I have had VERY few patients where occupation was limited SOLELY by
decreased strength and ROM. But, I know that it does happen and in those
cases, I agree that exercises, etc are indicated. But, the "PROBLEM"
with OT is that we only do ROM, strengthening, etc on the UE! Of course,
there are times when UE ROM is the ONLY thing indicated, but these
cases are the vast MINority of adult phys dys patients.
Occupation is a complex interaction of person, environment and activity.
Occupation includes SOOOOOO much more than just physical function. In
fact, physical function is often NOT the greatest limiting factor, even
when people have physical dysfunction. But, so many OT's are cornered
into OT = upper extremity and PT = lower extremity. And as long as this
is their approach, OT has a very slim chance of TRULY addressing
patient's most desired occupations.
If OT's would just ask patients the following questions, the therapist
would have a much better idea of what to do:
1. "When we are done with therapy, what do you want to be better able to
do".
<or>
2. "What daily self-care and productivity occupations that you want to
be able to do or do better".
If a patient says, "I want to be able to dress myself" and the patient
can't sit, stand, walk, move their arm and leg, what is an OT going to
do? Only focus on the arm? If so, how are they addressing occupation?
They aren't! Instead, they are addressing how an arm affects occupation.
And that is not nearly the same as addressing occupation. Talk about not
seeing the whole picture. Almost entire phy-dys OT profession is
"guilty" of not seeing the whole picture.
Thanks,
Ron
~~~
Ron Carson MHS, OT
www.OTnow.com
----- Original Message -----
From: Amber nollen <nollen...@msn.com>
Sent: Wednesday, July 01, 2009
To: otlist@otnow.com <otlist@otnow.com>
Subj: [OTlist] Just About To Give UP............
An> Hello,
An>
An> Without going into to much detail, (as I'm on break at work) I
An> think as OT's there is a time and a place for exercise, and a time
An> and a place for doing the actual functional activities that are
An> their goals. We have to break down the activity, "activity
An> analysis" If the patients primary reason why they can not complete
An> an certain occupation is based solely on decreased strength or range
An> of motion, then exercise, range of motion etc, needs to be
An> incoorporated into their treatment plan.
An>
An> To me this seems like not a black and white issue. I feel like we
An> would be doing our patients a disservice if we are missing the whole
picture.
An>
An> In my opinion cookie cutter therapy is what we need to get away
An> from, while at the same time gently reminding, and educating the uninformed
regarding OT.
An> Amber
An>
>> Date: Wed, 1 Jul 2009 09:31:42 -0400
>> From: rdcar...@otnow.com
>> To: OTlist@OTnow.com
>> Subject: Re: [OTlist] Just About To Give UP............
>>
>> Hello Diane and other:
>>
>> Diane, I strongly believe that when a patient has no identifiable
>> occupational goals, then they should not be seen by OT. After all, if
>> the goal of OT is enabling people to engage in occupation and yet there
>> are no occupational goals, then what is OT doing? More likely than not,
>> they are doing exercises, which is wrong on two levels:
>>
>> 1. Does not REQUIRE the skills of a therapist
>> 2. Is not OT
>>
>> Here's two patients I have today:
>>
>> 1. Patient is unable to care for himself because of weakness and fear of
>> falling. We will work on standing, transfers and mobility.
>>
>> 2. Patient is unable to care for herself and carry out daily occupations
>> related to her role as a wife. We will work on standing, transfers,
>> mobility, etc.
>>
>>
>> None of my interventions include focused treatment on UE, LE, strength,
>> etc. Instead the focus is on restoring lost occupation. This is done by
>> addressing SPECIFIC and IDENTIFIABLE problems which are preventing
>> SPECIFIC and IDENTIFIED occupational goals. It really is a practical
>> approach that I liken to learning to ride a bike. If a person wants to
>> ride a bike the best way is to practice, practice, practice. Like wise,
>> if a person wants to dress, toilet, bathe, shower, cook, clean, laundry,
>> etc, the best approach is practice, practice, practice.
>>
>> I want to address some other things, but I'm off to work.
>>
>> Ron
>>
>> ~~~
>> Ron Carson MHS, OT
>> www.OTnow.com
>>
>>
>> ----- Original Message -----
>> From: Diane Randall <spark...@rcn.com>
>> Sent: Tuesday, June 30, 2009
>> To: OTlist@OTnow.com <OTlist@OTnow.com>
>> Subj: [OTlist] Just About To Give UP............
