Diane,
I am not saying that an UE therex program is inappropriate. In fact it
is very beneficial treatment concept in OT for individuals who have
been bed bound and have experienced muscle atrophy because of the
immobilization. I am saying that you need to be careful how you
educate your patients, because saying that the UE exercises will help
the person with their transfers and ADL is not exactly true, regardless
is the person is a male and female. If you want to help them with
their UE strength to facilitate transitions from sit to stand from a
toilet and using the standard walker you need to have them do
wheelchair push ups, sit to stands, standing with the walker, or at
least scapular depression/tricep extension using a Rickshaw machine
(push down machine). You then can then say why you are helping them in
this area in prep for safer transfers. So he progressed from 5 to 10#?
I assume then he has enough ROM in his arms to bath himself, enough ROM
to donn a shirt, and enough grip to hold onto a shirt and pants. So
instead of educating him about UE strength to assist him in transfers
and ADL, I would educate him in the way that you desribed in your prior
email because this is true in terms of research and practical thinking.
"There is something aboutlifting weights that increases self-esteem
and the hope is that overall conditioning exercises will continue when
he is discharged since I do believe an overall weight lifting program
will benefit his continued weightloss over time."
Chris
-----Original Message-----
From: Diane Randall <spark...@rcn.com>
To: OTlist@OTnow.com
Sent: Sun, Jul 12, 2009 7:51 am
Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE
The patient was unable to bear weight on his legs due to PN and did not
have
the strength to hold his weight up in a RW, he also could not stand
beyond 5
seconds without his knees buckling as he is close to 500 pounds. He
worked
up from 5 to 10 llb weights in all planes per day and he was a very
debilitated when he arrived, using a hoyer. The UE therex at least
boosted
his confidence to be able to do this transfer along with improvemnents
in
standing tolerance and walking with PT. UE therex is not all he does in
therapy but I have noticed, especially with men, that they tend to
perform
ADL's better when they feel therapy includes an overall strengthening
program. He even keeps some weights in his room. There is something
about
lifting weights that increases self-esteem and the hope is that overall
conditioning exercises will continue when he is discharged since I do
believe an overall weight lifting program will benefit his continued
weight
loss over time. He has lost a significant amount of weight and he seems
very
motivated. Straight ADL's can be a source of stess for very proud men.
Most
of my patients are in therapy for debility. While it is not appropriate
for
everyone, I feel that in this case it was justified, even if as you say
the
UE program did not contribute significantly to his ability to transfer
when
is comes to to strength alone. It my opinion, the UE program is more of
a
holistic approach than a biomechanical one in this case.
-----Original Message-----
From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on
Behalf Of cmnahrw...@aol.com
Sent: Sunday, July 12, 2009 07:32
To: OTlist@OTnow.com
Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE
Diane,
I hate to be the devil's advocate, but because I veiw you as a very
compassionate young clinician, I think you might benefit from my
suggestions. With that being said, I am not sure that your UE strength
exercises helped this person with their ability to transfer into a
shower or complete bathing and dressing easier. Now I am not saying
that the UE strength program had no therapeutic benefits whatsoever,
like for overall strength and possibly functional endurance, but I
doubt if it helped him in the way that you think.
If this was the patient's first time with you in the shower, how do you
know that he couldn't have done this his first week? I think I remember
you saying that you are a COTA. If this is true, did the OT
specifically evaluate these abilities or did the therapist simulate or
extrapolate concepts during the evaluation?
What UE strength exercises did you work on in treatment? I am assuming
that you worked on the typical theraband, dowel rod, or dumbell
exercises that focus on isotonic strength. If this is true, then based
on the literature there is no established evidence or even any
associations for functional improvements in this area. And practically
speaking, most clinicians do not strengthen the correct muscles that
are even in the ball park when talking about functional mobility. When
I strengthen for functional mobility, I work on the patient's core
stability, the scapular depressors, and the triceps. Now when you
work on such muscle groups it is wise to strengthen the antagonist
muscle groups as well so you do not end up with muscle imbalance. This
is still just thinking practically, it still does not have any support
in the research.
If you want to go by the book, then you have to key into the concept of
task specific training. This is usually an easy concept for new
clinicians. If you want to get better at walking go ahead and walk, if
you want to get better at getting into a shower go ahead an get into a
shower, if you want to get better at bathing and dressing go ahead and
practice this as well.
Hope this helps,
Chris
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