Re: [OTlist] Mary Reilly's Eleanor Clark Slagle Lecture...
Ron, I encourage you to get the Padilla book A Professional Legacy, which is a compilation of all the Eleanor Clark Slagel Lectures. I took a class in my Ph D program where we had to read through each in order and analyze them in relation to history and to each other, it was fascinating. The Reilly lecture IS as relevent today if not more so, and there are other excellnt ones too--all pointing us down the same road-- occupation as our main meduim via which we delineate our unique and skilled service. Terrianne Jones, MA, OTR/L Faculty University of MN --- On Mon, 10/27/08, Ron Carson [EMAIL PROTECTED] wrote: From: Ron Carson [EMAIL PROTECTED] Subject: [OTlist] Mary Reilly's Eleanor Clark Slagle Lecture... To: OTlist@OTnow.com Date: Monday, October 27, 2008, 8:22 AM I located a copy of Ms. Reilly's 1961 lecture. I've never actually read the presentation but I must admit that even though it was written over 35 years ago, her words are quite refreshing. So, for those interested readers you can find a link to the lecture here: www.otnow.com/resources.html Just scroll towards the bottom of the page. The lecture is the first item listed under Education. NOTE: At one time, the files/links were password protected, but recently I removed that requirement. Thanks, 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] Yet, Another UE Referral
Ron, you did exactly as I have done often with referalls for people with shoulder issues that are temporary --eval only. I often wind up making suggestions for simple modifications and tips to deal with the temporary inconvenience of limited shoulder function. I then tell the PT to call me back in if, at the end of the PT treatment, it looks like the patient is not regaining function inspite of progressing through the exercise protocol. Yes they need help bathing, and I wil give them suggestions for help,but I can't go in and bathe them and bill it as OT.If they want a home health aide I set it up and send it over to the PT to manage. Beyond that, if there is nothing for me to do without duplicating services, I get out. This has worked well, and there have been a few occasions where the PT has called me back in and I've taken over having the patient try their daily activites and got them truly functional. Terrianne Terrianne Jones,MA, OTR/L University of MN --- On Thu, 10/23/08, Ron Carson [EMAIL PROTECTED] wrote: From: Ron Carson [EMAIL PROTECTED] Subject: [OTlist] Yet, Another UE Referral To: OTlist@OTnow.com Date: Thursday, October 23, 2008, 6:09 PM Yesterday, the home health PT told my director that OT was needed for a patient that she evaluated. The patient is s/p shoulder arthoplasty. I go there today, and the PTA has already started ROM exercises and is consulting with the MD for clarification. I evaluate the patient asking all the typical questions about daily occupation. Basically the patient needs assistance with dressing and bathing. BUT, this is all because of his shoulder surgery. So, I document that the patient is independent except for the above but this will resolve with his shoulder ROM returns, which is being addressed by PT. In your opinion was OT indicated for this patient? What if PT wasn't seeing the patient, would OT be indicated? 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] Elbow Break, Referral...
Hello Chis, Ron and others: Thanks for the stimulating discussion, which is really an already articulated issue discussed years ago by Grey, Wilcock, and others., the occupation as end versus occupation as mean argument. My own belief is that just because an OT does something does not make it 'occupational therapy'. Further, the basis of a true profession is that it is theory driven and in a constant reflective state to assess what is current best knowledge. Educational programs change to reflect current best practice for entry level. If you look back over the history of the profession, we have again and again added content and dropped content to meet the continual challenge of staying current. Our biggest mistake in my opinion was losing our connection to the fundamental philosophy of occupation as means during the 70's thru the early 90's. Most of us practicing with 15-20 years experience are the victims of the over emphasis on the medical model which held up the occupation as end argument, at the expense of occupation as the means of the profession. We got away with it because at the time no one else was explicitly concerned with overall function like we were. However, when things tightened up and everyone became concerned with function, we started losing ground because we cannot complete on fixing parts, even if the justification behind it it that the client will in the end be able to engage in occupation. The goal today is to graduate therapists grounded in occupation who can also work with body structures and functions to facilitate engagement in occupation,not just isolated occupational performance. Below is a reference list from a doctoral course paper I wrote about about this subject--older but still very interesting articles. Terrianne Jones, MA, OTR/L Faculty University of Minnesota Program in Occupational Therapy Fischer, (1998). Uniting practice and theory in an occupational framework. In R. Padilla Ed.), A professional legacy: the Eleanor Clark Slagle Lectures in occupational therapy, 1955-2004 (2nd ed., pp. 554-575). Bethesda, MD: AOTA press. Friedland, J. (1998). Occupational therapy and rehabilitation: an awkward alliance. In R. P. Cottrell (Ed.), Perspectives on purposeful activity: foundation and future of occupational therapy (2nd ed., pp. 69-75). Bethesda, MD: AOTA press. Gutman, S. (1998). The domain of function: Who’s got it? Who’s competing for it? In R.P. Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 555- 560). Bethesda MD: AOTA press. Meyer, A. (1920). The philosophy of occupational therapy. In RP Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 25-28). Bethesda MD: AOTA press. Nelson, D. (1997). Why the profession of occupational therapy will flourish in the 21st century. In R. P. Cottrell (Ed.), Perspectives for occupation-based practice (2nd ed, pp. 113-126). Bethesda, MD: AOTA Press. Peloquin, S. (1991). Occupational therapy service: individual and collective understandings of the founders. American Journal of Occupational Therapy, 45, 33-744. Reilly, M. (1962). Occupational therapy can be one of the great ideas of 20th century medicine. In RP Cottrell (Ed.), Perspectives for occupation based practice (2nd ed.pp. 77-84). Bethesda MD: AOTA press. Trombly, C. (1995). Occupation: purposefulness and meaningfullness as therapeutic mechanisms. In RP Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 159-171). Bethesda MD: AOTA press. West, W. (1984). A reaffirmed philosophy and practice of occupational therapy for the 1980’s. The American Journal of Occupational Therapy, 38, 15-23. Wilcock, A. (1998). An occupational perspective of health. Thorofare: Slack Incorporated. Yerxa, E. (1991). Seeking a relevant, ethical and realistic way of knowing for occupational therapy. The American Journal of Occupational Therapy 45, 19 Gray, J. (1998). Putting occupation into practice: occupation as ends, occupation as means. In R.P. Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 149-158).Bethesda MD: AOTA press. Gutman, S. (1998). The domain of function: Who’s got it? Who’s competing for it? In R.P. Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 555- 560). Bethesda MD: AOTA press. Howard, S. (1991) How high do we jump? The effect of reimbursement on occupational therapy. In R.P. Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 519-526). Bethesda MD: AOTA press. To: OTlist@OTnow.com Date: Sunday, August 31, 2008, 7:48 PM Who says we are practicing PT, and not OT?.? My credentials states OTR/L so therefore it is OT.? I don't know about you, but taking ROM measurements and treating the UE was taught in the OT education in which I went
Re: [OTlist] Would You Treat For Refer to PT?
