[OTlist] UE Evauation Yesterday...
Hello Everyone: Yesterday, I received a home health referral for a humeral fracture/tricpes tendon reattachement. By now, I'm sure most regular readers are aware of my stance on OT's NOT being UE experts. Interestingly, PT had already evaled the patient and said they couldn't do anything. So, as I'm sitting there talking with the patient, I'm encouraging her to use her affected UE for daily activity such as eating, dressing, toileting. During this time, I'm thinking there just isn't much role for OT. The patient's concern is ROM and pain, not occupation. For sure, improving her elbow function will improve occupational performance, but the patient's concern is NOT occupation. As I'm sitting there pondering doing ROM, exercises and strengthening the patient tells me that her doctor ordered outpatient PT. Since patients can not be on home health while going to outpatient therapy, I discharged the patient. It was an awkward situation. The family and I discussed the differences between OT and PT and how some OT's treat UE injuries. Ron -- Ron Carson MHS, OT -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] UE Evauation Yesterday...
Ron said: "For sure,?? improving?? her?? elbow? function? will? improve? occupational performance, but the patient's concern is NOT occupation." If the patient is not concerned about her occupations why does she want her elbow to improve in function? And the record player continues! Chris Nahrwold MS, OTR -Original Message- From: Ron Carson <[EMAIL PROTECTED]> To: OTlist@OTnow.com Sent: Tue, 21 Oct 2008 9:19 am Subject: [OTlist] UE Evauation Yesterday... Hello Everyone: Yesterday, I received a home health referral for a humeral fracture/tricpes tendon reattachement. By now, I'm sure most regular readers are aware of my stance on OT's NOT being UE experts. Interestingly, PT had already evaled the patient and said they couldn't do anything. So, as I'm sitting there talking with the patient, I'm encouraging her to use her affected UE for daily activity such as eating, dressing, toileting. During this time, I'm thinking there just isn't much role for OT. The patient's concern is ROM and pain, not occupation. For sure, improving her elbow function will improve occupational performance, but the patient's concern is NOT occupation. As I'm sitting there pondering doing ROM, exercises and strengthening the patient tells me that her doctor ordered outpatient PT. Since patients can not be on home health while going to outpatient therapy, I discharged the patient. It was an awkward situation. The family and I discussed the differences between OT and PT and how some OT's treat UE injuries. Ron -- Ron Carson MHS, OT -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] UE Evauation Yesterday...
I first have to agree with Chrisbut, my question is did you ask the patient, "Why do you want the range of motion to improve, and why do you want the pain to go away?" I emphasis a movement-strategy-impairment approach to examination. I first observe the patient perform functional tasks, decide if the strategy is faulty, and then hypothesize why (i.e. what impairments cause the faulty strategy in fu8nctional movements). If the patient demonstrates for you particular functional activites and the limitations of the strategy are evident, then you can correlate for her how the range and pain affect function. Secondly, I don't get it, Ron. Why did the PT say he/she could not do anything for this patient? David A. Lehman, PhD, PT Associate Professor Tennessee State University Department of Physical Therapy 3500 John A. Merritt Blvd. Nashville, TN 37209 615-963-5946 [EMAIL PROTECTED] Visit my website: http://www.tnstate.edu/interior.asp?mid=2410&ptid=1 This email and any files transmitted with it may contain confidential information and is intended solely for use by the individual to whom it is addressed. If you receive this correspondence in error, please notify the sender and delete the email from your system. Do not disclose its contents with others. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Tuesday, October 21, 2008 11:30 AM To: OTlist@OTnow.com Subject: Re: [OTlist] UE Evauation Yesterday... Ron said: "For sure,?? improving?? her?? elbow? function? will? improve? occupational performance, but the patient's concern is NOT occupation." If the patient is not concerned about her occupations why does she want her elbow to improve in function? And the record player continues! Chris Nahrwold MS, OTR -Original Message- From: Ron Carson <[EMAIL PROTECTED]> To: OTlist@OTnow.com Sent: Tue, 21 Oct 2008 9:19 am Subject: [OTlist] UE Evauation Yesterday... Hello Everyone: Yesterday, I received a home health referral for a humeral fracture/tricpes tendon reattachement. By now, I'm sure most regular readers are aware of my stance on OT's NOT being UE experts. Interestingly, PT had already evaled the patient and said they couldn't do anything. So, as I'm sitting there talking with the patient, I'm encouraging her to use her affected UE for daily activity such as eating, dressing, toileting. During this time, I'm thinking there just isn't much role for OT. The patient's concern is ROM and pain, not occupation. For sure, improving her elbow function will improve occupational performance, but the patient's concern is NOT occupation. As I'm sitting there pondering doing ROM, exercises and strengthening the patient tells me that her doctor ordered outpatient PT. Since patients can not be on home health while going to outpatient therapy, I discharged the patient. It was an awkward situation. The family and I discussed the differences between OT and PT and how some OT's treat UE injuries. Ron -- Ron Carson MHS, OT -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] UE Evauation Yesterday...
