[OTlist] Occupation as THE goal: Does it matter
Hello All: What follows are thoughts and opinion about using occupation as *THE* goal for OT treatment. Here's is the premise for my arguments: (1) When occupation is *THE* goal, outcome statements may be written in concise occupation-based outcomes. For example: Patient will safely and independently ambulate to/from toilet with RW and perform all hygiene without assistive equipment. Patient will transfer from w/c to bed using slide board transfers Patient will dress self using adaptive equipment as necessary (2) Conversely, when occupation is not *THE* goal, outcomes may be written so that occupation is a desired outcome but is based on improving underlying impairment(s). For example: Patient will increase UE elbow ROM to 115 degree active flexion to all for donning/doffing of shirt Patient will increase standing endurance/balance to allow them to safely and independently carry out toileting hygiene. Some argue there is little difference in the above approaches. However, I believe these approaches frame patient problems very differently. This is important because how we frame a problem drives our treatment. The first example clearly identifies that occupation is the goal. There is no expressed concern for underlying factors impairing occupation. However, and this if often overlooked, it is IMPLIED that all factors impairing the goal will be treated within the therapist's abilities. This is true because occupation includes the following factors: Physical, emotional, mental environmental, behavioral, social Thus, as OT's and within our scope of practice, occupation-based outcomes address all factors impairing the desire occupations. While the second example does include occupation as an outcome, only factors addressed in the goals are included for treatment. This severely limits treatment and in my opinion indicates that remediation of underlying impairments is the real goal. The implication is that if underlying impairments are remediated, occupation will improve. However, is inconsistent with OT theory because occupation is ALWAYS more than physical. In my opinion, the second example is much more like a PT rather than an OT goal! In closing, writing occupation-based goals is important for us and for the patient. These goals allow us to focus on occupation's many elements and complexity to best enable our patients. 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
Re: [OTlist] Double vision
Thnak you ..I will pass this along. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Sunday, February 15, 2009 21:11 To: OTlist@OTnow.com Subject: Re: [OTlist] Double vision One?technique that I use is partial patching of the eye by using transpore tape (found in most nursing stations)? I simply place the tape on the medial aspect of the patient's pair of glasses.? This will compensate for the double vision but at the same time allow stimulation to the eye to prevent problems and lack of peripheral vision. Chris Nahrwold MS, OTR -Original Message- From: ehthiers ehthi...@earthlink.net To: OTlist@OTnow.com Sent: Sun, 15 Feb 2009 8:55 pm Subject: Re: [OTlist] Double vision Besthing to do is find a neuro optometrist. Let them help the person first. I know we work with developmental/ neuroptometrists in our area. First see if they can correct for it, prisms, special patiching, etc. Does the person get it all the time? Is it just from vision or also from vestibular issues? Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Saturday, February 14, 2009 3:39 PM To: Diane Randall Subject: Re: [OTlist] Double vision The only compensation that I know of for double vision is patching one eye. Of course, there are complications associated with patching. Ron - Original Message - From: Diane Randall spark...@rcn.com Sent: Saturday, February 14, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] Double vision DR My supervisor is just finishing up an eval on a patient who has DR double vision secondary to brain surgury. Has anyone had a patient DR with this particular deficit and can offer ideas on compensation DR strategies to perform adls/safe functional mobility. etc? Thanks DR -- DR Options? DR www.otnow.com/mailman/options/otlist_otnow.com DR Archive? DR 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] Double vision
Thank you. I believe the double vision is a direct result of the surgery. I will have to talk to my supervisor. thanks -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of ehthiers Sent: Sunday, February 15, 2009 20:56 To: OTlist@OTnow.com Subject: Re: [OTlist] Double vision Besthing to do is find a neuro optometrist. Let them help the person first. I know we work with developmental/ neuroptometrists in our area. First see if they can correct for it, prisms, special patiching, etc. Does the person get it all the time? Is it just from vision or also from vestibular issues? Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Saturday, February 14, 2009 3:39 PM To: Diane Randall Subject: Re: [OTlist] Double vision The only compensation that I know of for double vision is patching one eye. Of course, there are complications associated with patching. Ron - Original Message - From: Diane Randall spark...@rcn.com Sent: Saturday, February 14, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] Double vision DR My supervisor is just finishing up an eval on a patient who has DR double vision secondary to brain surgury. Has anyone had a patient DR with this particular deficit and can offer ideas on compensation DR strategies to perform adls/safe functional mobility. etc? Thanks DR -- DR Options? DR www.otnow.com/mailman/options/otlist_otnow.com DR Archive? DR 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] Occupation as THE goal: Does it matter