Ron, I find myself in a very similar situation currently with a gentleman who is s/p humeral fracture. He went to an urgent care clinic wear they x-rayed him, gave him a sling and told him to wear it for 4 weeks, then wrote an order for OT. I am seeing him under Medicare part B in his ALF facility. He is reporting minimal pain, and even though it is his right (dominant arm), he totally figured out how to compensate and was very functional during his recuperation when he had limitation on weightlifting, etc. I debated back and forth what to do--turf to PT or attempt to do what I hate to do (straight exercises for the entire visit). Logistics prevailed and it was easier early on for me to come to the man than for him to get to a PT, so I proceeded, setting him up on graded range of motion programs. I have progressed him now to the point where we are using occupation based interventions during our sessions. But I will confess that I felt a bit like a fraud during the early weeks when I was doing straight exercise with him, because I wanted him to have the benefit of a skilled PT versus me, a generalist who is not a fan of exercise as a main modality for OT. In fact, now his main complaint is continued decreased ROM. It has gotten better, and he is quite functional, but he wants 100% return. I am going to refer him to PT and D/C him as I think I have maxed out what I can offer. Had this man been status post surery, or a rotator cuff repair, I woud have turfed him immediatley to the PT's. I have enjoyed great realtionships with the PT's I've worked with over the years and I think its becasue I let them do what they are experts at, and I do that at which I am an expert (facilitating engagement in occupation). In fact, more than once I have been thanked for acknowledging my limitations, especially in the ortho category--I am very aware of the potential for trouble because I saw first hand a bad outcome due to negligence on the part of the OT . The OT thought she knew what she was doing in regard to shoulder rehab and repeatedly put a client with a rotator cuff injury on the arm bike and re-injured the man. Needless to say, that did not help our pofessional credibilty one bit. Terrianne --- On Tue, 8/26/08, [EMAIL PROTECTED] [EMAIL PROTECTED] wrote: From: [EMAIL PROTECTED] [EMAIL PROTECTED] Subject: Re: [OTlist] Would You Treat For Refer to PT? To: OTlist@OTnow.com Date: Tuesday, August 26, 2008, 9:36 PM Does she?not lift?with her right shoulder because of the high pain level?? If she lives alone how will she take her trash out?? How will she load and unload her groceries from her car?? How will she carry her laundry basket to her room to put her clothes away?? Unless this lady has a fulltime maid, her life is a little difficult right now.? Perhaps prompting the lady's memory isn't such a bad idea, considering that her mind is probably focused on her high pain level, and she is probably thinking to herself Why does this guy have to know that information, I just want him to work on my arm, and she is giving you short answers, probably unaware that you were going to DC her. ?I would start on goal oriented compensation techniques to get her through her typical IADLs and a restorative program for her shoulder involving modalities, soft tissue mobilization around the coracoid process, relaxation facilitation techniques for?the shoulder,?and a graded therapeutic exercise program.? Based on AOTAs position papers over the years, this is certainly an appropriate?approach.? What is wrong with a bottom up approach starting with body functions and gradually improving to graded functional activities when the pain and the AROM improves significantly.? There is no way a patient like this would improve based on a top down approach.? She would learn to compensate, but from your evaluation it sounds like she wants her pain to improve, and for her shoulder to improve to her normal baseline.? Why in the world wouldn't a skilled OT with orthopedic shoulder?experience take this case? As OTs it is in our scope of practice to treat shoulders, knees, backs, hips, whatever, from a compensation and a restorative approach depending on the state in which you practice.? Now based on our level of education I would not suggest diving into restorative techniques for these areas unless you have had?extensive training, and if your PT partner on the other side of the clinic is working on the same thing.? Team work and communication is the key for those situations. -Original Message- From: Ron Carson [EMAIL PROTECTED] To: Kari Rogozinski OTlist@OTnow.com Sent: Tue, 26 Aug 2008 7:03 pm Subject: Re: [OTlist] Would You Treat For Refer to PT? Oops, I failed to mention that I my referral to PT was s/p my OT eval. Everything the patient stated matched my observation of her movement. Yes, it is her dominant side. She does not do much lifting with her right arm, because of the pain. She
Re: [OTlist] OT as stand-alone therapy in home health
Hi Sue, that is the way my agency does it as well, and I was told that the reason PT needed to go back out at least once was to avoid looking like we were using the PT order just to open OT. Terrianne Sue Hossack [EMAIL PROTECTED] wrote: Hi all, I have a question that I am hoping someone on the list can answer. According to AOTA, although OT cannot open a Medicare home-health patient, we can be a stand-alone therapy once the Start-of-care has been performed by the PT/SLP/RN. This makes sense for a patient with OT-only deficits such as visual-field cut, hand or shoulder injury, that has no nursing or PT needs. However, my supervisor has told me that we have to have at least 2 skilled PT or ST visits - one before the OT visit during which the initial assessment also is conducted and one after the initial OT visit. Continuing OT may then be provided as needed and ordered. I.e the PT must provide a skilled visit even though the patient has no PT needs. Does anyone have any experience of this or any documentation that says otherwise? Thanks Sue -- Sue Hossack MOT, OTR/L, ATP Occupational Therapist http://www.ot-care.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** - Take the Internet to Go: Yahoo!Go puts the Internet in your pocket: mail, news, photos more. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Occupational Deprivation
No, in my never to be humble opinion, it is not much different. Some would argue there is a difference between an activity such as sorting silver ware and cone sorting because one is recognizable task (taken out of its usual context) and the other is totally contrived task (at least I've never seen spontaneous cone stacking!), but I maintain that if the client finds no value in the activity then from a therapeutic perspective there isn't much difference. Terrianne Ron Carson [EMAIL PROTECTED], now.com wrote: Hey Terrianne: I love the Canadian Model of Occupational Performance! Thanks for sharing that definition from the Enabling Occupation book!! A great resource for ALL OT's!! Continuing on with questions. In the context that we are discussing, is sorting silverware any different than sorting cones/pegs? I FULLY understand that if a patient has a true goal of sorting silverware of if sorting silverware is a subset of a higher level task (making a meal) and that patient has difficulty sorting, then this is appropriate. But anythign else seems like cones, just a little more shiny . Ron - Original Message - From: Terrianne Jones Sent: Tuesday, September 11, 2007 To: OTlist@OTnow.com Subj: [OTlist] Occupational Deprivation TJ Hi Ron and others- TJ I've been lurking and decided to jump in with the mention of occupational deprivation, and TJ your question Ron about assumptions with persons who cannot indicate they are truly engaging TJ in occupation. This question almost brings occupation to a philosophical level. If TJ occupations are are defined as activities of everyday life, named, organized and given value TJ and meaning