Re: [OTlist] Evidence?
Some conflicing evidence, but from my brief lit review it looks like practice is the major factor. In the second study the intervention was only to meet with the student twice a week for 30 minutes lasting 10 weeks. The intervention consisted of biomechanical, sensorimotor, and teaching learning strategies (practice and feedback?). In the first study provided it states that they compared sensorimotor (strength, coordination, sensory training?) versus practice and the practice intervention was more effective, in fact the sensorimotor group declined in their ability. 1) The effects of sensorimotor-based intervention versus therapeutic practice on improving handwriting performance in 6- to 11-year-old children P. L. Denton, S. Cope and C. Moser (2006) Journal Title: American Journal of Occupational Therapy Volume 60; Issue 1; Pages 16-27 Abstract OBJECTIVE: The aim of this study was to investigate the effects of two interventions (sensorimotor and therapeutic practice) on handwriting and selected sensorimotor components in elementary-age children. METHOD: Thirty-eight children 6 to 11 years of age with handwriting dysfunction but no identified educational need were randomly assigned to one of the two intervention groups or a control group. Intervention groups met four times per week over 5 weeks. Handwriting was measured pre- and postintervention using the Test of Handwriting Skills. Visual perception (motor-reduced), visual-motor integration, proprioception, and in-hand manipulation were also measured. RESULTS: Children receiving therapeutic practice moderately improved handwriting whereas children receiving sensorimotor intervention declined in handwriting performance. The control group did not change significantly. Sensorimotor impairment was noted at pretest in three or four components and selected sensorimotor component function improved with intervention. CONCLUSION: Therapeutic practice was more effective than sensorimotor-based intervention at improving handwriting performance. Children who received sensorimotor intervention improved in some sensorimotor components but also experienced a clinically meaningful decline in handwriting performance. 2) Effect of an occupational intervention on printing in children with economic disadvantages C. Q. Peterson and D. L. Nelson (2003) Journal Title: American Journal of Occupational Therapy Volume 57; Issue 2; Pages 152-60 Abstract OBJECTIVE: The purpose of this study was to evaluate whether an occupational therapy intervention improved an academic outcome (D'Nealian printing) in a school setting. The study specifically examined improvement in printing skills in economically disadvantaged first graders who were at risk academically and socially. The intervention was based on an occupational framework including biomechanical, sensorimotor, and teaching-learning strategies. METHOD: The final sample consisted of 59 first-grade children from a low socioeconomic urban elementary school-based health center who were randomly assigned to an occupational therapy intervention or a control condition. In addition to regular academic instruction, the intervention group received 10 weeks of training twice a week for 30-minute sessions. The control group received only regular academic instruction. Subjects were pretested and posttested on the Minnesota Handwriting Test, which assesses legibility, space, line, si ze, and form (the main variables in this study) as well as speed. RESULTS: Multivariate analysis of variance confirmed that the gain scores in the occupational therapy intervention group were significantly greater than those in the control group. The Hotelling-Lawley Trace value was 0.606, with F(5, 53) = 6.43, p .0001). The estimated effect size (eta2) was .378, with an observed power of .994. Largest gains for the intervention group were in the areas of space, line, and size. CONCLUSION: The intervention group demonstrated a significant increase in scores on the posttest of the Minnesota Handwriting Test when compared to the scores of the control group. Occupational intervention was effective in improving the academic outcome of printing in children who are economically disadvantaged Chris Nahrwold -Original Message- From: Renee Lowrey renee.low...@mmsean.com To: otlist@otnow.com Sent: Fri, Feb 19, 2010 7:18 am 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
Re: [OTlist] Bed Mobility
Difficult situation. I assume that he has not grip strength because his triceps won't work. I think I would first recommend a bed rail and then I would come up with a lasso/belt like system that I would harness to the bed rail and then practice use his deltoid and biceps for your advantage by practicing moving his arms into the lasso using shoulder movements and then using his biceps, flex his elbows firmly on the lasso, and finally attempting to roll himself over. Long shot, but worth a try. Chris Nahrwold Anderson Indiana -Original Message- From: Ron Carson rdcar...@otnow.com To: Neal Luther OTlist@OTnow.com Sent: Tue, Jan 5, 2010 7:44 am Subject: Re: [OTlist] Bed Mobility Neal, does the patient have a hospital bed with rails? - Original Message - From: Neal Luther neal.lut...@advhomecare.org Sent: Monday, January 04, 2010 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Bed Mobility NL Hello everyone and Happy New Year! NL Has anyone ever had success in teaching a quadriplegic pt. to be able to NL independently reposition into sidelying in bed? My pt. has great bicep NL and deltoid strength. Little to no triceps. Thanks for any help. NL Neal C. Luther,OTR/L NL Advanced Home Care, Burlington Office NL 1-336-538-1194, xt 6672 NL neal.lut...@advhomecare.org NL Home Care is our Business...Caring is our Specialty NL Neal Luther.vcf NL P Please consider the environment before printing this e-mail NL The information contained in this electronic document from Advanced NL Home Care is privileged and confidential information intended for NL the sole use of otl...@otnow.com. If the reader of this NL communication is not the intended recipient, or the employee or NL agent responsible for delivering it to the intended recipient, you NL are hereby notified that any dissemination, distribution or copying NL of this communication is strictly prohibited. If you have received NL this communication in error, please immediately notify the person NL listed above and discard the original. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Standing
Because some people do not understand what we truly do. The only way they will see the contribution is through the voice of the patient. -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Sat, Aug 29, 2009 3:34 pm Subject: Re: [OTlist] Standing Oh Chris, I so value what I do, and I KNOW that other OT's value what they do. But the PROBLEM, at least in my experience, is that almost no one else TRULY values our contribution. Why? - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Saturday, August 29, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Standing cac The obvious answer is OT services are NOT invaluable and that cac patients cac apparently do just fine when receiving PT only. cac Hmmm.I wonder why there is such a continued prevelance of falls at cac home and readmits into hospitals, because people have not been able to cac take care of themselves and therefore leading to a downward spiral a) cac can't get out of bed or do not have the motivation or a reason to get cac out of bed b) stay in bed for long periods of time c) can't get to cac their medications cac We are much more than a profession of arm movers, but a profession that cac values the patient's well being, and helps by giving people hope that cac they can continue to live a life of purpose and meaning cac We can add so much more than.the popular main stream therapies, if we cac only cared about the lives of our patients. If we only cracked open cac the book, beyond the surface of each patient in which we encounter to cac determine how we could potentially help them in a real way. cac Sorry about all of philosophy, but that comment struck a nerve. cac Chris cac -Original Message- cac From: Ron Carson rdcar...@otnow.com cac To: OTlist OTlist@OTnow.com cac Sent: Sat, Aug 29, 2009 5:09 am cac Subject: [OTlist] Standing cac There's a legal term called standing. cac The legal right to bring a lawsuit. As a general rule, cac only a cac person with something at stake has standing to bring a lawsuit. cac As I understand it, standing means that a person has a legal cac basis for cac brining a claim against another entity. I'm sure there's a lot more cac to the cac term, but that's my basic understanding. cac While driving the other day, it dawned on me that in so many cac settings and cac with so many people OT has little to no standing. I'm not talking in a cac legal cac sense, instead in the sense of what our profession offers. cac When I think about my home health company, OT is such a non-entity. We cac have cac so few OT compared to PT. OT can't open a case. OT very rarely stands cac alone. cac OT is rarely called upon as EXPERTS in anything, unless it's fine cac motor. OT cac is not recognized by the majority of patients. OT is often not cac referred to cac by the MD. cac For me, the bottom line is that OT hardly even exists as a highly cac valued cac profession. In fact, I was thinking yesterday, what happens to the cac VAST cac majority of home health patients not getting home health? How is it cac that I cac sell my services as invaluable, but most patients don't get the cac services? cac The obvious answer is OT services are NOT invaluable and that cac patients cac apparently do just fine when receiving PT only. cac Again, just another missing piece of our confusing puzzle cac Ron cac ~~~ cac Ron Carson MHS, OT cac www.OTnow.com cac -- cac Options? cac www.otnow.com/mailman/options/otlist_otnow.com cac Archive? cac www.mail-archive.com/otlist@otnow.com cac -- cac Options? cac www.otnow.com/mailman/options/otlist_otnow.com cac Archive? cac 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] Standing
I bet if you get a string of people like Shirley, they would have to listen. Really dumb not to. Easy for me to say though. All of my bosses and even the higher ups are OTs, so we have a major advantage. Perhaps that is another way to get our foot in the door. Become the door. -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Sun, Aug 30, 2009 3:18 pm Subject: Re: [OTlist] Standing As a rule, people are resistant to change. And even worse than people, institutions are VERY resistant to change. Shirley, the mother of a home health patient, wrote an e-mail to the CEO of my home health company explaining how difficult it was for the patient to get OT started. Personally, I have heard nothing from my company about this situation. I wonder why? - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Sunday, August 30, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Standing cac Because some people do not understand what we truly do. The only way cac they will see the contribution is through the voice of the patient. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Backpack Unawareness
The whole backpack awareness day in my opinion is a little on the shady side. OTs are educating students and teachers that there should be a 10% body weight limit placed in back packs and often have students use a scale to weigh themselves and then their backpacks. The problem is from my understanding and from completing a quick literature review on OTseeker.com and Pubmed, that there is insefficient data for such recommendations. In fact the most recent publication in Work (2009) demonstrates that the body weight limit did not factor in much at all, but instead it was shown that a possible psychological component involved that caused this adolescent back pain that spans into adulthood. It did show that both straps of the backpack should be worn versus unilateral and the most troublesome spot for injuries to occur would be in the unstable shoulder and not the back. So perhaps we need to complete psychological profiles versus weighing the backpacks? You cannot tell me that AOTA is not aware of this research. Do they ignore it because of the free publicity that OTs receive? Creating a solution that does not really help in hopes to promote the profession is odd in my opinion. I am not an expert in this area, so I would love to learn what the experts have to say about this topic. Perhaps I am missing the important data that AOTA is reading. Chris Nahrwold MS,OTR -Original Message- From: Diane Randall spark...@rcn.com To: OTlist@OTnow.com Sent: Tue, Aug 18, 2009 10:41 pm Subject: Re: [OTlist] Backpack Unawareness I am not familiar with what the controversy is surrounding this issue. What research about this is lacking? What kind of money is being spent on the issue and why is it not relevant to OT? Diane COTA/L Peds -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Tuesday, August 18, 2009 21:13 To: OTlist@OTnow.com Subject: Re: [OTlist] Backpack Unawareness Yes, especially since there is little research to back it up. -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist OTlist@OTnow.com Sent: Tue, Aug 18, 2009 7:17 pm Subject: [OTlist] Backpack Unawareness Does anyone else think that AOTA's dribble on Backpack Awareness is a total waste of time and money? Well, maybe not for school/ped therapists, but certainly for the rest of the OT world. Ron ~~~ Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Difference?
I'm not a big fan of that breakdown in components either, but what I did gather from that quote was the agitated person wouldn't do anything but shoot baskets, so I think that both PT and OT had to stretch a bit in order for the patient to get through the agitated stage from an inurance point of view, if you know what I mean. From a multidiciplinary approach I can see why both disciplines would use that treatment choice. I'm sure working on a dynamic challenge like that would assist with a PT's walking and stair climbing goals. I'm sure working on a game like that in OT would help with their ADL goals and the actual leisure goal of playing BB. Not sure if I would feel comfortable with both disciplines working on it at the same time, for every treatment session. That would be odd. but I guess the world of traumatic brain injury is a unique animal in which treatment choices are limited especially during the intitial stages of the game. And to let the patient lie around and do nothing until they come around is unlikely and tough on the body, mind, and soul. I can see Ron's point about the perception of PTs using occupations as a modality, but when it comes down to it, I think in this situation they were doing all that was allowed by the patient. I would be more concerned if they wrote goals that were directly occupationally based versus pain, steps, balance, ROM, strenght, etc. Not trying to minimize the problem, just trying to provide a rational explaination, because it happens all of the time in acute rehab, when the patient doesn't feel like getting up and moving. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist OTlist@OTnow.com Sent: Tue, Aug 18, 2009 7:16 pm Subject: [OTlist] Difference? If a patient does not respond to a specific treatment intervention, team members discuss what is working for them and incorporate that into the PT sessions. For example, we had a patient who enjoyed playing basketball but wasn't interested in much else due to his agitated state from his brain injury. The OT used this task for counting, visual perceptual training and attention. The PT used this task by having the patient stand and shoot baskets from varying distances to address balance and coordination. When treating persons with acquired brain injury, it is essential to identify what will motivate them to participate in therapy while providing interventions that will address their impairments and functional limitations SOURCE: (Rehab Management. Vol. 22, No.7, Page 15.) The above quote is taken from a brief physician written article on an interdisciplinary approach to stroke rehab. I should mention that the magazines article has a picture of an OT doing UE range of motion, what else right??? None the less, look at the quote. Notice that the MD refers to incorporating intervention into PT sessions? Oversight on his part, or just a fact that PT IS the team? Also, please tell me what the heck is the difference between what the PT and the OT are doing? The whole concept of separating basketball into specific treatment spectrums is just plain silly. If a person is playing basketball isn't he working on ALL the processes needed to through the ball into a hoop? Why would OT segment out their treatment into cognitive stuff while the PT addresses the physical stuff? In my opinion OT should be the ONLY discipline using basketball for rehab. PT should be in the gym working on ROM, strength, pain, etc. For 10 YEARS, I've been preaching that occupation is our bread and butter. But, phys-dys OT's are so stupidly stuck on limiting themselves to UE rehab that OTHER disciplines are grabbing onto the VERY TERRITORY that we should be staking claim to. I predict, that one day in the future, OT's will look back and say, why did we let PT take over using daily occupation as a treatment modality. We are literally shooting ourselves in the foot just so we can lay claim to the stupid arm! Tragic really!!! Ron ~~~ Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Backpack Unawareness
Yes, especially since there is little research to back it up. -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist OTlist@OTnow.com Sent: Tue, Aug 18, 2009 7:17 pm Subject: [OTlist] Backpack Unawareness Does anyone else think that AOTA's dribble on Backpack Awareness is a total waste of time and money? Well, maybe not for school/ped therapists, but certainly for the rest of the OT world. Ron ~~~ Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Bully
Ron, Please do not be discouraged by the most recent ex-members. Sometimes the truth hurts, but hopefully we all left a lasting impression prior to their departure. -Original Message- From: jcd...@gmail.com To: OTlist@OTnow.com Sent: Fri, Aug 14, 2009 12:39 pm Subject: Re: [OTlist] Bully Ron just wanted to drop my 2cents. I have not met an OT who is as passionate as you about our profession. I know were u are coming from and don't feel that you are bullying anyone. You are strong opinions, but not offensive. I hope that other OT's don't leave the list and continue to support this vital venue that you creted. Keep it up --Original Message-- From: Ron Carson Sender: otlist-boun...@otnow.com To: OTlist ReplyTo: OTlist@OTnow.com Subject: [OTlist] Bully Sent: Aug 14, 2009 11:12 AM Several people, some long-time members, have recently left the list. They commented that I am coming off as a bully and this list should not be about me. If you feel bullied by my comments, then I am sorry. It is not my desire nor intention to bully anyone. However, I do have strong opinions and convictions about OT-related topics and I'm not hesitant to post them. But, do NOT let that stop you from posting as well. In my opinion, one thing sorely lacking in the OT profession is CONVICTION. We have too few people with too little conviction about th eir theory, beliefs and practices. Conversely, we have way too many sheep just going with the flow of traditional practice patterns, even when these patterns are inconsistent with theory. Finally, don't take things personally. This is NOT about YOU or ME, it's about the practice of OT. I have NO negative feelings towards anyone, past or present, on this list. I will gladly shake the hand of any OTnow.com list member or ex-member. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com Sent on the Sprint® Now Network from my BlackBerry® -- 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] One Example of How Other Dispciplines Address Function...
They talk, but we do. -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist OTlist@OTnow.com Sent: Tue, Aug 11, 2009 9:20 am Subject: [OTlist] One Example of How Other Dispciplines Address Function... This is a partial quote from a PT on a different listserve: One thing to note is that this guy is an avid marathoner. He runs several a year, including Boston. His surgeon actually said he was more worried about his scapula than his lungs regarding returning to running. I have previously argued that all healthcare disciplines address function. And this is just one example. Often OT claims to be experts in function, but that is just not the case. Anymore, every discipline is an expert in function. Everyone from surgeons to OT's claim to restore people back to daily living. So, what is OT's expertise that separates us from everyone else Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Massive new CVA patient
there is nothing YOU can do to SIGNIFICANTLY increase his awareness. Agree with everything except this statement, because of what research has taught us. Check out strokengine.com for specific evidence based reviews on neglect training. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson rdcar...@otnow.com To: Diane Randall OTlist@OTnow.com Sent: Thu, Aug 6, 2009 6:59 am Subject: Re: [OTlist] Massive new CVA patient Great patient to work with. At this point, there is nothing YOU can do to SIGNIFICANTLY increase his awareness. I would educate him, if appropriate, and family, if available, about visual and verbal cueing, but I would NOT waste a lot of time doing this. Over time, the neglect may subside but I believe this is one of those areas that takes a great deal of time and sort of spontaneous recovery. Are you a COTA or OT (this is why I ask people to include their credentials in messages). If you are the OT, I would change the goal to: Patient will perform basic ADL's Don't limit the patient and your treatment to the neglect. Surely there are other things inhibiting the patient's independence. Make a list of the patient's problems: physical, mental, emotional, environmental. Prioritize which of these problems are most significant AND that you have the ability to significantly improve. There is no use working on something that will not likely show significant change. My suspicion, is that you should be working on sitting balance. If the patient can sit, then work on standing balance, if the patient can stand, work on mobility. And no matter what, you must address the patient's emotional needs to be in control and have self-worth and dignity. In my opinion, this is best done through an honest therapeutic relationship. I believe that in complicated situations, the therapist MUST organize available information in a manner that allows them to address the most salient issues. We only have limited time with patients, so we MUST make best use of that time by addressing those issues which most impair patient's occupations. Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Diane Randall spark...@rcn.com Sent: Thursday, August 06, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] Massive new CVA patient DR Hello, I have been given (along with 11 other patients I have) a new CVA DR patient. I have never worked with someone tis impaired and i don't know DR where to start. I am in a SNF and pt had been in an acute rehab for about a DR month prior for therapy. He is Dependent for all ADL's and DR transfers...sometimes hard to get his attention at all. Total left neglect. DR Trouble following simple commands. 1 finger sublux. Just not sure where to DR even begin. Goals are to increase attention to the left to perform ADL's DR but is this relistic at this point and what activites can I do with him that DR will encourge attention to left or attention to anything at all. Thanks DR Diane DR -- DR Options? DR www.otnow.com/mailman/options/otlist_otnow.com DR Archive? DR www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Massive new CVA patient
Just a short reference list 1 http://www.springerlink.com/content/t1lp7wh87wm71t70/ Motor and functional recovery of stroke patients with neglect seems to be significantly improved by the simultaneous presence of a treatment specifically focused on neglect. 2.http://cat.inist.fr/?aModele=afficheNcpsidt=2126247 3. http://brain.oxfordjournals.org/cgi/content/abstract/125/3/608 4. http://linkinghub.elsevier.com/retrieve/pii/S0003999397902367 The Bon Saint Come method seems to significantly improve recent and chronic UNS, as well as ADL function. These encouraging results could have resulted from a synergistic effect of spatial reconditioning and voluntary trunk rotation. It must be assessed by a new study with more patients. 5.http://linkinghub.elsevier.com/retrieve/pii/S0003999305003308 Thanks, Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: Linda Stovall OTlist@OTnow.com Sent: Thu, Aug 6, 2009 4:27 pm Subject: Re: [OTlist] Massive new CVA patient From Cochrane.org: http://www.cochrane.org/reviews/en/ab003586.html The benefit of cognitive rehabilitation for unilateral spatial neglect, a condition that can affect stroke survivors, is unclear. Unilateral spatial neglect is a condition which reduces a person's ability to look, listen or make movements in one half of their environment. This can affect their ability to carry out many everyday tasks such as eating, reading and getting dressed, and restricts a person's independence. Our review of 12 studies involving306participants found that rehabilitation specifically targeted at neglect appeared to improve a person's ability to complete tests such as finding visual targets and marking the mid-point of a line. However, its effect on their ability to carry out a meaningful everyday task or to live independently was not clear. Patients with neglect should continue to receive general stroke rehabilitation services but better quality research is needed to identify optimal treatments. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Linda Stovall 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] Patient Requests Different Therapist....
