[OTlist] Suggestions for Botox Patient
Hi everyone, I am looking for some suggestions for a splint for a client who is post Botox. This client is an older lady with CP who has significant finger flexor tone combine with wrist extension. The hand was getting very tight and painful. This has been reduced with Botox and now I can range the fingers out to 30 - 40 % of composite extension. There was previous joint damage to two DIPs (3 4) due to the increased tone so they have hyperextension deformities. I would like to try and maintain some of the gains made with Botox and also allow the hand to air out some. I dont think serial casting would be helpful here due to the distal joint deformities. We do have some voluntary grasp and release which we are working on finger foods and some object manipulation. Thanks for the suggestions. Sue D -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Evidence?
I would recommend directing this question to Dianne Long at dl...@ithaca.edu. She did an extensive look at consultation programs etc. Sue D From: renee.low...@mmsean.com To: otlist@otnow.com Date: Fri, 19 Feb 2010 06:18:46 -0600 Subject: [OTlist] Evidence? I am working in a school district where we provide ‘hands-on’ consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work best and then education teachers on how to use and follow through with the recommendations. I recently completed an eval on a student for handwriting legibility (per mom). I recommended acc/mods for home school and provided some strengthening activities that could be incorporated into the natural context of his school day. Unfortunately, but mom was not satisfied with these recommendations. She wants us to work on hand strengthening (like in the a clinic) setting so his hand doesn’t get tired when he writes (He’s in 3rd grade now). No matter how I explain how services are better provided in the context of the classroom and how the acc/mods will allow him to participate in his education, she is not satisfied. She doesn’t want him to depend on the acc/mods, which she thinks will result in decreased hand strength and therefore illegible handwriting. Does anyone know of any research regarding the efficacy, or lack thereof, of hand strengthening exercises and improved hand writing; or of the benefits of a consultation model rather than an direct, pull-out model in school systems? Any info will be most appreciated. Thanks, Renée L., 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] Contracting
I think that was the arrangement that existed at one of the hospitals I worked at for speech therapy. the private practice company contracted for not only HH but also outpatient and inpatient acute and acute rehab. I think the company got out of HH but still has the other contracts. Sue D Date: Thu, 15 Oct 2009 09:38:38 -0400 From: rdcar...@otnow.com To: OTlist@OTnow.com Subject: Re: [OTlist] Contracting In theory, yes. In my personal experience, no. - Original Message - From: jcd...@gmail.com jcd...@gmail.com Sent: Wednesday, October 14, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] Contracting jgc Hello everyone. I have a question for those in private practice. I jgc wanted to know if you have a PP, can your company be contracted by jgc a home care company. So the HC company use your company and your therapist. jgc Sent on the Sprint® Now Network from my BlackBerry® jgc -- jgc Options? jgc www.otnow.com/mailman/options/otlist_otnow.com jgc Archive? jgc 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
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
Re: [OTlist] Massive new CVA patient
Diane, I am going to comment here rather than Lurking. There are some great resources to help you with evidence-based interventions Treatment of Neglect etc. Go to www.ebrsr.com and read module 11. The treatments for neglect that has been demonstrated to have some impact on reducing the neglect and improving performance in self care tasks are: 1. TENS 2. Neck muscle vibration therapy 3. Bilateral half field eye patches 4. feedback strategies 5. limb activation strategies They are described in the module. These interventions combined with basic initiation of early self care tasks and balance with improve the outcomes. In this patient the results will require time and persistence. Subluxation 1. The only evidence for improving and preventing subluxation is with the use of an electrical stimulation program. This involves 2 channel deltoid and triceps stim for most effective not supra spinatus Upper extremtity return (by the way here the outcomes are focused on occupation and use occupation for an effective intervention strategy so I treat UE as part of my overall intervention program not in isolation) See module at above website on upper extremity. 1. Electrical stimulation 2. begin the early stages of visualization and mental imagery focusing on attention to task with this patient. 3. follow some of the other strategies in the module. Need to run so cannot elaborate further. Sue Sue D From: spark...@rcn.com To: otlist@otnow.com Date: Thu, 6 Aug 2009 05:43:33 -0400 Subject: [OTlist] Massive new CVA patient Hello, I have been given (along with 11 other patients I have) a new CVA patient. I have never worked with someone tis impaired and i don't know where to start. I am in a SNF and pt had been in an acute rehab for about a month prior for therapy. He is Dependent for all ADL's and transfers...sometimes hard to get his attention at all. Total left neglect. Trouble following simple commands. 1 finger sublux. Just not sure where to even begin. Goals are to increase attention to the left to perform ADL's but is this relistic at this point and what activites can I do with him that will encourge attention to left or attention to anything at all. Thanks Diane -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Massive new CVA patient
Ron, While that is the current Cochrane one it is over 3 years old. The one from EBRSR is this last year. As a Cochrane author I prefer the Cochrane methodology to some of the others and think it produces a more accurate and thorough outcome but in this case I think the EBSR is a little more current. Sue D Date: Thu, 6 Aug 2009 17:27:58 -0400 From: rdcar...@otnow.com To: OTlist@OTnow.com Subject: Re: [OTlist] Massive new CVA patient From Cochrane.org: http://www.cochrane.org/reviews/en/ab003586.html The benefit of cognitive rehabilitation for unilateral spatial neglect, a condition that can affect stroke survivors, is unclear. Unilateral spatial neglect is a condition which reduces a person's ability to look, listen or make movements in one half of their environment. This can affect their ability to carry out many everyday tasks such as eating, reading and getting dressed, and restricts a person's independence. Our review of 12 studies involving306participants found that rehabilitation specifically targeted at neglect appeared to improve a person's ability to complete tests such as finding visual targets and marking the mid-point of a line. However, its effect on their ability to carry out a meaningful everyday task or to live independently was not clear. Patients with neglect should continue to receive general stroke rehabilitation services but better quality research is needed to identify optimal treatments. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Linda Stovall lstov...@mhg.com Sent: Thursday, August 06, 2009 To: otlist@OTnow.com otlist@OTnow.com Subj: [OTlist] Massive new CVA patient LS In contrast to Ron, I think there are some things to be done to address LS the neglect...and it is important to work on this, so that function can LS become a reality. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Vision ~vs~ Reality
