Re: [OTlist] Best practice
Veronica Going back to your case, you should definitely not prescribe equipment that you do not feel will meet your patients needs in a safe way. I recently recieved a referral from a physio to raise a patients bed to ease hoisting the patient on/off bed. (the patient lives in a residential home) On assessment it became clear that the patient who has parkinsons was mostly transferring on/off bed with time and assistance (not hoist). She at times had falls and it was in these instances that the home staff were hoisting her off the floor and into bed. The patient had a divan bed (that was her own) which they had raised themselves (on inapproriate raisers) to allow the hoist legs to go under the bed. So, the bed was 25 high, far too high for the patient to transfer on and off even with assistance, so not only did it eliminate the patients supported transfers (which should have been encouraged) but also posed a risk when the patient was in the bed as she often initiated transfers without requesting help. On assessment I advised them that the raisers they had put on were inappropriate and unsafe for that type of bed. They requested I provide the appropriate raisers, I advised them that I would not reccommend raising the bed at all for the above reasons. They were very pushy saying that they needed a bed that they could use a hoist with for the safety of their staff. The patient was also expressing that she did not want to change her bed. I sat with the patient and support worker and advised that I recommended the patient use one of the res home beds which were standard 19 but unlike the divan bed had a gap underneath to allow space for the hoist if needed. The patient was not happy with the situation and I left the home and the bed still inappropriately raised. I then clearly documented the assessment and my reasoning and completed an advice sheet which I sent to the patient and home. In any situation where there is conflict it is vital we keep our professional reasoning and clearly assess risks involved. Sometimes you will have to leave a potentially unsafe situation because the patient will not listen to our advice, it feels uncomfortable but as long as it is documented clearly then you can feel satisfied that you have performed your role effectively while keeping your professional integrity. Having said that, there is one more OT tool we can draw upon in this situation and that is our person skills and therapeutic relationship, if we can develop trust with the patient then hopefully they will then appreciate our advice is based on professional knowledge with their interests at heart. In my example one more visit to the patient and meeting with the staff resulted in the very simple intervention of them changing the bed, which met the need of the patient and staff in a safe and appropriate way !!! Good luck! Kind Regards Lucy Simpson For Quality Stationery and Greetings Cards check out this website: www.phoenix-trading.co.uk/web/lucysimpson Save it in your favourites for the next time you need cards. --- On Thu, 26/3/09, Ron Carson rdcar...@otnow.com wrote: From: Ron Carson rdcar...@otnow.com Subject: Re: [OTlist] Best practice To: Veronica OTlist@OTnow.com Date: Thursday, 26 March, 2009, 11:13 PM Veronica, IF I were you, I would NOT recommend the equipment and CLEARLY document why. In my opinion, it's wrong to recommend equipment that in your professional opinion is inappropriate. I would NOT cave to pressure from the mom. But, I would also take her suggestions into consideration. If you have done this and still know the equipment is inappropriate, do NOT recommend it! Good luck, Ron - Original Message - From: Veronica groenewal...@yahoo.co.uk Sent: Thursday, March 26, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best practice V Ron, I wish I knew why this mum is asking for inappropriate V equipment. At the moment there appears to be a 'competition' element V in my area where one child gets a piece of equipment provided because V they DO need it, and then the other mum's hear about it and insist V that THEIR child also needs it. Not all of the mum's do it but this V one DOES. We bang our heads against a brick wall trying to get her V to 'see' that her daughter is able to manage these tasks and have had V the child 'demonstrate' her ability in executing tasks. I get the V feeling that mum sees her daughter's not quite 'perfect' movements as V being a reason for her to be highlighted as 'special'. This is a mum V who decided to put her daughter (who is in secondary school) in V incontinence pants 'just in case' despite the fact that 1. her V daughter is ambulatory 2. her daughter is independent in toileting. V There are some child protection concerns. V Sorry, not trying to shoot down your comments, I appreciate the V input, it allows brainstorming... just getting a bit frustrated as it V feels like our
[OTlist] Best practice
Hi, does anyone have any (research) information that would help substantiate why it would be a BAD idea for a teenager (or adult) with a neurological condition to use a drop-down shower seat? One of my collegues has a child that she is currently working with and the mother is applying A LOT of pressure to try and get this done. We're trying to give her best practice information and it would be helpful if there is any documentation/research into the use of drop-down shower seats and safe handling. Many thanks Veronica Children's Occupational Therapist -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best practice
Does the patient have any issues with tone? Typically drop-down shower seats have no arms or positioning belts. If a patient has increased tone, it may kick in and cause them to slide off the seat or to hit the walls of the shower causing injury. If they have decreased tone, do they have any trouble maintaining a sitting position? If so, how many hands does a caregiver require to keep them on the seat? It is almost impossible to support someone to maintain sitting while also manipulating soap, washcloth, and other needed items safely and/or successfully. If the patient is able to do any of the bathing themselves, I would also observe and see if any of the movements needed (i.e. bending to wash feet, reaching with two hands to shampoo, etc.) trigger tone or decrease sitting balance. Also, it is important to know if the patient has seizures. If so, are they well controlled or do they happen often? If a seizure happens while in the shower, what will the result be? That's just the beginning of the list of questions I would want to find out. Anything that might cause fall risk or decrease safety with that type of seat that could be altered by a different type. Good luck. Hope this is helpful. Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Mar 26, 2009, at 5:32 AM, Veronica wrote: Hi, does anyone have any (research) information that would help substantiate why it would be a BAD idea for a teenager (or adult) with a neurological condition to use a drop-down shower seat? One of my collegues has a child that she is currently working with and the mother is applying A LOT of pressure to try and get this done. We're trying to give her best practice information and it would be helpful if there is any documentation/research into the use of drop- down shower seats and safe handling. Many thanks Veronica Children's Occupational Therapist -- 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
Hello Veroncia: Good question, but I'm pretty confident there's NO research on this subject. However, what you may find is anecdotal evidence(i.e. experience of others) this device with neurological patients. If you provide more information, OTlist readers may be able to provide such evidence. Also, I find that ALL adaptive equipment, is a combination of good and bad. Generally, I do a cost/benefit analysis and present this to the patient/caregiver. Perhaps you can discuss and even show the mom both the good and bad of the equipment. This will then allow her to make an informed decision. To me, THIS is best practice and also empowers and educates the mom. Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: Veronica groenewal...@yahoo.co.uk Sent: Thursday, March 26, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best practice V Hi, does anyone have any (research) information that would help V substantiate why it would be a BAD idea for a teenager (or adult) V with a neurological condition to use a drop-down shower seat? One of V my collegues has a child that she is currently working with and the V mother is applying A LOT of pressure to try and get this done. We're V trying to give her best practice information and it would be helpful V if there is any documentation/research into the use of drop-down V shower seats and safe handling. V Many thanks V Veronica V Children's Occupational Therapist V V -- V Options? V www.otnow.com/mailman/options/otlist_otnow.com V Archive? V 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