Ron, Usually the answer to those types of questions come from within. Why do you think that your personalities clashed? Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist@OTnow.com Sent: Tue, Aug 4, 2009 5:58 am Subject: [OTlist] Patient Requests Different Therapist Yesterday, a patient requested that I not be his therapist. He told an appt scheduler that our personality's clashed. I have previously seen this patient and agree with his assessment about personality clash. I KNOW these things happen, at least to me. I am very interested in learning what it is about my personality that clashes. Is it my words, actions, attitude, etc that the patient doesn't like. The ONLY reason I want to know is really just for 'learning'. I want to know if there is something that I'm doing wrong. But, how can I find this out. Most people are not willing or maybe able to talk about such things. Would YOU pursue trying to find this out? If so, how? Thanks, Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Vision ~vs~ Reality
Well put Shirley! I wish all OTs would have an understanding of their own profession. You seem to understand the concept, and you are not even in the profession. What has Ron done in his treatment sessions with your daughter that has made the most impact for her well being and her independence? Thank you so much for sharing your insight. Chris Nahrwold -Original Message- From: shirley roberson lrih...@yahoo.com To: OTlist@OTnow.com Sent: Thu, Jul 23, 2009 7:40 am Subject: Re: [OTlist] Vision ~vs~ Reality Unfortunatly I probably would not have been inpressed. I say that because we had OT's in the hospital and in rehab, they did just what you explainedfocused on the upper extremities and it did not help my daughter very much. By that I mean it did not help her to get back to the normal way of doing things, it did not put her whole body together. I know that sounds a little unprofessional, but that's the way I see it. Seems when a patient, especially like my daughter, has been in bed for so long, they have forgotten how everything works together. Shirley --- On Thu, 7/23/09, Ron Carson rdcar...@otnow.com wrote: From: Ron Carson rdcar...@otnow.com Subject: Re: [OTlist] Vision ~vs~ Reality To: shirley roberson OTlist@OTnow.com Date: Thursday, July 23, 2009, 7:41 AM Shirley, what if I did OT the way past20OT's had done? If I focused treatment on the upper extremity would you still say we are beginning to see how well OT works for our loved ones? Just to remind everyone, Shirley is the mother of a patient that I'm seeing. She has been exposed to a LOT a therapy. - Original Message - From: shirley roberson lrih...@yahoo.com Sent: Wednesday, July 22, 2009 To: otl...@otnow.com OTlist@OTnow.com Subj: [OTlist] Vision ~vs~ Reality sr Ron, sr sr Maybe somehow you could inform the public..? I sure have learned sr about OT this past year. I know this week when I told my sr son-in-law to contact the agency and ask for you, he was given first sr a CNA and then a PT, but I had to have him call again to get you, sr the OT. It seems that as patients and family we are beginning to sr see how well OT works for our loved ones, but for whatever reason, sr the agencies want to send out personnel as ie: 1,2,3 and the OT seems to be 3. sr Shirley -- 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] Vision ~vs~ Reality
Diane, Can you work on creating a schedule board for the department. This is what we use in rehab, and it works out well. With fourteen patients you can have one group treatment (3-4 pateints) once a day focusing on a general conditioning program for an hour or so. This group wuld rotate every day so only 25% of the time is devoted to group therapy per week. You then would have five hours to see the rest of other ten patients in which you can double and work on personal occupations. would only work if you have a rehab tech though, or you will be using all of your time seeking patients, and we all know how that works. -Original Message- From: Diane Randall spark...@rcn.com To: OTlist@OTnow.com Sent: Thu, Jul 23, 2009 9:21 pm Subject: Re: [OTlist] Vision ~vs~ Reality The problem that I have noticed is that there is no set time where I am at. Patients just start showing up at random. Sometimes I have to go get them myself. I never know when someone will arrive and I can have six or more at a time in the gym that I have to share with PT and Speech. I am right out of school and certainly not superwoman. One or two at a time is managable but SIX. It is not that I think I would be fired for doing the right thing, I just just think it is darn near impossible with the way everything is set up. I have only been doing this a month. I think I am looking forward to working in Peds. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of shirley roberson Sent: Thursday, July 23, 2009 20:21 To: OTlist@OTnow.com Subject: Re: [OTlist] Vision ~vs~ Reality Diane, I do know how demanding your work is in rehab. I have seen the OT's and PT's running around trying to get to everyone. The trouble with it from the patients side is when one of them comes to your room (with no set time given) and the patient is not ready, off they go never to return that day. If the patient is mobile, they can come to the therapy room and wait until someone can get to them, jumping back and forth between other patients. There is no continuity of treatment. This is not your fault, I am not blaming any therapist. I blame the system that is so greedy to get the dollars that they sacrifice the patient and do not allow the professionals to do their job correctly. It really makes me angry. I really do not know or have any idea how you could change that. If you tried to do what you know is right, you would probably get fired. Chris, When Ron first came to my daughters home, he sat done and talked with us about what Susan wanted to accomplish and how he would go about it. He also stated, very kindly I might add, that if in 3 or 4 weeks he didn't see that she was progressing or was not trying, he would feel that he needed to discharge her. I don't know if it got my daughters attention, but it sure got mine! I believe that you need to have people, family, whoever, interested in the progress of the patient. That being said, Ron developed a relationship with her. She saw that he wanted her to get better and he worked very hard for a full hour with her 5 days a week for over 3 months. He didn't let her slack, reprimanded her when she balked some. Had her trying to do things that she would be doing when he is gone. Gives her cognition tests to see where she is mentally. In other words, he is working to get her better all around. The family gives credit to Susan coming so far to the treatment that has come from Ron. He does whatever he thinks will help. The balancing ball, the standing disc, walking, getting up from the bed and chair, playing catch, talking and listening when she is down, you name it, I think Ron has tried it... I commend all of you for trying to find ways to do your job better for the help of others..My thanks go to all of you.. Shirley --- On Thu, 7/23/09, Diane Randall spark...@rcn.com wrote: From: Diane Randall spark...@rcn.com Subject: Re: [OTlist] Vision ~vs~ Reality To: OTlist@OTnow.com Date: Thursday, July 23, 2009, 6:24 PM 0D I am with you about the UE problem in rehab but I really need to know how we can fix this...I have 14 patients to see within 6 hours, some are ADL's but I cannot have one on one treatments most of the time. I cannot do a shower transfer and have 6 patients waiting in the gym. I am kind of at a loss and wondering what a typical gym SNF would look like in ideal circumstances. I think a lot of blame is one therapists when we are the ones in the trenches just trying to get the minutes in and figuring out how to do it and it is the corporate structure that has forced UE rehab into the SNFs as a majority treatment by packing the gym full of patients each day. Home health is totally different. There is so much you can do one on one especially within the home. I am doing my best and frankly...I am Peds is my first love and I will be dong outpatient one on one in a a
Re: [OTlist] Why OT's Should NOT Focus on the UE
So the essentials for going home safely is what I gather A) Dressing and bathing themselves. Not only should we OTs practice these skills with possible compensation techniques and environmental adaptation, we should also analyze what part of the activity is difficult. For example a patient might have a significant balance problem or decreased standing tolerance from immobility. This can certainly be addressed in the gym through the practice of sit to stands, dynamic balance challenges, functional ambulation (gathering clothes from closet with a walker and possibly a walker tray or basket), and reaching for clothes placed at low levels and high levels. Think high repetiions to generalize learning. B) Toilet transfers and toileting-Practie, practice practice. Even if they do not have to go, practice. Find a strategy that works best for them.Everyone is not the same, so experiment and if does not work out, back to the drawing board C) Kitchen mobility, dining room mobility, family room mobility, car transfers--practice in multiple treatment environments and get the patient talking about their situation at home so the situation can be matched as best as possible D) cooking-If you don't have a kitchen than simulate to the best of your ability-transporting objects from point A to B with a rolling walker and a walker tray, scooting objects on countertops without loss of balance. Education about how to set up their ki tchen at home for optimized safety. E) Make sure the patient and you talk through the above homemaking plan if they think family or another agency will complete for them. Make sure you know in detail the exact plan. If the story is gray you might have to make a few phone calls and possibly get the social worker involved to determine if the cost for an agency to complete the homemaking is realistic for the patient. -Original Message- From: Miranda Hayek mltaylo...@hotmail.com To: otlist@otnow.com Sent: Wed, Jul 15, 2009 6:06 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE I guess I am not thinking of any specific patient at this point, it's just nice to hear other peoples ideas for interventions. I know each patient has their own goals, but the majority are hoping to return home, be independent with ADL's and do as much home management tasks as they can (but are willing to have family or community support services to assist with laundry, vacuuming.). Basically they just want to go home vs. nursing home! Sorry it's so fague, I am not thinking of anything specific so I realize it's a hard question to answer! To: OTlist@OTnow.com Date: Tue, 14 Jul 2009 21:53:49 -0400 From: cmnahrw...@aol.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Miranda, What occupations does the patient desire to improve o n? Chris -Original Message- From: Miranda Hayek mltaylo...@hotmail.com To: otlist@otnow.com Sent: Tue, Jul 14, 2009 7:00 pm Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE I find the information being shared between Diane and others is helpful. I too am new to the profession and feel that we learn interventions/treatments on the job (my schooling taught me the theory of OT more than hands on!). At my job I learn from the other therapists, and find our afternoon treatments involve dowel, theraband exercises. Morning treatments involve ADL's. (acute and skilled hospital setting). We are also limited on our space for opportunities for more home management or other activities. So was wondering if anyone can provide some examples of treatments they do with their patients. Generally my patients are in the hospital for TKA, THA, CVA (mild-mod), deconditioned due to pneumonia, etc. Thanks. From: spark...@rcn.com To: OTlist@OTnow.com Date: Mon, 13 Jul 2009 12:30:41 -0400 Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE? Being that I am new to this and my employment forces me to live in UE therex landperhaps you could give me an indication as to what I can do with this person. Others more experienced than me in the dept go with the flow. He is 500 pounds...can now walk about 50ft with someone following him in a W/C and he is able to stand aboout 2-3 min in a RW. I have done all ADL's..and although he is able to life weights in all planes he does not have the arm length to bipass his midsection to do LE dresssing. He has serious LE PN issues so he cannot use a sock aid. he has refused both a dressing stick and reacher. I have done transfers with him from W/C to bed, W/C to toilet, W/C to shower I have done standing tolerance...he likes to draw so I have him stand in front of a white boards and he draws murals for the department. He does W/C pushups. He lives alone,
Re: [OTlist] Suction-cupped grab bars
Very good to know. Thanks Susan. Do you give them any information about professionally installed grab bars, like a list of these professionals? Or do you refer them to the yellow pages? Hard to know who is trustworthy. -Original Message- From: Sue soupy...@yahoo.com To: otlist@otnow.com; OTlist@OTnow.com Sent: Tue, Jul 14, 2009 7:00 am Subject: [OTlist] Suction-cupped grab bars I work in home health and I cringe every time I see one of those suction cup grab bars in a shower area. I will not instruct patients on transfers using the suction cup grab bars. I feel they are risky. I have seen them slide along the wall; I have pulled on them and some have come off the wall. I tell my patients that I only recommend professionally installed grab bars and if they are not willing to follow my recommendations, then I recommend sponge bathing and document as such. Susan --- On Tue, 7/14/09, lucy payne lucy_payn...@live.co.uk wrote: From: lucy payne lucy_payn...@live.co.uk Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE To: otlist@otnow.com Date: Tuesday, July 14, 2009, 3:18 AM Re: suction grab rails When I worked in the community here in England we did not recommend the suction cup grab rails as there were too many risks such as they could be re-positioned in such a way as to cause more of a hinderance than=2 0a help and that they will not take as much pressure/pull/push as a permanent grab rail. Regards Lucy To: OTlist@OTnow.com Date: Mon, 13 Jul 2009 20:20:57 -0400 From: cmnahrw...@aol.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE In this case I would practice both a walk in shower and bathtub shower combo transfers. I am sure he will have either or. When the apartment is finalized, schedule a home evaluation and make sure your recommendations are well known and documented. Sounds like he will need a heavy duty shower chair or a heavy duty transfer tub bench, professionally installed grab bars, hand held shower, non slip stickers, long handled bath sponge. That reminds me of a question that I had this morning. Has anyone had any luck with suction cup grab bars. I work in acute rehab and patients often want to order them for home, but I do not get to follow up with them after their DC to determine if they actually work. I think this may be a good question for the home heatlh OTs. I read in consumer reports that the person should not put significant weight through them, and to only use them for balance. I am wondering if I should recommend them at all _ MSN straight to your mobile - news, entertainment, videos and more. http://clk.atdmt.com/UKM/go/147991039/di rect/01/ -- 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] Why OT's Should NOT Focus on the UE
Can you further explain 1. Proper placement is critical. Are you talking about certain places found in fiberglass showers that are not a good idea to place, or are you talking about proper placement that will optimize the safety during the transfer? Are there some types of showers or tubs in which the suction cup grab bars will not work? -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Tue, Jul 14, 2009 8:46 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE I would NOT recommend them unless you are there to supervise their use. On the other hand, you may make patients aware of the device while at the same time giving them precautions such as: 1. Proper placement is critical 2. Not designed to bear weight 3. Check before using etc. Also, there are different quality suction devices. I always recommend the most expensive devices. I like empowering patients to make informed decisions about devices. Be it a walker or reacher, I try leaving the final decision up to the patient/caregiver, if possible. Ron - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Monday, July 13, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE cac That reminds me of a question that I had this morning. Has anyone had cac any luck with suction cup grab bars. I work in acute rehab and cac patients often want to order them for home, but I do not get to follow cac up with them after their DC to determine if they actually work. I cac think this may be a good question for the home heatlh OTs. I read in cac consumer reports that the person should not put significant weight cac through them, and to only use them for balance. I am wondering if I cac should recommend them at all -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
Miranda, What occupations does the patient desire to improve on? Chris -Original Message- From: Miranda Hayek mltaylo...@hotmail.com To: otlist@otnow.com Sent: Tue, Jul 14, 2009 7:00 pm Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE I find the information being shared between Diane and others is helpful. I too am new to the profession and feel that we learn interventions/treatments on the job (my schooling taught me the theory of OT more than hands on!). At my job I learn from the other therapists, and find our afternoon treatments involve dowel, theraband exercises. Morning treatments involve ADL's. (acute and skilled hospital setting). We are also limited on our space for opportunities for more home management or other activities. So was wondering if anyone can provide some examples of treatments they do with their patients. Generally my patients are in the hospital for TKA, THA, CVA (mild-mod), deconditioned due to pneumonia, etc. Thanks. From: spark...@rcn.com To: OTlist@OTnow.com Date: Mon, 13 Jul 2009 12:30:41 -0400 Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE? Being that I am new to this and my employment forces me to live in UE therex landperhaps you could give me an indication as to what I can do with this person. Others more experienced than me in the dept go with the flow. He is 500 pounds...can now walk about 50ft with someone following him in a W/C and he is able to stand aboout 2-3 min in a RW. I have done all ADL's..and although he is able to life weights in all planes he does not have the arm length to bipass his midsection to do LE dresssing. He has serious LE PN issues so he cannot use a sock aid. he has refused both a dressing stick and reacher. I have done transfers with him from W/C to bed, W/C to toilet, W/C to shower I have done standing tolerance...he likes to draw so I have him stand in front of a white boards and he draws murals for the department. He does W/C pushups. He lives alone, rarely ever left his home due to his weight, microwaves all his meals, and lives on disbaility. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of Ron Carson Sent: Sunday, July 12, 2009 22:08 To: Diane Randall Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE? For me, general phy-dys practitioner's focus on the UE while disregarding the rest of the body severely hampers our professional autonomy. We MUST break free from the mold of being UE therapists! Ron - Original Message - From: Diane Randall spark...@rcn.com Sent: Sunday, July 12, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE DR I see your point...I was mistaken if I implied in my very first post that I DR told the patient that he needed UE program in order to transfer. It was DR justified to increase his overall conditioning. My inital reason for the DR post was to point out that sometimes our patients assume the things we do in DR the gym are therapy and the functional ADL's are just extras we do...which DR of course is the very opposite. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com _ Lauren found her dream laptop. Find the PC that’s right for you. http://www.microsoft.com/windows/choosepc/?ocid=ftp_val_wl_290 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com =0 A -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
Sounds like you are working him pretty hard. Hard to get around barriers when patients' refuse dressing equipment. Try a large sock aide or a soft sock aide for the pain issues of his feet. -Original Message- From: Diane Randall spark...@rcn.com To: OTlist@OTnow.com Sent: Mon, Jul 13, 2009 11:30 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE? Being that I am new to this and my employment forces me to live in UE therex landperhaps you could give me an indication as to what I can do with this person. Others more experienced than me in the dept go with the flow. He is 500 pounds...can now walk about 50ft with someone following him in a W/C and he is able to stand aboout 2-3 min in a RW. I have done all ADL's..and although he is able to life weights in all planes he does not have the arm length to bipass his midsection to do LE dresssing. He has serious LE PN issues so he cannot use a sock aid. he has refused both a dressing stick and reacher. I have done transfers with him from W/C to bed, W/C to toilet, W/C to shower I have done standing tolerance...he likes to draw so I have him stand in front of a white boards and he draws murals for the department. He does W/C pushups. He lives alone, rarely ever left his home due to his weight, microwaves all his meals, and lives on disbaility. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of Ron Carson Sent: Sunday, July 12, 2009 22:08 To: Diane Randall Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE? For me, general phy-dys practitioner's focus on the UE while disregarding the rest of the body severely hampers our professional autonomy. We MUST break free from the mold of being UE therapists! Ron - Original Message - From: Diane Randall spark...@rcn.com Sent: Sunday, July 12, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE DR I see your point...I was mistaken if I implied in my very first post that I DR told the patient that he needed UE program in order to transfer. It was DR justified to increase his overall conditioning. My inital reason for the DR post was to point out that sometimes our patients assume the things we do in DR the gym are therapy and the functional ADL's are just extras we do...which DR of course is the very opposite. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
In this case I would practice both a walk in shower and bathtub shower combo transfers. I am sure he will have either or. When the apartment is finalized, schedule a home evaluation and make sure your recommendations are well known and documented. Sounds like he will need a heavy duty shower chair or a heavy duty transfer tub bench, professionally installed grab bars, hand held shower, non slip stickers, long handled bath sponge. That reminds me of a question that I had this morning. Has anyone had any luck with suction cup grab bars. I work in acute rehab and patients often want to order them for home, but I do not get to follow up with them after their DC to determine if they actually work. I think this may be a good question for the home heatlh OTs. I read in consumer reports that the person should not put significant weight through them, and to only use them for balance. I am wondering if I should recommend them at all -Original Message- From: Diane Randall spark...@rcn.com To: OTlist@OTnow.com Sent: Mon, Jul 13, 2009 11:34 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Is it a roll-in shower, walk-in shower, tub w/ a shower, glass doors, does it have a seat, how big is the shower, does it have grab rails. Here is another problem. He had been at the SNF forover a month without a shower before he finally transfered in. I aked about his bathing facilites at home and he has a claw foot bathtub that he has not used in over a year because he cannot get into it and it is all around too small. He is renting. He is working with SS to move to another apartment. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of Ron Carson Sent: Monday, July 13, 2009 09:25 To: cmnahrw...@aol.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE I will take Chris' suggestions a little further. If the patient wants to bathe in the shower, you must 1st know the environment in which this occurs. Is it a roll-in shower, walk-in shower, tub w/ a shower, glass doors, does it have a seat, how big is the shower, does it have grab rails. These environmental issues are VERY important to the goal of showering. Also, you must understand the persons physical, mental, cognitive and social strengths and weakness. IF showering is the goal, a skilled OT looks at all factors involved in the process, identifies which are hindering success and then works on overcoming these factors. Also, if showering is the goal, it is NOT necessary to shower with the patient during every treatment session. What IS important is identifying barriers (and there are more than I listed) and then working on the most significant problem(s). If LE strength is a KNOWN limitation, then make the patient's muscles stronger. Personally, I don't do exercises. I tell patient's that's PT's job. I am not well enough trained to identify and treat SPECIFIC muscle weakness/imbalance. Instead, I ask patients to do challenging physical activity. The list of possible barriers is really endless. Two of the most common barriers patient encounter are fear and lack of competency. In these situations, a skilled OT can progress the patient by engaging them in over-achieving activity. For example, if a patient wants to shower but is afraid to step over a 4 threshold into their shower, set up a clinical situation where the patient has a 5 threshold. Provide various challenges (i.e. walker ~vs~ no walker, rail ~vs~ no rail). Practice, practice, practice is what builds competency and decreases fear. Remember, ALL therapy should require the skills of a therapist. I frequently tell patients, I am not going to do that because it does not require my skills. Ask yourself, are you doing something that an aide could be doing? If so, then you are not doing therapy! If you are sitting around bored to death, watching patients do exercise, you are not doing therapy. If you are not challenging your patients beyond their ability, you are not doing therapy. If patients are not progressing to their goals, you are not doing therapy. Therapy is a SKILL. If you are not applying skill, you are not doing therapy! Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Sunday, July 12, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE cac If you want to go by the book, then you have to key into the concept of cac task specific training. This is usually an easy concept for new cac clinicians. If you want to get better at walking go ahead and walk, if cac you want to get better at getting into a shower go ahead an get into a cac shower, if you want to get better at bathing and dressing go ahead and cac practice this as well. cac Hope this helps, cac Chris --
Re: [OTlist] Why OT's Should NOT Focus on the UE
Diane, I am not saying that an UE therex program is inappropriate. In fact it is very beneficial treatment concept in OT for individuals who have been bed bound and have experienced muscle atrophy because of the immobilization. I am saying that you need to be careful how you educate your patients, because saying that the UE exercises will help the person with their transfers and ADL is not exactly true, regardless is the person is a male and female. If you want to help them with their UE strength to facilitate transitions from sit to stand from a toilet and using the standard walker you need to have them do wheelchair push ups, sit to stands, standing with the walker, or at least scapular depression/tricep extension using a Rickshaw machine (push down machine). You then can then say why you are helping them in this area in prep for safer transfers. So he progressed from 5 to 10#? I assume then he has enough ROM in his arms to bath himself, enough ROM to donn a shirt, and enough grip to hold onto a shirt and pants. So instead of educating him about UE strength to assist him in transfers and ADL, I would educate him in the way that you desribed in your prior email because this is true in terms of research and practical thinking. There is something aboutlifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weightloss over time. Chris -Original Message- From: Diane Randall spark...@rcn.com To: OTlist@OTnow.com Sent: Sun, Jul 12, 2009 7:51 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE The patient was unable to bear weight on his legs due to PN and did not have the strength to hold his weight up in a RW, he also could not stand beyond 5 seconds without his knees buckling as he is close to 500 pounds. He worked up from 5 to 10 llb weights in all planes per day and he was a very debilitated when he arrived, using a hoyer. The UE therex at least boosted his confidence to be able to do this transfer along with improvemnents in standing tolerance and walking with PT. UE therex is not all he does in therapy but I have noticed, especially with men, that they tend to perform ADL's better when they feel therapy includes an overall strengthening program. He even keeps some weights in his room. There is something about lifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weight loss over time. He has lost a significant amount of weight and he seems very motivated. Straight ADL's can be a source of stess for very proud men. Most of my patients are in therapy for debility. While it is not appropriate for everyone, I feel that in this case it was justified, even if as you say the UE program did not contribute significantly to his ability to transfer when is comes to to strength alone. It my opinion, the UE program is more of a holistic approach than a biomechanical one in this case. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Sunday, July 12, 2009 07:32 To: OTlist@OTnow.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Diane, I hate to be the devil's advocate, but because I veiw you as a very compassionate young clinician, I think you might benefit from my suggestions. With that being said, I am not sure that your UE strength exercises helped this person with their ability to transfer into a shower or complete bathing and dressing easier. Now I am not saying that the UE strength program had no therapeutic benefits whatsoever, like for overall strength and possibly functional endurance, but I doubt if it helped him in the way that you think. If this was the patient's first time with you in the shower, how do you know that he couldn't have done this his first week? I think I remember you saying that you are a COTA. If this is true, did the OT specifically evaluate these abilities or did the therapist simulate or extrapolate concepts during the evaluation? What UE strength exercises did you work on in treatment? I am assuming that you worked on the typical theraband, dowel rod, or dumbell exercises that focus on isotonic strength. If this is true, then based on the literature there is no established evidence or even any associations for functional improvements in this area. And practically speaking, most clinicians do not strengthen the correct muscles that are even in the ball park when talking about functional mobility. When I strengthen for functional mobility, I work on the patient's core stability, the scapular depressors, and the triceps. Now when you work on such muscle groups it is wise to strengthen the antagonist muscle
Re: [OTlist] Over Utilization of PT in Home Health
...home care area the ratio is 3 to 1 in favour of OCCUPATIONAL THERAPY if we have a PT at all. The situation is reversed in acute care. I think this is as it should be. I agree with Joan. I also think that it should be 1:1 in acute rehab hospitals. Patients get three hours of therapy per day and it is usually divded into half OT and half PT, unless ST is involved. Because of the specific guidlines set by CMS, there are very few single leg hip and knee replacements anymore, but there should only be complex orthopedic cases with significant medical issues. As a result there are many issues that OTs can address with each patient. The government is also frowning upon group therapy in which the patients' do not have a reasonable reason to be in it (staffing issues does not count). Along with that, doubling patients is beginning to be frowned upon. There really is no a excuse anymore why OTs are only completing UE strength training as the only modality in therapy. In my opinion this pattern begins as a student, in the level II Fieldwork. I have had many students over the years, and they are amazed at what I do with patients compared to their other experiences. Chris -Original Message- From: Joan Riches jric...@telusplanet.net To: OTlist@OTnow.com Sent: Sat, Jul 11, 2009 1:20 pm Subject: Re: [OTlist] Over Utilization of PT in Home Health Ed Are you in Canada? I'm interested in where you got the Canadian stats. In this rural home care area the ratio is 3 to 1 in favour of OCCUPATIONAL THERAPY if we have a PT at all. The situation is reversed in acute care. I think this is as it should be. I also have a theory on why PT is better known. We more often deal with people who have multifactorial presentations and/or are marginalised for some reason - old, poor, disabled, mentally ill, who are not as able to problem solve through their own rehab as the active demographic in their productive years. Most people have had some contact with a PT either themselves or through others they know and most of these people do not need occupational therapy to continue or resume their usual everyday lives. Ron's stories of the clients who have been exposed to OTs 'going mindlessly through the motions' so some employer can collect payment in wasted health care dollars make my heart sick. Blessings, Joan -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ed Kaine Sent: July 10, 2009 3:01 PM To: OTlist@otnow.com Subject: Re: [OTlist] Over Utilization of PT in Home Health Hi All; If not in a name... then what? Is PTs service and skill set that much superior to OTs that it warrants about a 3 to 5 fold bias from OT to PT in nearly every setting? Your facility is probably fairly average in the 3 to 15 ratio... and that is home care. In the USA OTs are most plentiful treating pediatric populations... in Canada there is not this strong support for OT. In most settings there there are at least twice as many PTs as OTs. I'm not trying to be rhetorical here... I'm serious... I can't understand it if it's not due to our incomprehensible name. I think PT's title is just so obvious in what they can offer and why go to an OT if you're retired? I got this one again today. Administration puts their money where they expect volume and return on investment. In my opinion OT is more efficient at getting functional outcomes... but we are not known. Occupation means what it means... not what we say it means (unless it did, then it would). I think the concept is useful and we should try to get the word known, the definition expanded, but my Blog challenge cannot get it to happen, not within a year or even several. I'd really like your thoughts on the why PT is so successful and we are so not. Yours, Ed -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com Checked by AVG - www.avg.com Version: 8.5.375 / Virus Database: 270.13.9/2229 - Release Date: 07/10/09 07:05:00 Checked by AVG - www.avg.com Version: 8.5.375 / Virus Database: 270.13.9/2229 - Release Date: 07/11/09 05:57:00 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] A Vision For Patients?
Sounds like the man has given up on life. Perhaps he has no goals because he has no expectations of getting better. Perhaps you can show him the way on a few self generated goals, and then watch out the flood gate of goals may come open. Sad that the prior OTs only focused on UE ROM. Sounds like a waste of time. I usually use this concept to continue neuromotor training: If a patient has no movement in the flaccid arm (absolutely no movement) in a reasonable amount of time, then I train the patient and family on keeping the arm comfortable. I then move on to more reasonable and achievable goals. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist@OTnow.com Sent: Sat, Jul 4, 2009 2:16 pm Subject: [OTlist] A Vision For Patients? Do you ever sit back and envision a new life for your patients? Do you imagine how patients' lives can be after therapy is done? While fishing today, a patient I just evaluated crossed my mind and I wondered how I could improve the quality of his life. How I could make a life for this person. I developed a vision of how this many might live his life. BUT, this is my vision, not his. In the two meetings I've had with the patient, he's not verbalized any goals or passions. This middle aged man experienced a stroke about 12 years earlier. It left him severely impaired. He is essentially dependent for all self-care. He is unable to unable to do almost anything for himself. The man has received countless hours of therapy since his stroke. Based on reports from caregivers, past OT's have focused on ROM for the patient's UE. At my last appointment, I asked the patient what are your goals?, what do you want to do with your life? The caregiver, who has been with the patient 5x/week for 1 year, stated that no therapist had ever asked the patient what HIS goals were. If true, that's a pretty sad statement about the OT's who came before me. But that's another message. I am seeing this man 5x/week and I want to get inside his brain and help him figure out how he wants the rest of his life to play out. I'm sure he wishes that this nightmare would just end, but the sad reality is that he will probably spend the rest of his life in a wheelchair. I told him that there was nothing I could do to make a substantial improvement in his physical condition. I told him that my job is teaching people how to take care of themselves and be productive. At the moment, self care is out of question, but productivity has lots of possibility. But, I want to get this thing right. I want to ensure that I am on the same page as the patient. What if the patient has no goals? What if he just doesn't care and has given up? What if he has no vision for his life? Can one person give another person a vision? Can I show this man that his life may never be the way it was, but that it can be better than right now? Help me find a vision for this man!! Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] A Vision For Patients?
I most certainly address the LE. Usually it is through practice of occupations, but occasionally I will work on specific leg movements and standing balance in order to eventually achieve an occupational goal. I only mentioned flaccid arm, because that is what the prior OTs worked on with the patient you mentioned. Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Sat, Jul 4, 2009 9:45 pm Subject: Re: [OTlist] A Vision For Patients? Thanks Chris. I concept of getting better is difficult to define and envision. But, I understand what you are saying. And yes, it is possible he's given up. Now, this is a loaded question. You mention only a flaccid arm is that because you don't address the LE? - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Saturday, July 04, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] A Vision For Patients? cac Sounds like the man has given up on life. Perhaps he has no goals cac because he has no expectations of getting better. Perhaps you can cac show him the way on a few self generated goals, and then watch out the cac flood gate of goals may come open. Sad that the prior OTs only focused cac on UE ROM. Sounds like a waste of time. I usually use this concept to cac continue neuromotor training: If a patient has no movement in the cac flaccid arm (absolutely no movement) in a reasonable amount of time, cac then I train the patient and family on keeping the arm comfortable. I cac then move on to more reasonable and achievable goals. cac Chris Nahrwold MS, OTR cac -Original Message- cac From: Ron Carson rdcar...@otnow.com cac To: OTlist@OTnow.com cac Sent: Sat, Jul 4, 2009 2:16 pm cac Subject: [OTlist] A Vision For Patients? cac Do you ever sit back and envision a new life for your patients? Do you cac imagine how patients' lives can be after therapy is done? While fishing cac today, a patient I just evaluated crossed my mind and I wondered how I cac could improve the quality of his life. How I could make a life for this cac person. I developed a vision of how this many might live his life. cac BUT, this is my vision, not his. In the two meetings I've had with the cac patient, he's not verbalized any goals or passions. cac This middle aged man experienced a stroke about 12 years earlier. It cac left him severely impaired. He is essentially dependent for all cac self-care. He is unable to unable to do almost anything for himself. The cac man has received countless hours of therapy since his stroke. Based on cac reports from caregivers, past OT's have focused on ROM for the patient's cac UE. cac At my last appointment, I asked the patient what are your goals?, cac what do you want to do with your life? The caregiver, who has been cac with the patient 5x/week for 1 year, stated that no therapist had ever cac asked the patient what HIS goals were. If true, that's a pretty sad cac statement about the OT's who came before me. But that's another message. cac I am seeing this man 5x/week and I want to get inside his brain and help cac him figure out how he wants the rest of his life to play out. I'm sure cac he wishes that this nightmare would just end, but the sad reality is cac that he will probably spend the rest of his life in a wheelchair. I told cac him that there was nothing I could do to make a substantial cac improvement in his physical condition. I told him that my job is cac teaching people how to take care of themselves and be productive. At the cac moment, self care is out of question, but productivity has lots of cac possibility. cac But, I want to get this thing right. I want to ensure that I am on the cac same page as the patient. What if the patient has no goals? What if he cac just doesn't care and has given up? What if he has no vision for his cac life? Can one person give another person a vision? Can I show this man cac that his life may never be the way it was, but that it can be better cac than right now? Help me find a vision for this man!! cac Thanks, cac Ron cac ~~~ cac Ron Carson MHS, OT cac www.OTnow.com cac -- cac Options? cac www.otnow.com/mailman/options/otlist_otnow.com cac Archive? cac www.mail-archive.com/otlist@otnow.com cac -- cac Options? cac www.otnow.com/mailman/options/otlist_otnow.com cac Archive? cac 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] Just About To Give UP............
I agree with Ron, but I bet the nursing home company in which you work for will not like that idea much. -Original Message- From: Ron Carson rdcar...@otnow.com To: Diane Randall OTlist@OTnow.com Sent: Wed, Jul 1, 2009 8:31 am Subject: Re: [OTlist] Just About To Give UP Hello Diane and other: Diane, I strongly believe that when a patient has no identifiable occupational goals, then they should not be seen by OT. After all, if the goal of OT is enabling people to engage in occupation and yet there are no occupational goals, then what is OT doing? More likely than not, they are doing exercises, which is wrong on two levels: 1. Does not REQUIRE the skills of a therapist 2. Is not OT Here's two patients I have today: 1. Patient is unable to care for himself because of weakness and fear of falling. We will work on standing, transfers and mobility. 2. Patient is unable to care for herself and carry out daily occupations related to her role as a wife. We will work on standing, transfers, mobility, etc. None of my interventions include focused treatment on UE, LE, strength, etc. Instead the focus is on restoring lost occupation. This is done by addressing SPECIFIC and IDENTIFIABLE problems which are preventing SPECIFIC and IDENTIFIED occupational goals. It really is a practical approach that I liken to learning to ride a bike. If a person wants to ride a bike the best way is to practice, practice, practice. Like wise, if a person wants to dress, toilet, bathe, shower, cook, clean, laundry, etc, the best approach is practice, practice, practice. I want to address some other things, but I'm off to work. Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Diane Randall spark...@rcn.com Sent: Tuesday, June 30, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Just About To Give UP DR Hello, As a new OTA/L a week into my first job in a SNF, I have become well DR acquainted with the UE focus of OT. But, I think the most frustrating part DR of the process is not some much the interventions but the fact that so many DR of my patients have really no occupation to look forward to when DR discharged from rehab. It is no wonder we may be tempted to stick with just DR UE exercises. ( besides ADL's we do in rooms) DR Question...tell me about a typical day you spend at home? DR Replies (paraphrased) DR Patient A- I just watch Soaps..my daughter does everything (cooking, DR cleaning) DR Patient B- I have not worked since I gained weight...have not left the DR house except to come here for 2 weeks...thank god for disability. DR Patient C- I don't want therapy and you can't make me go. DR patient D- The nurses do everything for me...why should I dress myself DR How can we motivate patients to value occupation when thier goals are to DR just get strong enough to go back to their lives which in many cases is DR totally dependent on others. Even simple ADL's do not seem to be a goal of DR some patients? DR I also see in some ways why UE has become so popular in SNF'sit's easy, DR it looks productive, and it can be done simultaneously with others. DR Productivity expectations have created UE ther-ex focused treatment. It is DR almost impossible to individualize OT treatment when you have 5-6 or more DR patients seeking your attention all at one time. In addition , I have DR noticed PT/OT /Speech seem to be in melting pot of therapy. I see speech do DR cognitive activities I learned in school. Sometimes the only difference you DR can really tell between an OT and PT in the gym setting is where they focus DR patient work (above or below the belt) DR HH is a little different..I would expect a HH agency to value occupation. I DR mean...it is one on one therapy for gods sakes. So much can be done in that DR setting. I would be frustrated too. We have to make a commitment to see UE DR ther-ex as a means to an end. Strength to transfer to a toilet DR independently-standing tolerance to create a simple meal in the kitchen from DR a recipe chosen by the patient). But is should never be the only focus or DR we have essentially become PT's..we all need to educate our patients about DR what we do...and sadly other professionals around us. DR -Original Message- DR From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on DR Behalf Of Ron Carson DR Sent: Tuesday, June 30, 2009 20:28 DR To: OTlist@OTnow.com DR Subject: [OTlist] Just About To Give UP DR I am just about at the end of a very long road of trying to change my DR profession. DR No one seems to value occupation as an outcome. I refuse to see DR patient's with the purpose of improving UE function so my HH agency just DR calls other OT's who will. PT's don't appreciate occupation but it DR encroaches on their treatment. My agency is clueless about occupation DR and has no
Re: [OTlist] Dental Hygienst Knows About OT...
