Re: [OTlist] AARGH!
-PT completes standing challenges so the patient can walk and improve in their balance.? Treatment usually stops when a certain distance has been reached or a certain grade of balance has been achieved.? I have rarely (work hardening is the only example I can think of)?seen a PT use an ADL or an IADL for a treatment modality or a functional outcome unless is is reported from the patient subjectively through oral report or via a standardized functional survey (outpatient). -OT completes standing challenges so the patient can stand to pull up pants, stand at the sink to groom, stand at the kitchen counter to cook, stand to take out the garbage.? When a therapist uses a standing challenge it should be verbalized as to why it is important to work on standing in order to get to their personal occupational goal.? That is what makes it a "meaningful activity". When safe and physically ready, the actual task should be integrated into the treatment session (as soon as possible), in which at that point the actual task should be performed?and practiced to reinforce learning.??This concept could and should be applied to everything we do as OTs (fine motor, gross motor, strength, vision/perception, soft tissue mobilization, joint mobilization).? That way the patient can actually see the meaning behind the activity so they can see the light at the end of the tunnel.? When we only do things to improve strength, improve coordination, improve standing balance, and not looking toward the big picture,?then what we?are doing is physical therapy in my book.? This concept has been hard for me in outpatient hand?and UE stroke rehab though, but I am constantly trying to make improvements in this area, and have liked the ideas of Ron as these areas being specialized areas in which an OT happens to be working in. As far as the SNF issues, I think seeing that many people at the same time is fraud.? To see a group like that you must bill the patients' with?the group charge and only 25% of the patient's minutes can be group minutes.? I suspect that the patients are being seen for a lesser time than being billed, because of such a huge group.? How can anyone time or watch a clock for 6-8 patients to ensure they are getting the necessary time? I highly doubt if 6-8 stop watches are on for each patient.? I also suspect that therapists are plugging in different times for each patient although they were all seen at the same time.? I know this because I once worked on a SNF and they tried to get me to do this to be more productive.? Needless to say I only worked there for 3 months.? If you don't believe me just call medicare or the group that runs medicare in your area.? I am sure they will give you some answers, but just be prepared to be on the phone for a long time, trust me I know.? And when confronting management do not be surprised if you get fired, but I would certainly let management know that medicare will be getting a call so they should be prepared for an audit.? The only way that this situation will change is if we all stand up for ourselves.? It sounds like more than a verbal discussion needs to take place for your SNF patient population to identify occupational goals.? For the client whom states that they like to sit on their chair and watch TV all day I would work on bed to chair transfers, sit to stands in order to safely get to the TV, walking to get the remote to change the channel, and education about the importance of doing more in life to avoid immobility problems.? I highly doubt if that is the only thing the patient has to do the entire day, doesn't the patient have to eat and use the restroom at least?? I would sit down by yourself on the computer and think of all of the different possible occupations in which a patient has to perform on a daily basis (ranging from getting out of bed to watering the plants).? I would?make this into a checklist format and during the evaluation and re-evaluations I would have the patient fill it out with your assistance depending on their cognitive level.? We have to remember that many of the patients suffer from depression and dementia in this area, so of course they are going to give you an non excited response.? Most of them are so depressed that deep down they all just want to be alone to die.? It is our job to show them that there is someone who cares about their well being and believes in them.? Try to get to know them and talk to them and slowly but surely help them to achieve a few goals.? I think you will be surprised. Chris Nahrwold MS, OTR -Original Message- From: Diane Randall <[EMAIL PROTECTED]> To: OTlist@OTnow.com Sent: Sun, 30 Nov 2008 8:33 pm Subject: Re: [OTlist] AARGH! I believe standing is functional...but I am trying to understand how we differ from PT. Pt has already merged with OT in regards to "self-care". I find this all very confusig as a student. Our teacher seems to think clothpins a
Re: [OTlist] AARGH!
