Re: [OTlist] Blurring the lines
This is my first time responding and I am encouraged by the lively discussion. It's interesting to me the subject matter as I have wondered and even lost jobs over these very things (e.g., not accepting productivity standards based on everything but pt. care). It is in fact a "pay for performance" world we live in and for better or worse not likely to change any time soon. It is my opinion, that we play a crucial role in defining the positives of this model. For example, if I were to take any tx./tx. plan I have ever offered to a pt. and try to "sell" it to that same pt. outside of the "system" would anyone "buy" it? I know this sounds very commercial and consumer driven and yet in the end none of us want to work for free. But we have assumed for years that the "system" would pay if we just jumped through the right documentation hoops. Again, it is my opinion that this is were the rub is. We've fought for and won, to varying degrees, at the legislative level but, forgotten the consumer. Look no further than No Child Left Behind or IDEA as an example. And in the end we create legions of dependants on the "system" to give them what they want not necessarily what they need. We have to go to the consumer with a "product" that is valuable and stands on its own merits and is made available through insurances. Again, I offer "alternative medicine" as an example. Not that long ago it was unheard of that insurance would consider paying for massage therapy or chiropractic intervention. Now, it is becoming commonplace. This is in part because these practice groups have "sold" their product to the consumer and at the same time focused on legislative advocacy where appropriate. I agree with the professor from TSU to some degree in that one day we will be one discipline if we do not do a better a job of explaining the "overlap" and selling the differences. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lehman, David Sent: Wednesday, August 20, 2008 11:47 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Blurring the lines I feel the OT profession and its association failed to promote what the true meaning of Occupational Science is and they (as well as PT) let the modern medical money making machine split the body in half. In addition, now OT is left fighting for its life in trying to get reimbursement for occupational innervation versus upper body impairment and function treatment. OT must join the evidence based wagon and show the insurance companies that true occupational therapy/science improves outcomes in daily life skills (not just focus on the general ADLs that we all work on (i.e. bed mobility, transfers, bathing, walking, etc). OT has so much to offer outside the basic ADLs and I feel for people that cannot get true OT for their lives would be so much more fulling The PT is not limited to impairment improvment and never really has been. PTs that were and some that still are caught in the mindset that treating impairments is what we do are poor clinical thinkers in that we must take impairments to the functional level or it makes no sense. What I have a big problem with is the jump PTs make from thinking that improving an impairment is actually improving a function. For example, there is no scientifc evidence that a 3/5 or 4/5 manual muscle test leads to improved sit to stand. I have to make my students think about the theory behind why they choose to improve an impairment and that theory must be related to improving function. I am going out on a limb here, but, I feel one day professions such as PT, OT, activity therapists, etc. will all be one (i.e a rehabilitation specialist) and this overlap/turf war will be gone. Does this make any sense? 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 [EMAIL PROTECTED] 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
Re: [OTlist] Blurring the lines
If PT is the tire then OT is the road. You've gotta put the rubber on the road at some point. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Friday, August 22, 2008 9:32 AM To: Pat Subject: Re: [OTlist] Blurring the lines I certainly don't subscribe to the whole UE/LE concept, and I constantly find myself explaining myself to other providers, employers and patients. So, how do you describe the difference? Generally, I visualize and articulate the following: When the focus of treatment is on a body part (leg, arm, hand, foot, etc), then it's PT. When the focus of treatment is on occupation, then it's OT. Obviously overlap exists between body parts and occupation, but it's the FOCUS of treatment (i.e. the goals) separating PT and OT. In home health, a GREAT place for OT, I really find that this treatment approach integrates well with PT and patient outcomes. Ron - Original Message - From: Pat <[EMAIL PROTECTED]> Sent: Friday, August 22, 2008 To: OTlist@OTnow.com Subj: [OTlist] Blurring the lines P> "What is the difference between OT and PT?" -- 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] bioness
I agree with the statement about TENS in general upper quad use for the neuro population. I have used it adjunctively to other tx. (Saeboflex)that is more active for the CVA population not MS. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Sunday, August 24, 2008 7:34 AM To: Bill Maloney Subject: Re: [OTlist] bioness I am skeptical of e-stim devices for the hand. In my experience, there is little a therapist or device can do to restore permanent and meaning ability to a hand affected by a CVA. Of course, I've seen patient's recover hand function s/p CVA, but this normally occurred spontaneously and rather quickly after the CVA. When someone is 1 year or more out from their stroke, and hand function is not meaningful, I do not feel that meaningful use will return. Others' opinion?? - Original Message - From: Bill Maloney <[EMAIL PROTECTED]> Sent: Saturday, August 23, 2008 To: otlist@otnow.com Subj: [OTlist] bioness BM> I am relieved to see the OTlist responding to the recent "CPR" it received. BM> I hope it never dies. BM> Does anyone out there have any specific experience with the Bioness device BM> for treatment of the hands for patients diagnosed with multiple sclerosis? BM> (FYI http://www.bioness.com/bioness_hand_main.php). I appreciate any BM> feedback. BM> Bill Maloney, OTR BM> www.embracelifewell.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] Do You Agree with This Statement?
As it relates to occupation--sure. The obvious application is industry. However, I have used ergonomic/overuse principals in homecare with 80 yo women who have never heard of any of this stuff. All they want to be able to do is go out to the garden again without fear of falling and all that pain in back/shoulders/hips/knees. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Monday, August 25, 2008 3:24 PM To: Chuck Willmarth Subject: Re: [OTlist] Do You Agree with This Statement? Chuck, stop busting my bubble As usual, Chuck is correct. The quote IS from AOTA's Grip and Grin brochure. And as Paul Harvey say's, "Here's the rest of the story." I recently received an AOTA e-mail announcing that an OT was going to be on "The Early Show", discussing preventing hand and wrist injuries on the campaign trail. The source of the message was Heather Huhman, AOTA Media Relations Manager. Because I am so against OT being affiliated with UE/hand issues, I promptly replied to Ms. Huhman's message with the following: Great, National exposure about OT's being hand/UE therapists. That's the LAST thing our profession needs. Let's get some media relations about OT helping people engage in occupations, especially those that don't focus on the hand/UE! Apparently, my message was forwarded to Chritine Metzler (who works for AOTA but I'm not sure in what capacity) and she replied to me. Part of her reply was directing me to AOTA's "Grip and Grin" brochure. The quote in the brochure, which I included in the original message of this thread, stood out. I posted it because I'm curious to know if any OT's on this list agree with statement. I'm still curious to know if any OT's see themselves as: "expert in preventing and treating conditions such as repetitive-motion injuries". I know for a fact, that is NOT how I see OT. Thanks. Ron - Original Message - From: Chuck Willmarth <[EMAIL PROTECTED]> Sent: Monday, August 25, 2008 To: OTlist@OTnow.com Subj: [OTlist] Do You Agree with This Statement? CW> Ron, CW> Looks like that quote was pulled from AOTA's Grip and Grin brochure CW> which is a promotional item rather than an official document. CW> See: CW> http://www.aota.org/Practitioners/Advocacy/Tools/PromotionalItems/39726. CW> aspx CW> Grip and Grin: AOTPAC Chair Amy Lamb Appears on CBS to Talk About CW> Preventing Injuries on the Campaign Trail CW> On Wednesday, August 13, 2008, Cindy McCain, the wife of Senator John CW> McCain, sustained a wrist injury after shaking hands with an CW> enthusiastic supporter. AOTPAC Chair Amy Lamb, OTD, OTR/L, spoke with CW> the CBS Early Show about AOTA's Grip and Grin campaign and how CW> candidates across the country can prevent similar injuries. CW> See the video online at: CW> http://www.aota.org/News/Announcements/GripandGrin.aspx CW> Chuck CW> -Original Message- CW> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On CW> Behalf Of Ron Carson CW> Sent: Saturday, August 23, 2008 7:05 AM CW> To: OTlist CW> Subject: [OTlist] Do You Agree with This Statement? >> Occupational therapy practitioners are health, wellness, and >> rehabilitation professionals who are expert in preventing and >> treating conditions such as repetitive-motion injuries resulting >> from excessive handshaking. CW> The above statement is from an official AOTA document. CW> If you are an OT/COTA, do you see yourself as an expert in preventing CW> and treating conditions such as repetitive-motion injuries resulting CW> from hand shaking? CW> Ron CW> -- CW> Ron Carson MHS, OT CW> www.OTnow.com CW> -- CW> Options? CW> www.otnow.com/mailman/options/otlist_otnow.com CW> Archive? CW> 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] OT/PT perspective
Mary, Your comments are well spoken. They actually lead me to ask you and any others willing to chime in a question. How would you suggest starting a program to train home health PT's or OT's to perform power mobility/seating assessments? Our company is a large, not-for-profit company with ~ 160 therapists across three states. We currently have an underdeveloped power w-c/specialty seating service line. They are however, distinctly separate from the home health side of our business. I want them to work together. Any thoughts. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary Alice Cafiero Sent: Monday, August 25, 2008 11:19 PM To: OTlist@OTnow.com Subject: [OTlist] OT/PT perspective I first must start my comment by saying that many of my dear friends are Physical Therapists. I love them and learn from the constantly. I also continually learn the differences in our approaches to situations. The example coming to mind is when I am doing a wheelchair clinic at a teaching hospital with a PM&R doctor, patient and patient family, and wheelchair supplier. My role was previously done by a PT who is now doing research full time. I have not met her directly but have heard wonderful things about her. I do know that her approach to a seating assessment and my approach to the same assessment are very different. For instance, she measured every joint angle upper and lower extremity with a goniometer. I want to know what is limited and what that limitation hinders. I also want to know the mechanism for why it is limited, and if it is fixed or flexible. I want a lot more information in question and answer format or in patient giving me a narrative format about how they use their chair, what they can and cannot do in their chair, and what needs to be different next time around. I think much of the most valuable information I get comes from that type of conversation. BUT I don't get a goniometer out of my briefcase. I'll tell the supplier that we need to have a specific type of footplate because their knees can't come to 90 degrees, but I'm not going to measure it. So, is that a huge difference? Not in and of itself. My focus is on getting the client the best equipment possible so that mobility is easy and they can go do what they want to do. I wish it was simple to do that. It's very complex and is what consumes my life these days. The above comments are not a knock on PT. I work with some amazing PTs who do wonderful seating and mobility evaluations. Conversely, I work with some OTs who totally miss the point and should not be doing a mobility evaluation. PTs and OTs alike need to be willing to admit that Seating and Mobility is another specialty area. Not every new graduate from every program has the skills to walk in and start doing evaluations for complex rehab equipment. Until our national organizations agree with this, we are fighting a seriously uphill battle! That was a little rantish. And a bit oddball and tangential because I am very tired. If it doesn't make sense, just ask me! Mary Alice Mary Alice Cafiero [EMAIL PROTECTED] 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. > -- 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] Expertise
Occupational task analysis. The rest is down hill from there. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Audra Ray Sent: Wednesday, September 03, 2008 4:09 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Expertise Anything that the person does or thinks is important, hence occupation. --- On Mon, 9/1/08, Ron Carson <[EMAIL PROTECTED]> wrote: From: Ron Carson <[EMAIL PROTECTED]> Subject: Re: [OTlist] Expertise To: "Ron Carson" Date: Monday, September 1, 2008, 4:33 PM Anyone??? - Original Message - From: Ron Carson <[EMAIL PROTECTED]> Sent: Saturday, August 30, 2008 To: OTlist Subj: [OTlist] Expertise RC> What do you think is OT's expertise? RC> Ron RC> -- RC> Ron Carson MHS, OT -- 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] Advance for OT Article: Point #3
Arley I could not agree more! You are making some of the same points that I believe Dr. Sorenesen has made recently with regard to EI (quite a broohaha). We simply don't know how/when to D/C I believe in part because we have not established plans of care based on sound clinical reasoning. We confuse altruism with therapeutic intervention (give a man a fish vs. teach a man to fish). This results in treating everyone and everything and if done so long enough even the smallest changes/improvements are claimed to be as result of treatment. My two cents. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Johnson, Arley Sent: Friday, September 05, 2008 9:19 AM To: OTlist@OTnow.com Subject: Re: [OTlist] Advance for OT Article: Point #3 I would like to start by asking this question: If an OT is treating a stroke patient and uses neurofacilitation strategies in their treatment or a peds therapist performs prepping techniques prior to her play activities, is there a difference when an OT uses PAMs and strengthening exercises with the ortho population en route to addressing occupation based deficits? I think we need to address the root of the problem by appropriate means and then bring it home to the patient during and after every session to a functional, meaningful implication/connection. The thought pattern posed in the original query should prohibit us from being on burn units. There is a lot of biomechanical activity going on in this field prior to addressing the functional deficits directly. But the therapists are aware that without proper splinting, constant ROM and strengthening, the ability to regain any true function in any capacity would be limited by skin contractures. I admit, when I did ortho rehab, my supervisors thought I pulled the discharge trigger too early, but I wasn't comfortable treating them when they didn't have any functional deficits. If pain was present, but didn't limit their engagement in their roles successfully, then I recommended the physician to address the issue, not therapy. Just my humble opinion... Arley Johnson MS, OTR/L -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Friday, September 05, 2008 8:28 AM To: OTlist Subject: [OTlist] Advance for OT Article: Point #3 = SOURCE: Advance for OT, Sep 1, 2008, P. 46 Article Title: "Injuries to the Wrist: Beneath the Surface of Ulnar Wrist Pain." "[OT] treatment generally involved rest by splinting and activity modification; reduction of pain and inflammation by cryotherapy and .. ROM and strengthening..." Again, recognizing that this article is about treating an injury, is the above description accurate for OT? What is different about the above compared to what PT might do? IF OT's expertise is occupation, where's the occupation in the above description? Thanks, Ron -- Ron Carson MHS, OT -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com The information contained in this e-mail message is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify us immediately by e-mail, and delete the original message. -- 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] Advance for OT Article: Point #3