by individuals and a culture (Law, Polatajko, Townsend, 1997, p. 32), then can TJ we really ever know if a person is engaging in occupation if they cannot tell us or somehow TJ indicate the value of the engagement? In my opinion, we cannot, and thats ok. Sometimes the TJ best we can offer our clients who cannot tell us whether or not they value an activity as an TJ occupation is an enjoyable experience that meets some physical or sensory need and supports TJ their overall wellbeing. But I don't think we can call this occupation. According to the OT TJ practice frame work, while occupation is the goal and main TJ modality of the OT, there is also room when appropriate for purposeful actives (ie, sorting TJ silverware) if they enable participation in other aspects of daily life. TJ Terrianne TJ Occupation is so subjective. TJ Ron Carson wrote: Man, you write at an advanced level!! I THINK I TJ understand what you are TJ saying but if my response is way off base let me know. TJ Occupational deprivation is a common age-associate malady. I see it TJ everyday in my practice. But, IF a person is unable to verbalize TJ (vocally or non-vocally) the meaning and worth of an engaged activity, TJ are we justified in assuming they are engaged in occupation? TJ I understand about being isolated. I work alone and have for several TJ years. The OTlist is about the only place where I can freely exchange TJ ideas. I wish more subscribers would feel the same! TJ Ron TJ - Original Message - TJ From: Joan Riches TJ Sent: Monday, September 10, 2007 TJ To: OTlist@OTnow.com TJ Subj: [OTlist] Sorting Silverware? JR Well - if occupation is what people do and occupation is idiosyncratic to JR the person, then meaning seems to have many different levels. People at this JR level certainly have emotions - and those emotions are often mitigated by a JR sense of doing. Certainly we need the concept of occupational deprivation to JR comprehend behaviour changes when opportunities 'to do' are provided. JR Thank you to you. The list has been such a source of professional JR connection. TJ -- TJ Options? TJ www.otnow.com/mailman/options/otlist_otnow.com TJ Archive? TJ www.mail-archive.com/otlist@otnow.com TJ ** TJ Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the TJ skills and credentials to propel your career. TJ www.otdegree.com/otn TJ ** TJ TJ - TJ Moody friends. Drama queens. Your life? Nope! - their life, your story. TJ Play Sims Stories at Yahoo! Games. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn
Re: [OTlist] Occupational Deprivation
Hi, I think the scenario you describes makes them more purposeful activities, but not necessarily occupations. Terrianne Mary Alice Cafiero [EMAIL PROTECTED] wrote: OK, I will jump in really quickly before I have to put kids in bed. I've seen situations in dementia units where the patients range from mid to late stage where they sort the silverware as it comes out of the dishwashers for the facility. It is then used for mealtimes. The same with sorting and folding socks and towels when living in a facility so the laundry isn't necessarily the client's own. Do you think those situations make these activities any more of an occupation? By the way, I'm not in this setting anymore, but find the discussion very interesting. Mary Alice On Sep 11, 2007, at 8:21 PM, Terrianne Jones wrote: No, in my never to be humble opinion, it is not much different. Some would argue there is a difference between an activity such as sorting silver ware and cone sorting because one is recognizable task (taken out of its usual context) and the other is totally contrived task (at least I've never seen spontaneous cone stacking!), but I maintain that if the client finds no value in the activity then from a therapeutic perspective there isn't much difference. Terrianne Ron Carson wrote: Hey Terrianne: I love the Canadian Model of Occupational Performance! Thanks for sharing that definition from the Enabling Occupation book!! A great resource for ALL OT's!! Continuing on with questions. In the context that we are discussing, is sorting silverware any different than sorting cones/pegs? I FULLY understand that if a patient has a true goal of sorting silverware of if sorting silverware is a subset of a higher level task (making a meal) and that patient has difficulty sorting, then this is appropriate. But anythign else seems like cones, just a little more shiny . Ron - Original Message - From: Terrianne Jones Sent: Tuesday, September 11, 2007 To: OTlist@OTnow.com Subj: [OTlist] Occupational Deprivation TJ Hi Ron and others- TJ I've been lurking and decided to jump in with the mention of occupational deprivation, and TJ your question Ron about assumptions with persons who cannot indicate they are truly engaging TJ in occupation. This question almost brings occupation to a philosophical level. If TJ occupations are are defined as activities of everyday life, named, organized and given value TJ and meaning by individuals and a culture (Law, Polatajko, Townsend, 1997, p. 32), then can TJ we really ever know if a person is engaging in occupation if they cannot tell us or somehow TJ indicate the value of the engagement? In my opinion, we cannot, and thats ok. Sometimes the TJ best we can offer our clients who cannot tell us whether or not they value an activity as an TJ occupation is an enjoyable experience that meets some physical or sensory need and supports TJ their overall wellbeing. But I don't think we can call this occupation. According to the OT TJ practice frame work, while occupation is the goal and main TJ modality of the OT, there is also room when appropriate for purposeful actives (ie, sorting TJ silverware) if they enable participation in other aspects of daily life. TJ Terrianne TJ Occupation is so subjective. TJ Ron Carson wrote: Man, you write at an advanced level!! I THINK I TJ understand what you are TJ saying but if my response is way off base let me know. TJ Occupational deprivation is a common age-associate malady. I see it TJ everyday in my practice. But, IF a person is unable to verbalize TJ (vocally or non-vocally) the meaning and worth of an engaged activity, TJ are we justified in assuming they are engaged in occupation? TJ I understand about being isolated. I work alone and have for several TJ years. The OTlist is about the only place where I can freely exchange TJ ideas. I wish more subscribers would feel the same! TJ Ron TJ - Original Message - TJ From: Joan Riches TJ Sent: Monday, September 10, 2007 TJ To: OTlist@OTnow.com TJ Subj: [OTlist] Sorting Silverware? JR Well - if occupation is what people do and occupation is idiosyncratic to JR the person, then meaning seems to have many different levels. People at this JR level certainly have emotions - and those emotions are often mitigated by a JR sense of doing. Certainly we need the concept of occupational deprivation to JR comprehend behaviour changes when opportunities 'to do' are provided. JR Thank you to you. The list has been such a source of professional JR connection. TJ -- TJ Options? TJ www.otnow.com/mailman/options/otlist_otnow.com TJ Archive? TJ www.mail-archive.com/otlist@otnow.com TJ
Re: [OTlist] Neurofacilitation