In Inpatient Rehab you cannot see more than one patient as a time unless they are part of a group. If they are a group they have to have similar goals that are part of each patients individual plan that can be matched together. While there is no set limit on how much group therapy a patient can receive as a proportion of their therapy, Skilled nursing facilities are limited to 25% and it is recommended that rehab does not exceed this as well. While some of patient's goals often include being able to use their affected upper extremity one should really focus on the clients occupational goals. The problems generally start with the evaluation process. If you do not identify occupational issues and patient goals in your evaluation but identify upper extremity issues that is where you will focus your treatment. Has anyone used the Cardinal Hill Occupational Framework documentation that identifies documentation that focuses on the occupational framework and hence helps to guide the clinical reasoning process to a more occupationally focuses manner. This then means that generally the clinical setting needs to change particularly in rehab, so that the treatment media would need to be focused on various occupational options. I built boxes or kits with a variety of options that my clients expressed interest in. It is best to use the real objects and occupations. Hope this helps some. Sue D From: mltaylo...@hotmail.com To: otlist@otnow.com Date: Thu, 23 Jul 2009 19:40:03 -0500 Subject: Re: [OTlist] Vision ~vs~ Reality Ron can you provide some examples of how you made it work in the in-patient rehab setting. You mentioned that you would see 2-3 people at a time, how did you work with each of them on their own occupations? Also, why is a cooking group, folding towels, not good occupations to work on? Thanks, ~ Miranda ~ Date: Thu, 23 Jul 2009 20:31:45 -0400 From: rdcar...@otnow.com To: OTlist@OTnow.com Subject: Re: [OTlist] Vision ~vs~ Reality In all honesty, the problem of OT is not directly related to the work setting. I've worked or have direct experience in acute care rehab, academia, very briefly in-patient hospital, outpatient, private practice, SNF and home health. ALL of these settings have a majority of OT's focusing treatment on the UE. As far as being in the trenches, that's a choice. I said no to inpatient, got fired from a SNF, quite rehab to work and academia. There are plenty of jobs. But, the problem is not the location. The problem is the therapist. If an OT focuses on occupation, they WILL NOT BE UE THERAPISTS. You can't be both! Many people claim to do it, but I think that's a line of junk. I fully understand that being in a SNF is VERY tough. The primary problem in that setting is not UE ~vs~ occupation, its fraud ~vs~ medically necessary treatment. I got fired because I REFUSED to treat patient's like cattle. Neither the 'system' nor I were willing to change, so they let me go during my probationary period. No harm and no foul, but there was no way I was going to cheat Medicare and rob patients in that system. I first started practicing occupation-based treatment while working at an in-patient rehab hospital. It was routine to see 2 patients at a time and 3 at a time wasn't unheard of. I couldn't spend an hour with each patient but the time I had WAS spent on improving their desired occupation(s). I wasn't perfect, but in my opinion, it was a heck of a lot more therapeutic than having patients fold laundry, do dowel exercises in a large group, wash windows, cook group, sanding a table top, playing childish games, etc. At times, I despise my profession because of the way so many adult phys-dys OT practice. Our professional identity STINKS. In fact, I don't even think we have an identity. And if we do, it's pretty dang crappy. Today, I made up a flyer to distribute to my home health company's nurses. Here it is: = Occupational Therapy: What Is It? 1) Education: a) OT’s have either a bachelor, masters or doctoral degree b) OT assistants have an associate degree 2) Definitions of occupation: a) Any activity that occupies a person's attention b) Activity that a person does to take care of themselves and be productive 3) History of OT: a) Founded in 1914 b) Originally performed by nurses c) Use of crafts to restore meaning and value to injured and impaired soldiers returning from war d) Later, moved to the medical model of care 4) Current Practice: a) Very diverse profession b) Work across the life span because all people have occupational needs/issues i) OT works with neo-nates to terminally ill c) Some OT’s focus on treating the upper extremity, i.e. hand therapists d) Some OT’s focus on
Re: [OTlist] 7 minute rule
While that is the billing rule, there are also other issues involved. Medicare likes to know exactly the minutes of treatment given and under each billing code. Depending on where that service was given, start and end times that include only the direct contact time with the patient are also required (eg acute and outpatient services) In rehab the total minutes for the day across all disciplines much total 180 (3 hrs) as a minimum. Sue D Date: Thu, 18 Jun 2009 07:06:29 -0600 To: OTlist@OTnow.com From: pat0...@earthlink.net Subject: [OTlist] 7 minute rule Hi Ron, I don't do any kind of billing (at my present job I just write down the times and someone else does the math and bills it), but I am going to be doing some work on the side and doing my own billing. It is my understanding that the minutes vary slightly for medicare and private insurance. Do you (or anyone else) know the different times for each? Are the times listed below for medicare or private insurance? Thanks! Pat At 06:00 PM 6/11/2009, you wrote: Hello Mary: The 7 minute rule is this: 1 unit= greater than 8 minutes bus less than 23 minutes 2 units = greater than 23 minutes but less than 38 minutes 3 units = greater than 38 minutes but less than 53 minutes 4 units = greater than 53 minutes but less than 68 minutes etc -- 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?
I work in Inpatient Rehabilitation and I have never had a restriction. We use the O2 monitor all the time without needing an order. We generally report the results if anything unusual to the MD or RN. Sue D From: thegoo...@aol.com Date: Mon, 2 Mar 2009 20:06:28 -0500 To: OTlist@OTnow.com Subject: Re: [OTlist] What Would YOU Do? Hi..I worked in a SNF and also never heard that restriction. If we want to take someone's O2 STATs then we just do...Cindy In a message dated 3/2/2009 7:50:50 P.M. Eastern Standard Time, caguirr...@msn.com writes: 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 caguirr...@msn.com Sent: Thursday, February 26, 2009 To: otlist@otnow.com 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
Re: [OTlist] OT's for swallow evals?
