[OTlist] Expertise
What do you think is OT's expertise? Ron -- Ron Carson MHS, OT -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
[OTlist] Elbow Break, Referral...
Received a new referral for a elbow fracture. I shouldn't have taken it but I did. And here is the dilemma facing our profession. The patient is 95, previously living independently. Fractured elbow in a fall. Now living with daughter. She is in a large amount of pain. Obviously, she is dependent for most of her occupations. She currently uses a cane but is not safe. The patient's immediate concerns are her elbow. When pressed, she of course wants to go back home, but that is not an immediate goal. So what do I write for goals? For example should I write: Patient will self-report pain as 3 out of 10 Patient's will increase active elbow extension to -20 degrees These goals seem to direct the patients and doctor's concerns but are not occupationally oriented. So, should I write: Patient will safely and independently dress lower body Patient will safely and independently ambulate to the bathroom using the least restrictive mobility aid I like these goals but they don't address the immediate concerns. Ron -- Ron Carson MHS, OT -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Difficulty Articulating Occupational
Ron, My clients and their families often wonder what is Occupational Therapy (?), and in my practice at a SNF, the main issue for the geriatric patients is getting back home...whatever it takes. So I try to explain from the very start that Occupation all things people want or need to get back to doing, and the Therapy is all the things that need to be done to make that happen. Educating the client that the interventions will be very functionally based and based on every-day tasks need to begin early and repeated often. My Subacute Rehab clients want to know what is in it for them... and to use a business term, they need to be marketed to, like a coach or consultant. They need a good sales pitch! A great percentage of my clientele, and their families,are becoming increasingly savy and sophisicated, goal-directed, and often do not tolerate any interventions that seem like a waste of time. This fact is welcome because it often makes treatment effective, effecient, and meaningful. The key is to get off to a good start, reach a common understanding, and meet Occupational needs by being relevant to the client. It is client-centered practice and does require a great degree of effort and skill. In our department we have a display board that show pictures of former clients in OT doing Occupation- based tasks, cooking , shopping, laundry, using adaptive equipment, etc.. in our department environment. This board is used to show touring visitors, and newlly admitted clients examples of what can be addressed in OT...a picture (board) is worth 1000 words This often helps especially with families who realize these areas will need to be addressed. But there are a certain percentage of my clients that don't get the concept of Occupational Therapy because of a history of bad experiences with OT, or have observed others having a bad experience...doing unwanted, meaningless, sometime mudane tasks. They also have a concept of all therapy solely involving exercises and walking. This perception is hard to overcome if the persons mindset has be reinforced from other facillity staff and bad history. People even refuse to perform needed Occupation-based relevant and meaningful tasks prior to discharge due to their resistance, fear, and denial. They often assume things will be just fine when they get home. Theses clients require a lot of work and skill to motivate, engage, and connect with. It really can be what I call a public relations challenge. Additionally, there are the folks who have a very passive mindset, and wish to be simply want to fixed by therapy without any personal goals,effort, or planning. THese patients often can't identify Occupation in their life because, upon detailed examination, their lives are devoid of much Occupation as a result of chromic disease or social deprivation. Here the challenge is again to motivate, engage and connect, and make an relevant impact where possible to get that client in the best situation to maximize the opportunity for a good quality of life. Theses are usually your nursing home residents and they require a great deal of skill and perserverence to adequately serve as a therapist. So the Public Relations Challenge faced by OTs requires a consistent overall effort to first understand peoples needsand then be understood through education and communication. This is hard work in a demanding productivity-driven work place. It helps to have a department of likeminded energetic OTs. Otherwise, it's often tempting to just pass out a peg board and some cones and go finish my charting. But that onlly leads to further professional grief! I'm just a boy whose intentions are good..Oh Lord.. Please don't let me be misunderstood... The Animals ...somewhere fromthe 1960s (LOL) Thanks for listening, Brent Cheyne OTR/L Sarsota --- On Sat, 8/30/08, [EMAIL PROTECTED] [EMAIL PROTECTED] wrote: From: [EMAIL PROTECTED] [EMAIL PROTECTED] Subject: OTlist Digest, Vol 41, Issue 19 To: otlist@otnow.com Date: Saturday, August 30, 2008, 3:00 PM 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 [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your Subject line so it is more specific than Re: Contents of OTlist digest... Today's Topics: 1. Difficulty Articulating OT (Ron Carson) -- Message: 1 Date: Fri, 29 Aug 2008 18:06:32 -0400 From: Ron Carson [EMAIL PROTECTED] Subject: [OTlist] Difficulty Articulating OT To: OTlist OTlist@OTnow.com Message-ID: [EMAIL PROTECTED] Content-Type: text/plain; charset=windows-1252 Has anyone noticed that people have difficulty