Hello, evidence based practice is more than finding randomized control trials in the literature to support an intervention--yes, critically appraising the currently available literature is a large part of EBP, but so is critical thinking and clinical experience. Together these should guide our practice. In the case of NDT, it is true that much has not been proven, but perhaps a lit search for weight bearing and some of the techniques NDT may yield some studies. I am not NDT certified myself -- never will be-- and am about as far into the occupation camp as an OT can get (as those who have seen my previous posts will attest), yet even I believe that a working knowledge of motor learning and neuro theories serves an OT well. I encourage you to find the literature that you can and appraise it critically and present it to your supervisor. Mc Master University (see below) has a great website to walk you through this--good luck. Terrianne www.srs-mcmaster.ca/nbspnbspResearchResourcesnbspnbsp/EvidenceBasedPractice/EvidenceBasedPracticeResearchGroup/tabid/630/Default.aspx Johnson, Arley [EMAIL PROTECTED] wrote: Since I didn't get a response, then I shall assume that no one else has any other strategies. That's good because I was close to engaging in a drawn out debate with a PT with an APTA neuro specialty cert that felt an OT did not need a practical understanding of NDT principles to deliver comprehensive care in the acute rehab environment. I believe that her point of view was NDT did not have much, if any, supportive literature proving its' effectiveness. Therefore, NDT had failed the evidence based practice test and I should not require an OT working on a Stroke unit to complete a competency on NDT principles and application. Evidence based practice makes sense, but to exclude a treatment option because limited research exists, does not mean that it does not work. As always, the research itself needs to be reviewed to determine if it measured relevant areas. I'll get off my soapbox now ... Please, I welcome any comments, because my debate isn't officially over. Arley Johnson MS, OTR/L 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 ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** - Park yourself in front of a world of choices in alternative vehicles. Visit the Yahoo! Auto Green Center. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Neurofacilitation
Joan, thanks for the excellent recommendation. I agree with you 100% about brain neuroplasticity potential, which is why I encourage all of us to search the literature and not become dependent on isolated techniques or old learning--I have been theorizing since I started in rehab 15 years ago that short stays have forced OT into a compensatory approach at the expense of neuro recovery--and as always, I can't emphasize enough that when it comes to the brain, occupation is 'organizing'. Terrianne Joan Riches [EMAIL PROTECTED] wrote: On the whole question of 'good enough evidence' I recommend to all of you The Brain that Changes Itself by Norman Doidge M.D. It makes far more sense to me based on my experience and observations than the neuroscientific orthodoxy we were all brought up on, especially the belief that once a post stroke patient 'plateaus' the rehab window is closed. Comments, anecdotes anyone. Despite my commitment to a 'compensation' model I think neuroplastcity will be the future of rehab and we ignore these developments at our peril. Joan -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Terrianne Jones Sent: Monday, August 13, 2007 7:30 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Neurofacilitation Hello, evidence based practice is more than finding randomized control trials in the literature to support an intervention--yes, critically appraising the currently available literature is a large part of EBP, but so is critical thinking and clinical experience. Together these should guide our practice. In the case of NDT, it is true that much has not been proven, but perhaps a lit search for weight bearing and some of the techniques NDT may yield some studies. I am not NDT certified myself -- never will be-- and am about as far into the occupation camp as an OT can get (as those who have seen my previous posts will attest), yet even I believe that a working knowledge of motor learning and neuro theories serves an OT well. I encourage you to find the literature that you can and appraise it critically and present it to your supervisor. Mc Master University (see below) has a great website to walk you through this--good luck. Terrianne www.srs-mcmaster.ca/nbspnbspResearchResourcesnbspnbsp/EvidenceBasedPractice/ EvidenceBasedPracticeResearchGroup/tabid/630/Default.aspx Johnson, Arley wrote: Since I didn't get a response, then I shall assume that no one else has any other strategies. That's good because I was close to engaging in a drawn out debate with a PT with an APTA neuro specialty cert that felt an OT did not need a practical understanding of NDT principles to deliver comprehensive care in the acute rehab environment. I believe that her point of view was NDT did not have much, if any, supportive literature proving its' effectiveness. Therefore, NDT had failed the evidence based practice test and I should not require an OT working on a Stroke unit to complete a competency on NDT principles and application. Evidence based practice makes sense, but to exclude a treatment option because limited research exists, does not mean that it does not work. As always, the research itself needs to be reviewed to determine if it measured relevant areas. I'll get off my soapbox now ... Please, I welcome any comments, because my debate isn't officially over. Arley Johnson MS, OTR/L 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 ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** - Park yourself in front of a world of choices in alternative vehicles. Visit the Yahoo! Auto Green Center. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn
Re: [OTlist] Question on placements
Hi Becky, the one thing I always remind students of when it comes to fieldwork is that one can learn just as much about how NOT to practice OT as how to do it well. Even the tough/bad placements teach us something. -Terrianne Becky Heath [EMAIL PROTECTED] wrote: I have been thinking to my placements. I have had two great placements with a friendly team and a supportive educator and then I had a negative placement where I lost alot of confidence. I was wondering about everyone's experience with placements - How much did your placements help you decide where you wanted to specialise? And having a negative experience in a placement did it put you off working in a specific field? Thanks Becky :-) _ The next generation of Hotmail is here! http://www.newhotmail.co.uk -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** - Get your own web address. Have a HUGE year through Yahoo! Small Business. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Do You Ever Wonder?
Hi Ron, I had day like that myself today--called the county adult protection office on my first client, sent the second one the the ER, endured a torturous third visit with a very old lady (99!) who wants to die and whose family can't seem to get it through their head that no matter how much money they have,they cannot buy her back to health--argghh--they are mad at me and the PT because our therapy is not working. They are from a culture where social class and status is important, and they see myslef and the female PT as extensions of their household help--I could go on and on--today was one of those days when I thought, why do I do this?? But when I step back, I realize that it not their fault, its not mine--its the result of a fractured health care system that sends medically fragile people home way too soon; of understaffed nursing homes where loved ones feel they could do just as well or better at caring for their loved one at home, and of burnt out caregivers who grab onto any of us in home care as life rafts to prevent themselves from going down too. I guess you need a few days like these to make the awesome ones stand out! Terrianne Ron Carson [EMAIL PROTECTED] wrote: Do you ever wonder if you are a good therapist? I mean sometimes, it just seems like I can't do anything right. Patient's family questioning therapy, patients having complaints, residents complaining. Man, sometimes it just seems like I'm in the wrong profession. Does anyone else feel this way? Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** - No need to miss a message. Get email on-the-go with Yahoo! Mail for Mobile. Get started. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Do you regret becoming an OT?
