Re: [OTlist] Why OT's Should NOT Focus on the UE
Thanks for the feedback! I feel a little more confident in my OT skills after reading your suggestions as I do all of those things. I guess when I hear everyone talk so negatively about dowel exercises/theraband, and we do those with our patients, I felt maybe I wasn't doing enough. But I do address all those other areas in conjuction with my session of exercises for afternoon treatments! Thanks again! > To: OTlist@OTnow.com > Date: Wed, 15 Jul 2009 19:08:46 -0400 > From: cmnahrw...@aol.com > Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE > > So the essentials for going home safely is what I gather > > A) Dressing and bathing themselves. Not only should we OTs practice > these skills with possible compensation techniques and environmental > adaptation, we should also analyze what part of the activity is > difficult. For example a patient might have a significant balance > problem or decreased standing tolerance from immobility. This can > certainly be addressed in the gym through the practice of sit to > stands, dynamic balance challenges, functional ambulation (gathering > clothes from closet with a walker and possibly a walker tray or > basket), and reaching for clothes placed at low levels and high levels. > Think high repetiions to generalize learning. > B) Toilet transfers and toileting-Practie, practice practice. Even if > they do not have to go, practice. Find a strategy that works best for > them.Everyone is not the same, so experiment and if does not work out, > back to the drawing board > C) Kitchen mobility, dining room mobility, family room mobility, car > transfers--practice in multiple treatment environments and get the > patient talking about their situation at home so the situation can be > matched as best as possible > > D) cooking-If you don't have a kitchen than simulate to the best of > your ability-transporting objects from point A to B with a rolling > walker and a walker tray, scooting objects on countertops without loss > of balance. Education about how to set up their ki > tchen at home for > optimized safety. > > E) Make sure the patient and you talk through the above homemaking plan > if they think family or another agency will complete for them. Make > sure you know in detail the exact plan. If the story is gray you might > have to make a few phone calls and possibly get the social worker > involved to determine if the cost for an agency to complete the > homemaking is realistic for the patient. > > > -Original Message----- > From: Miranda Hayek > To: otlist@otnow.com > Sent: Wed, Jul 15, 2009 6:06 am > Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE > > > I guess I am not thinking of any specific patient at this point, it's > just nice to hear other peoples ideas for interventions. I know each > patient has their own goals, but the majority are hoping to return > home, be independent with ADL's and do as much home management tasks as > they can (but are willing to have family or community support services > to assist with laundry, vacuuming.). Basically they just want to go > home vs. nursing home! Sorry it's so fague, I am not thinking of > anything specific so I realize it's a hard question to answer! > > > > > > > > > To: OTlist@OTnow.com > > Date: Tue, 14 Jul 2009 21:53:49 -0400 > > From: cmnahrw...@aol.com > > Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE > > > > Miranda, > > > > What occupations does the patient desire to improve o > n? > > > > Chris > > > > -Original Message- > > From: Miranda Hayek > > To: otlist@otnow.com > > Sent: Tue, Jul 14, 2009 7:00 pm > > Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE > > > > > > I find the information being shared between Diane and others is > > helpful. I too am new to the profession and feel that we learn > > interventions/treatments on the job (my schooling taught me the > theory > > of OT more than hands on!). At my job I learn from the other > > therapists, and find our afternoon treatments involve dowel, > theraband > > exercises. Morning treatments involve ADL's. (acute and skilled > > hospital setting). We are also limited on our space for opportunities > > for more home management or other activities. So was wondering if > > anyone can provide some examples of treatments they do with their > > patients. Generally my patients are in the hospital for TKA, THA, CVA > > (mild-mod), deconditioned due to pneumonia, etc. > > > > > > > > Thanks. > > >
Re: [OTlist] Why OT's Should NOT Focus on the UE
In my opinion, if a therapist is consistently PERFORMING 'therapy' that an aide an do, then it's not therapy. By definition, therapy REQUIRES the skills of a therapist. Again it's my opinion, that routine, repetitive "exercises" that do not target SPECIFIC muscle(s) is not-therapy. Now, if someone has an injury and there are concerns about certain movements, weight restrictions, etc, then a therapist is necessary. But, my experience is that VERY few patient's meet this criteria. Ron - Original Message - From: Diane Randall Sent: Monday, July 13, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE RC> " Ask yourself, are you doing something that an aide could be doing? RC> If so, then you are not doing therapy!" DR> Please explain... you are correct in that aides may not know the clinical DR> reasoning behind a therapy but the actual physical part of engaging in DR> theraputic activity with a patient can sometimes be done by an aide although DR> unethical...just saying it is physically possible. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
So the essentials for going home safely is what I gather A) Dressing and bathing themselves. Not only should we OTs practice these skills with possible compensation techniques and environmental adaptation, we should also analyze what part of the activity is difficult. For example a patient might have a significant balance problem or decreased standing tolerance from immobility. This can certainly be addressed in the gym through the practice of sit to stands, dynamic balance challenges, functional ambulation (gathering clothes from closet with a walker and possibly a walker tray or basket), and reaching for clothes placed at low levels and high levels. Think high repetiions to generalize learning. B) Toilet transfers and toileting-Practie, practice practice. Even if they do not have to go, practice. Find a strategy that works best for them.Everyone is not the same, so experiment and if does not work out, back to the drawing board C) Kitchen mobility, dining room mobility, family room mobility, car transfers--practice in multiple treatment environments and get the patient talking about their situation at home so the situation can be matched as best as possible D) cooking-If you don't have a kitchen than simulate to the best of your ability-transporting objects from point A to B with a rolling walker and a walker tray, scooting objects on countertops without loss of balance. Education about how to set up their ki tchen at home for optimized safety. E) Make sure the patient and you talk through the above homemaking plan if they think family or another agency will complete for them. Make sure you know in detail the exact plan. If the story is gray you might have to make a few phone calls and possibly get the social worker involved to determine if the cost for an agency to complete the homemaking is realistic for the patient. -Original Message- From: Miranda Hayek To: otlist@otnow.com Sent: Wed, Jul 15, 2009 6:06 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE I guess I am not thinking of any specific patient at this point, it's just nice to hear other peoples ideas for interventions. I know each patient has their own goals, but the majority are hoping to return home, be independent with ADL's and do as much home management tasks as they can (but are willing to have family or community support services to assist with laundry, vacuuming.). Basically they just want to go home vs. nursing home! Sorry it's so fague, I am not thinking of anything specific so I realize it's a hard question to answer! To: OTlist@OTnow.com Date: Tue, 14 Jul 2009 21:53:49 -0400 From: cmnahrw...@aol.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Miranda, What occupations does the patient desire to improve o n? Chris -Original Message- From: Miranda Hayek To: otlist@otnow.com Sent: Tue, Jul 14, 2009 7:00 pm Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE I find the information being shared between Diane and others is helpful. I too am new to the profession and feel that we learn interventions/treatments on the job (my schooling taught me the theory of OT more than hands on!). At my job I learn from the other therapists, and find our afternoon treatments involve dowel, theraband exercises. Morning treatments involve ADL's. (acute and skilled hospital setting). We are also limited on our space for opportunities for more home management or other activities. So was wondering if anyone can provide some examples of treatments they do with their patients. Generally my patients are in the hospital for TKA, THA, CVA (mild-mod), deconditioned due to pneumonia, etc. Thanks. > From: spark...@rcn.com > To: OTlist@OTnow.com > Date: Mon, 13 Jul 2009 12:30:41 -0400 > Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE > > > "My concern in this is that you ONLY mention and UE program. If general > conditioning prevented the patient from performing occupation, why limit > it only to the UE?" > > > Being that I am new to this and my employment forces me to live in "UE > therex" landperhaps you could give me an indication as to what I can do > with this person. Others more experienced than me in the dept go with the > flow. He is 500 pounds...can now walk about 50ft with someone following him > in a W/C and he is able to stand aboout 2-3 min in a RW. > > I have done all ADL's..and although he is able to life weights in all planes > he does not have the arm length to bipass his midsection to do LE dresssing. > He has serious LE PN issues so he cannot use a sock aid. he has refused both > a dressing stick and reacher. > > I have done transfers with him from W/C to bed, W/C to toilet, W/C to shower > I have done standing tolerance...he likes to draw s