makes me smile. Over all the years I have been an OT it started out initially OTs doing the swallowing evaluation. We have been significantly involved in the development of the procedures etc for this practice area. Sue D Date: Tue, 24 Feb 2009 05:34:28 -0700 To: OTlist@OTnow.com From: pat0...@earthlink.net Subject: Re: [OTlist] OT's for swallow evals? Miranda, I have never had call to do swallowing evals on the job, but it was part of my schooling to the point that classmates had to team up on a project that included having to videotape us feeding each other while evaluating swallowing. I can kind of understand the ST feeling a bit possessive about it though, the same as OTs can feel possessive when another kind of therapist (not mentioning names, but it rhymes with PT) steps into what we consider to be our territory. Pat At 07:15 PM 2/23/2009, you wrote: Thanks Mary Alice! Was the feeding team for all populations, such as geriatrics and pediatrics? Our speech therapist feels the OT's are not qualified to do swallow evals and doesn't believe we can charge for this service. In my OT schooling, which has been in the past two years, we learned about doing swallow evals, and according to my books it could be OT or ST. Thanks ~ Miranda ~ Date: Mon, 23 Feb 2009 20:08:58 -0500 From: m...@mac.com To: OTlist@OTnow.com Subject: Re: [OTlist] OT's for swallow evals? I have been on the feeding team in three different hospitals as an OT. Sometimes there was speech too, and sometimes there was not. Either way I participated in the swallow study and oral motor/feeding assessment. I also helped with education regarding the results of the study and the implementation of recommendations. Not all OTs were comfortable in this role, but the ones who had experience and/or were interested were welcomed on the team. Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Feb 23, 2009, at 6:42 PM, Miranda Hayek wrote: Hi, I work in a small community hospital where we have 4 OT's and 1 Speech Therapist. We are trying to inquire with various OT's as to their experience/hospital policy with performing swallow evaluations. We have occasions where our Speech Therapist is gone, and a swallow evaluation is put through. We are questioning if other hospitals have their occupational therapist perform the swallow eval or do they find a PRN/contract speech therapist to complete this. Thanks, Miranda -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com _ It’s the same Hotmail®. If by “same” you mean up to 70% faster. http://windowslive.com/online/hotmail?ocid=TXT_TAGLM_WL_HM_AE_Same_022009 -- 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
This again is a very interesting topic. There are many OTs who are trained and work in vestiblular therapy. There are many issues involved and to do it well one needs advanced training but there is so much overlap with visual problems etc and impacts on so many occupational areas. It also involve understanding balance in a multifaceted manner. I did a lot of work in the area in trauma with mild brain injuries. We see a significant number of clients with impairments after strokes. Sue D From: spark...@rcn.com To: OTlist@OTnow.com Date: Tue, 24 Feb 2009 18:36:44 -0500 Subject: Re: [OTlist] vestibular OT Hmm. not sure but I used to babysit for a vestibular PT. He once told me that OT's cannot do vestibular therapy. Not sure why or even if it is accurate? I am not sure what vestibular OT would look like as a treatment. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of d. chang Sent: Tuesday, February 24, 2009 00:10 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] Philosophy ~vs~ treatment in the real world?
Ron, As someone with as unique an experience as yours or more so. 30 yrs OT, clinical practice in multiple areas, academia, researcher and back in the clinic full time, in a few different countries I want to add a couple of interesting thoughts. 1. We know that people do not generalize new information well until they have experienced putting it in practice in a variety of situations. Hence if we really work on functionally, occupationally based OT we need to address learning in a variety of real life settings. The same applies to therapists and how they learn. I think we rely on this experience being provided in the clinical affiliations but frequently the focus is on the basic survival skills. 2. Often those teaching students are unable to integrate the practices themselves or are not able to place them in real life clinical situations. On going continuing education needs to include providing those opportunities for our clinical educators as well. Educators and theorists need to be able to model and provide clear application examples that are relevant to today's clinical situations. We need to break down the learning for therapists. Believe me I think therapists are hungry to learn where they can follow the steps. OK just a couple of early morning thoughts. Need to get back to the research before heading off to the clinic Sue D Date: Tue, 17 Feb 2009 06:11:00 -0800 From: soupy...@yahoo.com To: OTlist@OTnow.com Subject: Re: [OTlist] Philosophy ~vs~ treatment in the real world? I believe that taking time to listen to our patient/clients is what enables us to employ the soft theories. I find that I feel that I've usually served my patient/client well when I listen to them and develop the plan of care based upon what he or she is telling me is important to him or her. Think about the thank you notes we receive: the greatest compliment is when I read that I really listened to my patient; I took the time that was needed, etc. I think that when someone says, he or she is a really good therapist, that therapist has probably consistently applied both hard and soft theory in their practice. Different treatment settings will either allow or preclude this from occurring and that is why I enjoy home health. The treatment session pace is a little slower, the treatment is one-on-one. I know when I am feeling frustrated in my work, it is often due to being overwhelmed with too many visits scheduled in a day and I am rushed. I may start to feel an imbalance in my employment of hard and soft theory. I find home health to be one of the optimal venues for OT and wish other treatment settings afforded the same opportunity. Susan --- On Mon, 2/16/09, Ron Carson rdcar...@otnow.com wrote: From: Ron Carson rdcar...@otnow.com Subject: [OTlist] Philosophy ~vs~ treatment in the real world? To: OTlist@OTnow.com Date: Monday, February 16, 2009, 9:09 PM I fancy myself as being in a rather unique position to address this question. In the twelve years since graduating from OT school, I've gone from full-time clinician, to full-time academician back to full-time clinician. The real world of OT is generally considered to be the clinic. In this setting, theory and philosophy often take a back seat to rigors and demands of for-profit health care. Theory is not totally void in practice, but it certainly is not part of everyday discussion and in my experience it often does not drive practice. While there are many possible explanation for this, I offer only one. A theory is not a part of practice because it is not seen as having DIRECT application. These types of theory are abstract and difficult to 'pin down' in the real world. Clinician's minds are overwhelmed with practical clinical decisions and taking time to access abstract thought is not part of the time sensitive equation of daily treatment. Thus, well thought out theories are often left in the classroom or in clinician's notebooks. In my experience, clinician's cling to theories such as NDT, Bobath, constraint-induced treatment, etc. These hard theories all have an application and hands-on component lacking in soft theories such as Enabling Occupation, therapeutic relationship, Practice Framework, etc. But, I believe these soft theories are equally important and perhaps even more important to our profession. As clinician's we *MUST* integrate soft theory into our daily practice. We *MUST* develop a sense of who we are as both as a profession and individuals and this comes from soft theory. While are most easily grasped, developed and recognized, they tend to not define who and what we are. Obviously, I offer no solutions to the age-old debate of theory ~vs~ practice but I felt compelled to write something!! Ron -- Ron Carson MHS, OT
Re: [OTlist] Double vision