Hi Ron, this approach has been tried (and failed) in the past. Mum is a rather interesting character who is trying to make her daughter more 'disabled' than she is. This child has a very mild spastic CP and is in fact ambulatory. There is no functional reason why she should not be mobilising independently into a level access shower. Mum has pushed us into providing equipement in the past, since it's a 'free' service for her, and now is trying to manipulate things in order to have her own way (through approaching various senior channels). We've discussed this with the head of the OT service, unfortunately the amount of backing received through the HOD is limited as she often tends to cave in to pressure in order to avoid conflict. Our reasoning is that this child has the functional skills to be independent without all the bells and whistles that mum is insisting on. The shower chair in no way benefits her and she is more likely to slide out of it than remain in it. From our perspective it puts her more 'at risk' than providing it would. I do appreciate any advice/input Veronica Good question, but I'm pretty confident there's NO research on this subject. However, what you may find is anecdotal evidence(i.e. experience of others) this device with neurological patients. If you provide more information, OTlist readers may be able to provide such evidence. Also, I find that ALL adaptive equipment, is a combination of good and bad. Generally, I do a cost/benefit analysis and present this to the patient/caregiver. Perhaps you can discuss and even show the mom both the good and bad of the equipment. This will then allow her to make an informed decision. To me, THIS is best practice and also empowers and educates the mom. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best practice
Is there anyway that you can safely demonstrate the risks of the equipment? Can you SHOW the mom that the equipment is dangerous to the child? Perhaps you can video the child using the equipment as a way to clearly document your recommendations to not get equipment. Also, are you SURE that the mom is NOT correct? Why do you think the mom wants equipment that you feel is inappropriate? Thanks, Ron - Original Message - From: Veronica groenewal...@yahoo.co.uk Sent: Thursday, March 26, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best practice V Hi Ron, this approach has been tried (and failed) in the past. Mum V is a rather interesting character who is trying to make her daughter V more 'disabled' than she is. This child has a very mild spastic CP V and is in fact ambulatory. There is no functional reason why she V should not be mobilising independently into a level access shower. V Mum has pushed us into providing equipement in the past, since it's a V 'free' service for her, and now is trying to manipulate things in V order to have her own way (through approaching various senior V channels). We've discussed this with the head of the OT service, V unfortunately the amount of backing received through the HOD is V limited as she often tends to cave in to pressure in order to avoid V conflict. Our reasoning is that this child has the functional skills V to be independent without all the bells and whistles that mum is insisting on. V The shower chair in no way benefits her and she is more likely to V slide out of it than remain in it. From our perspective it puts her V more 'at risk' than providing it would. V I do appreciate any advice/input V Veronica V Good question, but I'm pretty confident there's NO research on this V subject. However, what you may find is anecdotal evidence(i.e. V experience of others) this device with neurological patients. If you V provide more information, OTlist readers may be able to provide such V evidence. V Also, I find that ALL adaptive equipment, is a combination of good and V bad. Generally, I do a cost/benefit analysis and present this to the V patient/caregiver. Perhaps you can discuss and even show the mom both V the good and bad of the equipment. This will then allow her to make an V informed decision. To me, THIS is best practice and also empowers and V educates the mom. V V -- V Options? V www.otnow.com/mailman/options/otlist_otnow.com V Archive? V www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best practice
Ron, I wish I knew why this mum is asking for inappropriate equipment. At the moment there appears to be a 'competition' element in my area where one child gets a piece of equipment provided because they DO need it, and then the other mum's hear about it and insist that THEIR child also needs it. Not all of the mum's do it but this one DOES. We bang our heads against a brick wall trying to get her to 'see' that her daughter is able to manage these tasks and have had the child 'demonstrate' her ability in executing tasks. I get the feeling that mum sees her daughter's not quite 'perfect' movements as being a reason for her to be highlighted as 'special'. This is a mum who decided to put her daughter (who is in secondary school) in incontinence pants 'just in case' despite the fact that 1. her daughter is ambulatory 2. her daughter is independent in toileting. There are some child protection concerns. Sorry, not trying to shoot down your comments, I appreciate the input, it allows brainstorming... just getting a bit frustrated as it feels like our hands are tied (it doesn't help when the HOD says 'just give in, it's easier' when you know that it's not in the child's best interests). Thanks again, Veronica Is there anyway that you can safely demonstrate the risks of the equipment? Can you SHOW the mom that the equipment is dangerous to the child? Perhaps you can video the child using the equipment as a way to clearly document your recommendations to not get equipment. Also, are you SURE that the mom is NOT correct? Why do you think the mom wants equipment that you feel is inappropriate? Thanks, Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best practice
Hi Veronica! Just for clarity: You would prefer for this girl to take her showers standing rather than sitting, right? I'm guessing you'd like her to have and maintain the skills to shower standing in order to, say, shower after gym classes, at camps, at friends' places - anywhere - as opposed to being tied to only bathe with some wall mounted equipment in her home? (Not to mention thus derived needs for double equipment, transportable equipment, a car to transport equipment.) And, I get she's already able to do this - with what level of assistance/supervision - if any? Might there be safety or hygienic issues - at least in mom's eyes - and does she feel her concerns about this are heard and addressed? (She may need to feel fully heard before she can hear you!) What does mom think about her daughter's need for independence in bathing outside of the home - does she have other strategies for that? And last but not least what does the girl want - can you help her see the long term implications of using equipment or not, so she can make an informed decision? Only then comes IMO the question of what kind of equipment, if any, and who is to pay for it. Warmly susanne, denmark Original Message From: Veronica groenewal...@yahoo.co.uk To: OTlist@OTnow.com Sent: Thursday, March 26, 2009 2:38 PM Subject: Re: [OTlist] Best practice Ron, I wish I knew why this mum is asking for inappropriate equipment. At the moment there appears to be a 'competition' element in my area where one child gets a piece of equipment provided because they DO need it, and then the other mum's hear about it and insist that THEIR child also needs it. Not all of the mum's do it but this one DOES. We bang our heads against a brick wall trying to get her to 'see' that her daughter is able to manage these tasks and have had the child 'demonstrate' her ability in executing tasks.. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best practice
