Here's another interesting thought, maybe.
If the symptoms of a person with a stroke are put on a continuum, one
possible example might be:
|- High cholesterol ->Stroke event ->Impairments ->Disability ->Handicap -|
The above shows that the client had high cholesterol which eventually
caused a stroke, leaving the patient with impairments, preventing them
from caring for themselves, being productive or having fun (i.e. a
disability) and thus keeping them from fulfilling their social roles
(i.e. handicap).
The above continuum is very vague. You can fill in the categories with
whatever fits. For example, 'impairments' might include:
-decreased balance
-decreased range of motion
-increase pain, etc
Disability might include:
-inability to dress
-inability to eat
-inability to bathe, etc
Now, here's a question. Based on the above example, what exactly is the
'problem' with this hypothetical client?
In reality, most people can tell that there are really many 'problems'
and issues associated with the client's current condition.
Each profession involved with this client, will see 'problems' from a
different primary perspective. For example, a dietitian may see the
primary 'problem' as the clients poor nutritional habits; the surgeon
will see the arterial plaque buildup as the primary 'problem', the
primary care physician may see the actual stroke event as the
'problem'. While each profession does not categorically exclude other
professions' concerns, each profession has a PRIMARY domain of concern.
Anything outside of this domain may be considered adjunctive or 'nice
to know' information but is certainly not going to be evaluated,
treated and considered as part of that profession's outcome.
Where does OT fit on the above continuum? In other words, ow might the
OT profession define the 'problems' with this client? Is the primary
'problem' that the client may not be able to move their hand, arm,
foot? Or is the primary 'problem' that the client may not be able to
brush their teeth, drive their car or go to work (or whatever
disability the client's experiencing)?
It appears to me that as a profession, we articulate that the client's
disability (i.e. occupational deficits) are the primary 'problems'.
However, much of what I read and witness indicates that many, many
practitioners are not practicing within primary domain. Instead, they
are practicing from an impairment perspective which say's that the loss
of range of motion, strength, coordination, etc are the primary
'problems'.
While some may argue that my stamens are just rhetoric, I believe that
they may hold some merit in understanding different experiences of
practitioners, students and educators. For how the 'problem' is defined
dictates both the nature of treatment and the desired outcome.
So, how SHOULD the profession frame the 'problem' and how ARE
practitioners actually framing the 'problem'? If the two are different
is this a problem? What can or should be done about this? Should I get
a life and quit worry about this? <grin>
Ron
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