Hello Ron, I'm not sure I completely follow. If you are saying the point is occupational goal setting--I could not agree more. The exception I take is that many times we are reduced to glorified "shower attendants" in the name of occupation. More specifically, I have never had a pt. that had xfers as a goal. I may have influenced their opinion to that end but, they have never initially volunteered BADL type goals. As has been discussed before, most people "just want be a able to walk again". The problem, as we know, is we stand on the other side of the "river bank" with our pt's and we are trying to help them "build a bridge" to the other side. In my best moments of task analysis there are many types of "bridges"...some more precarious than others. Sometimes you "walk" over and sometimes you build in rest breaks. What's my point? Yes, functional I with the "necessities" of life are a part of occupational performance (BADL), but it is not the "end" for our pt's. For example, the xfers you mentioned before, they should be viewed in my opinion as the bridge to the greater goal/question of "what does the pt. want/need to be able to do once they are in?". The same is true at the other end of the spectrum of performance (modalities--->decreased pain/increased AROM--->increased functional I). Rambling?Yeah...but look at the metaphors! Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Saturday, September 06, 2008 8:23 AM To: Neal Luther Subject: Re: [OTlist] Advance for OT Article: Point #3 Hello Neal: If OT's would adopt occupational goals then patients would be d/c when those goals are achieved. For example, if the goal is: "By d/c, patient will safely and independently transfer to/from car" Once the goal is best achieved the patient is discharged. Of course, patients have multiple goals but the concept is the same. Just last week, I evaluated a patient with total hip replacement. The evaluation resulted in 5 goals (in abbreviated format): 1. In/out shower 2. In/out of car 3. On/off toilet 4. Simple meal prep 5. Lower body dressing Using the above approach, it's easy to tell when the goal(s) are achieved. If additional goals are not established, the patient is discharged. Also, this approach empowers the patient because they generate their own goals. I strongly believe that my job is NOT making goals, but facilitating the patient to achieve them. Of course, there are exceptions. Ron -- Ron Carson MHS, OT - Original Message - From: Neal Luther <[EMAIL PROTECTED]> Sent: Friday, September 05, 2008 To: OTlist@OTnow.com Subj: [OTlist] Advance for OT Article: Point #3 NL> Arley NL> I could not agree more! You are making some of the same points NL> that I believe Dr. Sorenesen has made recently with regard to EI NL> (quite a broohaha). We simply don't know how/when to D/C I NL> believe in part because we have not established plans of care NL> based on sound clinical reasoning. We confuse altruism with NL> therapeutic intervention (give a man a fish vs. teach a man to NL> fish). This results in treating everyone and everything and if NL> done so long enough even the smallest changes/improvements are NL> claimed to be as result of treatment. My two cents. NL> Neal C. Luther,OTR/L NL> Rehab Program Coordinator NL> Advanced Home Care NL> 1-336-878-8824 xt 3205 NL> [EMAIL PROTECTED] NL> Home Care is our Business...Caring is our Specialty -- 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] expertise
Great Quote! Global Warming, anyone? Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Brent Cheyne Sent: Sunday, September 07, 2008 6:44 PM To: otlist@otnow.com Subject: Re: [OTlist] expertise Ron and all, While I love OT as a profession, I remain open-minded to doing what is proven to work, If Occupation is all that we believe it to be, it will become evident when studied...a good idea it won't die. We owe it to our clients to confirm objectively what gets results and meet their goals and discard what doesn't. Food for thought "Men who have excessive faith in their theories or ideas are not only ill prepared for making discoveries: they also make very poor observations. Of necessity, they observe with a preconceived idea, and when they devise an experiment, they can see, in its results,only a confirmation of their theory. In this way they distort observation and often neglect very impotant facts because they do not further their aim. But it happens further quite naturally that men who believe too firmly in their theories, do not believe enough in the theories of others. So the dominant idea of these despisers of their fellows is to find others' theories faulty and try to contradict them. The difficulty for science is still the same." Claude Bernard, "An Introduction to the Study of Experimental Medicine,1865 Sincerely Brent Cheyne OTR/L -- 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] expertise
I would suggest the COPM as you mentioned, Ron. And the study done at USC with the geriatric population...can't remember the name. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Sunday, September 07, 2008 7:14 PM To: Brent Cheyne Subject: Re: [OTlist] expertise Brent, the issue of research supporting practice is very valid. I don't have a good reply other than to follow up with your sentiments that OT is NOT alone in the lack of evidence supporting practice. At this point, I must confess a small secret. I do not like research; I don't like doing it or reading it. I KNOW it's important but I am just NOT a research man. As such, I tend to never focus on the research question(s) that you mention, but maybe I should. Maybe someone else on the list has a better answer. None the less, thanks for taking time to write. Ron -- Ron Carson MHS, OT - Original Message - From: Brent Cheyne <[EMAIL PROTECTED]> Sent: Sunday, September 07, 2008 To: otlist@otnow.com Subj: [OTlist] expertise BC> Ron and all, BC> While defining expertise for OTs as being "Occupation" seems BC> to fill the void of a professional identitity crisis. To be an BC> "expert" as a profession should be more than just about what we BC> "believe in" or what we "hold dear". These beliefs, values, and BC> assumptions are a philosophical ideology (Theory) which has great BC> usefulness in forming a professional identity but what about the BC> role facts and evidence in refining our practices? What if facts BC> and evidence refute our belief about the use of Occupation in BC> certain situations?...will we refine our beliefs and practices? BC> Currently it seems as though practices can neither be fully confirmed or refuted BC> When we make these judgements about what is good OT and BC> not-good OT shouldn't we also have an scientific method of BC> establishing what does work and refine our practice from that BC> data. Shouldn't all theories be tested and questioned and BC> proven?...or at least a tendency or trend be established? BC>Granted it is very hard work to find information that BC> supports and validates completely certain practices, please steer BC> me in the direction of some good research and outcomes that shows BC> that Occupation is a powerful tool, process, method, to achieve BC> functional outcomesI know that we all believe in Occupation BC> but is that enough? This kind of information would validate our BC> practices and confirm us as experts. We are not alone in this BC> disconnection between theory and objective evidence. The lack of BC> evidence and science in practice is a problem for not only OT, but BC> PT, MDs, pharmacology and countless other health-related professions. BC> It feels good to believe but I want more specifics for my work in Geriatric Rehab. BC> Sincerely, BC> Brent Cheyne OTR/L BC> BC> -- 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] expertise, goals, and my 2 cents
I could not agree more!! Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Sue O Sent: Monday, September 08, 2008 10:12 PM To: OTlist@OTnow.com Subject: Re: [OTlist] expertise, goals, and my 2 cents Hi all - very interesting discussion. If, by expertise, you mean what differentiates us from other rehab professions, I would say that our expertise is (or should be) facilitating occupational performance. We may include preparatory interventions to accomplish occupational performance goals, but if we stop at the preparatory step, or write our goals to reflect preparatory skills (like strength, ROM, etc.) then we are not doing OCCUPATIONal therapy. I don't write ROM or strength goals, nor do I teach my students to do so either. Once you shift your thinking, it's not that difficult to write goals that reflect occupational performance. I would never start a goal with the performance skill or client factor (increase ROM to do something). That, to me is like describing OT by how it's not like PT. I always start (and end) with occupational performance. Why not simply state as a goal that the client will don pullover clothing (if that is what they identify as the problem), or even something more general like complete self-care tasks requiring overhead reaching (and maybe give a couple of examples), if the physical problem is shoulder ROM? The intervention plan itself will spell out that I might work on ROM or teach the client some self-stretching, but that should not be the goal. I respectfully disagree with those who say that just because something is done by an OT, then it's OT. That mentality has, in my opinion, caused some of the identity problem we now wrestle with. That's like saying I'm a dentist, so if I happen to be good at giving massages, and I choose to give you a massage while you're in the chair, then it is dentistry (I realize my analogy is a bit absurd, but in a way some of what we do isn't that different). We have tried to be all things to all people, and it's taken us away from our roots, which is the power of occupation to promote mental and physical health. Therapists trained during the heavy "medical model" years were taught a more reductionistic perspective. But in the past 10-15 years there has been a decided shift back to a more holistic foundation based on the power of occupation. I really like the language that the Canadian model uses, which is exemplified in the COPM, which asks the client "what things do you need to do, want to do, or are expected to do, that you can't do, don't do, or aren't satisfied with how you do them, due to your (fill in the blank diagnosis, health condition, situation)"? Starting with an assessment like the COPM, it's almost impossible not to be both client centered and occupational based. Once the occupational performance deficits are identified and goals developed, then we can address the "why" and add in the necessary assessment and interventions to address the appropriate performance skills in pursuit of the occupational performance goals. The bottom line, to me, is if there are no occupational performance goals (i.e. the client's condition is not affecting their occupational performance in any meaningful way, as perceived by the client), then OT is not indicated. I know by reading the posts on this topic that some of you will disagree with me - no problem. But as someone who has been teaching OT for the last 11 years and has experienced the shift first hand, I see the handwriting (no pun intended) on the wall. I have tremendously enjoyed the debate and look forward to more! Sue Ordinetz Assistant Professor of Occupational Therapy American International College Springfield MA 01109 -- 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] expertise
Hey Brent, Just curious...what brought you to USA? Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Brent Cheyne Sent: Tuesday, September 09, 2008 3:09 PM To: otlist@otnow.com Subject: Re: [OTlist] expertise To Ron and the OTList> I was glad to see the COPM mentioned more than once in rhe recent discussion as I was born raised and edcuated in Canada and have been taught by some of the designers of the COPM. I need to go back and get a copy of that material and start using it in practice. The OT profession in Canada is strong and dynamic, at least it was when I left 15 years ago. I wonder if some of the problems in practice related to occupation-based treatments are related to the different healthcare system(?) being a single payer system vs our US system which has a lot of big business influences. I have written earlier about what the Medicare PPS system and RUGS classification and Rehab companies have done to OT practice in SNFs..productivity, staffing, etc.. have made it hard to practice in a more ideal OT way. And it has created bad habits for the profession in terms of good occupation-based interentions. Good to hear about some EBP going on our there too...but I know that a great majority of therapist don't really use it at this time including me. But objective validation of practices through science would clarifiy a body of knowledge and level of expertise. If OT is a powerful idea it will be shown through the evidence. \Good Discussion Brent Cheyne OTR/L -- 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] OT role in ADL
You're right Brent. It's analogous to OT orders for splinting...its reductionist thinking. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Brent Cheyne Sent: Tuesday, September 09, 2008 3:47 PM To: otlist@otnow.com Subject: Re: [OTlist] OT role in ADL Linda, Ron and all, I work in SNF and the issue of ADL and showers comes up a lot. My thought is that ideed there are some patients that it is too soon to work on showersso there should be no goal in the treatment plan for showering at that time. Sometimes basic grooming and washing and dressing are challenging and engaging enough to match the patients capability. Goals should be set for this type of activity. This is a clinical judgement. It is a matter of activity analysis and grading of activity which takes some critical thinking and logical progression. Eventually the goal of completing a shower with assistance would come as a progression and be an appropriate challange. If you take a patient and hose them down and scub them up and dry them off such that they are a passive receiver of the shower, it would be unethical to bill for therapy for that type of treatment and we couldn't call it occupation-based either. People don't improve function by being in the presence of occupation but by engaging in it. There is sucha a thing as too much too soon which is a big waste of therapy time. On the other hand just taking patients to the gym and randomly doing puzzles and playing cards isn't right either. WIth all due respect, I don't think blanket rule about "OT must bathe the patient once a week makes a lot of sense...a bit of rigid overkill" which implicates that there is no thought, or decision-making skills required to plan, analyze and progress the patient in logical and effective manner. In that case the therapist is not needed . But, believe me I do understand and relate to the frustration managers have with who don't seem to "get it" about occupation. Staff education, inservicing, skill building, mentoring, and team building are oftern required to keep a team fresh and dynamic and out of bad habits. Besides...its important to look at outcomes, if patients are progressing to the point where they can shower independently and go homesomebody must be doing something right..who are they and what are they doing? Eliminate those thiings that don't need doing. "There's a time for everything under the sun" It's a gradual and logiccal process. SIncerely, submitted wtih respect Brent Cheyne OTR/L -- 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] Best Practice