Re: [OTlist] Difficulty Articulating Occupational
Great post Brent, thanks. I've also noticed that people have actual trouble saying occupational. Maybe it's just because it's an uncommon word! Ron -- Ron Carson MHS, OT - Original Message - From: Brent Cheyne [EMAIL PROTECTED] Sent: Saturday, August 30, 2008 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] Difficulty Articulating Occupational BC Ron, BC My clients and their families often wonder what is Occupational BC Therapy (?), and in my practice at a SNF, the main issue for the BC geriatric patients is getting back home...whatever it takes. So I BC try to explain from the very start that Occupation all things BC people want or need to get back to doing, and the Therapy is all BC the things that need to be done to make that happen. Educating the BC client that the interventions will be very functionally based and BC based on every-day tasks need to begin early and repeated often. BC BC My Subacute Rehab clients want to know what is in it for them... BC and to use a business term, they need to be marketed to, like a BC coach or consultant. They need a good sales pitch! A great BC percentage of my clientele, and their families,are becoming BC increasingly savy and sophisicated, goal-directed, and often do BC not tolerate any interventions that seem like a waste of time. BC This fact is welcome because it often makes treatment effective, BC effecient, and meaningful. The key is to get off to a good start, BC reach a common understanding, and meet Occupational needs by being BC relevant to the client. It is client-centered practice and does BC require a great degree of effort and skill. BC BC In our department we have a display board that show pictures of BC former clients in OT doing Occupation- based tasks, cooking , BC shopping, laundry, using adaptive equipment, etc.. in our BC department environment. This board is used to show touring BC visitors, and newlly admitted clients examples of what can be BC addressed in OT...a picture (board) is worth 1000 words This BC often helps especially with families who realize these areas will need to be addressed. BC BC But there are a certain percentage of my clients that don't get BC the concept of Occupational Therapy because of a history of bad BC experiences with OT, or have observed others having a bad BC experience...doing unwanted, meaningless, sometime mudane tasks. BC They also have a concept of all therapy solely involving exercises BC and walking. This perception is hard to overcome if the persons BC mindset has be reinforced from other facillity staff and bad BC history. People even refuse to perform needed Occupation-based relevant and meaningful tasks BC prior to discharge due to their resistance, fear, and denial. BC They often assume things will be just fine when they get home. BC Theses clients require a lot of work and skill to motivate, BC engage, and connect with. It really can be what I call a public relations challenge. BC BC Additionally, there are the folks who have a very passive BC mindset, and wish to be simply want to fixed by therapy without BC any personal goals,effort, or planning. THese patients often can't BC identify Occupation in their life because, upon detailed BC examination, their lives are devoid of much Occupation as a result BC of chromic disease or social deprivation. Here the challenge is BC again to motivate, engage and connect, and make an relevant BC impact where possible to get that client in the best situation to BC maximize the opportunity for a good quality of life. Theses are BC usually your nursing home residents and they require a great deal BC of skill and perserverence to adequately serve as a therapist. BC BC So the Public Relations Challenge faced by OTs requires a BC consistent overall effort to first understand peoples needsand BC then be understood through education and communication. This is BC hard work in a demanding productivity-driven work place. It helps BC to have a department of likeminded energetic OTs. Otherwise, it's BC often tempting to just pass out a peg board and some cones and go BC finish my charting. But that onlly leads to further professional grief! BC BC I'm just a boy whose intentions are good..Oh BC Lord.. Please don't let me be misunderstood... The Animals ...somewhere fromthe 1960s BC (LOL) BC Thanks for listening, BC Brent Cheyne OTR/L BC Sarsota BC BC --- On Sat, 8/30/08, [EMAIL PROTECTED] BC [EMAIL PROTECTED] wrote: BC From: [EMAIL PROTECTED] [EMAIL PROTECTED] BC Subject: OTlist Digest, Vol 41, Issue 19 BC To: otlist@otnow.com BC Date: Saturday, August 30, 2008, 3:00 PM BC Send OTlist mailing list submissions to BC otlist@otnow.com BC To subscribe or unsubscribe via the World Wide Web, visit BC http://otnow.com/mailman/listinfo/otlist_otnow.com BC or, via email, send a message with subject or body 'help' to BC [EMAIL PROTECTED] BC You can reach the person
Re: [OTlist] Elbow Break, Referral...
