to the fullest.Alayna Adams,Occupational Therapist ------------------------------ Message: 3 Date: Mon, 20 Apr 2009 06:59:32 -0400 From: Ron Carson <rdcar...@otnow.com> Subject: [OTlist] Welcome to Our Newest Member(s) To: OTlist@OTnow.com Message-ID: <851391650.20090420065...@otnow.com> Content-Type: text/plain; charset=windows-1252 Welcome to our newest member(s): ##################################### kokme...@bronsonhg.org tthom...@stormontvail.org Tiffany <tiffanyd...@comcast.net> Donna <dcolaia...@hsc.wvu.edu> Colleen <colle...@bellsouth.net> Shannon Brown <sabrown...@gmail.com> jwh...@challiance.org Terri <pixie...@hotmail.com> Aadil <aa...@360customer.com> t...@yahoo.com ##################################### I want to personally welcome our 10 newest members!! Thanks for joining and please feel welcome to post messages on any topic relating to occupation or occupational therapy. Keep spreading the word! Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com ------------------------------ Message: 4 Date: Mon, 20 Apr 2009 19:06:29 -0400 From: Ron Carson <rdcar...@otnow.com> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? To: OTlist@OTnow.com Message-ID: <547513938.20090420190...@otnow.com> Content-Type: text/plain; charset=windows-1252 Hello All: A couple weeks ago, I worked with a CVA patient who despite having multiple occupational deficits, he was unwilling to verbalize any OT-related goals. And after a couple of weeks, the patient was d/c'd. The patient's UE and LE were compromised by the CVA. He had almost no active movement in his affected arm. His shoulder was extremely painful during any AROM. I initially told the patient that as an OT, I would address his most important occupations but that I could do nothing about his arm. Over the course of treatment, his wife reported having difficulty bathing under the patients arm. After doing some gentle PROM, I concluded that there was a possible impingement. I believed an orthopedic appointment was necessary. I conferred with the PT and she concurred. I also confirmed that the treating PTA would address the shoulder ROM/Pain. Last Friday, I received a new referral for this same patient. When I questioned it, I was told that: "...[PT saw the patient] and he has some issues so nursing went back in and she felt OT needed back in also so we received an order to do an eval and treat." Based on this my ever so sweet scheduler made an appt with the patient. At this point I had no idea why OT was called back in but suspected it was an arm "thing". Just by coincidence, before my scheduled appointment, I ran into the treating PTA. When I asked her about the referral she confirmed that the PT wanted OT to address the patient's arm. The PTA said that they thought a different OT than myself would be sent to the patient. And if fact, I was later called by my homehealth office and "advised" that I didn't need to see the patient because it was an shoulder thing and they understood that I don't do shoulders. I've written countless paragraphs about breaking the 'band of UE therapy', but at this point, I'm thinking it may not even be possible. What is the message when one OT says "no" to focused shoulder treatment while others cordially say "yes". Heck, at this point I'm confused! Sadly yours, Ron ~~~ Ron Carson MHS, OT www.OTnow.com ------------------------------ Message: 5 Date: Mon, 20 Apr 2009 19:17:32 -0700 (PDT) From: Audra Ray <audra...@yahoo.com> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? To: OTlist@OTnow.com Message-ID: <491584.58897...@web45514.mail.sp1.yahoo.com> Content-Type: text/plain; charset=iso-8859-1 Ron, ? I would have been one of those OTs that treated the patient. His caregiver had a goal to bathe under the patient's arm. As an OT trained in physical disabilities, I know how to treat a shoulder impingement and would have. I know I'll probably get railed at, but this is how my treatment plan would have gone:?? the patient has pain with ROM, so treat the pain; strengthen what can be strengthened to also reduce pain and probably fix a possible subluxation; patient/caregiver education to continue home exercise program to maintain what is gained. By doing these things, the patient/caregiver is now able to meet his occupational goal of washing under his arm. The?goal would have been written as follows: The patient/caregiver will bathe under affected arm without pain or discomfort. ? I had a patient recently discharged that came to me saying her arm/neck was killing her. Her goals were as follows: -decrease pain. -be able to use arm in daily occupations without discomfort. I helped her do just that. We used PAMs to decrease her pain, which took over a month to do. She used to have a flat affect and slept alot because of all the pain medicine she took. Now she is smiling, going to activities frequently, and has 0/10 pain with daily occupations. I did my job as an OT to make someone's life better. ? Audra Ray, OTR/L ? What I don't understand is why you only follow one Model: MOHO?? There are many models that we base treatment on. ? --- On Mon, 4/20/09, Ron Carson <rdcar...