Veronica, IF I were you, I would NOT recommend the equipment and CLEARLY document why. In my opinion, it's wrong to recommend equipment that in your professional opinion is inappropriate. I would NOT cave to pressure from the mom. But, I would also take her suggestions into consideration. If you have done this and still know the equipment is inappropriate, do NOT recommend it! Good luck, Ron - Original Message - From: Veronica groenewal...@yahoo.co.uk Sent: Thursday, March 26, 2009 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best practice V Ron, I wish I knew why this mum is asking for inappropriate V equipment. At the moment there appears to be a 'competition' element V in my area where one child gets a piece of equipment provided because V they DO need it, and then the other mum's hear about it and insist V that THEIR child also needs it. Not all of the mum's do it but this V one DOES. We bang our heads against a brick wall trying to get her V to 'see' that her daughter is able to manage these tasks and have had V the child 'demonstrate' her ability in executing tasks. I get the V feeling that mum sees her daughter's not quite 'perfect' movements as V being a reason for her to be highlighted as 'special'. This is a mum V who decided to put her daughter (who is in secondary school) in V incontinence pants 'just in case' despite the fact that 1. her V daughter is ambulatory 2. her daughter is independent in toileting. V There are some child protection concerns. V Sorry, not trying to shoot down your comments, I appreciate the V input, it allows brainstorming... just getting a bit frustrated as it V feels like our hands are tied (it doesn't help when the HOD says V 'just give in, it's easier' when you know that it's not in the child's best interests). V Thanks again, V Veronica V V Is there anyway that you can safely demonstrate the risks of the V equipment? Can you SHOW the mom that the equipment is dangerous to the V child? Perhaps you can video the child using the equipment as a way to V clearly document your recommendations to not get equipment. Also, are V you SURE that the mom is NOT correct? Why do you think the mom wants V equipment that you feel is inappropriate? V Thanks, V Ron V V -- V Options? V www.otnow.com/mailman/options/otlist_otnow.com V Archive? V 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
Chris, I'm going to reply, but I need to take a break ... 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
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
Thought you might all be interested in an international discussion on very much the same thing I just cut a piece of the conversation out of the Australian stroke list serve to post. It is happening with OT everywhere. What a great conversation...reviving the lost art of creative activities in OT! Wouldn't it be great if OTs had easy access to a broad range of DIY activities/projects that could be adapted to achieve therapeutic goals. I have stated doing this with a working age stroke survivor (cutting, painting and attaching a picket fence) and plan to search the internet, check out the Bunnings book etcIf anyone knows of accessible resources, please share. Regards, Ken McKenzie Occupational Therapist Rural Stroke Team Clarissa Wilson [EMAIL PROTECTED] I've been watching how Mum's admitted on ward with pregnancy complications(sometimes for weeks) intuitively do D-I-Y occupational interventions, often with a creative streak, to respond to role loss or change etc. (eg writing story for child at home about getting a new sister, craft to say thank you etc) And then I've been reflecting on how OTs gather that D-I-Y information and build on it for problems that have overwhelmed those intuitive D-I-Y OT resources and capabilities. So reflecting about Sandra's comments on creativity/artistic and OT practice(the art and science of the process) enable people to engage with meaningful occupation, particularly reflection on artistic practice (the part of OT that somehow has slipped off the radar). . . I'm interested in pursuing this conversation and would be interested to hear more about the Arts Health Symposium and Music Therapy conference. . .is this inappropriate space/ are others interested also? Do tell more Sandra :-) And how do others harness D-I-Y occupational interventions? Or incorporate creativity into practice? Particularly in neuro and/or traditional settings? Sincerely, Clarissa -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] 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
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] Best Practice
Precisely!
Neal C. Luther,OTR/L
Rehab Program Coordinator
Advanced Home Care
1-336-878-8824 xt 3205
[EMAIL PROTECTED]
Home Care is our Business...Caring is our Specialty
The information contained in this electronic document from Advanced Home Care
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PROTECTED] If the reader of this communication is not the intended recipient,
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this communication in error, please immediately notify the person listed above
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From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
Behalf Of Carmen Aguirre
Sent: Monday, October 27, 2008 8:03 PM
To: otlist@otnow.com
Subject: Re: [OTlist] Best Practice
I think the message here limits the power of task analysis and task
equivalency. There a MANY times when a client will need physical agent
modalities/ neuromuscular re-education, lymphedema treatment , etc to
prepare a body segment to perform then or later, a desired occupation.
The role of OT is important to id. those components that would
facilitate the occupational outcome. I would not ID those physical agent
modalities, refer my patient to PT, wait until I'm told they are ready
and then work with my patient on the occupation. It is a segmented
approach and unnecessary in my opinion. We are competent to see the
process from beginning to end.
Carmen
Date: Sun, 5 Oct 2008 20:17:43 -0400
From: [EMAIL PROTECTED]
To: OTlist@OTnow.com
Subject: [OTlist] Best Practice
I just posted the following on AOTA's Phy-Dys list serve and wanted to
get OTnow.com readers' opinion. As usual, it's lengthy:
## START ##
I have always believe that OT intervention and goals must be a
straight and direct line. In other words, what OT does MUST have a
DIRECT effect on the patient's occupational deficits. To accomplish
this intervention, I've sort of developed an outline which is
primarily based on the Canadian Model of Occupational Performance.
What follows is a simplified model which helps establish the DIRECT
LINE between goals and treatment:
1. Help the patient figure out what they want or need to do
(i.e. occupation)
2. Figure out what is keeping the patient from doing their
identified occupations:
a. Environmental
b. Cognition
c. Physical
d. Social
e. Emotional
1. Fear
2. Motivation
3. Prioritize the above into those things that can be changed
and THEN GET BUSY CHANGING THEM! Don't waste therapist or
patient time addressing those issues which can not be changed.
Now this is simple and incomplete, but it works because outcomes and
treatment focus on occupation. Recently, it's been suggested, both on
this list and in print, that quality OT must include occupation into
treatment sessions. I do not feel that such an approach is mandated by
AOTA's Framework, not is it always appropriate.
Here are several passages from the OT Framework, Rev 2 collaborating
this concept:
{EVALUATION}
Occupation-based activity analysis places the person [client]
in the foreground. It takes into account the particular
person's [client's] interests, goals, abilities, and contexts,
as well as the demands of the activity itself. These
considerations shape the practitioner's efforts to help
the...person [client] reach his/her goals through
carefully
designed evaluation and intervention. (Crepeau, 2003, p. 193)
(P. 651)
Analyzing occupational performance requires an understanding
of the complex and dynamic interaction among performance
skills, performance patterns, contexts and environments,
activity demands, and client factors. (P. 651)
{INTERVENTION}
The intervention process consists of the skilled actions taken
by occupational therapy practitioners in collaboration with
the client to facilitate engagement in occupation related to
health and participation. (P. 652)
The intervention focusisonmodifyingthe
environment/contexts and activity demands or patterns,
promoting health, establishing or restoring and maintaining
occupational performance, and preventing further disability
and occupational performance problems. (P. 652)
Intervention implementation
Re: [OTlist] Best Practice
CA We are competent to see the process from beginning to end. Carmen
You know Carmen, I really don't think OT's are competent to see the
process from beginning to end because it's really two different
processes.
CA There a MANY times when a client will need physical agent
CA modalities/ neuromuscular re-education, lymphedema treatment , etc
CA to prepare a body segment to perform then or later, a desired
CA occupation
People perform occupations, not body segments.
Your above quote sort of highlights what I'm trying to say about two
different processes. Also, you are advocating something that is no
different than PT, except for the use of the word occupation. This
approach has great merit and there are certainly times when a patient
needs focused treatment on a segment. However, I believe these are
the patient's best suited for PT. Or for the OT with a focused
treatment area, such as the UE or lymphedema. But I think calling such
focal treatments occupational therapy, is not consistent with our
history, framework, payers, patients and outcomes.
CA The role of OT is important to id. those components that would
CA facilitate the occupational outcome.
In my opinion, the role of OT is to identify SPECIFIC components which
impede a SPECIFIC occupation. However, the goal is the occupation, not
the components. FOCUSED component level treatment is the realm of PT.