I would write all 4 goals.? Why in the world would you not take this patient?? I shouldn't have taken it but I did.? What patient's do you take? Chris Nahrwold MS, OTR St. John's Hospital Anderson, Indiana -Original Message- From: Ron Carson [EMAIL PROTECTED] To: OTlist OTlist@OTnow.com Sent: Sat, 30 Aug 2008 2:48 pm Subject: [OTlist] Elbow Break, Referral... Received a new referral for a elbow fracture. I shouldn't have taken it but I did. And here is the dilemma facing our profession. The patient is 95, previously living independently. Fractured elbow in a fall. Now living with daughter. She is in a large amount of pain. Obviously, she is dependent for most of her occupations. She currently uses a cane but is not safe. The patient's immediate concerns are her elbow. When pressed, she of course wants to go back home, but that is not an immediate goal. So what do I write for goals? For example should I write: Patient will self-report pain as 3 out of 10 Patient's will increase active elbow extension to -20 degrees These goals seem to direct the patients and doctor's concerns but are not occupationally oriented. So, should I write: Patient will safely and independently dress lower body Patient will safely and independently ambulate to the bathroom using the least restrictive mobility aid I like these goals but they don't address the immediate concerns. Ron -- Ron Carson MHS, OT -- 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
Re: [OTlist] Articulating Occupation
Ron, In my humble opinion and based on my observation Here are 10 reasons why Occupation-based treatment isn't regularly provided in the SNF setting. When it is not routinely practiced, it is very difficult to explain it to clients/patients. 1) Lack of consistent therapists for patients over treatment course leads to disjointed, sporatic interventions including hit and miss use Occupation of PRN and contract therapists. 3) Therapists who don't have an ongoing relationship or knowledge of the patient no offense intended people) doing what treatment they can with the patient for that session, that day. 4) An overall lack of appropriate (ie short) staffing of a department. 3) High Productivity Standards leading to treatment of multiple patients at a time and overwhelming paper work. 4) Lack of equipment/space/materials needed for Occupation-based treatment Busy-noisy-crowded clinics distracting environments discourage communication. 5) TIme needed to set-up, conduct,and clean up Occupation based interventions discourages effeciency. 6) Lack of time or enthusiasm for professional development, program building, team building, inservicing, energy and enthusiasm within a facility/ OTdepartment and culture of just seeing the patei getting through the day attitude. 7) Inappropriately prolonging intervention sessions, and course of treatment with patients without real skilled srvice or occupational interventions or without progress in order to satisfy Medicare RUGS categories, facility census numbers, and discharge dates. (as pressured by facility administrations). 8) Lack of creativity in providing occupation based treament and programming due to therapist inexperience, lack of peer support, and mentorship, 9) Lack of teamwork with other disciplines (PT, NSG). 10) Lack of professional involvement in local forums, state (FLOTA) and national organizations (AOTA) that provide support, resources, and professional advocacy. By no means are these 10 easy to fix, nor are they excuses for complacency, but they do show that the working conditions of some therapists make it challenging to practice according to our funadmental philosophy. It takes positive energy, enthusiasm, and persistence to get back to Occupation based practices. Thanks for listening Brent Cheyne OTR/L --- On Sat, 8/30/08, [EMAIL PROTECTED] [EMAIL PROTECTED] wrote: From: [EMAIL PROTECTED] [EMAIL PROTECTED] Subject: OTlist Digest, Vol 41, Issue 19 To: otlist@otnow.com Date: Saturday, August 30, 2008, 3:00 PM 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 [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your Subject line so it is more specific than Re: Contents of OTlist digest... Today's Topics: 1. Difficulty Articulating OT (Ron Carson) -- Message: 1 Date: Fri, 29 Aug 2008 18:06:32 -0400 From: Ron Carson [EMAIL PROTECTED] Subject: [OTlist] Difficulty Articulating OT To: OTlist OTlist@OTnow.com Message-ID: [EMAIL PROTECTED] Content-Type: text/plain; charset=windows-1252 Has anyone noticed that people have difficulty articulating the word occupational? Just today, a patient's husband had difficulty saying the word. And, I noticed it with other people as well, even with health care providers. Anyone else? Ron -- Ron Carson MHS, OT -- -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com Help? [EMAIL PROTECTED] End of OTlist Digest, Vol 41, Issue 19 ** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Elbow Break, Referral...