Ron, I agree with with 95% of what you are saying the only things that I disagree with are: I concede that it is not occupational therapy, but we should not call it PT either. Gray area of practice. 1. It is not UE PT. It is UE therapy. I concede that it is not occupational therapy, but we should not call it PT either. Gray area of practice. 2. It is not always a waste of time, but I agree that most of the time for most clinicians it is a waste of time. It is only meaningful if the therapist knows what they are doing and only does it when there is an impairment, and not to fill time. Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Sun, Jun 14, 2009 5:41 am Subject: Re: [OTlist] Dental Hygienst Knows About OT... Chris, I do not feel like I'm straddling the fence. When I do lymphedema treatment, that is EXACTLY what I'm doing. I am NOT doing OT. I feel that same about hand therapy, driver training, etc. These specialized roles (especially ones that are discipline independent (e.g. lymphedema, hand therapy) are so far removed from mainstream OT that they should not be referred to as OT. I have NO problem with OT's doing UE therapy, but that is what they should call it. My problem is that the vast majority of OT's that I know practice neither impairment-based nor occupation-based therapy. Instead, they practice an amalgam of both which is really just mush. I ask my patients if they had OT before seeing me. The majority say yes. I ask them what the OT did. The VAST majority indicate UE function. I ask them if is was effective in helping reach their goals. The majority just sort of shrug and roll their eyes. THIS IS MY EXPERIENCE about OT. It is my opinion that the MAJORITY of people having knowledge and interaction with adult phys dys OT think one of two things: 1. It's UE PT 2. It's a waste of time. Neither of these are acceptable to me. I want people to see OT as the profession that restored their lives. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Saturday, June 13, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Dental Hygienst Knows About OT... cac Ron, cac Not sure where the disagreement is found Chris, so of what you say is cac correct, but much isn't cac So it is ok to step out of your traditional role as an OT to complete cac lymphedma treatment, but it is not ok to step out of the traditional cac role as an OT to complete UE orthopedic treatment? Seems to me you are cac on both sides of the fence, but for some reason you cannot stand UE cac impairment based treatment. cac Chris cac -Original Message- cac From: Ron Carson rdcar...@otnow.com cac To: cmnahrw...@aol.com OTlist@OTnow.com cac Sent: Sat, Jun 13, 2009 3:07 pm cac Subject: Re: [OTlist] Dental Hygienst Knows About OT... cac Hello All: cac Chris, so of what you say is correct, but much isn't. cac I am 100% for treating physical disabilities as they impair occupation. cac However, my experience is that MOST (almost 100% is my guess) ONLY TREAT cac the UE as it relates to occupation. That to me is WRONG for patients and cac wrong for our profession. cac I agree that true hand therapy is a gray area and as you mention, can cac be done by OT or PT. In these cases I prefer to think the person is cac doing hand therapy, not OT or PT. At some point, any professional can cac move so far away from their practice paradigm that they are no longer cac practicing their profession. This is almost never a clear cut line. cac However, hand therapy is not a real concern for me. What does bother me cac is that most OT's who I know that work in adult phys dys practice like cac hand therapists, but without the advanced skills. In my experience, OT cac is known as UE hand therapy. Almost EVERY experience that people relate cac to me about OT is hand/UE related. I almost NEVER hear about an OT cac giving people back their lives, or restoring occupation, etc. cac In my opinion, despite a significant change in AOTA's literature, almost cac nothing has changed in adult phys dys practice. Today, OT use the word cac occupation, but that's about it. They don't really practice occupation cac based therapy because if they did, most of them would not be focused on cac the UE. cac In my home health company, I refuse to treat UE injury UNLESS the cac patient is FOCUSED ON IMPROVING OCCUPATION. Initially this caused a cac significant rift for my employer but they have accepted it and worked cac around it by referring such patients to other OT's. But, this does not cac mean I don't treat PEOPLE with UE injury. In fact, I just d/c'd such a cac person. cac It is my SINCERE (and I mean SINCERE) desire to see the profession of OT cac
Re: [OTlist] Dental Hygienst Knows About OT...
Ron, Not sure where the disagreement is found Chris, so of what you say is correct, but much isn't So it is ok to step out of your traditional role as an OT to complete lymphedma treatment, but it is not ok to step out of the traditional role as an OT to complete UE orthopedic treatment? Seems to me you are on both sides of the fence, but for some reason you cannot stand UE impairment based treatment. Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Sat, Jun 13, 2009 3:07 pm Subject: Re: [OTlist] Dental Hygienst Knows About OT... Hello All: Chris, so of what you say is correct, but much isn't. I am 100% for treating physical disabilities as they impair occupation. However, my experience is that MOST (almost 100% is my guess) ONLY TREAT the UE as it relates to occupation. That to me is WRONG for patients and wrong for our profession. I agree that true hand therapy is a gray area and as you mention, can be done by OT or PT. In these cases I prefer to think the person is doing hand therapy, not OT or PT. At some point, any professional can move so far away from their practice paradigm that they are no longer practicing their profession. This is almost never a clear cut line. However, hand therapy is not a real concern for me. What does bother me is that most OT's who I know that work in adult phys dys practice like hand therapists, but without the advanced skills. In my experience, OT is known as UE hand therapy. Almost EVERY experience that people relate to me about OT is hand/UE related. I almost NEVER hear about an OT giving people back their lives, or restoring occupation, etc. In my opinion, despite a significant change in AOTA's literature, almost nothing has changed in adult phys dys practice. Today, OT use the word occupation, but that's about it. They don't really practice occupation based therapy because if they did, most of them would not be focused on the UE. In my home health company, I refuse to treat UE injury UNLESS the patient is FOCUSED ON IMPROVING OCCUPATION. Initially this caused a significant rift for my employer but they have accepted it and worked around it by referring such patients to other OT's. But, this does not mean I don't treat PEOPLE with UE injury. In fact, I just d/c'd such a person. It is my SINCERE (and I mean SINCERE) desire to see the profession of OT embrace occupation. I will continue beating this horse until I give up or die. And I mean that with all my heart. - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Saturday, June 13, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Dental Hygienst Knows About OT... cac I see the horse is not dead yet cac This age old debate revolves around the top down approach and the cac bottom up approach to treatment, or the occupation as a means or an cac end. We as OTs in physical disabilities can choose either to treat cac occupational dysfunction in two ways a) Use occupations as the cac treatment modality to combat the issue of occupational dysfunction cac either through restoration or compensation or b) Treat the underlying cac impairment. In my opinion it simply depends on what is causing the cac occupational dysfunction. If an occupational takes an interest in hand cac therapy and they decide to specialize in this area (PTs can do this cac too) then I would say that the occupational therapist is doing hand cac therapy. I would not state that they are doing physical therapy cac because this is a gray area. Perhaps a physical therapist takes an cac interest in visual perceptual training ( my PT friend did) because of cac their strong background in neurorehabilitation. When they utilize this cac training during treatment sessions to facilitate better outcomes with cac gait and balance, would they state that they are doing occupational cac therapy? What if a PT takes a liking to driving evals and training cac (IADL),. Would they call it occupational therapy or drivers training? cac What Ron is simply trying to do is change the paradigm of occupatonal cac therapy and simply rewrite the textbooks we once read in school, by cac erasing the biomechanical model. I applaud him to a certain extent, cac but at times I an confused by his reasoning. cac Hand Therapy does not necessarily mean a cone or peg pusher therapist. cac A Hand therapist does not necessarily give the pubilic a certain image cac of what OT is , but it is the misguided therapist that provides OT cac without meaning in order complete enough time to reach a certain RUG cac level or complete the Three hour rule. I do not think it is Ron's cac intent to upset all of the OTs who practice hand therapy, but to guide cac phys dys OTs to provide meaning during their therapy sessions in order cac to clean up the public perception of what we do. cac Chris
Re: [OTlist] Dental Hygienst Knows About OT...
I see the horse is not dead yet This age old debate revolves around the top down approach and the bottom up approach to treatment, or the occupation as a means or an end. We as OTs in physical disabilities can choose either to treat occupational dysfunction in two ways a) Use occupations as the treatment modality to combat the issue of occupational dysfunction either through restoration or compensation or b) Treat the underlying impairment. In my opinion it simply depends on what is causing the occupational dysfunction. If an occupational takes an interest in hand therapy and they decide to specialize in this area (PTs can do this too) then I would say that the occupational therapist is doing hand therapy. I would not state that they are doing physical therapy because this is a gray area. Perhaps a physical therapist takes an interest in visual perceptual training ( my PT friend did) because of their strong background in neurorehabilitation. When they utilize this training during treatment sessions to facilitate better outcomes with gait and balance, would they state that they are doing occupational therapy? What if a PT takes a liking to driving evals and training (IADL),. Would they call it occupational therapy or drivers training? What Ron is simply trying to do is change the paradigm of occupatonal therapy and simply rewrite the textbooks we once read in school, by erasing the biomechanical model. I applaud him to a certain extent, but at times I an confused by his reasoning. Hand Therapy does not necessarily mean a cone or peg pusher therapist. A Hand therapist does not necessarily give the pubilic a certain image of what OT is , but it is the misguided therapist that provides OT without meaning in order complete enough time to reach a certain RUG level or complete the Three hour rule. I do not think it is Ron's intent to upset all of the OTs who practice hand therapy, but to guide phys dys OTs to provide meaning during their therapy sessions in order to clean up the public perception of what we do. Chris Nahrwold MS, OTR.. -Original Message- From: Ron Carson rdcar...@otnow.com To: Kristin OTlist@OTnow.com Sent: Fri, 12 Jun 2009 10:04 pm Subject: Re: [OTlist] Dental Hygienst Knows About OT... Kristin, I don't really know where to start, so let me just jump in. In my opinion, the BIGGEST problem facing OT is that we do not do what we say we do. Comparing AOTA's rhetoric and practice patterns of adult phys dys OT's does not paint a congruent picture. On paper, the OT profession is all about occupation. In practice, adult phys dys is all about UE rehab. For me, this inconsistency is killing our profession! I'm going to disagree with some of what you've written: 1) A broken finger may or may not cause occupational deficits. And even if it does, these deficits may not require the skill of an OT. 2) I don't care if the hygienist had a good or bad experience. I do care if the experience revolved around occupation. 3) Occupation should NOT be things talked about during rote therapy. Occupation should be the FOCUS and outcome of treatment. 4) The profession needs therapists who are experts in occupation. Leave the UE specialization to PT. Disclaimer: My comments are not directed towards YOU. They are just general comments about how I feel towards OT. Everyone is welcome to join this conversation. Only through honest and logical dialogue will we better understand and appreciate everyone's viewpoints. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: Kristin kay42...@yahoo.com Sent: Thursday, June 11, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] Dental Hygienst Knows About OT... K I guess I dont understand why it's such a horrible thing for OT's to K be knowledgeable and profiecient in treating UE ailments. I agree K that shouldn't be the only area for the profession to focus on, but K having a broken finger causes dysfunctional occupational performance! K At least the dental hygenist had a good experience with OT as opposed K to the 'cone therapists'. I would be interested to hear if the K therapist discussed what the patient could do at home to reduce pain K and improve function. The things we should be talking about when K performing more rote therapy techniques. K I think the profession needs OT's who are UE specialists! We don't K want to loose that specialty area! K Kristin -- 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] Healing the Splintered Mind
You go Ron! -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist@OTnow.com Sent: Mon, 27 Apr 2009 10:04 pm Subject: [OTlist] Healing the Splintered Mind From Advance for Directors in Rehabilitation, Vol 18, No.4 Here's a great quote from the article on page 33: the role of a therapist must expand beyond traditional objectives to a view that allows clients to return to community ambulation and a satisfying, productive life. This requires a thorough understanding of the 'whole person' - a patient with unique physical, cognitive, emotional , social and spiritual characteristics. A holistic treatment plan can address these comprehensive issues and define primary roles for therapists across disciplines. This is a great description of how OT should be. Too bad this is written by a PT about PT! I left one word of out the quote's 1st line, it actually reads: the role of a PHYSICAL therapist... Once again, as adult phys dys OT's are stuck in the STUPID role of being crappy upper extremity PT's, the PT's are starting to do what we should already be doing! I sometimes think we are the dumbest profession on the face of the earth. How did we ever make it this far? How and why are 1,000's of OT standing around with their thumbs up their nose wasting money and time doing non-necessary, non-skilled, UE exercises while patients can't get from point A to point B to do the things they want? That slogan of PT teaches you how to walk and OT teaches what to do when you get there is dumb. It's dumb because patients do not care what they are going to do when they get there! They primarily care about getting there! For a long time, I've said that OT should be the mobility experts and the above quote is EXACTLY why. We, yes OT, is the best profession to look at the multiple factors inhibiting and contributing to successful engagement in mobility-related occupations. Why must PT see that mobility is much more than gait but OT refuses to recognize that occupation involves gait. Can I teach a person to get from point A to point B? Sure. Do I get overly involved in the correct procedure of toe off, swing through, etc? No. That's PT! Do, I worry about causing injury from improper gait? Sure! Do I do stretching and LE exercises? Only to show the patient, the rest I leave up to PT. See, I think PT needs to stay in their well-defined role of being PHYSICAL therapists. They are the EXPERTS on physical dysfunction. Strengthening, ROM, pain - these are PT's domain. On the other hand, OT's domain is OCCUPATION. It's the doing of daily activity from going pee to cooking a meal to driving a car. It's the rich world of making our lives worth living. It's the utterly complex and at time overwhelming treatment realm of physical, mental, emotional, social and environmental all rolled up into one big ball of string! It's a WONDERFUL place for and OT to call home! You know, OT needs to heal OUR splintered mind! 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
[OTlist] Positive comment of the day
Have a patient in rehab this week who has parkinson's disease and suffered a fall while gathering a drink out of the fridge.. Yesterday we made a list of all of the occupations he wants to be able to do in order to make it home and to improve his quality of life again. So far we have the basics like showering, dressing, laundry, loading the dishwasher, and getting a drink out of the refridgerator. Well today his wife came to therapy and was very happy to see her husband engaging in such activity. She states that she now understands why his depression has lifted a bit since yesterday. Very interesting comment. Could it be the antidepressive drugs or the engagment in occupations that give the patient hope to return to a regular life again? Hopefully a combination of both. Chris Nahrwold MS, OTR -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even
Arley. Good points. Thanks for bringing me back to reality. -Original Message- From: Johnson, Arley arley.john...@uphs.upenn.edu To: OTlist@OTnow.com Sent: Fri, 24 Apr 2009 8:17 pm Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Having some experience with a RAC review a few years ago, they will go after anything to deny payment. I don't know if CMS fixed their incentive loophole, but they would get a percent of whatever amount they denied. If the facility appealed the denials(80% turnover rate) and won, the RAC would still get paid their cut. At the time, my OTs did plenty of UE ther ex (which I disliked, but that's another convo) with the joint replacement patients, but the RAC never mentioned that in our reason for denials. That leads me back to my initial statement that they will hunt for anything in the chart to get a denial. To expand, they were inconsistent with their reviews. One patient had unstable hgb levels, UTI and newly diagnosed diabetes. They said she did not demonstrate a need for 24 hr medical supervision,but yet they approved a straight forward unilateral TKR with no acute illnesses. Go figure. To conclude, we shouldn't get so bent on that one experience as the fall of OT. :-) These reviewers aren't always the sharpest pencils in the bunch. Arley Johnson, MS, OTR/L Site Manager, Pennsylvania Hospital Rehabilitation Services From: otlist-boun...@otnow.com on behalf of cmnahrw...@aol.com Sent: Fri 4/24/2009 5:04 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even PatJoan, I do not think you understand. Medicare (our government payor source for the elderly)is now not allowing general debility patients into acute rehab period. We used to have this 75% rule in which 75% of our cases had to match a certain diagnois (stroke, spinal cord, etc), and the other 25% could be whatever diagnosis. Now Medicare CMS is auditing charts and making rehab facilities pay back millions of dollars finding that the patients were not appropriate to be there. Several cases she explained was that the OT did not have enough documentation to support that they truly needed OT. Her claim was that a general debility patient would not need OT for arm exercises. When a person has 5/5 strength and the therapists complete UE exerise and group therapy all day long that is totally inapproriate. We need to complete ADLs during the first three days of their stay to document the need for skilled OT and then actually work on those issues during their stay to demonstrate improvement on the FIM. The funny thing is the patients improve much faster when we take an occupational approach. It is not rocket science. Bottom line is that patients need to get up of the the wheelchair and get moving by engaging in their daily occuapations in the way they plan on completing them at home. We OTs need to speak up to the OTs who are screwing our profession up. I am sure AOTA is aware of these issues because these Medicare RACK audits is a hot topic in rehab right now. -Original Message- From: Joan Riches jric...@telusplanet.net To: OTlist@OTnow.com Sent: Fri, 24 Apr 2009 2:32 pm Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Have you reported this with names and details to AOTA for follow-up? What was the result of the debate? Will this person continue the blanket refusal of all OT? Targeted refusals of UE exercise without specific rationale and a UE diagnosis might go a long way to changing practice. I wonder how widespread this is in Canada. I did see it 25 years ago as a student. It definitely does not happen in this area. All the OTs are far too busy too waste time that way. Joan Riches B.Sc.O.T., OT(C) Specialist in Cognitive Disability Riches Consulting High River, Alberta, Canada 403 652 7928 -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of cmnahrw...@aol.com Sent: April 23, 2009 8:12 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Listened to a medicare teleconference describing why CMS is denying debility patients from acute rehab stays. When asked why this is so, the medicare communicater stated that they did not have medical necessity for occupational therapy. When debating this issue and how occupational therapy works on a debility patient's occupations, the communicator stated that she thought that all we did was UE exercise. I guess from all of her chart audits she has concluded this over the years. I am starting to slowly see Ron's point of view even clearer now. I now am recognizing that this is more of a standard practice than I thought. I think we really need to focus on occupations when the goal is to get the patient home or to improve their quality of life. I think it is ok to work on UE strength, fine motor control
Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even
Listened to a medicare teleconference describing why CMS is denying debility patients from acute rehab stays. When asked why this is so, the medicare communicater stated that they did not have medical necessity for occupational therapy. When debating this issue and how occupational therapy works on a debility patient's occupations, the communicator stated that she thought that all we did was UE exercise. I guess from all of her chart audits she has concluded this over the years. I am starting to slowly see Ron's point of view even clearer now. I now am recognizing that this is more of a standard practice than I thought. I think we really need to focus on occupations when the goal is to get the patient home or to improve their quality of life. I think it is ok to work on UE strength, fine motor control to an extent especiallly when the imparment is effecting the individual on a disability level, but the focus needs to be on the skills that will allow the patient to go home safelyl. I believe that this move by medicare CMS will slowly trickle down into other areas of our care. We need to start now to force our other therapists to treat as occupational therapists not cone and peg pushers. Managers need to initiate policies that address these issues now, -Original Message- From: Ron Carson rdcar...@otnow.com To: ocil...@comcast.net OTlist@OTnow.com Sent: Thu, 23 Apr 2009 8:24 pm Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Hello Ilene: I appreciate your message! In this case, the pain was caused by probably joint misalignment resulting from paralysis of the shoulder girdle. I believe I did assist this patient by providing him my opinion on his shoulder pain, and referred him to an ortho MD. I am pretty confident that this patient understood occupation and OT. Well, at least it was explained to him. In fact, he was discharged because his only stated goal was, walking like a man. Thanks again! Ron - Original Message - From: ocil...@comcast.net ocil...@comcast.net Sent: Wednesday, April 22, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even ocn Ron, IMO there were many things an OT could have done to assist ocn that patient even without directly treating his arm. Pain disrupts ocn occupational function in all areas. We can work with chronic pain ocn patients to learn relaxation techniques. We can educate them and ocn their caregivers on how to prevent further pain and deformity (many ocn times CVA patients do make things worse because of dysfunctional ocn strageties they develop to perfom self-care, poor arm placement ocn during transfer, etc) We can help them learn how to find a chronic ocn pain support group or how to find assistive devices on the ocn internet. I think patients really have no idea all that OT offers, ocn nor often what occupation really is. The best way to get OT's out ocn of the UE box, is to show them what we CAN do for them, rather ocn than say there is nothing we can do, refer to PT for a patient like that. ocn ~Ilene Rosenthal, OTR/L ocn From: Ron Carson rdcar...@otnow.com ocn Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even ocn Possible? ocn To: OTlist@OTnow.com ocn Date: Monday, April 20, 2009, 4:06 PM ocn Hello All: ocn A couple weeks ago, I worked with a CVA patient who despite having ocn multiple occupational deficits, he was unwilling to verbalize any ocn OT-related goals. And after a couple of weeks, the patient was d/c'd. ocn The patient's UE and LE were compromised by the CVA. He had almost no ocn active movement in his affected arm. His shoulder was extremely painful ocn during any AROM. ocn I initially told the patient that as an OT, I would address his most ocn important occupations but that I could do nothing about his arm. Over ocn the? course of? treatment, his wife reported having difficulty bathing ocn under the patients arm. After doing some gentle PROM, I concluded that ocn there was a possible impingement. I believed an orthopedic appointment ocn was necessary. I conferred? with the PT and? she concurred. I ocn also ocn confirmed that the treating PTA would address ocn the shoulder ocn ROM/Pain. ocn -- ocn Options? ocn www.otnow.com/mailman/options/otlist_otnow.com ocn Archive? ocn www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible?