And if it's not, it should be. Because when the focus of treatment is
on the component(s), it can't be also on the occupation. And, I do not
think a therapist can mentally switch from component level to
occupation level treatment. Maybe I'm wrong, but I think it's one or
the other.
Ron
--
Ron Carson MHS, OT
- Original Message -
From: Carmen Aguirre [EMAIL PROTECTED]
Sent: Monday, October 27, 2008
To: otlist@otnow.com otlist@otnow.com
Subj: [OTlist] Best Practice
CA I think the message here limits the power of task analysis and
CA task equivalency. There a MANY times when a client will need
CA physical agent modalities/ neuromuscular re-education, lymphedema
CA treatment , etc to prepare a body segment to perform then or
CA later, a desired occupation. The role of OT is important to id.
CA those components that would facilitate the occupational outcome. I
CA would not ID those physical agent modalities, refer my patient to
CA PT, wait until I'm told they are ready and then work with my
CA patient on the occupation. It is a segmented approach and
CA unnecessary in my opinion. We are competent to see the process from
beginning to end.
CA Carmen
CA
Date: Sun, 5 Oct 2008 20:17:43 -0400
From: [EMAIL PROTECTED]
To: OTlist@OTnow.com
Subject: [OTlist] Best Practice
I just posted the following on AOTA's Phy-Dys list serve and wanted to
get OTnow.com readers' opinion. As usual, it's lengthy:
## START ##
I have always believe that OT intervention and goals must be a
straight and direct line. In other words, what OT does MUST have a
DIRECT effect on the patient's occupational deficits. To accomplish
this intervention, I've sort of developed an outline which is
primarily based on the Canadian Model of Occupational Performance.
What follows is a simplified model which helps establish the DIRECT
LINE between goals and treatment:
1. Help the patient figure out what they want or need to do
(i.e. occupation)
2. Figure out what is keeping the patient from doing their
identified occupations:
a. Environmental
b. Cognition
c. Physical
d. Social
e. Emotional
1. Fear
2. Motivation
3. Prioritize the above into those things that can be changed
and THEN GET BUSY CHANGING THEM! Don't waste therapist or
patient time addressing those issues which can not be changed.
Now this is simple and incomplete, but it works because outcomes and
treatment focus on occupation. Recently, it's been suggested, both on
this list and in print, that quality OT must include occupation into
treatment sessions. I do not feel that such an approach is mandated by
AOTA's Framework, not is it always appropriate.
Here are several passages from the OT Framework, Rev 2 collaborating
this concept:
{EVALUATION}
Occupation-based activity analysis places the person [client]
in the foreground. It takes into account the particular
person’s [client’s] interests, goals, abilities, and contexts,
as well as the demands of the activity itself. These
considerations shape the practitioner’s efforts to help
the…person [client] reach his/her goals through carefully
Re: [OTlist] Best Practice
However, the goal is the occupation, not the components. FOCUSED component level treatment is the realm of PT. And if it's not, it should be. Because when the focus of treatment is on the component(s), it can't be also on the occupation. And, I do not think a therapist can mentally switch from component level to occupation level treatment. Maybe I'm wrong, but I think it's one or the other.In reply to your post Ron, I disagree. Some of our clients cannot do the occupation because of something, whether it is pain, lack of ROM, decreased strength. I think we are very qualified to address the issues that limit the person from completing occupation. In fact,I think it is our job to find these problems and address them. The goal being to be independent or require less assistance with the occupation being addressed.I guess we'll have to agree to disagree Ron.Thanks for listening,Audra Ray, OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best Practice
Sorry about the way the post looks. For some reason it wouldn't wrap right. Audra Ray --- On Tue, 10/28/08, Audra Ray [EMAIL PROTECTED] wrote: From: Audra Ray [EMAIL PROTECTED] Subject: Re: [OTlist] Best Practice To: OTlist@OTnow.com Date: Tuesday, October 28, 2008, 6:45 PM However, the goal is the occupation, not the components. FOCUSED component level treatment is the realm of PT. And if it's not, it should be. Because when the focus of treatment is on the component(s), it can't be also on the occupation. And, I do not think a therapist can mentally switch from component level to occupation level treatment. Maybe I'm wrong, but I think it's one or the other.In reply to your post Ron, I disagree. Some of our clients cannot do the occupation because of something, whether it is pain, lack of ROM, decreased strength. I think we are very qualified to address the issues that limit the person from completing occupation. In fact,I think it is our job to find these problems and address them. The goal being to be independent or require less assistance with the occupation being addressed.I guess we'll have to agree to disagree Ron.Thanks for listening,Audra Ray, OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best Practice
I think the message here limits the power of task analysis and task
equivalency. There a MANY times when a client will need physical agent
modalities/ neuromuscular re-education, lymphedema treatment , etc to prepare a
body segment to perform then or later, a desired occupation. The role of OT is
important to id. those components that would facilitate the occupational
outcome. I would not ID those physical agent modalities, refer my patient to
PT, wait until I'm told they are ready and then work with my patient on the
occupation. It is a segmented approach and unnecessary in my opinion. We are
competent to see the process from beginning to end.
Carmen
Date: Sun, 5 Oct 2008 20:17:43 -0400
From: [EMAIL PROTECTED]
To: OTlist@OTnow.com
Subject: [OTlist] Best Practice
I just posted the following on AOTA's Phy-Dys list serve and wanted to
get OTnow.com readers' opinion. As usual, it's lengthy:
## START ##
I have always believe that OT intervention and goals must be a
straight and direct line. In other words, what OT does MUST have a
DIRECT effect on the patient's occupational deficits. To accomplish
this intervention, I've sort of developed an outline which is
primarily based on the Canadian Model of Occupational Performance.
What follows is a simplified model which helps establish the DIRECT
LINE between goals and treatment:
1. Help the patient figure out what they want or need to do
(i.e. occupation)
2. Figure out what is keeping the patient from doing their
identified occupations:
a. Environmental
b. Cognition
c. Physical
d. Social
e. Emotional
1. Fear
2. Motivation
3. Prioritize the above into those things that can be changed
and THEN GET BUSY CHANGING THEM! Don't waste therapist or
patient time addressing those issues which can not be changed.
Now this is simple and incomplete, but it works because outcomes and
treatment focus on occupation. Recently, it's been suggested, both on
this list and in print, that quality OT must include occupation into
treatment sessions. I do not feel that such an approach is mandated by
AOTA's Framework, not is it always appropriate.
Here are several passages from the OT Framework, Rev 2 collaborating
this concept:
{EVALUATION}
Occupation-based activity analysis places the person [client]
in the foreground. It takes into account the particular
person’s [client’s] interests, goals, abilities, and contexts,
as well as the demands of the activity itself. These
considerations shape the practitioner’s efforts to help
the…person [client] reach his/her goals through carefully
designed evaluation and intervention. (Crepeau, 2003, p. 193)
(P. 651)
Analyzing occupational performance requires an understanding
of the complex and dynamic interaction among performance
skills, performance patterns, contexts and environments,
activity demands, and client factors. (P. 651)
{INTERVENTION}
The intervention process consists of the skilled actions taken
by occupational therapy practitioners in collaboration with
the client to facilitate engagement in occupation related to
health and participation. (P. 652)
The intervention focusisonmodifyingthe
environment/contexts and activity demands or patterns,
promoting health, establishing or restoring and maintaining
occupational performance, and preventing further disability
and occupational performance problems. (P. 652)
Intervention implementation is the process of putting the plan
into action. It involves the skilled process of altering
factors in the client, activity, and context and environment
for the purpose of effecting positive change in the client’s
desired engagement in occupation, health, and participation.
