[OTlist] Massive new CVA patient
Hello, I have been given (along with 11 other patients I have) a new CVA patient. I have never worked with someone tis impaired and i don't know where to start. I am in a SNF and pt had been in an acute rehab for about a month prior for therapy. He is Dependent for all ADL's and transfers...sometimes hard to get his attention at all. Total left neglect. Trouble following simple commands. 1 finger sublux. Just not sure where to even begin. Goals are to increase attention to the left to perform ADL's but is this relistic at this point and what activites can I do with him that will encourge attention to left or attention to anything at all. Thanks Diane -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Massive new CVA patient
Great patient to work with. At this point, there is nothing YOU can do to SIGNIFICANTLY increase his awareness. I would educate him, if appropriate, and family, if available, about visual and verbal cueing, but I would NOT waste a lot of time doing this. Over time, the neglect may subside but I believe this is one of those areas that takes a great deal of time and sort of spontaneous recovery. Are you a COTA or OT (this is why I ask people to include their credentials in messages). If you are the OT, I would change the goal to: "Patient will perform basic ADL's...". Don't limit the patient and your treatment to the neglect. Surely there are other things inhibiting the patient's independence. Make a list of the patient's "problems": physical, mental, emotional, environmental. Prioritize which of these problems are most significant AND that you have the ability to significantly improve. There is no use working on something that will not likely show significant change. My suspicion, is that you should be working on sitting balance. If the patient can sit, then work on standing balance, if the patient can stand, work on mobility. And no matter what, you must address the patient's emotional needs to be in control and have self-worth and dignity. In my opinion, this is best done through an honest therapeutic relationship. I believe that in "complicated" situations, the therapist MUST organize available information in a manner that allows them to address the most salient issues. We only have limited time with patients, so we MUST make best use of that time by addressing those issues which most impair patient's occupations. Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Diane Randall Sent: Thursday, August 06, 2009 To: otlist@otnow.com Subj: [OTlist] Massive new CVA patient DR> Hello, I have been given (along with 11 other patients I have) a new CVA DR> patient. I have never worked with someone tis impaired and i don't know DR> where to start. I am in a SNF and pt had been in an acute rehab for about a DR> month prior for therapy. He is Dependent for all ADL's and DR> transfers...sometimes hard to get his attention at all. Total left neglect. DR> Trouble following simple commands. 1 finger sublux. Just not sure where to DR> even begin. Goals are to increase attention to the left to perform ADL's DR> but is this relistic at this point and what activites can I do with him that DR> will encourge attention to left or attention to anything at all. Thanks DR> Diane 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
Re: [OTlist] Massive new CVA patient
Diane, you could try engaging him in very basic ADL's, such as combing hair, washing face, brushing teeth. This will focus on following one step commands, engaging in ADL's, which would hopefully improve is self-worth, maybe some neglect issues (where you would cue him to comb the left side of his head,etc. ~ Miranda ~ > From: spark...@rcn.com > To: otlist@otnow.com > Date: Thu, 6 Aug 2009 05:43:33 -0400 > Subject: [OTlist] Massive new CVA patient > > Hello, I have been given (along with 11 other patients I have) a new CVA > patient. I have never worked with someone tis impaired and i don't know > where to start. I am in a SNF and pt had been in an acute rehab for about a > month prior for therapy. He is Dependent for all ADL's and > transfers...sometimes hard to get his attention at all. Total left neglect. > Trouble following simple commands. 1 finger sublux. Just not sure where to > even begin. Goals are to increase attention to the left to perform ADL's > but is this relistic at this point and what activites can I do with him that > will encourge attention to left or attention to anything at all. Thanks > Diane > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/otlist@otnow.com _ Express your personality in color! Preview and select themes for Hotmail®. http://www.windowslive-hotmail.com/LearnMore/personalize.aspx?ocid=PID23391::T:WLMTAGL:ON:WL:en-US:WM_HYGN_express:082009 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Would you?