Lets face the facts. Most PTs do not know how to treat stroke shoulder dysfunction. Most OTs do not know how to properly treat stroke shoulder dysfunction. They think they can, but most of them do a botched up waste of time job. It is a specialized skill, that warrents continued education. It is beyond crazy busy for an OT with education in this area, because most clinicians in both the field of OT and PT do not feel comfortable with it and will gladly refer their patients to you. -Original Message- From: Carmen Aguirre caguirr...@msn.com To: otlist@otnow.com Sent: Tue, 21 Apr 2009 6:12 pm Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? I think treating the shoulder seemed to be warranted given the limitations it brough about to pt's and caregiver routines at home. It seemed to be related to safety, prevention of further limitation in his adl's or caregivers ability to care for him appropriately. Techniques applied such as bilateral integration, re-education during those adl tasks the caregiver seemed to be having difficulty with. Thanks Carmen Date: Mon, 20 Apr 2009 19:06:29 -0400 From: rdcar...@otnow.com To: OTlist@OTnow.com Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? Hello All: A couple weeks ago, I worked with a CVA patient who despite having =0 A multiple occupational deficits, he was unwilling to verbalize any OT-related goals. And after a couple of weeks, the patient was d/c'd. The patient's UE and LE were compromised by the CVA. He had almost no active movement in his affected arm. His shoulder was extremely painful during any AROM. I initially told the patient that as an OT, I would address his most important occupations but that I could do nothing about his arm. Over the course of treatment, his wife reported having difficulty bathing under the patients arm. After doing some gentle PROM, I concluded that there was a possible impingement. I believed an orthopedic appointment was necessary. I conferred with the PT and she concurred. I also confirmed that the treating PTA would address the shoulder ROM/Pain. Last Friday, I received a new referral for this same patient. When I questioned it, I was told that: ...[PT saw the patient] and he has some issues so nursing went back in and she felt OT needed back in also so we received an order to do an eval and treat. Based on this my ever so sweet scheduler made an appt with the patient. At this point I had no idea why OT was called back in but suspected it was an arm thing. Just by coincidence, before my scheduled appointment, I ran into the treating PTA. When I asked her about the referral she confirmed that the PT wanted OT to address the patient's arm. The PTA said that they thought a different OT than myself would be sent to the patient. And if fact, I was later called by my homehealth office and advised that I didn't need to see the patient because it was an shoulder thing and they understood that I don't do shoulders. I've written countless paragraphs about breaking the 'band of UE therapy', but at this point, I'm thinking it may not even be possible. What is the message when one OT says no to focused shoulder treatment while others cordially say yes. Heck, at this point I'm confused! Sadly yours, 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 _ Windows Live™ Hotmail®:…more than just e-mail. http://windowslive.com/online/hotmail?ocid=TXT_TAGLM_WL_HM_more_042009 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] AOTA's BRAN Bus
That is the key to the President's statement. We must start. If that does not occur we can forget it. Not sure what they have planned for this aspect. It would be a good question to ask her on her blog. -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Wed, 15 Apr 2009 7:33 am Subject: Re: [OTlist] AOTA's BRAN Bus In my opinion, the AOTA's president's own quote clearly shows that branding will not work for OT. She says: Branding actually starts with the occupational therapy practitioner in that all practitioners must ensure their servicesare efficient, effective, result in client satisfaction, and have value in terms of the cost-benefit. Right off the bat, we KNOW that ALL practitioners do NOT provide effective occupational therapy resulting in patient satisfaction. The coners and peggers ensure this doesn't happen! In my honest opinion of OT, our single biggest problem is INTERNAL, not external. As a profession, we do NOT do what we say. And NOTHING will kill a product or profession more quickly and efficiently than not delivering what is promised and/or promoted! The more the branding process proceeds the more we are shooting ourselves in the foot. The more we promote living life to it fullest while delivering crappy PT the more disenchanted our patients and referral sources become and the practice of phsy-dys OT will become even more disenfranchised! Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Wednesday, April 15, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] AOTA's BRAN Bus cac Here is a quote from the AOTA president that supports my statements cac As a profession, we seem to understand marketing more than we cac understand a branding process. Branding is about building the emotional cac reaction to a product or service over time. Branding actually starts cac with the occupational therapy practitioner in that all practitioners cac must ensure their services are efficient, effective, result in client cac satisfaction, and have value in terms of the cost-benefit. Branding cac starts with ensuring a basic level of competence, as well as making cac sure that every practitioner can deliver the message of what we do. We cac all know that this is difficult given all the different types of cac services we provide and the client problems that we solve. cac Therefore, branding is not about a single tag line, poster, etc. It is cac really about capturing the essence of our impact. Marketing we have cac done before with the posters about skills for the job of living. It cac described occupational therapy as a discipline where practitioners cac worked with people with a disabling condition to do things like brush cac their hair, etc. This was a great one-time marketing campaign, it was cac not a branding process. Granted occupational therapy is about getting cac people back to doing; but, when we did the marketing research some 8 cac years later with our consumers and potential consumers, the good news cac was that we did not have a bad image. The bad news was that we did not cac have an image. Perhaps likening living to a job did not emotionally cac resonate with our consumers.-Moyers -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] NEED HELP WITH PATIENT
Ron, How does she currently perform in the kitchen (min/mod/ max assist/or verbal cues?). If the patient had completed the cooking prior to the dementia it is possible that this will be an automatic task for her like bathing and dressing is still generrally easy for her. I would then find something in the kitchen for her to be able to complete so the patient's husband goal of able to help out in the kitchen would be clearly addressed. There has to be something she can do to help in the kitchen that is safe and relatively simple. Are there any key dementia problems in which you could address or educate the clients on? 1) wondering 2) agitation 3) reluctance to shower or dress 4) reluctance to take her meds 5) other neurobehavioral issues. Chris Nahrwold -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist@OTnow.com Sent: Mon, 13 Apr 2009 5:08 pm Subject: [OTlist] NEED HELP WITH PATIENT I evaluated a home health patient and I need help determining if OT is indicated. The patient's primary diagnosis is Alz. dementia. She also was recently d/c'd from the hospital secondary to a non-healing brown recluse spider bite, s/p 5 years ago. Her score on the SLUMS cogn screen is a 6/30, indicating mod-severe dementia. She lives with her husband, who is healthy but has had two recent falls in their modular home. The husband does all the housework, cooking and driving. The patient performs her own basic selfcare with supervison. She req. occasional asst. with sequencing for dressing. The patient reports she is an active reader. She attends church services every Sunday. The patient has no stated goals. She reports being happy and content with her life. She says that everyone else is worried about her memory but she knows that it will get better. The husband states it would be nice if his wife were able to help out in the kitchen. I told the husband that I needed to ponder the situation. I wasn't sure if I could help his wife or not. So, I'm turning to you guys. My wife suggested that I work with both the husband and the patient to teach him how to better integrate his wife into the daily routines. I presented this idea to him tonight on the phone and he said: hum, I need to think about that. So, what do you guys say. Can OT help this lady? If so, how Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] AOTA's BRAN Bus
Branding is not a way to describe a product it is a way to evoke an emotional trigger. Nike's Just do it clearly does not explain that Nike makes shoe, but it clealy evokes an emotional trigger. AOTA has been trying for many many many years to explain the concept of OT to the general public failing to do so. This new branding is meant to evoke an emotional trigger in which people will find out for themselves what OT is all about. This learning might occur these days via google and hopefully leading them to the AOTA page. People only care to learn about OT for a few reasons 1) curiosity 2) they or a loved one are going through OT first hand. The emotional trigger in my opinion is to promote reason #1. But as Ron strongly point out many OTs are giving the puplic is distorted picture of reason #2 making the issue more complex then it has to be. My vote is to continue #1 but to come down hard on the OTs that distort #2. Don't know how to do that, but it is my vote. Chris -Original Message- From: d. chang skc...@gmail.com To: OTlist@otnow.com Sent: Mon, 13 Apr 2009 8:15 pm Subject: Re: [OTlist] AOTA's BRAN Bus occupational therapy is so confusing. On Mon, Apr 13, 2009 at 9:11 PM, Ron Carson rdcar...@otnow.com wrote: Carmen, I think the concept of living life to the fullest IS static. Living life to the fullest is really a value statement about a person. In other words, it describes a type of person. And I believe that this value is fairly consistent across the life span. While values certainly do change over time, we generally, do NOT go back in fort between what we do and don't. So, I think the living life to the fullest is a value statement that is expressed through an individual's occupations. While the occupations may change, the values being expressed are generally consistent. Really, these concepts are fascinating and quite intriguing to me. The whole purpose of branding is creating a unique identity that is associated with our product. If other professions are associated with living life to the fullest, then the branding campaign has miserably failed. Ron ~~~ Ron Carson MHS, OT www.OTnow.com http://www.otnow.com/ - Original Message - From: Carmen Aguirre caguirr...@msn.com Sent: Monday, April 13, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] AOTA's BRAN Bus CA I think words are taken to a far too rigid context. If a patient CA chooses walking as their main area to make their life complet: So be CA it! PT should be helping them feel whole and live to the best they CA can...The same principle applies to the MD who takes the cancer away CA or he pain away; or the nurse that cures the wound or resolves the CA constipation issue, or the massage therapist who takes the back pain CA away...etc. My point is healthcare delivery is not and will never be CA the property of one discipline. The branding is a tool to help CA identify what we do ; no brand will never capture all areas of CA function at 100% because among other things, we are dealing with CA people: complex beings that change and evolve and will never have a CA static concept of living to the fulllest. what is relevant to our CA client now will soon change . The branding will never be able to CA capture the magnitude of a full life but help us point our efforts CA to get as close as we can. CA Carmen -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- daiana www.dchangphoto.com www.flickr.com/photos/dchangphoto/sets/ Let it go and let it flow - me - I am only one, but still I am one. I cannot do everything, but still I can do something. I will not refuse to do something I can do. If I advance, follow me. If I stop, push me. If I fall, inspire me. He, who loses money; loses much; He, who loses a friend; loses much more; He, who loses faith; loses all. If you can imagine it, you can create it. If you can dream it, you can become it ( ; -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] AOTA's BRAN Bus
Well branding does not work on everyone, but AOTA sources say that the poster evoked an emotional response on a significant amount of marketing voluenteers. -Original Message- From: Caryn Carson c...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Tue, 14 Apr 2009 8:46 pm Subject: Re: [OTlist] AOTA's BRAN Bus As a non-OT, but who has a vested interest in OT, since I am married to one, I wanted to add my opinion of the branding poster. When I looked at the poster, I felt nothing. It did not incite me to do nor think anything other than what does and icecream cone have to do with OT? I think that is sad, considering I know a little about the profession. Had I have known nothing, I would have simply shrugged my shoulders at the poster and moved on in my life. The Nike branding at least they show the shoe...they didnt just say Just do it and show you pics of an icecream cone or even a track (that you could run on in their shoes) or a treadmill or anything like that. You know it is about shoes! The slogan only stood on its own after the gazillion dollars spent promoting it with the shoes... Shouldnt an OT branding poster show occupation? People fishing, cooking, walking up a flight of stairs, heck even tying their Nikes...something to do with the profession??? I cant even tell you what was on the poster, other than the cone! Anyway, I have been reading the discussions and had to share a non-OT opinion... Caryn == On 4/14/2009, cmnahrw...@aol.com wrote: Branding is not a way to describe a product it is a way to evoke an emotional trigger. Nike's Just do it clearly does not explain that Nike makes shoe, but it clealy evokes an emotional trigger. AOTA has been trying for many many many years to explain the concept of OT to the general public failing to do so. This new branding is meant to evoke an emotional trigger in which people will find out for themselves what OT is all about. This learning might occur these days via google and hopefully leading them to the AOTA page. People only care to learn about OT for a few reasons 1) curiosity 2) they or a loved one are going through OT first hand. The emotional trigger in my opinion is to promote reason #1. But as Ron strongly point out many OTs are giving the puplic is distorted picture of reason #2 making the issue more complex then it has to be. My vote is to continue #1 but to come down hard on the OTs that distort #2. Don't know how to do that, but it is my vote. Chris -Original Message- From: d. chang skc...@gmail.com To: OTlist@otnow.com Sent: Mon, 13 Apr 2009 8:15 pm Subject: Re: [OTlist] AOTA's BRAN Bus occupational therapy is so confusing. On Mon, Apr 13, 2009 at 9:11 PM, Ron Carson rdcar...@otnow.com wrote: Carmen, I think the concept of living life to the fullest IS static. Living life to the fullest is really a value statement about a person. In other words, it describes a type of person. And I believe that this value is fairly consistent across the life span. While values certainly do change over time, we generally, do NOT go back in fort between what we do and don't. So, I think the living life to the fullest is a value statement that is expressed through an individual's occupations. While the occupations may change, the values being expressed are generally consistent. Really, these concepts are fascinating and quite intriguing to me. The whole purpose of branding is creating a unique identity that is associated with our product. If other professions are associated with living life to the fullest, then the branding campaign has miserably failed. Ron ~~~ Ron Carson MHS, OT www.OTnow.com http://www.otnow.com/ - Original Message - From: Carmen Aguirre caguirr...@msn.com Sent: Monday, April 13, 2009 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] AOTA's BRAN Bus CA I think words are taken to a far too rigid context. If a patient CA chooses walking as their main area to make their life complet: So be CA it! PT should be helping them feel whole and live to the best they CA can...The same principle applies to the MD who takes the cancer away CA or he pain away; or the nurse that cures the wound or resolves the CA constipation issue, or the massage therapist who takes the back pain CA away...etc. My point is healthcare delivery is not and will never be CA the property of one discipline. The branding is a tool to help CA identify what we do ; no brand will never capture all areas of CA function at 100% because among other things, we are dealing with CA people: complex beings that change and evolve and will never have a CA static concept of living to the fulllest. what is relevant to our CA client now will soon change . The branding will never be able to CA capture
Re: [OTlist] AOTA's BRAN Bus
Nike made an even more incredible amount of money on top of its gazilion because of the power of branding. Branding is not just a picture or a slogan but a campaign to subconsiously get into the mind of the public. The Just Do It campaign made some of us believe that we needed a pair of differeint shoes depending on what activity we were doing a) walking b)running c)cross training d)tennis e)basketball f) Hicking g) etc etc. Don't you think it worked? I do not think that AOTA only intends to come up with a poster, a slogan, and then have a bunch of us hang them up. I think this is going to be an entire campaign for this branding process, in which one component will be to clearly define what we do. Now what they plan on doing or how they plan on conveying the message I have no idea, but I am excited to see. I personally would love to capatilize off the popularity of reality/science based shows/medical shows. How many people learned a little more about CSI people from when watching the show. Even though it overestimated the scope of CSI peoople it still evoked an emotional response. Why not have a dramatization show of miracle patients who make a miraculous recovery in rehab. I am positive that every rehab deparment has at least one incredible story. They then can demonstrate clearly what each discipline does over time. Ron can be the director so he can cut all of the peg pushers or cone lifters. Chris -Original Message- From: cmnahrw...@aol.com To: OTlist@OTnow.com Sent: Tue, 14 Apr 2009 9:52 pm Subject: Re: [OTlist] AOTA's BRAN Bus Well branding does not work on everyone, but AOTA sources say that the poster evoked an emotional response on a significant amount of marketing voluenteers. -Original Message- From: Caryn Carson c...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Tue, 14 Apr 2009 8:46 pm Subject: Re: [OTlist] AOTA's BRAN Bus As a non-OT, but who has a vested interest in OT, since I am married to one, I wanted to add my opinion of the branding poster. When I looked at the poster, I felt nothing. It did not incite me to do nor think anything other than what does and icecream cone have to do with OT? I think that is sad, considering I know a little about the profession. Had I have known nothing, I would have simply shrugged my shoulders at the poster and moved on in my life. The Nike branding at least they show the shoe...they didnt just say Just do it and show you pics of an icecream cone or even a track (that you could run on in their shoes) or a treadmill or anything like that. You know it is about shoes! The slogan only stood on its own after the gazillion dollars spent promoting it with the shoes... Shouldnt an OT branding poster show occupation? People fishing, cooking, walking up a flight of stairs, heck even tying their Nikes...something to do with the profession??? I cant even tell you what was on the poster, other than the cone! Anyway, I have been reading the discussions and had to share a non-OT opinion... Caryn == On 4/14/2009, cmnahrw...@aol.com wrote: Branding is not a way to describe a product it is a way to evoke an emotional trigger. Nike's Just do it clearly does not explain that Nike makes shoe, but it clealy evokes an emotional trigger. AOTA has been trying for many many many years to explain the concept of OT to the general public failing to do so. This new branding is meant to evoke an emotional trigger in which people will find out for themselves what OT is all about. This learning might occur these days via google and hopefully leading them to the AOTA page. People only care to learn about OT for a few reasons 1) curiosity 2) they or a loved one are going through OT first hand. The emotional trigger in my opinion is to promote reason #1. But as Ron strongly point out many OTs are giving the puplic is distorted picture of reason #2 making the issue more complex then it has to be. My vote is to continue #1 but to come down hard on the OTs that distort #2. Don't know how to do that, but it is my vote. Chris -Original Message- From: d. chang skc...@gmail.com To: OTlist@otnow.com Sent: Mon, 13 Apr 2009 8:15 pm Subject: Re: [OTlist] AOTA's BRAN Bus occupational therapy is so confusing. On Mon, Apr 13, 2009 at 9:11 PM, Ron Carson rdcar...@otnow.com wrote: Carmen, I think the concept of living life to the fullest IS static. Living life to the fullest is really a value statement about a person. In other words, it describes a type of person. And I believe that this value is fairly consistent across the life span. While values certainly do change over time, we generally, do NOT go back in fort between what we do and don't. So, I think the living life to the fullest is a value statement that is expressed through an individual's occupations. While the
Re: [OTlist] AOTA's BRAN Bus
Here is a quote from the AOTA president that supports my statements As a profession, we seem to understand marketing more than we understand a branding process. Branding is about building the emotional reaction to a product or service over time. Branding actually starts with the occupational therapy practitioner in that all practitioners must ensure their services are efficient, effective, result in client satisfaction, and have value in terms of the cost-benefit. Branding starts with ensuring a basic level of competence, as well as making sure that every practitioner can deliver the message of what we do. We all know that this is difficult given all the different types of services we provide and the client problems that we solve. Therefore, branding is not about a single tag line, poster, etc. It is really about capturing the essence of our impact. Marketing we have done before with the posters about skills for the job of living. It described occupational therapy as a discipline where practitioners worked with people with a disabling condition to do things like brush their hair, etc. This was a great one-time marketing campaign, it was not a branding process. Granted occupational therapy is about getting people back to doing; but, when we did the marketing research some 8 years later with our consumers and potential consumers, the good news was that we did not have a bad image. The bad news was that we did not have an image. Perhaps likening living to a job did not emotionally resonate with our consumers.-Moyers -Original Message- From: cmnahrw...@aol.com To: OTlist@OTnow.com Sent: Tue, 14 Apr 2009 10:58 pm Subject: Re: [OTlist] AOTA's BRAN Bus Nike made an even more incredible amount of money on top of its gazilion because of the power of branding. Branding is not just a picture or a slogan but a campaign to subconsiously get into the mind of the public. The Just Do It campaign made some of us believe that we needed a pair of differeint shoes depending on what activity we were doing a) walking b)running c)cross training d)tennis e)basketball f) Hicking g) etc etc. Don't you think it worked? I do not think that AOTA only intends to come up with a poster, a slogan, and then have a bunch of us hang them up. I think this is going to be an entire campaign for this branding process, in which one component will be to clearly define what we do. Now what they plan on doing or how they plan on conveying the message I have no idea, but I am excited to see. I personally would love to capatilize off the popularity of reality/science based shows/medical shows. How many people learned a little more about CSI people from when watching the show. Even though it overestimated the scope of CSI peoople it still evoked an emotional response. Why not have a dramatization show of miracle patients who make a miraculous recovery in rehab. I am positive that every rehab deparment has at least one incredible story. They then can demonstrate clearly what each discipline does over time. Ron can be the director so he can cut all of the peg pushers or cone lifters. Chris -Original Message- From: cmnahrw...@aol.com To: OTlist@OTnow.com Sent: Tue, 14 Apr 2009 9:52 pm Subject: Re: [OTlist] AOTA's BRAN Bus Well branding does not work on everyone, but AOTA sources say that the poster evoked an emotional response on a significant amount of marketing voluenteers. -Original Message- From: Caryn Carson c...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Tue, 14 Apr 2009 8:46 pm Subject: Re: [OTlist] AOTA's BRAN Bus As a non-OT, but who has a vested interest in OT, since I am married to one, I wanted to add my opinion of the branding poster. When I looked at the poster, I felt nothing. It did not incite me to do nor think anything other than what does and icecream cone have to do with OT? I think that is sad, considering I know a little about the profession. Had I have known nothing, I would have simply shrugged my shoulders at the poster and moved on in my life. The Nike branding at least they show the shoe...they didnt just say Just do it and show you pics of an icecream cone or even a track (that you could run on in their shoes) or a treadmill or anything like that. You know it is about shoes! The slogan only stood on its own after the gazillion dollars spent promoting it with the shoes... Shouldnt an OT branding poster show occupation? People fishing, cooking, walking up a flight of stairs, heck even tying their Nikes...something to do with the profession??? I cant even tell you what was on the poster, other than the cone! Anyway, I have been reading the discussions and had to share a non-OT opinion... Caryn == On 4/14/2009, cmnahrw...@aol.com wrote: Branding is not a way to describe a product it is a way to evoke an emotional trigger. Nike's Just do it
Re: [OTlist] Reflections on OT Month-Don't Leave the List!
Brent, Glad you are feeling better! We all have days like yours once in a while. I have changed my perspective the past three years. I used to get hung up on defining what my profession was and if I was making a difference. All that led to was anxiety, overly neurotic thoughts that other proffessions were taling over my turf (smile Ron), and a bad case of acid reflux from the above mental health issues. The sad fact was I built my identity around what I did for my career, and if I did not think that all was well in my career then I was not a productive member of society. Well, the key thing that I changed was building my identity around my Creator. From that perspective I have learned to serve others in the way that I would want to be treated if I were in a hospital. That does not mean doing everything for the patient, but doing what is best for the patient regardless of perceived turf wars, time restraints, productivity issues,or respect of my profession.. The ironic thing is that I now have an awesome relationship with the other disciplines, MDs are seeking me out to work with their patients, my productivity is fine, and I now respect my profession. Ron, Not sure where you are getting your information about OT being an inferior profession. The US News and World Report voted us one of the fasted growing professions to be in. Is this a perceived scale that you are using for your local area, or have you read something? NOT ALL OTs IN THE USA DO OT LIKE THE OTs YOU HAVE WROTE ABOUT. I also believe that the centenial vision goals for AOTA are right on. If we would all read the research one would know about all of this. It should be exciting for OT. Chris -Original Message- From: Brent Cheyne brentche...@yahoo.com To: Ron Carson otlist@otnow.com Sent: Fri, 10 Apr 2009 4:58 pm Subject: [OTlist] Reflections on OT Month-Don't Leave the List! Ron and to all re:On a less lighter note, immediately after your post, some unsubscribed from the list. LOL SorryI hope I'm not driving people off this listserv with my recent posts. I will admit, my recent rant was a bit over-dramatic . Just giving a dose of pure emotional honesty. However OTList unsubscribers and OT Centennial Visionaries be advised--any science-driven and evidence-based profession needs a self-critical dialogue full of fervernt debate, any uncontested and group-think conformist model of organization will never evolve or advance the cause for their profession. As you wrote, there are a lot of OT who don't want to examine the problems of their profession---hence the screening of blog entries at AOTA. I can see why the censorship might occur as a means of keeping up the professional morale and positive public relations. AOTA Membership as a percentage of actual licensed US therapists is particularly low---but they still get my money every year, so perhaps I've paid for the right to have an opinion too. And I don't think it too arrogant to state that I have been an above average representative of OT in my 15 years of treating clients with high quality service despite an entire system rife with flaws and failures. So don't leave the OTList just because of a some negativity and criticism in the exchanges. Expect some critical appraisal and some venting occasionally, and join in. If you only want postive, inspirational, and an unquestioned uniform message about OT go to the AOTA website. (It's really pretty good). But my hope is that the OTList is more about debate and critical thought and a harder examination of these professional issues. We need a place for that. Brent (who really is a positive person) Quote of the day The unexamined life is not worth living.-Socrates -- 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] Reflections on OT Month-Don't Leave the List!
Ron, Why can't we open a home health episode or become a required discipline for CORF? Sounds like a lobbyist issue. They said we would never get OT liscensure in the state of Indiana, but after 20 years of trying it finally passed. Really love the way you operate Ron. I think you are a mastermind in motivating us all to change our practice patterns. I often catch myself thnking at work Now would Ron approve of this? Great to have an online mentor, even though some of our opinions are not the same. Hope you don't get too annoyed by my pesky comments. Have a great OT story from the other week. I was on a two week vacation from work not long ago to be with my family as our new little girl was welcomed into the world. When I came back, my friend Paula who is a PT on my unit told me that she was so glad that I was back. She said that the PRN therapists never got the patients out of their chairs, and they did nothing but stupidity. She said that the patient's stunk from not having showers (she was half joking I think on that one), and the patients were not showing as much progress as they usually do when I am on the case. Here is the clincher Nice to have an OT who actually works on occupations. Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Fri, 10 Apr 2009 8:14 pm Subject: Re: [OTlist] Reflections on OT Month-Don't Leave the List! Chris, my information about the practice of OT comes from multiple sources: 1. My education 2. My experiences in multiple settings including: a. Home health b. Private practice c. Rehab d. Acute care 3. My experiences in two different states 4. What I read in on-line and print articles 5. Messages posted on this list I understand that ALL OT's do not practice the same. But, it's my belief that the VAST MAJORITY of OT's working in adult physical dysfunction continue practicing by focusing treatment on the UE. Oh, they may throw around some new terms, but overall the field remains in a quagmire. And for the record, I believe the centennial vision goals are nothing more than an illusion. How is world is OT going to become a widely recognized force? We can't even open a home health episode of care and we are not a required discipline for a CORF. I'm all for having a vision, but if a vision is unreachable what's the point? Thanks, Ron - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Friday, April 10, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Reflections on OT Month-Don't Leave the List! cac Ron, cac Not sure where you are getting your information about OT being an cac inferior profession. The US News and World Report voted us one of the cac fasted growing professions to be in. Is this a perceived scale cac that cac you are using for your local area, or have you read something? NOT ALL cac OTs IN THE USA DO OT LIKE THE OTs YOU HAVE WROTE ABOUT. I also believe cac that the centenial vision goals for AOTA are right on. If we would all cac read the research one would know about all of this. It should be cac exciting for OT. cac Chris -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] What's so sad about folding clothes?
That was the funniest thing I have read in a long time! -Original Message- From: Brent Cheyne brentche...@yahoo.com To: Ron Carson otlist@otnow.com Sent: Fri, 20 Mar 2009 5:30 pm Subject: [OTlist] What's so sad about folding clothes? Dear Colleagues, Regarding the comment... Isn't it a bit childish that OT is remembered for folding clothes? Should we be remembered for something a little more substantial? My question is:does it matter if Ron C. thinks folding clothes is chidlish (?) ;or is the more relevant question--does the patient need/want to return to performing this task? I think not being able to fold clothes is childish...if you expect someone else do it for you and become a dependent or disabled person. It's all about clarifying expectations, but it's not about super imposing the therapist's biased judgements about what is important and meaningful activity onto the pt's situation. BY THE WAY IT IS VERY DIFFICULT TO GET A CHILD TO FOLD CLOTHES WITHOUT BRIBERY OR THREAT OF PUNISHMENT : ) I totally agree with Sarah Croft about being sure to identify needs and goal--that is the key to a client centered approach. The lady is 90 but planning to live alone again or at home with the son...laundry might be something she actually enjoys--maybe not. or what else might it be? Isn't OT often about the simple things in life that matter to daily life? It begs the question--- Ron--What shoud the OT be remembered for doing with the patient? Explain. Sara Croft--What professional image are you trying to fight for? Explain..use simple language..I only have a bachelor's degree:) Occupation, according to my understanding, involves the things we do each day, that are necessary, productive, fulfill a meaningful purpose and contribute to a role. Occupations are not always gradiose projects, or complex activities, The are the simple every things that need doing. Perhaps I'm too confused about what OT is supposed to be anymore! A list of Sad Occupations Folding clothes...too childish, to mundane Making a sandwhich--too ordinary? Too domestic Watering plants--too agricultural? Too rural Feed the cat/dog---too zoological? Too interspecies Take out the garbage--too unsanitary? Too trashy Make Coffee and serve a guest--Too much caffeine? Too friendly Make the bed--to much servantude? Too much responsibility Playing cards--to many decisions, to much thinking? Too much like real fun Question:To be clear and stated in the positive..What are the sophisticated, approved, and impressive occupations that would better earn respect from our friends and neighors? Please List those therapy activities we can brag about! I want to know theMore Substantial ones. Expalin. Mary Alice C I agreed with your post about getting more positive stories, I second that motion! Quote: Thank goodness you are an OT. Other people I have worked with in rehab places in the past have not done a good job of listening to what I have to say about what I want and need. The OTs are always my saving grace because they start out by asking what I want to work on. If a man begin with certainties, he shall end with doubts, but if he will be content to begin with doubts, he shall end in certainties ---Francis Bacon, English Scientist/Philosopher OTs--Examine your certainties, revisit your doubts Brent C Submitted with tonge in cheek to engage but not to insult..BC:) -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Occupation as THE goal: Does it matter
Sorry Ron but the great debate continue There is a budding branch of research that does support the use of impairment based OT to improve occupational outcomes post stroke. This is a very short list, due to time constraints. I can offer more research to you if you wantme to. I really enjoy research so I can probably dig up tons of info if anyone esle is interested. 1) AOTA said this regarding Constraint Induced movement therapy in their evidenced based bytes after an extensive review of the research: “CIT, then, is strongly effective in improving behavioral outcomes. Its effectiveness on impairments of dexterity, coordination, and strength are most pronounced, whereas its effectiveness on ADL and participation in greater amounts of activity is less. The latter finding needs further study using reliable, objective, and more sensitive measuring instruments. CIT does not appear to be contraindicated for patients who are willing to enter into a behavioral contract to carry out the stringent requirements of this treatment.” (http://aota.org/Educate/Research/EB/Stroke/SFQ/37823.aspx) ***Sure the research states that ADL and participation was a less significant change compared to improvements found when measuring the impairments but non the less it was a significant change. This is at least a start in the research. 2) CITATION: Jongbloed, L., Stacey, S., Brighton, C. (1989). Stroke rehabilitation: Sensor imotor integrative treatment versus functional treatment. American Journal of Occupational Therapy, 43, 391-397 RESEARCH QUESTION How does the effectiveness of two OT approaches to treatment of stroke patients-the functional and sensorimotor integrative approaches-differ? DESIGN Randomized controlled trial (RCT) Subjects were randomly assigned to one of two groups: Sensorimotor Integrative or Functional OUTCOME MEASURES (R = Reliability established; V = Validity established) Barthel Index - R, V Meal Preperation - Reliability and validity not established Eight Sensorimotor integration tests - R, V INTERVENTION DESCRIPTION Group 1: Functional Approach: Emphasizes the practice of tasks, usually activities of daily living (ADL). The emphasis is on treatment of the symptom rather than on the cause of the dysfunction. Two methods are used: compensation and adaptation. Group 2: Sensorimotor Integrative Approach: Emphasizes treating the cause of the dysfunction rather than compensating for, or adapting to, the problem. The principles that guided treatment were: (a) provide planned and controlled sensory input; (b) elicit an adaptive response; (c) enhance organization of brain mechanisms; and (d) facilitate the developmental sequence. INTERVENTION DESCRIPTION Group 1: Functional Approach: Emphasizes the practice of tasks, usually activities of daily living (ADL). The emphasis is on treatment of the symptom rather than on the cause of the dysfunction. Two m ethods are used: compensation and adaptation. Group 2: Sensorimotor Integrative Approach: Emphasizes treating the cause of the dysfunction rather than compensating for, or adapting to, the problem. The principles that guided treatment were: (a) provide planned and controlled sensory input; (b) elicit an adaptive response; (c) enhance organization of brain mechanisms; and (d) facilitate the developmental sequence AUTHORS' CONCLUSIONS The authors concluded that if there are any differences between functional treatment and sensorimotor integrative treatment they are small. The findings suggest that occupational therapists can consider using either approach in planning treatment for CVA patients. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Female Urinal devices
I am not a big fan of bed pans or urinals but I undestand how useful they are in emergencies especially at night. I would strongly suggest a bed side commode for that needed out of bed activity during the day, and perhaps a female urinal and a standard bed pan at night. I have used a female urinal for a client found in the Sammons and Preston catelog with moderate success, but this lady was a bilateral above the knee amputation so it was easier to place the urinal where it belonged. I imagine it will take some practice. I remember that the easiest position was being completely supine versus reclined secondary to some spilling that occured in the reclined position. Again, I strongly recommend that the patient is out of bed as much as possbile because the effects of bed immobility and atrophy is lethal if left untreated. These pieces of adaptive equipment often becomes a crutch which hinders a patient's progress. Chris Nahrwold MS, OTR -Original Message- From: Robertson, Susan (NIH/CC/RMD) [E] srobert...@cc.nih.gov To: OTlist@OTnow.com Sent: Wed, 25 Feb 2009 4:58 pm Subject: Re: [OTlist] Female Urinal devices You might check the Sammon Preston catalog Sammonspreston.com -Original Message- From: Sue Mikolajczak [mailto:susanjmikol-...@twmi.rr.com] Sent: Wednesday, February 25, 2009 3:38 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Female Urinal devices A 91-year old friend who originated a low vision support group that I help facilitate has been partially bed-ridden since falling in her home in December. She has been using a Depend-type underwear and requires help from her husband to change the pant. She is very anxious to start helping with her toileting activities, in order to assist her husband with the burden of her care, and to reduce the associated frustration of leaking, etc. She is able to independently get into a reclining position in bed, but cannot yet get out of bed without assistance. I noticed various types of female urinals while surfing the net and wondered if anyone has had success with a particular design that would work for someone of her abilities. She is legally blind, but is cognitively as sharp as a tack. She broke some ribs from her fall, but I believe her manual dexterity is good for someone of her age. Even if she was able to use the urinal with her husband's assistance, it might eliminate some of the negative issues attached to the current toileting method (odor, spills, etc). I would appreciate feedback from anyone who has had experience with these devices. Sue -- 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] hello company...it's misery calling!
