Thanks Chris. I concept of getting better is difficult to define and envision. But, I understand what you are saying. And yes, it is possible he's given up.
Now, this is a "loaded" question. You mention only a flaccid arm is that because you don't address the LE? ----- Original Message ----- From: cmnahrw...@aol.com <cmnahrw...@aol.com> Sent: Saturday, July 04, 2009 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] A Vision For Patients? cac> Sounds like the man has given up on life. Perhaps he has no goals cac> because he has no expectations of getting "better". Perhaps you can cac> show him the way on a few self generated goals, and then watch out the cac> flood gate of goals may come open. Sad that the prior OTs only focused cac> on UE ROM. Sounds like a waste of time. I usually use this concept to cac> continue neuromotor training: If a patient has no movement in the cac> flaccid arm (absolutely no movement) in a reasonable amount of time, cac> then I train the patient and family on keeping the arm comfortable. I cac> then move on to more reasonable and achievable goals. cac> Chris Nahrwold MS, OTR cac> -----Original Message----- cac> From: Ron Carson <rdcar...@otnow.com> cac> To: OTlist@OTnow.com cac> Sent: Sat, Jul 4, 2009 2:16 pm cac> Subject: [OTlist] A Vision For Patients? cac> Do you ever sit back and envision a new life for your patients? Do you cac> imagine how patients' lives can be after therapy is done? While fishing cac> today, a patient I just evaluated crossed my mind and I wondered how I cac> could improve the quality of his life. How I could make a life for this cac> person. I developed a "vision" of how this many might live his life. cac> BUT, this is my vision, not his. In the two meetings I've had with the cac> patient, he's not verbalized any goals or passions. cac> This middle aged man experienced a stroke about 12 years earlier. It cac> left him severely impaired. He is essentially dependent for all cac> self-care. He is unable to unable to do almost anything for himself. The cac> man has received countless hours of therapy since his stroke. Based on cac> reports from caregivers, past OT's have focused on ROM for the patient's cac> UE. cac> At my last appointment, I asked the patient "what are your goals?", cac> "what do you want to do with your life?" The caregiver, who has been cac> with the patient 5x/week for 1 year, stated that no therapist had ever cac> asked the patient what HIS goals were. If true, that's a pretty sad cac> statement about the OT's who came before me. But that's another message. cac> I am seeing this man 5x/week and I want to get inside his brain and help cac> him figure out how he wants the rest of his life to play out. I'm sure cac> he wishes that this "nightmare" would just end, but the sad reality is cac> that he will probably spend the rest of his life in a wheelchair. I told cac> him that there was nothing "I" could do to make a substantial cac> improvement in his physical condition. I told him that my job is cac> teaching people how to take care of themselves and be productive. At the cac> moment, self care is out of question, but productivity has lots of cac> possibility. cac> But, I want to get this thing right. I want to ensure that I am on the cac> same page as the patient. What if the patient has no goals? What if he cac> just doesn't care and has given up? What if he has no vision for his cac> life? Can one person give another person a vision? Can I "show" this man cac> that his life may never be the way it was, but that it can be better cac> than right now? Help me find a vision for this man!! cac> Thanks, cac> Ron cac> ~~~ cac> Ron Carson MHS, OT cac> www.OTnow.com cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> www.mail-archive.com/otlist@otnow.com cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