Hello All: No, this is not a hypothetical situation. I did in fact decline seeing this therapist's patients. To me, it only makes sense that a therapist who believes that OT should NOT focus on the UE would not treat patients where the focus is on the UE. Remember, that a while back, I sent my clinical supervisor and regional manager a message declining to work with UE-focused patients. I was called into their offices to explain my message. So, to now see patients with an UE focus is just wrong. Regarding the statement, "goals should be related to function", EVERY therapists goals are related to "function". Almost every PT goal is read is about function. So, what is it that makes OT different? I remain convinced that the insistent focus on treating UE is nothing but 'crappy PT', to quote another OT listserver. Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Amber nollen Sent: Wednesday, August 05, 2009 To: otlist@otnow.com Subj: [OTlist] Would you? An> H, I have to say... I hope these are hypothetical ethics An> questions. I guess I really am not seeing why you would refuse to An> cover the patient, because of the treatment the other therapist is An> providing. Wouldn't this be "your time to shine", a time to An> "prove what OT really is". The therapists goals should be related An> to function in some way, right. And even if not, we are OT's for An> Gods sake, we are all about adapting, grading, and analyzing An> activities. In summary... yes, I would cover for the therapist. An> I would look at the goals, and bring function into the mix if it had not been addressed. An> Amber An> >> From: re_...@hotmail.com >> To: otlist@otnow.com >> Date: Thu, 6 Aug 2009 01:04:52 + >> Subject: Re: [OTlist] Would you? >> >> >> haaa sometimes you ask things that are thought provoking and I get that- and >> sometimes I wonder if you are insane! haaa agree with last comment- I >> AINT YOU pal >> >> > Date: Wed, 5 Aug 2009 15:28:19 -0700 >> > From: audra...@yahoo.com >> > To: OTlist@OTnow.com >> > Subject: Re: [OTlist] Would you? >> > >> > No, I would not refuse to see another OT's patients, because I don't mind >> > treating patients with UE problems, But I am not you. >> > >> > >> > --- On Tue, 8/4/09, Ron Carson wrote: >> > >> > >> > From: Ron Carson >> > Subject: [OTlist] Would you? >> > To: "OTlist" >> > Date: Tuesday, August 4, 2009, 5:53 PM >> > >> > >> > Would you "refuse" to treat another OT's patient because the other OT >> > sees patients primarily for UE rehab? >> > >> > We have an OT on vacation and I was asked to "cover". When I learned >> > who the OT was and knowing her practice patterns, I suggested the >> > agency find another OT. >> > >> > Would you do this, why or why not? >> > >> > 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 >> >> _ >> Get free photo software from Windows Live >> http://www.windowslive.com/online/photos?ocid=PID23393::T:WLMTAGL:ON:WL:en-US:SI_PH_software:082009 >> -- >> Options? >> www.otnow.com/mailman/options/otlist_otnow.com >> >> Archive? >> www.mail-archive.com/otlist@otnow.com An> _ An> Get your vacation photos on your phone! An> http://windowsliveformobile.com/en-us/photos/default.aspx?&OCID=0809TL-HM An> -- An> Options? An> www.otnow.com/mailman/options/otlist_otnow.com An> Archive? An> 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] Massive new CVA patient
In contrast to Ron, I think there are some things to be done to address the neglect...and it is important to work on this, so that function can become a reality. Positioning in the wheelchair (where the patient will spend most of his day) is very important. Use of some type of arm board, or support, so that the left arm has some weight bearing through the shoulder (also helps with the shoulder problems), provides some stimulation to this side of the body, and keeping the arm as much as possible in the visual field of the patient help the patient regain awareness of it. Consistently encourage the patient to be responsible for where his left arm/leg are, and to take care of those parts of his body. Positioning of the bed and in the bed is also important. If everything is kept to the right side in his room, and he is never positioned where he has to look to the left, then the room is just a place to be rather than the room itself being therapeutic. If he likes to watch tv, and it is able to be moved...place it in his field of vision and then day by day move it farther to the left. Encourage and educate the family to provide stimulation from the left also... I do agree that sitting balance and trunk control are the beginning of a lot of functionso I would do a lot of work on basic bed mobility, rolling, bridging, transfers, trunk control, balance, weight shift, etc...all with functional components...while sitting you can practice grooming, dressing, etc. that all challenge balance. You can also do some higher level reaching tasks (without cones !)