It depends on why there is the double vision. Often the picture can be offset by changes in musculature of one eye vs another or by difficulty with convergence. You need to determine which by examination. Then you need to have a direct plan to address these issues. Depending on where the difficulty is you can consider partial patching with the Transpore tape to get a single picture. I would use this for times when it is essential to decrease the double vision but not 100% as you need to also look at trying to remediate the problem not just compensate for the difficulties. So a compbination of patching and eye exercises would be initially where I would start. The situation generally resolves in a short period of time post surgery if you follow the above. If not then I would have the patient follow up with a neuro-optometrist who has significant experience in working with these types of patients. I see this problem regularyly (as in at least 1 -2 weekly) after stroke or brain injury. Sue D From: spark...@rcn.com To: OTlist@OTnow.com Date: Mon, 16 Feb 2009 08:08:53 -0500 Subject: Re: [OTlist] Double vision Thank you. I believe the double vision is a direct result of the surgery. I will have to talk to my supervisor. thanks -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of ehthiers Sent: Sunday, February 15, 2009 20:56 To: OTlist@OTnow.com Subject: Re: [OTlist] Double vision Besthing to do is find a neuro optometrist. Let them help the person first. I know we work with developmental/ neuroptometrists in our area. First see if they can correct for it, prisms, special patiching, etc. Does the person get it all the time? Is it just from vision or also from vestibular issues? Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net-Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Saturday, February 14, 2009 3:39 PM To: Diane Randall Subject: Re: [OTlist] Double vision The only compensation that I know of for double vision is patching one eye. Of course, there are complications associated with patching. Ron - Original Message - From: Diane Randall spark...@rcn.com Sent: Saturday, February 14, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] Double vision DR My supervisor is just finishing up an eval on a patient who has DR double vision secondary to brain surgury. Has anyone had a patient DR with this particular deficit and can offer ideas on compensation DR strategies to perform adls/safe functional mobility. etc? Thanks DR -- DR Options? DR www.otnow.com/mailman/options/otlist_otnow.com DR Archive? DR www.mail-archive.com/otlist@otnow.com-- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com-- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Double vision
I tend to hold off on the neuro - optometrist straight away as generally there are significant changes in the first couple of weeks if the patient is given exercises etc. Practicing focusing and scanning task, one eye at a time and then the 2 together etc. The changes often alter what the neuro-optometrist would do and may even resolve the situation. I spent a lot of time working with our neuro-optometrist and do call him in for advice on complicated patients.Sue D From: ehthi...@earthlink.net To: OTlist@OTnow.com Date: Sun, 15 Feb 2009 20:55:41 -0500 Subject: Re: [OTlist] Double vision Besthing to do is find a neuro optometrist. Let them help the person first. I know we work with developmental/ neuroptometrists in our area. First see if they can correct for it, prisms, special patiching, etc. Does the person get it all the time? Is it just from vision or also from vestibular issues? Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net-Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Saturday, February 14, 2009 3:39 PM To: Diane Randall Subject: Re: [OTlist] Double visionThe only compensation that I know of for double vision is patching one eye. Of course, there are complications associated with patching.Ron- Original Message - From: Diane Randall spark...@rcn.com Sent: Saturday, February 14, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] Double vision DR My supervisor is just finishing up an eval on a patient who has DR double vision secondary to brain surgury. Has anyone had a patient DR with this particular deficit and can offer ideas on compensation DR strategies to perform adls/safe functional mobility. etc? Thanks DR -- DR Options? DR www.otnow.com/mailman/options/otlist_otnow.com DR Archive? DR www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.comArchive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] The Saddest OT Statement I've Ever Heard
I am the lead therapist in an inpatient rehab center. We focus on the clients goals and predominantly use functional tasks. Even spent the afternoon knitting and compiling emails with a patient. I have a carburetor that I have had out several times for some of the men to work on as their goal has been to go back to working on their car. Sue D From: spark...@rcn.com To: OTlist@OTnow.com Date: Thu, 12 Feb 2009 19:46:44 -0500 Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard I do not have alot of experience yet ...I am still a student, but I have been in places that simply sit patients up at tables and gave them something to do that may or may not be functional for them specifically. For example, a patient may get something out of cognitively out of sorting colored pegs on a peg board but is has no meaning to their life. Our challenge as professionals is to dig deeper and find something that we can do to reach the same goal but make it applicable to the patients life. However, I understand this has been all but impossible in many rehabs because of productivity demands. I happen to be in a rehab setting that is more flexible because the we smaller and it is acute rehab vs. SNF. I cannot judge how other places are run, in fact, I do feel I am in a unique facility and although I may never be employed there, I will take this experience with me wherever I go. ADL's are the first priority and ususaly what the patients say are goals for themselves but we can make meals, simulate homemaking activites, and the list goes on..the point is that is has some functional application to the patient...so it is always different and changing. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of bbh1...@comcast.net Sent: Thursday, February 12, 2009 19:06 To: OTlist@OTnow.com Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard How about sharing some specifics - some typical tx sessions. When you say adult rehab, do you mean outpatient,..home health...? This is becoming a mantra - Productivity requirements impose cookie cutter approaches. Therapists are caught in the middle and many give up swimming upstream. I haven't given up, but I know I have to go elsewhere to accomplish this. I'd like to run my own department someday, but I want to learn as much as I can specifically about functional treatment, that is, in addition to doing ADLs with patients. Any info would be appreciated. Barb Howard, COTA - Original Message - From: Diane Randall spark...@rcn.com To: OTlist@OTnow.com Sent: Thursday, February 12, 2009 6:31:35 PM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard Wow..I am interning in adult rehab right now and UE therex is only used for people who really need it. Been there six weeks and everything revolves around function. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of Ron Carson Sent: Wednesday, February 11, 2009 18:40 To: OTlist@OTnow.com Subject: [OTlist] The Saddest OT Statement I've Ever Heard Today, I met a new PT assistant who was just starting with our home health company. He was just finishing with a patient as I was starting my evaluation. The PTA came from 20 years of geriatric rehab and rehab experiences. About 1/2 through my eval he said to me, and I quote: I'm not use to OT's working on functional things. He went on to say that at his rehab facility, the OT's mainly did UE exercises. Living life to the fullest. What a crock! 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] Art Therapy