Ron, Are you saying that PT, nursing, and nursing aides is working on increased independence in clients' occupations? Or does it appear that they are addressing the issues by completing them for the patient? Perhaps it would be wise to have a tag along day with these disciplines to create a team approarch. I think one of the best things a home OT can do is become friends with the home aides because they can help with the needed correct repetiion of your treatment interventions outside of formal therapy time. You know Ron, I once thought like you in regards to the perception of OT in the setting in which I worked OT has no TRULY unique and HIGHLY valued role, but there was a time in which I stopped listening to that unproductive self talk, and decided to put all of my efforts into the clients. I learned a few things in the past five years since changing my attitude and to help to chage the culture of a department a) respect is dependent on the hard work you put into your clients b) constant continuuing education and inservicing to the staff has helped change perceptions c) lowering my ego by helping out with toileting and bowel accident clean ups instead of calling the nurse and running has helped to build a more team approach and provides an opportunity to share important information d) the better I know the nursing and therapy staff on a personal level the more they learn about OT. A few months ago I had my friend and collegue Pat a nurse talk to me about how her opinion of OT has changed in the past few years. She admitted that she never really had a clear grasp on what we did because she never got the opportunity to see us in action when she worked in home care. But when she transitioned to the rehab unit she was outstounded by the the reality of what we worked on. She regrets that she did not have that knowledge prior and how that could of helped many patients in the home therapy setting. She told me that she once thought physical therapy was the go to therapy, but now she understands how imperative OT is to the recovery of a client. I now get constant phone calls from Pat and the other nursing staff about certain things they see when they are helping clients with their morning ADLs and how they want my advise to deal with the problems. We then often work together to come up with a solution. Looking back at my career so far I learned it really was not the other hospital staff that devalued OT but in reality it was I whom came to hate what I was doing because my focus and passion was on myself and not on the client. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson rdcar...@otnow.com To: Brent Cheyne OTlist@OTnow.com Sent: Wed, 25 Feb 2009 8:41 pm Subject: Re: [OTlist] hello c ompany...it's misery calling! Hello Brent: The question of home health being the best practice setting is complicated. In a perfect world, I say unequivocally yes, but in the real world, I say no. It seems to me that in home health, like other settings, OT has no TRULY unique and HIGHLY valued role. There seems to be very little that OT does which isn't already covered by either PT, nursing or the aide. Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: Brent Cheyne brentche...@yahoo.com Sent: Saturday, February 21, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] hello company...it's misery calling! BC RON: I related so well to your well written response to Ilene (Message BC 4,2/21/09), I have a similar history to you and worked in the SNFs in BC the late 1990's, but woe is me... I still do today. As you stated the BC business model doesn't foster the best that OT can be as a profession. BC It is very inflexible and stifles innovation, creativity, and quality in BC favor of effeciency, profit, and bureaucratic compliance to Medicare BC rules and regs which set the system up to be as lame as it is. Some how BC I have found a way continue in this practice setting for almost 15 years BC and have sought out the most high quality employe rs and facilities with BC a bit of luck had good results. But I too am growing VERY WEARY BC of all the issues you so effectively stated. I even spent one week as a BC Rehab Manager and quit..it made me physically ill, tried o/p hand BC therapy for 6months and was quite unsatisfied. I have thought of BC leaving the SNF setting, but every now and then I get a patient or case BC or two that goes so well and is so satisfying that it draws me back BC in...it's like trying to leave the Mafia :), Ron do you think home BC health is the best OT practice setting? -- 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
I think it might be common for PTs to work on vestibular rehab in the adult population when people are suffering from inner ear impairments and neurological impairments that effect the vestibular system. The clinic I work for has a specialized program dealing with this with about a million dollars worth of computer equipment and there is a PT who went to a long course to learn how to treat in this area beyond entry level. That is what he does all day long. There are many courses being taught in this area and they have been open to OTs as well from my experience. There is also an OT vestibular geru who wrote many research articles on the topic and even came up with a hiearchy of ADLs to challenge patients as their condition improves to intergrate higher level performance. Cannot recall her name at the moment but I will look into it. I believe that it is common place for OTs in the pediatric setting to work on sensory integration impairments. This is a much different ball park than vestubular impairments from what I understand. Chris Nahrwold MS, OTR -Original Message- From: Sue Doyle sue...@hotmail.com To: otlist@otnow.com Sent: Tue, 24 Feb 2009 11:05 pm Subject: 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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Occupation as THE goal: Does it matter
Seems like in your example of occupation that the UE is left out of the equation, although through some improvement it can lead to improvements in the patient's personal goals of occupation. Just because there is no function in the flaccid UE does not mean there will not be any improvement 6 months down the road, especially with intentional focus on the issue. I can make the UE treatment focus on occupation just like you state, but it will take much longer. Instead of writing patient will improve AROM by 30 degrees in order to assist with self feeding I can simply write patient will reach for a glass of water from table using his involved arm. The problem is it might take 6 months to a year to achieve this occupationally written goal, but it only might take 2-3 months to show 30 degrees of progress if the patient has good rehab potential in arm function. The structure of insurance re-imbursement is set up on showing immediate progress, otherwise we are told to DC a patient or set more achievable goals. Even though we as neuro OTs might wright goals that focus on body impairments, it does not mean that we are not looking at occupation. It only means that we want to continue to work with the patient that has the potential of using their arm in occuation again, but unfortunately we need to be able to document improvements relatively quickly for insurance to foot the bill. This sytem of billing does not match up with the natural progression of improvement in a patient's arm after a stroke.The road to recovery for a stroke patient's flaccid arm is a long and painful one, in which sometimes the road does not lead to a positive outcome. How can we justify seeing them for an entire year, and then finally one day we state that the patient is not appropriate for OT any longer. There needs to be incremental steps along the way to occupation showing that the patient is making progress towards that goals that we predicted would eventually be achievable. And let me tell you, when that area of occupatiion is finally achieved after such time and effort from the therapist and patient, there is not greater feeling in OT. I wish we could see them for an entire year, following one occuaptionally based goal and not having to worry about the measurements of tone, strength, ROM, coordination, but with the system that we bill under now, we have to follow the rules. Your examples of training in sit to stands, balance retraining, functional transfers are on the mark of occupation. However these areas of impairment are often easier to demonstrate improvements in occupation simply showing the assist level of improvement (patient inproved from a total assist to a supervision when toileting). These areas of occupation are more certainly easier to treat in the timeframe we are given to show progress. The area of impairment involving the flaccid UE is much more complex and difficult to show immediate progress. It is impossible to write goals that focus on occupation because it would be impossilbe to show incremental progress on the actual occupation when the patient wants to incorporate he flaccid arm into occuaption again. If the patient is a total assistance with reaching for a glass of water using the hemi arm, it would be impossible to demonstrate in a months time that the patient is at a maximal assistance, moderate, or minimal assistance for the task while using the hemi arm. The assist levels do not quantify the small incremental improvement. I can certainly document that the patient is using their arm more duing occupation through the use of activity journals, or subjective surveys that the patient fills out based on their perceptions, but it is near impossible to visually recognize that a patient improved from a total assistance to a maximal assist with the reaching task, because of the limitations of the assist level scales. It is much more quantifiable to use standardized scales that focus on body impairments like the dynamomenter, goniometer, Motor Assessement scales, Wolf Activity Scales, Modified Ashworth Scale, and the like to show these small incremental scales of progress required for changes in the patient's occupational goals. Chris Nahrwold MS, OTR. -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Sat, 21 Feb 2009 5:19 am Subject: Re: [OTlist] Occupation as THE goal: Does it matter Chris, after thinking about your question, I conclude that the best I can offer is a hypothetical situation. So, here goes Take my patient today. A CVA patient. He has a flaccid UE with no functional use. He requires assist for sit/stand and ambulates with a quad cane with supervision. IF the goal is improving the occupation of self-care to the supervision/setup level, treatment might look like this: Therapeutic activity to include: sit/stand and
Re: [OTlist] The Timing of OT...
It is ironic though that the man has muscular dystrophy though and wants to focus only on PT. I wonder if the man realizes the progression of his disease and how aggressive strength training can cause problems. It seems as though the man is in denial about his disease and wants to fight it by building up his body, but in reality the nature of his disease will most likely force him to compensate during his daily occupations. This would be the perfect oppurtunity for early OT to pave the way for this man's unfortunate future to help in his quality of life. I have a feeling that this man will encounter OT again in the future ,but this time he will have a new appreciation for our role. A strong educational program including the neurologist, PT, psycologist, and nursing would alleviate this problem in educating this man on the common progression of the disease and how an OT can help with the occupational issues for the future. -Original Message- From: Ron Carson rdcar...@otnow.com To: Mary Alice Cafiero OTlist@OTnow.com Sent: Sat, 21 Feb 2009 8:03 am Subject: Re: [OTlist] The Timing of OT... Hello Mary Alice: Let me be the 1st to say Thanks for writing. I understand what you mean about taking time to write and then not getting any responses. But, such is the nature of listserves!smile. I think you've touched on at least ONE area that can frustrate the OT process. IF an OT is focused on improving occupation but the patient is focused on improving strength/ROM there is inconsistency. Notice that I say FOCUS because as you correctly identified, improving occupation usually results in improving the underlying impairments. But in this case, the patient stated he was doing all he could. OT is a bizzaro world! smile Ron - Original Message - From: Mary Alice Cafiero m...@mac.com Sent: Saturday, February 21, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] The Timing of OT... MAC I think that patients often equate PT not only with walking, but also MAC with strengthening. It seems they often feel that the majority of MAC their problems doing things are because of weakness. If they can just MAC get stronger, all else will fix itself. I can see this especially MAC being true with a diagnosis like MS or other progressive neuromuscular MAC disease. MAC We, as OTs, can clearly see that learning to do the things you need to MAC do for yourself has inherent value. It also ends up addressing MAC strengthening without doing a straight exercise program. I tend to MAC think that patients often prescribe to the no pain, no gain theory MAC and feel that they have to do multiple reps of an exercise in order to MAC address weak muscles. MAC My two cents. I'll be curious to see if anyone responds. The majority MAC of times that I post a response on this board, no one directly MAC responds, and my answers just get shuffled over. Not sure of the MAC reason for that, but it is certainly frustrating. Makes me reluctant MAC to post because it doesn't seem to add to or lead to further discussion. MAC Mary Alice MAC Mary Alice Cafiero, MSOT/L, ATP MAC m...@mac.com MAC 972-757-3733 MAC Fax 888-708-8683 MAC This message, including any attachments, may include confidential, MAC privileged and/or inside information. Any distribution or use of this MAC communication by anyone other than the intended recipient(s) is MAC strictly prohibited and may be unlawful. If you are not the recipient MAC of this message, please notify the sender and permanently delete the MAC message from your system. MAC On Feb 21, 2009, at 1:21 AM, Ron Carson wrote: I had an interesting experience that I want to share. Last week, I evaluated a middle-aged man with muscular dystrophy. He had recently moved back home with his parent and was started on home health. The man essentially told me that there was nothing I could do for him. He said that PT was all he needed. I explained that as an OT, my job was to teach him to take care of himself as much as possible and desired. But, he still felt that PT is what he needed. I am really perplexed as to why someone might value PT instead of OT? I have some ideas, which I'll share, but I hope readers are willing to discuss this situation. 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 MAC -- MAC Options? MAC www.otnow.com/mailman/options/otlist_otnow.com MAC Archive? MAC 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] Puposeful activity
It is hard for me to answer such questions because I do not work in a skilled nursing facility, and I have not worked in one for over 7years. I cannot really comment on changing practice patterns in nursing home any longer because I do not work in that reality. I should only comment on changing practice patterns in the acute rehab setting, because this is where I have changed my practice patterns. I think that the skilled nursing environment is one of the most diffiult settings to work in for OTs based on productivity, payment level structures, and the motivation level of most patients. To have a patient get out of bed for the day is someimes a major victory in OT. I would love to hear how OTs whom actually work in SNF have been able to move from pegs to occuaption. Is is actually possible? -Original Message- From: bbh1...@comcast.net To: OTlist@OTnow.com Sent: Sat, 21 Feb 2009 11:52 am Subject: Re: [OTlist] Puposeful activity Hello Ilene, Your post was satisfying to me, as I work in the same setting and am faced with the same concerns re tx. Put my reaction down to misery loves company, although I am not miserable in my position. What I do with patients may not be strictly OT as defined by most of those who contribute to this site, but I have made peace with that because I know that I am definitely helping my patients heal and return to20a higher level of function in their daily lives. I, too, have been asking for more concrete suggestions as to how this is done in the SNF/subacute world which is so focussed on profit. Thanks for sharing a similar concern. It is so easy to feel alone, and not good enough with regard to the cones and pegs controversy! Barb Howard COTA - Original Message - From: ocil...@comcast.net To: otlist@otnow.com Sent: Wednesday, February 18, 2009 7:00:20 PM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] Puposeful activity Hi Joan and thanks for your insight! May I ask what you would want an OT to work on with you though before you had sufficient range to fasten your bra behind your back, if increasing the range of motion or adapting the task (i.e fastening int he front) were not options you would want? IMO, when therapists resort to cones, etc, it is not because they are lazy, it is because they don't know what else to do, either because they only have experience in work settings where cones and pegs were used, or they are in a subactute setting where they are seeing multiple people at once. Of course that is not ideal, but it is reality. I for one would like to move into this more ideal realm and change the way I practice, but there is precious little practical how to's for doing this, especially in settings like mine, where there is no kitchen, ADL suite, etc, and it is impossible to see everyone one on one for ADL's. There is no course that I can find on taking OT back to the functional in today's money-driven practice settings, in fact I have never seen a shoulder course for OT that doesn't focus on increasing range and other medically-based PT-type interventions. Even here, many people say do this but very few say specifically HOW or offer any practical ideas for the therapists stuck in peg/cone world who want to be more functional but are up against a practice world that just wants numbers. If you or anyone can offer any practical advice, point to a book or course to help therapists work more functionally with patients (who often, in a nursing home setting, can't even come up with goals of their own or answer nothing or watch TV when asked what they would like to be able to resume doing) I would be most appreciative. Thanks, Ilene Rosenthal, OTR/L Message: 1 Date: Tue, 17 Feb 2009 11:30:40 -0700 From: Joan Riches jric...@telusplanet.net Subject: Re: [OTlist] purposeful activity To: OTlist@OTnow.com Message-ID: !~!UENERkVCMDkAAQACABgAqpIeEyoaqEeUzXp6QaY++8KAA aaq8ulnq9shyumb39sehxogoqeaa...@telusplanet.net Content-Type: text/plain; charset=US-ASCII Greetings to all I couldn't resist this one. In my opinion (like Ron's) all activity has purpose for someone or something (witness the reproduction of plants) .=2 0The OT question re the activities we use as treatment interventions is: Does this activity have purpose and therefore meaning for this client in terms of their explicit and implicit occupational goals? I absolutely agree with Ron's goal formulation where the only goal is some form of OCCUPATIONAL performance. (In the presence of cognitive deficits this becomes a much more difficult question.) Below is my personal physical and OT/PT case example. I've been thinking about it a lot in my present situation and how it plays out. I am still after 14 months working on the stability of the hip that was pinned and the range and strength in the shoulder with a nondisplaced fracture. Although I am determined not to walk or run with the typical 'hip'
Re: [OTlist] hello company...it's misery calling!
Brent, Great comments Do you need an understudy for the sock puppet show? Simply hilarious! Chris -Original Message- From: Brent Cheyne brentche...@yahoo.com To: OTlist@OTnow.com Sent: Sat, 21 Feb 2009 6:37 pm Subject: Re: [OTlist] hello company...it's misery calling! Ron, Ilene, and Mary Alice and the rest of you I love reading this listserv and enjoy your comments...though somedays reading it makes me want to quit my OT career and join the Circus or start that pumpkin carving business...(maybe not...too seasonal for steady cash flow!;)) MARY ALICE: I wanted to respond to you because you have such good comments and DONT STOP contributing...I agree with you that patients come to rehab and have a lot of preconcieved notions about what efforts/methods will create what results, they think I just need strengthening orI just need to walk.. they don't make the connections about the rehab process that we know so well. So much of the challenge is to educated people on the process of OT, addressing the goals. This requires very good communication skills on the part of the OT. Pt's with chronic illnesses or even subacute health issues are reluctant to attempt the process of adapting to their condition because of denial of the loss function. They really are in phase of wanting to FIX IT NOW back to normal. As we know this is not always possible or realistic. OTs are superior to most other professions at teaching adaptation to Enable Occupation. In some cases we fix things in an innovative and effective way.The disadvantage is in the OT concepts where ,of course ,we know that occupation is that complex multifactorial phenomena that is the essence of performing daily life and is so much a part of our lives, and so individually subjective. Peeple don't think about it in the same terms we describe it in but they often get the connection when we do our jobs well. It is a tough job but rewarding. RON: I related so well to your well written response to Ilene (Message 4,2/21/09), I have a similar history to you and worked in the SNFs in the late 1990's, but woe is me... I still do today. As you stated the business model doesn't foster the best that OT can be as a profession. It is very inflexible and stifles innovation, creativity, and quality in favor of effeciency, profit, and bureaucratic compliance to Medicare rules and regs which set the system up to be as lame as it is. Some how I have found a way continue in20this practice setting for almost 15 years and have sought out the most high quality employers and facilities with a bit of luck had good results. But I too am growing VERY WEARY of all the issues you so effectively stated. I even spent one week as a Rehab Manager and quit..it made me physically ill, tried o/p hand therapy for 6months and was quite unsatisfied. I have thought of leaving the SNF setting, but every now and then I get a patient or case or two that goes so well and is so satisfying that it draws me back in...it's like trying to leave the Mafia :), Ron do you think home health is the best OT practice setting? ILENE: I could totally relate to you comments about SNF and goal setting and treatment ideas. Isn't this such a challenging population. SPEAKING OF THEORIES:My theory is that people who know the value of occupation to health status practice what they preach in that they engage in meaningful occupations and enjoy a high quality of life and health status, and when they do get sick or have issues they are quick to self -treat with the motivation, and goal-oriented mind set to get back to living and and the flexibility to adapt to their condition. And they use their OT as a reso urce to achieve goals. I see a few of these kinds of patients in SNFS, BUT, the greater majority of the SNF patient's I see have an ongoing Occupation deficit which correlates with their poor health status and issues and lack of ability to adapt. We are often faced with the toughest cases, with people who's prior level of occupation is so dysfunctional/deficient or co-dependent on a caregiving relationship that they just don't have a OT-like outlook. Many clients outsource their occupation by expecting spouses, neighbors, hired caregivers, meals on wheels, etc..to provided ADL.So I think we are often faced with the most challenging and ill fitting clients for OT at the SNF setting, Hello company...it's misery calling. So should I begin selling snow cones at the north pole, or take my sock puppet show on a national tour as a new career? What Say you RON? (LOL) Brent -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive?
Re: [OTlist] Occupation as THE goal: Does it matter
Ron, Great outline.? Can you next explain how the treatment will differ? Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist@OTnow.com Sent: Mon, 16 Feb 2009 7:52 am Subject: [OTlist] Occupation as THE goal: Does it matter Hello All: What follows are thoughts and opinion about using occupation as *THE* goal for OT treatment. Here's is the premise for my arguments: (1) When occupation is *THE* goal, outcome statements may be written in concise occupation-based outcomes. For example: Patient will safely and independently ambulate to/from toilet with RW and perform all hygiene without assistive equipment. Patient will transfer from w/c to bed using slide board transfers Patient will dress self using adaptive equipment as necessary (2) Conversely, when occupation is not *THE* goal, outcomes may be written so that occupation is a desired outcome but is based on improving underlying impairment(s). For example: Patient will increase UE elbow ROM to 115 degree active flexion to all for donning/doffing of shirt Patient will increase standing endurance/balance to allow them to safely and independently carry out toileting hygiene. Some argue there is little difference in the above approaches. However, I believe these approaches frame patient problems very differently. This is important because how we frame a problem drives our treatment. The first example clearly identifies that occupation is the goal. There is no expressed concern for underlying factors impairing occupation. However, and this if often overlooked, it is IMPLIED that all factors impairing the goal will be treated within the therapist's abilities. This is true because occupation includes the following factors: Physical, emotional, mental environmental, behavioral, social Thus, as OT's and within our scope of practice, occupation-based outcomes address all factors impairing the desire occupations. While the second example does include occupation as an outcome, only factors addressed in the goals are included for treatment. This severely limits treatment and in my opinion indicates that remediation of underlying impairments is the real goal. The implication is that if underlying impairments are remediated, occupation will improve. However, is inconsistent with OT theory because occupation is ALWAYS more than physical. In my opinion, the second example is much more like a PT rather than an OT goal! In closing, writing occupation-based goals is important for us and for the patient. These goals allow us to focus on occupation's many elements and complexity to best enable our patients. Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Double vision
One?technique that I use is partial patching of the eye by using transpore tape (found in most nursing stations)? I simply place the tape on the medial aspect of the patient's pair of glasses.? This will compensate for the double vision but at the same time allow stimulation to the eye to prevent problems and lack of peripheral vision. Chris Nahrwold MS, OTR -Original Message- From: ehthiers ehthi...@earthlink.net To: OTlist@OTnow.com Sent: Sun, 15 Feb 2009 8:55 pm 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
Re: [OTlist] From Standing to Toilet Transfers
Ron, ?I never did apologize. Just stated a fact that I was not criticizing you for your treatment plan. It is my summation that you write about the Philosophy of OT.? I do not think that if you take two seasoned OTs found in the same setting with a strong dedication to their clients and put them in two groups a) Working towards occupation and b)Working on occupation, that you would find much difference in their treatment plans, quite possibly their treatment interventions, and the natural activity progression that occurs in providing skilled occupational therapy.? The true difference comes from their treatment philosophy and the wording that they may use to describe their work.? To me personally this difference in philosophy and wording is irrelevent in the real world.? But I do see the value of this philosophy when teaching students and therapists who are stuck in a rut pushing cones and peg boards off as therapy. It is also my opinion that it is easy to switch to your line of thinking by just changing a few words in the goal.? Instead of writing Increase ROM to so much in order to comb hair I could simply write Patient will comb her hair with no assistance.? Instead of writing increase standing balance by so many minutes in order to toilet one can write Patient will complete his toileting with min assist.? I think the treatment plan and interventions would be the same depending on the skill level of the therapist and the motivation of the patient. -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Mon, 9 Feb 2009 9:59 pm Subject: Re: [OTlist] From Standing to Toilet Transfers Hey Chris, no need to apologize, even if you are being critical. I like to believe that these on-line discussion hone my actual practice patterns!! Now, on with the discussion... ## Working ON occupation ~vs~ Working TOWARDS occupation: What's the difference? ## When working ON occupation, I maintain that occupation-based practice is a straight line from goal to intervention. Along that line, there may be any number of specific intervention, but the line is never broken between treatment and goal. Thus, when I'm working on standing balance for a patient that can't stand at the toilet, I'm working on the line between occupation and treatment. Working TOWARDS occupation is not so direct an approach. Working towards something is vague and nondescript. It's the notion that if I improve standing balance the patient will be better able to stand at the toilet. This approach is NOT unique to OT and is used by most therapy-type professions. When working TOWARDS occupation, occupation is not necessarily the goal. This is evident when a goal is written like: Patient will increase right elbow range of motion to 120 active flexion to allow for brushing of hair. GREAT discussion!! Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Sunday, February 08, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] From Standing to Toilet Transfers cac You may say that you are working on occupation from the beginning cac of the session to the end, but it sure sounds to me that you are?at cac times?working towards an occupation, especially in the beginning of cac the treatment process.? You state that at several times you worked cac on sit to stands, standing, and ambulating with the patient.? In my cac book those are foundati onal skills of an occupation.that got the cac patient to the point in which they could actually practice their cac goal of getting on and off the commode to toilet.? Without these cac core foundational skills of an occupation?the client would not have cac made it off the bed or out of the chair and would be laying on the cac floor with a dirty pair of slacks.? I am by no means criticizing cac your treatment plan, because I would have done the same thing. cac Archive? cac 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] From Standing to Toilet Transfers
You may say that you are working on occupation from the beginning of the session to the end, but it sure sounds to me that you are?at times?working towards an occupation, especially in the beginning of the treatment process.? You state that at several times you worked on sit to stands, standing, and ambulating with the patient.? In my book those are foundational skills of an occupation.that got the patient to the point in which they could actually practice their goal of getting on and off the commode to toilet.? Without these core foundational skills of an occupation?the client would not have made it off the bed or out of the chair and would be laying on the floor with a dirty pair of slacks.? I am by no means criticizing your treatment plan, because I would have done the same thing. -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Sun, 8 Feb 2009 8:36 pm Subject: Re: [OTlist] From Standing to Toilet Transfers Chris, I want to make a clarification about the below text. When I first evaluated the patient, she stated that she wanted to be able to walk to her bathroom and use the toilet. I do not consider that I worked on foundational skills to work towards and occupational goal. Instead, I work on occupation from the beginning to the end of my treatment duration. To me, this IS the hallmark difference between OT and PT. PT may work on mobility so that a patient can get to the toilet, but OT works on getting the patient to the toilet. Some people say this distinction is arbitrary and is primarily semantics. However, for me, it is FUNDAMENTAL to being an OT. I don't want to step on toes, but to me, working on foundational skills to improve occupation is no different that what PT does. It makes no difference if it's an arm or a leg. Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Wednesday, February 04, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] From Standing to Toilet Transfers cac I view hand therapy and stroke rehabilitation in the same light. cac Working on the foundational skills in order to work towards an occupatioanal goal. cac 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] From Standing to Toilet Transfers