...by having him maybe writing on a write-on wipe off board with his good hand while balancing on the mat...and this can be encouraging the awareness of the left also...weight bearing through the left arm/hand while sitting will help with balance and increase awareness...basic NDT techniques are a lot of what I would be doing...especially to facilitate the trunk control, weight shift, balance, etc that will allow for better function... Hope that helps.. Linda Linda Stovall, OTR/L lstov...@mhg.com Program Manager Memorial Hospital at Gulfport Comprehensive Medical Rehabilitation Program 228-867-4179 228-867-5357 (fax) 228-883-8443 (beeper) A CARF (Three-Year) Accreditation was awarded to MHG for the following programs: Inpatient Rehab - Adults, Adolescents, and Children Inpatient Rehab- Stroke Specialty >>> "Miranda Hayek" 8/6/2009 6:05 AM >>> Diane, you could try engaging him in very basic ADL's, such as combing hair, washing face, brushing teeth. This will focus on following one step commands, engaging in ADL's, which would hopefully improve is self-worth, maybe some neglect issues (where you would cue him to comb the left side of his head,etc. ~ Miranda ~ > From: spark...@rcn.com > To: otlist@otnow.com > Date: Thu, 6 Aug 2009 05:43:33 -0400 > Subject: [OTlist] Massive new CVA patient > > Hello, I have been given (along with 11 other patients I have) a new CVA > patient. I have never worked with someone tis impaired and i don't know > where to start. I am in a SNF and pt had been in an acute rehab for about a > month prior for therapy. He is Dependent for all ADL's and > transfers...sometimes hard to get his attention at all. Total left neglect. > Trouble following simple commands. 1 finger sublux. Just not sure where to > even begin. Goals are to increase attention to the left to perform ADL's > but is this relistic at this point and what activites can I do with him that > will encourge attention to left or attention to anything at all. Thanks > Diane > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/otlist@otnow.com _ Express your personality in color! Preview and select themes for Hotmail®. http://www.windowslive-hotmail.com/LearnMore/pe rsonalize.aspx?ocid=PID23391::T:WLMTAGL:ON:WL:en-US:WM_HYGN_express:082009 -- 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] Massive new CVA patient
Diane, I am going to comment here rather than "Lurking". There are some great resources to help you with "evidence-based interventions" Treatment of Neglect etc. Go to www.ebrsr.com and read module 11. The treatments for neglect that has been demonstrated to have some impact on reducing the neglect and improving performance in self care tasks are: 1. TENS 2. Neck muscle vibration therapy 3. Bilateral half field eye patches 4. feedback strategies 5. limb activation strategies They are described in the module. These interventions combined with basic initiation of early self care tasks and balance with improve the outcomes. In this patient the results will require time and persistence. Subluxation 1. The only evidence for improving and preventing subluxation is with the use of an electrical stimulation program. This involves 2 channel deltoid and triceps stim for most effective not supra spinatus Upper extremtity return (by the way here the outcomes are focused on occupation and use occupation for an effective intervention strategy so I treat UE as part of my overall intervention program not in isolation) See module at above website on upper extremity. 1. Electrical stimulation 2. begin the early stages of visualization and mental imagery focusing on attention to task with this patient. 3. follow some of the other strategies in the module. Need to run so cannot elaborate further. Sue Sue D > From: spark...@rcn.com > To: otlist@otnow.com > Date: Thu, 6 Aug 2009 05:43:33 -0400 > Subject: [OTlist] Massive new CVA patient > > Hello, I have been given (along with 11 other patients I have) a new CVA > patient. I have never worked with someone tis impaired and i don't know > where to start. I am in a SNF and pt had been in an acute rehab for about a > month prior for therapy. He is Dependent for all ADL's and > transfers...sometimes hard to get his attention at all. Total left neglect. > Trouble following simple commands. 1 finger sublux. Just not sure where to > even begin. Goals are to increase attention to the left to perform ADL's > but is this relistic at this point and what activites can I do with him that > will encourge attention to left or attention to anything at all. Thanks > Diane > > > > -- > 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] Massive new CVA patient