Re: [OTlist] Why OT's Should NOT Focus on the UE
Hello Diane: Here would be my approach: 1. Identify the patient's occupational goal(s) a. What does he want/need to do in order to live as safely and independently as reasonably possible 2. Identify underlying barriers: a. Physical b. Cognitive c. Mental d. Social e. Environmental 3. Prioritize the goals/barriers 4. Address those barriers that are within your scope of practice and expertise. Forget about the UE, LE stuff. Focus on the occupational needs/desires of the patient. If it's endurance, then work on endurance. If it's fear, then work on fear. If it's motivation, then work on motivation. The BIGGEST challenge is knowing the occupations and barriers to address On a final note. It may be time to d/c the patient if: 1. There are no occupational goals 2. The goals have been met 3. You are unable to address the causes leading to the occupational dysfunction. 4. The patient does not desire to address his occupational need. In my opinion, you must not let yourself be pigeon-holed into the UE therex mentality. Expand your horizons. Meet the patient where THEY are. Figure out who and what they are about. Develop rapport with him so that you can be of greatest therapeutic benefit. Remember, the goal is to improve occupational performance. Stay in touch, keep us informed and keep asking questions. You are 100% on the right track to becomming a "non-UE therex occupational therapist." Gotta love it! Ron - Original Message - From: Diane Randall Sent: Monday, July 13, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE DR> Being that I am new to this and my employment forces me to live in "UE DR> therex" landperhaps you could give me an indication as to what I can do DR> with this person. Others more experienced than me in the dept go with the DR> flow. He is 500 pounds...can now walk about 50ft with someone following him DR> in a W/C and he is able to stand aboout 2-3 min in a RW. DR> I have done all ADL's..and although he is able to life weights in all planes DR> he does not have the arm length to bipass his midsection to do LE dresssing. DR> He has serious LE PN issues so he cannot use a sock aid. he has refused both DR> a dressing stick and reacher. DR> I have done transfers with him from W/C to bed, W/C to toilet, W/C to shower DR> I have done standing tolerance...he likes to draw so I have him stand in DR> front of a white boards and he draws murals for the department. DR> He does W/C pushups. DR> He lives alone, rarely ever left his home due to his weight, microwaves all DR> his meals, and lives on disbaility. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
I guess I am not thinking of any specific patient at this point, it's just nice to hear other peoples ideas for interventions. I know each patient has their own goals, but the majority are hoping to return home, be independent with ADL's and do as much home management tasks as they can (but are willing to have family or community support services to assist with laundry, vacuuming.). Basically they just want to go home vs. nursing home! Sorry it's so fague, I am not thinking of anything specific so I realize it's a hard question to answer! > To: OTlist@OTnow.com > Date: Tue, 14 Jul 2009 21:53:49 -0400 > From: cmnahrw...@aol.com > Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE > > Miranda, > > What occupations does the patient desire to improve on? > > Chris > > -Original Message- > From: Miranda Hayek > To: otlist@otnow.com > Sent: Tue, Jul 14, 2009 7:00 pm > Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE > > > I find the information being shared between Diane and others is > helpful. I too am new to the profession and feel that we learn > interventions/treatments on the job (my schooling taught me the theory > of OT more than hands on!). At my job I learn from the other > therapists, and find our afternoon treatments involve dowel, theraband > exercises. Morning treatments involve ADL's. (acute and skilled > hospital setting). We are also limited on our space for opportunities > for more home management or other activities. So was wondering if > anyone can provide some examples of treatments they do with their > patients. Generally my patients are in the hospital for TKA, THA, CVA > (mild-mod), deconditioned due to pneumonia, etc. > > > > Thanks. > > > > > > > > > > From: spark...@rcn.com > > To: OTlist@OTnow.com > > Date: Mon, 13 Jul 2009 12:30:41 -0400 > > Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE > > > > > > "My concern in this is that you ONLY mention and UE program. If > general > > conditioning prevented the patient from performing occupation, why > limit > > it only to the UE?" > > > > > > Being that I am new to this and my employment forces > me to live in "UE > > therex" landperhaps you could give me an indication as to what I > can do > > with this person. Others more experienced than me in the dept go with > the > > flow. He is 500 pounds...can now walk about 50ft with someone > following him > > in a W/C and he is able to stand aboout 2-3 min in a RW. > > > > I have done all ADL's..and although he is able to life weights in all > planes > > he does not have the arm length to bipass his midsection to do LE > dresssing. > > He has serious LE PN issues so he cannot use a sock aid. he has > refused both > > a dressing stick and reacher. > > > > I have done transfers with him from W/C to bed, W/C to toilet, W/C to > shower > > I have done standing tolerance...he likes to draw so I have him stand > in > > front of a white boards and he draws murals for the department. > > > > He does W/C pushups. > > > > He lives alone, rarely ever left his home due to his weight, > microwaves all > > his meals, and lives on disbaility. > > > > > > > > > > > > -Original Message- > > From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on > > Behalf Of Ron Carson > > Sent: Sunday, July 12, 2009 22:08 > > To: Diane Randall > > Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE > > > > > > My concern in this is that you ONLY mention and UE program. If general > > conditioning prevented the patient from performing occupation, why > limit > > it only > to the UE? > > > > For me, general phy-dys practitioner's focus on the UE while > > disregarding the rest of the body severely hampers our professional > > autonomy. > > > > We MUST break free from the mold of being UE therapists! > > > > Ron > > > > - Original Message - > > From: Diane Randall > > Sent: Sunday, July 12, 2009 > > To: OTlist@OTnow.com > > Subj: [OTlist] Why OT's Should NOT Focus on the UE > > > > DR> I see your point...I was mistaken if I implied in my very first > post > > that I > > DR> told the patient that he needed UE program in order to transfer. > It was > > DR> justified to increase his overall conditioning. My inital reason > for the > > DR> post was to
Re: [OTlist] Why OT's Should NOT Focus on the UE
