I have been following this thread, and it brings up many of the concerns i 
often have. Currently I spend about 30 hours a week as the only OTR in a 
nursing home, and the other 10 hours I am developing a program for OT 
intervention in the Welfare - to - Work poulation (very exciting) As an OT 
of eight years, among which i was a traveling therapist and a float covering 
for a company with 80 nursing facilities, i have seen many types of 
practice.  None of these, however were 100% client centered or functional.   
There are many OT's (perhaps even myself at times) that justify dowel 
exercises, arm bikes, standing activities as being functional because they 
provide the body with the ability to be useful in functional activities such 
as dressing.



I have now eliminated dowel exercises from most of my client's programs, 
only using them if the client specifically asks for "arm exercises".  I 
believe that this is is functional, because they are performing an activity 
with a goal -- physical fitness -- in their own mind.

However, a question that I find myself asking consistently is ... how many 
of these clients are truly obtaining their goals because of my intervention? 
  Would they regain their standing tolerance on their own?  Does PT do 
enough for endurance?

I know I am of benefit when the client needs to learn adaptive techniques or 
when my functional approach encourages resistant clients to attempt greater 
independence, but what about the person who is merely deconditioned from 
being in the hospital too long?  Will they spontaneously recover if given 
the opportunity to do for themselves?

Much of this uncertainty comes from working in areas where I believe 
overutilization of all services (not OT only) was the rule.  I graduated 
into a health care system that told me I didn't truly understand what OT was 
if I didn't see all my clients for 45 minutes twice a day, using the same 
equipment for all of them.

I think this is a very valuable discussion, and I appreciate all your input.


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