Hi Ron and Diane! I still think Diane is onto something - when doing something meaningful, or interesting, or fun, at least two things IMO are likely to happen: 1: You'll have your attention a bit off your standing problem, and thus may be able to stand for longer. 2: You're in a more realistic situation than when just working on the standing - there may be some reaching etc to do to accomplish the task. Could make the timed standing result better - or worse - but still, valuable information for both patient and therapist. (This may be neither OT, nor PT - but more like bits of movement science, which could be applied to both?) Also - your take on the situation, Ron, to me seems to require that the therapist can uncover, and then cover, all the things the patient actually wants and needs to do in the future. I suggest this is not always possible, and we sometimes need to also look at some commonly occurring situations (IN the patient's desired occupations and lifestyle) - of which doing things while standing at a tabletop just might be one - and then find the most representative examples we can come up with in the current setting. I have a patient with hemiplegia - with me chooses to work on involving his left hand in his ADL's - like supporting dish and food with it while he eats - braking/unbraking wheelchair - supporting pants during toileting, dressing/undressing/transfers - plus I generally help him fine tune transfers, toileting, night routines, whatever comes up - plus some assisted walking to the dining room whenever he feels like. I'm employed in the evening care team of this NH department. Same time he's genuinely happy with his OT in the training team - who has him play board games using his left hand (although he's right-handed) - and, I know, lots of other things that I build on - but he really focuses on this - he likes the fact that he can train while using his still strong skills at these board games, and wants board games for Christmas. He is way over 90, and is in the NH to stay - his wife visits every day for many hours - he is a pleasure to be around, an interesting conversation partner with much concern for other people and world events - and I suspect his deepest goal is to continue to be just that - a person who fulfills his life roles, as a partner, friend, companion, resident, patient, citizen - still growing and contributing, so not dead yet! Does he have any occupational problems not addressed - yes - as a partner where his wife so wishes she could take him more out, or home for the day, but is afraid to because of things like frequent episodes with his catheter, and not sufficient care offered outside the NH. He suffers, mostly because she suffers, that he can't fulfill the role of companion and partner outside the NH. That is a barrier I only know how to work on more generally and long term - by being an engaged citizen and OT, who cares about care politics and tries to raise awareness of the many needs not yet addressed. warmly susanne, denmark Original Message From: "Ron Carson" <[EMAIL PROTECTED]> To: "Diane Randall" Sent: Sunday, November 30, 2008 1:14 PM Subject: Re: [OTlist] AARGH! > Hello Diane: > > Thanks for writing. > > I want to encourage you to try and see things a little > differently. > > You said: > > "Instead of timing someone with a stopwatch > for standing balance, I find out what table top > activities are meaningful to them and have > them stand while engaging in those > activities. " > > Unless a particular activity is a patient's stated goal, > I suggest NOT having patients standing at table doing > activities. Instead, engage patients in those > occupations which are impeded by decreased standing > balance, endurance, etc. For example, if a patient > can't get their clothes from the closet because they > can't stand with their walker, > then work on standing with a walker. If a patient > can't ambulate to > get their clothes, then work on mobility with a walker. > Get away from > the table top and move out into the "real world"! > > I also think that using a stop watch has merit because > it gives the patient tangible and visual feedback on > improvement. While standing > for a certain amount of time should NEVER be a goal, > patients can be highly motivated by seeing > improvement in standing endurance. (snip) -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] AARGH!