I second that motion. -Original Message- From: Lehman, David dleh...@tnstate.edu To: OTlist@OTnow.com OTlist@OTnow.com Sent: Wed, 4 Feb 2009 12:57 pm Subject: Re: [OTlist] From Standing to Toilet Transfers I say combine the professions of PT and OT thus ending the territory issue and what we can and cannot do. I see what you described as exactly what I would do as a PTbut, I know you are just as competent and good at is as I am, Ron So, lets combine the 2 professions. David A. Lehman, PhD, PT Associate Professor Tennessee State University Department of Physical Therapy 3500 John A. Merritt Blvd. Nashville, TN 37209 615-963-5946 dleh...@tnstate.edu Visit my website: http://www.tnstate.edu/interior.asp?mid=2410ptid=1 This email and any files transmitted with it may contain confidential information and is intended solely for use by the individual to whom it is addressed. If you receive this correspondence in error, please notify the sender and delete the email from your system. Do not disclose its contents with others. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of cmnahrw...@aol.com Sent: Wednesday, February 04, 2009 11:50 AM To: OTlist@OTnow.com Subject: Re: [OTlist] From Standing to Toilet Transfers Bravo!!!? I believe that is task analysis at its absolute best.? Taking the foundational skills and working up the ladder towards her occupational goal. I view hand therapy and stroke rehabilitation in the same light. Working on the foundational skills in order to work towards an occupatioanal goal. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist@OTnow.com Sent: Tue, 3 Feb 2009 10:40 pm Subject: [OTlist] From Standing to Toilet Transfers A while back on an AOTA forum, I was criticized for working on mobility when there were not obvious occupational forms present (i.e. toilet, shower, chairs, etc). At least one person's contention was that working on mobility in the absence of an occupational form is not OT. I want to share a quick case study which highlights why I take exception with the person's comments. For the sake of brevity, I'll keep Jan e's case study as simple as possible. Jane has a spinal condition leaving her with partial lower extremity paralysis. The patient's initial goals are of course to walk but also to transfer to her toilet, shower, etc. Again for brevity, she wants to learn skills for the job of living. Initially, the patient was unable to stand, so we began working on standing. This required maximum, and I mean max, assistance x1. At this early stage, the patient was unable to use a walker. After a week or so, I progressed the patient to a walker, but she still required knee blocking to stand. Eventually, the patient was able to stand without knee blocking and finally began taking steps. After she was able to walk 10-15 feet with a rolling walker, we tried transfers from wheelchair to wheelchair. This was very difficult and required continuing practice. After approximately 6 weeks of almost daily OT, TODAY, the patient transferred from her w/c to her toilet using a walker. She required assistance with sit to stand and cuing with the transfer but it was essentially her doing the transfer. This is a huge milestone for this patient and made her VERY happy and optimistic that her life was going to again have some semblance of normal. ## Now, in my opinion, I have been working on occupation from day ONE! The patient had occupation-related deficits, her barriers were identified I was competent to address thos e barriers and the patient had good potential to make significant progress towards her goals. So what do you think? Should OT work on mobility/ambulation in the immediate absence of occupational forms? Should OT address mobility from the very beginning, if mobility is a barrier to occupational goals? I'm interested to hear what other's say! Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mail man/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] Game using reacher
As long as the patient knows why they are practicing a specific skill then I am all for it.? In my experience it usually takes the cognitively intact clients a few activities to understand how to use a reacher, not an entire session.? They then can borrow a reacher to use in their room so they can practice for real, and then ask questions when issues arise.? Now for the cognitively impaired (primarily moderate to severe dementia) the practice of a reacher is a waste of time because patients at that level have the inability to learn new information.? The emphasis of treatment should at that point be on family training and maximizing their physical abilities, not on cognitive restoration.? Cognitive compensation might be an option, but don't count on it. For the mildly impaired I think practice in this area is critical, especially if they are going to be living by themsolves or not receiving 24 hour supervision. What I see in practice is therapists completing? non?therapeutic games and splinter skills that have no relevance except to capture minutes for a higher payment level.?Do not get me wrong, ?I am all for activities that promote social interaction and higher level balance improvement, those activities sounded outstanding.? In fact I might steal that one for clinical use, since it deals with dual task challenges, which is supported in the research.? The grim reality is this: if our profession as a whole continues to complete treatment interventions that have no relevance to the patients' improvement, then through the very nature of cost containment we will be phased out.? Pick up a new book in OT, read a new research article, go to a course, by all means do all you can to provide relevance to the patient's care and improvement. Chris Nahrwold MS, OTR -Original Message- From: Diane Randall spark...@rcn.com To: OTlist@OTnow.com Sent: Wed, 4 Feb 2009 7:10 pm Subject: Re: [OTlist] Game using reacher Very well said!!! -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of bbh1...@comcast.net Sent: Wednesday, February 04, 2009 18:16 To: OTlist@OTnow.com Subject: Re: [OTlist] Game using reacher If someone is going to be using a reacher for the foreseeable future after D/C because of medically established precautions against trunk flexion, etc. then this kind of practice with a reacher is medically beneficial. Call it whatever perjorative name you like, patients enjoy activities that are entertaining as well as medically necessary/useful/goal-directed. I am certainly not going to sit with a patient and make him/her take her pants on and off interminably just because that is how the goal is worded - LB ADL Indep using AE... Come on, people. Lighten up! And as far as social interaction is concerned, there is NOTHING that is more conducive to helping patients progress, especially those in SNFs, than interaction with the therapist or with other patients. You don't need a goal. It is ALWAYS a factor, hence it is therapeutic to the goals you are working on. Just today, I had a patient who more easily lost his balance because of laughter. He is a funny guy and likes to joke around. Because I engaged with him, I was able to observe this phenonmenon directly. I then suggested that we should have him watch funny videos standing so that he can practice his dynamic balance. This was a direct result of social interaction. Social interaction is an integral part of any occupation, and I mean that in the broad OT sense of the word. Well, I guess not for hermits, or possibly accountants and others whose goals are impeded by interaction. But you get the drift. Thanks for your suggestion, Barbara. I may try this with appropriate patients. I have a few on my caseload with precautions like these. I find that competitive games are very helpful in supporting patients by giving them tangible evidence that they are not the only person in the world struggling to recover/adapt to a ne w medical condition. Barb Howard - Original Message - From: Neal Luther neal.lut...@advhomecare.org To: OTlist@OTnow.com Sent: Wednesday, February 4, 2009 8:33:02 AM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] Game using reacher Could not agree more. In addition, this just simply sounds juvenile...pediatric. Neal C. Luther,OTR/L Advanced Home Care, Burlington Office 1-336-538-1194, xt 6672 neal.lut...@advhomecare.org Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of otl...@otnow.com. If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error,
Re: [OTlist] new interventions, preventions or techniques in OT
I have used many of the Saebo equipment that is relatively new in OT for stroke rehabilitation?a) Saebostretch b) Saeboflex c) Saeboreach.? Check out Saebo.com for more details.? They even have a budding foundation in the research.? Use the key terms Functional tone management and/or Saeboflex to search the databases. Chris Nahrwold MS, OTR -Original Message- From: Melissa Ferrando melis7...@yahoo.com To: otlist@otnow.com Sent: Tue, 3 Feb 2009 2:18 pm Subject: [OTlist] new interventions, preventions or techniques in OT I am a OT student learning about evidence based practice.? I am looking for an interesting clinical concern in OT to investigate.? I have only completed level 1 fieldwork so I don't have a lot of clinical experience.? Are there any new interventions, preventions or techniques that?may be new in the field?? ?It has to be related to adults.? Any information would be appreciated.? Thank you. M -- 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] Fn. Mobility ~vs~ Gait Training
Yes I am comfortable with faciliating the patient to take steps.??Why???Because I have been trained to do it the correct way. And yes I feel comfortable with advancing the patient's mobility aide when they are improving with ambulating to the toilet.?Why? Because I am an occupational therapist and bathroom mobility is often my game. Again, I do not have a direct answer for this.? I have never been challenged in the area of scope of practice or denied via insurance?so I guess after 8 years I'm still doing ok.? I think the key is to take a team approach.? I agree with the prior letter.? Why does it all come back to PT versus OT? Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Mon, 19 Jan 2009 8:02 pm Subject: Re: [OTlist] Fn. Mobility ~vs~ Gait Training So Chris, if you had a patient that could only stand, but not ambulate are you comfortable in facilitating the patient to take steps? Why or why not? And if the GOAL is for the patient to ambulate to the toilet with the lease restrictive aid, can OT advance patient's mobility aides? Again, why or why not? P.S., ANYONE feel welcome to reply. Messages on the list are usually meant for general discussion, or at least they should be!! Ron - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Sunday, January 18, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Fn. Mobility ~vs~ Gait Training cac I don't have a direct answer to that.? I guess it depends on cac where your level of expertise falls in this area.? I have it cac easy, because I work with an amazing group of PTs who teach me on cac each patient how they want them to walk.? That way I can help the cac patient receive the much needed practice in this area,but at the cac same time I can consult with the PT since I did not have this cac area taught in school.? I always attempt to complete the sit to cac stands and the low level functional mobility in a context of an cac occupation that the patient has determined important a) walking cac to dresser to gather clothes b) walking to the toilet to complete cac toileting c) walking to the dining room chair for meal time. It cac is then amazing when the patient can perform the functional cac mobility, and then carryout out the occupation!.? cac Ninety nine percent of the time when I ask a patient what their cac goals are for rehab they state to walk better.? I then ask them cac why they want to walk better.? They often look at me strangely cac and then state so I can get to the kitchen and cook, do the cac laundry, go out to eat with my friends, etc etc.? The cac occupational goals nearly write themselves. cac Chris Nahrwold MS, OTR cac -Original Message- cac From: Ron Carson rdcar...@otnow.com cac To: cmnahrw...@aol.com OTli s...@otnow.com cac Sent: Sat, 17 Jan 2009 7:38 pm cac Subject: Re: [OTlist] Fn. Mobility ~vs~ Gait Training cac I like your definitions. cac In the two cases you mention, the patients are already ambulatory. cac What if they weren't and still wanted to achieve the same outcomes? cac - Original Message - cac From: cmnahrw...@aol.com cmnahrw...@aol.com cac Sent: Saturday, January 17, 2009 cac To: OTlist@OTnow.com OTlist@OTnow.com cac Subj: [OTlist] Fn. Mobility ~vs~ Gait Training cac To me functional mobility is the process of getting to point A to cac point B regardless of compensation techniqes in the context of an cac activity or a desired functional outcome.? Just the other day I cac had a patient who wanted to cook and set the table for her cac family, to achieve this desired outcome a walker tray had to cac implemented with further practice of safe strategies.? Just the cac other day I had a hip replacement patient who wanted to be able cac to get to the bathroom safely without breaking her hip cac precautions, so? raised toilet was implemented with further cac practice of safe strategies. cac Gait training is when a therapist observes a patient's gait and cac objectively determines what movement functions?cause the patient cac to walk abnormally.? They then use therapeutic techniques to cac faciliate a normal gait pattern.? I see this being used by PT in cac neurological rehabilitation.? cac Chris cac -- cac Options? cac www.otnow.com/mailman/options/otlist_otnow.com cac Archive? cac www.mail-archive.com/otlist@otnow.com cac -- cac Options? cac www.otnow.com/mailman/options/otlist_otnow.com cac Archive? cac 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] Fn. Mobility ~vs~ Gait Training
I don't have a direct answer to that.? I guess it depends on where your level of expertise falls in this area.? I have it easy, because I work with an amazing group of PTs who teach me on each patient how they want them to walk.? That way I can help the patient receive the much needed practice in this area,but at the same time I can consult with the PT since I did not have this area taught in school.? I always attempt to complete the sit to stands and the low level functional mobility in a context of an occupation that the patient has determined important a) walking to dresser to gather clothes b) walking to the toilet to complete toileting c) walking to the dining room chair for meal time. It is then amazing when the patient can perform the functional mobility, and then carryout out the occupation!.? Ninety nine percent of the time when I ask a patient what their goals are for rehab they state to walk better.? I then ask them why they want to walk better.? They often look at me strangely and then state so I can get to the kitchen and cook, do the laundry, go out to eat with my friends, etc etc.? The occupational goals nearly write themselves. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Sat, 17 Jan 2009 7:38 pm Subject: Re: [OTlist] Fn. Mobility ~vs~ Gait Training I like your definitions. In the two cases you mention, the patients are already ambulatory. What if they weren't and still wanted to achieve the same outcomes? - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Saturday, January 17, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Fn. Mobility ~vs~ Gait Training cac To me functional mobility is the process of getting to point A to cac point B regardless of compensation techniqes in the context of an cac activity or a desired functional outcome.? Just the other day I cac had a patient who wanted to cook and set the table for her cac family, to achieve this desired outcome a walker tray had to cac implemented with further practice of safe strategies.? Just the cac other day I had a hip replacement patient who wanted to be able cac to get to the bathroom safely without breaking her hip cac precautions, so? raised toilet was implemented with further cac practice of safe strategies. cac Gait training is when a therapist observes a patient's gait and cac objectively determines what movement functions?cause the patient cac to walk abnormally.? They then use therapeutic techniques to cac faciliate a normal gait pattern.? I see this being used by PT in cac neurological rehabilitation.? cac Chris -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Fn. Mobility ~vs~ Gait Training
If the patien'ts functional transfer baseline prior to a hospital admit or new condition?is to use a wheelchair close to the toilet and transfer and they then desire to continue to use this same method I would practice this method with them.? However if they want to change this pattern and if the rehab prognosis is positive and realistic, I certainly would practice walking to the toilet from their recliner, bed, etc, etc. Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Fri, 16 Jan 2009 7:39 pm Subject: Re: [OTlist] Fn. Mobility ~vs~ Gait Training Chris, will you expand on the following comment: What does matter is what method the patient wants to work towards ...? Thanks, Ron - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Friday, January 16, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Fn. Mobility ~vs~ Gait Training cac It is certainly not PT.? Our goal as OTs?is to faciliate a cac positive outcome in a patient's independence in the activiites cac that occupy a person's life.? Getting to the toilet is certainly cac one of those activiites that a person usually wants to do for cac themselves.? Whether walking to the toilet or transferring, in my cac opinion it does not matter.? What does matter is what method the cac patient wants to work towards and what the realistic rehab cac potential of accomplishing the goal through this choosen method.? cac 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] How About This?
Can she stand and walk at all? Since her goal is not to complete her occupations from the wheelchiar, I would certainly make every attempt to adapt her environment and practice and adapt?her activities with that desired goal in mind.? Hard to answer without actually seeing the patient for real.? I guess the real question is do you think that this is a realistic goal for her at this stage in the game?? If not then you have the tough job of explaining realistic versus unrealistic goals in the current stage of her recovery. Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: cmnahrw...@aol.com OTlist@OTnow.com Sent: Fri, 16 Jan 2009 7:41 pm Subject: Re: [OTlist] How About This? Yes, the patient can move her legs. There are no clear-cut answers on the rehab potential. The patient can already slide-board transfer. What if the patient doesn't want to learn from the w/c level? - Original Message - From: cmnahrw...@aol.com cmnahrw...@aol.com Sent: Friday, January 16, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] How About This? cac What do you mean by limited bi-lateral LE's?.? Can she move cac them at all?? If she has no control in her LEs at all I would do the following: cac 1) Find out what the patient's?damage is and the cac possible?recovery potential by calling the surgeon's office. cac 2)Teach and train?her to compensate through the use of slide cac board and sit pivot transfers until swelling in her back goes cac down and hopefully function in her LEs returns. cac 3) Teach and train occupations from the wheelchair level until? cac hopefully more?function in her LEs return.. cac 4) DME and AE recommendations cac Chris Nahrwold MS, OTR cac -- cac Options? cac www.otnow.com/mailman/options/otlist_otnow.com cac Archive? cac www.mail-archive.com/otlist@otnow.com cac -- cac Options? cac www.otnow.com/mailman/options/otlist_otnow.com cac Archive? cac 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] Fn. Mobility ~vs~ Gait Training
To me functional mobility is the process of getting to point A to point B regardless of compensation techniqes in the context of an activity or a desired functional outcome.? Just the other day I had a patient who wanted to cook and set the table for her family, to achieve this desired outcome a walker tray had to implemented with further practice of safe strategies.? Just the other day I had a hip replacement patient who wanted to be able to get to the bathroom safely without breaking her hip precautions, so? raised toilet was implemented with further practice of safe strategies. Gait training is when a therapist observes a patient's gait and objectively determines what movement functions?cause the patient to walk abnormally.? They then use therapeutic techniques to faciliate a normal gait pattern.? I see this being used by PT in neurological rehabilitation.? Chris -Original Message- From: Ron Carson rdcar...@otnow.com To: Audra Ray OTlist@OTnow.com Sent: Sat, 17 Jan 2009 7:46 am Subject: Re: [OTlist] Fn. Mobility ~vs~ Gait Training What is the difference between functional mobility and gait training? Is their a definitive line between the two? - Original Message - From: Audra Ray audra...@yahoo.com Sent: Friday, January 16, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Fn. Mobility ~vs~ Gait Training AR If this is an activity that is important to the patient and they AR want to engage in, then it is OT. Transfers and functional AR mobility is within the domain of OT practice. AR Audra Ray AR --- On Thu, 1/15/09, Ron Carson rdcar...@otnow.com wrote: AR From: Ron Carson rdcar...@otnow.com AR Subject: [OTlist] Fn. Mobility ~vs~ Gait Training AR To: OTlist@OTnow.com AR Date: Thursday, January 15, 2009, 4:36 PM AR If an OT facilitates a non-ambulatory patient to transfer to/from her AR toilet using a walker is this PT? AR If an OT facilitates a patient to walk from their w/c to the toildet, AR is this PT? AR Thanks, AR Ron AR -- AR Ron Carson MHS, OT AR Hope Therapy Services, LLC AR www.HopeTherapyServices.com AR www.OTnow.com AR -- AR Options? AR www.otnow.com/mailman/options/otlist_otnow.com AR Archive? AR www.mail-archive.com/otlist@otnow.com AR AR -- AR Options? AR www.otnow.com/mailman/options/otlist_otnow.com AR Archive? AR 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] Fn. Mobility ~vs~ Gait Training
It is certainly not PT.? Our goal as OTs?is to faciliate a positive outcome in a patient's independence in the activiites that occupy a person's life.? Getting to the toilet is certainly one of those activiites that a person usually wants to do for themselves.? Whether walking to the toilet or transferring, in my opinion it does not matter.? What does matter is what method the patient wants to work towards and what the realistic rehab potential of accomplishing the goal through this choosen method.? Chris Nahrwold? MS, OTR -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist@OTnow.com Sent: Thu, 15 Jan 2009 7:36 pm Subject: [OTlist] Fn. Mobility ~vs~ Gait Training If an OT facilitates a non-ambulatory patient to transfer to/from her toilet using a walker is this PT? If an OT facilitates a patient to walk from their w/c to the toildet, is this PT? Thanks, Ron -- Ron Carson MHS, OT Hope Therapy Services, LLC www.HopeTherapyServices.com www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] How About This?
What do you mean by limited bi-lateral LE's?.? Can she move them at all?? If she has no control in her LEs at all I would do the following: 1) Find out what the patient's?damage is and the possible?recovery potential by calling the surgeon's office. 2)Teach and train?her to compensate through the use of slide board and sit pivot transfers until swelling in her back goes down and hopefully function in her LEs returns. 3) Teach and train occupations from the wheelchair level until? hopefully more?function in her LEs return.. 4) DME and AE recommendations Chris Nahrwold MS, OTR -Original Message- From: Ron Carson rdcar...@otnow.com To: OTlist@OTnow.com Sent: Fri, 16 Jan 2009 6:42 am Subject: [OTlist] How About This? Scenario: Home health patient with incomplete paraplegia from a spinal surgery. Exact nature of damage is unknown as is the patient's recovery potential. The patient wishes to carry out her daily routine using a walker, as she did prior to her surgery. The patient has strong UE, weakened trunk and limited use of her bi-lateral LE's. Prior to her surgery, she ambulated with a walker and was totally independent. As her OT, what might be your treatment with this patient? Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Help with Treatment Plan???
Ron, Just went to a course on Dementia.? Possible goals 1) Decrease agitation while showering and dressing?2) Decrease agitation during transition of the nursing staff. 3) Decrease agitation throughout the day by 25%. I would then make a log, in which Joan mentioned, called a behavioral mapping log.? This identifies during the day and night when these agitations occur and what was going on in the enviroment.?Staff will have to be trained on how to fill it out. ?Some possible triggers from my experience?are a)showering at night time when they are used to showering in the morning b) too much TV c)hates to get dressed d) when the daytime shift nurses go home and the evening nursed come in (nursing transition). Some practical evidence based behavioral treatment ideas for the above: a) Play some soft music that was once the patient's favorite, if the family is involved prior to and during showering.? Try a routine that matches the patient's preference (morning versus night).? Allow calming scents prior to the shower to calm the patient.? Reward the patient with her favorite type of candy during and after the shower (usually chocolate kisses work). b)Many times watching Jerry Springer and the other daytime trashy shows can cause an episode of agitation.? I would elminate the shows and replace it with more meaninful activities a) Memory lane activities b) Trunk full of junk from their generation era, so they can safely fidget with different things. c) Play soft music and reward with chocolate or something they enjoy.? Simple guiding tecniques in which you initiate part of the dressing can help. d) To decrease agitation during staff transition, I tend to train the staff to complete this transition as secretely as possible.? Do not say your goodbyes to patients or staff members, because they often think they get to leave as well and then flip out when they don't get to leave.? This is a perfect time to have an activity for the most agitated so a distraction can occur.? I am also big on walking clubs.? This is where everyone gets to go for a walk sometime during the day.? All the staff members get to participate in this one (even the lunch lady).?Just be sure to match the skilled therapists with the pateint's that cannot walk well and the non therapy staff with the patient's who can walk well. This has been shown to decrease agitation as well. Chris Nahrwold MS, OTR -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Arrgh! SNF OTs on the hot seat!
I have been thinking how to be concrete in treatment ideas that I would use in a SNF. This is?for the new therapists out there.? This would be for the general debility patient that we often encounter at SNFs.? I seperated?everything into?four categories for simplicity.? This is not an exhausted list whatsover and completing therapeutic activities, therapeutic exercise, and cognitive training?should only be done if there is an issue with balance/tolerance/strength/coordination/cognition that interfers with a patient's identified occupational goals (ie working on standing balance in prep for pants pull up after toileting or during dressing performance).? I have seen a particular SNF close to the hospital in which I work, whom has excellent OTs and it is not by chance that this SNF is the most popular and busiest SNF around.? They brag a 90% home rate for their skilled beds.? Is the huge success from OT?? I bet they are a huge part of that success 1.? ADL/IADL: All of the patients identified goals that occupy their life in which they desire to get back to in order?to make it back home safely or to improve their quality of life in the nursing home if they are a?lifetime resident. Bathing, dressing, grooming, toileting, toilet transfers, tub/shower transfers, self feeding, home management tasks (laundry, cooking, making the bed, petcare, cleaning the home), medication routine, emergency response safety, car/van/SUV transfers, getting mail, getting their newspaper, community mobility.? The list can go on for days!? It would be imposible to do many of these activities with 6-8 people in a group.? Perhaps two patient's at a time with dovetailing,?rest breaks, and with a good rehab tech. 2. Therapeutic activities.? Basic steps?toward function that helps to make improvements with #1.? Sit to stands from wheelchair, wheelchair to mat transfer, wheelchair to chair transfers, transfers in and out of a numerous sized chairs around the facility, sitting/standing balance activities that encourage the patient to reach out of their base of support in many ways, sitting/standing tolerance activities with timed performance,??gathering clothes from a closet, proper way to pick objects?up with a walker with or without a reacher?The list goes on and on depending on the patient's needs.? Perfect way to group a few patients together. 3. Therapetic exercise/neuromuscular re-education: Basic steps to improve body functions that will hence?make steps in the right direction in #1.?These exercises should not be used unless?it has been found in the evaluation that it is an impairment?a) Strength training: All muscle groups should be worked on, discuss with your rehab team how this should be delegated.? In my facility, it is by tradition that OT work on UE strength issues and PT works on LE strength issues, but you can tell from the above that the LEs are certainly worked on in OT as well, just not with PROM, AROM, and strength training programs.? I tend to spend time strengthening the triceps and scapular depressors because it assists with sit to stands and standard walker mobility big time. I then use a general exercise program to facilitate muscle balance to prevent injury.? All strength training should follow a warm up, stretching program, and end with a cool down.? b) Gross motor/fine motor control-functional reaching, grasping exercise, pinch exercises in the three functional positions.? These exercises are perfect to have a large group. 4. Cognitive training? Working on memory, problem solving, comprehension,metacognition.? I usually use functional activities for this one: Meal planning group, newspaper review group, money management (counting coins, counting paper money, check book, ATM if available, and money problem solving, time management (telling time and time management problem solving), home safety scenerios (picture identification, verbal response hypothetical type questions, action plan for their real life environment), medication routine (often with help from ST and nursing staff) my role sometimes is coming up with compensation techniques for home like a medicaiton check list or a medication alarm watch.? This list goes on and on as well. Hope this helps the newbies a bit.? OT is a great proffession if done right, don't let us pessimists get you down Chris Nahrwold MS,OTR -Original Message- From: Diane Randall [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Fri, 5 Dec 2008 8:57 am Subject: Re: [OTlist] Arrgh! SNF OTs on the hot seat! If I agreed with everything everyone said on this forum, I would not be on it. It would be boring. I am just a student right now and I am learning a lot about the profession from reading these posts. I don't feel qualified to really contribute in the ways that some on here have done because I do not have the experience yet. I want to know what frustrations I may encounter out there in the real world. It is beginning
Re: [OTlist] Arrgh! SNF OTs on the hot seat!
Brent, I believe the criticism originally came from Ron in regards to a therapist in a rehab hospital.? We?can all be?guilty of poor rehab at times no matter what practice setting.? I responded to warn people of potential fraud that therapists might be committing and not even realizing it. Chris Nahrwold MS, OTR -Original Message- From: Brent Cheyne [EMAIL PROTECTED] To: Ron Carson otlist@otnow.com Sent: Tue, 2 Dec 2008 6:40 pm Subject: Re: [OTlist] Arrgh! SNF OTs on the hot seat! ??? Some further thoughts on OT?practice in the?SNF. However critical and disappointed some of us who don't work in SNF feel about the pracitices of those who do, keep in mind that each practice setting has its own unique challenges and limitations. ??? The PPS system has the RUG system where the highest reinbursment is for those patient who participate in as much as 360 minutes of OT a week.. That's? 6 days of 60 minute sessions, so if a person stays for a month they receive 24 hours (?1440 minutes) of OT in a month. And this process is multiplied got?each OT practitioner?by a caseload (lets say for average) 7 patients per day.?Each minute of each session is structured and guided by the therapist while navigating a complex system of all the other therapies, nursing care, and scheduling taking place?within the facility. ??? This means there is a lot of therapy? being provided and?therefore a lot of designing and implementing and documenting interventions. Making every? minute of every session wonderful, meaningful, enjoyable, and occupational is quite a challenge. I venture to predict that rehab professional in SNF spend more time with their clients than any other professionals in the whole healthcare system! Other posts on this list have also observed that the SNF rehab client is not always the most motivated of clients either and clients are often unable to identify meaningful occupations on which to base treatments. Due to reasons explained previously in my other recent post, and the factors above, some patients might have incidences of bad OT.? Given the shear abount of time spent in treatment, the odds of having some non-meaningful?or bad experiences are? pretty high. I think any of us can identify unsatisfactory experiences with healthcare and other professionals on occasion. I personally have had?occasional frustration and disappointment?at the dentist, doctor, optometrist, or even with the waiter at a restaurant. I think on average there are a lot of hard working OTs in SNF doing a great job! Of course we always hear about the worst and best therapy experiences that people have. ? While all the criticism, judgement and discussion ongoing in the OT community may be necessary to encourage us to focus on occupation, there is no shortage of equal scrutiny by our administrations and regulators who have there own definition of what expected and required of OTs. Keeping everyone satisfied in no easy task and I think bad OT is more a function of being overwhelmed than being lazy. Let us find a way to support and encourage eachother! Brent C -- 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] AARGH!
It is funny in what we consider functional and not functional.? How can standing not be functional but doing a bunch of crafts, reaching for clothes pins and cones is considered functional?? Ninety percent of the clients I see do not like crafts and have no intention of starting crafts, so why is so much time devoted in school?in this?area?? We need?to focus on concrete functional?evaluations and treatments in?schools.?Seventy percent of the clients I see do not have arm dysfunction but I still see therapists whip out the theraband.?? We just need to find?what are the patient's priorities for rehab, the impairments, and the environmental barriers that will prevent progress. ?Most people in acute rehab just want to make it back home, so why not focus on all of the?activities that they have to complete safely to make that a reality?? You have to think beyond just simple bathing and dressing though!? I can certainly understand when a patient is very low level in their abilities and they have to start at the bottom of the ladder, but there comes a point when you have to prepare them for home.? It is so simple and rewarding to take this aproach in occupational therapy. Chris Nahrwold MS, OTR St. John's Hospital of ?Anderson Indiana -Original Message- From: Ron Carson [EMAIL PROTECTED] To: Diane Randall OTlist@OTnow.com Sent: Sun, 30 Nov 2008 12:27 pm Subject: Re: [OTlist] AARGH! Thanks to some comments I've read on this list, I've stopped being concerned if what I'm doing LOOKS like PT. I sort of laugh at this statement because on Friday a patient asked me: Now, are you the PT or the OT. Ron -- Ron Carson MHS, OT - Original Message - From: Diane Randall [EMAIL PROTECTED] Sent: Sunday, November 30, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] AARGH! DR I always like to read your take on things. I agree with you. I just had in DR the back of my mind a COTA I was following who made a woman stand for the DR sake of standing but did not combine it with anything functional. As a DR student, this confused me. It looked more like PT. Thanks for your comments. -- 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] AARGH!