Dear Emily, I think you are wise to explore and ask those in any given field this question. For myself, OT has been so much more than a job, but a passion really. And when the fit is right, you will find yourself engaging in life long learning to support your passion. As far as the anti intellectual assessment, I couldn't disagree more--perhaps it is because I am in the middle of my Ph D program, surrpounded by equally passionate OT's who are bold, critical thinkers--I see us as a profession attracting individuals who can grapple with the abstract concepts related to occupation, who can integrate mind and body and soul into our approaches, enabling people to lives lives of meaning as defined by their priorities. So, if you are interested in what makes people unique, if you find yourself drawn to creativity in any sense, if you like the humanities, sociology, psychology, etc., if you love a good challenge and on your feet problem solving, the process of becoming an OT and practicing as an OT will most likely be a stimulating, intellectual endeavor for you. If however your preference is for more linear, structured approachs, if you like to see direct cause -effect relationships, if you like to know exaclty what you're in for each day when you get to work, there are other health care fields that may be a better fit--laboratory, radiography, respiratory therapy, etc. All require critical thinking, but in a different way than OT. I hope this helps. Terrianne Jones, MA, OTR/L Emily L. [EMAIL PROTECTED] wrote: Hello, I'm an undegraduate human biology major looking into going into some sort of health care. I have experience on the other end of OT (Cerebral Palsy) and like the patient-centered nature of OT. I'm looking into doing some observation hours with OTs this summer to get a better feel for the profession, but in the mean time, I'd like to know what you think of the profession. I've heard from some OTs who left the profession to become MDs, citing thw anti-inlellectual nature of OT, the fact that they felt like they could basically be replaced by a CNA, and the lack of respect. What do you think about these things? Idf you could do it again, would you stay an OT? Why or why not? Thanks, Emily - Ahhh...imagining that irresistible new car smell? Check outnew cars at Yahoo! Autos. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** - Ahhh...imagining that irresistible new car smell? Check outnew cars at Yahoo! Autos. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] on the uselessness of OT and other things
Yes Ron, go ahead. I love this list and I don't get around to posting too often, but I was inspired last night.-Terrianne Ron Carson [EMAIL PROTECTED] wrote: Hello Terrianne: My reply is NOT on the OTlist. I thourghly enjoyed your below message. I would like to add it to the OTnews wide site. This is a portion of OTnow where I've written a few commentaries. Are you acceptable to me doing some minor edits to your message and then posting on the OTnews site? Thanks, Ron Carson - Original Message - From: Terrianne Jones Sent: Sunday, March 11, 2007 To: OTlist@OTnow.com Subj: [OTlist] on the uselessness of OT and other things TJ My other curiosity is why, if people are having such TJ negative OT experiences in rehab, they bother to come for TJ more OT once discharged? TJ Jeanne, you pose an interesting question, and one that is TJ pretty easily answered. For the population covered by Medicare A TJ , which is the main payer for physical rehabilitation for the TJ largest portion of the population receiving OT services, it is TJ ignorance plain and simple. Most of these clients have no idea TJ what the MD's order; many a time I go to do a home care OT eval TJ and my clients will balk that they didn't know the doctor ordered TJ home care let alone OT. So in a sense they are somehat a captive TJ audience. And since under the part A benefit they cannot be TJ balanced billed, the see no direct out of pocket cost associated TJ with OT.So, although they may hate or love their OT, until our TJ clients have more connection to the investment versus outcome TJ assoicated with OT, we will continue to offer in some TJ circumstances a mediocre product with not much accountability, TJ because the market will bear it. I am surprised quiet frankly TJ that Medicare hasn't demanded more from the TJ profession. TJ When I teach OT students, my mantra is always would YOU pay TJ out of pocket for your service? Would others see the value in what TJ you are doing with their loved one? Would there be enough face TJ validity to your interventions that you could feel good about what TJ you are doing and what you charge for the skilled service? If TJ you can't answer yes to these questions, then in all likelihood TJ you are not offering a skilled intervention and will burn out in TJ this field TJ After 15 years in this profession, I have really come to the TJ conclusion that many OT's in adult and geriatric rehab are not TJ that invested in truly operating as professionals. They want the TJ paycheck and some sort of prestige, but they don't hold up their TJ end of the equation by continuing their educations, using the best TJ evidence and offering their clients a truly unique and skilled TJ service. And they can get away with it because the TJ patients/clients don't know any better and don't have to yet. TJ If there were even a $5co -pay under part A for every therapy TJ visit/session, this situation would change in a heartbeat, because TJ the clients would demand better from us, and we would have to TJ deliver to remain viable as a profession. TJ The real question is: do we continue to feast on a sinking TJ ship or do we abandon sloppy practice and hold ourselves TJ accountable before we are forced to do so? In my mind that is what TJ makes a real professional. TJ Terrianne TJ JM wrote: TJ they were supposed to do, they would make a big difference in patient's lives. TJ I would also be interested in knowing what the sister believes O T's are TJ supposed to be doing a lot of people don't even know what OT is. My TJ other curiosity is why, if people are having such negative OT TJ experiences in rehab, they bother to come for more OT once discharged? TJ I would be very uncomfortable working in a SNF where I was not allowed TJ to address mobility in regards to ADLsI have been fortunate to never TJ have been pigeon-holed in that manner. Currently in my inpatient acute TJ setting, I am constantly working on educating other staff that I am not TJ a PT because I happen to get people out of bed-Unfortunetly, I TJ follow several OT's that never got people out of bed--fairly useless in TJ my opinion TJ On another topic, I am arranging activities at my facility for OT TJ month--I had to cringe when the COTA was wanting to bring the cones and TJ the arc to the demonstration table as OT modalities. I don't use these TJ things as a general rule except with very low level neuro for TJ tracking/color recognition and some basic grasp etc. I gently declined TJ in favor of providing information on how not to pack a backpack and fall TJ prevention in the community.Just having items on a table doesn't TJ show purpose even when there is one... TJ anyway, always intersting to open my OTLIST digests : TJ Jeanne Marie TJ -- TJ Options? TJ www.otnow.com/mailman/options/otlist_otnow.com TJ Archive? TJ www.mail-archive.com/otlist@otnow.com TJ