I believe standing is functional...but I am trying to understand how we differ from PT. Pt has already merged with OT in regards to "self-care". I find this all very confusig as a student. Our teacher seems to think clothpins and cones are usually not functional. She would rather us mimic the activity doing something more meaningful to the pt. What? That is the hard part for me. I often wonder how the idealism of our program matches the real world OT experience. I will find out soon. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of [EMAIL PROTECTED] Sent: Sunday, November 30, 2008 18:28 To: OTlist@OTnow.com Subject: Re: [OTlist] AARGH! It is funny in what we consider functional and not functional.? How can standing not be functional but doing a bunch of crafts, reaching for clothes pins and cones is considered functional?? Ninety percent of the clients I see do not like crafts and have no intention of starting crafts, so why is so much time devoted in school?in this?area?? We need?to focus on concrete functional?evaluations and treatments in?schools.?Seventy percent of the clients I see do not have arm dysfunction but I still see therapists whip out the theraband.?? We just need to find?what are the patient's priorities for rehab, the impairments, and the environmental barriers that will prevent progress. ?Most people in acute rehab just want to make it back home, so why not focus on all of the?activities that they have to complete safely to make that a reality?? You have to think beyond just simple bathing and dressing though!? I can certainly understand when a patient is very low level in their abilities a! nd they have to start at the bottom of the ladder, but there comes a point when you have to prepare them for home.? It is so simple and rewarding to take this aproach in occupational therapy. Chris Nahrwold MS, OTR St. John's Hospital of ?Anderson Indiana -Original Message- From: Ron Carson <[EMAIL PROTECTED]> To: Diane Randall Sent: Sun, 30 Nov 2008 12:27 pm Subject: Re: [OTlist] AARGH! Thanks to some comments I've read on this list, I've stopped being concerned if what I'm doing "LOOKS" like PT. I sort of laugh at this statement because on Friday a patient asked me: "Now, are you the PT or the OT". Ron -- Ron Carson MHS, OT - Original Message - From: Diane Randall <[EMAIL PROTECTED]> Sent: Sunday, November 30, 2008 To: OTlist@OTnow.com Subj: [OTlist] AARGH! DR> I always like to read your take on things. I agree with you. I just had in DR> the back of my mind a COTA I was following who made a woman stand for the DR> sake of standing but did not combine it with anything functional. As a DR> student, this confused me. It looked more like PT. Thanks for your comments. -- 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] AARGH!
Hi Ilene, I know exactly what you mean. I work in a SNF setting and have the same problem. A lot of the time I have found that it is difficult to find something that is meaningful to the patient. If I ask them what is important to them, or what activities do they like, I'll get a shrug or something like: "Oh, I just sit in my chair, watching tv all day. I don't like to do anything." I address what I have to in order to get the patient independent enough to discharge to the desired location. Audra Ray, OTR/L --- On Sun, 11/30/08, Ron Carson <[EMAIL PROTECTED]> wrote: From: Ron Carson <[EMAIL PROTECTED]> Subject: Re: [OTlist] AARGH! To: "[EMAIL PROTECTED]" Date: Sunday, November 30, 2008, 3:31 PM Hello Ilene: Thanks for coming "out of the closet" and posting! I think you represent the other end of the spectrum because you work in an environment that is not conducive to occupation based practice. I have LIMITED SNF experience but what I had was very negative. Basically, I refused to practice the way the SNF company wanted, exactly what you describe, and I was fired. I say all of this because I'm NOT the right person for giving SNF advice. I wish I had encouraging words, but I truly think corporate greed makes meaningful OT very, very difficult. Maybe others on the list have more positive advice. There is just no way that you can see a hoard of patients and provide meaningful OT. At least in my opinion and experience Ron -- Ron Carson MHS, OT - Original Message - From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Sent: Sunday, November 30, 2008 To: otlist@otnow.com Subj: [OTlist] AARGH! ocn> Hello from a long time lurker, first time poster. I am one of ocn> those OT's being criticized for having patients play cards, stand ocn> and fold/hang up laundry, etc for standing tolerance. I don't do ocn> these activities because I am lazy, but am actually trying the ocn> best I can to be functional in less-than-ideal environments and ocn> situations. First of all, I never learned real-world OT ocn> activities that are truly functional. In school, every case study ocn> had two things in common; the first is that there was some hidden ocn> passion that was just waiting to be discovered by the OT (she ocn> used to love water painting, or something like that) the second ocn> was that there seemed to be unlimited time in which to engage ocn> patients, and facilities with unlimited funds and space. My ocn> fieldwork placements were very medically oriented and did not ocn> give me much in the way of functional treatment ideas. ocn> So in my situation, I work in a SNF. Most of the patients we see ocn> are long-term or live in the ALF side. We have a tiny gym, no ocn> kitchen, no ADL suites, and limited equipment. I do a.m. ADL's as ocn> much as I can, but can only do 1-2 in the morning (all residents ocn> have to be in the dining room by 8). Sure, I have patients get ocn> things from dressers and work on transfers in the gym, but the ocn> reality is that I have 6-8 people in the gym at once (the PT and ocn> I do not split treatment but treat everyone in the same room, ocn> basically together). The things mentioned about take all of 15 ocn> minutes, but I have to see these patients for an hour. I always ocn> try to find out their interests both now and before they lived in ocn> the nursing home but it is often without much success. ocn> I am not making excuses, rather I am asking for ideas. I am ocn> always searching the net and journals for more functional ocn> treatment ideas, and do not find much. On the boards, I see a lot ocn> of "OT's shouldn't do that, we should be more creative" but that ocn> is easy to say without offering any solutions. I also see a lot ocn> of "well, go to Home Health" but obviously we can't all do that, ocn> and I enjoy the SNF setting. What I am asking for with this post ocn> is real-world ideas. I am hungry for them but see little offered. ocn> Ron, how about doing a seminar? Most of the seminars offered are ocn> medically oriented but offer few functional treatment ideas. What do others in my situation do? ocn> Thanks, ocn> Ilene from Jersey ocn> -- ocn> Options? ocn> www.otnow.com/mailman/options/otlist_otnow.com ocn> Archive? ocn> 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] AARGH!