-PT completes standing challenges so the patient can walk and improve in their balance.? Treatment usually stops when a certain distance has been reached or a certain grade of balance has been achieved.? I have rarely (work hardening is the only example I can think of)?seen a PT use an ADL or an IADL for a treatment modality or a functional outcome unless is is reported from the patient subjectively through oral report or via a standardized functional survey (outpatient). -OT completes standing challenges so the patient can stand to pull up pants, stand at the sink to groom, stand at the kitchen counter to cook, stand to take out the garbage.? When a therapist uses a standing challenge it should be verbalized as to why it is important to work on standing in order to get to their personal occupational goal.? That is what makes it a meaningful activity. When safe and physically ready, the actual task should be integrated into the treatment session (as soon as possible), in which at that point the actual task should be performed?and practiced to reinforce learning.??This concept could and should be applied to everything we do as OTs (fine motor, gross motor, strength, vision/perception, soft tissue mobilization, joint mobilization).? That way the patient can actually see the meaning behind the activity so they can see the light at the end of the tunnel.? When we only do things to improve strength, improve coordination, improve standing balance, and not looking toward the big picture,?then what we?are doing is physical therapy in my book.? This concept has been hard for me in outpatient hand?and UE stroke rehab though, but I am constantly trying to make improvements in this area, and have liked the ideas of Ron as these areas being specialized areas in which an OT happens to be working in. As far as the SNF issues, I think seeing that many people at the same time is fraud.? To see a group like that you must bill the patients' with?the group charge and only 25% of the patient's minutes can be group minutes.? I suspect that the patients are being seen for a lesser time than being billed, because of such a huge group.? How can anyone time or watch a clock for 6-8 patients to ensure they are getting the necessary time? I highly doubt if 6-8 stop watches are on for each patient.? I also suspect that therapists are plugging in different times for each patient although they were all seen at the same time.? I know this because I once worked on a SNF and they tried to get me to do this to be more productive.? Needless to say I only worked there for 3 months.? If you don't believe me just call medicare or the group that runs medicare in your area.? I am sure they will give you some answers, but just be prepared to be on the phone for a long time, trust me I know.? And when confronting management do not be surprised if you get fired, but I would certainly let management know that medicare will be getting a call so they should be prepared for an audit.? The only way that this situation will change is if we all stand up for ourselves.? It sounds like more than a verbal discussion needs to take place for your SNF patient population to identify occupational goals.? For the client whom states that they like to sit on their chair and watch TV all day I would work on bed to chair transfers, sit to stands in order to safely get to the TV, walking to get the remote to change the channel, and education about the importance of doing more in life to avoid immobility problems.? I highly doubt if that is the only thing the patient has to do the entire day, doesn't the patient have to eat and use the restroom at least?? I would sit down by yourself on the computer and think of all of the different possible occupations in which a patient has to perform on a daily basis (ranging from getting out of bed to watering the plants).? I would?make this into a checklist format and during the evaluation and re-evaluations I would have the patient fill it out with your assistance depending on their cognitive level.? We have to remember that many of the patients suffer from depression and dementia in this area, so of course they are going to give you an non excited response.? Most of them are so depressed that deep down they all just want to be alone to die.? It is our job to show them that there is someone who cares about their well being and believes in them.? Try to get to know them and talk to them and slowly but surely help them to achieve a few goals.? I think you will be surprised. Chris Nahrwold MS, OTR -Original Message- From: Diane Randall [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Sun, 30 Nov 2008 8:33 pm Subject: Re: [OTlist] AARGH! I believe standing is functional...but I am trying to understand how we differ from PT. Pt has already merged with OT in regards to self-care. I find this all very confusig as a student. Our teacher seems to think clothpins and
Re: [OTlist] I still can't explain OT
Brent, that was awesome! Over the years I have become?simplistic with my definition of OT when describing it to my clients prior to their reheb program.? OT on Bennett rehab typically helps patients to become more independent with all of the actvities that occupy a person's life in order to get home safely ( I work on an acute rehab unit)? I then explain how we use the actual goal as a treatment activity, and how we can use exercise/therapeutic activity/compensation strategy, etc to achieve the individual's identified goals. Chris Nahrwold MS, OTR -Original Message- From: Neal Luther [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Fri, 14 Nov 2008 8:16 am Subject: Re: [OTlist] I still can't explain OT BrentFUNNY Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of [EMAIL PROTECTED] If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Brent Cheyne Sent: Thursday, November 13, 2008 6:33 PM To: Ron Carson Subject: Re: [OTlist] I still can't explain OT I've been an OT for a long time and I still can NOT explain my profession in a way that is: * Concise * CLEARLY differentiates OT from other professions * Makes sense to other people (i.e. patients, MD's, nurses, etc) * Consistent: - With others - Across patient populations - Supported by practice - Supported by documentation * Satisfies me Other professions with identity crisis, (job the club) Physical Therapist vs athletic trainer vs massage therapist vs chiropractor, vs exercise physiologist,vs kinesiologist, vs personal trainer vs body worker, yoga instructor vs pilates instructor vs fitness personality Chiropractor vs Osteopath vs Naturopath vs Homeopath vs Acupuncturist vs Oriental Medicine Specialist vs Natural Healer Psychiatrist vs Psychologist vs Mental Health Counsellor vs Psychotherapist vs addiction cousellors vs Personal Coach vs Personal Shopper vs Personal Assistant :) Physicians assistant vs Nurse Practitioner, Nurse Anasthestatists, Nurse Midwives, Nutritionis t vs Dietitian vs Sports Nutrition Counsellor vs Dietary services manager Nurse Case Manager vs Social Worker vs Geriatric Care Manager vs Life Care Managers vs Disablilty Managers Speech Language Pathologist vs Audiologists vs Special Education Teachers vs Learning Disabled Specialist vs Educaitonal Psychologist Computer Engineer vs Software Engineer vs Network Management specialist vs information technology manager, vs systems analyst vs data base manager vs website developer. Engineers: Civil vs Mechanical vs Electrical vs Structural vs Chemical vs Biomedical vs Architects vs Urban Planners Optometrists vs Opthamologists Lawyers: Corporate Lawyers vs Environmental Lawyers vs Estate Lawyers vs Criminal Lawyers vs Constitutional Lawyers vs Personal Injury Lawyers vs Entertainment and Intellectual Property Lawyers Business: CEO, COO, CFO, CIO, Chairman, President, Owner, Majority Holder CIA vs FBI vs Department of Homeland Security vs Sheriffs Department vs City Police Department vs NSA,vs FEMA Publicist vs Public Relations Specialist vs Advisor/handler vs Agent Journalist vs Columnist vs Pundit vs Blogger vs Poparrattzzi vs TV/Radio Talk Show Host Rabbi vs Priest vs Pastor vs Guru vs Eman vs Shaman vs Minister vs Spiritual Advisor Compassionate Social Conservative Republican vs Fiscally Responsible Progressive Liberal Democrat vs...dare I go on? Sorry, this was just a fun mental exercise for me, there are a lot of professions that overlap in areas of expertise and infuence and turf...the boundries can be social, legal, or cultural, and even political. OT is not alone in the search for a universally understood definition. Stay relevant by being useful and effective with your clients. I try to remain content in my career and enjoy my work despite a lack of concrete and defined professional boundries. Brent -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] I still can't explain OT
What you explained 'she said they had her mom sitting at a table doing pegs, cards, etc with her unaffected arm to keep it strong.?'? is certainly not OT and it is not even UE rehabilitation.? To me it is nonsense, and the evidence of a very lazy therapist without any clinical reasoning ability.? That is why OT sometimes has a bad name! Chris Nahrwold MS, OTR -Original Message- From: Ron Carson [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Wed, 12 Nov 2008 7:06 am Subject: [OTlist] I still can't explain OT I've been an OT for a long time and I still can NOT explain my profession in a way that is: * Concise * CLEARLY differentiates OT from other professions * Makes sense to other people (i.e. patients, MD's, nurses, etc) * Consistent: - With others - Across patient populations - Supported by practice - Supported by documentation * Satisfies me Yesterday, I evaled a patient s/p shoulder replacement. PT was already on the case. I struggled understanding my OT role with this patient and how it might be different if PT wasn't already seeing the patient. I wondered how other OT's would approach the patient. The patient is a retired nurse and her daughter is a retired special needs kids. Both of them had knowledge of OT, which sometimes is a bad thing. The patient was recently d/c'd from rehab for her shoulder surgery. The shoulder became dislocated while in rehab and when I asked the daughter if OT or PT worked on the shoulder, she said OT. When I asked her what they did once the shoulder was dislocated, she said they had her mom sitting at a table doing pegs, cards, etc with her unaffected arm to keep it strong. I love being an OT but it is such a confusing profession. When I evaluate people, the only thing that really makes sense is occupation. But, that often leads to mobility issues, and if PT is on the case, they already address this, so there's nothing for me to do. I'll never understand how OT has become so pigeonholed into UE treatment. I can find no good logic or reason why OT as a profession focuses on the UE but it seems to be the predominate pattern. Ron -- Ron Carson MHS, OT -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] doubling patient in acute rehab
Great point of discussion Brent. I think doubling/dovetailing can be used ethically, but I also think it can be used unethically. I have seen some rehab departments use doubling/dovetailing quite well that was actually therapeutic psychosocially as well. I have also seen rehab departments that have become machines in which the same type of exercises are used for no apparent reason except to capture time. This might be an unspoken truth in the therapy world, but I guarantee that most of us have seen this happen at one time or another. To me personally I have a hard time with doubling because it takes away my therapeutic sense at that moment. Usually when I am doubling I am thinking about the activity that will occupy the individuals without truly focusing on the individual that I am trying to help. When I am one on one I can give my all to that individual to focus on the key areas that they are dealing with. So to me personally it could be argued that I would be violating principle 1 in the area of the client's well being. I am sure that there are individuals who can overcome this, perhaps it takes much practice. But in the eight years that I have been practicing I continue to struggle with it, so I try to avoid it. Chris Nahrwold MS, OTR -Original Message- From: Brent Cheyne [EMAIL PROTECTED] To: otlist@otnow.com Sent: Thu, 6 Nov 2008 6:51 pm Subject: Re: [OTlist] doubling patient in acute rehab To Ron, Chris and the List, or the sake of continuing the doubling/dovetailing conversation, I'd like to alk about ethics...the labels of ethical and unethical situations get reely tossed around a lot in talk about the OT world. To say that something is unethical because it is against the rules means if you follow the rules your re supposedlyethical. However, truly ethical conduct goes beyond the mere act of following the rules', and is far more complicated. As we have already observed one clinical etting (acute rehab) may have different rules than another (SNF, Peds etc.). nd often the rules are hard to find, pin down, verify, or subject to multiple nterpretations. Rules change frequently...does that mean our ethics are lso constantly in flux based on corporate,medicare, or insurance provider olicies? he AOTA has a Code of Ethics (2005) with 7 principles as components: rinciple 1.demonstrate a concern for the safety and well-being of the ecipients of their services. (BENEFICENCE) rinciple 2. take measures to ensure a recipientʼs safety and avoid imposing or nflicting harm. (NONMALEFICENCE) rinciple 3 respect recipients to assure their rights. (AUTONOMY, ONFIDENTIALITY) rinciple 4. achieve and continually maintain high standards of competence. DUTY). rinciple 5.comply with laws and Association policies guiding the profession of ccupational therapy. (PROCEDURAL JUSTICE) rinciple 6. provide accurate information when representing the profession. VERACITY) rinciple 7. treat colleagues and other professionals with respect, fairness, iscretion, and integrity. (FIDELITY) According to the AOTA these are the ethical principles we follow to determine f a situation or even a rule is ethical. Additionally these ethical principles re held in conjuction with the OT Core Values (AOTA 1993): Altruism, Equality, reedom, Justice, Truth and Prudence. o...Based on AOTA Ethical Principles and Core Values, we take a look back at oubling/dovetailing patients for treatment and we know there are certain rules o follow in a variety of contexts of clinical practice, Questions Come p: Should doubling/dovetailing (DB/DT) always be considered unethical egardless of the clinical setting ? If DBDT is allowed by rule is it still nethical? If it is generally unethical by what ethical principle? Is DBDT nly unethical because it is harder (or easier) work for the therapist, or can t be proven to be less (or more) efficient in providing the most effective reatment to the most people for the least cost? think all these questions should have good answers before we go to our olleagues, managers, and administrators to talk about the ethics of practices nd policies such as DBDTing. ny other thoughts or responses? rent, an OT -- On Thu, 11/6/08, [EMAIL PROTECTED] [EMAIL PROTECTED] wrote: From: [EMAIL PROTECTED] [EMAIL PROTECTED] ubject: OTlist Digest, Vol 44, Issue 7 o: otlist@otnow.com ate: Thursday, November 6, 2008, 3:00 PM Send OTlist mailing list submissions to otlist@otnow.com To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com r, via email, send a message with subject or body 'help' to [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your Subject line so it is more specific han Re: Contents of OTlist digest... oday's Topics: 1. Re: doubling patient in acute rehab ([EMAIL PROTECTED])
Re: [OTlist] doubling patient in acute rehab
I think doubling and dovetailing in unethical in acute rehab, since it is a rule from medicare.? I have not read the rules for SNFs. -Original Message- From: Brent Cheyne [EMAIL PROTECTED] To: Ron Carson otlist@otnow.com Sent: Tue, 4 Nov 2008 6:16 pm Subject: Re: [OTlist] doubling patient in acute rehab Hello everyone and good topic, I've worked in SNF rehab geriatrics for the better part of 15 years and doubling/dovetailing has often been part and parcel of business as usual especially since the PPS RUGs category system was put into place. Coupled with this? RUGs phenomena is a fairly high productivity standard which usually between 85% to 95% in companies I've known or worked for.?( 8 hour day means 408min?or 6.8 hours?to 456 min or 7.6 hours of therapy contact and 24-72 minutes?to do everything else including meetings, and documentation). As Jennifer Mc Laughlin OT/L?has said MCR has changed and allows Med A to be treated concurrently and billed for the minutes engaged in tx as this is a minutes billing vs a modality treatment billing. The MCR B patients?I've seen have always been one-on-one. ? There seem to? be a lot of different interpretations of the? Medicare Rules and Regs and different? Rehab companies and many?therapists/managers are often convinced that they have it all straight.?Curiously, this?doesn't explain the vastly different ranges of accepted practices and?policies?amongst? different settings and companies. As a therapist who has done a fair share of doubling/dovetailing...I am keenly aware of the advantages and limitations of it's use. And yes--there are times when it is completely inappropriate for conducting skilled intervention related to occupations.However, there are times when it is appropriate to double up patient?when? it is selectively used to conduct treatment efficiently and free up more time to work one-on-one with a more involved patient in the same caseload. This takes good treatment?planning,time management,?and? clinical judgement ??? The real problem is when the dovetailing/doubling becomes an everyday-all day practice in which no 1:1 time is available at any time for anybody. Then caseloads simply become a? corporate billing mechanism but not skilled service. ? ??? The question I have is (as I play devil's advocate)Is doublling really unethical in all circumstances?, or which circumstances? And if it is please explain what is meant by unethical, in what manner is doubling unethical...that assertion is?one worth specifically articulating. I'd be interested in hearing from any of you, Respectfully, Brent the 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] Doubling patients
Sue, Can you explain what type of groups you are able to have and how you clearly demonstrate that the group was in the clients best interest not the time/staff management of the unit.? I would love to hear about those forms that you have developed. Our unit has been doing great with the three hour rule.? If the patient does not have ST, then OT and PT will usually devide the time and block by?45 minute sessions.? If the patient does have ST, they try to see them anywhere between 30-60 minutes pending the patient's need for ST.? We use a minute tracker in which we keep in a common area of the department and after each session we write in the time we were able to see them.? If we do not get the usual amount of time we try to write the minutes in red to alert the other staff to help out if able.? We also?use a team approach for our designated patients in which each OT has a team member from PT in which we can communicate when we need help. Shared your last email with my boss and now she is a little worried and is calling our prior consultant.? Thanks for your time. Chris Nahrwold MS, OTR -Original Message- From: Sue Doyle [EMAIL PROTECTED] To: otlist@otnow.com Sent: Sun, 2 Nov 2008 5:12 pm Subject: 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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
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
Re: [OTlist] Doubling patients in acute rehab
Jennifer, I am talking about inpt rehab.? But none the less your comments about quality care were highly valued. -Original Message- From: McLaughlin, Jennifer [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Mon, 3 Nov 2008 5:21 pm Subject: Re: [OTlist] Doubling patients in acute rehab That is called dovetailing or overlapping. Must bill MCR B as group in these instances as has been delineated in earlier postings. MCR has changed and allows Med A to be treated concurrently and billed for the minutes engaged in tx as this is a minutes billing vs a modality treatment billing. I agree that it is rare that we have the luxury of having patients with that similar a need or functional level that using a group therpauetically is an option. I am in charge of OT staffing in 2 CCRC facilities and we do not overlap or dovetail. Sometimes this means the resident gets fewer minutes with us but we feel it is unethical, illegal (in the case of Med B) and not best practice. So we treat with the believe that fewer quality min of one on one is better than more time but less quality of minutes. Yes staffing is hard and using perdiem staff is only a partial solution. OT service in its most base nature demands a one on one approach, in my humble opinion. Good luck in changing your management's focus, which seems to be very productivity and reimbursement focused. Look at the group rates and do an analysis of the revenue difference for your Med B. That being said, sounds as though you may be either talking of Med As or inpt rehab as there is no 3 hour rule for SNF or Med B clients. Just a few thoughts Jennifer McLaughlin, OT/L -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Barbara H. Hale Sent: Monday, November 03, 2008 4:36 PM To: otlist@otnow.com 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/otlist@otnow.com The information contained in this message may be privileged and/or confidential and protected from disclosure. If the reader of this message is not the intended recipient or an employee or agent responsible for delivering this message 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 notify us immediately by replying to this message and deleting the material from any computer. Thank you. -- 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
Sue, Right now there is one OT and one OTA, one PT and one PTA, and one ST for the 13 bed rehab unit.? We see each patient for 1 hour to 1.5 hours per day in OT depending if ST is seeing them.? So with the unit full right now, I can potentially have 13 treatment sessions per day, which is hard to complete without doubling.? Did not know that doubling counts towards groups, and that they have to have common goals for the group.? Thanks. -- 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] Best Practice
Sorry about the typo: If you agree that it was occupational therapy, how can you justify that estim to the digit extensors in prep for functional reaching in which the patient's goal is to reach for items easier, is not occupational therapy. -Original Message- From: [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Tue, 28 Oct 2008 8:46 pm Subject: Re: [OTlist] Best Practice Ron But I think calling such focal treatments occupational Ron therapy, is not consistent with our history, framework, payers, Ron patients and outcomes. I'm not sure what history you are talking about, but we were primarily created from a mental health framework, in which occupations were utilized for a mental therapeutic response. This mental therapeutic response could be argued to be a body segment, this being of course the brain. These occupations used to create a mental therapeutic ressponse were arts and crafts. Clearly not the same occupations you are defining. Not sure which framework you are talking about, because the framework in which I have states that we should focus on the body functions and structures that impede function. In fact, AOTA has endorsed the use of physical agent modalities through a position paper a number of years back. So in your case study, in which the goal for the patient was to make it to the toilet. Was that specifically occupational therapy when you worked on standing tolerance and ambulation the entire session? If you agree that it was occupational therapy, how can you justify that estim to the digit extensors in prep for functional reaching in which the patient's goal is to reach for items easier. The patient wants to be able to reach easier for the following self identified goals for treatment a) self feeding efficiency b) dressing efficiency c)social greetings. If you do not agree that what you did in your session was not occupational therapy how can you ethically bill for the service? Chris Nahrwold MS, OTR -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best Practice
Ron And, I do not think a therapist can mentally switch from Ron component level to occupation level treatment. Maybe I'm Ron wrong, but I think it's one or the other. But in your case study you are switching back and forth from the component level to eventually the occupational level. Standing tolerance=component level (cardiovasular, quad strength, static standing balance). Ambulation=componet level (cardiovascular, quad strength both concentric and eccentric contractions, dynamic balance). All of this was leading to the individual's personal occupational goal. In my case study I was switching back and forth from the component level to eventually the occupational level. Estim to the digit extensors=component level (facilitation of the neural pathway to enhance neuroplasticity which in turn leads to digit extensor strength and control). All of this leading to the individual's personal occupational goal. Chris Nahrwold MS, OTR -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best Practice
I think all of the described professions all facilitate function for their particular scope of practice.? As OTs we can facilitate function for a particular personal occupational goal.? The beauty of it comes when the patient can actually perform their desired goal.? The actual activity goal can also be used as a therapetic means to acheive the personal occupational goal, if the patient is at the point in which this is beneficial from a therapeutic point of view (ie I wouldn't have a patient work on buttoning a shirt with both hands if their hand is completely flaccid, because this would be a?waste of time.? Instead I would use compensation and restorative tecniques unil the actual goal of the patient can be practiced). Chris Nahrwold MS, OTR -Original Message- From: Ron Carson [EMAIL PROTECTED] To: [EMAIL PROTECTED] OTlist@OTnow.com Sent: Wed, 29 Oct 2008 9:46 am Subject: Re: [OTlist] Best Practice Chris, unfortunately I don't have time to respond in length but let me quickly say this. If we extrapolating out the contention that FOCUSED work at the component level to facilitate function is considered OT, then many different professions are doing OT! PT, RT, RN, Surgeon, etc all focus treatment at the component level with the belief that increased component-level function will increase overall function. Ron -- Ron Carson MHS, OT - Original Message - From: [EMAIL PROTECTED] [EMAIL PROTECTED] Sent: Wednesday, October 29, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best Practice Ron And, I do not think? a? therapist? can? mentally? switch? from? Ron component? level? to occupation? level? treatment. Maybe I'm Ron wrong, but I think it's one or the other. cac But in your case study you are switching back and forth from the cac component level to eventually the occupational level.? Standing cac tolerance=component level (cardiovasular, quad strength, static cac standing balance).? Ambulation=componet level (cardiovascular, quad cac strength both concentric and eccentric contractions, dynamic cac balance).? All of this was leading to the individual's personal cac occupational goal. cac In my case study I was switching back and forth from the component cac level to eventually the occupational level.? Estim to the digit cac extensors=component level (facilitation of the neural pathway to cac enhance neuroplasticity which in turn leads to digit extensor strength cac and control).? All of this leading? to the individual's personal cac occupational goal. cac Chris Nahrwold MS, OTR cac -- cac Options? cac www.otnow.com/mailman/options/otlist_otnow.com cac Archive? cac 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] Thoughts on Limiting Our Practice
I do not think an occupation-based approach to evaluation, treatment and outcomes limits the practice of OT.? I only think giving up on UE treatment in hand clinics and with stroke patients would debilitate the field of OT.? I have not disagreed on very many of your specific case studies that you have provided in which you have DC'd a patient from OT.? I would have probably done the same thing.? I primarily work in an acute rehab unit, and taking an occupation based approach is the only way to go when the patient's goal is to make it back home.? I can totally see your point of view when trying to totally get away from UE treatment based on a?large sample of rehab hospital/nursing home therapists who provide only UE treatment to pass time without any purpose or meaning.?I strongly agree that OT would be much more of a?solidified profession if all of the OTs?in?acute rehab, home health, and?nursing homes would take an occupation based approach. ?I do not think this should ruin the reputation of all of the hard working OTs in hand therapy and neuro clinics who provide a critical service to patient's with UE dysfunction.? I continue to believe that these therapists are OTs and they are providing OT services that impact the patient's personal occupations. I hope there is a solution?for all of the therapists whom give us OTs a poor reputation.? I have worked with individuals like this and they more often than not are oblivous to the fact that what they are doing is not really OT or therapy at all for that matter.? Somtimes a simple talking to works, sometimes it doesn't.? I think one step we can take is to try to be a mentor for individuals whom are stuck in an OT rut.?Another step that I think would be of value would be more continuuing education involving OT and occupation.? There are so many courses out their taught by PT focusing on body functions/structures, it is to no wonder that?therapists are focusing primarily on these issues.? I think we need more on occupation, practical solutions for impairments from top notch green thumb therapists.?Perhaps with a?major push in this we would see a trickle down effect in the quality of care. ?Ron have you ever thought about taking your act on the road and teaching on the continuuing ed circuit? Chris Nahrwold MS, OTR -Original Message- From: Ron Carson [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Thu, 23 Oct 2008 7:16 pm Subject: [OTlist] Thoughts on Limiting Our Practice It's been suggested that a occupation-based approach to evaluation, treatment and outcomes limits the practice of OT. I want to suggest that such an approach does just the opposite. First, there is NO profession addressing occupation. There are some professions, namely PT, SLP, Aides, RN, OT, that address PARTS of occupation, but no profession sees the entire picture from start to finish. And because of this, many, many patients never truly achieve their highest potential! Second, facilitating occupation is excruciating difficult. But, because of this, it's wonderfully rewarding. Case in point, is Martha. One of her goals is independently getting on/off the toilet. Over the course of her treatment, Martha has been able to transfer to/from the toilet. And she has even successfully used her OLD toilet. I say old because in an effort to make transfers easier, a higher toilet was installed. BUT, the new toilet has a different seat in which Martha sinks into. Thus, while she can easier sit on her new toilet, she can not TURN while sitting to allow her to grad installed hand rails. Thus, the new toilet seat doesn't work well. You know, who would think that the shape of a toilet seat is the difference between independence and dependence. So, the observation skills, problem solving, environmental awareness, biomechanics, and even common sense that goes into occupation-based practice is anything but limiting. And while occupation-based practice does exclude some practice areas, notably acute injury, there are many more areas and patients who benefit from these services. Sorry for typos/graphos; I'm typing about as fast as I'm thinking! 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] UE Evauation Yesterday...
Ron, What do you think about OTs that practice as occupation-based therapists but on occasion can switch gears and become impairment based minded?? I like how you said no, I'm an occupational therapist doing lymphedema treatment.? I guess that is what I do when I help out in the hand therapy clinic. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson [EMAIL PROTECTED] To: Sue Doyle OTlist@OTnow.com Sent: Fri, 24 Oct 2008 8:24 am Subject: Re: [OTlist] UE Evauation Yesterday... Sue, and there in lies the beauty of occupation-based treatment. The approach encompasses almost ALL areas that impair occupation. BUT, and this is big, remediating those areas is NOT the goal. And yes, yes, yes, occupation does address impairments. For example, I've had many patients who could not swing a leg into the bathtub, or could not sit/rise from the toilet because of LE weakness. So, I direct patients to do LE strengthening exercises BUT I don't sit their and count their reps. That is something they can do on their own. When I return for the next treatment, the patient again attempts their desired occupation. If positive changes occur, then they are doing something right and so am I. If no changes then I will address the exercise situation. But again, ROM, strength, balance, cognition, etc ARE NOT THE PROBLEMS AND THUS ARE NOT THE GOALS! I do think that OT can address impairments soley for the sake of treating those impairments. But, this drives the therapist away from occupation. And in these cases, I think it's best to claim what the therapist does as hand therapy, low vision therapy, lymphedema treatment, cognitive rehab, etc. Because, in my mind these things are not truly OT. I think I've mentioned that I'm trained in lymphedema management. Just yesterday, I was an an SNF getting ready to do an eval. The nurse asked me if I was the massage therapist (which is a first for me). I quickly said no, I'm an occupational therapist doing lymphedema treatment. In this way, the nurse knew that I was licensed as an OT but that I was doing lymphedema treatment. Ron -- Ron Carson MHS, OT - Original Message - From: Sue Doyle [EMAIL PROTECTED] Sent: Friday, October 24, 2008 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] UE Evauation Yesterday... SD Ron, SD PTs would love what you just said. Not all impairments are within SD the PT education and practice scope. Though I think they would SD love to think so. The areas of visual perception, cognition, are SD two component areas that I can think of where their skill level SD and training are limited. (Though so are some OTs.) SD SD PTs are strongly arguing to increase their scope of practice SD without the base. But how does that argument flow for OTs? What SD truly is our base? If Occupation how do we address the impairments SD that impact? And really given what we know about motor control and SD motor relearning and cognition and generalization can we treat SD impairments successfully outside of the context? SD SD Just some early morning ramblings? -- 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] UE Evauation Yesterday...
Ron said: For sure,?? improving?? her?? elbow? function? will? improve? occupational performance, but the patient's concern is NOT occupation. If the patient is not concerned about her occupations why does she want her elbow to improve in function? And the record player continues! Chris Nahrwold MS, OTR -Original Message- From: Ron Carson [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Tue, 21 Oct 2008 9:19 am Subject: [OTlist] UE Evauation Yesterday... Hello Everyone: Yesterday, I received a home health referral for a humeral fracture/tricpes tendon reattachement. By now, I'm sure most regular readers are aware of my stance on OT's NOT being UE experts. Interestingly, PT had already evaled the patient and said they couldn't do anything. So, as I'm sitting there talking with the patient, I'm encouraging her to use her affected UE for daily activity such as eating, dressing, toileting. During this time, I'm thinking there just isn't much role for OT. The patient's concern is ROM and pain, not occupation. For sure, improving her elbow function will improve occupational performance, but the patient's concern is NOT occupation. As I'm sitting there pondering doing ROM, exercises and strengthening the patient tells me that her doctor ordered outpatient PT. Since patients can not be on home health while going to outpatient therapy, I discharged the patient. It was an awkward situation. The family and I discussed the differences between OT and PT and how some OT's treat UE injuries. 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] Clearly DelineatingOT and PT?
I agree with the delineation provided by Ron.? As OTs though, we need not be afraid to address the physical limitation that is a barrier to the person's occupational profile.? Funny how we spend 100s of dollars a year on continuuing education that mainly focus on the impairment level, also I might add that these courses are usually endorsed by AOTA.?Funny how AOTA has this article called the practice framwork in which the restoration of?client factors a) body functions b) body structures is clearly outlined. I think the UE/LE divide has evolved out of professional courtesy over the years mainly in the relm of outpatient clinics.? I would have no objections for a PT to treat a UE/hand if they are skilled to do so.? I would have no objections for an OT to treat the LE if they are skilled to do so (I have?seldom heard of this happening though).? I think the complexeties of the of body functions and structures are large enough that both disciplines should share in the workload of research and treatment.? Again, I strongly believe that to stop treating the UE would be professional suicide for Occupational Therapy, as Ron is unfortunately experiencing firsthand in his quest to become an occupation as an only?means therapist. Is this record player broken?? I keep hearing the same song over and over again.? Smile! Chris Nahrwold MS, OTR -Original Message- From: Ron Carson [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Tue, 21 Oct 2008 4:47 pm Subject: [OTlist] Clearly DelineatingOT and PT? Our most recent discussion leads me to ask this question: Can you CLEARLY delineate the role between PT and OT? My Answer: PT is most indicated when the FOCUS of concern (by referral source and/or patient) is on body parts or body processes. OT is most indicated when the FOCUS of concern is on human occupation. 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] Clearly DelineatingOT and PT?