(P. 656)
Nothing in these passages suggests that occupation (or more often
contrived occupation) must or should be a part of each and every
treatment session. What does stand out is the concept that OT is about
occupation as an outcome and as a measure. If an OT's therapy is
DIRECTLY connected to a SPECIFIC occupational goal, then I believe
that quality occupational therapy is being performed. Remember,
quality OT is not about what's being done, it's WHY!
Why are you doing e-stim? Why are you ambulating with your patients?
Why are you stacking cones? Is it so
Re: [OTlist] Best Practice
Neal, I've been pondering the below question for some time. The question really had me thinking about my evaluation process. Then I remembered that the eval form that I use (provided by the home health agency) includes a check box section regarding daily living skills. I did NOT include this section in my on-line evaluation, but should have. Thanks for pointing out my error. I still think we are on different ends of the spectrum, but I guess that's a well-beaten horse, right? smile Ron -- Ron Carson MHS, OT - Original Message - From: Neal Luther [EMAIL PROTECTED] Sent: Monday, October 13, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best Practice NL The only occupation mentioned (toileting)is in relation to pain. Your NL goals reflect occupational performance areas but your eval does not. NL Why? -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best Practice and OT expertise
Hi Cheryl It is great to know that you are getting a course in the Science of Occupation near the beginning of your Occupational Therapy degree at UofA. The words we use affect the way we think. My wish for you is that with this start you will be able to stay grounded in occupation as you work with all the great clients and colleagues who will come in to your life. Joan Joan Riches B.Sc.O.T., Uof A '88, OT(C) Specialist in Cognitive Disability Riches Consulting High River, Alberta, Canada 403 652 7928 -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Cheryl Frost Sent: October 10, 2008 5:42 PM To: otlist@otnow.com Subject: Re: [OTlist] Best Practice and OT expertise Hi all, In response to the question of my area of practice, well, I'm a first year OT Master's student (I survived my first month!) in Alberta. The discussion regarding Best Practice is really interesting to me. Right now, we have a class dedicated to studying occupation itself; that is, with no regard to pathology or disability. We are just focused on answering the basic questions what is occupation and what do occupations mean to individuals and societies?. So really, I feel that as of now, the way Ron is discussing the role of OT is what is being enforced to us, in that occupations is what sets OT apart from the rest of health care and is the place we can really make our mark. I start my first placement on Tuesday, and am anxious to see how it works in the real world. Thanks, Cheryl _ -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com No virus found in this incoming message. Checked by AVG - http://www.avg.com Version: 8.0.173 / Virus Database: 270.8.0/1719 - Release Date: 10/10/2008 4:08 PM -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best Practice
Ron, I disagree. We are not at different ends of the spectrum. I think we have different ways of expressing the same desire to keep occupation the central tenet of OT. However, I still think you are trying to burn both ends of the candle by not admitting in order to establish baseline occupational performance one must establish baseline human deficit. We are limited creatures, who depend on these bodies that are decaying (some more rapidly than others) to successfully engage in the things (occupations) that are meaningful to us. Your own case history reveals this. You do a great job of establishing in a snap shot where the deficits are: Martha: A Case Study History: 90 y/o female s/p CVA (approximately 10 years) with mild residual affects Generalized weakness Decreased endurance Diffuse pattern of extremity pain HTTN Severe anxiety Evaluation: Decreased strength in bi-lateral LE Pain in right LE, secondary to injury while standing from toilet Decreased endurance Dependent for most ADL's. Requires mod - max assist with transfers Non-ambulatory Prior Level of Function: Previously ambulated with RW, short distances Transferred independently The only occupation mentioned (toileting)is in relation to pain. Your goals reflect occupational performance areas but your eval does not. Why? Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] Home Care is our Business...Caring is our Specialty -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Saturday, October 11, 2008 6:49 AM To: Neal Luther Subject: Re: [OTlist] Best Practice Hello Neal: I do not feel that I'm splitting hairs at all. What you and I are saying are at two ends of the spectrum. We are describing totally different theoretical approaches to treatment. Using IADL's to remediate balance is nothing unique to our profession. And, I think this type of approach leads some OT's to do pretty silly stuff like cones, shoulder arc, pegs, balloons, laundry, washing windows, etc. What I'm arguing is that OT's role should not be remediating underlying issues, other profession's do that. Instead, our primary role, and distinction is remediating occupational issues. Ron -- Ron Carson MHS, OT - Original Message - From: Neal Luther [EMAIL PROTECTED] Sent: Friday, October 10, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best Practice NL Ron, NL Your splitting hairs. NL I put IADL/balance in the context of treating an ortho pt. (TKR). NL Respectfully, NL Neal C. Luther,OTR/L NL Rehab Program Coordinator NL Advanced Home Care NL 1-336-878-8824 xt 3205 NL [EMAIL PROTECTED] NL Home Care is our Business...Caring is our Specialty NL -Original Message- NL From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On NL Behalf Of Ron Carson NL Sent: Thursday, October 09, 2008 9:36 PM NL To: Neal Luther NL Subject: Re: [OTlist] Best Practice NL Neal, it seems that we look at things differently: NL You say: NL we do higher level IADL tasks ... usually to work on the NL dynamics of balance NL I look at it this way: NL I do higher level tasks so the patient can learn to do these NL tasks independently and NL I work on the dynamics of balance so the patient can do higher NL level tasks NL Also, for me, I know if interventions are successful if the patient NL has improved occupational performance. Lastly, In my opinion, OT's NL role is not PREPARING the patient for return to activity, it's NL RETURNING them to activity. NL Does any of this make sense or is it just rubbish smile NL Ron NL -- NL Ron Carson MHS, OT NL - Original Message - NL From: Neal Luther [EMAIL PROTECTED] NL Sent: Thursday, October 09, 2008 NL To: OTlist@OTnow.com OTlist@OTnow.com NL Subj: [OTlist] Best Practice NL Simple. If we don't know that our interventions are successful we NL dare NL not make claims on occupational performance. It's akin to NL performing NL PROM on someone in a coma (which can be a good thing) and when they NL come NL out of the coma claiming our intervention as the reason they are NL able NL feed themselves now. Another example would be in orthopedics. Why NL do NL we do higher level IADL tasks. In my experience, it is usually to NL work NL on the dynamics of balance (especially with TKR's). If I do not NL know NL the effects of single leg stance on the joint and whether that pt. NL Is NL ready (usually in consult with PT) then I can't plan occupational NL tasks NL accordingly. And if this is not addressed then I have not done my NL job to NL prepare that pt. For return to meaningful activity. NL Neal C. Luther,OTR/L NL Rehab Program Coordinator NL Advanced Home Care NL 1-336-878-8824
Re: [OTlist] Best Practice