Hello Ilene: Thanks for coming "out of the closet" and posting! I think you represent the other end of the spectrum because you work in an environment that is not conducive to occupation based practice. I have LIMITED SNF experience but what I had was very negative. Basically, I refused to practice the way the SNF company wanted, exactly what you describe, and I was fired. I say all of this because I'm NOT the right person for giving SNF advice. I wish I had encouraging words, but I truly think corporate greed makes meaningful OT very, very difficult. Maybe others on the list have more positive advice. There is just no way that you can see a hoard of patients and provide meaningful OT. At least in my opinion and experience Ron -- Ron Carson MHS, OT - Original Message - From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Sent: Sunday, November 30, 2008 To: otlist@otnow.com Subj: [OTlist] AARGH! ocn> Hello from a long time lurker, first time poster. I am one of ocn> those OT's being criticized for having patients play cards, stand ocn> and fold/hang up laundry, etc for standing tolerance. I don't do ocn> these activities because I am lazy, but am actually trying the ocn> best I can to be functional in less-than-ideal environments and ocn> situations. First of all, I never learned real-world OT ocn> activities that are truly functional. In school, every case study ocn> had two things in common; the first is that there was some hidden ocn> passion that was just waiting to be discovered by the OT (she ocn> used to love water painting, or something like that) the second ocn> was that there seemed to be unlimited time in which to engage ocn> patients, and facilities with unlimited funds and space. My ocn> fieldwork placements were very medically oriented and did not ocn> give me much in the way of functional treatment ideas. ocn> So in my situation, I work in a SNF. Most of the patients we see ocn> are long-term or live in the ALF side. We have a tiny gym, no ocn> kitchen, no ADL suites, and limited equipment. I do a.m. ADL's as ocn> much as I can, but can only do 1-2 in the morning (all residents ocn> have to be in the dining room by 8). Sure, I have patients get ocn> things from dressers and work on transfers in the gym, but the ocn> reality is that I have 6-8 people in the gym at once (the PT and ocn> I do not split treatment but treat everyone in the same room, ocn> basically together). The things mentioned about take all of 15 ocn> minutes, but I have to see these patients for an hour. I always ocn> try to find out their interests both now and before they lived in ocn> the nursing home but it is often without much success. ocn> I am not making excuses, rather I am asking for ideas. I am ocn> always searching the net and journals for more functional ocn> treatment ideas, and do not find much. On the boards, I see a lot ocn> of "OT's shouldn't do that, we should be more creative" but that ocn> is easy to say without offering any solutions. I also see a lot ocn> of "well, go to Home Health" but obviously we can't all do that, ocn> and I enjoy the SNF setting. What I am asking for with this post ocn> is real-world ideas. I am hungry for them but see little offered. ocn> Ron, how about doing a seminar? Most of the seminars offered are ocn> medically oriented but offer few functional treatment ideas. What do others in my situation do? ocn> Thanks, ocn> Ilene from Jersey ocn> -- ocn> Options? ocn> www.otnow.com/mailman/options/otlist_otnow.com ocn> Archive? ocn> 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] AARGH!