Re: [OTlist] on the uselessness of OT and other things
My other curiosity is why, if people are having such negative OT experiences in rehab, they bother to come for more OT once discharged? Jeanne, you pose an interesting question, and one that is pretty easily answered. For the population covered by Medicare A , which is the main payer for physical rehabilitation for the largest portion of the population receiving OT services, it is ignorance plain and simple. Most of these clients have no idea what the MD's order; many a time I go to do a home care OT eval and my clients will balk that they didn't know the doctor ordered home care let alone OT. So in a sense they are somehat a captive audience. And since under the part A benefit they cannot be balanced billed, the see no direct out of pocket cost associated with OT.So, although they may hate or love their OT, until our clients have more connection to the investment versus outcome assoicated with OT, we will continue to offer in some circumstances a mediocre product with not much accountability, because the market will bear it. I am surprised quiet frankly that Medicare hasn't demanded more from the profession. When I teach OT students, my mantra is always would YOU pay out of pocket for your service? Would others see the value in what you are doing with their loved one? Would there be enough face validity to your interventions that you could feel good about what you are doing and what you charge for the skilled service? If you can't answer yes to these questions, then in all likelihood you are not offering a skilled intervention and will burn out in this field After 15 years in this profession, I have really come to the conclusion that many OT's in adult and geriatric rehab are not that invested in truly operating as professionals. They want the paycheck and some sort of prestige, but they don't hold up their end of the equation by continuing their educations, using the best evidence and offering their clients a truly unique and skilled service. And they can get away with it because the patients/clients don't know any better and don't have to yet. If there were even a $5co -pay under part A for every therapy visit/session, this situation would change in a heartbeat, because the clients would demand better from us, and we would have to deliver to remain viable as a profession. The real question is: do we continue to feast on a sinking ship or do we abandon sloppy practice and hold ourselves accountable before we are forced to do so? In my mind that is what makes a real professional. Terrianne JM [EMAIL PROTECTED] wrote: they were supposed to do, they would make a big difference in patient's lives. I would also be interested in knowing what the sister believes O T's are supposed to be doing a lot of people don't even know what OT is. My other curiosity is why, if people are having such negative OT experiences in rehab, they bother to come for more OT once discharged? I would be very uncomfortable working in a SNF where I was not allowed to address mobility in regards to ADLsI have been fortunate to never have been pigeon-holed in that manner. Currently in my inpatient acute setting, I am constantly working on educating other staff that I am not a PT because I happen to get people out of bed-Unfortunetly, I follow several OT's that never got people out of bed--fairly useless in my opinion On another topic, I am arranging activities at my facility for OT month--I had to cringe when the COTA was wanting to bring the cones and the arc to the demonstration table as OT modalities. I don't use these things as a general rule except with very low level neuro for tracking/color recognition and some basic grasp etc. I gently declined in favor of providing information on how not to pack a backpack and fall prevention in the community.Just having items on a table doesn't show purpose even when there is one... anyway, always intersting to open my OTLIST digests : Jeanne Marie -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** - Be a PS3 game guru. Get your game face on with the latest PS3 news and previews at Yahoo! Games. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn
Re: [OTlist] Another OT Horror Story
Hi Ron, I find myself having to damage control several times a week in my home care practice. Many of my clients had OT in a SNF before returning home, and when I get there they many tell me right off the bat they they do not want OT. When I ask them why, they proceed with stories similar to the one you related, ie they felt stupid, didn't see the point, etc. I wiggle my way in by telling then that in home care, the role of the OT is to be a problem solver who can help them do the daily thing s they want or need or desire to do. Then I ask them to walk me through a typical day for them (pre-SNF) and we compare it to how they are doing now that they are home. Once I assure them that we CAN tackle some of the things that are problematic for them.they are sold. I also tell my clients flat out that I am not the exercise lady , which seems to go over well. In the end I hope my clients perception of OT is changed for the better. One thing I always do to make sure it sinks in is to correct my patients when they refer to me as a PT or a nurse, I always say kindly, remember, I am the occupational therapist. It seems to be working...Terrianne Ron Carson [EMAIL PROTECTED] wrote: Well, not really horror but I think it's a catchy title! Today, my 80 y/o patient's daughter was present for therapy. She says something about continuing our PT. I give the same ol' standard spiel about being an OT and she say's Oh, I see it on your shirt. A few minutes later I started to explain a little about occupation and OT. The daughter chimes in: Oh, Mom had OT in the SNF. About this time, the daughter starts doing the UE cycle 'dance'. And then the Mom chimes in about places pegs in a mat. The Mom says; It was stupid, they just wanted to see if I had a brain. I tried doing the two-step to explain about the theory behind the pegs but they weren't really interested. I just sort of said that they had been through some 'contrived' OT. Aaah, it never ends! Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** - Now that's room service! Choose from over 150,000 hotels in 45,000 destinations on Yahoo! Travel to find your fit. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] COPM Scores as the Goal?