"there is nothing YOU can do to SIGNIFICANTLY increase his awareness." Agree with everything except this statement, because of what research has taught us. Check out strokengine.com for specific evidence based reviews on neglect training. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson To: Diane Randall Sent: Thu, Aug 6, 2009 6:59 am Subject: Re: [OTlist] Massive new CVA patient Great patient to work with. At this point, there is nothing YOU can do to SIGNIFICANTLY increase his awareness. I would educate him, if appropriate, and family, if available, about visual and verbal cueing, but I would NOT waste a lot of time doing this. Over time, the neglect may subside but I believe this is one of those areas that takes a great deal of time and sort of spontaneous recovery. Are you a COTA or OT (this is why I ask people to include their credentials in messages). If you are the OT, I would change the goal to: "Patient will perform basic ADL's...". Don't limit the patient and your treatment to the neglect. Surely there are other things inhibiting the patient's independence. Make a list of the patient's "problems": physical, mental, emotional, environmental. Prioritize which of these problems are most significant AND that you have the ability to significantly improve. There is no use working on something that will not likely show significant change. My suspicion, is that you should be working on sitting balance. If the patient can sit, then work on standing balance, if the patient can stand, work on mobility. And no matter what, you must address the patient's emotional needs to be in control and have self-worth and dignity. In my opinion, this is best done through an honest therapeutic relationship. I believe that in "complicated" situations, the therapist MUST organize available information in a manner that allows them to address the most salient issues. We only have limited time with patients, so we MUST make best use of that time by addressing those issues which most impair patient's occupations. Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Diane Randall Sent: Thursday, August 06, 2009 To: otlist@otnow.com Subj: [OTlist] Massive new CVA patient DR> Hello, I have been given (along with 11 other patients I have) a new CVA DR> patient. I have never worked with someone tis impaired and i don't know DR> where to start. I am in a SNF and pt had been in an acute rehab for about a DR> month prior for therapy. He is Dependent for all ADL's and DR> transfers...sometimes hard to get his attention at all. Total left neglect. DR> Trouble following simple commands. 1 finger sublux. Just not sure where to DR> even begin. Goals are to increase attention to the left to perform ADL's DR> but is this relistic at this point and what activites can I do with him that DR> will encourge attention to left or attention to anything at all. Thanks DR> Diane 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
Re: [OTlist] Massive new CVA patient
Great input everyone. I must concur that there are lots of things that you can do. The ebrsr is a terrific resource for evidence based intervention for stroke. I really don't have much to add other than using a watch with an alarm and or hourly chime to be placed on the left UE. This will encourage him to attend to the left arm even if it is to locate an annoying watch alarm that he keeps on hearing. He also has to engage in a bit of bilateral movement to turn the alarm off (if he will initiate this). This movement would be more "automatic" as far as his initiation to attempt to move the left arm to meet the right arm to silence the watch alarm. Hope this helps too. Michael A. Holmes MSOTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Massive new CVA patient
I agree with what the other posts have suggested. It is difficult when there is very little response from the patient. I would start with making sure his environment is therapeutic to him. Inculding wheelchair positioning, bed positioning, room changes, education to patient, family, and staff to encourage patients attention to the left. Activities that encourage crossing midline with the right side of his body, even if this is done passively. Sitting balance, weightbearing through the shoulder, tactile stimulation to the left side of his body, visual tracking exercises. During dressing he may be dependent, but verbal education throughout making him a part of the activity is important. Instead of having staff doing stuff TO him, they will be doing these activities FOR him. Make sure there is good lines of communication between all staff and family. Hope everyones suggestions gives you somewhere to start, let us know if you have any other specific questions as time goes on. :) Amber > Date: Thu, 6 Aug 2009 07:44:45 -0500 > From: lstov...