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" Subject: Re: [OTlist] purposeful activity To: Message-ID: 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) . The 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' gait or to limit my reach and ability with my arm I find it very difficult to persist in activities that are not useful and meaningful 'at the time'. Especially now that the physical limitations are only apparent when I'm challenged - trying to walk a distance across a large parking lot quickly to keep an appointment for instance or helping to unload plywood from the truck or screwing a light bulb into a ceiling fixture - it is easy to have 'life' push out the daily excercises. I am not of the generation the 'works out for the sake of'. I have a brilliant and understanding PT. He knows the 30 to 45 straight minutes a day will just not get done. He knows that I want to recover not adapt. So he knows what I need to do and collaborates with me to find ways to incorporate the movements into my regular activities such as mindfully using the stairs, varying pace, not using the railings to pull myself up etc. The stairs themselves cue me as do the top shelves in the kitchen where I store at least three things that I use for breakfast each morning. My morning routine now includes an exercise where I need a significant break between sets. So I do a set and then clean my teeth etc. thus being purposeful with the 'dead' time. There is an exercise for my shoulder for which I need help. This has been tacked on to my husband's regular morning care. I do his compression stockings and he does my shoulder. Bob checks my style and is available if I have questions but my next visit will be in eight weeks - down from six the last time - down from 3X/week when we started. I have no doubt at all that what Bob does for me is PT. His purpose is directed to foundation abilities and what else affects my occupational performance is not his concern. Over time he sees my delighted reporting of the things I can do as evidence that his treatment of the foundation skill is effective. I have a good team with a PT and an OT(me). My occupational goals include all the things that I need to walk or run, reach, carry or support including the effectiv
Re: [OTlist] Puposeful activity
Hello Ilene: I hear your "pain" and I hope I can help. In 1997, I worked at a large rehab hospital. Seeing 2 patients/hr was normal and 3/hr was not that rare. Like everyone else, OT and PT, I was just trying to see patients without having any REAL and personally meaningful treatment. I was pretty unhappy with the type of therapy that I was providing and honestly, using pegs, cones, UE exercises, etc was my normal pattern of treatment. But, in 1998 that changed. I don't remember how I first heard of this book, but I obtained a copy of: "Enabling Occupation, An Occupational Therapy Perspective". I am serious when I say that this book changed my practice patterns in ways that I still follow today. The book offers a step-by-step approach to becoming an "Enabling Occupation" therapist. But, it's not easy! As you know, today's corporate healthcare makes individualized treatment very difficult. And, the very sad reality is that YOUR setting may not allow you to be an OCCUPATIONal therapist. I once was fired from a SNF because I refused to practice like a robot. In my opinion, occupation-based practice will NOT work in every healthcare setting. That's not to say that therapists working in a SNF can't move towards occupation-based practice, but it will not be easy. But, if you are committed, it can occur. Make a commitment to identify your patient's occupational needs/desires. And, if they have NO occupational goals and/or potential for improvement, don't see them for therapy. Part of the problem may be that you are seeing people for OT who don't need OT. Once you identify OT goals, figure out what is keeping patients from achieving their goals. And then, get to work on fixing these problems. In some ways occupation-based practice is super easy, but in other ways it's very difficult. Sometimes, the greatest challenge is identifying occupational therapy goals. For example, I spent almost 2 HOURS yesterday with a home health patient just trying to understand where they wanted to go with their life. This is extreme, but I firmly believe that getting accurate goals is *THE* foundation of occupation-based treatment. You may also find that occupation-based practice challenges your comfort zone is that PT is "threatened" by what your NEW therapy involves. I say this, because in my experience, patient's primary goals almost ALWAYS involve mobility. Patient's want/need to be able to stand and walk by themselves in order to go to the toilet, dress themselves, shower, etc. I found that ambulation became a major focus of my treatment and sometimes, OT's are not comfortable with this, and PT's fell that you are encroaching on them. Of course, PT doesn't "own" ambulation any more than OT owns self-care. So, this is a long response that hopefully give a little encouragement and some direction. My final suggestion is "get the book"! Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: ocil...