Ron, thats intersting-previously we have been told that goals such as increase shouder range of motion by 30 degreees or increase UE muscle strength to grade 4+ etc are no good because they still don't communicate improvement in function. So by extension, outcomes that are based only on improvements in ROM, strength etc would also not be truly indicative of improved function.It seems to me that tools such as the FIM help quantify function in a more numeric way, perhaps that is where the directive is leading us?? Terrianne Ron Carson [EMAIL PROTECTED] wrote: Hello Terrianne: I understand what you are saying about third party payers not wanting goals that reflect scores, however, I think their primary concern is about ROM, strength, distance, etc. Do you agree? In fact, CMS just came out with new 'directives' advising the use of outcome measures that are very 'numbers based'. It seems that there must be some way of quantifying progress. Thanks, Ron - Original Message - From: Terrianne Jones Sent: Wednesday, January 31, 2007 To: OTlist@OTnow.com Subj: [OTlist] COPM Scores as the Goal? TJ Ron, for years now we have been hearing that third party TJ payers do not want goals that reflect improvement in scores, but TJ rather improvment in function. You are correct that an MD or TJ anybody else other than an OT for that matter would look at the TJ COPM scores and say what does that tell me?? I love the COPM and TJ use it daily in my homecare practice, however I do not include the TJ numbers in my goals. Instead, I document that I administed the TJ COPM to help determine which goal areas to focus on from a client TJ centered approach, but the actual goals I write are functional TJ such as your second example. TJ Terrianne TJ Ron Carson wrote: Hello All: TJ I just evaluated a patient with multiple medical issues. As part of TJ the eval, I administered the COPM. The patient scores indicate that TJ she is dissatisfied with her mobility and self-feeding. She has joint TJ ROM issues and pain secondary to RA and is mildly depressed because of TJ her living situation. Here COPM scores are: TJ Performance Satisfaction TJ Mobility 5 3 TJ Feeding 10 5 TJ So here's my question. TJ When drafting the patient's plan of treatment what becomes the goals; TJ 1. Improving the COPM performance and satisfaction scores TJ 2. Improving the patient's actual mobility and self-feeding. TJ To put it another way, if we take the mobility issue, should the goal TJ read: TJ 1. Patient's COPM mobility scores will improve to 8 and 10 TJ 1. Patient will safely and independtly ambulate to/from her ALF dining TJ room using a 4-wheel rolling walker. TJ I like the concept of using the COPM scores but I can only imagine TJ what an MD thinks when he reads this stuff. I don't send them the TJ actual COPM, only my plan of treatment. TJ Ron TJ -- TJ Ron Carson MHS, OTR/L TJ www.OTnow.com TJ -- TJ Options? TJ www.otnow.com/mailman/options/otlist_otnow.com TJ Archive? TJ www.mail-archive.com/otlist@otnow.com TJ ** TJ Enroll in Boston University's post-professional Master of TJ Science for OTs Online. Gain the skills and credentials to propel TJ your career. TJ www.otdegree.com/otn TJ ** TJ - TJ Get your own web address. TJ Have a HUGE year through Yahoo! Small Business. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** - Don't get soaked. Take a quick peak at the forecast with theYahoo! Search weather shortcut. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Revisiting some old articles for a an updated perspective
in motor control theory which indicate that engagement in goal directed and meaningful tasks elicits greater motor responses and function as compared to engagement in contrived or simulated tasks. Over the years many prominent figures in the field have lectured and written extensively about the topic of occupation and its role in the profession. Over 40 years have passed since Reilly asked is occupational therapy a sufficiently vital and unique service for medicine to support and society to reward? (1962, p. 77). West articulated the reaffirmed philosophy and practice of OT for the 1980s (1984, p. 15) as one revolving explicitly around occupation versus activities or purposeful activities. Yerxa (1991) pointed out that it is becoming more difficult to differentiate occupational therapy practice from physical therapy practice (p. 202) and envisioned a foundational science in occupation that would enhance and support our understanding of its applications. Friedland (1998) explored the relationship between occupational therapy and rehabilitation, identifying it as an awkward alliance (p. 69) and worried whether the profession would be up to the challenge of connecting to its unique focus on occupation versus function. Nelson (1996) implored the profession to resist the temptation to redefine ourselves with every new trend in health care (p. 550) and reminded us that we are occupational therapists, not functional therapists or functional outcomes therapists (p. 550). Fischer in her 1998 Slagle lecture challenged the profession to practice legitimate occupational therapy and give back exercises and most of our use of contrived occupation to their legitimate owners (p. 561). The return of occupation-based practice to occupational therapy is critical to our identity as a profession and our desire to remain a contributor to health and well being.We as occupational therapists are the experts on occupation, and we need to reclaim it and use it again.. As Nelson (1996) stated, what makes us unique is not that we document functional outcomes but that we use occupation as the method to achieve positive outcomes (p. 550). References AOTA (2002).Occupational therapy practice framework: Domain and process. In R. P. Cottrell (Ed), Perspectives for occupation-based practice (2nd ed., pp. 601-624). Bethesda, MD: AOTA Press. Christiansen, C., Baum, C. (1991). Occupational Therapy: Overcoming Human Performance Deficits. Thorofare: Slack Incorporated. Fischer, (1998). Uniting practice and theory in an occupational framework. In R. Padilla Ed.), A professional legacy: the Eleanor Clark Slagle Lectures in occupational therapy, 1955-2004 (2nd ed., pp. 554-575). Bethesda, MD: AOTA press. Friedland, J. (1998). Occupational therapy and rehabilitation: an awkward alliance. In R. P. Cottrell (Ed.), Perspectives on purposeful activity: foundation and future of occupational therapy (2nd ed., pp. 69-75). Bethesda, MD: AOTA press. Gutman, S. (1998). The domain of function: Whos got it? Whos competing for it? In R.P. Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 555- 560). Bethesda MD: AOTA press. Meyer, A. (1920). The philosophy of occupational therapy. In RP Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 25-28). Bethesda MD: AOTA press. Nelson, D. (1997). Why the profession of occupational therapy will flourish in the 21st century. In R. P. Cottrell (Ed.), Perspectives for occupation-based practice (2nd ed, pp. 113-126). Bethesda, MD: AOTA Press. Peloquin, S. (1991). Occupational therapy service: individual and collective understandings of the founders. American Journal of Occupational Therapy, 45, 33-744. Reilly, M. (1962). Occupational therapy can be one of the great ideas of 20th century medicine. In RP Cottrell (Ed.), Perspectives for occupation based practice (2nd ed.pp. 77-84). Bethesda MD: AOTA press. Trombly, C. (1995). Occupation: purposefulness and meaningless as therapeutic mechanisms. In RP Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 159-171). Bethesda MD: AOTA press. West, W. (1984). A reaffirmed philosophy and practice of occupational therapy for the 1980s. The American Journal of Occupational Therapy, 38, 15-23. Wilcock, A. (1998). An occupational perspective of health. Thorofare: Slack Incorporated. Yerxa, E. (1991). Seeking a relevant, ethical and realistic way of knowing for occupational therapy. The American Journal of Occupational Therapy 45, 199-204. Terrianne Jones [EMAIL PROTECTED] wrote: Hello all, In light of the discussions re: UE/LE, exercise, acute care, etc., I'd like to share with you something I wrote for an OT doctoral course recently. It was an argument for the use of an occupation centered
Re: [OTlist] Acute Care OT?