Barb, We often act like UE PTs so I guess no wonder the assumption would be made. Yes I do try to use them as much as possible..There are so many ways to incorporate the hemi arm, deal with adjustment issues, etc etc.. Sue Date: Fri, 30 Jan 2009 13:49:47 + From: bbh1...@comcast.net To: OTlist@OTnow.com Subject: Re: [OTlist] Art Therapy So, do you use crafts in your job? I feel that this aspect does make OT unique and has been severely compromised over the years because of financial priorities. Dare I say, some would say we are just upper body PT's. Yikes! That should get a rise out of everyone. Barb Howard, COTA - Original Message - From: Sue Doyle sue...@hotmail.com To: otlist@otnow.com Sent: Thursday, January 29, 2009 10:53:21 PM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] Art Therapy I work in Physical disabilities, INpatient Rehab. I would be concerned about this significantly. I feel like we are really loosing what it is that makes us OTs. Sue Date: Fri, 30 Jan 2009 00:13:26 + From: bbh1...@comcast.net To: OTlist@OTnow.com Subject: Re: [OTlist] Art Therapy What setting do you work in? Physical disability (SNFs) don't do a thing with crafts anymore. There's no cash in the budget for such luxuries. Are you in psych? Barb Howard - Original Message - From: ehthiers ehthi...@earthlink.net To: OTlist@OTnow.com Sent: Thursday, January 29, 2009 2:42:03 PM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] Art Therapy We use crafts like adult therapist used to. Beading, painting, coloring, weaving, sand art, cut and paste and by doing so we touch on all those areas mentioned below. We are occupational therapists. The problem is if they coop the whole idea of utilizing these mediums. We've already in the state of Florida lost the right to massage someone unless you are a massage therapist. Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Thursday, January 29, 2009 8:20 AM To: Chuck Willmarth Subject: Re: [OTlist] Art Therapy Sounds like a good definition of art therapy. I am not a peds therapist so I don't know how this bill might impact OT's working in peds. Personally, I feel no threat for adult phys-dys practice from this bill. Thanks for asking!!! Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: Chuck Willmarth cwillma...@aota.org Sent: Monday, January 26, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Art Therapy CW House Bill 73 defines the practice of art therapy as the CW integrated use of psychotherapeutic principles, visual art media CW and the creative process in the assessment, treatment, and CW remediation of psychosocial, emotional, cognitive, physical, and CW developmental disorders in children, adolescents, adults, CW families, and groups... -- 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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Art Therapy
I work in Physical disabilities, INpatient Rehab. I would be concerned about this significantly. I feel like we are really loosing what it is that makes us OTs. Sue Date: Fri, 30 Jan 2009 00:13:26 + From: bbh1...@comcast.net To: OTlist@OTnow.com Subject: Re: [OTlist] Art Therapy What setting do you work in? Physical disability (SNFs) don't do a thing with crafts anymore. There's no cash in the budget for such luxuries. Are you in psych? Barb Howard - Original Message - From: ehthiers ehthi...@earthlink.net To: OTlist@OTnow.com Sent: Thursday, January 29, 2009 2:42:03 PM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] Art Therapy We use crafts like adult therapist used to. Beading, painting, coloring, weaving, sand art, cut and paste and by doing so we touch on all those areas mentioned below. We are occupational therapists. The problem is if they coop the whole idea of utilizing these mediums. We've already in the state of Florida lost the right to massage someone unless you are a massage therapist. Elizabeth Thiers, OTR/L FECTS ehthiersfe...@earthlink.net -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Thursday, January 29, 2009 8:20 AM To: Chuck Willmarth Subject: Re: [OTlist] Art Therapy Sounds like a good definition of art therapy. I am not a peds therapist so I don't know how this bill might impact OT's working in peds. Personally, I feel no threat for adult phys-dys practice from this bill. Thanks for asking!!! Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: Chuck Willmarth cwillma...@aota.org Sent: Monday, January 26, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Art Therapy CW House Bill 73 defines the practice of art therapy as the CW integrated use of psychotherapeutic principles, visual art media CW and the creative process in the assessment, treatment, and CW remediation of psychosocial, emotional, cognitive, physical, and CW developmental disorders in children, adolescents, adults, CW families, and groups... -- 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] Doubling patients in acute rehab
The overlapping is technically called dovetailing and is frowned upon by CMS is my understanding. The consultants that worked with us said that any time a therapist has more than one patient it is called a group and the group rules apply. Sue To: OTlist@OTnow.com Date: Mon, 3 Nov 2008 21:46:31 -0500 From: [EMAIL PROTECTED] Subject: Re: [OTlist] Doubling patients in acute rehab Barbara, That to me is doubling. Whether they are doing the same task or different tasks it is doubling. -Original Message- From: Barbara H. Hale [EMAIL PROTECTED] To: otlist@otnow.com Sent: Mon, 3 Nov 2008 4:36 pm Subject: [OTlist] Doubling patients in acute rehab I also work in a small acute rehab unit. Does doubling mean overlapping a session? A patient is set up and working somewhat independently the therapist turns to begin getting the other patient started on tasks. ? ? --? Options?? www.otnow.com/mailman/options/otlist_otnow.com? ? Archive?? www.mail-archive.com/[EMAIL PROTECTED] -- 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 patients
Chris, I work in the same sized rehab unit. What are you total staffing numbers? Medicare from what the last lot of consulting we had in (currently still here) CMS does not approve of doubling unless it is billed as a group charge. Where you see any more than one patient at a time, it is considered a group. When billed as a group charge it must be able to be clearly demonstrated that the group was in the clients best interests not the time/staff management of the unit. Groups need to be structured about similar type patients with individual but similar goals that are clearly written for the group process. I have developed several forms for the groups that we run. Our consultants also warned us that dovetailing is also a practice frowned upon by CMS. (Some of our consultants have been like the director at Cedar Sinai etc). While there is now written limit on the amount of group time in the rehab setting as in SNF it is recommended that you stick to no more than 25% of the total treatment time for a patient be in group sessions. Would like to discuss more about scheduling, implementing the 3 hours rule etc with you. Sue To: otlist@otnow.com Date: Sun, 2 Nov 2008 17:02:48 -0500 From: [EMAIL PROTECTED] Subject: [OTlist] Doubling patients Hey gang, Just a little frustrated from last week at work.? I work in a small 13 bed acute rehab unit, in which the OTs have had a lot of pride in being occupationally based.? Just last week we were told we would have to start doubling patients at times because of increased census.? My boss is an OT so she should understand the correlation between one on one?OT and positive outcomes.? I understand that this might have to happen from time to time because of high census, but I have been frustrated that no plan has been initiated to find more help or at least calling the PRN therapists that could help cover the extra patients, since this has been an issue for 6 months.? I am beginning to think that?management is just trying to save money, but at the same time expecting the FIM scores to improve.? Just wanted to ask if anyone had to deal with this issue and what they did to remain occupationally based.? Is it ethically ok to double, and is it ok from a Medicare guidline perspective in acute rehab?? Thanks. Chris Nahrwold MS, 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] Client without goals
I think it is very appropriate. We need to be continuing to address these issues. The psychosocial issues impact significantly on our countries health care. We need to expand on the well elderly study and demonstrate the outcomes of this type of intervention and refine and teach the skills needed in OT. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best Practice