It is funny in what we consider functional and not functional.? How can standing not be functional but doing a bunch of crafts, reaching for clothes pins and cones is considered functional?? Ninety percent of the clients I see do not like crafts and have no intention of starting crafts, so why is so much time devoted in school?in this?area?? We need?to focus on concrete functional?evaluations and treatments in?schools.?Seventy percent of the clients I see do not have arm dysfunction but I still see therapists whip out the theraband.?? We just need to find?what are the patient's priorities for rehab, the impairments, and the environmental barriers that will prevent progress. ?Most people in acute rehab just want to make it back home, so why not focus on all of the?activities that they have to complete safely to make that a reality?? You have to think beyond just simple bathing and dressing though!? I can certainly understand when a patient is very low level in their abilities and they have to start at the bottom of the ladder, but there comes a point when you have to prepare them for home.? It is so simple and rewarding to take this aproach in occupational therapy. Chris Nahrwold MS, OTR St. John's Hospital of ?Anderson Indiana -Original Message- From: Ron Carson <[EMAIL PROTECTED]> To: Diane Randall Sent: Sun, 30 Nov 2008 12:27 pm Subject: Re: [OTlist] AARGH! Thanks to some comments I've read on this list, I've stopped being concerned if what I'm doing "LOOKS" like PT. I sort of laugh at this statement because on Friday a patient asked me: "Now, are you the PT or the OT". Ron -- Ron Carson MHS, OT - Original Message - From: Diane Randall <[EMAIL PROTECTED]> Sent: Sunday, November 30, 2008 To: OTlist@OTnow.com Subj: [OTlist] AARGH! DR> I always like to read your take on things. I agree with you. I just had in DR> the back of my mind a COTA I was following who made a woman stand for the DR> sake of standing but did not combine it with anything functional. As a DR> student, this confused me. It looked more like PT. Thanks for your comments. -- 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] AARGH!
Hello from a long time lurker, first time poster. I am one of those OT's being criticized for having patients play cards, stand and fold/hang up laundry, etc for standing tolerance. I don't do these activities because I am lazy, but am actually trying the best I can to be functional in less-than-ideal environments and situations. First of all, I never learned real-world OT activities that are truly functional. In school, every case study had two things in common; the first is that there was some hidden passion that was just waiting to be discovered by the OT (she used to love water painting, or something like that) the second was that there seemed to be unlimited time in which to engage patients, and facilities with unlimited funds and space. My fieldwork placements were very medically oriented and did not give me much in the way of functional treatment ideas. So in my situation, I work in a SNF. Most of the patients we see are long-term or live in the ALF side. We have a tiny gym, no kitchen, no ADL suites, and limited equipment. I do a.m. ADL's as much as I can, but can only do 1-2 in the morning (all residents have to be in the dining room by 8). Sure, I have patients get things from dressers and work on transfers in the gym, but the reality is that I have 6-8 people in the gym at once (the PT and I do not split treatment but treat everyone in the same room, basically together). The things mentioned about take all of 15 minutes, but I have to see these patients for an hour. I always try to find out their interests both now and before they lived in the nursing home but it is often without much success. I am not making excuses, rather I am asking for ideas. I am always searching the net and journals for more functional treatment ideas, and do not find much. On the boards, I see a lot of "OT's shouldn't do that, we should be more creative" but that is easy to say without offering any solutions. I also see a lot of "well, go to Home Health" but obviously we can't all do that, and I enjoy the SNF setting. What I am asking for with this post is real-world ideas. I am hungry for them but see little offered. Ron, how about doing a seminar? Most of the seminars offered are medically oriented but offer few functional treatment ideas. What do others in my situation do? Thanks, Ilene from Jersey -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] AARGH!
Thanks to some comments I've read on this list, I've stopped being concerned if what I'm doing "LOOKS" like PT. I sort of laugh at this statement because on Friday a patient asked me: "Now, are you the PT or the OT". Ron -- Ron Carson MHS, OT - Original Message - From: Diane Randall <[EMAIL PROTECTED]> Sent: Sunday, November 30, 2008 To: OTlist@OTnow.com Subj: [OTlist] AARGH! DR> I always like to read your take on things. I agree with you. I just had in DR> the back of my mind a COTA I was following who made a woman stand for the DR> sake of standing but did not combine it with anything functional. As a DR> student, this confused me. It looked more like PT. Thanks for your comments. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] AARGH!