Hello Neal: I do not feel that I'm splitting hairs at all. What you and I are saying are at two ends of the spectrum. We are describing totally different theoretical approaches to treatment. Using IADL's to remediate balance is nothing unique to our profession. And, I think this type of approach leads some OT's to do pretty silly stuff like cones, shoulder arc, pegs, balloons, laundry, washing windows, etc. What I'm arguing is that OT's role should not be remediating underlying issues, other profession's do that. Instead, our primary role, and distinction is remediating occupational issues. Ron -- Ron Carson MHS, OT - Original Message - From: Neal Luther [EMAIL PROTECTED] Sent: Friday, October 10, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best Practice NL Ron, NL Your splitting hairs. NL I put IADL/balance in the context of treating an ortho pt. (TKR). NL Respectfully, NL Neal C. Luther,OTR/L NL Rehab Program Coordinator NL Advanced Home Care NL 1-336-878-8824 xt 3205 NL [EMAIL PROTECTED] NL Home Care is our Business...Caring is our Specialty NL -Original Message- NL From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On NL Behalf Of Ron Carson NL Sent: Thursday, October 09, 2008 9:36 PM NL To: Neal Luther NL Subject: Re: [OTlist] Best Practice NL Neal, it seems that we look at things differently: NL You say: NL we do higher level IADL tasks ... usually to work on the NL dynamics of balance NL I look at it this way: NL I do higher level tasks so the patient can learn to do these NL tasks independently and NL I work on the dynamics of balance so the patient can do higher NL level tasks NL Also, for me, I know if interventions are successful if the patient NL has improved occupational performance. Lastly, In my opinion, OT's NL role is not PREPARING the patient for return to activity, it's NL RETURNING them to activity. NL Does any of this make sense or is it just rubbish smile NL Ron NL -- NL Ron Carson MHS, OT NL - Original Message - NL From: Neal Luther [EMAIL PROTECTED] NL Sent: Thursday, October 09, 2008 NL To: OTlist@OTnow.com OTlist@OTnow.com NL Subj: [OTlist] Best Practice NL Simple. If we don't know that our interventions are successful we NL dare NL not make claims on occupational performance. It's akin to NL performing NL PROM on someone in a coma (which can be a good thing) and when they NL come NL out of the coma claiming our intervention as the reason they are NL able NL feed themselves now. Another example would be in orthopedics. Why NL do NL we do higher level IADL tasks. In my experience, it is usually to NL work NL on the dynamics of balance (especially with TKR's). If I do not NL know NL the effects of single leg stance on the joint and whether that pt. NL Is NL ready (usually in consult with PT) then I can't plan occupational NL tasks NL accordingly. And if this is not addressed then I have not done my NL job to NL prepare that pt. For return to meaningful activity. NL Neal C. Luther,OTR/L NL Rehab Program Coordinator NL Advanced Home Care NL 1-336-878-8824 xt 3205 NL [EMAIL PROTECTED] NL Home Care is our Business...Caring is our Specialty NL The information contained in this electronic document from NL Advanced Home Care is privileged and confidential information NL intended for the sole use of [EMAIL PROTECTED] If the reader of NL this communication is not the intended recipient, or the employee NL or agent responsible for delivering it to the intended recipient, NL you are hereby notified that any dissemination, distribution or NL copying of this communication is strictly prohibited. If you have NL received this communication in error, please immediately notify NL the person listed above and discard the original.-Original NL Message- NL From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On NL Behalf Of Ron Carson NL Sent: Wednesday, October 08, 2008 9:13 PM NL To: Neal Luther NL Subject: Re: [OTlist] Best Practice NL Why? NL Ron NL -- NL Ron Carson MHS, OT NL - Original Message - NL From: Neal Luther [EMAIL PROTECTED] NL Sent: Wednesday, October 08, 2008 NL To: OTlist@OTnow.com OTlist@OTnow.com NL Subj: [OTlist] Best Practice NL Also, I think we have to measure success at both levels --the NL treated area and occupational performance. NL -- NL Options? NL www.otnow.com/mailman/options/otlist_otnow.com NL Archive? NL www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best Practice
for my thinking? Chris Nahrwold MS, OTR -Original Message- From: Ron Carson [EMAIL PROTECTED] To: [EMAIL PROTECTED] OTlist@OTnow.com Sent: Sat, 11 Oct 2008 6:49 am Subject: Re: [OTlist] Best Practice Chris, do you have a reference for the below??? Thanks, Ron - Original Message - From: [EMAIL PROTECTED] [EMAIL PROTECTED] Sent: Thursday, October 09, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best Practice cac We were in fact a subspeciality of physical therapy in the cac military. -- 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 and OT expertise
Pat, I think there are always OUTLIERS in what a specific OT practitioner might do. And your situation is a perfect example. I also have an example, because I am trained in lymphedema care. When treating lymphedema, I consider myself to be an OT doing lymphedema. I do NOT consider what I do as true OT. But, what I'm striving for is not examples like ours, but mainstream OT. OT that is practiced by the vast majority of practitioners. OT that is recognized by referral sources and that they fully comprehend what OT does. Right now, I think the vast majority of OT referrals sources (adult phys-dys) see OT as UE PT or ADL trainer. Frankly, I am much more pleased with the ADL trainer perspective, but what I really hope is that referral sources, and other professions such as PT, see us as occupation experts. And it's precisely this reason that I think AOTA MUST start a national campaign ad promoting occupation. I know a lot of people jump on the backpack awarness ad, but I for one, do not think it serves our profession very well. On the other hand, if AOTA put advertising dollars into promoting occupation, the profession as a whole would benefit. Ron -- Ron Carson MHS, OT - Original Message - From: Pat [EMAIL PROTECTED] Sent: Friday, October 10, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best Practice and OT expertise P Ron, P You say I don't take ROM or muscle strength measures. In my P setting (chronic pain management/functional restoration), I can't get P away with not doing that. I do a complete Physical Performance Test, P including ROM and static and dynamic strength testing, before, P during, and after the program... because the insurance companies I P deal with demand them. P Just this week a patient was denied an extension of services because P their increases in ROM and strength, and their decrease in pain P levels, were minimal... despite the fact that this patient had P significantly improved in function. The peer review dr was totally P disinterested in function, despite that returning patients to work P was one of the insurance companies main goals. The dr said he P wouldn't approve more days because they didn't benefit from the days P they already had, despite all my concrete examples of how they HAD P improved. All they cared about were the numbers. P The ODG guidelines require baseline measurements (I don't know if P that is just a Texas thing, or not), yet they deny coverage for P intake testing (to GET the baseline measurements) as being medically P unnecessary! They force us to do the initial eval for free, and then P base the number of days they get in the program strictly on the P numbers, and if and how they change. (Scores on the BAI and BDI and P pain scales are numbers we also use). Fortunately, they do pay for P the subsequent PPTs. P Despite the fact that they only cover specific body parts, it is a P full body program, both physically and psychologically... but we P can only document the covered parts. P I am certain that what I do at work would be not be considered to be P true OT, and certainly not best practice as you define it. All I P can do is MY best to help my patients regain as much function, in the P form of occupation, as possible. P I think best practice is meaningful only to us, as OTs. If we do P our best we darn sure aren't going to get paid for it! P Pat P At 04:23 AM 10/10/2008, you wrote: Then adaptation and education might be indicated. Joan, in using the approach I outlined, there isn't a difference between treating people with cog deficits and phy deficits. In fact, that's the beauty of the approach; The focus is occupational performance, not underlying issues. And because the focus is on the universal phenomena of occupation performance, it applies to all people having occupation deficits. Of course, that does not mean we don't treat those underlying issues, it simply means that issues aren't our measure. For example, I don't take ROM or muscle strength measures. To be sure, I range limbs and do manual muscle testing, but I almost never record measurements. Why? Because improving these measurements is not my goal. However, I may assess range and strength because these may be barriers to occupation. In practice, however, I usually have patients attempt desired occupational goals or preliminary steps to those goals. My observation of the patient's occupational performance gives me a much better picture of occupation barriers than simple strength/rom measurements. In summary, using the outline I provided, really serves to unify OT across its diverse treatment spectrum. Peds, adults, gero, neuro, etc. can all use a similar approach. As I was typing this another example of this model popped into my head. I just started treating a man with what is essentially fatigue. He's had lots