@otnow.com> wrote: From: Ron Carson <rdcar...@otnow.com> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? To: OTlist@OTnow.com Date: Monday, April 20, 2009, 4:06 PM Hello All: A? couple? weeks? ago,? I? worked? with a CVA patient who despite having multiple? occupational? deficits,? he? was? unwilling? to? verbalize any OT-related goals. And after a couple of weeks, the patient was d/c'd. The? patient's? UE? and LE were compromised by the CVA. He had almost no active? movement in his affected arm. His shoulder was extremely painful during any AROM. I? initially? told? the? patient that as an OT, I would address his most important? occupations? but? that I could do nothing about his arm. Over the? course? of? treatment,? his wife reported having difficulty bathing under? the? patients arm. After doing some gentle PROM, I concluded that there? was? a possible impingement. I believed an orthopedic appointment was? necessary.? I? conferred? with? the? PT? and? she? concurred. I also confirmed???that???the???treating???PTA???would???address? the? shoulder ROM/Pain. Last? Friday,? I? received? a new referral for this same patient. When I questioned? it, I was told that: ? ? ? ? "...[PT? saw the patient] and he has some issues so nursing ? ? ? ? went? back in and she felt OT needed back in also so we received ? ? ? ? an order to do an eval and treat." Based? on this my ever so sweet scheduler made an appt with the patient. At? this? point I had no idea why OT was called back in but suspected it was an arm "thing". Just? by? coincidence,? before? my scheduled appointment, I ran into the treating PTA. When I asked her about the referral she confirmed that the PT? wanted? OT? to? address? the? patient's? arm. The PTA said that they thought? a different OT than myself would be sent to the patient. And if fact,? I? was? later called by my homehealth office and "advised" that I didn't need to see the patient because it was an shoulder thing and they understood that I don't do shoulders. I've? written? countless? paragraphs? about? breaking? the? 'band? of UE therapy',? but? at this point, I'm thinking it may not even be possible.. What? is the message when one OT says "no" to focused shoulder treatment while others cordially say "yes". Heck, at this point I'm confused! Sadly yours, 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 ------------------------------ Message: 6 Date: Tue, 21 Apr 2009 11:03:20 +0000 (GMT) From: Lucy Simpson <lucy_simpso...@yahoo.co.uk> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? To: OTlist@OTnow.com Message-ID: <500549.42714...@web23302.mail.ird.yahoo.com> Content-Type: text/plain; charset=iso-8859-1 Audra/Ron ? I appreciate Ron that you feel as OT's we should not look at UE exclusively e.g. to increase ROM or reduce pain, but is it ever exclusive?? ? ?As, with Audra's example the outcome of addressing reduced ROM and pain is likely to be an increase in independence, quality of life and participation in occupations. Effective UE's are the pre-requisite for participating in activities so if not addressed, alongside functional goals?we miss?a huge area of potential in our patients. ? There are?times that the pain and movement issues need to be addressed before we can attempt effective participation in activities. Certainly in the UK we have OT's working in critical care ensuring patients are positioned and passively moved through ROM to reduce contractures, and to maintain ROM with the expectation that this gives them the optimal chance of participating in occupation in the future,?once they are medically stable........ ? I am seeing a lady who has had a stroke currently who has made great progress from being bed bound, disorientated and flat affect?- walking short distances with no aid, completeing personal care tasks independently and preparing and planning simple meals. ? She has memory, behavioural and cogntive deficits which we are developing strategies to manage and she has reduced ROM in her shoulder, reduced fine motor control and sensation in her hand. This is limiting her ability to reach up to cupboards, shelves (e.g. when shopping), she struggles to dry and dress herself and it affects her?ability to write. ? Now that?many of this lady's deficits have been addressed (rehabbed or compensated for) it is apparent that?the?reduced efficiency of her?UE is playing an important part in her continued deficits. In order for her arm and hand to be effective her shoulder needs to be stable, and strengthened, she currently is following a program of shoulder exercises in supine, provided by Physio and OT in collaboration. Along with this she continues to be encouraged to use her Right UE in functional activities, and activities are set up to encourage reach, grip and fine motor control, and normal movement is promoted. ? In this case do you feel Ron that it is the physio's role to work on the base of UE strength and ROM, and the OT to take over and promote normal movement in functional activities?? ? I am not sure, in my experience joint OT/PT?working is often effective (if possible!),?certainly this?lady requires specific UE exercises as purely using arm in function is not making a significant difference......... ? Kind Regards Lucy Simpson For Quality Stationery and Greetings Cards check out?this website: www.phoenix-trading.co.uk/web/lucysimpson Save it in your favourites for the next time you need cards. ? --- On Tue, 21/4/09, Audra Ray <audra...