Ron, IMO there were many things an OT could have done to assist that patient even without directly treating his arm. Pain disrupts occupational function in all areas. We can work with chronic pain patients to learn relaxation techniques. We can educate them and their caregivers on how to prevent further pain and deformity (many times CVA patients do make things worse because of dysfunctional strageties they develop to perfom self-care, poor arm placement during transfer, etc) We can help them learn how to find a chronic pain support group or how to find assistive devices on the internet. I think patients really have no idea all that OT offers, nor often what "occupation" really is. The best way to get OT's out of the "UE" box, is to show them what we CAN do for them, rather than say "there is nothing we can do, refer to PT" for a patient like that.
~Ilene Rosenthal, OTR/L 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. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