Miranda, What occupations does the patient desire to improve on? Chris -Original Message- From: Miranda Hayek To: otlist@otnow.com Sent: Tue, Jul 14, 2009 7:00 pm Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE I find the information being shared between Diane and others is helpful. I too am new to the profession and feel that we learn interventions/treatments on the job (my schooling taught me the theory of OT more than hands on!). At my job I learn from the other therapists, and find our afternoon treatments involve dowel, theraband exercises. Morning treatments involve ADL's. (acute and skilled hospital setting). We are also limited on our space for opportunities for more home management or other activities. So was wondering if anyone can provide some examples of treatments they do with their patients. Generally my patients are in the hospital for TKA, THA, CVA (mild-mod), deconditioned due to pneumonia, etc. Thanks. From: spark...@rcn.com To: OTlist@OTnow.com Date: Mon, 13 Jul 2009 12:30:41 -0400 Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE "My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE?" Being that I am new to this and my employment forces me to live in "UE therex" landperhaps you could give me an indication as to what I can do with this person. Others more experienced than me in the dept go with the flow. He is 500 pounds...can now walk about 50ft with someone following him in a W/C and he is able to stand aboout 2-3 min in a RW. I have done all ADL's..and although he is able to life weights in all planes he does not have the arm length to bipass his midsection to do LE dresssing. He has serious LE PN issues so he cannot use a sock aid. he has refused both a dressing stick and reacher. I have done transfers with him from W/C to bed, W/C to toilet, W/C to shower I have done standing tolerance...he likes to draw so I have him stand in front of a white boards and he draws murals for the department. He does W/C pushups. He lives alone, rarely ever left his home due to his weight, microwaves all his meals, and lives on disbaility. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of Ron Carson Sent: Sunday, July 12, 2009 22:08 To: Diane Randall Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE? For me, general phy-dys practitioner's focus on the UE while disregarding the rest of the body severely hampers our professional autonomy. We MUST break free from the mold of being UE therapists! Ron - Original Message - From: Diane Randall Sent: Sunday, July 12, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE DR> I see your point...I was mistaken if I implied in my very first post that I DR> told the patient that he needed UE program in order to transfer. It was DR> justified to increase his overall conditioning. My inital reason for the DR> post was to point out that sometimes our patients assume the things we do in DR> the gym are "therapy" and the functional ADL's are just extras we do...which DR> of course is the very opposite. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com _ Lauren found her dream laptop. Find the PC that’s right for you. http://www.microsoft.com/windows/choosepc/?ocid=ftp_val_wl_290 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com =0 A -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
I find the information being shared between Diane and others is helpful. I too am new to the profession and feel that we learn interventions/treatments on the job (my schooling taught me the theory of OT more than hands on!). At my job I learn from the other therapists, and find our afternoon treatments involve dowel, theraband exercises. Morning treatments involve ADL's. (acute and skilled hospital setting). We are also limited on our space for opportunities for more home management or other activities. So was wondering if anyone can provide some examples of treatments they do with their patients. Generally my patients are in the hospital for TKA, THA, CVA (mild-mod), deconditioned due to pneumonia, etc. Thanks. > From: spark...@rcn.com > To: OTlist@OTnow.com > Date: Mon, 13 Jul 2009 12:30:41 -0400 > Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE > > > "My concern in this is that you ONLY mention and UE program. If general > conditioning prevented the patient from performing occupation, why limit > it only to the UE?" > > > Being that I am new to this and my employment forces me to live in "UE > therex" landperhaps you could give me an indication as to what I can do > with this person. Others more experienced than me in the dept go with the > flow. He is 500 pounds...can now walk about 50ft with someone following him > in a W/C and he is able to stand aboout 2-3 min in a RW. > > I have done all ADL's..and although he is able to life weights in all planes > he does not have the arm length to bipass his midsection to do LE dresssing. > He has serious LE PN issues so he cannot use a sock aid. he has refused both > a dressing stick and reacher. > > I have done transfers with him from W/C to bed, W/C to toilet, W/C to shower > I have done standing tolerance...he likes to draw so I have him stand in > front of a white boards and he draws murals for the department. > > He does W/C pushups. > > He lives alone, rarely ever left his home due to his weight, microwaves all > his meals, and lives on disbaility. > > > > > > -Original Message- > From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on > Behalf Of Ron Carson > Sent: Sunday, July 12, 2009 22:08 > To: Diane Randall > Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE > > > My concern in this is that you ONLY mention and UE program. If general > conditioning prevented the patient from performing occupation, why limit > it only to the UE? > > For me, general phy-dys practitioner's focus on the UE while > disregarding the rest of the body severely hampers our professional > autonomy. > > We MUST break free from the mold of being UE therapists! > > Ron > > - Original Message - > From: Diane Randall > Sent: Sunday, July 12, 2009 > To: OTlist@OTnow.com > Subj: [OTlist] Why OT's Should NOT Focus on the UE > > DR> I see your point...I was mistaken if I implied in my very first post > that I > DR> told the patient that he needed UE program in order to transfer. It was > DR> justified to increase his overall conditioning. My inital reason for the > DR> post was to point out that sometimes our patients assume the things we > do in > DR> the gym are "therapy" and the functional ADL's are just extras we > do...which > DR> of course is the very opposite. > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/otlist@otnow.com > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/otlist@otnow.com _ Lauren found her dream laptop. Find the PC that’s right for you. http://www.microsoft.com/windows/choosepc/?ocid=ftp_val_wl_290 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
The grab rails will not hold if placed on a rough or dirty surface. They will also not hold if placed over grout lines. Generally speaking any smooth and clean surface is appropriate. - Original Message - From: cmnahrw...@aol.com Sent: Tuesday, July 14, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE cac> Can you further explain "1. Proper placement is critical". Are you cac> talking about certain places found in fiberglass showers that are not a cac> good idea to place, or are you talking about proper placement that will cac> optimize the safety during the transfer? Are there some types of cac> showers or tubs in which the suction cup grab bars will not work? cac> -Original Message- cac> From: Ron Carson cac> To: cmnahrw...@aol.com cac> Sent: Tue, Jul 14, 2009 8:46 am cac> Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE cac> I would NOT recommend them unless you are there to supervise their use. cac> On the other hand, you may make patients aware of the device while at cac> the same time giving them precautions such as: cac> 1. Proper placement is critical cac> 2. Not designed to bear weight cac> 3. Check before using cac> etc. cac> Also, there are different quality suction devices. I always recommend cac> the most expensive devices. cac> I like empowering patients to make informed decisions about devices. Be cac> it a walker or reacher, I try leaving the final decision up to the cac> patient/caregiver, if possible. cac> Ron cac> - Original Message - cac> From: cmnahrw...@aol.com cac> Sent: Monday, July 13, 2009 cac> To: OTlist@OTnow.com cac> Subj: [OTlist] Why OT's Should NOT Focus on the UE cac>> That reminds me of a question that I had this morning. Has anyone cac> had cac>> any luck with suction cup grab bars. I work in acute rehab and cac>> patients often want to order them for home, but I do not get to cac> follow cac>> up with them after their DC to determine if they actually work. I cac>> think this may be a good question for the home heatlh OTs. I read cac> in cac>> consumer reports that the person should not put significant weight cac>> through them, and to only use them for balance. I am wondering cac> if I cac>> should recommend them at all cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> www.mail-archive.com/otlist@otnow.com cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
Can you further explain "1. Proper placement is critical". Are you talking about certain places found in fiberglass showers that are not a good idea to place, or are you talking about proper placement that will optimize the safety during the transfer? Are there some types of showers or tubs in which the suction cup grab bars will not work? -Original Message- From: Ron Carson To: cmnahrw...@aol.com Sent: Tue, Jul 14, 2009 8:46 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE I would NOT recommend them unless you are there to supervise their use. On the other hand, you may make patients aware of the device while at the same time giving them precautions such as: 1. Proper placement is critical 2. Not designed to bear weight 3. Check before using etc. Also, there are different quality suction devices. I always recommend the most expensive devices. I like empowering patients to make informed decisions about devices. Be it a walker or reacher, I try leaving the final decision up to the patient/caregiver, if possible. Ron - Original Message - From: cmnahrw...@aol.com Sent: Monday, July 13, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE cac> That reminds me of a question that I had this morning. Has anyone had cac> any luck with suction cup grab bars. I work in acute rehab and cac> patients often want to order them for home, but I do not get to follow cac> up with them after their DC to determine if they actually work. I cac> think this may be a good question for the home heatlh OTs. I read in cac> consumer reports that the person should not put significant weight cac> through them, and to only use them for balance. I am wondering if I cac> should recommend them at all -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