>>
>> DR> Hello, As a new OTA/L a week into my first job in a SNF, I have become
>> well
>> DR> acquainted with the UE focus of OT. But, I think the most frustrating
>> part
>> DR> of the process is not some much the interventions but the fact that so
>> many
>> DR> of my patients have really no "occupation" to look forward to when
>> DR> discharged from rehab. It is no wonder we may be tempted to stick with
>> just
>> DR> UE exercises. ( besides ADL's we do in rooms)
>>
>> DR> Question...tell me about a typical day you spend at home?
>>
>> DR> Replies (paraphrased)
>>
>> DR> Patient A- "I just watch Soaps..my daughter does everything (cooking,
>> DR> cleaning)"
>> DR> Patient B- "I have not worked since I gained weight...have not left the
>> DR> house except to come here for 2 weeks...thank god for disability."
>> DR> Patient C- "I don't want therapy and you can't make me go".
>> DR> patient D- " The nurses do everything for me...why should I dress myself"
>>
>> DR> How can we motivate patients to value "occupation" when thier goals are
>> to
>> DR> just get strong enough to go back to their lives which in many cases is
>> DR> totally dependent on others. Even simple ADL's do not seem to be a goal
>> of
>> DR> some patients?
>>
>> DR> I also see in some ways why UE has become so popular in SNF's....it's
>> easy,
>> DR> it looks productive, and it can be done simultaneously with others.
>> DR> Productivity expectations have created UE ther-ex focused treatment. It
>> is
>> DR> almost impossible to individualize OT treatment when you have 5-6 or more
>> DR> patients seeking your attention all at one time. In addition , I have
>> DR> noticed PT/OT /Speech seem to be in melting pot of therapy. I see speech
>> do
>> DR> cognitive activities I learned in school. Sometimes the only difference
>> you
>> DR> can really tell between an OT and PT in the gym setting is where they
>> focus
>> DR> patient work (above or below the belt)
>>
>> DR> HH is a little different..I would expect a HH agency to value
>> occupation. I
>> DR> mean...it is one on one therapy for gods sakes. So much can be done in
>> that
>> DR> setting. I would be frustrated too. We have to make a commitment to see
>> UE
>> DR> ther-ex as a means to an end. Strength to transfer to a toilet
>> DR> independently-standing tolerance to create a simple meal in the kitchen
>> from
>> DR> a recipe chosen by the patient). But is should never be the "only" focus
>> or
>> DR> we have essentially become PT's..we all need to educate our patients
>> about
>> DR> what we do...and sadly other professionals around us.
>>
>> DR> -----Original Message-----
>> DR> From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on
>> DR> Behalf Of Ron Carson
>> DR> Sent: Tuesday, June 30, 2009 20:28
>> DR> To: OTlist@OTnow.com
>> DR> Subject: [OTlist] Just About To Give UP............
>>
>>
>> DR> I am just about at the end of a very long road of trying to change my
>> DR> profession.
>>
>> DR> No one seems to value occupation as an outcome. I refuse to see
>> DR> patient's with the purpose of improving UE function so my HH agency just
>> DR> calls other OT's who will. PT's don't appreciate occupation but it
>> DR> encroaches on their treatment. My agency is clueless about occupation
>> DR> and has no reason to learn about it.
>>
>> DR> I so value what I do and I believe that most of my patient's do as well.
>> DR> Most of them can not articulate occupation or occupational therapy but
>> DR> they do know that I'm there to teach them two things:
>>
>> DR> 1. How to take care of themselves
>>
>> DR> 2. How to be productive
>>
>> DR> I almost cried when I left my agency's staff meeting today. EVERTHING is
>> DR> about PT, PT, PT, and how wonderful they are. There must be like 15 PT's
>> DR> while there is only 3 OT's. It's really a sad state of affairs. I am
>> DR> tired of going from "hero to zero". Hero with patients and zero with my
>> DR> agency and other therapists.
>>
>> DR> The other day a nurse with 24 years experience told a patient that OT
>> DR> was about small muscles and PT was about gait and large muscle groups. I
>> DR> promptly called the nurse and explained that OT is about occupation -
>> DR> i.e. take care of yourself and being productive. She said, that she
>> DR> didn't know and that even after all these years she really has no idea
>> DR> what OT does. She suggested that I call my agency and do an inservice.
>> DR> Now can you even imagine that a home health agency needs an inservice on
>> DR> the role of OT!! Sad state of affairs.
>>
>> DR> Am I the ONLY OT who experiences and feel these emotions???????????????
>> DR> Gosh, I hope not. But then on the other hand, maybe it's just me. Maybe
>> DR> I just refuse to accept the way things are. Maybe I'm just a
>> DR> self-centered egotist who is totally clueless about OT. I truly, truly
>> DR> don't understand WHY "things" are the way they are. And more
>> DR> importantly, what can be done, if anything, to change the direction of
>> DR> UE physical dysfunction OT.
>>
>>
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>>
>>
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