Re: [OTlist] Why OT's Should NOT Focus on the UE
My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE? For me, general phy-dys practitioner's focus on the UE while disregarding the rest of the body severely hampers our professional autonomy. We MUST break free from the mold of being UE therapists! Ron - Original Message - From: Diane Randall Sent: Sunday, July 12, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE DR> I see your point...I was mistaken if I implied in my very first post that I DR> told the patient that he needed UE program in order to transfer. It was DR> justified to increase his overall conditioning. My inital reason for the DR> post was to point out that sometimes our patients assume the things we do in DR> the gym are "therapy" and the functional ADL's are just extras we do...which DR> of course is the very opposite. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
[OTlist] Function is NOT Occupation
I want to try and make this painfully clear. Occupation and function are NOT the same thing. There are both major and subtle differences between the words, and these are NOT just semantics. OT must embrace occupation. We must live, breathe and practice occupation. We must sell it to ourselves, each other, other professions, and to patients. When we say we are occupation therapists, it must be expected that we are going to work on improving patient's occupations. It makes no difference the manner in which we work. Be it weights, ambulation, games, dressing, or cooking. The means is NOT ultimately important, but the outcome is fundamentally what separates us from other professions. We hold the keys to our success! -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Over Utilization of PT in Home Health
Yes, PT's skill set is much superior to OT's in the domain and manner in which they are applied. While on one hand, OT is often seen as UE experts, I am constantly amazed at the number of OT's who ask how to treat a rotator cuff injury (not that I know how). And beyond the actual skill set, PT has earned, developed and marketed itself as EXPERTS in physical function. Also, there is general consistency from one phy-dys PT to another phy-dys PT. And, not only is what they similar, it's what doctors expect and it's what patients expect. Basically, PT provides well know solutions to perceived problems. They are like car mechanics. When the car breaks and you can't fix it yourself, you take it to a mechanic, right. Same thing with the human body; you take it to a PT. Now, it's not PT's NAME that has brought them recognition and "fame". It the entire package of being a profession that they have successfully "grown" over the years. There name helps, but it's only a small part of why others see them "superior" to OT. Now, I personally don't think PT is superior to OT. I think we each have our domains. However, when an OT operates outside the domain of "occupation", then I generally think they are less effective than PT. The same is true for PT. When they start operating in the domain of occupation, they are generally less effective than PT. Ron - Original Message - From: Ed Kaine Sent: Friday, July 10, 2009 To: OTlist@otnow.com Subj: [OTlist] Over Utilization of PT in Home Health EK> If not in a name... then what? Is PTs service and skill set that EK> much superior to OTs that it warrants about a 3 to 5 fold bias from EK> OT to PT in nearly every setting? Your facility is probably fairly EK> average in the 3 to 15 ratio... and that is home care. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
I see your point...I was mistaken if I implied in my very first post that I told the patient that he needed UE program in order to transfer. It was justified to increase his overall conditioning. My inital reason for the post was to point out that sometimes our patients assume the things we do in the gym are "therapy" and the functional ADL's are just extras we do...which of course is the very opposite. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Sunday, July 12, 2009 13:49 To: OTlist@OTnow.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Diane, I am not saying that an UE therex program is inappropriate. In fact it is very beneficial treatment concept in OT for individuals who have been bed bound and have experienced muscle atrophy because of the immobilization. I am saying that you need to be careful how you educate your patients, because saying that the UE exercises will help the person with their transfers and ADL is not exactly true, regardless is the person is a male and female. If you want to help them with their UE strength to facilitate transitions from sit to stand from a toilet and using the standard walker you need to have them do wheelchair push ups, sit to stands, standing with the walker, or at least scapular depression/tricep extension using a Rickshaw machine (push down machine). You then can then say why you are helping them in this area in prep for safer transfers. So he progressed from 5 to 10#? I assume then he has enough ROM in his arms to bath himself, enough ROM to donn a shirt, and enough grip to hold onto a shirt and pants. So instead of educating him about UE strength to assist him in transfers and ADL, I would educate him in the way that you desribed in your prior email because this is true in