To follow the below logic, doesn't a patient need to increase ROM to sit on the toilet? Doesn't the patient need to reduce pain to get into the shower? My point is that there is this artificially created separation where OT expertise is ONLY above the waist. I think we either need to expand our musculoskeltal expertise to include the whole body, or stop focusing on the UE. And it is up to the patient to understand what we are doing. For one, it allows the patient to be part of the process, not a bystander. Regarding need to increase elbow function to hook a bra or reach for a kettle, I don't know that the patient wears a bra or reaches for a kettle. I understand that you don't mean these specific things, but in a patient-centered approach to OT, when possible, the patient drives the goal-making process, not the therapist. IF this patient said, you know I really want put on my bra but this dang elbow just won't let me, then I'd say 100% OT is the correct profession. But if I say, I'm going to increase your elbow function so you can put on your bra, isn't that PT? If I had an elbow fracture, and I did about 7 years ago, the VERY LAST thing on my mind was fastening my bra (joke). Really though, it was hard for me to zip my pants but that wasn't my concern. My concern was the pain and the loss of ROM. If I went to a therapist and he said what's your goals, I would say; 1. decrease my pain and 2. increase my ROM. If they came out with questions about dressing I'd say, yeah, you meet the above goals and I'll be able to dress myself Making occupational goals when patients are not concerned about occupation makes very little sense. What does make sense is fixing the problem causing the occupational issues. And I believe that if that's the case, and that's the focus and it's musculoskeltal issue, it should go to the PT. And, do you know of situations where is the ONLY provider when a patient has a recent hip fracture or hip replacement? Or, what about a TKR, I've never seen OT being the only therapist. So, why is OT often the only provider when an UE is injured? These are all situations where a musculoskeltal issue impacts occupation, so why isn't OT involved in the remediation of these issues? Gosh, I hate long messages.. Ron -- Ron Carson MHS, OT - Original Message - From: LRappap765 [EMAIL PROTECTED] Sent: Saturday, August 30, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Elbow Break, Referral... L Hi, L I don't think it's so unusual for a patient to focus on L eliminating pain. I don't think it means they are not interested L in occupations. Aren't we doing both things? Doesn't she need to L increase active elbow extension to hook her bra on, or L reach for the kettle to make tea. Just because she doesn't L articulate these things doesn't mean that' L s not the goal, does it? Isn't it really up to the OT to see the L link and make the connection and Maybe impart an understanding to L the patient. It's really up to us to understand what we do and L why, not the patient. Also, Using a cane safely also seems like L it falls in our domain. Just my 2 cents... L Linda Rappaport, MS, OTR/L L In a message dated 08/30/08 15:49:07 Eastern Daylight Time, [EMAIL PROTECTED] writes: L Received a new referral for a elbow fracture. I shouldn't have taken L it but I did. L And here is the dilemma facing our profession. The patient is 95, L previously living independently. Fractured elbow in a fall. Now living L with daughter. She is in a large amount of pain. Obviously, she is L dependent for most of her occupations. She currently uses a cane but L is not safe. L The patient's immediate concerns are her elbow. When pressed, she of L course wants to go back home, but that is not an immediate goal. L So what do I write for goals? For example should I write: LPatient will self-report pain as 3 out of 10 LPatient's will increase active elbow extension to -20 degrees L These goals seem to direct the patients and doctor's concerns but are L not occupationally oriented. So, should I write: LPatient will safely and independently dress lower body LPatient will safely and independently ambulate to the bathroom Lusing the least restrictive mobility aid L I like these goals but they don't address the immediate concerns. L Ron L -- L Ron Carson MHS, OT L -- L Options? L www.otnow.com/mailman/options/otlist_otnow.com L Archive? L www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Elbow Break, Referral...