@comcast.net Sent: Wednesday, February 18, 2009 To: otlist@otnow.com Subj: [OTlist] Puposeful activity ocn> Hi Joan and thanks for your insight! May I ask what you would want ocn> an OT to work on with you though before ocn> you had sufficient range to fasten your bra behind your back, if ocn> increasing the range of motion or adapting the task (i.e fastening ocn> int he front) were not options you would want? ocn> IMO, when therapists resort to cones, etc, it is not because they ocn> are lazy, it is because they don't know what else to do, either ocn> because they only have experience in work settings where cones and ocn> pegs were used, or they are in a subactute setting where they are ocn> seeing multiple people at once. Of course that is not ideal, but it ocn> is reality. I for one would like to move into this more ideal realm ocn> and change the way I practice, but there is precious little ocn> practical "how to's" for doing this, especially in settings like ocn> mine, where there is no kitchen, ADL suite, etc, and it is ocn> impossible to see everyone one on one for ADL's. There is no course ocn> that I can find on taking OT back to the functional in today's ocn> money-driven practice settings, in fact I have never seen a ocn> shoulder course for OT that doesn't focus on increasing range and ocn> other medically-based PT-type interventions. Even here, many people ocn> say "do this" but very few say specifically HOW or offer any ocn> practical ideas for the therapists stuck in peg/cone world who want ocn> to be more functional but are up against a practice world that just ocn> wants numbers. If you or anyone can offer any practical advice,
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 to a 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" Subject: Re: [OTlist] purposeful activity To: Message-ID: 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) . The 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' gait or to limit my reach and ability with my arm I find it very difficult to persist in activities that are not useful and meaningful 'at the time'. Especially now that the physical limitations are only apparent when I'm challenged - trying to walk a distance across a large parking lot quickly to keep an appointment for instance or helping to unload plywood from the truck or screwing a light bulb into a ceiling fixture - it is easy to have 'life' push out the daily excercises. I am not of the generation the 'works out for the sake of'. I have a brilliant and understanding PT. He knows the 30 to 45 straight minutes a day will just not get done. He knows that I want to recover not adapt. So he knows what I need to do and collaborates with me to find ways to incorporate the movements into my regular activities such as mindfully using the stairs, varying pace, not using the railings to pull myself up etc. T
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" Subject: Re: [OTlist] purposeful activity To: Message-ID: 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' gait or to limit
Re: [OTlist] Puposeful activity
Hi Ilene The book Ron Mentioned, "Enabling Occupation: An Occupational Therapy Perspective", as well as "Enabling Occupation II: Advancing an Occupational Therapy Vision for Health Well-being and Justice and Through Occupation" are the official guiding documents for OT in Canada. They are both published and available from www.caot.ca. You wrote "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 in the front) were not options you would want?" Increasing range, strength and stability as well as adapting the task were all necessary and, of course, increasing range strength and stability improved occupational performance in many other ADL and IADL tasks. What I would have wanted from another OT, if I had not been doing it for myself was good task analysis and grading. Analyzing how I pulled up my pants and to what extent that was facilitating internal rotation is an example of grading toward the ultimate goal of fastening my bra at the back. Pulling up the pants can be graded from starting at the front and wiggling into them to gradually moving both hands further back. It was several months before I could pull up my pants with both hands behind my back. It was also a good way to see progress with my Peete exercises (I can't resist leaving this in. I have just begun to be able to dictate to my computer. It has not yet learned what I'm talking about). I guess in my own case I did have multiple goals because I was analyzing all the things that I had to do differently, how I was doing them, how I wanted to do them and how I could grade the movements I was making to lead toward how I wanted to do things rather than falling into bad habits of accommodation, especially the habit of limiting myself in terms of what I was willing to do. Because I had a hip fracture as well I was particularly concerned about not developing an accommodated gait. However my measurable goal for my hip was to be able to cut my toenails on that foot. I can do it now but it is a real struggle and when I can do it easily I think that the stride of both legs will be equal and my gait will be balanced. The movie a black, This example is only applicable to a client with intact cognition who can look forward and see the implications of the difficulties they are having. In other words they will be able to follow the logic of your reasoning. It is a very different matter when you are working with people who have a cognitive deficit. They are unlikely to understand working toward a measurable goal. The goal in that case may be implicit in terms of comfort so your analysis and grading may lead you toward some motions