Ron, Great outline.? Can you next explain how the treatment will differ? Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist@OTnow.com Sent: Mon, 16 Feb 2009 7:52 am Subject: [OTlist] Occupation as THE goal: Does it matter Hello All: What follows are thoughts and opinion about using occupation as *THE* goal for OT treatment. Here's is the premise for my arguments: (1) When occupation is *THE* goal, outcome statements may be written in concise occupation-based outcomes. For example: Patient will safely and independently ambulate to/from toilet with RW and perform all hygiene without assistive equipment. Patient will transfer from w/c to bed using slide board transfers Patient will dress self using adaptive equipment as necessary (2) Conversely, when occupation is not *THE* goal, outcomes may be written so that occupation is a desired outcome but is based on improving underlying impairment(s). For example: Patient will increase UE elbow ROM to 115 degree active flexion to all for donning/doffing of shirt Patient will increase standing endurance/balance to allow them to safely and independently carry out toileting hygiene. Some argue there is little difference in the above approaches. However, I believe these approaches frame patient problems very differently. This is important because how we frame a problem drives our treatment. The first example clearly identifies that occupation is the goal. There is no expressed concern for underlying factors impairing occupation. However, and this if often overlooked, it is IMPLIED that all factors impairing the goal will be treated within the therapist's abilities. This is true because occupation includes the following factors: Physical, emotional, mental environmental, behavioral, social Thus, as OT's and within our scope of practice, occupation-based outcomes address all factors impairing the desire occupations. While the second example does include occupation as an outcome, only factors addressed in the goals are included for treatment. This severely limits treatment and in my opinion indicates that remediation of underlying impairments is the real goal. The implication is that if underlying impairments are remediated, occupation will improve. However, is inconsistent with OT theory because occupation is ALWAYS more than physical. In my opinion, the second example is much more like a PT rather than an OT goal! In closing, writing occupation-based goals is important for us and for the patient. These goals allow us to focus on occupation's many elements and complexity to best enable our patients. 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] Double vision
It depends on why there is the double vision. Often the picture can be offset by changes in musculature of one eye vs another or by difficulty with convergence. You need to determine which by examination. Then you need to have a direct plan to address these issues. Depending on where the difficulty is you can consider partial patching with the Transpore tape to get a single picture. I would use this for times when it is essential to decrease the double vision but not 100% as you need to also look at trying to remediate the problem not just compensate for the difficulties. So a compbination of patching and eye exercises would be initially where I would start. The situation generally resolves in a short period of time post surgery if you follow the above. If not then I would have the patient follow up with a neuro-optometrist who has significant experience in working with these types of patients. I see this problem regularyly (as in at least 1 -2 weekly) after stroke or brain injury. Sue D From: spark...@rcn.com To: OTlist@OTnow.com Date: Mon, 16 Feb 2009 08:08:53 -0500 Subject: Re: [OTlist] Double vision Thank you. I believe the double vision is a direct result of the surgery. I will have to talk to my supervisor. thanks -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of ehthiers Sent: Sunday, February 15, 2009 20:56 To: OTlist@OTnow.com Subject: Re: [OTlist] Double vision Besthing to do is find a neuro optometrist. Let them help the person first. I know we work with developmental/ neuroptometrists in our area. First see if they can correct for it, prisms, special patiching, etc. Does the person get it all the time? Is it just from vision or also from vestibular issues? Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net-Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Saturday, February 14, 2009 3:39 PM To: Diane Randall Subject: Re: [OTlist] Double vision The only compensation that I know of for double vision is patching one eye. Of course, there are complications associated with patching. Ron - Original Message - From: Diane Randall spark...@rcn.com Sent: Saturday, February 14, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] Double vision DR My supervisor is just finishing up an eval on a patient who has DR double vision secondary to brain surgury. Has anyone had a patient DR with this particular deficit and can offer ideas on compensation DR strategies to perform adls/safe functional mobility. etc? Thanks DR -- DR Options? DR www.otnow.com/mailman/options/otlist_otnow.com DR Archive? DR 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] Double vision