I agree with Chris, I would take this patient and right all 4 goals. The only exception is i would state why i was going to decrease the pain or increase ROM. I would probably say something like: Pt. will increase active elbow extension to -20 degrees to allow for increased independence with upper body dressing or decrease reports or pain to increase functional performance with bilateral upper extremity tasks (grooming, bathing, dressing, etc.) Ron, you have now given us examples of 2 patients you would not treat, I too am wondering what kind of patient would you see? Kari, MOT, OTR/L Hollywood, Florida --- On Sat, 8/30/08, [EMAIL PROTECTED] [EMAIL PROTECTED] wrote: From: [EMAIL PROTECTED] [EMAIL PROTECTED] Subject: Re: [OTlist] Elbow Break, Referral... To: OTlist@OTnow.com Date: Saturday, August 30, 2008, 5:21 PM I would write all 4 goals.? Why in the world would you not take this patient?? I shouldn't have taken it but I did.? What patient's do you take? Chris Nahrwold MS, OTR St. John's Hospital Anderson, Indiana -Original Message- From: Ron Carson [EMAIL PROTECTED] To: OTlist OTlist@OTnow.com Sent: Sat, 30 Aug 2008 2:48 pm Subject: [OTlist] Elbow Break, Referral... Received a new referral for a elbow fracture. I shouldn't have taken it but I did. And here is the dilemma facing our profession. The patient is 95, previously living independently. Fractured elbow in a fall. Now living with daughter. She is in a large amount of pain. Obviously, she is dependent for most of her occupations. She currently uses a cane but is not safe. The patient's immediate concerns are her elbow. When pressed, she of course wants to go back home, but that is not an immediate goal. So what do I write for goals? For example should I write: Patient will self-report pain as 3 out of 10 Patient's will increase active elbow extension to -20 degrees These goals seem to direct the patients and doctor's concerns but are not occupationally oriented. So, should I write: Patient will safely and independently dress lower body Patient will safely and independently ambulate to the bathroom using the least restrictive mobility aid I like these goals but they don't address the immediate concerns. Ron -- Ron Carson MHS, OT -- 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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Elbow Break, Referral...