@mhg.com > To: otlist@OTnow.com > Subject: Re: [OTlist] Massive new CVA patient > > In contrast to Ron, I think there are some things to be done to address > the neglect...and it is important to work on this, so that function can > become a reality. Positioning in the wheelchair (where the patient will > spend most of his day) is very important. Use of some type of arm board, > or support, so that the left arm has some weight bearing through the > shoulder (also helps with the shoulder problems), provides some > stimulation to this side of the body, and keeping the arm as much as > possible in the visual field of the patient help the patient regain > awareness of it. Consistently encourage the patient to be responsible > for where his left arm/leg are, and to take care of those parts of his > body. Positioning of the bed and in the bed is also important. If > everything is kept to the right side in his room, and he is never > positioned where he has to look to the left, then the room is just a > place to be rather than the room itself being therapeutic. If he likes > to watch tv, and it is able to be moved...place it in his field of > vision and then day by day move it farther to the left. Encourage and > educate the family to provide stimulation from the left also... > > I do agree that sitting balance and trunk control are the beginning of > a lot of functionso I would do a lot of work on basic bed mobility, > rolling, bridging, transfers, trunk control, balance, weight shift, > etc...all with functional components...while sitting you can practice > grooming, dressing, etc. that all challenge balance. You can also do > some higher level reaching tasks (without cones !)...by having him maybe > writing on a write-on wipe off board with his good hand while balancing > on the mat...and this can be encouraging the awareness of the left > also...weight bearing through the left arm/hand while sitting will help > with balance and increase awareness...basic NDT techniques are a lot of > what I would be doing...especially to facilitate the trunk control, > weight shift, balance, etc that will allow for better function... > > Hope that helps.. > > Linda > > Linda Stovall, OTR/L > lstov...@mhg.com > Program Manager > Memorial Hospital at Gulfport > Comprehensive Medical Rehabilitation Program > 228-867-4179 > 228-867-5357 (fax) > 228-883-8443 (beeper) > A CARF (Three-Year) Accreditation was awarded to MHG for the following > programs: > Inpatient Rehab - Adults, Adolescents, and Children > Inpatient Rehab- Stroke Specialty > > > > >>> "Miranda Hayek" 8/6/2009 6:05 AM >>> > > Diane, you could try engaging him in very basic ADL's, such as combing > hair, washing face, brushing teeth. This will focus on following one > step commands, engaging in ADL's, which would hopefully improve is > self-worth, maybe some neglect issues (where you would cue him to comb > the left side of his head,etc. > > > ~ Miranda ~ > > > > > > From: spark...@rcn.com > > To: otlist@otnow.com > > Date: Thu, 6 Aug 2009 05:43:33 -0400 > > Subject: [OTlist] Massive new CVA patient > > > > Hello, I have been given (along with 11 other patients I have) a new > CVA > > patient. I have never worked with someone tis impaired and i don't > know > > where to start. I am in a SNF and pt had been in an acute rehab for > about a > > month prior for therapy. He is Dependent for all ADL's and > > transfers...sometimes hard to get his attention at all. Total left > neglect. > > Trouble following simple commands. 1 finger sublux. Just not sure > where to > > even begin. Goals are to increase attention to the left to perform > ADL's > > but is this relistic at this point and what activites can I do with > him that > > will encourge attention to left or attention to anything at all. > Thanks > > Diane > > > > > > > > -- > > Options? > > www.otnow.com/mailman/options/otli
Re: [OTlist] OTlist Digest, Vol 73, Issue 2
Dianne - RE: your CVA pt. I work with client's like this quite regularly and there is heaps you can do. I feel that there is often a period post CVA almost like an amnesiac state where pt's aren't very attentive in general. It can last for 6-8 weeks sometimes. If you have a good medical team you could chat to them about this side of things as some medications can perk people up a bit out of this state. Also get them assess mood if you think that is an issue. The first thing I do with stroke pt's like this is to try and sort their schedule to encourage periods of rest and activity, even if activity is sitting in a chair for 15 mins, instead of lying in the bed. He will need lots of rest for his brain to heal but needs to be encouraged to refocus on the world too. So get therapists to space out their sessions. So breakfast then rest, then shower then rest, then PT then rest, then SLT then rest etc etc. And I would arrange their room so their left side faces where people approach from, this will encourage him to take note of that side. Educate the client about their neglect and show them. "See how you can't see me but I'm here because you can hear me" and get their family to approach and talk to them from that side. I disagree with Ron in that I've seen people make huge recovery in terms of left neglect, partly through brain fixing itself and partly through compensation. Google the Lighthouse Strategy for later treatment approaches. And protect that shoulder with some positioning charts, education of nurses and family and get someone (an assistant) to do daily stretches. Once you've arranged their environment, given some education and sorted their daily schedule out you can begin in earnest. Treating all stroke clients should always be hierarchical. You need to have a look at the