Re: [OTlist] Game using reacher
I completely agree about the benefits and importance of social interaction. I definitely don't think it has to be a specific goal to be effective. I also think that you can uncover a world of problems or issues by observing a patient interacting with staff, peers, family, etc. Might end up finding new areas that need to be addressed. Therapeutic use of self and using real world activities are completely OT! Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Feb 4, 2009, at 5:16 PM, bbh1...@comcast.net wrote: If someone is going to be using a reacher for the foreseeable future after D/C because of medically established precautions against trunk flexion, etc. then this kind of practice with a reacher is medically beneficial. Call it whatever perjorative name you like, patients enjoy activities that are entertaining as well as medically necessary/useful/goal-directed. I am certainly not going to sit with a patient and make him/her take her pants on and off interminably just because that is how the goal is worded - LB ADL Indep using AE... Come on, people. Lighten up! And as far as social interaction is concerned, there is NOTHING that is more conducive to helping patients progress, especially those in SNFs, than interaction with the therapist or with other patients. You don't need a goal. It is ALWAYS a factor, hence it is therapeutic to the goals you are working on. Just today, I had a patient who more easily lost his balance because of laughter. He is a funny guy and likes to joke around. Because I engaged with him, I was able to observe this phenonmenon directly. I then suggested that we should have him watch funny videos standing so that he can practice his dynamic balance. This was a direct result of social interaction. Social interaction is an integral part of any occupation, and I mean that in the broad OT sense of the word. Well, I guess not for hermits, or possibly accountants and others whose goals are impeded by interaction. But you get the drift. Thanks for your suggestion, Barbara. I may try this with appropriate patients. I have a few on my caseload with precautions like these. I find that competitive games are very helpful in supporting patients by giving them tangible evidence that they are not the only person in the world struggling to recover/ adapt to a new medical condition. Barb Howard - Original Message - From: "Neal Luther" To: OTlist@OTnow.com Sent: Wednesday, February 4, 2009 8:33:02 AM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] Game using reacher Could not agree more. In addition, this just simply sounds juvenile...pediatric. Neal C. Luther,OTR/L Advanced Home Care, Burlington Office 1-336-538-1194, xt 6672 neal.lut...@advhomecare.org Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of otl...@otnow.com. If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Tuesday, February 03, 2009 5:50 AM To: Barbara H. Hale Subject: Re: [OTlist] Game using reacher I don't want to sound negative, but I can't help wondering what patient's think about using what should be medically necessary equipment to play "games". What "message" might this send to patients, other professionals and payers? Finally, should social interaction only be considered as therapeutic if it's an actual goal? Just some random questions. Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: Barbara H. Hale Sent: Monday, February 02, 2009 To: OTlist@OTnow.com Subj: [OTlist] Game using reacher BHH> I have a bean bag tic tac toe game that I use for a reacher training BHH> activity. The grid for the game is painted on a fabric square that I place BHH> within reach on the floor. Each bean bag has an X or an O painted on it. All BHH> the items fit into a tote bag and I usually hold the bag for the patient to BHH> clean up our game at the end by placing
Re: [OTlist] Game using reacher
As long as the patient knows why they are practicing a specific skill then I am all for it.? In my experience it usually takes the cognitively intact clients a few activities to understand how to use a reacher, not an entire session.? They then can borrow a reacher to use in their room so they can practice for real, and then ask questions when issues arise.? Now for the cognitively impaired (primarily moderate to severe dementia) the practice of a reacher is a waste of time because patients at that level have the inability to learn new information.? The emphasis of treatment should at that point be on family training and maximizing their physical abilities, not on cognitive restoration.? Cognitive compensation might be an option, but don't count on it. For the mildly impaired I think practice in this area is critical, especially if they are going to be living by themsolves or not receiving 24 hour supervision. What I see in practice is therapists completing? non?therapeutic games and splinter skills that have no relevance except to capture minutes for a higher payment level.?Do not get me wrong, ?I am all for activities that promote social interaction and higher level balance improvement, those activities sounded outstanding.? In fact I might steal that one for clinical use, since it deals with dual task challenges, which is supported in the research.? The grim reality is this: if our profession as a whole continues to complete treatment interventions that have no relevance to the patients' improvement, then through the very nature of cost containment we will be phased out.? Pick up a new book in OT, read a new research article, go to a course, by all means do all you can to provide relevance to the patient's care and improvement. Chris Nahrwold MS, OTR -Original Message- From: Diane Randall To: OTlist@OTnow.com Sent: Wed, 4 Feb 2009 7:10 pm Subject: Re: [OTlist] Game using reacher Very well said!!! -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of bbh1...