terms of research and practical thinking. "There is something aboutlifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weightloss over time." Chris -Original Message- From: Diane Randall To: OTlist@OTnow.com Sent: Sun, Jul 12, 2009 7:51 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE The patient was unable to bear weight on his legs due to PN and did not have the strength to hold his weight up in a RW, he also could not stand beyond 5 seconds without his knees buckling as he is close to 500 pounds. He worked up from 5 to 10 llb weights in all planes per day and he was a very debilitated when he arrived, using a hoyer. The UE therex at least boosted his confidence to be able to do this transfer along with improvemnents in standing tolerance and walking with PT. UE therex is not all he does in therapy but I have noticed, especially with men, that they tend to perform ADL's better when they feel therapy includes an overall strengthening program. He even keeps some weights in his room. There is something about lifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weight loss over time. He has lost a significant amount of weight and he seems very motivated. Straight ADL's can be a source of stess for very proud men. Most of my patients are in therapy for debility. While it is not appropriate for everyone, I feel that in this case it was justified, even if as you say the UE program did not contribute significantly to his ability to transfer when is comes to to strength alone. It my opinion, the UE program is more of a holistic approach than a biomechanical one in this case. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Sunday, July 12, 2009 07:32 To: OTlist@OTnow.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Diane, I hate to be the devil's advocate, but because I veiw you as a very compassionate young clinician, I think you might benefit from my suggestions. With that being said, I am not sure that your UE strength exercises helped this person with their ability to transfer into a shower or complete bathing and dressing easier. Now I am not saying that the UE strength program had no therapeutic benefits whatsoever, like for overall strength and possibly functional endurance, but I doubt if it helped him in the way that you think. If this was the patient's first time with you in the shower, how do you know that he couldn't have done this his first week? I think I remember you saying that you are a COTA. If this is true, did the OT specifically evaluate these abilities or did the therapist simulate or extrapolate concepts during the evaluation? What UE strength exercises did you work on in treatment? I am assuming that you worked on the typical ther
Re: [OTlist] Personalisation
Hi Linda I worked as a community OT for adults with Phys dis in England up until April this year. There were big changes happening regarding the Single Assessment Process etc. I was based in an office with Social Workers and our roles were beginning to become blurred, where the OT's were being asked to Commission care for patients (for the S/W to review 6 weeks later). Previously the OT would have referred to the S/W and not got involved in the care. This did not sit comfortably with me, and it sounds like you are a leap further where your title has changed.. and you have a dual role? With your way of working, do the S/W's and OT's train each other? The initial assessment is a vital part of the OT process, is there a risk that the two disciplines may miss something in the assessment that the other would usually pick up? If a social worker completes an assessment and identifies specific OT needs does the practitioner with OT background then take over the case? In this area of OT it is common for a patient to see a no. of professionals, particularly OT, PT and S/W's so I guess this is with an aim to reduce the no. of professionals involved?? I find it very scary and a real threat to our profession, once you are not called an OT then that professional identity is lost and a role like OT that is so often misunderstood will become even more confused.. to other professionals and the patients. How do you feel about these changes? regards Lucy > From: peacefulwarr...@btopenworld.com > To: OTlist@OTnow.com > Date: Sun, 12 Jul 2009 10:55:33 +0100 > Subject: [OTlist] Personalisation > > I am an OT working in England for Adult Social Care (Social Services), we > are implementing the personalisation agenda, giving choice and control to > service users through individual budgets. I am now working in a team > alongside my Social Work colleagues, our title has been changed to Self > Directed Support Practitioners, assessing for both OT and SW. Are there any > others out there who are experiencing this change? I realise this e-mail is > not very informative but will expand more if I receive any questions. > > Linda Hicks > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/otlist@otnow.com _ MSN straight to your mobile - news, entertainment, videos and more. http://clk.atdmt.com/UKM/go/147991039/direct/01/ -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
