I think this post says more about the perceptions of the PT who wrote it, than necessarily a statement about the approach of the OTs with whom he/she worked. An example: person who has undergone a total knee replacement comes to our rehab center. In assessing her, we discussed her central roles of homemaker and wife, and the fact that her husband suffers from severe COPD and is unable to help in self care or maintaining the home. She takes great pride in her home and in caring for her invalid husband. In order for her to resume these roles, we worked on her learning to dress and bathe herself, using a few adaptations - allowing her to resume self care her husband could not assist with. We worked on how to carry laundry and objects in the kitchen and bedroom, given the fact she was now using a walker. We stood at a table during meal preparation and folding the laundry after it dried, increasing her endurance for the occupational tasks of housework she considers so central to her roles. While doing this we discussed the concerns she had about going home, and her ways of coping with the chronic illness of her husband. This is not all we did or talked about, just a sampling of my approach with her. By the time she left, she felt confident she would be able to resume many/most of her roles at home. To the PT working with her, it probably looked like I: "worked on dressing, bathing, standing balance and endurance. Rom and Strength, home assessments, cooking, etc." and "when the OT walked the patient down the hall to the bathroom she was working on the goal of independently bathing " - both direct quotes from the PT post Ron shared. I have heard PT's talk about how important focusing on function is, and yet have seen little understanding of how to truly address their patients in any more than the most rudimentary of functional approaches. The PT post indicated "when I walked the same patient to the gym I was working on endurance to be able to walk home" and seems to infer that by doing this they are working on function, just like the OT. Who knows, as has been stated in replies to Ron's post, maybe some of you feel I took a "reductionist" approach to this patient, but I feel we addressed her own goals related to her occupational roles, and did it within the reimbursement and structural confines of a medical model. Its possible that the OTs being observed by this PT were using similar approaches - so much of what we do with our patients is determined by how we think and plan our programs. Since thinking and planning are internal processes, it is very difficult/impossible for someone watching to understand the process that is occurring, and whether it involves a client centered, occupational approach - or a "reductionist" one. Ann
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