Well, it's artificial in the sense the occupation doesn't start and stop above the waist Finally, a short message... smile Ron -- Ron Carson MHS, OT - Original Message - From: [EMAIL PROTECTED] [EMAIL PROTECTED] Sent: Saturday, August 30, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Elbow Break, Referral... cac I don't thing the separation is artificial at all.? Just look at what we cac learned in school during our orthopedic classes.? Not saying it is right, it is cac just the experience of the professors at my class?and in the profession from what cac I can tell. cac -Original Message- cac From: Ron Carson [EMAIL PROTECTED] cac To: LRappap765 OTlist@OTnow.com cac Sent: Sat, 30 Aug 2008 6:23 pm cac Subject: Re: [OTlist] Elbow Break, Referral... cac To follow the below logic, doesn't a patient need to increase ROM to cac sit on the toilet? Doesn't the patient need to reduce pain to get into cac the shower? cac My point is that there is this artificially created separation where cac OT expertise is ONLY above the waist. I think we either need to expand cac our musculoskeltal expertise to include the whole body, or stop cac focusing on the UE. cac And it is up to the patient to understand what we are doing. For one, cac it allows the patient to be part of the process, not a bystander. cac Regarding need to increase elbow function to hook a bra or reach cac for a kettle, I don't know that the patient wears a bra or reaches cac for a kettle. I understand that you don't mean these specific things, cac but in a patient-centered approach to OT, when possible, the patient cac drives the goal-making process, not the therapist. cac IF this patient said, you know I really want put on my bra but this cac dang elbow just won't let me, then I'd say 100% OT is the correct cac profession. But if I say, I'm going to increase your elbow function cac so you can put on your bra, isn't that PT? cac If I had an elbow fracture, and I did about 7 years ago, the VERY LAST cac thing on my mind was fastening my bra (joke). Really though, it was cac hard for me to zip my pants but that wasn't my concern. My concern was cac the pain and the loss of ROM. If I went to a therapist and he said cac what's your goals, I would say; 1. decrease my pain and 2. increase my cac ROM. If they came out with questions about dressing I'd say, yeah, cac you meet the above goals and I'll be able to dress myself cac Making occupational goals when patients are not concerned about cac occupation makes very little sense. What does make sense is fixing the cac problem causing the occupational issues. And I believe that if that's cac the case, and that's the focus and it's musculoskeltal issue, it cac should go to the PT. cac And, do you know of situations where is the ONLY provider when a cac patient has a recent hip fracture or hip replacement? Or, wha cac t about a cac TKR, I've never seen OT being the only therapist. So, why is OT often cac the only provider when an UE is injured? These are all situations cac where a musculoskeltal issue impacts occupation, so why isn't OT cac involved in the remediation of these issues? cac Gosh, I hate long messages.. cac Ron cac -- cac Ron Carson MHS, OT cac - Original Message - cac From: LRappap765 [EMAIL PROTECTED] cac Sent: Saturday, August 30, 2008 cac To: OTlist@OTnow.com OTlist@OTnow.com cac Subj: [OTlist] Elbow Break, Referral... L Hi, L I don't think it's so unusual for a patient to focus on L eliminating pain. I don't think it means they are not interested L in occupations. Aren't we doing both things? Doesn't she need to L increase active elbow extension to hook her bra on, or L reach for the kettle to make tea. Just because she doesn't L articulate these things doesn't mean that' L s not the goal, does it? Isn't it really up to the OT to see the L link and make the connection and Maybe impart an understanding to L the patient. It's really up to us to understand what we do and L why, not the patient. Also, Using a cane safely also seems like L it falls in our domain. Just my 2 cents... L Linda Rappaport, MS, OTR/L L In a message dated 08/30/08 15:49:07 Eastern Daylight Time, cac [EMAIL PROTECTED] writes: L Received a new referral for a elbow fracture. I shouldn't have taken L it but I did. L And here is the dilemma facing our profession. The patient is 95, L previously living independently. Fractured elbow in a fall. Now living L with daughter. She is in a large amount of pain. Obviously, she is L dependent for most of her occupations. She currently uses a cane but L is not safe. L The patient's immediate concerns are her elbow. When pressed, she of L course wants to go back home, but that is not an immediate goal. L So what do I write for goals? For example should I write: LPatient will
Re: [OTlist] Elbow Break, Referral...