Original Message From: "Lehman, David" <[EMAIL PROTECTED]> To: Sent: Tuesday, October 21, 2008 6:45 PM Subject: Re: [OTlist] UE Evauation Yesterday... > I first have to agree with Chrisbut, my question is > did you ask the patient, "Why do you want the range of > motion to improve, and why do you want the pain to go > away?" Thanks David and Chris - that really contributed to my understanding about why I feel uncomfortable with this - and a strategy to go deeper. Myself, I'd not like my access to treatment to be limited by whether I could come up with a 'specific' occupation when first asked. Remaining as 'flexible' (both joint wise and otherwise) as possible seems important to me in order to join in on what demands and offerings life has in store for me. Whether I happen to be already engaged in them or not... Warmly susanne -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] UE Evauation Yesterday...
She wants her elbow to improve because: 1. It hurts 2. It doesn't work correctly Which is exactly what I would expect for myself and most other people with a recent elbow fracture. Several years ago, I chipped my dominant-side elbow. It hurt like heck and didn't work very well. I had difficulty doing my daily activity. BUT, my primary concern was my elbow, not my daily activity. My focus was on the elbow, not the loss of occupation. And in such cases as this, mostly acute injury, in my opinion PT is the profession of choice. Ron -- Ron Carson MHS, OT - Original Message - From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Sent: Tuesday, October 21, 2008 To: OTlist@OTnow.com Subj: [OTlist] UE Evauation Yesterday... cac> Ron said: cac> "For sure,?? improving?? her?? elbow? function? will? improve? occupational cac> performance, but the patient's concern is NOT occupation." cac> If the patient is not concerned about her occupations why does cac> she want her elbow to improve in function? And the record player continues! cac> Chris Nahrwold MS, OTR cac> -Original Message- cac> From: Ron Carson <[EMAIL PROTECTED]> cac> To: OTlist@OTnow.com cac> Sent: Tue, 21 Oct 2008 9:19 am cac> Subject: [OTlist] UE Evauation Yesterday... cac> Hello Everyone: cac> Yesterday, I received a home health referral for a humeral cac> fracture/tricpes tendon reattachement. By now, I'm sure most regular cac> readers are aware of my stance on OT's NOT being UE experts. cac> Interestingly, PT had already evaled the patient and said they cac> couldn't do anything. cac> So, as I'm sitting there talking with the patient, I'm encouraging her cac> to use her affected UE for daily activity such as eating, dressing, cac> toileting. During this time, I'm thinking there just isn't much role cac> for OT. The patient's concern is ROM and pain, not occupation. For cac> sure, improving her elbow function will improve occupational cac> performance, but the patient's concern is NOT occupation. cac> As I'm sitting there pondering doing ROM, exercises and strengthening cac> the patient tells me that her doctor ordered outpatient PT. Since cac> patients can not be on home health while going to outpatient therapy, cac> I discharged the patient. cac> It was an awkward situation. The family and I discussed the cac> differences between OT and PT and how some OT's treat UE injuries. cac> Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] UE Evauation Yesterday...