Diane, I am not saying that an UE therex program is inappropriate. In fact it is very beneficial treatment concept in OT for individuals who have been bed bound and have experienced muscle atrophy because of the immobilization. I am saying that you need to be careful how you educate your patients, because saying that the UE exercises will help the person with their transfers and ADL is not exactly true, regardless is the person is a male and female. If you want to help them with their UE strength to facilitate transitions from sit to stand from a toilet and using the standard walker you need to have them do wheelchair push ups, sit to stands, standing with the walker, or at least scapular depression/tricep extension using a Rickshaw machine (push down machine). You then can then say why you are helping them in this area in prep for safer transfers. So he progressed from 5 to 10#? I assume then he has enough ROM in his arms to bath himself, enough ROM to donn a shirt, and enough grip to hold onto a shirt and pants. So instead of educating him about UE strength to assist him in transfers and ADL, I would educate him in the way that you desribed in your prior email because this is true in terms of research and practical thinking. "There is something aboutlifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weightloss over time." Chris -Original Message- From: Diane Randall To: OTlist@OTnow.com Sent: Sun, Jul 12, 2009 7:51 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE The patient was unable to bear weight on his legs due to PN and did not have the strength to hold his weight up in a RW, he also could not stand beyond 5 seconds without his knees buckling as he is close to 500 pounds. He worked up from 5 to 10 llb weights in all planes per day and he was a very debilitated when he arrived, using a hoyer. The UE therex at least boosted his confidence to be able to do this transfer along with improvemnents in standing tolerance and walking with PT. UE therex is not all he does in therapy but I have noticed, especially with men, that they tend to perform ADL's better when they feel therapy includes an overall strengthening program. He even keeps some weights in his room. There is something about lifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weight loss over time. He has lost a significant amount of weight and he seems very motivated. Straight ADL's can be a source of stess for very proud men. Most of my patients are in therapy for debility. While it is not appropriate for everyone, I feel that in this case it was justified, even if as you say the UE program did not contribute significantly to his ability to transfer when is comes to to strength alone. It my opinion, the UE program is more of a holistic approach than a biomechanical one in this case. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Sunday, July 12, 2009 07:32 To: OTlist@OTnow.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Diane, I hate to be the devil's advocate, but because I veiw you as a very compassionate young clinician, I think you might benefit from my suggestions. With that being said, I am not sure that your UE strength exercises helped this person with their ability to transfer into a shower or complete bathing and dressing easier. Now I am not saying that the UE strength program had no therapeutic benefits whatsoever, like for overall strength and possibly functional endurance, but I doubt if it helped him in the way that you think. If this was the patient's first time with you in the shower, how do you know that he couldn't have done this his first week? I think I remember you saying that you are a COTA. If this is true, did the OT specifically evaluate these abilities or did the therapist simulate or extrapolate concepts during the evaluation? What UE strength exercises did you work on in treatment? I am assuming that you worked on the typical theraband, dowel rod, or dumbell exercises that focus on isotonic strength. If this is true, then based on the literature there is no established evidence or even any associations for functional improvements in this area. And practically speaking, most clinicians do not strengthen the correct muscles that are even in the ball park when talking about functional mobility. When I strengthen for functional mobility, I work on the patient's core stability, the scapular depressors, and the triceps. Now when you work on such muscle groups it is wise to strengthen the antagonist muscle groups as well so
[OTlist] Personalisation
I am an OT working in England for Adult Social Care (Social Services), we are implementing the personalisation agenda, giving choice and control to service users through individual budgets. I am now working in a team alongside my Social Work colleagues, our title has been changed to Self Directed Support Practitioners, assessing for both OT and SW. Are there any others out there who are experiencing this change? I realise this e-mail is not very informative but will expand more if I receive any questions. Linda Hicks -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