I can totally see Ron's point now.? I work in acute rehab and we actually have them undress and dress,?so it is easy for me.? To make things more functionally based in outpatient or home health I think I would trial the DASH.? This is an upper extremity assessment tool that is a pre and post treatment?survey of what functional problems the patient is encountering.? This will give the therapist a better idea of what to focus on based on the patients survey results.? Check it out on Google.? Based on a good description of what we do in OT?for the patient, I don't think they will have a problem talking about their occupational dysfunctions.? I would use both a therapeutic exercise/splinting/ and ADL practice/compensation approach. Chris Nahrwold MS, OTR St. John's Hospital Anderson, Indiana -Original Message- From: Ron Carson [EMAIL PROTECTED] To: Kari Rogozinski OTlist@OTnow.com Sent: Sat, 30 Aug 2008 6:54 pm Subject: Re: [OTlist] Elbow Break, Referral... Call me think-headed, but I don't see how those goals are any different than PT. When I read the goals I see the primary focus on decreasing pain and increasing ROM and the functional stuff is just thrown in. And that's primarily what PT does. OT knows there's a lot more to dressing than just physical dysfunction. There's the environment, cognition, motivation, family issues, etc. With your goals, what happens if ROM is increase so the patient SHOULD be able to dress but they still can't because the family doesn't feel they are safe? According to your goals, the patient is d/c. Either that or you'll need some new goals! I will also suggest that goals should not be written unless it has been assessed. In other words, I don't write ROM goals, because I don't take ROM measurements. I do assess occupation and those are the goals that I write. Again, what the therapists assess should be the goals. And conversely, if it's not assessed then it shouldn't be a goal. Also, goals must be measurable and progress must be made. How can a therapist measure progress towards a goal that is not initially measured? And, what measure is going to be used? I will say the increase functional performance with bilateral UE tasks is not exactly a measurable goal? Now, if you assessed that the patient required mod assist to donn her bra and the goal was Pt will independently donn/doff bra, then that's an OT assessment and goal. However, can you see this ladies face when I ask her about how much assistance she need to put on her bra, or pull up her underwear? She's going to think I'm nuts because she wants me to fix her arm, not worry about teaching her to get dressed! Gosh, I hate long messages. Sorry for typos/graphos Ron -- Ron Carson MHS, OT - Original Message - From: Kari Rogozinski [EMAIL PROTECTED] Sent: Saturday, August 30, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Elbow Break, Referral... KR I ag ree with Chris, I would take this patient and right all 4 KR goals.? The only exception is i would state why i was going to KR decrease the pain or increase ROM.? I would probably say something KR like: ? Pt. will increase active elbow extension to -20 degrees to KR allow for increased independence with upper body dressing or KR decrease reports or pain to increase functional performance with KR bilateral upper extremity tasks (grooming, bathing, dressing, etc.)? KR ? KR Ron, you have now given us examples of 2 patients you would not KR treat, I too am wondering what kind of patient would you see?? KR ? KR ? KR Kari, MOT, OTR/L KR Hollywood, Florida KR --- On Sat, 8/30/08, [EMAIL PROTECTED] [EMAIL PROTECTED] wrote: KR From: [EMAIL PROTECTED] [EMAIL PROTECTED] KR Subject: Re: [OTlist] Elbow Break, Referral... KR To: OTlist@OTnow.com KR Date: Saturday, August 30, 2008, 5:21 PM KR I would write all 4 goals.? Why in the world would you not take this patient?? KR I shouldn't have taken it but I did.? What patient's do you KR take? KR Chris Nahrwold MS, OTR KR St. John's Hospital KR Anderson, Indiana KR -Original Message- KR From: Ron Carson [EMAIL PROTECTED] KR To: OTlist OTlist@OTnow.com KR Sent: Sat, 30 Aug 2008 2:48 pm KR Subject: [OTlist] Elbow Break, Referral... KR Received a new referral for a elbow fracture. I shouldn't have taken KR it but I did. KR And here is the dilemma facing our profession. The patient is 95, KR previously living independently. Fractured elbow in a fall. Now living KR with daughter. She is in a large amount of pain. Obviously, she is KR dependent for most of her occupations. She currently uses a cane but KR is not safe. KR The patient's immediate concerns are her elbow. When pressed, she of KR course wants to go back home, but that is not an immediate goal. KR So what do I write for goals? For example should I write: KR Patient will self-report pain as 3 out of 10 KR