Thought you might all be interested in an international discussion on very much the same thing I just cut a piece of the conversation out of the Australian stroke list serve to post. It is happening with OT everywhere. What a great conversation...reviving the lost art of creative activities in OT! Wouldn't it be great if OTs had easy access to a broad range of DIY activities/projects that could be adapted to achieve therapeutic goals. I have stated doing this with a working age stroke survivor (cutting, painting and attaching a picket fence) and plan to search the internet, check out the Bunnings book etcIf anyone knows of accessible resources, please share. Regards, Ken McKenzie Occupational Therapist Rural Stroke Team Clarissa Wilson [EMAIL PROTECTED] I've been watching how Mum's admitted on ward with pregnancy complications(sometimes for weeks) intuitively do D-I-Y occupational interventions, often with a creative streak, to respond to role loss or change etc. (eg writing story for child at home about getting a new sister, craft to say thank you etc) And then I've been reflecting on how OTs gather that D-I-Y information and build on it for problems that have overwhelmed those intuitive D-I-Y OT resources and capabilities. So reflecting about Sandra's comments on creativity/artistic and OT practice(the art and science of the process) enable people to engage with meaningful occupation, particularly reflection on artistic practice (the part of OT that somehow has slipped off the radar). . . I'm interested in pursuing this conversation and would be interested to hear more about the Arts Health Symposium and Music Therapy conference. . .is this inappropriate space/ are others interested also? Do tell more Sandra :-) And how do others harness D-I-Y occupational interventions? Or incorporate creativity into practice? Particularly in neuro and/or traditional settings? Sincerely, Clarissa -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] ideas for fine motor warm ups for HW students? A story- long
I think it is a gross misrepresentation to state that that quote in it's context was referring to the Upper Extremity. It was referring to the use of Occupation. One may need their upper extremities to maximize the ability to do so. The full speech is available at AOTA -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] ideas for fine motor warm ups for HW students? A story- long
Having come from all the international roots mentioned below, I remember when I first moved to US from Australia thinking I did not need to bring all the resources with me I had for my professional practice because I was going to the US. I regretted that decision every day of my clinical life for the next 10 years. I find the US OT profession is very egocentric but then so is the country really. For those of us who were trained in countries like Australia and Canada there was never a move away from Occupation to the degree there was here in the US (mind you my experience of the other educational systems is from many years ago). So the occupational focus seems very common to us. The socialized medical systems of the other countries, for better or for worse, at least provide some support for more community based models of practice versus the stronger focus here due to where the money is on practice from the medical models. But again as Joan has so clearly stated and my fellow aussie, the breakdown that we see in persons overall performance is frequently multifactorial no matter where the specific obvious impairment is. For example people overall balance of occupation in their life. David was this the quote you were thinking of: That man through the use of his hands, as they are energizd by the mind and the will, can influence the state of his own health: Reilly 1962 Eleanor Clarke Slagle Lecture. Date: Sun, 26 Oct 2008 09:18:43 +1100 From: [EMAIL PROTECTED] To: OTlist@otnow.com Subject: Re: [OTlist] ideas for fine motor warm ups for HW students? A story- long Hi Joan, in Australia we might call you a stirrer for that kind of comment i.e. someone with a predisposition towards gentle leg pulling ; - ) I spent yesterday morning engaged in a presentation to the Australian Assoc of Hand Therapists. Title of the workshop session was Ergonomics and Computer Access. Content was 50/50 lit review and equipment demo. Lit review section was primarily research concerning social and psychological/personality factors that predispose to computer work related UL trauma and the best management thereof. There's a growing body of excellent studies around to show that many of these type of extremely costly injuries (both in terms of compensation/loss of business but also in the worker's loss of capacity to engage in occupations right across their lives) are related to the whole person - not just the structures of their ULs and the ways they use them. My reading of the audience receptiveness to this was excellent. For Hand Therapists (most of whom but not all were OTs) they seemed to have a very good grounding in thinking Occupationally - and not cutting up people's activities into nice little cause and effect pathways. In the course of my employment I've known a few other Hand people who tend to bristle quite openly at the suggestion that they've sold out OT in some way. I'm afraid I can't recall the name at present; but isn't there a pioneer of OT who said something like - apologies if I've got this quote completely wrong - but sure it's at least vaguely on track! And on the issue of the L's and the R's - in my state of Victoria, OT's aren't required to to be registered. We can be Accredited - which means we submit our CPD (Continuing Professional Development) Plan to our National Association; but it's by no means compulsory. I'd make the necessary points easily with all the presentations, reading and projects I'm required to do do as part of my job - frankly though, I'd rather give the fee they ask to my chosen charity. Since I've just got a Bachelor of OT (four year degree course) I choose just to sign OT like your mate from Argentina as well. cheers, David Harraway OTJoan Riches wrote: From one perspective this 'play' looks like hand therapy to me and what my young cowboy was doing was not play. His personal goal setting got him through his therapy which was preparing him for almost all the occupations he will perform for the rest of his life. He was not the only stakeholder in this. Working for the knots certainly made my life easier because without them it would have been much harder to achieve the goals of his teacher, his family, his team mates, the school board, the provincial government, the taxpayers. This is equally true with a somewhat different configuration for the seniors I treat who cannot begin to articulate their goals in the way you are demanding but whose personal goals for comfort, for safety, for inclusion, for meaning in their lives help me to serve them and the goals of the community in which they live. We are a social species, we live in community. As a profession we can facilitate the potential occupational performance of our society by addressing occupational dysfunction in individuals, and in social structures. We have gone through
Re: [OTlist] UE Evauation Yesterday...
Ron, PTs would love what you just said. Not all impairments are within the PT education and practice scope. Though I think they would love to think so. The areas of visual perception, cognition, are two component areas that I can think of where their skill level and training are limited. (Though so are some OTs.) PTs are strongly arguing to increase their scope of practice without the base. But how does that argument flow for OTs? What truly is our base? If Occupation how do we address the impairments that impact? And really given what we know about motor control and motor relearning and cognition and generalization can we treat impairments successfully outside of the context? Just some early morning ramblings? Date: Fri, 24 Oct 2008 09:00:39 -0400 From: [EMAIL PROTECTED] To: OTlist@OTnow.com Subject: Re: [OTlist] UE Evauation Yesterday... I don't want to pick on our esteemed PT colleague because I so greatly appreciate his presence on this forum. For those of you who don't know, David and used to teach together. I've clipped a comment from Dr. Lehman's earlier message because I think it highlights a hallmark differences between impairment-based and occupation-based approaches. I don't want to speak for David, but it appears that his approach, which I believe is also commonly used by OT's, uses a functional task to identify impairment problems. Once identified, intervention is directed at improving these impairments. Personally, I think this is a GREAT approach IF the goal is improving impairments, but it's not an optimal approach IF the goal is improving occupation. In my opinion, an occupation approach uses functional (really occupation, but I use function because it's more common) task to identify task that the patient can not do in a way that is satisfactory to them. The approach ALSO identifies impairments which contribute to the occupational problems. Once identified, intervention is directed to improving occupation. Let me try a case example with a fictitious patient named Polly Anna Miss Polly Anna: Has had a recent shoulder replacement secondary to RA. She