I would NOT recommend them unless you are there to supervise their use. On the other hand, you may make patients aware of the device while at the same time giving them precautions such as: 1. Proper placement is critical 2. Not designed to bear weight 3. Check before using etc. Also, there are different quality suction devices. I always recommend the most expensive devices. I like empowering patients to make informed decisions about devices. Be it a walker or reacher, I try leaving the final decision up to the patient/caregiver, if possible. Ron - Original Message - From: cmnahrw...@aol.com Sent: Monday, July 13, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE cac> That reminds me of a question that I had this morning. Has anyone had cac> any luck with suction cup grab bars. I work in acute rehab and cac> patients often want to order them for home, but I do not get to follow cac> up with them after their DC to determine if they actually work. I cac> think this may be a good question for the home heatlh OTs. I read in cac> consumer reports that the person should not put significant weight cac> through them, and to only use them for balance. I am wondering if I cac> should recommend them at all -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
Re: suction grab rails When I worked in the community here in England we did not recommend the suction cup grab rails as there were too many risks such as they could be re-positioned in such a way as to cause more of a hinderance than a help and that they will not take as much pressure/pull/push as a permanent grab rail. Regards Lucy > To: OTlist@OTnow.com > Date: Mon, 13 Jul 2009 20:20:57 -0400 > From: cmnahrw...@aol.com > Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE > > In this case I would practice both a walk in shower and bathtub shower > combo transfers. I am sure he will have either or. When the apartment > is finalized, schedule a home evaluation and make sure your > recommendations are well known and documented. Sounds like he will > need a heavy duty shower chair or a heavy duty transfer tub bench, > professionally installed grab bars, hand held shower, non slip > stickers, long handled bath sponge. > > That reminds me of a question that I had this morning. Has anyone had > any luck with suction cup grab bars. I work in acute rehab and > patients often want to order them for home, but I do not get to follow > up with them after their DC to determine if they actually work. I > think this may be a good question for the home heatlh OTs. I read in > consumer reports that the person should not put significant weight > through them, and to only use them for balance. I am wondering if I > should recommend them at all > > _ MSN straight to your mobile - news, entertainment, videos and more. http://clk.atdmt.com/UKM/go/147991039/direct/01/ -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
In this case I would practice both a walk in shower and bathtub shower combo transfers. I am sure he will have either or. When the apartment is finalized, schedule a home evaluation and make sure your recommendations are well known and documented. Sounds like he will need a heavy duty shower chair or a heavy duty transfer tub bench, professionally installed grab bars, hand held shower, non slip stickers, long handled bath sponge. That reminds me of a question that I had this morning. Has anyone had any luck with suction cup grab bars. I work in acute rehab and patients often want to order them for home, but I do not get to follow up with them after their DC to determine if they actually work. I think this may be a good question for the home heatlh OTs. I read in consumer reports that the person should not put significant weight through them, and to only use them for balance. I am wondering if I should recommend them at all -Original Message- From: Diane Randall To: OTlist@OTnow.com Sent: Mon, Jul 13, 2009 11:34 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE "Is it a roll-in shower, walk-in shower, tub w/ a shower, glass doors, does it have a seat, how big is the shower, does it have grab rails." Here is another problem. He had been at the SNF forover a month without a shower before he finally transfered in. I aked about his bathing facilites at home and he has a claw foot bathtub that he has not used in over a year because he cannot get into it and it is all around too small. He is renting. He is working with SS to move to another apartment. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of Ron Carson Sent: Monday, July 13, 2009 09:25 To: cmnahrw...@aol.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE I will take Chris' suggestions a little further. If the patient wants to bathe in the shower, you must 1st know the environment in which this occurs. Is it a roll-in shower, walk-in shower, tub w/ a shower, glass doors, does it have a seat, how big is the shower, does it have grab rails. These environmental issues are VERY important to the goal of showering. Also, you must understand the persons physical, mental, cognitive and social strengths and weakness. IF showering is the goal, a skilled OT looks at all factors involved in the process, identifies which are hindering success and then works on overcoming these factors. Also, if showering is the goal, it is NOT necessary to shower with the patient during every treatment session. What IS important is identifying barriers (and there are more than I listed) and then working on the most significant problem(s). If LE strength is a KNOWN limitation, then make the patient's muscles stronger. Personally, I don't do exercises. I tell patient's that's PT's job. I am not well enough trained to identify and treat SPECIFIC muscle weakness/imbalance. Instead, I ask patients to do challenging physical activity. The list of possible barriers is really endless. Two of the most common barriers patient encounter are fear and lack of competency. In these situations, a skilled OT can progress the patient by engaging them in over-achieving activity. For example, if a patient wants to shower but is afraid to step over a 4" threshold into their shower, set up a clinical situation where the patient has a 5" threshold. Provide various challenges (i.e. walker ~vs~ no walker, rail ~vs~ no rail). Practice, practice, practice is what builds competency and decreases fear. Remember, ALL therapy should require the skills of a therapist. I frequently tell patients, I am not going to do "that" because it does not require my skills. Ask yourself, are you doing something that an aide could be doing? If so, then you are not doing therapy! If you are sitting around bored to death, watching patients do exercise, you are not doing therapy. If you are not challenging your patients beyond their ability, you are not doing therapy. If patients are not progressing to their goals, you are not doing therapy. Therapy is a SKILL. If you are not applying skill, you are not doing therapy! Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: cmnahrw...@aol.com Sent: Sunday, July 12, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE cac> If you want to go by the book, then you have to key into the concept of cac> task specific training. This is usually an easy concept for new cac> clinicians. If you want to get better at walking go ahead and walk, if cac> you want to get better at getting into a shower go ahead an get into a cac> shower, if you want to get better at bathing and dressing go ahead and cac> practice
Re: [OTlist] Why OT's Should NOT Focus on the UE
Sounds like you are working him pretty hard. Hard to get around barriers when patients' refuse dressing equipment. Try a large sock aide or a soft sock aide for the pain issues of his feet. -Original Message- From: Diane Randall To: OTlist@OTnow.com Sent: Mon, Jul 13, 2009 11:30 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE "My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE?" Being that I am new to this and my employment forces me to live in "UE therex" landperhaps you could give me an indication as to what I can do with this person. Others more experienced than me in the dept go with the flow. He is 500 pounds...can now walk about 50ft with someone following him in a W/C and he is able to stand aboout 2-3 min in a RW. I have done all ADL's..and although he is able to life weights in all planes he does not have the arm length to bipass his midsection to do LE dresssing. He has serious LE PN issues so he cannot use a sock aid. he has refused both a dressing stick and reacher. I have done transfers with him from W/C to bed, W/C to toilet, W/C to shower I have done standing tolerance...he likes to draw so I have him stand in front of a white boards and he draws murals for the department. He does W/C pushups. He lives alone, rarely ever left his home due to his weight, microwaves all his meals, and lives on disbaility. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of Ron Carson Sent: Sunday, July 12, 2009 22:08 To: Diane Randall Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE? For me, general phy-dys practitioner's focus on the UE while disregarding the rest of the body severely hampers our professional autonomy. We MUST break free from the mold of being UE therapists! Ron - Original Message - From: Diane Randall Sent: Sunday, July 12, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE DR> I see your point...I was mistaken if I implied in my very first post that I DR> told the patient that he needed UE program in order to transfer. It was DR> justified to increase his overall conditioning. My inital reason for the DR> post was to point out that sometimes our patients assume the things we do in DR> the gym are "therapy" and the functional ADL's are just extras we do...which DR> of course is the very opposite. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