What should an OT do if the patient identifies that they want to be able to look to the left (attention?=body?function)?because of a right CVA?to their parietal lobe (body structure)?? They unfortunately do no personally state any occupations that they want to address in particular.? Should we pass the patient to physical therapy or should we coerce a few occupational goals?through common sense? Chris Nahrwold MS, OTR -Original Message- From: Ron Carson [EMAIL PROTECTED] To: [EMAIL PROTECTED] OTlist@OTnow.com Sent: Tue, 21 Oct 2008 7:59 pm Subject: Re: [OTlist] Clearly DelineatingOT and PT? I've been spinning this record for 10+ years and I'm not about to stop now! smile I also want to add that I have absolutely NO PROBLEM with OT's addressing physical limitation. Like you said, we are shooting ourselves in the proverbial foot if we stop treating physical limitations. However, I have two buts to add this statement: But 1: OT must NOT address ONLY upper extremity physical function. As occupational experts, we MUST learn to address the musculoskeltal function of all extremities. I'm not sure about the spine, but definately we must address the LE. But 2: OT must NOT address physical function for the sake of physical function. That is what PT does. OT's must address physical function from an empowering occupation perspective. In other words, OT's ONLY address physical function when improving occupation is the WRITTEN GOAL of treatment and a specific physical function is a CLEARLY identified barrier to a SPECIFIC occupation. For example, if my UE eval had stated something like: You know, I spill food with my left hand and I can't get my right elbow to bend far enough to get food in my mouth and I so want to eat with my right hand! Then, Bam! we have a SPECIFIC occupation that is clearly limited by physical function. However, OT's must not coerce or draw parallels between ABSTRACT occupational goals and physical barriers. Goals must be identified by the patient, often with the help of the OT. After all, goals should state what's important to the PATIENT, not what's important to the therapist, or the referring MD. If it's not important to the patient, then I don't think OT should be addressing it in therapy. Again, that should be a hallmark difference between OT and other professions. Ron -- Ron Carson MHS, OT - Original Message - From: [EMAIL PROTECTED] [EMAIL PROTECTED] Sent: Tuesday, October 21, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Clearly DelineatingOT and PT? cac I agree with the delineation provided by Ron.? As OTs though, we cac need not be afraid to address the physical limitation that is a cac barrier to the person's occupational profile.? Funny how we spend cac 100s of dollars a year on continuuing education that mainly focus cac on the impairment level, also I might add that these courses are cac usually endorsed by AOTA.?Funny how AOTA has this article called cac the practice framwork in which the restoration of?client factors cac a) body functions b) body structures is clearly outlined. cac I think the UE/LE divide has evolved out of professional cac courtesy over the years mainly in the relm of outpatient cac clinics.? I would have no objections for a PT to treat a UE/hand cac if they are skilled to do so.? I would have no objections for an cac OT to treat the LE if they are skilled to do so (I have?seldom cac heard of this happening though).? I think the complexeties of the cac of body functions and structures are large enough that both cac disciplines should share in the workload of research and cac treatment.? Again, I strongly believe that to stop treating the cac UE would be professional suicide for Occupational Therapy, as Ron cac is unfortunately experiencing firsthand in his quest to become an cac occupation as an only?means therapist. cac Is this record player broken?? I keep hearing the same song over and over again.? Smile! cac Chris Nahrwold MS, OTR cac -Original Message- cac From: Ron Carson [EMAIL PROTECTED] cac To: OTlist@OTnow.com cac Sent: Tue, 21 Oct 2008 4:47 pm cac Subject: [OTlist] Clearly DelineatingOT and PT? cac Our most recent discussion leads me to ask this question: cac Can you CLEARLY delineate the role between PT and OT? cac My Answer: cac PT is most indicated when the FOCUS of concern (by referral cac source and/or patient) is on body parts or body processes. OT cac is most indicated when the FOCUS of concern is on human cac oc cupation. cac Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] How Would YOU Treat This Patient?
Sounds like she might be back to her baseline with her ADL performance.? Her bi-lateral shoulder problem sounds like either severe arthritis or torn RTCs.? At her age surgery not?likely for the RT.? Is she ok with receiving assistance with bathing and dressing or is it a goal of hers to improve?? If it a goal for her to improve in ADL performance, I would attempt to teach her how to use adaptive equipment like a dressing stick to pull the shirt over her head so her arms would not have to go over 90 degrees.? I would also instruct the patient and family on heat and slow stretching so the limitation in her arms will not become worse and perhaps so she can lift her arms on a table or sink to slip on her shirt over her head and to groom/eat.? I just had a man in a similiar situation, but he was much younger.? The basic compensation techniques and exercises worked like a charm, and he was very happy about the progress, but he was very motivated to improve because his wife was unable to help him much. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Fri, 17 Oct 2008 6:58 pm Subject: [OTlist] How Would YOU Treat This Patient? Did an eval today and wondering how other OT's might address the situation. 94 y/o female living with her 70 y/o daughter. Recent fall resulting in femur fracture. Ambulates with a rolling walker and supervision. Independent with toileting. Requires assistance with upper body dressing, independent with LE dressing. Requires assistance with bathing. Patient previously received assistance with bathing and dressing. Patient has pain 8/10 in right femur with weight bearing. She is unable to raise her bi-lateral shoulders past approximately 90 degree flexion/abduction. How would you treat this patient and WHY??? 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] Lost my OT job today.... plus....
I have learned that OT is a hidden gem in the healthcare arena and I assume that every patient that I encounter does not understand what I do.? That is why I try to make a special point to educate every patient that I work with about OT.? There are many professions that I know that have unclear names and roles, take being a lawyer for example.? I have a vague sense of what lawyers do, but I would have no clue what an intellectual property lawyer does, unless I really need?one.? Same case with doctors.? I have no clear?idea what a?otolaryngologist does, but I'm sure I would learn real quick if I needed one. I think it is hard to quantify ourselves with other professions, because you can't compare apples to oranges.? PT has a practical name and you can find a PT clinic on every street corner nowadays.? Of course people are going to have a vague sense of what they do.? Basically, I have accepted to teach the medical community what OT does, not by my words but my actions.? I have done countless in services about what OT does, but that only primes the pump.? What you have to do is become an valued expert in what you do and the medical team around you will most certainly identify your area of value.? Continuing education is a prime example of how one can better there self and there profession.? I take several course per year and then in service the entire team, so they know that I have some special knowledge in an area.? One can't sit around and expect referrals to come in, you have to build it yourself. Chris Nahrwold MS, OTR -Original Message- From: Kelly Hunt [EMAIL PROTECTED] To: OTlist@otnow.com Sent: Fri, 17 Oct 2008 8:13 pm Subject: Re: [OTlist] Lost my OT job today plus Ron, etc., I admit I am a lurker, and generally a more subtle advocate for our profession, but even I get irked into irritation at times with the blatent disregard for our profession by our Association, the medical community, and other OTs. Case in point. I was called in to work at a rural outpatient clinic today at a hospital system that I work at PRN. On the wall there is a newspaper article for the local paper with the title New Physical Therapist and a picture next to it of someone I know to be an OT. The article was welcoming her to her new post (it was a few years dated) and in honor of OT month. YET TITLED AS A NEW PT!!! Now maybe the paper made a mistake, but the clinic chose to prominantly display this article for all the patients to see. And many of her pts called me a PT or asked, what is OT again? What's the difference? I was shocked!How as a profession can we expect to move forward and gain identity when our own colleagues don't distinguish us from other disciplines? Humbly, Kelly the OT! On Fri, Oct 17, 2008 at 6:21 PM, Ron Carson [EMAIL PROTECTED] wrote: Thanks EVERYONE. I just don't get it. I just don't understand how OT is so far behind... I don't know if I shared this or not, but one of the other therapists, a PT, documented over 45 visits in one week. Now, tell me how can a therapist make 45 visits in one week, especially when they are driving 100+ miles each day? The answer of course, is that each visit is 20 - 30 minutes. How is that quality therapy? Is that even therapy? I thought about going back to the manager and explaining that OT is vastly different and that OT takes more time than other professions. And that I can't do quality OT in 20 - 30 minutes, it's just not possible. But, like my lovely wife pointed out, the HH agency obviously cares more about money than quality therapy. I understand that as a corporation, there are revenue goals to be met but come on. You know, it would b e difficult meeting 30 visits/week. For one, I routinely drive over 100 miles/day and sometimes 150. That's a LOT of drive time. So, when is paperwork, phone calls, family calls, etc? It really is a shame. I give 100% to patient's outcomes, I often leave patient's homes wringing wet with sweat, and yet my agency is upset because I'm not meeting productivity. Sadly, I could go sit on my butt, counting exercise reps for 30 minutes and easily make productivity. But, how much benefit is that? I am so stinkin' frustrated with OT and AOTA. You know we've got that great centennial vision of OT being: apowerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society's occupational needs At times like this I think some people at AOTA are TOTALLY clueless just how bad it is. How can we meet society's needs when the VAST majority of society has no earthly idea what we do. Or when OT's are practicing so different from our framework that we are seen by almost EVERYONE working in phys dys as UE therapists. Almost every patient I meet in home health is
Re: [OTlist] Best Practice
Ron, ?I am so glad that you asked me that question.? The night before I wrote that response I was up late googling the history of occupational therapy.? It was a very late night of reading.? Unfortunately, I did not tag any of my references, but I was able to check the history of my computer to determine the differenct websites that I visited on Wed night.? I think the statement came from: http://www.newfoundations.com/History/OccTher.html.? Mistakingly, though I believe I may have mispoke from my late night of reading.? Reading it again I found that the specialists of physical medicine attempted to take over the education of occupational therapy to enhance the practice of physical medicine.? I could of sworn that I read something about OT/PT in the military after World War II and that OT was a sub speciality of PT because OT was not at that time, because they?did not have military status but only worked as civilians.? But please strike that comment I made, because I cannot back it up now, and I have been trying to find it for two hours. Does anyone know how and why OTs became involved in UE rehabilitation?? During the World war II I wonder if because of our close location to physical therapy in medical hospitals that we colaborated with them in some way.? Since we used leather, art projects, and work projects?for the mental health of the soldiers, I wonder if the physical therapists saw this as a potential modality for the soldiers with UE dysfunction.? And because of the overwhelming amount of injuried patients, I wonder if the OTs then joined to help with physical dysfunction.? As a natural line for treatment (UE/LE) I wonder if that just stuck.? Also in my reading, I noticed that there was a huge job shortage of physical therapists in 1956. http://www.recreationtherapy.com/history/rthistory3.htm.? I can't hep but to wonder if this was the time when OTs really went forward in the relm of UE dysfunction because of our huge involvement in helping individuals with polio. ?http://www1.aota.org/ajot/abstract.asp?IVol=39INum=12ArtID=5Date=December%201985? And because of the PT shortage we as OTs were required to step it up and help with the UE dysfunction side of things, if not it possibly would not have gotten done.? Because of this special specialization we of course gained expertise over the following decade and our involvement in UE dysfunciton has remained to this day.? This perspective is of course all speculation based on bits and pieces of our history on the net. This discussion has been good for me and it has made me reflect on my own practice patterns when I work in the outpatient setting.? I help with a lot of outpatient stroke rehab.? Most of the time the client centered goals of the stroke patient are to Move my arm more.? When asked why they state So I can do more stuff with it.? With more probing into the specifics they look at me like I am a idiot and often state Of course I want to use it to dress more effeciently, what kind of question is that?? But over the course of their therapy, often times new occupation goals emmerge from increases in their abilities to move their arms.? What I struggle with in outpatient is the short term goals.? As we know, the stroke population often progress slowly with the functional use of a hemiplegic arm.? It may be multiple months of tough OT before we even begin to see a positive change on an activity level spectrum.? That is why it is so hard to write short term goals with occupations in the relm of stroke rehab, because insurance companies demand to see measureable improvements quickly or they will deny services.? That is the reason why I take range of motion measurements, grip strength, coordination testing, because this is the only way I know to quantify gains on the short term.? And occupational treatment options using occupations as a therapeutic challenge are limited at first when the patient can only move in gravity elminated positions, and?are often a waste of time and only frustrate the patient. ?But as soon as?complex movements emmerge from graded therapeutic exercise/?neuromotor training, ?I think occupations are the best?next step, and in fact the ultimate goal. And occupations are certainly?a great way?for the patient to?complete a?contraint induced movement program at home, the problem is they have to be able to move so much for it to be worthwhile. ?Should I refer all of those patients to physical therapy for PT arm rehab, until they have enough functional movement to engage in occupations? Most PTs in the clinic I work with do not know how to help an individual with UE hemiplegia, and they would problably refer back to me because I have more experience with it.Perhaps I am acting like a PT at first during the initial stages of a patient stroke rehab, but I do not know what else to do, and the outcomes?have been on?the positive side the majority of the time. ?Any suggestions
Re: [OTlist] Elbow Break, Referral...
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 to school.? How do you comment on the OT guide to practice and our practice acts?? In my opinion it is dangerous to be that?narrow in our definition in what we do as OTs.? I certainly understand and respect your opinions, because they do make sense on paper, but when actually practicing we do have to address body functions/structures at times to help the patient make further progress.? I noticed a post that you made?in the AOTA listserve under the physical section.? In it you were giving advise about an individual with guillen barre (spelling?), and you of course talked about ADL performance, but then you gave an example of practicing sit to stands and unilateral reaching without being in the context of an ADL.? Isn't this the same as helping a patient with their arm functions through ther ex to facilitate a positive outcome with functional reaching?? Thanks again for the great discussion. Chris Nahrwold MS, OTR St. John's Hospital Anderson, Indiana -Original Message- From: Ron Carson [EMAIL PROTECTED] To: L Sloan OTlist@OTnow.com Sent: Sun, 31 Aug 2008 6:09 am Subject: Re: [OTlist] Elbow Break, Referral... If the goal is increased ROM or decreased pain, why include the functional component? It seems obvious to me that if ROM/pain are the ONLY things preventing the patient from doing self-care, then positively impacting these area will directly improve self-care. So, why even include the the function. If the goal is occupation, then I see no reason for the ROM/pain component. As and OT, I strongly believe that occupation should be the goal, but occupation is not always the goal of the patient or MD. And it's these situations where OT is out on a limb, because we are truly practicing OT, but PT. Ron -- Ron Carson MHS, OT - Original Message - From: L Sloan [EMAIL PROTECTED] Sent: Saturday, August 30, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Elbow Break, Referral... LS How About LS Patient will demonstrate increased active range of motion to LS during upper and lower body dressing activities.or... LS Patient will demonstrate increased AROM to ___ to allow patient LS to complete upper and lower body selfcare activities safely... LS Patient will demonstrate a decrease in pain from ___ to ___ to LS enable her to complete her dressing activities. LS ??? Lisa LS - Original Message LS From: Ron Carson [EMAIL PROTECTED] LS To: OTlist OTlist@OTnow.com LS Sent: Saturday, August 30, 2008 3:48:47 PM LS Subject: [OTlist] Elbow Break, Referral... LS Received? a? new referral for a elbow fracture. I shouldn't have taken LS it but I did. LS And? here? is? the? dilemma? facing our profession. The patient is 95, LS previously living independently. Fractured elbow in a fall. Now living LS with? daughter.? She? is? in a large amount of pain. Obviously, she is LS dependent? for? most of her occupations. She currently uses a cane but LS is not safe. LS The? patient's? immediate concerns are her elbow. When pressed, she of LS course wants to go back home, but that is not an immediate goal. LS So what do I write for goal s? For example should I write: LS ? ? ? ? Patient will self-report pain as 3 out of 10 LS ? ? ? ? Patient's will increase active elbow extension to -20 degrees LS These? goals seem to direct the patients and doctor's concerns but are LS not occupationally oriented. So, should I write: LS ? ? ? ? Patient will safely and independently dress lower body LS ? ? ? ? Patient? will safely and independently ambulate to the bathroom LS ? ? ? ? using the least restrictive mobility aid LS I like these goals but they don't address the immediate concerns. LS Ron LS -- LS Ron Carson MHS, OT LS -- LS Options? LS www..otnow.com/mailman/options/otlist_otnow.com LS Archive? LS www.mail-archive.com/otlist@otnow.com LS -- 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...
I would write all 4 goals.? Why in the world would you not take this patient?? I shouldn't have taken it but I did.? What patient's do you take? Chris Nahrwold MS, OTR St. John's Hospital Anderson, Indiana -Original Message- From: Ron Carson [EMAIL PROTECTED] To: OTlist OTlist@OTnow.com Sent: Sat, 30 Aug 2008 2:48 pm Subject: [OTlist] Elbow Break, Referral... Received a new referral for a elbow fracture. I shouldn't have taken it but I did. And here is the dilemma facing our profession. The patient is 95, previously living independently. Fractured elbow in a fall. Now living with daughter. She is in a large amount of pain. Obviously, she is dependent for most of her occupations. She currently uses a cane but is not safe. The patient's immediate concerns are her elbow. When pressed, she of course wants to go back home, but that is not an immediate goal. So what do I write for goals? For example should I write: Patient will self-report pain as 3 out of 10 Patient's will increase active elbow extension to -20 degrees These goals seem to direct the patients and doctor's concerns but are not occupationally oriented. So, should I write: Patient will safely and independently dress lower body Patient will safely and independently ambulate to the bathroom using the least restrictive mobility aid I like these goals but they don't address the immediate concerns. 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...
I can totally see Ron's point now.? I work in acute rehab and we actually have them undress and dress,?so it is easy for me.? To make things more functionally based in outpatient or home health I think I would trial the DASH.? This is an upper extremity assessment tool that is a pre and post treatment?survey of what functional problems the patient is encountering.? This will give the therapist a better idea of what to focus on based on the patients survey results.? Check it out on Google.? Based on a good description of what we do in OT?for the patient, I don't think they will have a problem talking about their occupational dysfunctions.? I would use both a therapeutic exercise/splinting/ and ADL practice/compensation approach. Chris Nahrwold MS, OTR St. John's Hospital Anderson, Indiana -Original Message- From: Ron Carson [EMAIL PROTECTED] To: Kari Rogozinski OTlist@OTnow.com Sent: Sat, 30 Aug 2008 6:54 pm Subject: Re: [OTlist] Elbow Break, Referral... Call me think-headed, but I don't see how those goals are any different than PT. When I read the goals I see the primary focus on decreasing pain and increasing ROM and the functional stuff is just thrown in. And that's primarily what PT does. OT knows there's a lot more to dressing than just physical dysfunction. There's the environment, cognition, motivation, family issues, etc. With your goals, what happens if ROM is increase so the patient SHOULD be able to dress but they still can't because the family doesn't feel they are safe? According to your goals, the patient is d/c. Either that or you'll need some new goals! I will also suggest that goals should not be written unless it has been assessed. In other words, I don't write ROM goals, because I don't take ROM measurements. I do assess occupation and those are the goals that I write. Again, what the therapists assess should be the goals. And conversely, if it's not assessed then it shouldn't be a goal. Also, goals must be measurable and progress must be made. How can a therapist measure progress towards a goal that is not initially measured? And, what measure is going to be used? I will say the increase functional performance with bilateral UE tasks is not exactly a measurable goal? Now, if you assessed that the patient required mod assist to donn her bra and the goal was Pt will independently donn/doff bra, then that's an OT assessment and goal. However, can you see this ladies face when I ask her about how much assistance she need to put on her bra, or pull up her underwear? She's going to think I'm nuts because she wants me to fix her arm, not worry about teaching her to get dressed! Gosh, I hate long messages. Sorry for typos/graphos Ron -- Ron Carson MHS, OT - Original Message - From: Kari Rogozinski [EMAIL PROTECTED] Sent: Saturday, August 30, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Elbow Break, Referral... KR I ag ree with Chris, I would take this patient and right all 4 KR goals.? The only exception is i would state why i was going to KR decrease the pain or increase ROM.? I would probably say something KR like: ? Pt. will increase active elbow extension to -20 degrees to KR allow for increased independence with upper body dressing or KR decrease reports or pain to increase functional performance with KR bilateral upper extremity tasks (grooming, bathing, dressing, etc.)? KR ? KR Ron, you have now given us examples of 2 patients you would not KR treat, I too am wondering what kind of patient would you see?? KR ? KR ? KR Kari, MOT, OTR/L KR Hollywood, Florida KR --- On Sat, 8/30/08, [EMAIL PROTECTED] [EMAIL PROTECTED] wrote: KR From: [EMAIL PROTECTED] [EMAIL PROTECTED] KR Subject: Re: [OTlist] Elbow Break, Referral... KR To: OTlist@OTnow.com KR Date: Saturday, August 30, 2008, 5:21 PM KR I would write all 4 goals.? Why in the world would you not take this patient?? KR I shouldn't have taken it but I did.? What patient's do you KR take? KR Chris Nahrwold MS, OTR KR St. John's Hospital KR Anderson, Indiana KR -Original Message- KR From: Ron Carson [EMAIL PROTECTED] KR To: OTlist OTlist@OTnow.com KR Sent: Sat, 30 Aug 2008 2:48 pm KR Subject: [OTlist] Elbow Break, Referral... KR Received a new referral for a elbow fracture. I shouldn't have taken KR it but I did. KR And here is the dilemma facing our profession. The patient is 95, KR previously living independently. Fractured elbow in a fall. Now living KR with daughter. She is in a large amount of pain. Obviously, she is KR dependent for most of her occupations. She currently uses a cane but KR is not safe. KR The patient's immediate concerns are her elbow. When pressed, she of KR course wants to go back home, but that is not an immediate goal. KR So what do I write for goals? For example should I write: KR Patient will self-report pain as 3 out of 10 KR
Re: [OTlist] Would You Treat For Refer to PT?
Are you sure she can reach up into high cabinets in order to cook and clean with that right arm? Can she fasten her bra the way she used to with an internal rotation?approach in back or is?she resorting to compensation, but she would like to get back to her?prior method??I'm sure if you dig hard?enough you?will find some occupational dysfunction. If not I would defer to PT. ?As an OT it depends if you are comfortable and competent to treat shoulder dysfunction.? I have had two post professional OT courses on shoulder dysfunctiion, ?taught at a credited program of OT, so I have to answer yes to your question. -Original Message- From: Ron Carson [EMAIL PROTECTED] To: OTlist OTlist@OTnow.com Sent: Tue, 26 Aug 2008 3:15 pm Subject: [OTlist] Would You Treat For Refer to PT? Received a new home health referral. Patient's diagnosis is right shoulder pain. Patient presents with bicep tendon pain during AROM, PROM and palpation. She lives alone and is independent with all her daily living tasks. I referred the patient to PT for the shoulder pain. Would you, as an OT, treat this patient? Thanks, Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Would You Treat For Refer to PT?
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 does close in work with her right arm, such as crocheting, eating, turning book pages, etc. But she does no lifting with her right shoulder. I also think that within the course of an evaluation, it's difficult to assess ALL daily living tasks, (i.e. driving, washing dishes, shampooing hair). What I do is extrapolate my observations and the patient's reports to form a basis of all daily living. However, it is best to not say all when I don't really know that to be a fact! Ron - Original Message - From: Kari Rogozinski [EMAIL PROTECTED] Sent: Tuesday, August 26, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Would You Treat For Refer to PT? KR Ron, KR ? KR I noticed that you said you asked the patient.? I find that KR usually when i have them perform specific tasks instead of asking, KR the findings don't match what is reported.? Don't you think she is KR entitled to an evaluation at least and then decide which way to KR go.? It is hard for me to believe that she is safe and Independent KR with all daily living tasks.? If her dominant side is affected( KR I'm assuming she is right dominant), it makes me wonder how she is KR lifting things or carrying things with that side.? Is she using KR proper compensatory techniques or is she going to cause damage elsewhere?? KR --- On Tue, 8/26/08, Ron Carson [EMAIL PROTECTED] wrote: KR From: Ron Carson [EMAIL PROTECTED] KR Subject: [OTlist] Would You Treat For Refer to PT? KR To: OTlist OTlist@OTnow.com KR Date: Tuesday, August 26, 2008, 4:15 PM KR Received a new home health referral. Patient's diagnosis is right KR shoulder pain. Patient presents with bicep tendon pain during AROM, KR PROM and palpation. She lives alone and is independent with all her KR daily living tasks. KR I referred the patient to PT for the shoulder pain. Would you, as an KR OT, treat this patient? KR Thanks, KR Ron KR -- KR Options? KR www.otnow.com/mailman/options/otlist_otnow.com KR Archive? KR www.mail-archive.com/otlist@otnow.com KR -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] bioness
I have had moderate success with the use of E-stim when applied in a functional way.? I like to stimulate the digit flexors and the digit extensors in an alternate pattern while combining a? graded grasp and release challenge.? The use of E-stim in the clinic is not enough to make a difference, so I usually set them up with a home unit and program if they are cognitively appropriate or a caregiver can assist.? Google strokengine to see all of the evidence on functional return from E-stim?through randomized control trials, I think the evidence will suprise you.? But like I said before you have to use it a lot. Chris Nahwold MS, OTR ST. John's Medical Center Anderson, Indiana -Original Message- From: Neal Luther [EMAIL PROTECTED] To: OTlist@OTnow.com Sent: Mon, 25 Aug 2008 7:56 am Subject: Re: [OTlist] bioness I agree with the statement about TENS in general upper quad use for the neuro population. I have used it adjunctively to other tx. (Saeboflex)that is more active for the CVA population not MS. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of [EMAIL PROTECTED] If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Sunday, August 24, 2008 7:34 AM To: Bill Maloney Subject: Re: [OTlist] bioness I am skeptical of e-stim devices for the hand. In my experience, there is little a therapist or device can do to restore permanent and meaning ability to a hand affected by a CVA. Of course, I've seen patient's recover hand function s/p CVA, but this normally occurred spontaneously and rather quickly after the CVA. When someone is 1 year or more out from their stroke, and hand function is not meaningful, I do not feel that meaningful use will return. Others' opinion?? - Original Message - From: Bill Maloney [EMAIL PROTECTED] Sent: Saturday, August 23, 2008 To: otlist@otnow.com otlist@otnow.com Subj: [OTlist] bioness BM I am relieved to see the OTlist responding to the recent CPR it received. BM I hope it never dies. BM Does anyone out there have any specific experience with the Bioness device BM for treatment of the hands for patients diagn osed with multiple sclerosis? BM (FYI http://www.bioness.com/bioness_hand_main.php). I appreciate any BM feedback. BM Bill Maloney, OTR BM www.embracelifewell.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Do You Agree with This Statement?
I view hand therapy as a special career path that some interested occupational therapists or physical therapists can take.? Just like other special career paths in OT a) driving evals/ training b) visual OT therapy c) etc. Now for some reason OT has in a sense took over the interest in that area perhaps because we had several courses in school focusing just on hands and splinting, and placement in fieldwork for hand therapy?might be easier for an OT versus a PT to find, because a OT cannot supervise a PT student.? I believe that what OTs do as hand therapists is OT, because number one the hand therapist is an OT and that is the credentials that follow their name.? Number two body structures and body functions?are certainly in our domain of practice written by AOTA.?The traditions of our profession have changed in some areas, and that is driven by patient needs. ?I can certainly understand Ron's point of view as viewing hand therapy as not being OT, but try to look at the big picture.? We are making a huge impact in the care of the patient,?using a bottom up approach versus a top down approach, ?which in turn leads to a positive functional outcome in hand OT.? I don't think we have to be so rigid with our definitions, but learn to respect and apprectiate?our places in healthcare.? Patient's will naturally learn what we do as OTs if we educate them the right way, and if we do a stand up job for them,?one patient at a time.? And no I am not a hand therpist or an OT practicing as a hand therapist.? Thanks for the discussion. Christ Nahrwold MS, OTR St. John's Hospital Anderson, Indiana -Original Message- From: Ron Carson [EMAIL PROTECTED] To: Mary Alice Cafiero OTlist@OTnow.com Sent: Mon, 25 Aug 2008 7:16 pm Subject: Re: [OTlist] Do You Agree with This Statement? Mary, I think that's ONE of the problems I have with the brochure. It does NOT specify hand therapist, it simply says occupational therapy. And as we all know, hand therapy and occupational therapy are not the same thing, right? - Original Message - From: Mary Alice Cafiero [EMAIL PROTECTED] Sent: Monday, August 25, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Do You Agree with This Statement? MAC I certainly don't see myself as a hand therapist in any way, shape, or MAC form -- 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