I hate that question, "Why do want to improve ROM, etc". It's an obvious question with an obvious answer. Can you imagine a surgeon asking, why do you want me to fix your elbow? Your strategy is different than mine. I asked the patient to drink, eat, etc with her affected extremity. She couldn't do any of them without compensation and pain. Being the "great" UE OT that I am, I told her to keep using her affected arm as much as possible to allow her to do the things she needed to do. I then suggest PT to help with her elbow function. The correlation between range/pain and function only provides a LIMITED view. It does not include several other factors such as motivation, environment, cognitions. In fact David and with due respect, your example is exactly how I think a good PT should look at function. But, and as I've said a millions times, my OT job is not restoring function, it's restoring occupation. David, regarding why the PT said they couldn't help, my only guess is because of the UE/LE divide... Ron -- Ron Carson MHS, OT - Original Message - From: Lehman, David <[EMAIL PROTECTED]> Sent: Tuesday, October 21, 2008 To: OTlist@OTnow.com Subj: [OTlist] UE Evauation Yesterday... LD> I first have to agree with Chrisbut, my question is did you LD> ask the patient, "Why do you want the range of motion to improve, LD> and why do you want the pain to go away?" I emphasis a LD> movement-strategy-impairment approach to examination. I first LD> observe the patient perform functional tasks, decide if the LD> strategy is faulty, and then hypothesize why (i.e. what LD> impairments cause the faulty strategy in fu8nctional movements). LD> If the patient demonstrates for you particular functional LD> activites and the limitations of the strategy are evident, then LD> you can correlate for her how the range and pain affect function. LD> Secondly, I don't get it, Ron. Why did the PT say he/she could LD> not do anything for this patient? LD> David A. Lehman, PhD, PT LD> Associate Professor LD> Tennessee State University LD> Department of Physical Therapy LD> 3500 John A. Merritt Blvd. LD> Nashville, TN 37209 LD> 615-963-5946 LD> [EMAIL PROTECTED] LD> Visit my website: http://www.tnstate.edu/interior.asp?mid=2410&ptid=1 LD> This email and any files transmitted with it may contain LD> confidential information and is intended solely for use by the LD> individual to whom it is addressed. If you receive this LD> correspondence in error, please notify the sender and delete the LD> email from your system. Do not disclose its contents with others. LD> -Original Message- LD> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] LD> Sent: Tuesday, October 21, 2008 11:30 AM LD> To: OTlist@OTnow.com LD> Subject: Re: [OTlist] UE Evauation Yesterday... LD> Ron said: LD> "For sure,?? improving?? her?? elbow? function? will? improve? occupational LD> performance, but the patient's concern is NOT occupation." LD> If the patient is not concerned about her occupations why does LD> she want her elbow to improve in function? And the record player continues! LD> Chris Nahrwold MS, OTR LD> -Original Message- LD> From: Ron Carson <[EMAIL PROTECTED]> LD> To: OTlist@OTnow.com LD> Sent: Tue, 21 Oct 2008 9:19 am LD> Subject: [OTlist] UE Evauation Yesterday... LD> Hello Everyone: LD> Yesterday, I received a home health referral for a humeral LD> fracture/tricpes tendon reattachement. By now, I'm sure most regular LD> readers are aware of my stance on OT's NOT being UE experts. LD> Interestingly, PT had already evaled the patient and said they LD> couldn't do anything. LD> So, as I'm sitting there talking with the patient, I'm encouraging her LD> to use her affected UE for daily activity such as eating, dressing, LD> toileting. During this time, I'm thinking there just isn't much role LD> for OT. The patient's concern is ROM and pain, not occupation. For LD> sure, improving her elbow function will improve occupational LD> performance, but the patient's concern is NOT occupation. LD> As I'm sitting there pondering doing ROM, exercises and strengthening LD> the patient tells me that her doctor ordered outpatient PT. Since LD> patients can not be on home health while going to outpatient therapy, LD> I discharged the patient. LD> It was an awkward situation. The family and I discussed the LD> differences between OT and PT and how some OT's treat UE injuries. LD> Ron LD> -- LD> Ron Carson MHS, OT
Re: [OTlist] UE Evauation Yesterday...