@yahoo.com> wrote: From: Audra Ray <audra...@yahoo.com> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? To: OTlist@OTnow.com Date: Tuesday, 21 April, 2009, 3:17 AM Ron, ? I would have been one of those OTs that treated the patient. His caregiver had a goal to bathe under the patient's arm. As an OT trained in physical disabilities, I know how to treat a shoulder impingement and would have. I know I'll probably get railed at, but this is how my treatment plan would have gone:?? the patient has pain with ROM, so treat the pain; strengthen what can be strengthened to also reduce pain and probably fix a possible subluxation; patient/caregiver education to continue home exercise program to maintain what is gained. By doing these things, the patient/caregiver is now able to meet his occupational goal of washing under his arm. The?goal would have been written as follows: The patient/caregiver will bathe under affected arm without pain or discomfort. ? I had a patient recently discharged that came to me saying her arm/neck was killing her. Her goals were as follows: -decrease pain. -be able to use arm in daily occupations without discomfort. I helped her do just that. We used PAMs to decrease her pain, which took over a month to do. She used to have a flat affect and slept alot because of all the pain medicine she took. Now she is smiling, going to activities frequently, and has 0/10 pain with daily occupations. I did my job as an OT to make someone's life better. ? Audra Ray, OTR/L ? What I don't understand is why you only follow one Model: MOHO?? There are many models that we base treatment on. ? --- On Mon, 4/20/09, Ron Carson <rdcar...@otnow.com> wrote: From: Ron Carson <rdcar...@otnow.com> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? To: OTlist@OTnow.com Date: Monday, April 20, 2009, 4:06 PM Hello All: A? couple? weeks? ago,? I? worked? with a CVA patient who despite having multiple? occupational? deficits,? he? was? unwilling? to? verbalize any OT-related goals. And after a couple of weeks, the patient was d/c'd. The? patient's? UE? and LE were compromised by the CVA. He had almost no active? movement in his affected arm. His shoulder was extremely painful during any AROM. I? initially? told? the? patient that as an OT, I would address his most important? occupations? but? that I could do nothing about his arm. Over the? course? of? treatment,? his wife reported having difficulty bathing under? the? patients arm. After doing some gentle PROM, I concluded that there? was? a possible impingement. I believed an orthopedic appointment was? necessary.? I? conferred? with? the? PT? and? she? concurred. I also confirmed???that???the???treating???PTA???would???address? the? shoulder ROM/Pain. Last? Friday,? I? received? a new referral for this same patient. When I questioned? it, I was told that: ? ? ? ? "...[PT? saw the patient] and he has some issues so nursing ? ? ? ? went? back in and she felt OT needed back in also so we received ? ? ? ? an order to do an eval and treat." Based? on this my ever so sweet scheduler made an appt with the patient. At? this? point I had no idea why OT was called back in but suspected it was an arm "thing". Just? by? coincidence,? before? my scheduled appointment, I ran into the treating PTA. When I asked her about the referral she confirmed that the PT? wanted? OT? to? address? the? patient's? arm. The PTA said that they thought? a different OT than myself would be sent to the patient. And if fact,? I? was? later called by my homehealth office and "advised" that I didn't need to see the patient because it was an shoulder thing and they understood that I don't do shoulders. I've? written? countless? paragraphs? about? breaking? the? 'band? of UE therapy',? but? at this point, I'm thinking it may not even be possible.. What? is the message when one OT says "no" to focused shoulder treatment while others cordially say "yes". Heck, at this point I'm confused! Sadly yours, 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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ------------------------------ Message: 7 Date: Tue, 21 Apr 2009 07:32:47 -0400 From: Ron Carson <rdcar...@otnow.com> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? To: Audra Ray <OTlist@OTnow.com> Message-ID: <1426569795.20090421073...