Simple. If we don't know that our interventions are successful we dare not make claims on occupational performance. It's akin to performing PROM on someone in a coma (which can be a good thing) and when they come out of the coma claiming our intervention as the reason they are able feed themselves now. Another example would be in orthopedics. Why do we do higher level IADL tasks. In my experience, it is usually to work on the dynamics of balance (especially with TKR's). If I do not know the effects of single leg stance on the joint and whether that pt. Is ready (usually in consult with PT) then I can't plan occupational tasks accordingly. And if this is not addressed then I have not done my job to prepare that pt. For return to meaningful activity. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Wednesday, October 08, 2008 9:13 PM To: Neal Luther Subject: Re: [OTlist] Best Practice Why? Ron -- Ron Carson MHS, OT - Original Message ----- From: Neal Luther <[EMAIL PROTECTED]> Sent: Wednesday, October 08, 2008 To: OTlist@OTnow.com Subj: [OTlist] Best Practice NL> Also, I think we have to measure success at both levels --the NL> treated area and occupational performance. -- 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] Best Practice
Ron, Your splitting hairs. I put IADL/balance in the context of treating an ortho pt. (TKR). Respectfully, Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] Home Care is our Business...Caring is our Specialty -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Thursday, October 09, 2008 9:36 PM To: Neal Luther Subject: Re: [OTlist] Best Practice Neal, it seems that we look at things differently: You say: "we do higher level IADL tasks ... usually to work on the dynamics of balance" I look at it this way: I do higher level tasks so the patient can learn to do these tasks independently I work on the dynamics of balance so the patient can do higher level tasks Also, for me, I know if interventions are successful if the patient has improved occupational performance. Lastly, In my opinion, OT's role is not PREPARING the patient for return to activity, it's RETURNING them to activity. Does any of this make sense or is it just "rubbish" Ron -- Ron Carson MHS, OT - Original Message - From: Neal Luther <[EMAIL PROTECTED]> Sent: Thursday, October 09, 2008 To: OTlist@OTnow.com Subj: [OTlist] Best Practice NL> Simple. If we don't know that our interventions are successful we dare NL> not make claims on occupational performance. It's akin to performing NL> PROM on someone in a coma (which can be a good thing) and when they come NL> out of the coma claiming our intervention as the reason they are able NL> feed themselves now. Another example would be in orthopedics. Why do NL> we do higher level IADL tasks. In my experience, it is usually to work NL> on the dynamics of balance (especially with TKR's). If I do not know NL> the effects of single leg stance on the joint and whether that pt. Is NL> ready (usually in consult with PT) then I can't plan occupational tasks NL> accordingly. And if this is not addressed then I have not done my job to NL> prepare that pt. For return to meaningful activity. NL> Neal C. Luther,OTR/L NL> Rehab Program Coordinator NL> Advanced Home Care NL> 1-336-878-8824 xt 3205 NL> [EMAIL PROTECTED] NL> Home Care is our Business...Caring is our Specialty NL> The information contained in this electronic document from NL> Advanced Home Care is privileged and confidential information NL> intended for the sole use of [EMAIL PROTECTED] If the reader of NL> this communication is not the intended recipient, or the employee NL> or agent responsible for delivering it to the intended recipient, NL> you are hereby notified that any dissemination, distribution or NL> copying of this communication is strictly prohibited. If you have NL> received this communication in error, please immediately notify NL> the person listed above and discard the original.-Original Message- NL> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On NL> Behalf Of Ron Carson NL> Sent: Wednesday, October 08, 2008 9:13 PM NL> To: Neal Luther NL> Subject: Re: [OTlist] Best Practice NL> Why? NL> Ron NL> -- NL> Ron Carson MHS, OT NL> - Original Message - NL> From: Neal Luther <[EMAIL PROTECTED]> NL> Sent: Wednesday, October 08, 2008 NL> To: OTlist@OTnow.com NL> Subj: [OTlist] Best Practice NL>> Also, I think we have to measure success at both levels --the NL>> treated area and occupational performance. -- 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] Best Practice
Ron, I disagree. We are not at different ends of the spectrum. I think we have different ways of expressing the same desire to keep occupation the central tenet of OT. However, I still think you are trying to "burn both ends of the candle" by not admitting in order to establish baseline occupational performance one must establish baseline "human" deficit. We are limited creatures, who depend on these bodies that are decaying (some more rapidly than others) to successfully engage in the things (occupations) that are meaningful to us. Your own case history reveals this. You do a great job of establishing in a snap shot where the deficits are: Martha: A Case Study History: 90 y/o female s/p CVA (approximately 10 years) with mild residual affects Generalized weakness Decreased endurance Diffuse pattern of extremity pain HTTN Severe anxiety Evaluation: Decreased strength in bi-lateral LE Pain in right LE, secondary to "injury" while standing from toilet Decreased endurance Dependent for most ADL's. Requires mod - max assist with transfers Non-ambulatory Prior Level of Function: Previously ambulated with RW, short distances Transferred independently The only occupation mentioned (toileting)is in relation to pain. Your goals reflect occupational performance areas but your eval does not. Why? Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] Home Care is our Business...Caring is our Specialty -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Saturday, October 11, 2008 6:49 AM To: Neal Luther Subject: Re: [OTlist] Best Practice Hello Neal: I do not feel that I'm splitting hairs at all. What you and I are saying are at two ends of the spectrum. We are describing totally different theoretical approaches to treatment. Using IADL's to remediate balance is nothing unique to our profession. And, I think this type of approach leads some OT's to do pretty silly stuff like cones, shoulder arc, pegs, balloons, laundry, washing windows, etc. What I'm arguing is that OT's role should not be remediating underlying issues, other profession's do that. Instead, our primary role, and distinction is remediating occupational issues. Ron -- Ron Carson MHS, OT - Original Message - From: Neal Luther <[EMAIL PROTECTED]> Sent: Friday, October 10, 2008 To: OTlist@OTnow.com Subj: [OTlist] Best Practice NL> Ron, NL> Your splitting hairs. NL> I put IADL/balance in the context of treating an ortho pt. (TKR). NL> Respectfully, NL> Neal C. Luther,OTR/L NL> Rehab Program Coordinator NL> Advanced Home Care NL> 1-336-878-8824 xt 3205 NL> [EMAIL PROTECTED] NL> Home Care is our Business...Caring is our Specialty NL> -Original Message- NL> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On NL> Behalf Of Ron Carson NL> Sent: Thursday, October 09, 2008 9:36 PM NL> To: Neal Luther NL> Subject: Re: [OTlist] Best Practice NL> Neal, it seems that we look at things differently: NL> You say: NL> "we do higher level IADL tasks ... usually to work on the NL> dynamics of balance" NL> I look at it this way: NL> I do higher level tasks so the patient can learn to do these NL> tasks independently NL> I work on the dynamics of balance so the patient can do higher NL> level tasks NL> Also, for me, I know if interventions are successful if the patient NL> has improved occupational performance. Lastly, In my opinion, OT's NL> role is not PREPARING the patient for return to activity, it's NL> RETURNING them to activity. NL> Does any of this make sense or is it just "rubbish" NL> Ron NL> -- NL> Ron Carson MHS, OT NL> - Original Message - NL> From: Neal Luther <[EMAIL PROTECTED]> NL> Sent: Thursday, October 09, 2008 NL> To: OTlist@OTnow.com NL> Subj: [OTlist] Best Practice NL>> Simple. If we don't know that our interventions are successful we NL> dare NL>> not make claims on occupational performance. It's akin to NL> performing NL>> PROM on someone in a coma (which can be a good thing) and when they NL> come NL>> out of the coma claiming our intervention as the reason they are NL> able NL>> feed themselves now. Another example would be in orthopedics. Why NL> do NL>> we do higher level IADL tasks. In my experience, it is usually to NL> work NL>> on the dynamics of balance (especially with TKR's). If I do not NL> know NL>> the effects of single leg stance on
Re: [OTlist] Best Practice
Fair enough. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Wednesday, October 15, 2008 8:27 PM To: Neal Luther Subject: Re: [OTlist] Best Practice Neal, I've been pondering the below question for some time. The question really had me thinking about my evaluation process. Then I remembered that the eval form that I use (provided by the home health agency) includes a check box section regarding daily living skills. I did NOT include this section in my on-line evaluation, but should have. Thanks for pointing out my error. I still think we are on different ends of the spectrum, but I guess that's a well-beaten horse, right? Ron -- Ron Carson MHS, OT - Original Message ----- From: Neal Luther <[EMAIL PROTECTED]> Sent: Monday, October 13, 2008 To: OTlist@OTnow.com Subj: [OTlist] Best Practice NL> The only occupation mentioned (toileting)is in relation to pain. Your NL> goals reflect occupational performance areas but your eval does not. NL> Why? -- 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] Clearly DelineatingOT and PT?
I think your research is incredibly valuable both to us as a profession and ultimately to the communities we serve. Here's why. I'll use one of the areas your research is focused--interpersonal expressions of caring. Often the aged/elderly population have lost so many meaningful expressions of "life and love" that bathing themselves is completely irrelevant. But holding that grand baby in their arms and rocking them to sleep... now, suddenly that same person is alive with meaningful occupation. The problem is (as always) third party payers could care less. And I believe they could not care less because we (OT's) have not demonstrated to them the value of this occupation and how it impacts this persons ability to stay engaged...maybe even stay home longer...maybe even have carry effect to other areas of personal self care. Keep it up! Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Sue Doyle Sent: Tuesday, October 21, 2008 11:02 PM To: otlist@otnow.com Subject: Re: [OTlist] Clearly DelineatingOT and PT? Just another idea from my OT researcher mind. I have been observing stroke patients for many years. Many patients can function well to complete their basic self care tasks one handed. The meaning of having both arms able to function well goes beyond the basic self care tasks we tend to focus on. The concepts of communication (how many of us talk with our hands), self esteem and sense of social acceptance (not being seen as disfigured or disabled), and interpersonal expressions of caring (eg hugs etc) are ones that I am currently observing as strong dissatisfiers for clients post stroke who have otherwise mastered basic self care but are still unhappy with their current performance levels or the upper extremity function. I am currently designing a research study to further investigate these concepts. But where does that take us as OTs with treatment? Just to spin the record at a slightly different speed. Sue> Date: Tue, 21 Oct 2008 22:26:59 -0400> From: [EMAIL PROTECTED]> To: OTlist@OTnow.com> Subject: Re: [OTlist] Clearly DelineatingOT and PT?> > If I evaluated a CVA patient (new or old) and they were unable to> identify occupation goals, they I would d/c them. Recommending PT> might or might not be indicated.> > No, I do not think we should use "common sense" to coerce goals.> Occupational goals are not about your or me, they are about a> patient's perceived needs and values. Just because we think something> is important, that is no indication that a patient will agree.> Especially were patients face catastrophic loss of occupation. What we> value may be meaningless to our patients. Thus, using a "common sense"> approach can create more harm than good and leave patient's feeling> utterly frustrated.> > On the other hand, a skilled OT may need to enlighten a patient as to> the realities of life with a CVA. Often this is done during the eval,> either through questioning or actual performance. After a> comprehensive occupation-based evaluation, it's is my opinion and> experience that an OT has a very good understanding of a patient's> concerns and thus their motives.> > I think a LOT of OT success lies in the timing of our services. If> patients are not willing or able to focus on occupation then our> success in improving occupation may be greatly diminished. However,> when patients are focused on lost occupation, and in the hands of a> skilled occupation-based OT, improvement in occupation performance is> almost guaranteed.> > Ron> --> Ron Carson MHS, OT> > - Original Message -> From: [EMAIL PROTECTED] <[EMAIL PROTECTED]>> Sent: Tuesday, October 21, 2008> To: OTlist@OTnow.com > Subj: [OTlist] Clearly DelineatingOT and PT?> > cac> What should an OT do if the patient identifies that they want to> cac> be able to look to the left (attention?=body?function)?because of> cac> a right CVA?to their parietal lobe (body structure)?? They> cac> unfortunately do no personally state any occupations that they> cac> want to address in particular.? Should we pass the patient to> cac> physical therapy or should we "coerce" a few occupational goals?through common sense?> > cac> Chris Nahrwold MS, OTR> > > cac> -Original Message-> cac>
Re: [OTlist] Best Practice
Precisely!
Neal C. Luther,OTR/L
Rehab Program Coordinator
Advanced Home Care
1-336-878-8824 xt 3205
[EMAIL PROTECTED]
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 [EMAIL
PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
Behalf Of Carmen Aguirre
Sent: Monday, October 27, 2008 8:03 PM
To: otlist@otnow.com
Subject: Re: [OTlist] Best Practice
I think the message here limits the power of task analysis and task
equivalency. There a MANY times when a client will need physical agent
modalities/ neuromuscular re-education, lymphedema treatment , etc to
prepare a body segment to perform then or later, a desired occupation.
The role of OT is important to id. those components that would
facilitate the occupational outcome. I would not ID those physical agent
modalities, refer my patient to PT, wait until I'm told "they are ready"
and then work with my patient on the occupation. It is a segmented
approach and unnecessary in my opinion. We are competent to see the
process from beginning to end.
Carmen
> Date: Sun, 5 Oct 2008 20:17:43 -0400
> From: [EMAIL PROTECTED]
> To: OTlist@OTnow.com
> Subject: [OTlist] Best Practice
>
> I just posted the following on AOTA's Phy-Dys list serve and wanted to
> get OTnow.com readers' opinion. As usual, it's lengthy:
>
> ## START ##
>
> I have always believe that OT intervention and goals must be a
> straight and direct line. In other words, what OT does MUST have a
> DIRECT effect on the patient's occupational deficits. To accomplish
> this intervention, I've sort of developed an "outline" which is
> primarily based on the Canadian Model of Occupational Performance.
> What follows is a simplified model which helps establish the DIRECT
> LINE between goals and treatment:
>
> 1. Help the patient figure out what they want or need to do
> (i.e. occupation)
>
> 2. Figure out what is keeping the patient from doing their
> identified occupations:
>
> a. Environmental
> b. Cognition
> c. Physical
> d. Social
> e. Emotional
> 1. Fear
> 2. Motivation
>
> 3. Prioritize the above into those things that can be changed
> and THEN GET BUSY CHANGING THEM! Don't waste therapist or
> patient time addressing those issues which can not be changed.
>
> Now this is simple and incomplete, but it works because outcomes and
> treatment focus on occupation. Recently, it's been suggested, both on
> this list and in print, that quality OT must include occupation into
> treatment sessions. I do not feel that such an approach is mandated by
> AOTA's Framework, not is it always appropriate.