client's vision first and try and ascertain what their visual fields, acuity and perception are. If they can't see they won't attend. Then you want to assess attention - you can get some simple attention screens off the internet. If the client can't attend then they will have difficulty learning any new skill and you should work on attention. By this I don't mean left inattention but their overall ability to attend cognitively. I'd also do a general cognitive assessment to get a baseline too. Do an ADL assessment. See them in the shower and get them to do as much as they can. I find that often these clients get to me and no-one has even asked them to attempt to wash themselves, so they are fully D. Yes they are very disabled but I don't think I've seen anyone who can't wash their face, weak arm, thighs, tummy etc with their good hand with prompting. Most people can brush their teeth, comb their hair, help with dressing. They will like that they are being asked to do it. Concentrate on what they can do and feed this back to them. Then I'd start seeing them for showering a couple of times a week if I had the time or get an assistant to do it - working on improving their I with this. Often people really perk up when they realise someone is asking them to do something and believes that they can do it. No-one wants to be fully D for personal cares. In the meantime PT should be working on their transfers, trunk and sitting balance etc. As they make improvements there challenge them more in ADL's. That should keep you going for a while, sorry for the novel!! Angela Message: 14 Date: Thu, 6 Aug 2009 05:43:33 -0400 From: "Diane Randall" Subject: [OTlist] Massive new CVA patient To: Message-ID: Content-Type: text/plain; charset="iso-8859-1" Hello, I have been given (along with 11 other patients I have) a new CVA patient. I have never worked with someone tis impaired and i don't know where to start. I am in a SNF and pt had been in an acute rehab for about a month prior for therapy. He is Dependent for all ADL's and transfers...sometimes hard to get his attention at all. Total left neglect. Trouble following simple commands. 1 finger sublux. Just not sure where to even begin. Goals are to increase attention to the left to perform ADL's but is this relistic at this point and what activites can I do with him that will encourge attention to left or attention to anything at all. Thanks Diane # Scanned by MailMarshal - Marshal8e6's comprehensive email content security solution. Download a free evaluation of MailMarshal at www.marshal.com # -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Massive new CVA patient
>From Cochrane.org: http://www.cochrane.org/reviews/en/ab003586.html The benefit of cognitive rehabilitation for unilateral spatial neglect, a condition that can affect stroke survivors, is unclear. Unilateral spatial neglect is a condition which reduces a person's ability to look, listen or make movements in one half of their environment. This can affect their ability to carry out many everyday tasks such as eating, reading and getting dressed, and restricts a person's independence. Our review of 12 studies involving306participants found that rehabilitation specifically targeted at neglect appeared to improve a person's ability to complete tests such as finding visual targets and marking the mid-point of a line. However, its effect on their ability to carry out a meaningful everyday task or to live independently was not clear. Patients with neglect should continue to receive general stroke rehabilitation services but better quality research is needed to identify optimal treatments. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Linda Stovall Sent: Thursday, August 06, 2009 To: otlist@OTnow.com Subj: [OTlist] Massive new CVA patient LS> In contrast to Ron, I think there are some things to be done to address LS> the neglect...and it is important to work on this, so that function can LS> become a reality. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] OTlist Digest, Vol 73, Issue 2
In my experience, some people do recover from neglect and some don't. It is my experience and belief that therapy has very little, but some, contribution in this recovery. It is my belief that significant spontaneous recover will or wont' occur regardless of therapeutic intervention. This is not to say that OT has NO role. I do believe we can facilitate this recovery but only in a limited fashion. The question of how best to do this is a whole different topic. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Angela King (ADHB) Sent: Thursday, August 06, 2009 To: otlist@otnow.com Subj: [OTlist] OTlist Digest, Vol 73, Issue 2 AKA> I disagree with Ron in AKA> that I've seen people make huge recovery in terms of left neglect, AKA> partly through brain fixing itself and partly through compensation. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Massive new CVA patient