I tend to hold off on the neuro - optometrist straight away as generally there are significant changes in the first couple of weeks if the patient is given exercises etc. Practicing focusing and scanning task, one eye at a time and then the 2 together etc. The changes often alter what the neuro-optometrist would do and may even resolve the situation. I spent a lot of time working with our neuro-optometrist and do call him in for advice on complicated patients.Sue D From: ehthi...@earthlink.net To: OTlist@OTnow.com Date: Sun, 15 Feb 2009 20:55:41 -0500 Subject: Re: [OTlist] Double vision Besthing to do is find a neuro optometrist. Let them help the person first. I know we work with developmental/ neuroptometrists in our area. First see if they can correct for it, prisms, special patiching, etc. Does the person get it all the time? Is it just from vision or also from vestibular issues? Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net-Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Saturday, February 14, 2009 3:39 PM To: Diane Randall Subject: Re: [OTlist] Double visionThe only compensation that I know of for double vision is patching one eye. Of course, there are complications associated with patching.Ron- Original Message - From: Diane Randall spark...@rcn.com Sent: Saturday, February 14, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] Double vision DR My supervisor is just finishing up an eval on a patient who has DR double vision secondary to brain surgury. Has anyone had a patient DR with this particular deficit and can offer ideas on compensation DR strategies to perform adls/safe functional mobility. etc? Thanks DR -- DR Options? DR www.otnow.com/mailman/options/otlist_otnow.com DR Archive? DR www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.comArchive? 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] Occupation as THE goal: Does it matter
I believe the first set of goals (occupational based) are the best way to go. This is how I write my goals, as it does leave room for the therapist to address several areas of impairment/need. It is typically the case that more than one factor is limiting the patient from being independent with their i.e. toileting, dressing, etc. ~ Miranda ~ To: OTlist@OTnow.com Date: Mon, 16 Feb 2009 10:28:10 -0500 From: cmnahrw...@aol.com Subject: Re: [OTlist] Occupation as THE goal: Does it matter Ron, Great outline.? Can you next explain how the treatment will differ? Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist@OTnow.com Sent: Mon, 16 Feb 2009 7:52 am Subject: [OTlist] Occupation as THE goal: Does it matter Hello All: What follows are thoughts and opinion about using occupation as *THE* goal for OT treatment. Here's is the premise for my arguments: (1) When occupation is *THE* goal, outcome statements may be written in concise occupation-based outcomes. For example: Patient will safely and independently ambulate to/from toilet with RW and perform all hygiene without assistive equipment. Patient will transfer from w/c to bed using slide board transfers Patient will dress self using adaptive equipment as necessary (2) Conversely, when occupation is not *THE* goal, outcomes may be written so that occupation is a desired outcome but is based on improving underlying impairment(s). For example: Patient will increase UE elbow ROM to 115 degree active flexion to all for donning/doffing of shirt Patient will increase standing endurance/balance to allow them to safely and independently carry out toileting hygiene. Some argue there is little difference in the above approaches. However, I believe these approaches frame patient problems very differently. This is important because how we frame a problem drives our treatment. The first example clearly identifies that occupation is the goal. There is no expressed concern for underlying factors impairing occupation. However, and this if often overlooked, it is IMPLIED that all factors impairing the goal will be treated within the therapist's abilities. This is true because occupation includes the following factors: Physical, emotional, mental environmental, behavioral, social Thus, as OT's and within our scope of practice, occupation-based outcomes address all factors impairing the desire occupations. While the second example does include occupation as an outcome, only factors addressed in the goals are included for treatment. This severely limits treatment and in my opinion indicates that remediation of underlying impairments is the real goal. The implication is that if underlying impairments are remediated, occupation will improve. However, is inconsistent with OT theory because occupation is ALWAYS more than physical. In my opinion, the second example is much more like a PT rather than an OT goal! In closing, writing occupation-based goals is important for us and for the patient. These goals allow us to focus on occupation's many elements and complexity to best enable our patients. 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 _ See how Windows Mobile brings your life together—at home, work, or on the go. http://clk.atdmt.com/MRT/go/msnnkwxp1020093182mrt/direct/01/ -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] The Saddest OT Statement I've Ever Heard
Enabling Occupation: An Occupational Therapy Perspective - Original Message - From: bbh1...@comcast.net bbh1...@comcast.net Sent: Saturday, February 14, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] The Saddest OT Statement I've Ever Heard bcn What was the book??? bcn I DO try to focus my tx around the patient's needs/desires. bcn Remediating underlying issues often DOES involve balance and bcn strengthening, especially when you are working with the elderly bcn whose main concern when coming into tx is debilitation and bcn weakness. Anxiety is also often a barrier as well as motivation - bcn do they really want to do for themselves or have they succombed to bcn the cultural prejudice of you're old and so you just can't do as bcn much anymore. The goals I work on with people are often pretty bcn basic - can you dress, wash and toilet on your own, and is it safe to do so. bcn Productivity is a HUGE issue. If I have to see 12 patients in a bcn day, most of whom