Thank you so much for your encouragement. Sometimes as a new COTA, I feel like I have limited power but it my short time working I have realized that I have more power than I initally thought to intervene and make the sessions more relevent to the individual. It is not easy in a SNF, I see 10 patients in 6 hours. One on one therapy is very hard to schedule. One patient of mine expressed an interest in learning how to use the internet. In her particular circumstances, I felt that this was a good idea. This was not anything listed in her short or long term goals by the OTR. I had to develope a relationship with her and find out what motivates her. I asked the OTR and she said it was fine. I am a little bit disheartened that the inital evals don't really indicate what the patients want as goals. It seems to be what the therapists think they need. I think it is up to me or whomever is the assigned therapist to pursue a holistic approach beyond what is written in the eval. And yes...Dr's told him he would not live another 10 years. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of susanne Sent: Monday, July 13, 2009 15:48 To: OTlist@OTnow.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Hi Diane! Me, I'm quite impressed with your work with your patient - you may not have conveyed to us all that you do and I guess this is because some of it happens "silently" - but you seem to have established a great working relationship with him. You've together found out a lot about his motivation. He actually is loosing weight - he keeps weights in his room - he wants to go on about his training, weight loss and independence. For a person whose problems stem from serious overweight this is really something!! So I hope you congratulate yourself about these achievements and don't start questioning everything you do as a result of our probing here. Consider the opposite: Him not being motivated to loose weight, work out, or much engage in changing his situation, the isolation included Even if you'd then succeed in some improved independence - ie from him learning some good ole OT tricks and lots of adaptive equipment and environment changes - my guess is he would soon either die from complications to his lifestyle, or suffer a very low quality of life. It's not that I disagree with what Ron and Chris said - it's just that there's more to it IMO - like establishing 'rapport' with patient, digging into motivation (like what actually 'moves' the patient), considering overall QOL etc. You seem to really have gone there, and I suspect this has guided your choice of intervention in more ways than meet the eye! Off my soap box for now:-) Warmly susanne, denmark PS: A few abbreviations I didn't understand: PN, therex, RW. Could you elaborate? -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
Hi Diane! Me, I'm quite impressed with your work with your patient - you may not have conveyed to us all that you do and I guess this is because some of it happens "silently" - but you seem to have established a great working relationship with him. You've together found out a lot about his motivation. He actually is loosing weight - he keeps weights in his room - he wants to go on about his training, weight loss and independence. For a person whose problems stem from serious overweight this is really something!! So I hope you congratulate yourself about these achievements and don't start questioning everything you do as a result of our probing here. Consider the opposite: Him not being motivated to loose weight, work out, or much engage in changing his situation, the isolation included Even if you'd then succeed in some improved independence - ie from him learning some good ole OT tricks and lots of adaptive equipment and environment changes - my guess is he would soon either die from complications to his lifestyle, or suffer a very low quality of life. It's not that I disagree with what Ron and Chris said - it's just that there's more to it IMO - like establishing 'rapport' with patient, digging into motivation (like what actually 'moves' the patient), considering overall QOL etc. You seem to really have gone there, and I suspect this has guided your choice of intervention in more ways than meet the eye! Off my soap box for now:-) Warmly susanne, denmark PS: A few abbreviations I didn't understand: PN, therex, RW. Could you elaborate? -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
" Ask yourself, are you doing something that an aide could be doing? If so, then you are not doing therapy!" Please explain... you are correct in that aides may not know the clinical reasoning behind a therapy but the actual physical part of engaging in theraputic activity with a patient can sometimes be done by an aide although unethical...just saying it is physically possible. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of Ron Carson Sent: Monday, July 13, 2009 09:25 To: cmnahrw...@aol.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE I will take Chris' suggestions a little further. If the patient wants to bathe in the shower, you must 1st know the environment in which this occurs. Is it a roll-in shower, walk-in shower, tub w/ a shower, glass doors, does it have a seat, how big is the shower, does it have grab rails. These environmental issues are VERY important to the goal of showering. Also, you must understand the persons physical, mental, cognitive and social strengths and weakness. IF showering is the goal, a skilled OT looks at all factors involved in the process, identifies which are hindering success and then works on overcoming these factors. Also, if showering is the goal, it is NOT necessary to shower with the patient during every treatment session. What IS important is identifying barriers (and there are more than I listed) and then working on the most significant problem(s). If LE strength is a KNOWN limitation, then make the patient's muscles stronger. Personally, I don't do exercises. I tell patient's that's PT's job. I am not well enough trained to identify and treat SPECIFIC muscle weakness/imbalance. Instead, I ask patients to do challenging physical activity. The list of possible barriers is really endless. Two of the most common barriers patient encounter are fear and lack of competency. In these situations, a skilled OT can progress the patient by engaging them in over-achieving activity. For example, if a patient wants to shower but is afraid to step over a 4" threshold into their shower, set up a clinical situation where the patient has a 5" threshold. Provide various challenges (i.e. walker ~vs~ no walker, rail ~vs~ no rail). Practice, practice, practice is what builds competency and decreases fear. Remember, ALL therapy should require the skills of a therapist. I frequently tell patients, I am not going to do "that" because it does not require my skills. Ask yourself, are you doing something that an aide could be doing? If so, then you are not doing therapy! If you are sitting around bored to death, watching patients do exercise, you are not doing therapy. If you are not challenging your patients beyond their ability, you are not doing therapy. If patients are not progressing to their goals, you are not doing therapy. Therapy is a SKILL. If you are not applying skill, you are not doing therapy! Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: cmnahrw...@aol.com Sent: Sunday, July 12, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE cac> If you want to go by the book, then you have to key into the concept of cac> task specific training. This is usually an easy concept for new cac> clinicians. If you want to get better at walking go ahead and walk, if cac> you want to get better at getting into a shower go ahead an get into a cac> shower, if you want to get better at bathing and dressing go ahead and cac> practice this as well. cac> Hope this helps, cac> Chris -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