>
> Here are several passages from the OT Framework, Rev 2 collaborating
> this concept:
>
> {EVALUATION}
>
> Occupation-based activity analysis places the person [client]
> in the foreground. It takes into account the particular
> person's [client's] interests, goals, abilities, and contexts,
> as well as the demands of the activity itself. These
> considerations shape the practitioner's efforts to help
> the...person [client] reach his/her goals through
carefully
> designed evaluation and intervention. (Crepeau, 2003, p. 193)
> (P. 651)
>
> Analyzing occupational performance requires an understanding
> of the complex and dynamic interaction among performance
> skills, performance patterns, contexts and environments,
> activity demands, and client factors. (P. 651)
>
> {INTERVENTION}
>
> The intervention process consists of the skilled actions taken
> by occupational therapy practitioners in collaboration with
> the client to facilitate engagement in occupation related to
> health and participation. (P. 652)
>
> The intervention focusisonmodifyingthe
> environment/contexts and activity demands or patterns,
> promoting health, establishing or restoring and maintaining
> occupational performance, and preventing further disability
> and occupa
Re: [OTlist] Client without goals
I would have done the same thing with one exception. I have always found a way to discuss faith issues. I find that lack of hope is related to lack of faith which is a great place to begin. When I say "faith" I do mean faith in God. It is an amazing thing to realize that the God of the universe who created all things created me/us with a purpose. In this one simple fact is meaning and hope and it is in Him that our faith should be placed. When we as therapists realize this it is a great gift we give to our patients to discuss these things and in fact build into the occupational framework of living. The more we look into ourselves for answers the emptier life is. When we turn our eyes/faith to Him and start everyday with that practice the world (no matter what our circumstances) is a better place. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary Alice Cafiero Sent: Friday, October 31, 2008 8:23 AM To: OTlist@OTnow.com Subject: Re: [OTlist] Client without goals I recently had this discussion with a good friend here who does home health. She had a patient that was very similar as far as not being able to identify goals. Her pt had a very flat affect and didn't do anything other than move from her bed to her couch during the day and occasionally get up to go to the kitchen for some snack food or similar that she just had to grab and eat. The referral actually got to home health because the lady had a shoulder arthroplasty done. However, when my friend did the evaluation, this lady was able to do all of her basic ADLs and even some IADLS in her home. PT was also on the case and was addressing the specifics of range and exercise for the shoulder. The first thought was that there were not really OT goals. My friend wasn't totally comfortable with this, and I'm sure that was, at least in part, because my friend does have some background working in mental health. She talked with the pt who agreed to have her come back to "check" on her. On the next visit, they talked about depression and how having a schedule of doing things during the day can help alleviate symptoms. They made a very simple plan/schedule for the pt to begin following each day with just 3-5 activities scheduled throughout the day. Simple things like getting dressed instead of staying in pajamas, brushing her hair and teeth, making a sandwich or microwave meal for lunch, stepping out into the front or backyard once or twice a day, etc. On just 1-2 follow-up visits, the pt was actually doing the things they scheduled and said she was feeling better and even smiled. The smile was huge because during the evaluation, the pt had an absolutely flat affect and showed no emotion the whole time. She was able to verbalize that she could understand why getting up for activities during the day made a difference in how she feels. Now, of course, we don't know if she will continue to do those things when no one is "checking", but I think the OT intervention was valid and meaningful even though the pt could not initially verbalize goals. Certainly, a recommendation was given to the HH agency and physician that a pscyh referral would be a good idea. My friend did a lot of education regarding depression and basic things that the pt can do around her home to combat the depression. What do y'all think? Was this appropriate US medical model home health OT intervention? Sorry for being long-winded, Mary Alice Mary Alice Cafiero, MSOT/L, ATP [EMAIL PROTECTED] 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 Oct 31, 2008, at 12:59 AM, FAY, Felicity wrote: > > Hi there, I'm a Mental Health OT from Australia and work with clients > who find it difficult to engage and identify their goals daily. > Sometimes just engaging with the person and building rapport for a > coupl
Re: [OTlist] Client without goals
Why? Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary Alice Cafiero Sent: Friday, October 31, 2008 11:55 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Client without goals I have two comments/questions. Ron, I think the other thing that I thought of with your patient is about when she said she wanted to be normal. Could she tell you in any way what normal was to her? I think I would have tried to use that as a starting point to find out what she thought she was lacking. Neal and Ron, I think hope/faith/whatever term you want to use like this is very important. I am always careful not to share my specific beliefs, especially when I don't know the patient's background or belief system. I think talking about hope, personal satisfaction/ stability (can't actually think of the word I'm looking for here) is fine but that recognizing the validity of other people's belief systems is also very important. I don't see my role as an OT including testifying to someone about my personal beliefs. It's just dangerous ground in my mind. Respectfully, Mary Alice Mary Alice Cafiero, MSOT/L, ATP [EMAIL PROTECTED] 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. -- 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] doubling patient in acute rehab
A couple of quick thoughts and observations. First, Wikipedia has good info on basic definitions of ethics and morality. Second, ultimately after one reads these definitions or others one comes to the question: Says who? On what authority does any "man" or system of "man" e.g. government, religion, etc. make their claim? Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Brent Cheyne Sent: Thursday, November 06, 2008 6:52 PM To: otlist@otnow.com Subject: Re: [OTlist] doubling patient in acute rehab To Ron, Chris and the List, For the sake of continuing the doubling/dovetailing conversation, I'd like to talk about ethics...the labels of "ethical and unethical" situations get freely tossed around a lot in talk about the OT world. To say that something is "unethical" because it is against the rules means if you follow the rules your are supposedly"ethical". However, truly ethical conduct goes beyond the mere act of following the 'rules', and is far more complicated. As we have already observed one clinical setting (acute rehab) may have different "rules" than another (SNF, Peds etc.). And often the rules are hard to find, pin down, verify, or subject to multiple interpretations. Rules change frequently...does that mean our ethics are also constantly in flux based on corporate,medicare, or insurance provider policies? The AOTA has a Code of Ethics (2005) with 7 principles as components: Principle 1.demonstrate a concern for the safety and well-being of the recipients of their services. (BENEFICENCE) Principle 2. take measures to ensure a recipient’s safety and avoid imposing or inflicting harm. (NONMALEFICENCE) Principle 3 respect recipients to assure their rights. (AUTONOMY, CONFIDENTIALITY) Principle 4. achieve and continually maintain high standards of competence. (DUTY). Principle 5.comply with laws and Association policies guiding the profession of occupational therapy. (PROCEDURAL JUSTICE) Principle 6. provide accurate information when representing the profession. (VERACITY) Principle 7. treat colleagues and other professionals with respect, fairness, discretion, and integrity. (FIDELITY) According to the AOTA these are the ethical principles we follow to determine if a situation or even a rule is ethical. Additionally these ethical principles are held in conjuction with the OT Core Values (AOTA 1993): Altruism, Equality, Freedom, Justice, Truth and Prudence. So...Based on AOTA Ethical Principles and Core Values, we take a look back at doubling/dovetailing patients for treatment and we know there are certain rules to follow in a variety of contexts of clinical practice, Questions Come Up: Should doubling/dovetailing (DB/DT) always be considered "unethical" regardless of the clinical setting ? If DBDT is allowed by rule is it still unethical? If it is generally unethical by what ethical principle? Is DBDT only unethical because it is harder (or easier) work for the therapist, or can it be proven to be less (or more) efficient in providing the most effective treatment to the most people for the least cost? I think all these questions should have good answers before we go to our colleagues, managers, and administrators to talk about the ethics of practices and policies such as DBDTing. Any other thoughts or responses? Brent, an OT --- On Thu, 11/6/08, [EMAIL PROTECTED] <[EMAIL PROTECTED]> wrote: From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Subject: OTlist Digest, Vol 44, Issue 7 To: otlist@otnow.com Date: Thursday, November 6, 2008, 3:00 PM Send OTlist mailing list submissions to otlist@otnow.com To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com or, via email, send a message with subject or body 'help' to [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your Subject line so it is more specific than "Re: Contents of OTlist digest..." Today's Topics: 1. Re: doubling patient in acute rehab ([EMAIL PROTECTED]) -- Message: 1 Date: Wed, 05 Nov 2008 19:05:30
Re: [OTlist] doubling patient in acute rehab
Bill, I think I hear what you are saying. If I may be so bold as to add a few thoughts. First, I do think healthcare should be viewed as a business. However, I think we look at it as a national commodity when in fact it is a service...a vital service, none the less a service. To further complicate matters we have taken this "commodity" and made it a "right" to "have access" in our conversations around how to regulate. So, strictly speaking from a business model, or more specifically an economic model we do not have true "free market" economic principals in play. Namely, supply and demand. Here is another way to look at it. If you or I had to take what we do as therapist and "package" it in a way that the consumer would buy it, I fear that most consumers would not buy. When I say consumer I do mean the end user not the "fiscal intermediator" or any other entity that holds the purse strings. So what is the answer? I think in part is lies (at least in the US) with "cleaning up" the insurance industry. This includes Medicare and all private insurances. It would involve new innovative ways of thinking that are actually not new. Give the consumer control. One of the "products" that I think could be useful in changing the paradigm is HSA's (healthcare savings accounts). You can find plenty of info on-line (try HSA.com) that speak to particulars. In a nutshell, these are insurance products that are a high deductible policy matched with a savings account that is interesting bearing and is yours. It is not dependant upon your employer. Something like this would have to be phased in gradually starting with 18 year olds. The power in a product like this is the same as any interest bearing accounts--compounded interest over time and it rolls over from year to year. This is so unlike any of the so called FSA's that do not encourage saving but spending. Anyway, at the end of the day we would be "selling" our services to the consumer and not to congress. I do see a place for congress to be involved, but on a limited basis and simply to provide oversight and safeguards where necessary (like making sure it is portable from state to state). Hope this makes sense. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Bill Maloney Sent: Saturday, November 08, 2008 12:28 PM To: OTlist Subject: Re: [OTlist] doubling patient in acute rehab On the subject of DB/DT: ethics, rules, varying standards of individual clinical practices, etc. notwithstanding, the bottom line is PROFIT. If you look very closely at ALL clinical settings, the bottom line has to be "healthy" (seemingly at whatever cost) or the business fails. With the US economy faltering, business owners, board members and trustees are more than likely interested in the path of least resistance when it comes to ethics, i.e. as long as you're not doing anything harmful enough to hurt business, rock on. I am absolutely and certainly not implying, in any way, that the "suits" don't hold themselves to high standards of ethical business behavior (perhaps some do, perhaps some don't). I am just jaded, I guess, by all the improprieties that are regularly surfacing from behind the scenes in the corporate world. Healthcare is no different, it is a business. The questions I would have are two: 1. The cart before the horse: does the business side of healthcare exist and do what it does to keep the wheels spinning in order for us to provide excellent care to our recipients; or do we provide our service to the recipients as a means of generating revenue for the business (is the dog wagging the tail, or vice-versa)? and 2. When you've applied ethical framework guidelines to how you're practicing, and asked all the appropriate questions, and answered them to the best of your interpretation, do you stay put or move on to something that better aligns with your personal practice philosophy? Thanks, Ron and others for allowing freedom of expression on this site. Bill Maloney, OTR -- 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] I still can't explain OT
Thank-you , David. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] Home Care is our Business...Caring is our Specialty -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lehman, David Sent: Wednesday, November 12, 2008 10:54 AM To: OTlist@OTnow.com Subject: Re: [OTlist] I still can't explain OT Neal...what I think you did was not a professional act but a human actyou can call it PT or OT.this is how I address my patients in the SNF I work at. Most times the OT is on top of the pt's life goals but, together we both address the life situation via our treatment (whether improvment in function or impairments). We have the ole' division of the body (if OT is seeing pt, I cannot address UE impairments/function, so, I relate it to LE impairments and overall function based on what the pt will be doing at discharge, whether staying in SNF or going home). I think we can all play the modern medical game to appease administration and insurance companies, but, knowing we are all actually looking our for the life improvement outcomes. Peace, David 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 [EMAIL PROTECTED] 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. From: [EMAIL PROTECTED] [EMAIL PROTECTED] On Behalf Of Neal Luther [EMAIL PROTECTED] Sent: Wednesday, November 12, 2008 9:51 AM To: OTlist@OTnow.com Subject: Re: [OTlist] I still can't explain OT I have one for you, Ron. I do some PRN work at a small community hospital that also has it's own SNF. Routinely, they will "eval" pt's who are being transferred to the SNF in the hospital before they leave. In addition, they are in the habit of telling pt's/families the pt. has to stay a minimum of 21 days for the insurance to pay. Under this working model I saw a pt. last weekend who was admitted with respiratory failure thru their ED--went to the floor for a few days--xfered to the SNF. When I saw her she had been in the SNF for three days. She was completely I with all BADL albeit she needed to tale rest breaks. Tx. plan involved IADL home mgmt. tasks. As is my habit when I do weekend work I asked the pt. what she does for fun (I usually get some very strange looks, but have found it to be a great way to build quick repoire). As it turns out the pt. had no interest at all in "meal planning/prep". What was important to her was relationships and socializing with friends/family. So, I re-directed her tx. that day to simply walking through the entire SNF looking for people she had played bingo with and talking/socializing. She even pushed another pt. to the dining room in their w/c. Was I right in my choice? Was what I did really PT? Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Wednesday, November 12, 2008 7:07 AM To: OTlist@OTnow.com Subject: [OTlist] I still can't explain OT I've been an OT for a long time and I still can NOT explain my profession in a way that is: * Concise * CLEARLY differentiates OT from other professions * Makes sense to other people (i.e. patients, MD's, nurses, etc) * Consistent: - With others - Across patient populations - Supported by practice - Supported by documentation * Satisfies me Yesterday, I evaled a patient s/p shoulder replacement. PT was already on the case. I struggled understanding my OT role with this patient and how it might be different if PT wasn't already seeing the patient. I wondered how other OT's would approach the patient. The patient is a retired nurse and her daughter is a retired "special needs" kids. Bot
Re: [OTlist] I still can't explain OT
I have one for you, Ron. I do some PRN work at a small community hospital that also has it's own SNF. Routinely, they will "eval" pt's who are being transferred to the SNF in the hospital before they leave. In addition, they are in the habit of telling pt's/families the pt. has to stay a minimum of 21 days for the insurance to pay. Under this working model I saw a pt. last weekend who was admitted with respiratory failure thru their ED--went to the floor for a few days--xfered to the SNF. When I saw her she had been in the SNF for three days. She was completely I with all BADL albeit she needed to tale rest breaks. Tx. plan involved IADL home mgmt. tasks. As is my habit when I do weekend work I asked the pt. what she does for fun (I usually get some very strange looks, but have found it to be a great way to build quick repoire). As it turns out the pt. had no interest at all in "meal planning/prep". What was important to her was relationships and socializing with friends/family. So, I re-directed her tx. that day to simply walking through the entire SNF looking for people she had played bingo with and talking/socializing. She even pushed another pt. to the dining room in their w/c. Was I right in my choice? Was what I did really PT? Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Wednesday, November 12, 2008 7:07 AM To: OTlist@OTnow.com Subject: [OTlist] I still can't explain OT I've been an OT for a long time and I still can NOT explain my profession in a way that is: * Concise * CLEARLY differentiates OT from other professions * Makes sense to other people (i.e. patients, MD's, nurses, etc) * Consistent: - With others - Across patient populations - Supported by practice - Supported by documentation * Satisfies me Yesterday, I evaled a patient s/p shoulder replacement. PT was already on the case. I struggled understanding my OT role with this patient and how it might be different if PT wasn't already seeing the patient. I wondered how other OT's would approach the patient. The patient is a retired nurse and her daughter is a retired "special needs" kids. Both of them had knowledge of OT, which sometimes is a bad thing. The patient was recently d/c'd from rehab for her shoulder surgery. The shoulder became dislocated while in rehab and when I asked the daughter if OT or PT worked on the shoulder, she said OT. When I asked her what they did once the shoulder was dislocated, she said they had her mom sitting at a table doing pegs, cards, etc with her unaffected arm to "keep it strong". I love being an OT but it is such a confusing profession. When I evaluate people, the only thing that really makes sense is occupation. But, that often leads to mobility issues, and if PT is on the case, they already address this, so there's nothing for me to do. I'll never understand how OT has become so pigeonholed into UE treatment. I can find no good logic or reason why OT as a profession focuses on the UE but it seems to be the predominate pattern. Ron -- Ron Carson MHS, OT -- 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] I still can't explain OT