is just out of her splint and the MD has ordered AROM as tolerated and PROM to 90 degrees in all planes, except 20 degrees for extension. The patient has increased pain during AROM. She is unable to feed herself, dress or toilet using her affected extremity. The patient has a recent fall history. In the impairment approach, the therapist may identify weak rotator cuff muscles, tight shortened elbow flexors and weak triceps as a primary reason the patient can not do her daily activity. As such, the therapist will begin treatment to address these issues with the goal that improving the impairments will improve the patient's independence and safety. In an occupation approach, a therapist may identify the patient is unable to independently care for herself because of her recent surgery and decreased safety while ambulating. The occupation-based therapist may recommend several environmental modifications, alternative dressing strategies, (including use of family/aides). The occupation-based therapist may also recommend the patient see an impairment-based therapist. So, in a brief and incomplete nutshell, this is an overly simplistic description of the difference between impairment-based and occupation-based approaches to the same problem. I want to add that neither approach is inherently better, they are just different. Both add outcomes and interventions that are needed by the patient and insurance companies. It should come as not surprise that in my warped world, OT is the profession for occupation-based treatment, while PT is the profession for impairment-based treatment. Lastly, Polly Anna is an UE case and in my opinion, occupation-based treatment for UE is not very complex. Should we discuss a LE case, or an UE case with LE involvement (i.e. CVA, Parkinson's, etc), occupation-based treatment is significantly more complex. The Martha case example highlights this point. Ron -- Ron Carson MHS, OT - Original Message - From: Lehman, David [EMAIL PROTECTED] Sent: Tuesday, October 21, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] UE Evauation Yesterday... LD I first observe the patient perform functional tasks, decide if LD the strategy is faulty, and then hypothesize why (i.e. what LD impairments cause the faulty strategy in functional movements). -- 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's Role in ADL's
Hi All, Linda on your discussion of staff not wanting to do the real bathing with patients. The Rules for the FIM measure are very clear that all bathroom (tub/shower) transfers should be performed wet and with no clothes on...that is the real thing. I also work in an inpatient rehab unit as the lead therapist. We do several real bathing sessions per day. It is an awesome place to work on many of the physical and cognitive components of self care aside from increasing their skills in bathing and comfort and safety levels prior to discharge. Bathing can be very therapeutic at all levels starting with a bed bath and then transfering to a shower or tub depending on the patients whole context etc. Date: Tue, 9 Sep 2008 21:27:36 + From: [EMAIL PROTECTED] To: OTlist@OTnow.com Subject: Re: [OTlist] OT's Role in ADL's Linda Coming in slightly late to this discussion. I previously worked in an in-patient rehab unit here in England and independent bathing/showering/strip washing was one of the most common goals of our patients. The OT would carry out an initial assessment with the patient to establish a base line and appropriate intervention, (intervention would be based on their level of function and pre morbid habits). The OT would then carry out a joint session with an assistant who would then continue with the bathing sessions from 2 - 5 times a week as required. The Ot would review the patient weekly and grade the activity increasing/decreasing demands as necessary to progress the patients rehab. When analysed bathing is a complex task which demands many components, and not only did our intervention often increase the patients independence in personal care but it increased skills which could be transferred to other areas of their life: a stroke patient with neglect worked on their scanning, body awareness, sequencing, perseveration...etc. For this reason it is a valuable and meaningful task which should be carried out early in our interventions (not just pre discharge) We had a great team of therapy assistants and health care assistants who would carry out our treatment plan with the patients on a frequent basis and working closely with the nursing assistants increased their understanding of OT which encouraged an enabling approach throughout the unit. Kind Regards Lucy Simpson For Quality Stationery and Greetings Cards check out this website: www.phoenix-trading.co.uk/web/lucysimpson Save it in your favourites for the next time you need cards. --- On Tue, 9/9/08, Johnson, Arley [EMAIL PROTECTED] wrote: From: Johnson, Arley [EMAIL PROTECTED] Subject: Re: [OTlist] OT's Role in ADL's To: OTlist@OTnow.com Date: Tuesday, 9 September, 2008, 5:06 PM Linda: I was never a big fan of performing IP baths because of selfish reasons, but I knew my feelings were a disservice to the patients. I'm sure you have discussed this with your staff, but it;s most likely a relevant patient goal and needs to happen. In my humble opinion, the only reasons that a real bath shouldn't occur is due to safety reasons or not a goal for the patient. After much discussion, I met patients in my time that said getting in the tub wasn't a goal for them and preferred their premorbid activity of sponge bathing. Who am I to judge? But, yes, we perform our bathing regimen as you described. But since we are ortho heavy, we tend to do bathing within the first 2 days of admission.Arley Johnson MS, OTR/L Site Manager, Rehabilitation Services, Pennsylvania Hospital Good Shepherd Penn Partners O: 215.829.5018 P: 215.422.0174 C: 215.776.4305 -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Linda Stovall Sent: Tuesday, September 09, 2008 8:44 AM To: otlist@OTnow.com Subject: [OTlist] OT's Role in ADL'sI am submitting a change in topic :)I am an OT with over 25 years of experience. Currently I am managing a inpatient rehab unit. Our OT's do a lot of dressing and grooming, but have a tendency to not participate in bathing of patients until close to discharge. They repeatedly state the patient is not ready for that yet. Well, the patient is getting bathed, of course, so they ARE ready for that and I think that OT should work with nursing on the best way to facilitate the patients independence in bathing during the entire stay, not just do one bath the day or two before discharge when the patient is more independent. I guess it is a difference in theory that I see bathing as a functional task that can be used as treatment for all sorts of things (body awareness, balance, following directions, motor control, etc) and they feel that they are just assessing the level of independence prior to discharge and teaching compensation (ie do they need a tub seat or bench, etc). I think the OT should do one bath
Re: [OTlist] OT's Role in ADL's
I have had the same issues and again with the younger staff. I just take responsibility now for doing the schedule and the shower schedule for the rehab unit. Makes it easier to keep adding extra showers to the daily activities...:) actually the other thing that made a difference was actually doing a lot of showers with patients myself and setting the expectations. Date: Wed, 10 Sep 2008 07:42:00 -0500 From: [EMAIL PROTECTED] To: OTlist@OTnow.com Subject: Re: [OTlist] OT's Role in ADL's Thanks for your responses. I do agree that the FIM score is based only on wet/naked bathing and I do get that score generally from nursing on admissionbecause they are the only ones doing a wet/naked bath then :) I think ya'll have validated my thoughts on bathing being a therapeutic activity, not just an item to be addressed as compensation close to going home. Honestly, I find it an issue MUCH more with our younger staff, the ones most recently out of school. They are the most resistant. My OT's who have been out of school for 10 years or more (and I have several of those) are much more willing to address bathing earlier.so it is nice to have my old school ideas validated by others in the profession :) Sometimes you have to put structure or guidelines in place (ie one bath per patient per week) or there is no way to hold those staff that just don't want to do it, because they just don't want to do it, accountable. I hate that I am having to take this step and maybe can get away from it when it becomes more common