"Is it a roll-in shower, walk-in shower, tub w/ a shower, glass doors, does it have a seat, how big is the shower, does it have grab rails." Here is another problem. He had been at the SNF forover a month without a shower before he finally transfered in. I aked about his bathing facilites at home and he has a claw foot bathtub that he has not used in over a year because he cannot get into it and it is all around too small. He is renting. He is working with SS to move to another apartment. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of Ron Carson Sent: Monday, July 13, 2009 09:25 To: cmnahrw...@aol.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE I will take Chris' suggestions a little further. If the patient wants to bathe in the shower, you must 1st know the environment in which this occurs. Is it a roll-in shower, walk-in shower, tub w/ a shower, glass doors, does it have a seat, how big is the shower, does it have grab rails. These environmental issues are VERY important to the goal of showering. Also, you must understand the persons physical, mental, cognitive and social strengths and weakness. IF showering is the goal, a skilled OT looks at all factors involved in the process, identifies which are hindering success and then works on overcoming these factors. Also, if showering is the goal, it is NOT necessary to shower with the patient during every treatment session. What IS important is identifying barriers (and there are more than I listed) and then working on the most significant problem(s). If LE strength is a KNOWN limitation, then make the patient's muscles stronger. Personally, I don't do exercises. I tell patient's that's PT's job. I am not well enough trained to identify and treat SPECIFIC muscle weakness/imbalance. Instead, I ask patients to do challenging physical activity. The list of possible barriers is really endless. Two of the most common barriers patient encounter are fear and lack of competency. In these situations, a skilled OT can progress the patient by engaging them in over-achieving activity. For example, if a patient wants to shower but is afraid to step over a 4" threshold into their shower, set up a clinical situation where the patient has a 5" threshold. Provide various challenges (i.e. walker ~vs~ no walker, rail ~vs~ no rail). Practice, practice, practice is what builds competency and decreases fear. Remember, ALL therapy should require the skills of a therapist. I frequently tell patients, I am not going to do "that" because it does not require my skills. Ask yourself, are you doing something that an aide could be doing? If so, then you are not doing therapy! If you are sitting around bored to death, watching patients do exercise, you are not doing therapy. If you are not challenging your patients beyond their ability, you are not doing therapy. If patients are not progressing to their goals, you are not doing therapy. Therapy is a SKILL. If you are not applying skill, you are not doing therapy! Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: cmnahrw...@aol.com Sent: Sunday, July 12, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE cac> If you want to go by the book, then you have to key into the concept of cac> task specific training. This is usually an easy concept for new cac> clinicians. If you want to get better at walking go ahead and walk, if cac> you want to get better at getting into a shower go ahead an get into a cac> shower, if you want to get better at bathing and dressing go ahead and cac> practice this as well. cac> Hope this helps, cac> Chris -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
"My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE?" Being that I am new to this and my employment forces me to live in "UE therex" landperhaps you could give me an indication as to what I can do with this person. Others more experienced than me in the dept go with the flow. He is 500 pounds...can now walk about 50ft with someone following him in a W/C and he is able to stand aboout 2-3 min in a RW. I have done all ADL's..and although he is able to life weights in all planes he does not have the arm length to bipass his midsection to do LE dresssing. He has serious LE PN issues so he cannot use a sock aid. he has refused both a dressing stick and reacher. I have done transfers with him from W/C to bed, W/C to toilet, W/C to shower I have done standing tolerance...he likes to draw so I have him stand in front of a white boards and he draws murals for the department. He does W/C pushups. He lives alone, rarely ever left his home due to his weight, microwaves all his meals, and lives on disbaility. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of Ron Carson Sent: Sunday, July 12, 2009 22:08 To: Diane Randall Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE? For me, general phy-dys practitioner's focus on the UE while disregarding the rest of the body severely hampers our professional autonomy. We MUST break free from the mold of being UE therapists! Ron - Original Message - From: Diane Randall Sent: Sunday, July 12, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE DR> I see your point...I was mistaken if I implied in my very first post that I DR> told the patient that he needed UE program in order to transfer. It was DR> justified to increase his overall conditioning. My inital reason for the DR> post was to point out that sometimes our patients assume the things we do in DR> the gym are "therapy" and the functional ADL's are just extras we do...which DR> of course is the very opposite. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
I will take Chris' suggestions a little further. If the patient wants to bathe in the shower, you must 1st know the environment in which this occurs. Is it a roll-in shower, walk-in shower, tub w/ a shower, glass doors, does it have a seat, how big is the shower, does it have grab rails. These environmental issues are VERY important to the goal of showering. Also, you must understand the persons physical, mental, cognitive and social strengths and weakness. IF showering is the goal, a skilled OT looks at all factors involved in the process, identifies which are hindering success and then works on overcoming these factors. Also, if showering is the goal, it is NOT necessary to shower with the patient during every treatment session. What IS important is identifying barriers (and there are more than I listed) and then working on the most significant problem(s). If LE strength is a KNOWN limitation, then make the patient's muscles stronger. Personally, I don't do exercises. I tell patient's that's PT's job. I am not well enough trained to identify and treat SPECIFIC muscle weakness/imbalance. Instead, I ask patients to do challenging physical activity. The list of possible barriers is really endless. Two of the most common barriers patient encounter are fear and lack of competency. In these situations, a skilled OT can progress the patient by engaging them in over-achieving activity. For example, if a patient wants to shower but is afraid to step over a 4" threshold into their shower, set up a clinical situation where the patient has a 5" threshold. Provide various challenges (i.e. walker ~vs~ no walker, rail ~vs~ no rail). Practice, practice, practice is what builds competency and decreases fear. Remember, ALL therapy should require the skills of a therapist. I frequently tell patients, I am not going to do "that" because it does not require my skills. Ask yourself, are you doing something that an aide could be doing? If so, then you are not doing therapy! If you are sitting around bored to death, watching patients do exercise, you are not doing therapy. If you are not challenging your patients beyond their ability, you are not doing therapy. If patients are not progressing to their goals, you are not doing therapy. Therapy is a SKILL. If you are not applying skill, you are not doing therapy! Ron ~~~ Ron Carson MHS, OT www.OTnow.com - Original Message - From: cmnahrw...@aol.com Sent: Sunday, July 12, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE cac> If you want to go by the book, then you have to key into the concept of cac> task specific training. This is usually an easy concept for new cac> clinicians. If you want to get better at walking go ahead and walk, if cac> you want to get better at getting into a shower go ahead an get into a cac> shower, if you want to get better at bathing and dressing go ahead and cac> practice this as well. cac> Hope this helps, cac> Chris -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
My concern in this is that you ONLY mention and UE program. If general conditioning prevented the patient from performing occupation, why limit it only to the UE? For me, general phy-dys practitioner's focus on the UE while disregarding the rest of the body severely hampers our professional autonomy. We MUST break free from the mold of being UE therapists! Ron - Original Message - From: Diane Randall Sent: Sunday, July 12, 2009 To: OTlist@OTnow.com Subj: [OTlist] Why OT's Should NOT Focus on the UE DR> I see your point...I was mistaken if I implied in my very first post that I DR> told the patient that he needed UE program in order to transfer. It was DR> justified to increase his overall conditioning. My inital reason for the DR> post was to point out that sometimes our patients assume the things we do in DR> the gym are "therapy" and the functional ADL's are just extras we do...which DR> of course is the very opposite. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