I don't want to "pick" on our esteemed PT colleague because I so greatly appreciate his presence on this forum. For those of you who don't know, David and used to teach together. I've clipped a comment from Dr. Lehman's earlier message because I think it highlights a hallmark differences between impairment-based and occupation-based approaches. I don't want to speak for David, but it appears that his approach, which I believe is also commonly used by OT's, uses a "functional" task to identify impairment problems. Once identified, intervention is directed at improving these impairments. Personally, I think this is a GREAT approach IF the goal is improving impairments, but it's not an optimal approach IF the goal is improving occupation. In my opinion, an occupation approach uses "functional" (really occupation, but I use "function" because it's more common) task to identify task that the patient can not do in a way that is satisfactory to them. The approach ALSO identifies impairments which contribute to the occupational problems. Once identified, intervention is directed to improving occupation. Let me try a case example with a fictitious patient named "Polly Anna" Miss Polly Anna: Has had a recent shoulder replacement secondary to RA. She is just out of her splint and the MD has ordered AROM as tolerated and PROM to 90 degrees in all planes, except 20 degrees for extension. The patient has increased pain during AROM. She is unable to feed herself, dress or toilet using her affected extremity. The patient has a recent fall history. In the impairment approach, the therapist may identify weak rotator cuff muscles, tight shortened elbow flexors and weak triceps as a primary reason the patient can not do her daily activity. As such, the therapist will begin treatment to address these issues with the goal that improving the impairments will improve the patient's independence and safety. In an occupation approach, a therapist may identify the patient is unable to independently care for herself because of her recent surgery and decreased safety while ambulating. The occupation-based therapist may recommend several environmental modifications, alternative dressingstrategies, (including use of family/aides). The occupation-based therapist may also recommend the patient see an impairment-based therapist. So, in a brief and incomplete nutshell, this is an overly simplistic description of the difference between impairment-based and occupation-based approaches to the same problem. I want to add that neither approach is inherently better, they are just different. Both add outcomes and interventions that are needed by the patient and insurance companies. It should come as not surprise that in my "warped" world, OT is the profession for occupation-based treatment, while PT is the profession for impairment-based treatment. Lastly, Polly Anna is an UE case and in my opinion, occupation-based treatment for UE is not very complex. Should we discuss a LE case, or an UE case with LE involvement (i.e. CVA, Parkinson's, etc), occupation-based treatment is significantly more complex. The "Martha" case example highlights this point. Ron -- Ron Carson MHS, OT - Original Message - From: Lehman, David <[EMAIL PROTECTED]> Sent: Tuesday, October 21, 2008 To: OTlist@OTnow.com Subj: [OTlist] UE Evauation Yesterday... LD> I first observe the patient perform functional tasks, decide if LD> the strategy is faulty, and then hypothesize why (i.e. what LD> impairments cause the faulty strategy in functional movements). -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] UE Evauation Yesterday...
Ron, PTs would love what you just said. Not all impairments are within the PT education and practice scope. Though I think they would love to think so. The areas of visual perception, cognition, are two component areas that I can think of where their skill level and training are limited. (Though so are some OTs.) PTs are strongly arguing to increase their scope of practice without the base. But how does that argument flow for OTs? What truly is our base? If Occupation how do we address the impairments that impact? And really given what we know about motor control and motor relearning and cognition and generalization can we treat impairments successfully outside of the context? Just some early morning ramblings?> Date: Fri, 24 Oct 2008 09:00:39 -0400> From: [EMAIL PROTECTED]> To: OTlist@OTnow.com> Subject: Re: [OTlist] UE Evauation Yesterday...> > I don't want to "pick" on our esteemed PT colleague because I so> greatly appreciate his presence on this forum. For those of you who> don't know, David and used to teach together.> > I've clipped a comment from Dr. Lehman's earlier message because I> think it highlights a hallmark differences between impairment-based> and occupation-based approaches.> > I don't want to speak for David, but it appears that his approach,> which I believe is also commonly used by OT's, uses a "functional"> task to identify impairment problems. Once identified, intervention is> directed at improving these impairments. Personally, I think this is a> GREAT approach IF the goal is improving impairments, but it's not an> optimal approach IF the goal is improving occupation.