So are you saying it was a good choice or not? Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Wednesday, November 12, 2008 3:29 PM To: OTlist@OTnow.com Subject: Re: [OTlist] I still can't explain OT Nope - what you did was Recreational Therapy - but since OTs have a monster leisure component to Occupation - then that is what occurred. In order to socialize with peers/family - you have to walk - you also have to obtain items and network - which is again - occupation. You did endurance activities and not PT - you took what she was vested in and ran with it. Connie S. Boggess, MS, CTRS, OTR/L Certified Therapeutic Recreation Specialist Occupational Therapist Registered/Licensed Confidentiality Notice: This message, including any attachments, is for the sole use of the individual or entity named above. This message may contain confidential health information that is legally protected by the Health Information Portability and Accountability Act (HIPAA), the Family Education Rights Privacy Act (FERPA) and/or the Individuals with Disabilities Act (IDEA). It is intended solely for the recipient named above. If you are not the intended recipient and/or have received this information and its contents in error, you are herby notified that any review, use, disclosure and/or distribution of this information is strictly prohibited. Please notify sender immediately and destroy the information. Thank you. **Get the Moviefone Toolbar. Showtimes, theaters, movie news & more!(http://pr.atwola.com/promoclk/10075x1212774565x1200812037/aol? redir=htt p://toolbar.aol.com/moviefone/download.html?ncid=emlcntusdown0001) -- 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] Still Can't Explain OT
Thanks, Bill, and all who have responded. I must confess I was "baiting" to a degree with my questions. I am absolutely convinced that the tools we have as OT's are underutilized. That is why I chose the intervention as I did. Incidentally, the patient was thrilled! Best regards, Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Bill Maloney Sent: Thursday, November 13, 2008 3:38 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Still Can't Explain OT I like David's explanation, a lot. It rings true with my thoughts and philosophy as well. And, for what it's worth, Neal, your socialization treatment for that SNF patient was OT. Not to add fuel to the fire, Ron, but you'll love this one: I arrived at a patient's home yesterday at the agreed time to find the PT already beginning her treatment. The PT has been on the case (s/p right THR secondary to hardware failure of previous ORIF) for about 2 weeks already. The best I could tell from observing her treatment "in the background" as I interviewd the caregivers and began to assess the living spaces, I deduced that she was working on "functional mobility" which I absolutely address as part of my plan, i.e. how can I not address that if we're loooking at safe, independent toileting as a goal? But, when I arrived for my initial OT evaluation, the patient was understandably confused. The PT jumped in and offered the following explanation: "Oh, he's the arm guy." Have a nice day, feelin' your pain.Bill Maloney, OTR -- 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] I still can't explain OT
BrentFUNNY Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] 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 [EMAIL PROTECTED] 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: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Brent Cheyne Sent: Thursday, November 13, 2008 6:33 PM To: Ron Carson Subject: Re: [OTlist] I still can't explain OT "I've been an OT for a long time and I still can NOT explain my profession in a way that is: * Concise * CLEARLY differentiates OT from other professions * Makes sense to other people (i.e. patients, MD's, nurses, etc) * Consistent: - With others - Across patient populations - Supported by practice - Supported by documentation * Satisfies me" Other professions with identity crisis, (job the club) Physical Therapist vs athletic trainer vs massage therapist vs chiropractor, vs exercise physiologist,vs kinesiologist, vs personal trainer vs body worker, yoga instructor vs pilates instructor vs "fitness personality" Chiropractor vs Osteopath vs Naturopath vs Homeopath vs Acupuncturist vs Oriental Medicine Specialist vs Natural Healer Psychiatrist vs Psychologist vs Mental Health Counsellor vs Psychotherapist vs addiction cousellors vs Personal Coach vs Personal Shopper vs Personal Assistant :) Physicians assistant vs Nurse Practitioner, Nurse Anasthestatists, Nurse Midwives, Nutritionist vs Dietitian vs Sports Nutrition Counsellor vs Dietary services manager Nurse Case Manager vs Social Worker vs Geriatric Care Manager vs Life Care Managers vs Disablilty Managers Speech Language Pathologist vs Audiologists vs Special Education Teachers vs Learning Disabled Specialist vs Educaitonal Psychologist Computer Engineer vs Software Engineer vs Network Management specialist vs information technology manager, vs systems analyst vs data base manager vs website developer. Engineers: Civil vs Mechanical vs Electrical vs Structural vs Chemical vs Biomedical vs Architects vs Urban Planners Optometrists vs Opthamologists Lawyers: Corporate Lawyers vs Environmental Lawyers vs Estate Lawyers vs Criminal Lawyers vs Constitutional Lawyers vs Personal Injury Lawyers vs Entertainment and Intellectual Property Lawyers Business: CEO, COO, CFO, CIO, Chairman, President, Owner, Majority Holder CIA vs FBI vs Department of Homeland Security vs Sheriffs Department vs City Police Department vs NSA,vs FEMA Publicist vs Public Relations Specialist vs Advisor/handler vs Agent Journalist vs Columnist vs Pundit vs Blogger vs Poparrattzzi vs TV/Radio Talk Show Host Rabbi vs Priest vs Pastor vs Guru vs Eman vs Shaman vs Minister vs Spiritual Advisor Compassionate Social Conservative Republican vs Fiscally Responsible Progressive Liberal Democrat vs...dare I go on? Sorry, this was just a fun mental exercise for me, there are a lot of professions that overlap in areas of expertise and infuence and turf...the boundries can be social, legal, or cultural, and even political. OT is not alone in the search for a universally understood definition. Stay relevant by being useful and effective with your clients. I try to remain content in my career and enjoy my work despite a lack of concrete and defined professional boundries. Brent -- 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] vestibular OT
It would be helpful to me for those with experience to talk about the differences in "vestibular" disorders and how you use this in an occupational model. Example, BPPV vs Meniere's disease vs sensory processing deficits. Thanks 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 ehthiers Sent: Tuesday, February 24, 2009 4:46 PM To: OTlist@OTnow.com Subject: Re: [OTlist] vestibular OT Ot's have been doing vestibular work since Jean Ayers (much of the basis for Sensory integration treatment starts at the vestibular system). However, with fall prevention becoming a big thing with Medicare everyone and their brother is becoming a vestibular specialist. I have vertigo and went through many local providers before I finally went to the one recommended by me in a course I took. Less physcial depends on if you have aides to help you out. It is a fascinating field and you would be mistaken for PT if you don't know how to bring an OT perspective to the program. Vestibular disorders association (VEDA) has lots of great information, here on the east coast an OT from the Ear Clinic in Atlanta does some great trainings. It all depends on what age group you want to work with. Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net > -Original Message- > From: otlist-boun...@otnow.com > [mailto:otlist-boun...@otnow.com] On Behalf Of d. chang > Sent: Tuesday, February 24, 2009 12:10 AM > To: OTlist@otnow.com > Subject: [OTlist] vestibular OT > > Hello !! > > I've been on this list for a while, but just as an owl. I > love reading > everything here. Im learning new things from each and every > one of you. > Education is just totally endless. There are so much stuff > to learn. Oh, before I go on, my name is Diana and Im in my > last year of OT program !! > > I'm very interested in vestibular field. A friend of mine > told me that the vestibular is an up and coming field for OT > AND its less physical demanding, which is perfect for me > because I have a meniere's disease and a low back pain. > > Does anyone know about this particular field? > > diana. > -- > 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] vestibular OT
Thanks, Jamie. Here is an attempt to make even further distinction. I think what the group has been talking about (vestibular rehab) and what appears in a lot of journals these days is related to falls in the adult population. Dr. Epley (neurologist) first pioneered/discovered that otolith crystals in the semicircular canals could be repositioned and "cure" issues with positional vertigo. The diagnosis is referred to as BPPV (benign paroxysmal positional vertigo). So, through a series of head, neck, trunk positioning maneuvers the pt. Can first be diagnosed in regards to which canal is causing the problem and this is observed thru nystagmus patterns in the eyes. The most common repositioning maneuvers are the Epley and the Dix-Hallpike. I think someone else already mentioned VEDA and their website. They are really the best source of info. Hope I got all that right... off the top of my head. 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 -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of jamie thomas Sent: Wednesday, February 25, 2009 5:34 PM To: OTlist@OTnow.com Subject: Re: [OTlist] vestibular OT Hi, This "vestibular" stuff is interesting to me. It seems I've gotten lots of continuing ed. brochures concerning "Vestibular Rehabilitation" that are put on by PTs. I do use sensory integration in my practice as a school OT, but from what I've done and seen in practice, the vestibular activities we do under this frame of reference look different than what people who practice "Vestibular Rehab", as it is termed, do. I was looking at a site (looks like it's written by a neurologist) that claims that mostly PTs do this sort of rehab, but that some OTs do it as well. "Vestibular Rehab", according to this site, seems to involve different techniques, maneuvers and tests that I'm not familiar with, and seems to be directed toward definite conditions that involve balance issues. For reference, here's the site (http://www.dizziness-and-balance.com/treatment/rehab.html#definition)  There seem to be slight differences in terminology that may determine what field the majority of practitioners come from. There is a course put on by OTs, Sheila Frick & Mary Kawar called "Vestibular Habilitation >From the Core", and I do also use this in practice via the "Astronaut Training" protocol.  Just my two cents...perhaps this will clarify (or confuse more ;-)) the question from the person who initially began this thread.  ~Jamie --- On Wed, 2/25/09, Neal Luther wrote: From: Neal Luther Subject: Re: [OTlist] vestibular OT To: OTlist@OTnow.com Date: Wednesday, February 25, 2009, 6:20 AM It would be helpful to me for those with experience to talk about the differences in "vestibular" disorders and how you use this in an occupational model. Example, BPPV vs Meniere's disease vs sensory processing deficits. Thanks 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 ehthiers Sent: Tuesday, February 24, 2009 4:46 PM To: OTlist@OTnow.com Subject: Re: [OTlist] vestibular OT Ot's have been doing vestibular work since Jean Ayers (much of the basis for Sensory integration treatment starts at the vestibular system). However, with fall prevention becoming a big thing with Medicare everyone and their brother is becoming a vestibular specialist. I have vertigo and went through many local providers before I finally went to the one recommended by me in a course I took. Less physcial depends on if you have aides to help you out. It is a fascinating field and you would be mistaken for PT if you don't know how to bring an OT perspective to the program. Vestibular disorders association (VEDA) has lots of great information, here on the east coast an OT from the Ear Clinic in Atlanta does some great trainings. It all depends on what age group you want to work with. Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net
Re: [OTlist] What Would YOU Do?
Absolutely. It's called the Modified Borg Scale. Respiratory therapists use it all the time. Good tool for OT to help with anxiety related to certain tasks that require more energy. 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: Thursday, February 26, 2009 9:14 PM To: Carmen Aguirre Subject: Re: [OTlist] What Would YOU Do? Interesting that you mention pulse ox. My clinical director has repeatedly told that staff that pulse oximetry can only be taken under an MD's order. Regarding the baseline, could you use a patient's self-reported fatigue level during the desired activity of ambulating to the dining room? Then use this as the measurable outcome. Ron - Original Message - From: Carmen Aguirre Sent: Thursday, February 26, 2009 To: otlist@otnow.com Subj: [OTlist] What Would YOU Do? CA> I would start with breathing exercises, 6-min activity testing to CA> meassure fatigue and shortness of breath to get a meassurable CA> baseline. Take pulse oxymetry and BP to help educate when rest is CA> needed if not aware of it and to manage energy levels. Work on basic CA> routines he wants to improve performance and quality; besides the CA> actual tasks/activities teach maint. pulmonary exercises to manage CA> his disease. Medication management to assess how he manages his CA> disease as well. Community resources and overall health management CA> skill. Balance retraining, strengthening would be part of my CA> treatment plan. CA> Carmen CA> >> Date: Thu, 26 Feb 2009 20:15:25 -0500 >> From: rdcar...@otnow.com >> To: OTlist@OTnow.com >> Subject: [OTlist] What Would YOU Do? >> >> Evaluated a man today, recently discharged from rehab. His primary >> diagnosis is congestive heart failure. >> >> He's presents with decreased fine motor control from an unknown >> etiology. He has decreased lower extremity strength and decreased >> balance. He is also short of breath during exertion. >> >> He is unable to do dishes, zip and button his clothes. He is unable to >> independently sit/stand and has difficulty getting into his shower Also, >> he is unable to consistently and safely walk to the dining room of the >> ALF. He desire to NOT use a wheelchair. His primary concern is >> mobility-related daily living activity. >> >> What treatment MIGHT you provide this patient and why? >> >> 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 CA> _ CA> Windows Live(tm): Discover 10 secrets about the new Windows Live. CA> http://windowslive.com/connect/post/jamiethomson.spaces.live.com-Blog-cn s!550F681DAD532637!7540.entry?ocid=TXT_TAGLM_WL_t2_ugc_post_022009 CA> -- CA> Options? CA> www.otnow.com/mailman/options/otlist_otnow.com CA> Archive? CA> 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] What Would YOU Do?
It simply requires the order as a "modality". It is not for whatever reason considered a vital sign. 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 Carmen Aguirre Sent: Friday, February 27, 2009 7:23 PM To: otlist@otnow.com Subject: Re: [OTlist] What Would YOU Do? I wonder why Carmen > Date: Thu, 26 Feb 2009 21:14:29 -0500 > From: rdcar...@otnow.com > To: OTlist@OTnow.com > Subject: Re: [OTlist] What Would YOU Do? > > Interesting that you mention pulse ox. My clinical director has > repeatedly told that staff that pulse oximetry can only be taken under > an MD's order. > > Regarding the baseline, could you use a patient's self-reported fatigue > level during the desired activity of ambulating to the dining room? Then > use this as the measurable outcome. > > Ron > > - Original Message - > From: Carmen Aguirre > Sent: Thursday, February 26, 2009 > To: otlist@otnow.com > Subj: [OTlist] What Would YOU Do? > > > CA> I would start with breathing exercises, 6-min activity testing to > CA> meassure fatigue and shortness of breath to get a meassurable > CA> baseline. Take pulse oxymetry and BP to help educate when rest is > CA> needed if not aware of it and to manage energy levels. Work on basic > CA> routines he wants to improve performance and quality; besides the > CA> actual tasks/activities teach maint. pulmonary exercises to manage > CA> his disease. Medication management to assess how he manages his > CA> disease as well. Community resources and overall health management > CA> skill. Balance retraining, strengthening would be part of my > CA> treatment plan. > > CA> Carmen > > > CA> > > >> Date: Thu, 26 Feb 2009 20:15:25 -0500 > >> From: rdcar...@otnow.com > >> To: OTlist@OTnow.com > >> Subject: [OTlist] What Would YOU Do? > >> > >> Evaluated a man today, recently discharged from rehab. His primary > >> diagnosis is congestive heart failure. > >> > >> He's presents with decreased fine motor control from an unknown > >> etiology. He has decreased lower extremity strength and decreased > >> balance. He is also short of breath during exertion. > >> > >> He is unable to do dishes, zip and button his clothes. He is unable to > >> independently sit/stand and has difficulty getting into his shower Also, > >> he is unable to consistently and safely walk to the dining room of the > >> ALF. He desire to NOT use a wheelchair. His primary concern is > >> mobility-related daily living activity. > >> > >> What treatment MIGHT you provide this patient and why? > >> > >> 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 > > CA> _ > CA> Windows Live(tm): Discover 10 secrets about the new Windows Live. > CA> http://windowslive.com/connect/post/jamiethomson.spaces.live.com-Blog-cn s!550F681DAD532637!7540.entry?ocid=TXT_TAGLM_WL_t2_ugc_post_022009 > CA> -- > CA> Options? > CA> www.otnow.com/mailman/options/otlist_otnow.com > > CA> Archive? > CA> www.mail-archive.com/otlist@otnow.com > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/otlist@otnow.com _ Access your email online and on the go with Windows Live Hotmail. http://windowslive.com/online/hotmail?ocid=TXT_TAGLM_WL_HM_AE_Access_022 009 -- 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] What Would YOU Do?