Jimmie, you make some very good points about the use of exercise in the bigger picture of OT practice. If only most OT's actually practiced as you described, there would be no problem. Unfortunately, in my experience--I currently work in home care and SNF's trans care-rote exercise is the rule rather than the exception. OTR's are routinely observed in my SNF setting to be sitting with clients going through graded exercise programs day after day, for almost all of the clients therapy minutes. In fact, it got so bad last year that the rehab director, a PT (!), had to put up signs in the therapy area reminding the OT's that they must adress functional goals related to self care--apparently an audit of this facility revelaed that OT was using the therapeutic exercise code nearly to the exclusion of the other codes. This company is loaded with new grads who don't know any other way to practice. I theorize that many therapists do not really posess a good understanding of occupation and the theoretical underpinnings of our profession, so out of professional insecurity they grab onto things that look legitimate so they don't have to try to explain something they don't understand. I personally refuse to write goals related to exercises, though it is standard in both of my practice settings that OT writes a goal for upper extremity home exercise programs regardless of the clients situation. I write many home programs which focus on increasing engagement in occupation, and I find that in home care anyway, my clients are pretty motivated to participate, because the programs are created to support the occuaptions they value. Terrianne Jim Arceneaux [EMAIL PROTECTED] wrote: One caveat though: Please don't get stuck in the ADL/function thing as well. OTs are too often identified as the ADL guys. This places us, in the eyes of non-rehab. disciplines, as glorified aides. Plus, the PT practice framework, or whatever they call it, states that PT's address ADL and function. OT is more complex than ADL or function. Also, in the rants, as people called them, several individuals mentioned OTs need to stop doing exercise. I argue that exercise is no worse than doing mindless activities like bouncing around a balloon or digging pennies out of therapy putty. Neither is truly OT. But, we must understand that OT practice must utilize occupation as its treatment medium of choice while also employing other learned techniques to facilitate return to the patient's desired occupation. It is not a sin against the OT gods to do an exercise, but it is also not OT if your primary focus is exercise. If you had a patient that couldn't put his sock on because of hip capsular tightness following an ORIF (that had the potential to do this without a sock aid) would you run to the PT to ask them to improve the range for you so you can meet your goal. I hope not! It would be best to find a way through participation in an occupational task to improve this range, but if necessary why can't you provide service to meet an establihed OT goal. AS Chuck stated, there is nothing in my practice act that says I can't and the practice framework from AOTA supports the addressing of client factors (i.e. ROM) in meeting occupational goals. I'm not certain why so often fellow OTs will look at another OT performing an exercise as something akin to a PT, but state another OT is a fine example while watching them play balloon volleyball as I mentioned above. You also don't here OTs often stating that NDT is not OT. Well, really it isn't, but it can be utilized by an OT to facilitate participaton in occupation. The NDT is no different than an exercise. Another rant...Wow! Jimmie Chris Smith wrote: bHalleujah--so many PT wannabees in the field. I have only worked in one LTC facility out of five that addressed Adls in an appropriate manner and by only one of the COTA not the other two. Where I am now the OT who does the majority of the evals and writes an obligatory ADL goal rarely addresses them herself. I do home health for a company owned by the LTC facility and work both in house and in HH. After I complained to the rehab director (a PTA of course) that by pts coming out of the facility couldn't do ADLS she told everyone they had to do one adl run through before DCing--what an attitude. If all we ever bill is 97110 why do they need us? They can just hire PTs. Sorry for the rant. Chris ___ Join Excite! - http://www.excite.com The most personalized portal on the Web! -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn
Re: [OTlist] Acute Care OT?
Ron, I have maintained for years (since rotating thru acute care myself 10 years ago) that we are not doing oursleves any favors by trying so hard to maintain a strong presence in acute care as a profession. When we are there, the focus should definitley be, for those who can tolerate it, on getting people up and moving, in the context of daily occupations (so no rote exercises). For those sicker or more incapacitated, our role should be gentle introduction to ADL and recommendations for how OT might be helpful within the continuum of care (recs for inpatient rehab versus home care , for example). This opinion was met with total resistance from my acute care colleagues, many of whom practiced in a manner that was nearly indistinguishable from PT. At that time, most of the OT's I worked with hated acute care, and the 2 of the 3 who loved it had tried unsuccessfully to get into PT school (late 1980's) and went into OT instead because the waiting list for PT was too long. They often refused to adress basic ADL or self care and focused almost exclusivley on upper extremity PT. They argued for more OT staff because the needs were so great, but in reality had they truly practiced OT and addressed occupation instead of exercise, there would not have been as big of a need for OT in acute care, something that those hell bent on competing with PT did not want to admit... Terrianne Ron Carson [EMAIL PROTECTED] wrote: I went on a PRN OT interview the other day. The position was for acute care weekend coverage. The person interviewing me worked in both outpatient and inpatient care. The OT duties for the acute care setting were explained something like this. We don't get people out of bed or work on mobility issues because this is what PT does. Basically what we do is address self-care issues such as dressing, bathing, etc. The is situation is both frustrating and confusing. Of course, I understand not wanting to duplicate services, but should OT be the profession getting people out of bed?? And, to continue with my rant about OT and UE, the outpatient side of the facility basically did UE rehab. If anyone on this list has acute care OT experience I would love to hear from you. And of course, other's opinion (including spouses :-)) are also welcome!! Thanks, Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ** - Check out the all-new Yahoo! Mail beta - Fire up a more powerful email and get things done faster. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com ** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **
Re: [OTlist] Another Question
My 2 cents:
The problem is that there are many OT's who ONLY focus on 'occupation as end'
and justify all their non-occupation internventions ('means'') because they
will enable occuaption. The problem is , in reality, that is usually the goal
of other disciplines too (ie, PT)...it is our use of 'occupations as means'
that makes us unique...
Terrianne
Joe Wells [EMAIL PROTECTED] wrote: Hi Ron:
Glad to see some activity again. I prefer the phrase end product instead
of by-product. I do not see a harm in viewing occupations as the ends of
our interventions (of course, ideally would like it to be the means as
well). Joe Wells
www.otdnetwork.org
___
Ron wrote:
In my opinion, a person with an injury is primarily focusing on just
that, the injury (or illness). Not that people don't think about
getting back to their activities and occupations, but in my
experience most people see lost activities and occupations as a
by-product of their injury or illness, not as the problem(s) to be
addressed.
__
--
Options?
www.otnow.com/mailman/options/otlist_otnow.com
Archive?
www.mail-archive.com/otlist@otnow.com
**
Enroll in Boston University's post-professional Master of Science for OTs
Online. Gain the skills and credentials to propel your career.
www.otdegree.com/otn
**
-
Get your email and more, right on the new Yahoo.com
--
Options?
www.otnow.com/mailman/options/otlist_otnow.com
Archive?
www.mail-archive.com/otlist@otnow.com
**
Enroll in Boston University's post-professional Master of Science for OTs
Online. Gain the skills and credentials to propel your career.
www.otdegree.com/otn
**