that can be elicited by an activity, such as balloon ball to encourage reaching up. The Canadian Occupational Performance Measure includes those things that a client wants or needs to do as well as those things that someone else needs or wants wants you to do. In the SNF setting treating a shoulder injury may have the goal of improving comfort during mechanical transfers so the want or need will be expressed by the caregivers not the client. As you well know this is a much more complicated situation in which to try to write a measureable occupational goal. I hope this helps. Please let's continue the conversation. Let the list know if you have been able to apply this. Tell us about your successes or your frustrations and thank you so much for asking. Blessings, Joan -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Puposeful activity
Back again. I didn't catch all the edits I needed to make in my dictation so I have done that below. I hope you were able to read over them but if not this may help. Also I apologise to Mary Alice for getting your name wrong. Obviously I have a Mary Catherine in my life. Joan Hi Ilene The book Ron Mentioned, "Enabling Occupation: An Occupational Therapy Perspective", as well as "Enabling Occupation II: Advancing an Occupational Therapy Vision for Health Well-being and Justice and Through Occupation" are the official guiding documents for OT in Canada. They are both published and available from www.caot.ca. They are good but do not address the payment and productivity demands of your SNF practice in the US. You wrote "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 in the front) were not options you would want?" Increasing range, strength and stability as well as adapting the task were all necessary and, of course, increasing range strength and stability improved occupational performance in many other ADL and IADL tasks. What I would have wanted from another OT, if I had not been doing it for myself was good task analysis and grading. Analyzing how I pulled up my pants and to what extent that was facilitating internal rotation is an example of grading toward the ultimate goal of fastening my bra at the back. Pulling up the pants can be graded from starting at the front and wiggling into them to gradually moving both hands further back. It was several months before I could pull up my pants with both hands behind my back. It was also a good way to see progress with my Peete exercises (I can't resist leaving this in. I have just begun to be able to dictate to my computer. It has not yet learned what I'm talking about). I guess in my own case I did have multiple goals because I was analyzing all the things that I had to do differently, how I was doing them, how I wanted to do them and how I could grade the movements I was making to lead toward how I wanted to do things rather than falling into bad habits of accommodation, especially the habit of limiting myself in terms of what I was willing to do. Because I had a hip fracture as well I was particularly concerned about not developing an accommodated gait. However my measurable goal for my hip was to be able to cut my toenails on that foot. I can do it now but it is a real struggle and when I can do it easily I think that the stride of both legs will be equal and my gait will be balanced. This example is only applicable to a client with intact cognition who can look forward and see the implications of the difficulties they are having. In other words they will be able to follow the logic of your reasoning. It is a very different matter when you are working with people who have a cognitive deficit. They are unlikely to understand working toward a measurable goal. The goal in that case may be implicit in terms of comfort so your analysis and grading may lead you toward some motions that can be elicited by an activity, such as balloon ball to encourage reaching up. The Canadian Occupational Performance Measure includes those things that a client wants or needs to do as well as those things that someone else needs or wants wants you to do. In the SNF setting treating a shoulder injury may have the goal of improving comfort during mechanical transfers so the want or need will be expressed by the caregivers not the client. As you well know this is a much more complicated situation in which to try to write a measureable occupational goal. I hope this helps. Please let's continue the conversation. Let the list know if you have been able to apply this. Tell us about your successes or your frustrations and thank you so much for asking. Blessings, Joan -- 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 - www.avg.com Version: 8.0.237 / Virus Database: 270.11.2/1964 - Release Date: 02/21/09 11:05:00 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Puposeful activity