I always like to read your take on things. I agree with you. I just had in the back of my mind a COTA I was following who made a woman stand for the sake of standing but did not combine it with anything functional. As a student, this confused me. It looked more like PT. Thanks for your comments. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Ron Carson Sent: Sunday, November 30, 2008 07:14 To: Diane Randall Subject: Re: [OTlist] AARGH! Hello Diane: Thanks for writing. I want to encourage you to try and see things a little differently. You said: "Instead of timing someone with a stopwatch for standing balance, I find out what table top activities are meaningful to them and have them stand while engaging in those activities. " Unless a particular activity is a patient's stated goal, I suggest NOT having patients standing at table doing activities. Instead, engage patients in those occupations which are impeded by decreased standing balance, endurance, etc. For example, if a patient can't get their clothes from the closet because they can't stand with their walker, then work on standing with a walker. If a patient can't ambulate to get their clothes, then work on mobility with a walker. Get away from the table top and move out into the "real world"! I also think that using a stop watch has merit because it gives the patient tangible and visual feedback on improvement. While standing for a certain amount of time should NEVER be a goal, patients can be highly motivated by seeing improvement in standing endurance. I recently d/c a home health patient whose had a goal to ambulate from her bed to her toilet. Treatment started with standing bedside. Her initial standing tolerance was 10 secs. I recorded this time and every time there after, not because they were goals, but because they were a measurement of progress towards her goal. Ron -- Ron Carson MHS, OT - Original Message - From: Diane Randall <[EMAIL PROTECTED]> Sent: Saturday, November 29, 2008 To: OTlist@OTnow.com Subj: [OTlist] AARGH! DR> Ron, I am a COTA student. I believe part of he problem is that media is not DR> being taught in OT school. There are two programs in our area. Our program DR> requires two media classes where we have to learn everything from knitting DR> to ceramics. Our teacher frowns upon "clothespins" and "cones" and makes us DR> up come up with a ideas that are functional and creative and meaningful to DR> the patient when we are treatment planning. The other program in the area DR> offers no media classes. At first, I could not understand why we were DR> learning so many crafts and why we were constantly forced to think outside DR> the box. Now that I am ready for my internship program, I see the benefit. I DR> have been taught to have a "bag of tricks" when I treat patients. Instead of DR> timing someone with a stopwatch for standing balance, I find out what table DR> top activities are meaningful to them and have them stand while engaging in DR> those activities. It is about taking the time to know your patients, however DR> briefly, and engaging them in activity that will sustain their attention and DR> interest. I know emphasis has been placed on productivity and profit seem to DR> have taken over some facilities. I think we can do both if we create our own DR> "bag of tricks" for our patients. It does have to be time consuming.Diane DR> -Original Message- DR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] DR> Behalf Of Ron Carson DR> Sent: Saturday, November 29, 2008 04:36 DR> To: Deann Bayerl, MS OTR/l DR> Subject: Re: [OTlist] AARGH! DR> I sort of struggle to understand how OT's who set up patients on DR> simple, redundant and often inappropriate activities are not "bad". I DR> understand the productivity push, but I don't understand being so lazy DR> that the best a therapist can do is clothespins, pegs, etc. DR> And I don't think it's that so many OT's are physically lazy as they DR> are mentally lazy. OT's have allowed themselves to be backed into a DR> corner of meaningless and silly activity that is often more DR> diversional than therapeutic. It seems that some OT's are quite DR> comfortable in the back seat of the rehab. In my opinion, these OT's DR> should be ashamed of their practice patterns. DR> Ron DR> -- DR> Ron Carson MHS, OT DR> - Original Message - DR> From: Deann Bayerl, MS OTR/l <[EMAIL PROTECTED]> DR> Sent: Friday, November 28, 2008 DR> To: otlist@otnow.com DR> Subj: [OTlist] AARGH! DBMOl>> Ron, DBMOl>> I do understand your frustration, even more so from having spent some DR> time DBMOl>> in IP rehab. Here are two of the problems outside of lack of DBMOl>> creativityproductivity and required IP pt rehab hours. Although I DBMOl>> preferred to work with pts on ADLs in the am, b/c they were the
Re: [OTlist] AARGH!