@comcast.net Sent: Wednesday, February 04, 2009 18:16 To: OTlist@OTnow.com Subject: Re: [OTlist] Game using reacher If someone is going to be using a reacher for the foreseeable future after D/C because of medically established precautions against trunk flexion, etc. then this kind of practice with a reacher is medically beneficial. Call it whatever perjorative name you like, patients enjoy activities that are entertaining as well as medically necessary/useful/goal-directed. I am certainly not going to sit with a patient and make him/her take her pants on and off interminably just because that is how the goal is worded - LB ADL Indep using AE... Come on, people. Lighten up! And as far as social interaction is concerned, there is NOTHING that is more conducive to helping patients progress, especially those in SNFs, than interaction with the therapist or with other patients. You don't need a goal. It is ALWAYS a factor, hence it is therapeutic to the goals you are working on. Just today, I had a patient who more easily lost his balance because of laughter. He is a funny guy and likes to joke around. Because I engaged with him, I was able to observe this phenonmenon directly. I then suggested that we should have him watch funny videos standing so that he can practice his dynamic balance. This was a direct result of social interaction. Social interaction is an integral part of any occupation, and I mean that in the broad OT sense of the word. Well, I guess not for hermits, or possibly accountants and others whose goals are impeded by interaction. But you get the drift. Thanks for your suggestion, Barbara. I may try this with appropriate patients. I have a few on my caseload with precautions like these. I find that competitive games are very helpful in supporting patients by giving them tangible evidence that they are not the only person in the world struggling to recover/adapt to a ne w medical condition. Barb Howard - Original Message - From: "Neal Luther" To: OTlist@OTnow.com Sent: Wednesday, February 4, 2009 8:33:02 AM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] Game using reacher Could not agree more. In addition, this just simply sounds juvenile...pediatric. Neal C. Luther,OTR/L Advanced Home Care, Burlington Office 1-336-538-1194, xt 6672 neal.lut...@advhomecare.org Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of otl...@otnow.com. If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed ab
Re: [OTlist] Game using reacher
Very well said!!! -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of bbh1...@comcast.net Sent: Wednesday, February 04, 2009 18:16 To: OTlist@OTnow.com Subject: Re: [OTlist] Game using reacher If someone is going to be using a reacher for the foreseeable future after D/C because of medically established precautions against trunk flexion, etc. then this kind of practice with a reacher is medically beneficial. Call it whatever perjorative name you like, patients enjoy activities that are entertaining as well as medically necessary/useful/goal-directed. I am certainly not going to sit with a patient and make him/her take her pants on and off interminably just because that is how the goal is worded - LB ADL Indep using AE... Come on, people. Lighten up! And as far as social interaction is concerned, there is NOTHING that is more conducive to helping patients progress, especially those in SNFs, than interaction with the therapist or with other patients. You don't need a goal. It is ALWAYS a factor, hence it is therapeutic to the goals you are working on. Just today, I had a patient who more easily lost his balance because of laughter. He is a funny guy and likes to joke around. Because I engaged with him, I was able to observe this phenonmenon directly. I then suggested that we should have him watch funny videos standing so that he can practice his dynamic balance. This was a direct result of social interaction. Social interaction is an integral part of any occupation, and I mean that in the broad OT sense of the word. Well, I guess not for hermits, or possibly accountants and others whose goals are impeded by interaction. But you get the drift. Thanks for your suggestion, Barbara. I may try this with appropriate patients. I have a few on my caseload with precautions like these. I find that competitive games are very helpful in supporting patients by giving them tangible evidence that they are not the only person in the world struggling to recover/adapt to a new medical condition. Barb Howard - Original Message - From: "Neal Luther" To: OTlist@OTnow.com Sent: Wednesday, February 4, 2009 8:33:02 AM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] Game using reacher Could not agree more. In addition, this just simply sounds juvenile...pediatric. Neal C. Luther,OTR/L Advanced Home Care, Burlington Office 1-336-538-1194, xt 6672 neal.lut...