Re: [OTlist] Best Practice and OT expertise
Ron, You say I don't take ROM or muscle strength measures. In my setting (chronic pain management/functional restoration), I can't get away with not doing that. I do a complete Physical Performance Test, including ROM and static and dynamic strength testing, before, during, and after the program... because the insurance companies I deal with demand them. Just this week a patient was denied an extension of services because their increases in ROM and strength, and their decrease in pain levels, were minimal... despite the fact that this patient had significantly improved in function. The peer review dr was totally disinterested in function, despite that returning patients to work was one of the insurance companies main goals. The dr said he wouldn't approve more days because they didn't benefit from the days they already had, despite all my concrete examples of how they HAD improved. All they cared about were the numbers. The ODG guidelines require baseline measurements (I don't know if that is just a Texas thing, or not), yet they deny coverage for intake testing (to GET the baseline measurements) as being medically unnecessary! They force us to do the initial eval for free, and then base the number of days they get in the program strictly on the numbers, and if and how they change. (Scores on the BAI and BDI and pain scales are numbers we also use). Fortunately, they do pay for the subsequent PPTs. Despite the fact that they only cover specific body parts, it is a full body program, both physically and psychologically... but we can only document the covered parts. I am certain that what I do at work would be not be considered to be true OT, and certainly not best practice as you define it. All I can do is MY best to help my patients regain as much function, in the form of occupation, as possible. I think best practice is meaningful only to us, as OTs. If we do our best we darn sure aren't going to get paid for it! Pat At 04:23 AM 10/10/2008, you wrote: Then adaptation and education might be indicated. Joan, in using the approach I outlined, there isn't a difference between treating people with cog deficits and phy deficits. In fact, that's the beauty of the approach; The focus is occupational performance, not underlying issues. And because the focus is on the universal phenomena of occupation performance, it applies to all people having occupation deficits. Of course, that does not mean we don't treat those underlying issues, it simply means that issues aren't our measure. For example, I don't take ROM or muscle strength measures. To be sure, I range limbs and do manual muscle testing, but I almost never record measurements. Why? Because improving these measurements is not my goal. However, I may assess range and strength because these may be barriers to occupation. In practice, however, I usually have patients attempt desired occupational goals or preliminary steps to those goals. My observation of the patient's occupational performance gives me a much better picture of occupation barriers than simple strength/rom measurements. In summary, using the outline I provided, really serves to unify OT across its diverse treatment spectrum. Peds, adults, gero, neuro, etc. can all use a similar approach. As I was typing this another example of this model popped into my head. I just started treating a man with what is essentially fatigue. He's had lots of medical issues and was hospitalized for a long time. He just came home and I picked him up on home health. During my eval, the patient presented with Parkinson's like symptoms; slow speech, tremors, flat affect, etc., however, there was no neuro diagnosis. I wanted a better idea of his cognitive status, so I whipped out my trusty MMSE. Surprisingly, he scored 27/30, which is normal. So, why did I do the MMSE? Simply put, I wanted to see if cognition was a possible barrier to his occupational performance. In this case it wasn't. But if it were, I would have probably use his goals as treatment. Again, the goal, and hence the measurement, is not remediating the underlying issue but improving occupation. So, an occupation-based approach applies to OT working in phys-dys, cognition, pediatrics, neuro, etc. But unlike other approaches, an OT using an occupation-based approach has one single purpose and reason for being, and that is improving occupational performance. Thanks, Ron -- Ron Carson MHS, OT - Original Message - From: Joan Riches [EMAIL PROTECTED] Sent: Friday, October 10, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best Practice and OT expertise JR .and if cognition cannot be remediated? JR Joan -- 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] Best Practice and OT expertise
Then adaptation and education might be indicated. Joan, in using the approach I outlined, there isn't a difference between treating people with cog deficits and phy deficits. In fact, that's the beauty of the approach; The focus is occupational performance, not underlying issues. And because the focus is on the universal phenomena of occupation performance, it applies to all people having occupation deficits. Of course, that does not mean we don't treat those underlying issues, it simply means that issues aren't our measure. For example, I don't take ROM or muscle strength measures. To be sure, I range limbs and do manual muscle testing, but I almost never record measurements. Why? Because improving these measurements is not my goal. However, I may assess range and strength because these may be barriers to occupation. In practice, however, I usually have patients attempt desired occupational goals or preliminary steps to those goals. My observation of the patient's occupational performance gives me a much better picture of occupation barriers than simple strength/rom measurements. In summary, using the outline I provided, really serves to unify OT across its diverse treatment spectrum. Peds, adults, gero, neuro, etc. can all use a similar approach. As I was typing this another example of this model popped into my head. I just started treating a man with what is essentially fatigue. He's had lots of medical issues and was hospitalized for a long time. He just came home and I picked him up on home health. During my eval, the patient presented with Parkinson's like symptoms; slow speech, tremors, flat affect, etc., however, there was no neuro diagnosis. I wanted a better idea of his cognitive status, so I whipped out my trusty MMSE. Surprisingly, he scored 27/30, which is normal. So, why did I do the MMSE? Simply put, I wanted to see if cognition was a possible barrier to his occupational performance. In this case it wasn't. But if it were, I would have probably use his goals as treatment. Again, the goal, and hence the measurement, is not remediating the underlying issue but improving occupation. So, an occupation-based approach applies to OT working in phys-dys, cognition, pediatrics, neuro, etc. But unlike other approaches, an OT using an occupation-based approach has one single purpose and reason for being, and that is improving occupational performance. Thanks, Ron -- Ron Carson MHS, OT - Original Message - From: Joan Riches [EMAIL PROTECTED] Sent: Friday, October 10, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best Practice and OT expertise JR .and if cognition cannot be remediated? JR Joan -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best Practice