@otnow.com> Content-Type: text/plain; charset=iso-8859-1 Thanks for writing. Maybe this is one of the cases were I was over zealous about NOT treating someone's arm. But, I truly feel that PT is much better trained and in my case, licensed, to treat bio-mechanical issues. It just floors me that a PT would refer back to OT for shoulder treatment. Here's some things to consider: 1. Why do OT's treat arms and not legs? 2. Aren't MOST PT's better trained to treat physical dysfunction? 3. Where is the line between focused treatment on an UE and focused treatment on occupation? Can both co-exist with the same patient/therapist? This is a very confusing case for me! Ron ----- Original Message ----- From: Audra Ray <audra...@yahoo.com> Sent: Monday, April 20, 2009 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? AR> Ron, AR> ? AR> I would have been one of those OTs that treated the patient. His AR> caregiver had a goal to bathe under the patient's arm. As an OT AR> trained in physical disabilities, I know how to treat a shoulder AR> impingement and would have. I know I'll probably get railed at, but AR> this is how my treatment plan would have gone:?? the patient has AR> pain with ROM, so treat the pain; strengthen what can be AR> strengthened to also reduce pain and probably fix a possible AR> subluxation; patient/caregiver education to continue home exercise AR> program to maintain what is gained. By doing these things, the AR> patient/caregiver is now able to meet his occupational goal of washing under his arm. AR> The?goal would have been written as follows: The patient/caregiver AR> will bathe under affected arm without pain or discomfort. AR> ? AR> I had a patient recently discharged that came to me saying her AR> arm/neck was killing her. Her goals were as follows: AR> -decrease pain. AR> -be able to use arm in daily occupations without discomfort. AR> I helped her do just that. We used PAMs to decrease her pain, which AR> took over a month to do. She used to have a flat affect and slept AR> alot because of all the pain medicine she took. Now she is smiling, AR> going to activities frequently, and has 0/10 pain with daily occupations. AR> I did my job as an OT to make someone's life better. AR> ? AR> Audra Ray, OTR/L AR> ? AR> What I don't understand is why you only follow one Model: MOHO?? AR> There are many models that we base treatment on. AR> ? AR> --- On Mon, 4/20/09, Ron Carson <rdcar...@otnow.com> wrote: AR> From: Ron Carson <rdcar...@otnow.com> AR> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? AR> To: OTlist@OTnow.com AR> Date: Monday, April 20, 2009, 4:06 PM AR> Hello All: AR> A? couple? weeks? ago,? I? worked? with a CVA patient who despite having AR> multiple? occupational? deficits,? he? was? unwilling? to? verbalize any AR> OT-related goals. And after a couple of weeks, the patient was d/c'd. AR> The? patient's? UE? and LE were compromised by the CVA. He had almost no AR> active? movement in his affected arm. His shoulder was extremely painful AR> during any AROM. AR> I? initially? told? the? patient that as an OT, I would address his most AR> important? occupations? but? that I could do nothing about his arm. Over AR> the? course? of? treatment,? his wife reported having difficulty bathing AR> under? the? patients arm. After doing some gentle PROM, I concluded that AR> there? was? a possible impingement. I believed an orthopedic appointment AR> was? necessary.? I? conferred? with? the? PT? and? she? concurred. I also AR> confirmed???that???the???treating???PTA???would???address? the? shoulder AR> ROM/Pain. AR> Last? Friday,? I? received? a new referral for this same patient. When I AR> questioned? it, I was told that: AR> ? ? ? ? "...[PT? saw the patient] and he has some issues so nursing AR> ? ? ? ? went? back in and she felt OT needed back in also so we received AR> ? ? ? ? an order to do an eval and treat." AR> Based? on this my ever so sweet scheduler made an appt with the patient. AR> At? this? point I had no idea why OT was called back in but suspected it AR> was an arm "thing". AR> Just? by? coincidence,? before? my scheduled appointment, I ran into the AR> treating PTA. When I asked her about the referral she confirmed that the AR> PT? wanted? OT? to? address? the? patient's? arm. The PTA said that they AR> thought? a different OT than myself would be sent to the patient. And if AR> fact,? I? was? later called by my homehealth office and "advised" that I AR> didn't need to see the patient because it was an shoulder thing and they AR> understood that I don't do shoulders. AR> I've? written? countless? paragraphs? about? breaking? the? 