@advhomecare.org Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of otl...@otnow.com. If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Tuesday, February 03, 2009 5:50 AM To: Barbara H. Hale Subject: R! e: [OTlist] Game using reacher I don't want to sound negative, but I can't help wondering what patient's think about using what should be medically necessary equipment to play "games". What "message" might this send to patients, other professionals and payers? Finally, should social interaction only be considered as therapeutic if it's an actual goal? Just some random questions. Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: Barbara H. Hale Sent: Monday, February 02, 2009 To: OTlist@OTnow.com Subj: [OTlist] Game using reacher BHH> I have a bean bag tic tac toe game that I use for a reacher training BHH> activity. The grid for the game is painted on a fabric square that I place BHH> within reach on the floor. Each bean bag has an X or an O painted on it. All BHH> the items fit into a tote bag and I usually hold the bag for the patient to BHH> clean up our game at the end by placing the bean bags in the tote bag. BHH> It is engaging for the pa! tient and I can use it for social interaction BHH> also. BHH> -- BHH> Options? BHH> www.otnow.com/mailman/options/otlist_otnow.com BHH> Archive? BHH> 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 -- 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] Game using reacher
If someone is going to be using a reacher for the foreseeable future after D/C because of medically established precautions against trunk flexion, etc. then this kind of practice with a reacher is medically beneficial. Call it whatever perjorative name you like, patients enjoy activities that are entertaining as well as medically necessary/useful/goal-directed. I am certainly not going to sit with a patient and make him/her take her pants on and off interminably just because that is how the goal is worded - LB ADL Indep using AE... Come on, people. Lighten up! And as far as social interaction is concerned, there is NOTHING that is more conducive to helping patients progress, especially those in SNFs, than interaction with the therapist or with other patients. You don't need a goal. It is ALWAYS a factor, hence it is therapeutic to the goals you are working on. Just today, I had a patient who more easily lost his balance because of laughter. He is a funny guy and likes to joke around. Because I engaged with him, I was able to observe this phenonmenon directly. I then suggested that we should have him watch funny videos standing so that he can practice his dynamic balance. This was a direct result of social interaction. Social interaction is an integral part of any occupation, and I mean that in the broad OT sense of the word. Well, I guess not for hermits, or possibly accountants and others whose goals are impeded by interaction. But you get the drift. Thanks for your suggestion, Barbara. I may try this with appropriate patients. I have a few on my caseload with precautions like these. I find that competitive games are very helpful in supporting patients by giving them tangible evidence that they are not the only person in the world struggling to recover/adapt to a new medical condition. Barb Howard - Original Message - From: "Neal Luther" To: OTlist@OTnow.com Sent: Wednesday, February 4, 2009 8:33:02 AM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] Game using reacher Could not agree more. In addition, this just simply sounds juvenile...pediatric. Neal C. Luther,OTR/L Advanced Home Care, Burlington Office 1-336-538-1194, xt 6672 neal.lut...@advhomecare.org Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of otl...@otnow.com. If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Tuesday, February 03, 2009 5:50 AM To: Barbara H. Hale Subject: Re: [OTlist] Game using reacher I don't want to sound negative, but I can't help wondering what patient's think about using what should be medically necessary equipment to play "games". What "message" might this send to patients, other professionals and payers? Finally, should social interaction only be considered as therapeutic if it's an actual goal? Just some random questions. Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: Barbara H. Hale Sent: Monday, February 02, 2009 To: OTlist@OTnow.com Subj: [OTlist] Game using reacher BHH> I have a bean bag tic tac toe game that I use for a reacher training BHH> activity. The grid for the game is painted on a fabric square that I place BHH> within reach on the floor. Each bean bag has an X or an O painted on it. All BHH> the items fit into a tote bag and I usually hold the bag for the patient to BHH> clean up our game at the end by placing the bean bags in the tote bag. BHH> It is engaging for the patient and I can use it for social interaction BHH> also. BHH> -- BHH> Options? BHH> www.otnow.com/mailman/options/otlist_otnow.com BHH> Archive? BHH> 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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] From Standing to Toilet Transfers