Simple. If we don't know that our interventions are successful we dare not make claims on occupational performance. It's akin to performing PROM on someone in a coma (which can be a good thing) and when they come out of the coma claiming our intervention as the reason they are able feed themselves now. Another example would be in orthopedics. Why do we do higher level IADL tasks. In my experience, it is usually to work on the dynamics of balance (especially with TKR's). If I do not know the effects of single leg stance on the joint and whether that pt. Is ready (usually in consult with PT) then I can't plan occupational tasks accordingly. And if this is not addressed then I have not done my job to prepare that pt. For return to meaningful activity. Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of [EMAIL PROTECTED] If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Wednesday, October 08, 2008 9:13 PM To: Neal Luther Subject: Re: [OTlist] Best Practice Why? Ron -- Ron Carson MHS, OT - Original Message - From: Neal Luther [EMAIL PROTECTED] Sent: Wednesday, October 08, 2008 To: OTlist@OTnow.com OTlist@OTnow.com Subj: [OTlist] Best Practice NL Also, I think we have to measure success at both levels --the NL treated area and occupational performance. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best Practice and OT expertise
Hello I am very pleased to see some of the vocabulary from Enabling Occupation II 'shaping' and 'enabling' appearing in the discussion. 'Contrived' is the other side of that coin. The way we express ourselves has a huge effect on the way we are able to think. Hans Jonsson has done some really helpful work with this. (Journal of Occupational Science Vol 15(1) April 2008. Page 3) Ron you seem to be viewing this whole issue through an adult physdis lens and backing yourself (and us) into a very reductionist corner. I can see your frustration with the UE focus and I agree with it but you are throwing out most of paeds practice as well as lots of the cognitive disability work along with hand therapy with your distortion of the Canadian Model of Occupational Performance. This model is now CMOP-E - and Engagement. The work of Townsend and Polatajko opens up great possibilities for both the growth and definition of the profession. My take on 'expertise' which I have been holding back thinking that there is a lot more to write than this, like my process of coming to this conclusion. I'll trust the list to weigh in with examples and arguments. My formulation of the expertise of the profession of Occupational Therapy (not necessarily the expertise of individual therapists) is; - to become consciously aware of mismatches between basic abilities and task demands (cognitive, psychological, social and physical), which interfere with the performance of needed, wanted, expected or potential occupations; - to analyze the mismatches; and - to design and offer interventions to mediate the mismatches. I acknowledge the thinking from this list, the Canadian practice document (Enabling Occupation II)especially the Taxonomic Code of Occupational Performance (TCOP), and the work I have been doing with Sarah Austin to articulate the theory of the Cognitive Disabilities Model in seeing that our expertise is a particular application of the concept of occupation. Joan Riches B.Sc.O.T., OT(C) Specialist in Cognitive Disability Riches Consulting High River, Alberta, Canada 403 652 7928 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Best Practice
I meant to add that just last week, a patient told me: I've had lots of therapy in my life, but you are the only OT I ever met whose left hand knew what his right hand was doing. I'm no great OT (I'm just an OT on a mission) so I don't say the above to toot my horn. Instead, I see it as a reflection on the other OT's who this lady had met. So, what might I do different from other OT's that inspired the comment? I'm not sure, but I suspect, that because I focus treatment on meeting patient occupational deficits and don't corner myself or patients into UE referrals, I learn a lot more about their needs and expectations. Focusing on occupation has so many advantages for OT and for our patients. But, even as good as OT can be, it obviously has it's limits. In fact, the person who said this to me was d/c after only one treatment session. Why? Because she and I agreed there was little that I could do to help her. But that conclusion was only reached after discussing her needs, providing suggestions and physically trying some things. But who knows, maybe if I would have seen her for more visits, she might say that I was the worst OT she ever met! But, talk about a narrow philosophy? The whole UE thing has us so backed into a corner that we can't even see beyond patient's belly buttons. Anyway, that's another discussion, right? Ron -- Ron Carson MHS, OT - Original Message - From: Ron Carson [EMAIL PROTECTED] Sent: Wednesday, October 08, 2008 To: [EMAIL PROTECTED] OTlist@OTnow.com Subj: [OTlist] Best Practice RC Chris, I'm not quite sure what solutions to discuss, but here's a RC venture. RC If the concern is that some OT's will lose their jobs, I believe that RC many more OT positions will open up if OT's will change their practice RC patterns. On the flip side, hand therapists might be best served if RC they form their another profession. I truly think that hand therapy is RC so specialized that much of the practice of general OT is lost. This RC is similar to a brain surgeon. While he's been through med school, he RC probably is not a good general practitioner, right? RC Also, I take exception that my philosophy is narrow. In fact, adopting RC an occupation-based approach to treatment significantly widens RC treatment options and venues. An occupation-based approach moves OT RC away from it's well-engrained pattern of UE therapy into a new an RC wonderful world. RC Ron RC -- RC Ron Carson MHS, OT RC - Original Message - RC From: [EMAIL PROTECTED] [EMAIL PROTECTED] RC Sent: Wednesday, October 08, 2008 RC To: OTlist@OTnow.com OTlist@OTnow.com RC Subj: [OTlist] Best Practice cac Any concrete solutions? cac Chris Nahrwold MS, OTR cac -Original Message- cac From: Ron Carson [EMAIL PROTECTED] cac To: [EMAIL PROTECTED] OTlist@OTnow.com cac Sent: Wed, 8 Oct 2008 8:31 pm cac Subject: Re: [OTlist] Best Practice cac I agree about the negativity of contrived. But, I don't think cac enabling or shaping is what I'm talking about. cac I have never believed that hand therapy is occupational therapy. cac Ron cac -- cac Ron Carson MHS, OT cac - Original Message - cac From: [EMAIL PROTECTED] [EMAIL PROTECTED] cac Sent: Wednesday, October 08, 2008 cac To: OTlist@OTnow.com OTlist@OTnow.com cac Subj: [OTlist] Best Practice cac Ron, cac I think the?phrase contrived OT is a very negative term to cac describe what you are going for.? I think a better phrase could cac be shaping OT or enabling OT.? Your perspective of what OT is cac is very narrow and boxed in.? Sure at it's worst a therapist can cac take advantage of the system while having the patient perform cac meaningless exercises and activities that will not have any cac impact of the patient's daily occupations.? This as a result cac makes our profession look horrible and uneducated.???But at its cac best a highly skilled therapist can make a huge difference in an cac individuals occupational needs?by means of shaping or enabling cac OT.? Lets not forget our highly skilled OTs that can make a cac difference in the neuro population, burn patients, hand trauma, cac etc etc.? You make it sound like these therapists are not OTs. cac I think that you are good at identifying the problems in our cac proffession, but can you offer?concrete solutions?? What do we do cac with the therapists who help neuro patients regain function in cac their UEs, or even?the typical hand therapists.? Some of us have cac become experts in this relm of OT, and to pass the patients to cac the PTs in this area would be a large injustice to the patient.? cac In fact we would probably work ourselves out of a job if we cac followed your narrow philisophy.? In fact there would be no more cac hand therapists.? What would happen to all of those therapists?? cac Would they all go back to school and become PTs??I believe that cac would cause a bunch of problems in our profession