have an average of 50 minutes (their RUG level bcn according to the Medicare system), I don't have much time to plan bcn individual tx's. Regardless, I really try to do this, contrived bcn activities and all. Filling up 50 minutes of tx time when you have bcn to work multiple patients and save time for documentation is a bcn challenge, even when I use the contrived activities. I do my best bcn to choose on the basis of the specific goals of the patient, and bcn attempt most days to schedule tx times so that I can work with bcn people who have similar/same issues so that I'm not just providing bcn busy work for one while I work with the other. Many people have bcn combined balance and UE limitations which make it extremely bcn difficult to find any activity to do with them, functional or not. bcn One thing I do accomplish with most patients is meaningful bcn interaction. This is an effective way to find out what their bcn needs/desires are. I say this because it is difficult to do when bcn you feel rushed to see many people at one time and to keep up bcn with what you are doing with each. Other therapists do not take bcn the time to do this, and sometimes come to me for help in bcn motivating a difficult patient. I don't say this as a criticism. bcn I understand exactly the pressure they work under. bcn Hence my obsession with concrete suggestions. And I mean concrete bcn as in... what did you do with patient x to address issues x, y and bcn z. I understand the overarching philosophical importance of bcn functional tx, but it is difficult to be a purist when the work bcn environment makes so many other demands of you, demands that must bcn be met to appease Medicare and your supervisors. Unfortunately, I bcn need a job. And I do like working in rehab. I just need to find a bcn way to juggle all these variables in a way that serves the patient bcn best. I am looking for a different position, but in Michigan, that takes time. bcn Thanks for listening, bcn Barb Howard bcn - Original Message - bcn From: Ron Carson rdcar...@otnow.com bcn To: bbh1...@comcast.net OTlist@OTnow.com bcn Sent: Friday, February 13, 2009 3:24:42 PM GMT -05:00 US/Canada Eastern bcn Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard bcn Barb, I want to offer a suggestion. In my early days as an OT, I worked bcn in adult rehab. It was VERY faced paced and therapists generally had 2 - bcn 3 patient's hour. In the beginning, I was stuck in the peg, cone, etc bcn routine, but one day I read a book that changed my practice. bcn I changed my practice pattern from UE/ADL to occupation-based treatment. bcn In this approach, a patients occupational needs/desires become the ONLY bcn reason for treatment. In the absence of occupational problems that are bcn improvable, there is no role for OT. bcn This approach 100% clarified my treatment for both myself and patients. bcn I no longer wondered what to do with patients. Suddenly, I began bcn stepping away from typical OT activity and began addressing patient's bcn most important needs. My treatment boundaries greatly expanded and I bcn began feeling much better about my treatments. bcn No longer did I do contrived OT treatment, instead I addressed the the bcn ACTUAL needs of the patients. Since you asked for concrete ideas here bcn they are: bcn 1. Identify client's needs/desires bcn 2. Identify why the can't do these things bcn 3. Direct 100% of your treatment to: bcn a. Remediating underlying issues bcn b. Compensating for uncorrectable problems bcn c. Changing environments bcn Forget made up activities, forget games and other silly things. YOU CAN bcn DO THIS! bcn Ron bcn -- bcn Ron Carson MHS, OT bcn www.OTnow.com bcn - Original Message - bcn From: bbh1...@comcast.net bbh1...@comcast.net bcn Sent: Friday, February 13, 2009 bcn To: OTlist@OTnow.com
[OTlist] Philosophy ~vs~ treatment in the real world?
I fancy myself as being in a rather unique position to address this question. In the twelve years since graduating from OT school, I've gone from full-time clinician, to full-time academician back to full-time clinician. The real world of OT is generally considered to be the clinic. In this setting, theory and philosophy often take a back seat to rigors and demands of for-profit health care. Theory is not totally void in practice, but it certainly is not part of everyday discussion and in my experience it often does not drive practice. While there are many possible explanation for this, I offer only one. A theory is not a part of practice because it is not seen as having DIRECT application. These types of theory are abstract and difficult to 'pin down' in the real world. Clinician's minds are overwhelmed with practical clinical decisions and taking time to access abstract thought is not part of the time sensitive equation of daily treatment. Thus, well thought out theories are often left in the classroom or in clinician's notebooks. In my experience, clinician's cling to theories such as NDT, Bobath, constraint-induced treatment, etc. These hard theories all have an application and hands-on component lacking in soft theories such as Enabling Occupation, therapeutic relationship, Practice Framework, etc. But, I believe these soft theories are equally important and perhaps even more important to our profession. As clinician's we *MUST* integrate soft theory into our daily practice. We *MUST* develop a sense of who we are as both as a profession and individuals and this comes from soft theory. While are most easily grasped, developed and recognized, they tend to not define who and what we are. Obviously, I offer no solutions to the age-old debate of theory ~vs~ practice but I felt compelled to write something!! 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