The patient was unable to bear weight on his legs due to PN and did not have the strength to hold his weight up in a RW, he also could not stand beyond 5 seconds without his knees buckling as he is close to 500 pounds. He worked up from 5 to 10 llb weights in all planes per day and he was a very debilitated when he arrived, using a hoyer. The UE therex at least boosted his confidence to be able to do this transfer along with improvemnents in standing tolerance and walking with PT. UE therex is not all he does in therapy but I have noticed, especially with men, that they tend to perform ADL's better when they feel therapy includes an overall strengthening program. He even keeps some weights in his room. There is something about lifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weight loss over time. He has lost a significant amount of weight and he seems very motivated. Straight ADL's can be a source of stess for very proud men. Most of my patients are in therapy for debility. While it is not appropriate for everyone, I feel that in this case it was justified, even if as you say the UE program did not contribute significantly to his ability to transfer when is comes to to strength alone. It my opinion, the UE program is more of a holistic approach than a biomechanical one in this case. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Sunday, July 12, 2009 07:32 To: OTlist@OTnow.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Diane, I hate to be the devil's advocate, but because I veiw you as a very compassionate young clinician, I think you might benefit from my suggestions. With that being said, I am not sure that your UE strength exercises helped this person with their ability to transfer into a shower or complete bathing and dressing easier. Now I am not saying that the UE strength program had no therapeutic benefits whatsoever, like for overall strength and possibly functional endurance, but I doubt if it helped him in the way that you think. If this was the patient's first time with you in the shower, how do you know that he couldn't have done this his first week? I think I remember you saying that you are a COTA. If this is true, did the OT specifically evaluate these abilities or did the therapist simulate or extrapolate concepts during the evaluation? What UE strength exercises did you work on in treatment? I am assuming that you worked on the typical theraband, dowel rod, or dumbell exercises that focus on isotonic strength. If this is true, then based on the literature there is no established evidence or even any associations for functional improvements in this area. And practically speaking, most clinicians do not strengthen the correct muscles that are even in the ball park when talking about functional mobility. When I strengthen for functional mobility, I work on the patient's core stability, the scapular depressors, and the triceps. Now when you work on such muscle groups it is wise to strengthen the antagonist muscle groups as well so you do not end up with muscle imbalance. This is still just thinking practically, it still does not have any support in the research. If you want to go by the book, then you have to key into the concept of task specific training. This is usually an easy concept for new clinicians. If you want to get better at walking go ahead and walk, if you want to get better at getting into a shower go ahead an get into a shower, if you want to get better at bathing and dressing go ahead and practice this as well. Hope this helps, Chris -- 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] Why OT's Should NOT Focus on the UE
Diane, I hate to be the devil's advocate, but because I veiw you as a very compassionate young clinician, I think you might benefit from my suggestions. With that being said, I am not sure that your UE strength exercises helped this person with their ability to transfer into a shower or complete bathing and dressing easier. Now I am not saying that the UE strength program had no therapeutic benefits whatsoever, like for overall strength and possibly functional endurance, but I doubt if it helped him in the way that you think. If this was the patient's first time with you in the shower, how do you know that he couldn't have done this his first week? I think I remember you saying that you are a COTA. If this is true, did the OT specifically evaluate these abilities or did the therapist simulate or extrapolate concepts during the evaluation? What UE strength exercises did you work on in treatment? I am assuming that you worked on the typical theraband, dowel rod, or dumbell exercises that focus on isotonic strength. If this is true, then based on the literature there is no established evidence or even any associations for functional improvements in this area. And practically speaking, most clinicians do not strengthen the correct muscles that are even in the ball park when talking about functional mobility. When I strengthen for functional mobility, I work on the patient's core stability, the scapular depressors, and the triceps. Now when you work on such muscle groups it is wise to strengthen the antagonist muscle groups as well so you do not end up with muscle imbalance. This is still just thinking practically, it still does not have any support in the research. If you want to go by the book, then you have to key into the concept of task specific training. This is usually an easy concept for new clinicians. If you want to get better at walking go ahead and walk, if you want to get better at getting into a shower go ahead an get into a shower, if you want to get better at bathing and dressing go ahead and practice this as well. Hope this helps, Chris -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