Hello Diane: Thanks for writing. I want to encourage you to try and see things a little differently. You said: "Instead of timing someone with a stopwatch for standing balance, I find out what table top activities are meaningful to them and have them stand while engaging in those activities. " Unless a particular activity is a patient's stated goal, I suggest NOT having patients standing at table doing activities. Instead, engage patients in those occupations which are impeded by decreased standing balance, endurance, etc. For example, if a patient can't get their clothes from the closet because they can't stand with their walker, then work on standing with a walker. If a patient can't ambulate to get their clothes, then work on mobility with a walker. Get away from the table top and move out into the "real world"! I also think that using a stop watch has merit because it gives the patient tangible and visual feedback on improvement. While standing for a certain amount of time should NEVER be a goal, patients can be highly motivated by seeing improvement in standing endurance. I recently d/c a home health patient whose had a goal to ambulate from her bed to her toilet. Treatment started with standing bedside. Her initial standing tolerance was 10 secs. I recorded this time and every time there after, not because they were goals, but because they were a measurement of progress towards her goal. Ron -- Ron Carson MHS, OT - Original Message - From: Diane Randall <[EMAIL PROTECTED]> Sent: Saturday, November 29, 2008 To: OTlist@OTnow.com Subj: [OTlist] AARGH! DR> Ron, I am a COTA student. I believe part of he problem is that media is not DR> being taught in OT school. There are two programs in our area. Our program DR> requires two media classes where we have to learn everything from knitting DR> to ceramics. Our teacher frowns upon "clothespins" and "cones" and makes us DR> up come up with a ideas that are functional and creative and meaningful to DR> the patient when we are treatment planning. The other program in the area DR> offers no media classes. At first, I could not understand why we were DR> learning so many crafts and why we were constantly forced to think outside DR> the box. Now that I am ready for my internship program, I see the benefit. I DR> have been taught to have a "bag of tricks" when I treat patients. Instead of DR> timing someone with a stopwatch for standing balance, I find out what table DR> top activities are meaningful to them and have them stand while engaging in DR> those activities. It is about taking the time to know your patients, however DR> briefly, and engaging them in activity that will sustain their attention and DR> interest. I know emphasis has been placed on productivity and profit seem to DR> have taken over some facilities. I think we can do both if we create our own DR> "bag of tricks" for our patients. It does have to be time consuming.Diane DR> -Original Message- DR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] DR> Behalf Of Ron Carson DR> Sent: Saturday, November 29, 2008 04:36 DR> To: Deann Bayerl, MS OTR/l DR> Subject: Re: [OTlist] AARGH! DR> I sort of struggle to understand how OT's who set up patients on DR> simple, redundant and often inappropriate activities are not "bad". I DR> understand the productivity push, but I don't understand being so lazy DR> that the best a therapist can do is clothespins, pegs, etc. DR> And I don't think it's that so many OT's are physically lazy as they DR> are mentally lazy. OT's have allowed themselves to be backed into a DR> corner of meaningless and silly activity that is often more DR> diversional than therapeutic. It seems that some OT's are quite DR> comfortable in the back seat of the rehab. In my opinion, these OT's DR> should be ashamed of their practice patterns. DR> Ron DR> -- DR> Ron Carson MHS, OT DR> - Original Message - DR> From: Deann Bayerl, MS OTR/l <[EMAIL PROTECTED]> DR> Sent: Friday, November 28, 2008 DR> To: otlist@otnow.com DR> Subj: [OTlist] AARGH! DBMOl>> Ron, DBMOl>> I do understand your frustration, even more so from having spent some DR> time DBMOl>> in IP rehab. Here are two of the problems outside of lack of DBMOl>> creativityproductivity and required IP pt rehab hours. Although I DBMOl>> preferred to work with pts on ADLs in the am, b/c they were the most DBMOl>> relevant, some of those pts had to be down to pt at an early hour & DR> you just DBMOl>> can't get to all of them (although you CAN shift your schedule around DR> from DBMOl>> day to day, but in my experience this was not often done). Thus the DR> next DBMOl>> part of the day was often working with pts in the rehab room, where DR> there DBMOl>> was a considerable push for working with more than one pt at a time. DBMOl>> Instead of working with them together, they w