I see your point...I was mistaken if I implied in my very first post that I told the patient that he needed UE program in order to transfer. It was justified to increase his overall conditioning. My inital reason for the post was to point out that sometimes our patients assume the things we do in the gym are "therapy" and the functional ADL's are just extras we do...which of course is the very opposite. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Sunday, July 12, 2009 13:49 To: OTlist@OTnow.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Diane, I am not saying that an UE therex program is inappropriate. In fact it is very beneficial treatment concept in OT for individuals who have been bed bound and have experienced muscle atrophy because of the immobilization. I am saying that you need to be careful how you educate your patients, because saying that the UE exercises will help the person with their transfers and ADL is not exactly true, regardless is the person is a male and female. If you want to help them with their UE strength to facilitate transitions from sit to stand from a toilet and using the standard walker you need to have them do wheelchair push ups, sit to stands, standing with the walker, or at least scapular depression/tricep extension using a Rickshaw machine (push down machine). You then can then say why you are helping them in this area in prep for safer transfers. So he progressed from 5 to 10#? I assume then he has enough ROM in his arms to bath himself, enough ROM to donn a shirt, and enough grip to hold onto a shirt and pants. So instead of educating him about UE strength to assist him in transfers and ADL, I would educate him in the way that you desribed in your prior email because this is true in terms of research and practical thinking. "There is something aboutlifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weightloss over time." Chris -Original Message- From: Diane Randall To: OTlist@OTnow.com Sent: Sun, Jul 12, 2009 7:51 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE The patient was unable to bear weight on his legs due to PN and did not have the strength to hold his weight up in a RW, he also could not stand beyond 5 seconds without his knees buckling as he is close to 500 pounds. He worked up from 5 to 10 llb weights in all planes per day and he was a very debilitated when he arrived, using a hoyer. The UE therex at least boosted his confidence to be able to do this transfer along with improvemnents in standing tolerance and walking with PT. UE therex is not all he does in therapy but I have noticed, especially with men, that they tend to perform ADL's better when they feel therapy includes an overall strengthening program. He even keeps some weights in his room. There is something about lifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weight loss over time. He has lost a significant amount of weight and he seems very motivated. Straight ADL's can be a source of stess for very proud men. Most of my patients are in therapy for debility. While it is not appropriate for everyone, I feel that in this case it was justified, even if as you say the UE program did not contribute significantly to his ability to transfer when is comes to to strength alone. It my opinion, the UE program is more of a holistic approach than a biomechanical one in this case. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Sunday, July 12, 2009 07:32 To: OTlist@OTnow.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Diane, I hate to be the devil's advocate, but because I veiw you as a very compassionate young clinician, I think you might benefit from my suggestions. With that being said, I am not sure that your UE strength exercises helped this person with their ability to transfer into a shower or complete bathing and dressing easier. Now I am not saying that the UE strength program had no therapeutic benefits whatsoever, like for overall strength and possibly functional endurance, but I doubt if it helped him in the way that you think. If this was the patient's first time with you in the shower, how do you know that he couldn't have done this his first week? I think I remember you saying that you are a COTA. If this is true, did the OT specifically evaluate these abilities or did the therapist simulate or extrapolate concepts during the evaluation? What UE strength exercises did you wo
Re: [OTlist] Why OT's Should NOT Focus on the UE
Diane, I am not saying that an UE therex program is inappropriate. In fact it is very beneficial treatment concept in OT for individuals who have been bed bound and have experienced muscle atrophy because of the immobilization. I am saying that you need to be careful how you educate your patients, because saying that the UE exercises will help the person with their transfers and ADL is not exactly true, regardless is the person is a male and female. If you want to help them with their UE strength to facilitate transitions from sit to stand from a toilet and using the standard walker you need to have them do wheelchair push ups, sit to stands, standing with the walker, or at least scapular depression/tricep extension using a Rickshaw machine (push down machine). You then can then say why you are helping them in this area in prep for safer transfers. So he progressed from 5 to 10#? I assume then he has enough ROM in his arms to bath himself, enough ROM to donn a shirt, and enough grip to hold onto a shirt and pants. So instead of educating him about UE strength to assist him in transfers and ADL, I would educate him in the way that you desribed in your prior email because this is true in terms of research and practical thinking. "There is something aboutlifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weightloss over time." Chris -Original Message- From: Diane Randall To: OTlist@OTnow.com Sent: Sun, Jul 12, 2009 7:51 am Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE The patient was unable to bear weight on his legs due to PN and did not have the strength to hold his weight up in a RW, he also could not stand beyond 5 seconds without his knees buckling as he is close to 500 pounds. He worked up from 5 to 10 llb weights in all planes per day and he was a very debilitated when he arrived, using a hoyer. The UE therex at least boosted his confidence to be able to do this transfer along with improvemnents in standing tolerance and walking with PT. UE therex is not all he does in therapy but I have noticed, especially with men, that they tend to perform ADL's better when they feel therapy includes an overall strengthening program. He even keeps some weights in his room. There is something about lifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weight loss over time. He has lost a significant amount of weight and he seems very motivated. Straight ADL's can be a source of stess for very proud men. Most of my patients are in therapy for debility. While it is not appropriate for everyone, I feel that in this case it was justified, even if as you say the UE program did not contribute significantly to his ability to transfer when is comes to to strength alone. It my opinion, the UE program is more of a holistic approach than a biomechanical one in this case. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Sunday, July 12, 2009 07:32 To: OTlist@OTnow.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Diane, I hate to be the devil's advocate, but because I veiw you as a very compassionate young clinician, I think you might benefit from my suggestions. With that being said, I am not sure that your UE strength exercises helped this person with their ability to transfer into a shower or complete bathing and dressing easier. Now I am not saying that the UE strength program had no therapeutic benefits whatsoever, like for overall strength and possibly functional endurance, but I doubt if it helped him in the way that you think. If this was the patient's first time with you in the shower, how do you know that he couldn't have done this his first week? I think I remember you saying that you are a COTA. If this is true, did the OT specifically evaluate these abilities or did the therapist simulate or extrapolate concepts during the evaluation? What UE strength exercises did you work on in treatment? I am assuming that you worked on the typical theraband, dowel rod, or dumbell exercises that focus on isotonic strength. If this is true, then based on the literature there is no established evidence or even any associations for functional improvements in this area. And practically speaking, most clinicians do not strengthen the correct muscles that are even in the ball park when talking about functional mobility. When I strengthen for functional mobility, I work on the patient's core stability, the scapular depressors, and the triceps. Now when you work on such muscle groups it is wise to
Re: [OTlist] Why OT's Should NOT Focus on the UE