Probably a state intermediary mandate. 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 -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Carmen Aguirre Sent: Monday, March 02, 2009 7:50 PM To: otlist@otnow.com Subject: Re: [OTlist] What Would YOU Do? I work in SNF. Never heard such restriction. I hope I'm not alone!! Carmen > Date: Mon, 2 Mar 2009 07:44:14 -0500 > From: neal.lut...@advhomecare.org > To: OTlist@OTnow.com > Subject: Re: [OTlist] What Would YOU Do? > > It simply requires the order as a "modality". It is not for whatever > reason considered a vital sign. > > > 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 Carmen Aguirre > Sent: Friday, February 27, 2009 7:23 PM > To: otlist@otnow.com > Subject: Re: [OTlist] What Would YOU Do? > > > > > I wonder why > > > > Carmen > > > > > > Date: Thu, 26 Feb 2009 21:14:29 -0500 > > From: rdcar...@otnow.com > > To: OTlist@OTnow.com > > Subject: Re: [OTlist] What Would YOU Do? > > > > Interesting that you mention pulse ox. My clinical director has > > repeatedly told that staff that pulse oximetry can only be taken under > > an MD's order. > > > > Regarding the baseline, could you use a patient's self-reported > fatigue > > level during the desired activity of ambulating to the dining room? > Then > > use this as the measurable outcome. > > > > Ron > > > > - Original Message - > > From: Carmen Aguirre > > Sent: Thursday, February 26, 2009 > > To: otlist@otnow.com > > Subj: [OTlist] What Would YOU Do? > > > > > > CA> I would start with breathing exercises, 6-min activity testing to > > CA> meassure fatigue and shortness of breath to get a meassurable > > CA> baseline. Take pulse oxymetry and BP to help educate when rest is > > CA> needed if not aware of it and to manage energy levels. Work on > basic > > CA> routines he wants to improve performance and quality; besides the > > CA> actual tasks/activities teach maint. pulmonary exercises to manage > > CA> his disease. Medication management to assess how he manages his > > CA> disease as well. Community resources and overall health management > > CA> skill. Balance retraining, strengthening would be part of my > > CA> treatment plan. > > > > CA> Carmen > > > > > > CA> > > > > >> Date: Thu, 26 Feb 2009 20:15:25 -0500 > > >> From: rdcar...@otnow.com > > >> To: OTlist@OTnow.com > > >> Subject: [OTlist] What Would YOU Do? > > >> > > >> Evaluated a man today, recently discharged from rehab. His primary > > >> diagnosis is congestive heart failure. > > >> > > >> He's presents with decreased fine motor control from an unknown > > >> etiology. He has decreased lower extremity strength and decreased > > >> balance. He is also short of breath during exertion. > > >> > > >> He is unable to do dishes, zip and button his clothes. He is unable > to > > >> independently sit/stand and has difficulty getting into his shower > Also, > > >> he is unable to consistently and safely walk to the dining room of > the > > >> ALF. He desire to NOT use a wheelchair. His primary concern is > > >> mobility-related daily living activity. > > >> > > >> What treatment MIGHT you provide this patient and why? > > >> > > >> 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 > > > > CA> _ > > CA> Windows Live(tm): Discover 10 secrets about the new Windows Live. > > CA> > http://windowslive.com/connect/post/jamiethomson.spaces.live.com-Blog-cn > s!550F681DAD532637!7540.entry?ocid=TXT_TAGLM_WL_t2_ugc_post_022009 > > CA> -- > > CA> Options? > > CA> www.otnow.com/mailman/options/otlist_otnow.com > > > > CA> Archive? > > CA> www.mail-archive.com/otlist@otnow.com > > > > > > -- > > Options? > > www.otnow.com/mailman/options/otlist_otnow.com > > > > Archive? > > www.mail-a
Re: [OTlist] Modified Borg Scale?
Patient. It is perceived (subjective) exertion. 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 P Please consider the environment before printing this e-mail 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, March 17, 2009 8:46 AM To: OTlist@OTnow.com Subject: [OTlist] Modified Borg Scale? Is the Modified Borg Scale scored by the patient or the therapist? 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] "Occupation"
Absolutely, and I include some broader language referring to occupational performance. 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 P Please consider the environment before printing this e-mail 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: Thursday, March 26, 2009 8:50 PM To: OTlist@OTnow.com Subject: [OTlist] "Occupation" Does anyone use the word "occupation" in their documentation? For example, I write: "Pt will complete daily occupations including bathing, dressing, and toileting" Ron -- 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] AOTA Screening Bloggers Comments?
Are you serious? It actually appears you have been censured? 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 P Please consider the environment before printing this e-mail 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: Thursday, April 09, 2009 9:18 PM To: OTlist@OTnow.com Subject: [OTlist] AOTA Screening Bloggers Comments? Hello All: On two different and recent occasions, my comments on the AOTA president's blog concerning the recent branding campaign were not posted. While I have no way of knowing who or even if someone is censoring my comments, it certainly appears to be the case. Given that AOTA is member supported organization is it acceptable for AOTA to censor members' messages, even if they are negative and non-supporting? You can read the AOTA President's blog here: http://tinyurl.com/dka9fm 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] We Better Wake Up...
Hey Ron, I've been taking a temporary break from responding but I could not agree with you more. It's what Deborah Aminni (sp?) (and I'm sure others) who writes a column for OT Advance calls a reductionist mentality. I think she's right. If, for example, we become the "go to" discipline for ue splinting this has the appearance of being a good thing simply from a "keeping the caseload full" perspective. In the end, however, we are reduced to becoming a vendor for all things regarding splinting. Case in point is a referral I received the other day who was clearly documented as having no further skilled OT need by the OT a couple of months ago. She did have some swallowing issues the SLP has been addressing. Here comes the kicker...the pt. Kept complaining to the staff and SLP about wanting another splint for her LUE. The CVA was some twenty years ago. The splint however, was deemed appropriate on the last referral. This time when I arrived and began my interview with the pt. All she wanted was the cover to be taken off and washed. The ALF facility claims they had no idea it came off. In the end I did not make any further recommendations. I did review appropriate care of splint with all parties. To me this was a complete waste of time. It kept me busy. But what a waste of time and resources. 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 P Please consider the environment before printing this e-mail 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: Thursday, April 09, 2009 9:17 AM To: Mary Alice Cafiero Subject: Re: [OTlist] We Better Wake Up... Hey Mary Alice, thanks for posting. I tend to be guilty of talking out of both sides of my mouth but I'm OK with that. Normally, being "double minded" is a bad thing, but in this case, I think it's OK. Like it or not, health care is a business and OT is part of this business model. And like most businesses, it's a "dog eat dog" world. As a business, OT must work VERY hard to expand its presence while at the same time, restricting the efforts of others who are doing the same. And while many OT's see this as a "bad" thing, it's what other professions do and it's what OT MUST also do. EVERY profession is literally in a war to protect itself from absorption. As it stands now, OT is a very small "player" in the health care world. We are not well known, even by professions who should know us. In my opinion, we are not well respected, even by profession who know what we do. And we do not do a good job of practicing what we preach. Lastly, OT has always had a large cadre of cheerleaders within the profession. In fact, it seems to me that in general OT does not do a good job of receiving self-critical analysis. As a profession, it seems that what we want is the sweet without the bitter. We want the cream without the fat. And while that may make us feel good, it really is a "head in the cloud" approach to the harsh realities of the highly competitive American healthcare model. I think many OT's are happy just sitting on their duff's taking whatever hand outs come their way. This "welfare" model may allow us to survive, but it will NOT allow us to thrive. As a play against our new brand, our profession is NOT living its life to the fullest. Thanks for the dialogue, I hope others join in Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Mary Alice Cafiero Sent: Wednesday, April 08, 2009 To: OTlist@OTnow.com Subj: [OTlist] We Better Wake Up... MAC> Susanne, MAC> I have to agree with you. I don't think OTs have a lock on the market MAC> of making an activity functional. Certainly I find plenty of OTs that MAC> are threatened by PTs use of functional activity and functional goals. MAC> Interestingly, the first time I heard that PT was trying to take over MAC> OT because they dared to say they were doing functional tasks was MAC> about 15 years ago. So far, it seems that there is plenty of room for MAC> all of us to help our patients in a variety of ways with varying MAC> approaches/frames of reference. MAC> It is hard to avoid feeling that many OTs who are upset by this are MAC> "talking out of bo
Re: [OTlist] AOTA Screening Bloggers Comments?
Wow!! 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 -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Friday, April 10, 2009 9:17 AM To: Neal Luther Subject: Re: [OTlist] AOTA Screening Bloggers Comments? Unfortunately, I am dead serious. I've posted two messages to Dr. Moyers' blog, but neither have appeared. I assume the blog is working because at least two other messages from different members appeared between my messages. The question for me, is what should I do about this situation? Thanks, Ron - Original Message ----- From: Neal Luther Sent: Friday, April 10, 2009 To: OTlist@OTnow.com Subj: [OTlist] AOTA Screening Bloggers Comments? NL> Are you serious? It actually appears you have been censured? NL> Neal C. Luther,OTR/L NL> Advanced Home Care, Burlington Office NL> 1-336-538-1194, xt 6672 NL> neal.lut...@advhomecare.org NL> Home Care is our Business...Caring is our Specialty NL> P Please consider the environment before printing this e-mail NL> The information contained in this electronic document from Advanced NL> Home Care is privileged and confidential information intended for NL> the sole use of otl...@otnow.com. If the reader of this NL> communication is not the intended recipient, or the employee or NL> agent responsible for delivering it to the intended recipient, you NL> are hereby notified that any dissemination, distribution or copying NL> of this communication is strictly prohibited. If you have received NL> this communication in error, please immediately notify the person NL> listed above and discard the original.-Original Message- NL> From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On NL> Behalf Of Ron Carson NL> Sent: Thursday, April 09, 2009 9:18 PM NL> To: OTlist@OTnow.com NL> Subject: [OTlist] AOTA Screening Bloggers Comments? NL> Hello All: NL> On two different and recent occasions, my comments on the AOTA NL> president's blog concerning the recent branding campaign were not NL> posted. While I have no way of knowing who or even if someone is NL> censoring my comments, it certainly appears to be the case. NL> Given that AOTA is member supported organization is it acceptable for NL> AOTA to censor members' messages, even if they are negative and NL> non-supporting? NL> You can read the AOTA President's blog here: http://tinyurl.com/dka9fm NL> Thanks, NL> Ron NL> ~~~ NL> Ron Carson MHS, OT NL> www.OTnow.com NL> -- NL> Options? NL> www.otnow.com/mailman/options/otlist_otnow.com NL> Archive? NL> 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] Empowering Your Patients...
I essentially do the same with proviso that I have sent communication notes to other team members and asking for their assist as to progress and if/when it may be appropriate to re-eval. 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 P Please consider the environment before printing this e-mail 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: Friday, April 10, 2009 10:20 PM To: OTlist@OTnow.com Subject: [OTlist] Empowering Your Patients... Hello All: I frequently, in fact almost always, let patients make decisions about therapy and I wonder if other therapists do the same. For example, today I explained to a patient that I could continue seeing her 5x/week, 3x/week or whatever else she wanted. To my surprise, the patient elected to decrease OT to 3x/week. Also, a couple weeks ago I left a patient with the statement that OT could only continue if the patient generated goals for himself. On the next visit, the patient told me his only goal was to "walk like a man". I explained that "walking" was a PT goal but that if he had any daily living goals, I could continue. He again stated that his only goal was walking. So, again to my surprise, I was left with no alternative but discharge. Also during evals, I leave the start of therapy up to the patient. I explain that I can see the patient or not, and it's up to them. I explain what I will do as far as general treatment but leave the decision to the patient. Do others do this same thing? One thing I can say is that this approach does not make my supervisor very happy. I tend to have more than the normal amount of "eval only". 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] A Typical Day, Is this Normal?