I second that motion. -Original Message- From: Lehman, David To: OTlist@OTnow.com Sent: Wed, 4 Feb 2009 12:57 pm Subject: Re: [OTlist] From Standing to Toilet Transfers I say combine the professions of PT and OT thus ending the territory issue and what we can and cannot do. I see what you described as exactly what I would do as a PTbut, I know you are just as competent and good at is as I am, Ron So, lets combine the 2 professions. David A. Lehman, PhD, PT Associate Professor Tennessee State University Department of Physical Therapy 3500 John A. Merritt Blvd. Nashville, TN 37209 615-963-5946 dleh...@tnstate.edu Visit my website: http://www.tnstate.edu/interior.asp?mid=2410&ptid=1 This email and any files transmitted with it may contain confidential information and is intended solely for use by the individual to whom it is addressed. If you receive this correspondence in error, please notify the sender and delete the email from your system. Do not disclose its contents with others. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of cmnahrw...@aol.com Sent: Wednesday, February 04, 2009 11:50 AM To: OTlist@OTnow.com Subject: Re: [OTlist] From Standing to Toilet Transfers Bravo!!!? I believe that is task analysis at its absolute best.? Taking the foundational skills and working up the ladder towards her occupational goal. I view hand therapy and stroke rehabilitation in the same light. Working on the foundational skills in order to work towards an occupatioanal goal. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson To: OTlist@OTnow.com Sent: Tue, 3 Feb 2009 10:40 pm Subject: [OTlist] From Standing to Toilet Transfers A while back on an AOTA forum, I was "criticized" for working on mobility when there were not obvious occupational forms present (i.e. toilet, shower, chairs, etc). At least one person's contention was that working on mobility in the absence of an occupational form is not OT. I want to share a quick case study which highlights why I take exception with the person's comments. For the sake of brevity, I'll keep "Jan e's" case study as simple as possible. Jane has a spinal condition leaving her with partial lower extremity paralysis. The patient's initial goals are of course to walk but also to transfer to her toilet, shower, etc. Again for brevity, she wants to learn "skills for the job of living". Initially, the patient was unable to stand, so we began working on standing. This required maximum, and I mean max, assistance x1. At this early stage, the patient was unable to use a walker. After a week or so, I progressed the patient to a walker, but she still required knee blocking to stand. Eventually, the patient was able to stand without knee blocking and finally began taking steps. After she was able to walk 10-15 feet with a rolling walker, we tried transfers from wheelchair to wheelchair. This was very difficult and required continuing practice. After approximately 6 weeks of almost daily OT, TODAY, the patient transferred from her w/c to her toilet using a walker. She required assistance with sit to stand and cuing with the transfer but it was essentially her doing the transfer. This is a huge milestone for this patient and made her VERY happy and optimistic that her life was going to again have some semblance of "normal". ## Now, in my opinion, I have been working on occupation from day ONE! The patient had occupation-related deficits, her barriers were identified I was competent to address thos e barriers and the patient had good potential to make significant progress towards her goals. So what do you think? Should OT work on mobility/ambulation in the immediate absence of occupational forms? Should OT address mobility from the very beginning, if mobility is a barrier to occupational goals? I'm interested to hear what other's say! Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mail man/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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] From Standing to Toilet Transfers
I say combine the professions of PT and OT thus ending the territory issue and what we can and cannot do. I see what you described as exactly what I would do as a PTbut, I know you are just as competent and good at is as I am, Ron So, lets combine the 2 professions. David A. Lehman, PhD, PT Associate Professor Tennessee State University Department of Physical Therapy 3500 John A. Merritt Blvd. Nashville, TN 37209 615-963-5946 dleh...@tnstate.edu Visit my website: http://www.tnstate.edu/interior.asp?mid=2410&ptid=1 This email and any files transmitted with it may contain confidential information and is intended solely for use by the individual to whom it is addressed. If you receive this correspondence in error, please notify the sender and delete the email from your system. Do not disclose its contents with others. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of cmnahrw...@aol.com Sent: Wednesday, February 04, 2009 11:50 AM To: OTlist@OTnow.com Subject: Re: [OTlist] From Standing to Toilet Transfers Bravo!!!? I believe that is task analysis at its absolute best.? Taking the foundational skills and working up the ladder towards her occupational goal. I view hand therapy and stroke rehabilitation in the same light. Working on the foundational skills in order to work towards an occupatioanal goal. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson To: OTlist@OTnow.com Sent: Tue, 3 Feb 2009 10:40 pm Subject: [OTlist] From Standing to Toilet Transfers A while back on an AOTA forum, I was "criticized" for working on mobility when there were not obvious occupational forms present (i.e. toilet, shower, chairs, etc). At least one person's contention was that working on mobility in the absence of an occupational form is not OT. I want to share a quick case study which highlights why I take exception with the person's comments. For the sake of brevity, I'll keep "Jane's" case study as simple as possible. Jane has a spinal condition leaving her with partial lower extremity paralysis. The patient's initial goals are of course to walk but also to transfer to her toilet, shower, etc. Again for brevity, she wants to learn "skills for the job of living". Initially, the patient was unable to stand, so we began working on standing. This required maximum, and I mean max, assistance x1. At this early stage, the patient was unable to use a walker. After a week or so, I progressed the patient to a walker, but she still required knee blocking to stand. Eventually, the patient was able to stand without knee blocking and finally began taking steps. After she was able to walk 10-15 feet with a rolling walker, we tried transfers from wheelchair to wheelchair. This was very difficult and required continuing practice. After approximately 6 weeks of almost daily OT, TODAY, the patient transferred from her w/c to her toilet using a walker. She required assistance with sit to stand and cuing with the transfer but it was essentially her doing the transfer. This is a huge milestone for this patient and made her VERY happy and optimistic that her life was going to again have some semblance of "normal". ## Now, in my opinion, I have been working on occupation from day ONE! The patient had occupation-related deficits, her barriers were identified I was competent to address thos e barriers and the patient had good potential to make significant progress towards her goals. So what do you think? Should OT work on mobility/ambulation in the immediate absence of occupational forms? Should OT address mobility from the very beginning, if mobility is a barrier to occupational goals? I'm interested to hear what other's say! Thanks, Ron -- Ron Carson MHS, OT www.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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] From Standing to Toilet Transfers
Bravo!!!? I believe that is task analysis at its absolute best.? Taking the foundational skills and working up the ladder towards her occupational goal. I view hand therapy and stroke rehabilitation in the same light. Working on the foundational skills in order to work towards an occupatioanal goal. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson To: OTlist@OTnow.com Sent: Tue, 3 Feb 2009 10:40 pm Subject: [OTlist] From Standing to Toilet Transfers A while back on an AOTA forum, I was "criticized" for working on mobility when there were not obvious occupational forms present (i.e. toilet, shower, chairs, etc). At least one person's contention was that working on mobility in the absence of an occupational form is not OT. I want to share a quick case study which highlights why I take exception with the person's comments. For the sake of brevity, I'll keep "Jane's" case study as simple as possible. Jane has a spinal condition leaving her with partial lower extremity paralysis. The patient's initial goals are of course to walk but also to transfer to her toilet, shower, etc. Again for brevity, she wants to learn "skills for the job of living". Initially, the patient was unable to stand, so we began working on standing. This required maximum, and I mean max, assistance x1. At this early stage, the patient was unable to use a walker. After a week or so, I progressed the patient to a walker, but she still required knee blocking to stand. Eventually, the patient was able to stand without knee blocking and finally began taking steps. After she was able to walk 10-15 feet with a rolling walker, we tried transfers from wheelchair to wheelchair. This was very difficult and required continuing practice. After approximately 6 weeks of almost daily OT, TODAY, the patient transferred from her w/c to her toilet using a walker. She required assistance with sit to stand and cuing with the transfer but it was essentially her doing the transfer. This is a huge milestone for this patient and made her VERY happy and optimistic that her life was going to again have some semblance of "normal". ## Now, in my opinion, I have been working on occupation from day ONE! The patient had occupation-related deficits, her barriers were identified I was competent to address thos e barriers and the patient had good potential to make significant progress towards her goals. So what do you think? Should OT work on mobility/ambulation in the immediate absence of occupational forms? Should OT address mobility from the very beginning, if mobility is a barrier to occupational goals? I'm interested to hear what other's say! Thanks, Ron -- Ron Carson MHS, OT www.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] Game using reacher