'band? of UE AR> therapy',? but? at this point, I'm thinking it may not even be possible.. AR> What? is the message when one OT says "no" to focused shoulder treatment AR> while others cordially say "yes". Heck, at this point I'm confused! AR> Sadly yours, AR> Ron AR> ~~~ AR> Ron Carson MHS, OT AR> www.OTnow.com AR> -- AR> Options? AR> www.otnow.com/mailman/options/otlist_otnow.com AR> Archive? AR> www.mail-archive.com/otlist@otnow.com AR> AR> -- AR> Options? AR> www.otnow.com/mailman/options/otlist_otnow.com AR> Archive? AR> www.mail-archive.com/otlist@otnow.com ------------------------------ Message: 8 Date: Tue, 21 Apr 2009 23:12:07 +0000 From: Carmen Aguirre <caguirr...@msn.com> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? To: <otlist@otnow.com> Message-ID: <col112-w31f28450e6f725becb7edbdd...@phx.gbl> Content-Type: text/plain; charset="Windows-1252" I think treating the shoulder seemed to be warranted given the limitations it brough about to pt's and caregiver routines at home. It seemed to be related to safety, prevention of further limitation in his adl's or caregivers ability to care for him appropriately. Techniques applied such as bilateral integration, re-education during those adl tasks the caregiver seemed to be having difficulty with. Thanks Carmen > Date: Mon, 20 Apr 2009 19:06:29 -0400 > From: rdcar...@otnow.com > To: OTlist@OTnow.com > Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? > > Hello All: > > A couple weeks ago, I worked with a CVA patient who despite having > multiple occupational deficits, he was unwilling to verbalize any > OT-related goals. And after a couple of weeks, the patient was d/c'd. > > The patient's UE and LE were compromised by the CVA. He had almost no > active movement in his affected arm. His shoulder was extremely painful > during any AROM. > > I initially told the patient that as an OT, I would address his most > important occupations but that I could do nothing about his arm. Over > the course of treatment, his wife reported having difficulty bathing > under the patients arm. After doing some gentle PROM, I concluded that > there was a possible impingement. I believed an orthopedic appointment > was necessary. I conferred with the PT and she concurred. I also > confirmed that the treating PTA would address the shoulder > ROM/Pain. > > Last Friday, I received a new referral for this same patient. When I > questioned it, I was told that: > > "...[PT saw the patient] and he has some issues so nursing > went back in and she felt OT needed back in also so we received > an order to do an eval and treat." > > Based on this my ever so sweet scheduler made an appt with the patient. > At this point I had no idea why OT was called back in but suspected it > was an arm "thing". > > Just by coincidence, before my scheduled appointment, I ran into the > treating PTA. When I asked her about the referral she confirmed that the > PT wanted OT to address the patient's arm. The PTA said that they > thought a different OT than myself would be sent to the patient. And if > fact, I was later called by my homehealth office and "advised" that I > didn't need to see the patient because it was an shoulder thing and they > understood that I don't do shoulders. > > I've written countless paragraphs about breaking the 'band of UE > therapy', but at this point, I'm thinking it may not even be possible. > What is the message when one OT says "no" to focused shoulder treatment > while others cordially say "yes". Heck, at this point I'm confused! > > Sadly yours, > > 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 _________________________________________________________________ Windows Live? Hotmail?:?more than just e-mail. http://windowslive.com/online/hotmail?ocid=TXT_TAGLM_WL_HM_more_042009 ------------------------------ Message: 9 Date: Tue, 21 Apr 2009 19:28:49 -0400 From: cmnahrw...@aol.com Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? To: OTlist@OTnow.com Message-ID: <8cb90f00f051c82-cd4...@webmail-dh47.sysops.aol.com> Content-Type: text/plain; charset="utf-8"; format=flowed Lets face the facts. Most PTs do not know how to treat stroke shoulder dysfunction. Most OTs do not know how to properly treat stroke shoulder dysfunction. They think they can, but most of them do a botched up waste of time job. It is a specialized skill, that warrents continued education. It is beyond crazy busy for an OT with education in this area, because most clinicians in both the field of OT and PT do not feel comfortable with it and will gladly refer their patients to you. -----Original Message----- From: Carmen Aguirre <caguirr...@msn.com> To: otlist@otnow.com Sent: Tue, 21 Apr 2009 6:12 pm Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? I think treating the shoulder seemed to be warranted given the limitations it brough about to pt's and caregiver routines at home. It seemed to be related to safety, prevention of further limitation in his adl's or caregivers ability to care for him appropriately. Techniques applied such as bilateral integration, re-education during those adl tasks the caregiver seemed to be having difficulty with. Thanks Carmen > Date: Mon, 20 Apr 2009 19:06:29 -0400 > From: rdcar...