Sounds to me like you're facility is RUGG'ing everyone at high/very high. Is that appropriate for your averagae 91 yo? 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 P Please consider the environment before printing this e-mail 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 Brent Cheyne Sent: Wednesday, April 15, 2009 6:53 AM To: Ron Carson Subject: [OTlist] A Typical Day, Is this Normal? There have been some very excellent and insightful posts recently and I need to go back and read them a second time before I respond..very thought provoking Over the past "busy season" at my place of work I've been having a very challenging caseload. Please review the circumstances and decide if it is a normal/comfortable work condition In an 8 hour day I have to treat and do daily notes, 1 weekly note, attend 1 weekly staff meeting and attend 1-2 care plan meetings. 1. 91 yo female, femur fx nwb-max assist ADL, wants to go home alone-60min 2 91 yo female, sternal fx max assist ADL, want to go home alone-60 min (Eval today) 3 85 yo female, total knee replacement ADL with supervision but encouragement 45min 4 82 yo female, distal radial fracture-ADL with minimal assit-home alone-60 min 5 81 yo male, total hip revision-ADL with minimal assist and encourge- to live alone 60 min 6 77 you female, CVA Aphasic right hemi- max assist self care- to live with spouse -60 min 7 63 yo female, Multiple sclerosis, max assist ADL, home with spouse, 60 min 8 74 yo femal, CVA right hemi-max assist ADL, r/oSNF placement , 60 minutes 9 65 yo male, Parkinson stand by assist ADL, home with spouse who works, 60 min So I'm scheduled to see these people today... about 465 minutes of treatment,5/9 patiens are maximal assist, all this week, did this all last week Does this sound like a reasonable and appropriate schedule? Am I going to be able to get through it and still provide that meaningful and effective, individualized treatment that will create a great public relations image? Give me some feedback Brent -- 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] AOTA's "BRAN" Bus
Not only that I dare say 1/100 OT's ever have a thought about cost/benefit to pt. 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 P Please consider the environment before printing this e-mail 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: Wednesday, April 15, 2009 7:33 AM To: cmnahrw...@aol.com Subject: Re: [OTlist] AOTA's "BRAN" Bus In my opinion, the AOTA's president's own quote clearly shows that branding will not work for OT. She says: Branding actually starts with the occupational therapy practitioner in that all practitioners must ensure their servicesare efficient, effective, result in client satisfaction, and have value in terms of the cost-benefit. Right off the bat, we KNOW that ALL practitioners do NOT provide effective occupational therapy resulting in patient satisfaction. The "coners" and "peggers" ensure this doesn't happen! In my honest opinion of OT, our single biggest problem is INTERNAL, not external. As a profession, we do NOT do what we say. And NOTHING will kill a product or profession more quickly and efficiently than not delivering what is promised and/or promoted! The more the branding process proceeds the more we are shooting ourselves in the foot. The more we promote "living life to it fullest" while delivering "crappy PT" the more disenchanted our patients and referral sources become and the practice of phsy-dys OT will become even more disenfranchised! Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: cmnahrw...@aol.com Sent: Wednesday, April 15, 2009 To: OTlist@OTnow.com Subj: [OTlist] AOTA's "BRAN" Bus cac> Here is a quote from the AOTA president that supports my statements cac> "As a profession, we seem to understand marketing more than we cac> understand a branding process. Branding is about building the emotional cac> reaction to a product or service over time. Branding actually starts cac> with the occupational therapy practitioner in that all practitioners cac> must ensure their services are efficient, effective, result in client cac> satisfaction, and have value in terms of the cost-benefit. Branding cac> starts with ensuring a basic level of competence, as well as making cac> sure that every practitioner can deliver the message of what we do. We cac> all know that this is difficult given all the different types of cac> services we provide and the client problems that we solve. cac> Therefore, branding is not about a single tag line, poster, etc. It is cac> really about capturing the essence of our impact. Marketing we have cac> done before with the posters about skills for the job of living. It cac> described occupational therapy as a discipline where practitioners cac> worked with people with a disabling condition to do things like brush cac> their hair, etc. This was a great one-time marketing campaign, it was cac> not a branding process. Granted occupational therapy is about getting cac> people back to doing; but, when we did the marketing research some 8 cac> years later with our consumers and potential consumers, the good news cac> was that we did not have a bad image. The bad news was that we did not cac> have an image. Perhaps likening living to a job did not emotionally cac> resonate with our consumers."-Moyers -- 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] Breaking the Bonds of Upper Extremity OT; Is it even
Hey Ron and group, Here is a case I had this week in home health. Brief history includes a significant emotional trauma about 4 years ago. Apparently the pt. got mixed up in a multi-level/pyramid scheme of some sort and lost lots of money. According to her husband, shortly after she had an emotional break down and has never recovered. Fast forward to the referral... now she has fallen at home with a displaced femoral neck fx. and surgical repair. She is only 68 yo and now has a dx. Of Alzheimer's type dementia for which she is taking Aricept and depression (taking Zoloft). The husband reports the med's have not helped. She is very impulsive, has the "lithium/trazadone stare", is not able to talk and will only occassionally follow directions/cues of any kind. The husband is the primary caregiver and is providing excellent care. What would you do to serve her occupational needs? P Please consider the environment before printing this e-mail 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: Thursday, April 23, 2009 9:25 PM To: ocil...@comcast.net Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Hello Ilene: I appreciate your message! In this case, the pain was caused by probably joint misalignment resulting from paralysis of the shoulder girdle. I believe I did assist this patient by providing him my opinion on his shoulder pain, and referred him to an ortho MD. I am pretty confident that this patient understood occupation and OT. Well, at least it was explained to him. In fact, he was discharged because his only stated goal was, "walking like a man". Thanks again! Ron - Original Message - From: ocil...@comcast.net Sent: Wednesday, April 22, 2009 To: otlist@otnow.com Subj: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even ocn> Ron, IMO there were many things an OT could have done to assist ocn> that patient even without directly treating his arm. Pain disrupts ocn> occupational function in all areas. We can work with chronic pain ocn> patients to learn relaxation techniques. We can educate them and ocn> their caregivers on how to prevent further pain and deformity (many ocn> times CVA patients do make things worse because of dysfunctional ocn> strageties they develop to perfom self-care, poor arm placement ocn> during transfer, etc) We can help them learn how to find a chronic ocn> pain support group or how to find assistive devices on the ocn> internet. I think patients really have no idea all that OT offers, ocn> nor often what "occupation" really is. The best way to get OT's out ocn> of the "UE" box, is to show them what we CAN do for them, rather ocn> than say "there is nothing we can do, refer to PT" for a patient like that. ocn> ~Ilene Rosenthal, OTR/L ocn> From: Ron Carson < rdcar...@otnow.com > ocn> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even ocn> Possible? ocn> To: OTlist@OTnow.com ocn> Date: Monday, April 20, 2009, 4:06 PM ocn> Hello All: ocn> A couple weeks ago, I worked with a CVA patient who despite having ocn> multiple occupational deficits, he was unwilling to verbalize any ocn> OT-related goals. And after a couple of weeks, the patient was d/c'd. ocn> The patient's UE and LE were compromised by the CVA. He had almost no ocn> active movement in his affected arm. His shoulder was extremely painful ocn> during any AROM. ocn> I initially told the patient that as an OT, I would address his most ocn> important occupations but that I could do nothing about his arm. Over ocn> the? course of? treatment, his wife reported having difficulty bathing ocn> under the patients arm. After doing some gentle PROM, I concluded that ocn> there was a possible impingement. I believed an orthopedic appointment ocn> was necessary. I conferred? with the PT and? she concurred. I ocn> also ocn> confirmed that the treating PTA would address ocn> the shoulder ocn> ROM/Pain. ocn> -- ocn> Options? ocn> www.otnow.com/mailman/options/otlist_otnow.com ocn> Archive? ocn> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Marketing Flyers
I strongly agree with whole concept. I believe marketing types call it "push/pull" marketing. In other words get your message to both the consumer and the referral source. This way when the consumer goes to the MD the MD has already heard the same message. As far specific suggestions try: 1)ageing successfully in place (which could include home safety/modifications,etc.), 2)marketing directly to caregivers of ageing parents (how to cope, strategies for keeping occupationally engaged), 3) general wellness and occupational performance. Hope this helps. Neal P Please consider the environment before printing this e-mail 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 Juan Turcios Sent: Wednesday, May 13, 2009 8:17 AM To: OTlist@otnow.com Subject: [OTlist] Marketing Flyers Hello everyone. I have a question for all OTs involved in OTPP. I have been trying to get referrals from MD's in my area, but i am having a difficult time. Ron, I know you told me so. I have been thinking lately to market the program to the client themselves, like the drug companies do now a days. Does anyone have any ideas on what I can say to the client themselves? I was thinking of reasons why they would benefit from OT (e.g. decrease in fxl status). Also once the client reaches out to me, will the MD be willing to be involved in the plan? Any comments and ideas are greatly appreciated. Thanks a lot, Juan -- 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] Dental Hygienst Knows About OT...
Well said, Chris. P Please consider the environment before printing this e-mail 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 cmnahrw...@aol.com Sent: Saturday, June 13, 2009 12:08 AM To: OTlist@OTnow.com Subject: Re: [OTlist] Dental Hygienst Knows About OT... I see the horse is not dead yet This age old debate revolves around the top down approach and the bottom up approach to treatment, or the occupation as a means or an end. We as OTs in physical disabilities can choose either to treat occupational dysfunction in two ways a) Use occupations as the treatment modality to combat the issue of occupational dysfunction either through restoration or compensation or b) Treat the underlying impairment. In my opinion it simply depends on what is causing the occupational dysfunction. If an occupational takes an interest in hand therapy and they decide to specialize in this area (PTs can do this too) then I would say that the occupational therapist is doing hand therapy. I would not state that they are doing physical therapy because this is a gray area. Perhaps a physical therapist takes an interest in visual perceptual training ( my PT friend did) because of their strong background in neurorehabilitation. When they utilize this training during treatment sessions to facilitate better outcomes with gait and balance, would they state that they are doing occupational therapy? What if a PT takes a liking to driving evals and training (IADL),. Would they call it occupational therapy or drivers training? What Ron is simply trying to do is change the paradigm of occupatonal therapy and simply rewrite the textbooks we once read in school, by erasing the biomechanical model. I applaud him to a certain extent, but at times I an confused by his reasoning. Hand Therapy does not necessarily mean a cone or peg pusher therapist. A Hand therapist does not necessarily give the pubilic a certain image of what OT is , but it is the misguided therapist that provides OT without meaning in order complete enough time to reach a certain RUG level or complete the "Three hour rule". I do not think it is Ron's intent to upset all of the OTs who practice hand therapy, but to guide phys dys OTs to provide meaning during their therapy sessions in order to clean up the public perception of what we do. Chris Nahrwold MS, OTR.. -Original Message- From: Ron Carson To: Kristin Sent: Fri, 12 Jun 2009 10:04 pm Subject: Re: [OTlist] Dental Hygienst Knows About OT... Kristin, I don't really know where to start, so let me just jump in. In my opinion, the BIGGEST problem facing OT is that we do not do what we say we do. Comparing AOTA's rhetoric and practice patterns of adult phys dys OT's does not paint a congruent picture. On paper, the OT profession is all about occupation. In practice, adult phys dys is all about UE rehab. For me, this inconsistency is killing our profession! I'm going to disagree with some of what you've written: 1) A broken finger may or may not cause occupational deficits. And even if it does, these deficits may not require the skill of an OT. 2) I don't care if the hygienist had a good or bad experience. I do care if the experience revolved around occupation. 3) Occupation should NOT be things talked about during rote therapy. Occupation should be the FOCUS and outcome of treatment. 4) The profession needs therapists who are experts in occupation. Leave the UE specialization to PT. Disclaimer: My comments are not directed towards YOU. They are just general comments about how I feel towards OT. Everyone is welcome to join this conversation. Only through honest and logical dialogue will we better understand and appreciate everyone's viewpoints. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Kristin Sent: Thursday, June 11, 2009 To: otlist@otnow.com Subj: [OTlist] Dental Hygienst Knows About OT... K> I guess I dont understand why it's such a horrible thing for OT's to K> be knowledgeable and profiecient in treating UE ailments. I agree K> that shouldn't be the only area for the profession to focus on, but K> having a broken finger causes dysfunctional occupational performance! K> At least the dental hygenist had a good
Re: [OTlist] Even PT's Think OT's Do Too Much ThereEx...
I love it. P Please consider the environment before printing this e-mail 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: Thursday, August 13, 2009 8:55 PM To: Ron Carson Subject: Re: [OTlist] Even PT's Think OT's Do Too Much ThereEx... This is the response I sent to the PT. It didn't get posted. I thought it was kind of clever, but I'm sure not everyone appreciates the humor. RC> Tell the OT's to stop doing therex. That's the realm of PT. Instead, RC> the OT SHOULD be working on daily occupation and specific barriers RC> inhibiting the patient's goal(s). RC> RC> Therex and OT go together like Obama and healthcare reform - they RC> don't RC> RC> RC> Ron Carson MHS, OT RC> Hope Therapy Services, LLC RC> www.HopeTherapyServices.com - Original Message - From: Ron Carson Sent: Thursday, August 13, 2009 To: OTlist Subj: [OTlist] Even PT's Think OT's Do Too Much ThereEx... RC> Once again, this is taken from another listserve and is written by a RC> PT: >> In the IRF setting, what percentage of your patients' OT services >> are ADL training each day? What are typical staffing schedules for >> your OTs? What do you see happening regularly as functional training >> tasks other than basic dressing/bathing tasks? I have a couple of >> staff that seem to be in a rut. I see my OTs doing what I percieve >> to be too much basic ther ex and too few ADL tasks. I am looking for >> data/statistics from other IRF settings to give them an idea of what >> is typical and expected from an ADL perspective. How much of your >> OTs' time is spent in patient rooms with ADLs vs. in the gym with >> ther ex? RC> Now we have a PT questioning that OT is spending too much time doing RC> EXERCISES. too funny!!! RC> Not funny at all. Just plain sad! RC> -- RC> Options? RC> www.otnow.com/mailman/options/otlist_otnow.com RC> Archive? RC> 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] Backpack Unawareness
Chris, Thanks for going the extra mile to actually confirm supposed best practice. This is in my opinion one of, if not the biggest, problems we have in healthcare. P Please consider the environment before printing this e-mail 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 cmnahrw...@aol.com Sent: Wednesday, August 19, 2009 4:02 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Backpack Unawareness The whole backpack awareness day in my opinion is a little on the shady side. OTs are educating students and teachers that there should be a 10% body weight limit placed in back packs and often have students use a scale to weigh themselves and then their backpacks. The problem is from my understanding and from completing a quick literature review on OTseeker.com and Pubmed, that there is insefficient data for such recommendations. In fact the most recent publication in Work (2009) demonstrates that the body weight limit did not factor in much at all, but instead it was shown that a possible psychological component involved that caused this adolescent back pain that spans into adulthood. It did show that both straps of the backpack should be worn versus unilateral and the most troublesome spot for injuries to occur would be in the unstable shoulder and not the back. So perhaps we need to complete psychological profiles versus weighing the backpacks? You cannot tell me that AOTA is not aware of this research. Do they ignore it because of the free publicity that OTs receive? Creating a solution that does not really help in hopes to promote the profession is odd in my opinion. I am not an expert in this area, so I would love to learn what the experts have to say about this topic. Perhaps I am missing the important data that AOTA is reading. Chris Nahrwold MS,OTR -Original Message- From: Diane Randall To: OTlist@OTnow.com Sent: Tue, Aug 18, 2009 10:41 pm Subject: Re: [OTlist] Backpack Unawareness I am not familiar with what the controversy is surrounding this issue. What research about this is lacking? What kind of money is being spent on the issue and why is it not relevant to OT? Diane COTA/L Peds -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Tuesday, August 18, 2009 21:13 To: OTlist@OTnow.com Subject: Re: [OTlist] Backpack Unawareness Yes, especially since there is little research to back it up. -Original Message- From: Ron Carson To: OTlist Sent: Tue, Aug 18, 2009 7:17 pm Subject: [OTlist] Backpack Unawareness Does anyone else think that AOTA's dribble on Backpack Awareness is a total waste of time and money? Well, maybe not for school/ped therapists, but certainly for the rest of the OT world. 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 -- 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] Renew AOTA or NOT??????