Joan, No worries at all on the name thing. When you have a double name that starts with Mary, you learn early on to answer to Mary Ann, Mary Beth, etc., etc. If someone calls me the wrong name, I just always say that if that is the worst than anyone calls me then I'm doing pretty good! 8-) I very much appreciated your comments in your earlier post. It's nice to know that people are listening and reading. I am pretty bad about not posting to say that I agree with something as well, so I will try to be more aware of that in the future. I have enjoyed all the discussions lately although we need more people to join in. Please don't be afraid to post! Everyone I've encountered here is very friendly--- although occasionally a bit passionate about their own view! Happy Weekend All! Mary Alice Mary Alice Cafiero, MSOT/L, ATP m...@mac.com 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Feb 21, 2009, at 5:42 PM, Joan Riches wrote: Back again. I didn't catch all the edits I needed to make in my dictation so I have done that below. I hope you were able to read over them but if not this may help. Also I apologise to Mary Alice for getting your name wrong. Obviously I have a Mary Catherine in my life. Joan Hi Ilene The book Ron Mentioned, "Enabling Occupation: An Occupational Therapy Perspective", as well as "Enabling Occupation II: Advancing an Occupational Therapy Vision for Health Well-being and Justice and Through Occupation" are the official guiding documents for OT in Canada. They are both published and available from www.caot.ca. They are good but do not address the payment and productivity demands of your SNF practice in the US. You wrote "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 in the front) were not options you would want?" Increasing range, strength and stability as well as adapting the task were all necessary and, of course, increasing range strength and stability improved occupational performance in many other ADL and IADL tasks. What I would have wanted from another OT, if I had not been doing it for myself was good task analysis and grading. Analyzing how I pulled up my pants and to what extent that was facilitating internal rotation is an example of grading toward the ultimate goal of fastening my bra at the back. Pulling up the pants can be graded from starting at the front and wiggling into them to gradually moving both hands further back. It was several months before I could pull up my pants with both hands behind my back. It was also a good way to see progress with my Peete exercises (I can't resist leaving this in. I have just begun to be able to dictate to my computer. It has not yet learned what I'm talking about). I guess in my own case I did have multiple goals because I was analyzing all the things that I had to do differently, how I was doing them, how I wanted to do them and how I could grade the movements I was making to lead toward how I wanted to do things rather than falling into bad habits of accommodation, especially the habit of limiting myself in terms of what I was willing to do. Because I had a hip fracture as well I was particularly concerned about not developing an accommodated gait. However my measurable goal for my hip was to be able to cut my toenails on that foot. I can do it now but it is a real struggle and when I can do it easily I think that the stride of both legs will be equal and my gait will be balanced. This example is only applicable to a client with intact cognition who can look forward and see the implications of the difficulties they are having. In other words they will be able to follow the logic of your reasoning. It is a very different matter when you are working with people who have a cognitive deficit. They are unlikely to understand working toward a measurable goal. The goal in that case may be implicit in terms of comfort so your analysis and grading may lead you toward some motions that can be elicited by an activity, such as balloon ball to encourage reaching up. The Canadian Occupational Performance Measure includes those things that a client wants or needs to do as well as those things that someone else needs or wants wants you to do. In the SNF setting treating a shoulder injury may have the goal of improving comfort during mechanical transfers so the want or need will be expressed by the caregivers not the client. As y
Re: [OTlist] Puposeful activity
THANKS Joan! Has me wondering: When we succeed - with the "just one goal" - approach - is it because we actually "educate" the patient to be their own OT - aka "Lifestyle Redesign"? And when we don't - and/or patient prefers PT - the underlying hunch of the patient is something along this line: "But life is so much more than this.. - and what about what I might want/need to do tomorrow?" Warmly susanne, denmark Original Message From: "Joan Riches" To: Sent: Sunday, February 22, 2009 12:42 AM Subject: Re: [OTlist] Puposeful activity (snip) Increasing range, strength and stability as well as > adapting the task were all necessary and, of course, > increasing range strength and stability improved > occupational performance in many other ADL and IADL > tasks. What I would have wanted from another OT, if I had > not been doing it for myself was good task analysis and > grading. Analyzing how I pulled up my pants and to what > extent that was facilitating internal rotation is an > example of grading toward the ultimate goal of fastening > my bra at the back. Pulling up the pants can be graded > from starting at the front and wiggling into them to > gradually moving both hands further back. It was several > months before I could pull up my pants with both hands > behind my back. It was also a good way to see progress > with my Peete exercises (I can't resist leaving this in. > I have just begun to be able to dictate to my computer. > It has not yet learned what I'm talking about). I guess > in my own case I did have multiple goals because I was > analyzing all the things that I had to do differently, > how I was doing them, how I wanted to do them and how I > could grade the movements