practice again. Thanks again for your input/thoughts.. Linda Linda Stovall, OTR/L [EMAIL PROTECTED] Program Manager Memorial Hospital at Gulfport Comprehensive Medical Rehabilitation Program 228-867-4179 228-867-5357 (fax) 228-883-8443 (beeper) A CARF (Three-Year) Accreditation was awarded to MHG for the following programs: Inpatient Rehab - Adults, Adolescents, and Children Inpatient Rehab- Stroke Specialty Ron Carson [EMAIL PROTECTED] 9/10/2008 7:04 AM When I worked in-patient rehab, I always found showering to be very therapeutic for myself and patients. For me, because it was one of the few places where patient's got real world experience. But, I also felt that there was limitation because our facility had nice big walk-in showers with grab rails and seats. As we now, that is NOT the reality of most patients' homes. Also, as a male therapist, I made 100% sure that patients were comfortable with bathing in front of me. There were many times when they were not and in those cases, I made arrangements for a female therapist to take my place. This worked out well, because it seemed that the female therapists had male patients that were also uncomfortable. Or, there were the occasional male patients who were inappropriate with our therapists. I highly encourage OT to demand home evals for their patients during the MIDDLE of the in-patient rehab stay. The home eval highlights many environmental barriers a patient will face and doing it in the middle of the stay allows the OT ample time to address the situations.Ron -- Ron Carson MHS, OT - Original Message - From: Sue Doyle [EMAIL PROTECTED] Sent: Tuesday, September 09, 2008 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] OT's Role in ADL's SD Hi All, SD Linda on your discussion of staff not wanting to do the real SD bathing with patients. The Rules for the FIM measure are very SD clear that all bathroom (tub/shower) transfers should be performed SD wet and with no clothes on...that is the real thing. I also work SD in an inpatient rehab unit as the lead therapist. We do several SD real bathing sessions per day. It is an awesome place to work on SD many of the physical and cognitive components of self care aside SD from increasing their skills in bathing and comfort and safety SD levels prior to discharge. Bathing can be very therapeutic at all SD levels starting with a bed bath and then transfering to a shower SD or tub depending on the patients whole context etc. SD Date: Tue, 9 Sep 2008 21:27:36 + From: [EMAIL PROTECTED] To: OTlist@OTnow.com Subject: Re: [OTlist] OT's Role in ADL's Linda Coming in slightly late to this discussion. I previously worked in an in-patient rehab unit here in England and independent bathing/showering/strip washing was one of the most common goals of our patients. The OT would carry out an initial assessment with the patient to establish a base line and appropriate intervention, (intervention would be based on their level of function and pre morbid habits). The OT would then carry out a joint session with an assistant who would then continue with the bathing sessions from 2 - 5 times a week as required. The Ot would review the patient weekly and grade the activity increasing/decreasing demands as necessary to progress the patients rehab. When analysed bathing is a complex task which demands many components
Re: [OTlist] OT's Role in ADL's
I am with Ron on the need for home evals. Time gets to be an issues. We have at least started a therapeutic pass with key goals to identify and a special form to fill in. Sue Date: Wed, 10 Sep 2008 08:04:26 -0400 From: [EMAIL PROTECTED] To: OTlist@OTnow.com Subject: Re: [OTlist] OT's Role in ADL's When I worked in-patient rehab, I always found showering to be very therapeutic for myself and patients. For me, because it was one of the few places where patient's got real world experience. But, I also felt that there was limitation because our facility had nice big walk-in showers with grab rails and seats. As we now, that is NOT the reality of most patients' homes. Also, as a male therapist, I made 100% sure that patients were comfortable with bathing in front of me. There were many times when they were not and in those cases, I made arrangements for a female therapist to take my place. This worked out well, because it seemed that the female therapists had male patients that were also uncomfortable. Or, there were the occasional male patients who were inappropriate with our therapists. I highly encourage OT to demand home evals for their patients during the MIDDLE of the in-patient rehab stay. The home eval highlights many environmental barriers a patient will face and doing it in the middle of the stay allows the OT ample time to address the situations.Ron -- Ron Carson MHS, OT - Original Message - From: Sue Doyle [EMAIL PROTECTED] Sent: Tuesday, September 09, 2008 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] OT's Role in ADL's SD Hi All, SD Linda on your discussion of staff not wanting to do the real SD bathing with patients. The Rules for the FIM measure are very SD clear that all bathroom (tub/shower) transfers should be performed SD wet and with no clothes on...that is the real thing. I also work SD in an inpatient rehab unit as the lead therapist. We do several SD real bathing sessions per day. It is an awesome place to work on SD many of the physical and cognitive components of self care aside SD from increasing their skills in bathing and comfort and safety SD levels prior to discharge. Bathing can be very therapeutic at all SD levels starting with a bed bath and then transfering to a shower SD or tub depending on the patients whole context etc. SD Date: Tue, 9 Sep 2008 21:27:36 + From: [EMAIL PROTECTED] To: OTlist@OTnow.com Subject: Re: [OTlist] OT's Role in ADL's Linda Coming in slightly late to this discussion. I previously worked in an in-patient rehab unit here in England and independent bathing/showering/strip washing was one of the most common goals of our patients. The OT would carry out an initial assessment with the patient to establish a base line and appropriate intervention, (intervention would be based on their level of function and pre morbid habits). The OT would then carry out a joint session with an assistant who would then continue with the bathing sessions from 2 - 5 times a week as required. The Ot would review the patient weekly and grade the activity increasing/decreasing demands as necessary to progress the patients rehab. When analysed bathing is a complex task which demands many components, and not only did our intervention often increase the patients independence in personal care but it increased skills which could be transferred to other areas of their life: a stroke patient with neglect worked on their scanning, body awareness, sequencing, perseveration...etc. For this reason it is a valuable and meaningful task which should be carried out early in our interventions (not just pre discharge) We had a great team of therapy assistants and health care assistants who would carry out our treatment plan with the patients on a frequent basis and working closely with the nursing assistants increased their understanding of OT which encouraged an enabling approach throughout the unit. Kind Regards Lucy SimpsonFor Quality Stationery and Greetings Cards check out this website: www.phoenix-trading.co.uk/web/lucysimpson Save it in your favourites for the next time you need cards.--- On Tue, 9/9/08, Johnson, Arley [EMAIL PROTECTED] wrote: From: Johnson, Arley [EMAIL PROTECTED] Subject: Re: [OTlist] OT's Role in ADL's To: OTlist@OTnow.com Date: Tuesday, 9 September, 2008, 5:06 PM Linda: I was never a big fan of performing IP baths because of selfish reasons, but I knew my feelings were a disservice to the patients. I'm sure you have discussed this with your staff, but it;s most likely a relevant patient goal and needs to happen. In my humble opinion, the only reasons that a real bath shouldn't occur is due to safety reasons or not a goal for the patient. After much discussion, I met patients in my time that said getting in the tub wasn't a goal for them and preferred their premorbid activity of sponge bathing. Who am I to judge? But, yes, we perform
Re: [OTlist] expertise
Well ELderly Study. Made the cover of JAMA the year it came out Date: Mon, 8 Sep 2008 09:20:35 -0400 From: [EMAIL PROTECTED] To: OTlist@OTnow.com Subject: 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 SpecialtyThe 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 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 BCBC -- 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