I would also like to chime in here. My concern about any professional group, be they healthcare or not, that depends so heavily on lobbying efforts to be relevant to the general public is practicing on shifting sand. P Please consider the environment before printing this e-mail 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: Thursday, August 20, 2009 6:54 AM To: Carmen Aguirre Subject: Re: [OTlist] Renew AOTA or NOT?? It's not only (+) commentary that grows a profession. In fact, our profession is sorely lacking in (-) commentary. - Original Message - From: Carmen Aguirre Sent: Wednesday, August 19, 2009 To: otlist@otnow.com Subj: [OTlist] Renew AOTA or NOT?? CA> Again, I said it long time ago in this listserve: What are you CA> complainers doing to make the difference AOTA is not doing in your CA> opinion? Where is the useful commentary that helps outr profession grow CA> and serve the community even better? -- 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] New subject
Any thoughts on how this should figure into the health care reform debate? You cannot legislate the poor into prosperity by legislating the wealthy out of prosperity. What one person receives without working for, another person must work for without receiving. The government cannot give to anybody anything that the government does not first take from somebody else. When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that my dear friend, is the beginning of the end of any nation. You cannot multiply wealth by dividing it." - Adrian Rogers, 1931 Neal Luther, OTR/L Advanced Home Care Burlington Office 1-336-538-1194, xt. 6672 Office 1-336-538-9948 Fax P Please consider the environment before printing this e-mail 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. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] New subject
Thanks for your response Ron. I agree. More specifically, I think the comments by Rogers are appropriate with regard to the angst that is expressed about OT awareness. So many people I see in home care and in other settings I have worked do not have "ownership" of their healthcare because: 1- They don't have to if the government (M'care and M'caid)is going to pay the bill, and 2- We don't explain ourselves at each and every contact with a pt. So why would they do their homework to figure out who we are? -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Saturday, August 29, 2009 5:59 AM To: Neal Luther Subject: Re: [OTlist] New subject It's such a difficult situation. I'm all for taking care of people who are truly unable to take care of themselves. I'm believe that individuals have a moral obligation to take care of themselves AND those around them. If a person is in need and I have the ability to help, then I should. I do NOT believe that healthcare is a RIGHT. And even if it is a right, with every right comes a responsibility. And responsibility is one thing that is sorely lacking in this country. So many people WANT what's "theirs" but they don't want to take responsibility for what they get. Great topic, I was hoping someone would bring it up. Ron PS, I'm a big fan of Adrian Rogers' teachings. - Original Message - From: Neal Luther Sent: Friday, August 28, 2009 To: OTlist@OTnow.com Subj: [OTlist] New subject NL> Any thoughts on how this should figure into the health care reform NL> debate? NL> You cannot legislate the poor into prosperity by legislating the wealthy NL> out of prosperity. What one person receives without working for, another NL> person must work for without receiving. The government cannot give to NL> anybody anything that the government does not first take from somebody NL> else. When half of the people get the idea that they do not have to work NL> because the other half is going to take care of them, and when the other NL> half gets the idea that it does no good to work because somebody else is NL> going to get what they work for, that my dear friend, is the beginning NL> of the end of any nation. You cannot multiply wealth by dividing it." NL> - Adrian Rogers, 1931 NL> Neal Luther, OTR/L NL> Advanced Home Care NL> Burlington Office NL> 1-336-538-1194, xt. 6672 Office NL> 1-336-538-9948 Fax NL> P Please consider the environment before printing this e-mail NL> The information contained in this electronic document from Advanced NL> Home Care is privileged and confidential information intended for the NL> sole use of otl...@otnow.com. If the reader of this communication is NL> not the intended recipient, or the employee or agent responsible for NL> delivering it to the intended recipient, you are hereby notified that NL> any dissemination, distribution or copying of this communication is NL> strictly prohibited. If you have received this communication in error, NL> please immediately notify the person listed above and discard the original. NL> -- NL> Options? NL> www.otnow.com/mailman/options/otlist_otnow.com NL> Archive? NL> 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] Help please
Survey Monkey works really well. If Ron allows it it could be very helpful. P Please consider the environment before printing this e-mail 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 Sue Doyle Sent: Tuesday, October 06, 2009 9:45 AM To: otlist@otnow.com Subject: Re: [OTlist] Help please I have a couple of questions. Could I post a link on here for survey monkey for some research for my PhD? How many of you would respond? (it is on sensory retraining after stroke) Has any one had experience with survey monkey and what are you thoughts? Thanks Sue D > From: o...@nvhospital.org > To: otl...@otnow.com. > Date: Mon, 5 Oct 2009 13:43:20 -0700 > Subject: [OTlist] Speaker > > Just came from the Washington OT conference and our keynote speaker was > Patch Adams. What a great speaker he was. If anyone ever gets a chance to > hear him speak it is certainly worth it. > > > > Michael A. Holmes MSOTR/L > > > > -- > 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
[OTlist] Bed Mobility
Hello everyone and Happy New Year! Has anyone ever had success in teaching a quadriplegic pt. to be able to independently reposition into sidelying in bed? My pt. has great bicep and deltoid strength. Little to no triceps. Thanks for any help. 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 <> P Please consider the environment before printing this e-mail 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.-- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Bed Mobility
Yes he has an electric head/foot hospital bed. He reports to me he had another therapist attempt this with him 4-5 yrs. ago, but was unsuccessful at that time. They apparently tried a graduated hand loop rope. The problem is once he gets into sidelying how does he stay put? He currently has a stage II/III decub. On the sacrum. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Tuesday, January 05, 2010 7:45 AM To: Neal Luther Subject: Re: [OTlist] Bed Mobility Neal, does the patient have a hospital bed with rails? - Original Message - From: Neal Luther Sent: Monday, January 04, 2010 To: OTlist@OTnow.com Subj: [OTlist] Bed Mobility NL> Hello everyone and Happy New Year! NL> Has anyone ever had success in teaching a quadriplegic pt. to be able to NL> independently reposition into sidelying in bed? My pt. has great bicep NL> and deltoid strength. Little to no triceps. Thanks for any help. NL> Neal C. Luther,OTR/L NL> Advanced Home Care, Burlington Office NL> 1-336-538-1194, xt 6672 NL> neal.lut...@advhomecare.org NL> Home Care is our Business...Caring is our Specialty NL> <> NL> P Please consider the environment before printing this e-mail NL> The information contained in this electronic document from Advanced NL> Home Care is privileged and confidential information intended for NL> the sole use of otl...@otnow.com. If the reader of this NL> communication is not the intended recipient, or the employee or NL> agent responsible for delivering it to the intended recipient, you NL> are hereby notified that any dissemination, distribution or copying NL> of this communication is strictly prohibited. If you have received NL> this communication in error, please immediately notify the person NL> listed above and discard the original. -- 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] Bed Mobility
Yes, see my response to Ron. Thanks. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Alexandra Lejeune Sent: Tuesday, January 05, 2010 8:27 AM To: OTlist@otnow.com Subject: Re: [OTlist] Bed Mobility Perhaps try a pull down bed rail or bed rope ladder so he has something to pull himself over with? Alex London UK On Mon, Jan 4, 2010 at 2:31 PM, Neal Luther wrote: > Hello everyone and Happy New Year! > Has anyone ever had success in teaching a quadriplegic pt. to be able to > independently reposition into sidelying in bed? My pt. has great bicep > and deltoid strength. Little to no triceps. Thanks for any help. > > 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 > <> > > > P Please consider the environment before printing this e-mail > > 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. > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/otlist@otnow.com > -- Alexandra Lejeune Occupational Therapist www.hpccheck.org -- 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] Fw: Bed Mobility
I could not agree more. This was a referral from a nurse and I am trying everything I can. P Please consider the environment before printing this e-mail 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 susanne Sent: Tuesday, January 05, 2010 8:42 PM To: OTlist@OTnow.com Subject: [OTlist] Fw: Bed Mobility (Sorry - I sent this a while ago - only now realized it did not arrive - as I sent it from the wrong email address)-: I see now that you wrote: >The problem is once he gets into sidelying how does he stay put? >He currently has a stage II/III decub. On the sacrum. In that case I'd say he needs help turning - to make sure it's sufficient - a wound like that needs not only pressure relief but also air, no traction etc. - once it's fully healed you can start experimenting.. cybs wrote: > Hi Neal! > > I don't personally have experience with this - although I lived with > my quad boyfriend for more than 10 years - sadly, he died this > summer. He was not able to turn himself - in part because he needed a > pillow firmly pressed against his back to maintain a side lying > position that would keep his sitting area free of the mattress - his > skin needed air at night. But I know some quads do, also at the level > you describe, which would be c5/6 with a trace of c7 - maybe not the > same in both sides, that is very usual. A message board we often used > for peer advice was the care/cure forums - I just went there and > found this thread for you: > > > http://sci.rutgers.edu/forum/showthread.php?t=126367&highlight=quad+turn ing+bed > > Sure there is more threads about this - or simply ask them - true > experts in my opinion! > > Warmly > susanne, denmark > > > Neal Luther wrote: >> Hello everyone and Happy New Year! >> Has anyone ever had success in teaching a quadriplegic pt. to be able >> to >> independently reposition into sidelying in bed? My pt. has great >> bicep >> and deltoid strength. Little to no triceps. Thanks for any help. >> >> 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 >> <> -- 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] Bed Mobility
Thanks, Chris. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of cmnahrw...@aol.com Sent: Tuesday, January 05, 2010 5:55 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Bed Mobility Difficult situation. I assume that he has not grip strength because his triceps won't work. I think I would first recommend a bed rail and then I would come up with a lasso/belt like system that I would harness to the bed rail and then practice use his deltoid and biceps for your advantage by practicing moving his arms into the lasso using shoulder movements and then using his biceps, flex his elbows firmly on the lasso, and finally attempting to roll himself over. Long shot, but worth a try. Chris Nahrwold Anderson Indiana -Original Message- From: Ron Carson To: Neal Luther Sent: Tue, Jan 5, 2010 7:44 am Subject: Re: [OTlist] Bed Mobility Neal, does the patient have a hospital bed with rails? - Original Message - From: Neal Luther Sent: Monday, January 04, 2010 To: OTlist@OTnow.com Subj: [OTlist] Bed Mobility NL> Hello everyone and Happy New Year! NL> Has anyone ever had success in teaching a quadriplegic pt. to be able to NL> independently reposition into sidelying in bed? My pt. has great bicep NL> and deltoid strength. Little to no triceps. Thanks for any help. NL> Neal C. Luther,OTR/L NL> Advanced Home Care, Burlington Office NL> 1-336-538-1194, xt 6672 NL> neal.lut...@advhomecare.org NL> Home Care is our Business...Caring is our Specialty NL> <> NL> P Please consider the environment before printing this e-mail NL> The information contained in this electronic document from Advanced NL> Home Care is privileged and confidential information intended for NL> the sole use of otl...@otnow.com. If the reader of this NL> communication is not the intended recipient, or the employee or NL> agent responsible for delivering it to the intended recipient, you NL> are hereby notified that any dissemination, distribution or copying NL> of this communication is strictly prohibited. If you have received NL> this communication in error, please immediately notify the person NL> listed above and discard the original. -- 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] Bed Mobility
Yeah, I intentionally left the details vague so as to "stoke the synapses". Thanks. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Alexandra Lejeune Sent: Wednesday, January 06, 2010 2:52 PM To: OTlist@otnow.com Subject: Re: [OTlist] Bed Mobility Ah, you didnt tell us that! Sounds like you should discuss with a specialist nurse whether he can have some sort of special mattress so he doesnt "have to turn" i.e the pressure is taken care of...he might still need rails so he can figet as he sees fits. Alex On Tue, Jan 5, 2010 at 2:02 PM, Neal Luther wrote: > Yes he has an electric head/foot hospital bed. He reports to me he had > another therapist attempt this with him 4-5 yrs. ago, but was > unsuccessful at that time. They apparently tried a graduated hand loop > rope. The problem is once he gets into sidelying how does he stay put? > He currently has a stage II/III decub. On the sacrum. > > -Original Message- > From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On > Behalf Of Ron Carson > Sent: Tuesday, January 05, 2010 7:45 AM > To: Neal Luther > Subject: Re: [OTlist] Bed Mobility > > Neal, does the patient have a hospital bed with rails? > > - Original Message - > From: Neal Luther > Sent: Monday, January 04, 2010 > To: OTlist@OTnow.com > Subj: [OTlist] Bed Mobility > > NL> Hello everyone and Happy New Year! > NL> Has anyone ever had success in teaching a quadriplegic pt. to be > able to > NL> independently reposition into sidelying in bed? My pt. has great > bicep > NL> and deltoid strength. Little to no triceps. Thanks for any help. > > NL> Neal C. Luther,OTR/L > NL> Advanced Home Care, Burlington Office > NL> 1-336-538-1194, xt 6672 > NL> neal.lut...@advhomecare.org > > NL> Home Care is our Business...Caring is our Specialty > NL> <> > > > NL> P Please consider the environment before printing this e-mail > > NL> The information contained in this electronic document from Advanced > NL> Home Care is privileged and confidential information intended for > NL> the sole use of otl...@otnow.com. If the reader of this > NL> communication is not the intended recipient, or the employee or > NL> agent responsible for delivering it to the intended recipient, you > NL> are hereby notified that any dissemination, distribution or copying > NL> of this communication is strictly prohibited. If you have received > NL> this communication in error, please immediately notify the person > NL> listed above and discard the original. > -- > 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 > -- Alexandra Lejeune Occupational Therapist www.hpccheck.org -- 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