> > In my opinion, an occupation approach uses "functional" (really> occupation, but I use "function" because it's more common) task to> identify task that the patient can not do in a way that is> satisfactory to them. The approach ALSO identifies impairments which> contribute to the occupational problems. Once identified, intervention> is directed to improving occupation. Let me try a case example with a> fictitious patient named "Polly Anna"> > Miss Polly Anna: Has had a recent shoulder replacement secondary to> RA. She is just out of her splint and the MD has ordered AROM as> tolerated and PROM to 90 degrees in all planes, except 20 degrees for> extension. The patient has increased pain during AROM. She is unable> to feed herself, dress or toilet using her affected extremity. The> patient has a recent fall history.> > In the impairment approach, the therapist may identify weak rotator> cuff muscles, tight shortened elbow flexors and weak triceps as a> primary reason the patient can not do her daily activity. As such,> the therapist will begin treatment to address these issues with the> goal that improving the impairments will improve the patient's> independence and safety.> > In an occupation approach, a therapist may identify the patient is> unable to independently care for herself because of her recent surgery> and decreased safety while ambulating. The occupation-based therapist> may recommend several environmental modifications, alternative> dressing strategies, (including use of family/aides). The> occupation-based therapist may also recommend the patient see an> impairment-based therapist.> > So, in a brief and incomplete nutshell, this is an overly simplistic> description of the difference between impairment-based and> occupation-based approaches to the same problem.> > I want to add that neither approach is inherently better, they are> just different. Both add outcomes and interventions that are needed by> the patient and insurance companies. It should come as not surprise> that in my "warped" world, OT is the profession for occupation-based> treatment, while PT is the profession for impairment-based treatment.> Lastly, Polly Anna is an UE case and in my opinion, occupation-based> treatment for UE is not very complex. Should we discuss a LE case, or> an UE case with LE involvement (i.e. CVA, Parkinson's, etc),> occupation-based treatment is significantly more complex. The "Martha"> case example highlights this point.> > > Ron> --> Ron Carson MHS, OT> > - Original Message -> From: Lehman, David <[EMAIL PROTECTED]>> Sent: Tuesday, October 21, 2008> To: OTlist@OTnow.com > Subj: [OTlist] UE Evauation Yesterday...> > LD> I first observe the patient perform functional tasks, decide if> LD> the strategy is faulty, and then hypothesize why (i.e. what> LD> impairments cause the faulty strategy in functional movements).> > > --> Options?> www.otnow.com/mailman/options/otlist_otnow.com> > Archive?> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] UE Evauation Yesterday...
Sue, and there in lies the beauty of occupation-based treatment. The approach encompasses almost ALL areas that impair occupation. BUT, and this is big, remediating those areas is NOT the goal. And yes, yes, yes, occupation does address impairments. For example, I've had many patients who could not swing a leg into the bathtub, or could not sit/rise from the toilet because of LE weakness. So, I direct patients to do LE strengthening exercises BUT I don't sit their and count their reps. That is something they can do on their own. When I return for the next treatment, the patient again attempts their desired occupation. If positive changes occur, then they are doing something right and so am I. If no changes then I will address the exercise situation. But again, ROM, strength, balance, cognition, etc ARE NOT THE PROBLEMS AND THUS ARE NOT THE GOALS! I do think that OT can address impairments soley for the sake of treating those impairments. But, this drives the therapist away from occupation. And in these cases, I think it's best to claim what the therapist does as hand therapy, low vision therapy, lymphedema treatment, cognitive rehab, etc. Because, in my mind these things are not truly OT. I think I've mentioned that I'm trained in lymphedema management. Just yesterday, I was an an SNF getting ready to do an eval. The nurse asked me if I was the massage therapist (which is a first for me). I quickly said "no, I'm an occupational therapist doing lymphedema treatment". In this way, the nurse knew that I was licensed as an OT but that I was doing lymphedema treatment. Ron -- Ron Carson MHS, OT - Original Message - From: Sue Doyle <[EMAIL PROTECTED]> Sent: Friday, October 24, 2008 To: otlist@otnow.com Subj: [OTlist] UE Evauation Yesterday... SD> Ron, SD> PTs would love what you just said. Not all impairments are within SD> the PT education and practice scope. Though I think they would SD> love to think so. The areas of visual perception, cognition, are SD> two component areas that I can think of where their skill level SD> and training are limited. (Though so are some OTs.) SD> SD> PTs are strongly arguing to increase their scope of practice SD> without the base. But how does that argument flow for OTs? What SD> truly is our base? If Occupation how do we address the impairments SD> that impact? And really given what we know about motor control and SD> motor relearning and cognition and generalization can we treat SD> impairments successfully outside of the context? SD> SD> Just some early morning ramblings? -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] UE Evauation Yesterday...