I was making to lead toward how > I wanted to do things rather than falling into bad habits > of accommodation, especially the habit of limiting myself > in terms of what I was willing to do. > Because I had a hip fracture as well I was particularly > concerned about not developing an accommodated gait. > However my measurable goal for my hip was to be able to > cut my toenails on that foot. I can do it now but it is a > real struggle and when I can do it easily I think that > the stride of both legs will be equal and my gait will be > balanced. > This example is only applicable to a client with intact > cognition who can look forward and see the implications > of the difficulties they are having. In other words they > will be able to follow the logic of your reasoning. > It is a very different matter when you are working with > people who have a cognitive deficit (snip) -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Puposeful activity
Barb, I don't think using cones/pegs/ etc should make you feel "not good enough". Heck, at least you are looking for a different way of being an OT. I'm sure that many OT's realize that cones and pegs isn't the best way to deliver services, but there are probably just as many who really don't even care. To me, it's the "non-caring" OT's who are the profession's biggest stumbling block. Maybe your setting does allow "best practice" for all patients, Maybe though, you can slip in some occupation-based treatment every now and then. And that's not a bad way to start, because changing treatment focus is bound to stretch your comfort zone. Hang in there! Ron -- Ron Carson MHS, OT www.OTnow.com - Original Message - From: bbh1...@comcast.net Sent: Saturday, February 21, 2009 To: OTlist@OTnow.com Subj: [OTlist] Puposeful activity bcn> Hello Ilene, bcn> Your post was satisfying to me, as I work in the same setting and bcn> am faced with the same concerns re tx. Put my reaction down to bcn> "misery loves company", although I am not miserable in my position. bcn> What I do with patients may not be strictly OT as defined by most bcn> of those who contribute to this site, but I have made peace with bcn> that because I know that I am definitely helping my patients heal bcn> and return to a higher level of function in their daily lives. I, bcn> too, have been asking for more concrete suggestions as to how this bcn> is done in the SNF/subacute world which is so focussed on profit. bcn> Thanks for sharing a similar concern. It is so easy to feel alone, bcn> and not good enough with regard to the cones and pegs controversy! bcn> Barb Howard COTA bcn> - Original Message - bcn> From: ocil...@comcast.net bcn> To: otlist@otnow.com bcn> Sent: Wednesday, February 18, 2009 7:00:20 PM GMT -05:00 US/Canada Eastern bcn> Subject: Re: [OTlist] Puposeful activity bcn> Hi Joan and thanks for your insight! May I ask what you would want bcn> an OT to work on with you though before bcn> you had sufficient range to fasten your bra behind your back, if bcn> increasing the range of motion or adapting the task (i.e fastening bcn> int he front) were not options you would want? bcn> IMO, when therapists resort to cones, etc, it is not because they bcn> are lazy, it is because they don't know what else to do, either bcn> because they only have experience in work settings where cones and bcn> pegs were used, or they are in a subactute setting where they are bcn> seeing multiple people at once. Of course that is not ideal, but it bcn> is reality. I for one would like to move into this more ideal realm bcn> and change the way I practice, but there is precious little bcn> practical "how to's" for doing this, especially in settings like bcn> mine, where there is no kitchen, ADL suite, etc, and it is bcn> impossible to see everyone one on one for ADL's. There is no course bcn> that I can find on taking OT back to the functional in today's bcn> money-driven practice settings, in fact I have never seen a bcn> shoulder course for OT that doesn't focus on increasing range and bcn> other medically-based PT-type interventions. Even here, many people bcn> say "do this" but very few say specifically HOW or offer any bcn> practical ideas for the therapists stuck in peg/cone world who want bcn> to be more functional but are up against a practice world that just bcn> wants numbers. If you or anyone can offer any practical advice, bcn> point to a book or course to help therapists work more functionally bcn> with patients (who often, in a nursing home setting, can't even bcn> come up with goals of their own or answer "nothing" or "watch TV" bcn> when asked what they would like to be able to resume doing) I would be most appreciative. bcn> Thanks, bcn> Ilene Rosenthal, OTR/L bcn> Message: 1 bcn> Date: Tue, 17 Feb 2009 11:30:40 -0700 bcn> From: "Joan Riches" bcn> Subject: Re: [OTlist] purposeful activity bcn> To: bcn> Message-ID: bcn> bcn> Content-Type: text/plain; charset="US-ASCII" bcn> Greetings to all bcn> I couldn't resist this one. bcn> In my opinion (like Ron's) all activity has purpose for someone or bcn> something (witness the reproduction of plants) . The OT question re the bcn> activities we use as treatment interventions is: Does this activity have bcn> purpose and therefore meaning for this client in terms of their explicit bcn> and implicit occupational goals? bcn> I absolutely agree with Ron's goal formulation where the only goal is bcn> some form of OCCUPATIONAL performance.