Just a short reference list 1 http://www.springerlink.com/content/t1lp7wh87wm71t70/ Motor and functional recovery of stroke patients with neglect seems to be significantly improved by the simultaneous presence of a treatment specifically focused on neglect. 2.http://cat.inist.fr/?aModele=afficheN&cpsidt=2126247 3. http://brain.oxfordjournals.org/cgi/content/abstract/125/3/608 4. http://linkinghub.elsevier.com/retrieve/pii/S0003999397902367 The Bon Saint Come method seems to significantly improve recent and chronic UNS, as well as ADL function. These encouraging results could have resulted from a synergistic effect of spatial reconditioning and voluntary trunk rotation. It must be assessed by a new study with more patients. 5.http://linkinghub.elsevier.com/retrieve/pii/S0003999305003308 Thanks, Chris -Original Message- From: Ron Carson To: Linda Stovall Sent: Thu, Aug 6, 2009 4:27 pm Subject: Re: [OTlist] Massive new CVA patient From Cochrane.org: http://www.cochrane.org/reviews/en/ab003586.html The benefit of cognitive rehabilitation for unilateral spatial neglect, a condition that can affect stroke survivors, is unclear. Unilateral spatial neglect is a condition which reduces a person's ability to look, listen or make movements in one half of their environment. This can affect their ability to carry out many everyday tasks such as eating, reading and getting dressed, and restricts a person's independence. Our review of 12 studies involving306participants found that rehabilitation specifically targeted at neglect appeared to improve a person's ability to complete tests such as finding visual targets and marking the mid-point of a line. However, its effect on their ability to carry out a meaningful everyday task or to live independently was not clear. Patients with neglect should continue to receive general stroke rehabilitation services but better quality research is needed to identify optimal treatments. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Linda Stovall Sent: Thursday, August 06, 2009 To: otlist@OTnow.com Subj: [OTlist] Massive new CVA patient LS> In contrast to Ron, I think there are some things to be done to address LS> the neglect...and it is important to work on this, so that function can LS> become a reality. -- 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
[OTlist] Off-Hand Compliment
Today, a patient was talking to the home office about his services. He told the nurse: "Ron is really good, I think of him almost as a PT. He really knows a lot". I didn't ask the patient, but what the heck does this mean? Only he know for sure, but it struck me as such a strange comment. I've been called a PT many times, but I've never been compared to PT in this manner. It really just struck me as "weird" and thought I would share.. 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] Massive new CVA patient
Interesting website. Thanks for the link... Ron - Original Message - From: Sue Doyle Sent: Thursday, August 06, 2009 To: otlist@otnow.com Subj: [OTlist] Massive new CVA patient SD> Diane, SD> I am going to comment here rather than "Lurking". SD> There are some great resources to help you with "evidence-based interventions" SD> Treatment of Neglect etc. SD> Go to www.ebrsr.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
[OTlist] World According to Ron - not
If you don't like my views, then simply delete without reading. Someone ask a question and I provided and answer and I also provided information from Cochrane.org substantiating my experience and opinion. Is that the evidence you speak of? Others have posted information that seems to counter Cochrane.org. That's good, and the topic has given me some additional "food for thought" about neglect. And don't forget, evidence also exists outside of published journals. And, I never said that OT could not affect neglect. I stated that we will have only minimal impact. Also, not everyone knows my views about OT. People join the list who have never been exposed to some of the concepts discussed here. It should be no secret that I started this list to share my opinion on occupation and OT. But, the topics have NEVER been restricted to supporting my views. ANY topic relating to OT is welcome. This message board exists for ALL of us to express our opinion. It's a "free" board in more ways than one. Anyone differing with my (or others) opinion can do one of three things: 1. Reply 2. Ignore 3. Unsubscribe I see you've chosen 1 and 2. Good, I'm glad you haven't chosen 3. There is ONLY one reason why I have more messages and express my views more frequently. EVERYONE on here can do the same. I have no magic want that I wave to make messages magically appear or disappear. Messages only appear when someone has enough concern or passion to write. Obviously, I have a lot of passion about occupation. I'm sure I will one day grow weary of all this typing, but until then you should expect more of the same from me. Thanks for sharing your opinion. Hopefully it made your day a little better ! Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Mary Alice Cafiero Sent: Thursday, August 06, 2009 To: OTlist@OTnow.com Subj: [OTlist] OTlist Digest, Vol 73, Issue 2 MAC> Ron, MAC> I must say that as our entire profession moves toward a practice model MAC> that is more evidence based, you seem intent to do what you do and MAC> believe what you believe because that is what you do. We are all very MAC> aware of your feelings on occupation and not being an upper extremity MAC> therapist. I think that is quite different, however, than saying that MAC> OT does not/cannot influence neglect syndromes as a result of CVA when MAC> there is documented research that shows differently. MAC> We all have beliefs based on our long or short term experience in the MAC> field and with patients. However, we must also be willing to modify MAC> our beliefs based on current trends and advances in medicine, science, MAC> therapy, and research. When there is evidence that OT makes a MAC> difference, OT should try to make a difference. MAC> I am typically very patient and tolerant. I am growing weary, however, MAC> of this appearing to be a message board based on the "World According MAC> to Ron". I don't think that is how you mean it. You have strong views MAC> and no reluctance to share them. However, it gets tiresome (to me at MAC> least). MAC> Maybe if more people continue to express their views and speak up on MAC> here, it will continue to grow in diversity and freedom of expression. MAC> I think some people, especially new to the list, are intimidated about MAC> speaking up when one view is expressed most often and most loudly. MAC> Sorry this doesn't sound respectful. I don't mean to sound harsh. It MAC> has been a very long day. MAC> Mary Alice MAC> Mary Alice Cafiero, MSOT/L, ATP MAC> m...@mac.com MAC> 972-757-3733 MAC> Fax 888-708-8683 MAC> This message, including any attachments, may include confidential, MAC> privileged and/or inside information. Any distribution or use of this MAC> communication by anyone other than the intended recipient(s) is MAC> strictly prohibited and may be unlawful. If you are not the recipient MAC> of this message, please notify the sender and permanently delete the MAC> message from your system. MAC> On Aug 6, 2009, at 5:06 PM, Ron Carson wrote: >> In my experience, some people do recover from neglect and some don't. >> It is my experience and belief that therapy has very little, but some, >> contribution in this recovery. >> >> It is my belief that significant spontaneous recover will or wont' >> occur regardless of therapeutic intervention. >> >> This is not to say that OT has NO role. I do believe we can facilitate >> this recovery but only in a limited fashion. The question of how best >> to do this is a whole different topic. >> >> Thanks, >> >> Ron >> >> ~~~ >> Ron Carson MHS, OT >> www.OTnow.com >> >> - Original Message - >> From: Angela King (ADHB) >> Sent: Thursday, August 06, 2009 >> To: otlist@otnow.com >> Subj: [OTlist] OTlist Digest, Vol 73, Issue 2 >> >> AKA> I disagree with Ron in >> AKA> that I've seen people make huge recovery in terms of left >> neg
Re: [OTlist] Massive new CVA patient
Ron, While that is the current Cochrane one it is over 3 years old. The one from EBRSR is this last year. As a Cochrane author I prefer the Cochrane methodology to some of the others and think it produces a more accurate and thorough outcome but in this case I think the EBSR is a little more current. Sue D > Date: Thu, 6 Aug 2009 17:27:58 -0400 > From: rdcar...@otnow.com > To: OTlist@OTnow.com > Subject: Re: [OTlist] Massive new CVA patient > > >From Cochrane.org: > > http://www.cochrane.org/reviews/en/ab003586.html > > The benefit of cognitive rehabilitation for unilateral spatial > neglect, a condition that can affect stroke survivors, is > unclear. Unilateral spatial neglect is a condition which reduces > a person's ability to look, listen or make movements in one half > of their environment. This can affect their ability to carry out > many everyday tasks such as eating, reading and getting dressed, > and restricts a person's independence. Our review of 12 studies > involving306participants found that rehabilitation > specifically targeted at neglect appeared to improve a person's > ability to complete tests such as finding visual targets and > marking the mid-point of a line. However, its effect on their > ability to carry out a meaningful everyday task or to live > independently was not clear. Patients with neglect should > continue to receive general stroke rehabilitation services but > better quality research is needed to identify optimal > treatments. > > Thanks, > > Ron > > ~~~ > Ron Carson MHS, OT > www.OTnow.com > > - Original Message - > From: Linda Stovall > Sent: Thursday, August 06, 2009 > To: otlist@OTnow.com > Subj: [OTlist] Massive new CVA patient > > LS> In contrast to Ron, I think there are some things to be done to address > LS> the neglect...and it is important to work on this, so that function can > LS> become a reality. > > > -- > 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