@otnow.com > To: OTlist@OTnow.com > Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? > > Hello All: > > A couple weeks ago, I worked with a CVA patient who despite having =0 A> multiple occupational deficits, he was unwilling to verbalize any > OT-related goals. And after a couple of weeks, the patient was d/c'd. > > The patient's UE and LE were compromised by the CVA. He had almost no > active movement in his affected arm. His shoulder was extremely painful > during any AROM. > > I initially told the patient that as an OT, I would address his most > important occupations but that I could do nothing about his arm. Over > the course of treatment, his wife reported having difficulty bathing > under the patients arm. After doing some gentle PROM, I concluded that > there was a possible impingement. I believed an orthopedic appointment > was necessary. I conferred with the PT and she concurred. I also > confirmed that the treating PTA would address the shoulder > ROM/Pain. > > Last Friday, I received a new referral for this same patient. When I > questioned it, I was told that: > > "...[PT saw the patient] and he has some issues so nursing > went back in and she felt OT needed back in also so we received > an order to do an eval and treat." > > Based on this my ever so sweet scheduler made an appt with the patient. > At this point I had no idea why OT was called back in but suspected it > was an arm "thing". > > Just by coincidence, before my scheduled appointment, I ran into the > treating PTA. When I asked her about the referral she confirmed that the > PT wanted OT to address the patient's arm. The PTA said that they > thought a different OT than myself would be sent to the patient. And if > fact, I was later called by my homehealth office and "advised" that I > didn't need to see the patient because it was an shoulder thing and they > understood that I don't do shoulders. > > I've written countless paragraphs about breaking the 'band of UE > therapy', but at this point, I'm thinking it may not even be possible. > What is the message when one OT says "no" to focused shoulder treatment > while others cordially say "yes". Heck, at this point I'm confused! > > Sadly yours, > > 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 _________________________________________________________________ Windows Live? Hotmail?:?more than just e-mail. http://windowslive.com/online/hotmail?ocid=TXT_TAGLM_WL_HM_more_042009 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ------------------------------ Message: 10 Date: Tue, 21 Apr 2009 20:22:34 -0400 From: Ron Carson <rdcar...@otnow.com> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? To: Ron Carson <OTlist@OTnow.com> Message-ID: <242249502.20090421202...@otnow.com> Content-Type: text/plain; charset=iso-8859-1 Hello All: I thought some more about this situation and I'm more comfortable with my decision to not treat this patient's shoulder. It is true that his wife said she was having difficulty bathing under the arm, and that's why I initiated contact with the PT. But, if I would have treated the patient what is an appropriate goal? Based on my treatment philosophy, ALL goals must be occupational. So, in this case, my goal would have been: "Pt will be able to bathe under right arm pit with assistance and no self-reported pain". To me, this is a great OT goal. But, when this goal is reached, which probably wouldn't take too long, what would be the outcome of the patient's shoulder. He may have gained 20 - 30 degrees of pain free passive ROM, allowing him to bathe under his armpit, but by my goal, the OT would have stopped. Is that really what is best for this patient? I don't think so. What I think he needs is SKILLED and focused treatment on his UE to reduce the pain and increase his PROM. But, for me, this is NOT the role of OT, it's the role of PT! Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: Ron Carson <rdcar...@otnow.com> Sent: Tuesday, April 21, 2009 To: Audra Ray <OTlist@OTnow.com> Subj: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? RC> Thanks for writing. RC> Maybe this is one of the cases were I was over zealous about NOT RC> treating someone's arm. But, I truly feel that PT is much better trained RC> and in my case, licensed, to treat bio-mechanical issues. It just floors RC> me that a PT would refer back to OT for shoulder treatment. RC> Here's some things to consider: RC> 1. Why do OT's treat arms and not legs? RC> 2. Aren't MOST PT's better trained to treat physical dysfunction? RC> 3. Where is the line between focused treatment on an UE and focused RC> treatment on occupation? Can both co-exist with the same RC> patient/therapist? RC> This is a very confusing case for me! RC> Ron ------------------------------ -- Unsubscribe? otlist-unsubscr...@otnow.com Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com Help? h...@otnow.com End of OTlist Digest, Vol 65, Issue 1 ************************************* -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