The patient was unable to bear weight on his legs due to PN and did not have the strength to hold his weight up in a RW, he also could not stand beyond 5 seconds without his knees buckling as he is close to 500 pounds. He worked up from 5 to 10 llb weights in all planes per day and he was a very debilitated when he arrived, using a hoyer. The UE therex at least boosted his confidence to be able to do this transfer along with improvemnents in standing tolerance and walking with PT. UE therex is not all he does in therapy but I have noticed, especially with men, that they tend to perform ADL's better when they feel therapy includes an overall strengthening program. He even keeps some weights in his room. There is something about lifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weight loss over time. He has lost a significant amount of weight and he seems very motivated. Straight ADL's can be a source of stess for very proud men. Most of my patients are in therapy for debility. While it is not appropriate for everyone, I feel that in this case it was justified, even if as you say the UE program did not contribute significantly to his ability to transfer when is comes to to strength alone. It my opinion, the UE program is more of a holistic approach than a biomechanical one in this case. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Sunday, July 12, 2009 07:32 To: OTlist@OTnow.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE Diane, I hate to be the devil's advocate, but because I veiw you as a very compassionate young clinician, I think you might benefit from my suggestions. With that being said, I am not sure that your UE strength exercises helped this person with their ability to transfer into a shower or complete bathing and dressing easier. Now I am not saying that the UE strength program had no therapeutic benefits whatsoever, like for overall strength and possibly functional endurance, but I doubt if it helped him in the way that you think. If this was the patient's first time with you in the shower, how do you know that he couldn't have done this his first week? I think I remember you saying that you are a COTA. If this is true, did the OT specifically evaluate these abilities or did the therapist simulate or extrapolate concepts during the evaluation? What UE strength exercises did you work on in treatment? I am assuming that you worked on the typical theraband, dowel rod, or dumbell exercises that focus on isotonic strength. If this is true, then based on the literature there is no established evidence or even any associations for functional improvements in this area. And practically speaking, most clinicians do not strengthen the correct muscles that are even in the ball park when talking about functional mobility. When I strengthen for functional mobility, I work on the patient's core stability, the scapular depressors, and the triceps. Now when you work on such muscle groups it is wise to strengthen the antagonist muscle groups as well so you do not end up with muscle imbalance. This is still just thinking practically, it still does not have any support in the research. If you want to go by the book, then you have to key into the concept of task specific training. This is usually an easy concept for new clinicians. If you want to get better at walking go ahead and walk, if you want to get better at getting into a shower go ahead an get into a shower, if you want to get better at bathing and dressing go ahead and practice this as well. Hope this helps, Chris -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
Diane, I hate to be the devil's advocate, but because I veiw you as a very compassionate young clinician, I think you might benefit from my suggestions. With that being said, I am not sure that your UE strength exercises helped this person with their ability to transfer into a shower or complete bathing and dressing easier. Now I am not saying that the UE strength program had no therapeutic benefits whatsoever, like for overall strength and possibly functional endurance, but I doubt if it helped him in the way that you think. If this was the patient's first time with you in the shower, how do you know that he couldn't have done this his first week? I think I remember you saying that you are a COTA. If this is true, did the OT specifically evaluate these abilities or did the therapist simulate or extrapolate concepts during the evaluation? What UE strength exercises did you work on in treatment? I am assuming that you worked on the typical theraband, dowel rod, or dumbell exercises that focus on isotonic strength. If this is true, then based on the literature there is no established evidence or even any associations for functional improvements in this area. And practically speaking, most clinicians do not strengthen the correct muscles that are even in the ball park when talking about functional mobility. When I strengthen for functional mobility, I work on the patient's core stability, the scapular depressors, and the triceps. Now when you work on such muscle groups it is wise to strengthen the antagonist muscle groups as well so you do not end up with muscle imbalance. This is still just thinking practically, it still does not have any support in the research. If you want to go by the book, then you have to key into the concept of task specific training. This is usually an easy concept for new clinicians. If you want to get better at walking go ahead and walk, if you want to get better at getting into a shower go ahead an get into a shower, if you want to get better at bathing and dressing go ahead and practice this as well. Hope this helps, Chris -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Why OT's Should NOT Focus on the UE
I am fairly new at this but I was suprised when I went into a very self-conscious and proud bariatric patients room for the first time to do an ADL with him and he could not understand why I was there. He was a little uncomfortable. I explained that although he sees me in the gym and he does perform UE strengthening exercises along with other therapies that my main focus was to make sure he was able to perform daily living activites with as much independence as possible. All gym therapy was a means to an end. Over the next few weeks his overall conditioning improved through exercise etc and he was able to transfer himself for the first time into the shower. He also made gains in his ability to not rely so much on the nursing staff to wash, bathe and dress him. He lost a significant amount of weight even in three weeks. I think that the problem is that therapists are not educating patients on what and why they are doing what they are doing. Even in Rehab, ADL's are a part of it all. Patients will assume we are simply helping the CNA staff because they might be shorthanded if we don't make the effort to educate them. -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of Ron Carson Sent: Friday, July 10, 2009 20:14 To: OTlist@OTnow.com Subject: [OTlist] Why OT's Should NOT Focus on the UE Today, I evaled a man on home health who had a recent cardiac bypass surgery. He was just home after 10 days in a rehab hospital getting OT and PT. During my eval, I explained what OT was all about. Thinking my words were falling on deaf ears, one of my worst nightmares came true. The patient had previously received OT. They explained that they already had hand exercisers and a reachers and that they didn't need any more OT. Now, this is a sad picture. The patient did need OT and I offered it but they declined. Here are two reasons why: 1. Previous OT's demonstrated that OT was about strengthening hands and arms. 2. Home health PT had already evaled the patient and THEY were providing what the patient needed. Now, why would OT work on giving this man hand exercisers? That makes NO sense to me and for the patient, OT has no apparent value for making this man safe and independent in his home. They felt that PT could do this better than OT. AND THAT IS AN ALL TO OFTEN STATEMENT ABOUT OT! AND THAT IS THE PROBLEM WITH OUR PROFESSION. IT'S NOT OUR NAME, IT'S THE THERAPISTS THAT ARE THE PROBLEM. Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
[OTlist] Why OT's Should NOT Focus on the UE
Today, I evaled a man on home health who had a recent cardiac bypass surgery. He was just home after 10 days in a rehab hospital getting OT and PT. During my eval, I explained what OT was all about. Thinking my words were falling on deaf ears, one of my worst nightmares came true. The patient had previously received OT. They explained that they already had hand exercisers and a reachers and that they didn't need any more OT. Now, this is a sad picture. The patient did need OT and I offered it but they declined. Here are two reasons why: 1. Previous OT's demonstrated that OT was about strengthening hands and arms. 2. Home health PT had already evaled the patient and THEY were providing what the patient needed. Now, why would OT work on giving this man hand exercisers? That makes NO sense to me and for the patient, OT has no apparent value for making this man safe and independent in his home. They felt that PT could do this better than OT. AND THAT IS AN ALL TO OFTEN STATEMENT ABOUT OT! AND THAT IS THE PROBLEM WITH OUR PROFESSION. IT'S NOT OUR NAME, IT'S THE THERAPISTS THAT ARE THE PROBLEM. Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