Could not agree more. In addition, this just simply sounds juvenile...pediatric. Neal C. Luther,OTR/L Advanced Home Care, Burlington Office 1-336-538-1194, xt 6672 neal.lut...@advhomecare.org Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of otl...@otnow.com. If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Tuesday, February 03, 2009 5:50 AM To: Barbara H. Hale Subject: Re: [OTlist] Game using reacher I don't want to sound negative, but I can't help wondering what patient's think about using what should be medically necessary equipment to play "games". What "message" might this send to patients, other professionals and payers? Finally, should social interaction only be considered as therapeutic if it's an actual goal? Just some random questions. Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: Barbara H. Hale Sent: Monday, February 02, 2009 To: OTlist@OTnow.com Subj: [OTlist] Game using reacher BHH> I have a bean bag tic tac toe game that I use for a reacher training BHH> activity. The grid for the game is painted on a fabric square that I place BHH> within reach on the floor. Each bean bag has an X or an O painted on it. All BHH> the items fit into a tote bag and I usually hold the bag for the patient to BHH> clean up our game at the end by placing the bean bags in the tote bag. BHH> It is engaging for the patient and I can use it for social interaction BHH> also. BHH> -- BHH> Options? BHH> www.otnow.com/mailman/options/otlist_otnow.com BHH> Archive? BHH> 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] Game using reacher
I don't think using a reacher is something most need "continued" training for but Hip Fx pts need to initially learn to use it. You would be suprised at some who have a hard time. We put pennies. paper , magazines and a variety of househols items on the floor to pick up. Some automatically want to reach down to pick items up. Training with the reacher forces them to learn to use it rather than to use thier own body and break hip precautions. It is especially necessary for those with impaired cognition. I am one who believe something can be fun and functional. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of Ron Carson Sent: Tuesday, February 03, 2009 23:20 To: Barbara H. Hale Subject: Re: [OTlist] Game using reacher Hello Barbara: Thanks for writing back. I'm still kind of stuck because using a reacher is well, pretty mindless. Heck, you can buy them at Home Depot and they are advertised on TV. So, I guess I just don't see where OT skills are needed for continued training on how to pick something up with a reacher. I agree that use of self, what Carl Rogers might call a "therapeutic relationship", is CRITICAL to achieving outcomes. But, I whole-heartedly believe that relationships should be formed while engaged in medically-necessary therapy. And no, that doesn't mean that every minute of every session is 100% therapy, but in my mind, if a treatment session is spent on playing "reacher games", that's sort of wasted time and dollars. Based on my education, social interaction is not an occupation. Social interaction is broad category that includes such occupations as playing cards, playing bingo, going to church, etc. Lastly, I have interactions with people all day long. Sometimes, I feel like a whole person, sometimes like a 1/2 person and sometimes I just feel like I don't matter. So, I'm not sure that I agree with the statement: "Having an interaction with some one is allowing the person to be recognized for their ability to be a thinking whole person." I've also seen many therapist and patient interactions leave patients with feelings of helplessness, confusion, disrespect, etc. By the way, these are great topics for discussion and I hope others will join in. S - Original Message - From: Barbara H. Hale Sent: Tuesday, February 03, 2009 To: OTlist@OTnow.com Subj: [OTlist] Game using reacher BHH> I understand what you are saying Ron. However, I would much rather play a BHH> game with the reacher to get a pt. to demonstrate they have the skills to BHH> use it. To dump out a container of blocks and have the patient pick them up BHH> and put them back into the same container is a mindless thing. Having an BHH> interaction with some one is allowing the person to be recognized for their BHH> ability to be a thinking whole person. Attention from a therapist while BHH> building a relationship will make a huge difference in the outcome, "use of BHH> self" was important in my training. Social interaction is in my view an BHH> occupation, important for providing a sense of accomplishment, trust in BHH> another person, a few laughs, making life a little more enjoyable. I cannot BHH> imagine it would be a negative to payers, professionals, or patients. Is BHH> everyone supposed to sit around and look depressed because it is a medically BHH> necessary piece of equipment? I believe the therapist is able to make a BHH> decision about the appropriate use of a game with a patient vs. practice of BHH> a skill. Just my opinion! BHH> -- BHH> Options? BHH> www.otnow.com/mailman/options/otlist_otnow.com BHH> Archive? BHH> 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