Ron, What do you think about OTs that practice as occupation-based therapists but on occasion can switch gears and become impairment based minded?? I like how you said "no, I'm an occupational therapist doing lymphedema treatment".? I guess that is what I do when I help out in the hand therapy clinic. Chris Nahrwold MS, OTR -Original Message- From: Ron Carson <[EMAIL PROTECTED]> To: Sue Doyle Sent: Fri, 24 Oct 2008 8:24 am Subject: Re: [OTlist] UE Evauation Yesterday... Sue, and there in lies the beauty of occupation-based treatment. The approach encompasses almost ALL areas that impair occupation. BUT, and this is big, remediating those areas is NOT the goal. And yes, yes, yes, occupation does address impairments. For example, I've had many patients who could not swing a leg into the bathtub, or could not sit/rise from the toilet because of LE weakness. So, I direct patients to do LE strengthening exercises BUT I don't sit their and count their reps. That is something they can do on their own. When I return for the next treatment, the patient again attempts their desired occupation. If positive changes occur, then they are doing something right and so am I. If no changes then I will address the exercise situation. But again, ROM, strength, balance, cognition, etc ARE NOT THE PROBLEMS AND THUS ARE NOT THE GOALS! I do think that OT can address impairments soley for the sake of treating those impairments. But, this drives the therapist away from occupation. And in these cases, I think it's best to claim what the therapist does as hand therapy, low vision therapy, lymphedema treatment, cognitive rehab, etc. Because, in my mind these things are not truly OT. I think I've mentioned that I'm trained in lymphedema management. Just yesterday, I was an an SNF getting ready to do an eval. The nurse asked me if I was the massage therapist (which is a first for me). I quickly said "no, I'm an occupational therapist doing lymphedema treatment". In this way, the nurse knew that I was licensed as an OT but that I was doing lymphedema treatment. Ron -- Ron Carson MHS, OT - Original Message - From: Sue Doyle <[EMAIL PROTECTED]> Sent: Friday, October 24, 2008 To: otlist@otnow.com Subj: [OTlist] UE Evauation Yesterday... SD> Ron, SD> PTs would love what you just said. Not all impairments are within SD> the PT education and practice scope. Though I think they would SD> love to think so. The areas of visual perception, cognition, are SD> two component areas that I can think of where their skill level SD> and training are limited. (Though so are some OTs.) SD> SD> PTs are strongly arguing to increase their scope of practice SD> without the base. But how does that argument flow for OTs? What SD> truly is our base? If Occupation how do we address the impairments SD> that impact? And really given what we know about motor control and SD> motor relearning and cognition and generalization can we treat SD> impairments successfully outside of the context? SD> SD> Just some early morning ramblings? -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] UE Evauation Yesterday...
Chris, I think hand therapists have a wonderfully challenging and rewarding job. But, I do NOT think that hand therapy is, nor should be, analogous with occupational therapy. And I say this for a couple reasons: 1. Hand therapy is way too specialized to be considered occupational therapy. Just the very nature of "HAND therapy" suggests that treatment is about the hand/UE. This is the same for any specialized treatment provided by an OT; lymphedema, wound care, cognitive retraining, etc. An OT can obviously do these things, but that doesn't imply that the OT is doing occupational therapy. 2. There is already so much confusion about OT and UE. I do not think it's generally good for our profession for hand therapist to be *closely* aligned with the OT profession. Many orthopedic doctor's already think of OT's as upper extremity people. Maybe this started with the hand therapists, I don't really know. But, continuing alignment of hand therapy and OT only serves to further entrench the OT/UE relationship. 3. A PT can equally do hand therapy. The CHT license exam is not specific to OT or PT. Undoubtedly, a PT and an OT bring different "flavors" to the hand therapy profession, but a "flavor" does not make a profession. 4. If I were going to a hand therapist, I would want that therapist to be kind, gentle, patient-centered and 100% invested in hand therapy. I would not want an OT or PT doing hand therapy, I would want a hand therapist doing my hand therapy. If it came from an OT fine, if it came from a PT fine. Ron -- Ron Carson MHS, OT - Original Message - From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Sent: Friday, October 24, 2008 To: OTlist@OTnow.com Subj: [OTlist] UE Evauation Yesterday... cac> Ron, cac> What do you think about OTs that practice as occupation-based cac> therapists but on occasion can switch gears and become impairment cac> based minded?? I like how you said "no, I'm an occupational therapist doing cac> lymphedema treatment".? I guess that is what I do when I help out in the hand therapy clinic. cac> Chris Nahrwold MS, OTR -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
