I left an entry-level graduate program with the notion of addressing: function - Purpose - MEANING.
I learned from my clinical affiliations and earlier employment: FUNCTION - FUNCTION - FUNCTION. I believe that functioning impacts purpose and meaning. Enhanced functioning (whether remediating an impariment or minimizing a disability) is of great importance. However, I have not often addressed handicap thoroughly due to the constrictions of my practice setting (e.g. acute rehabilitation or inpatient medical). It may be that practice arenas strongly influence the extent to which impairment/diability/handicap are addressed by the occupational therapist. Reimbursement also represents a strong govenor against OT's manimizing handicaps. OTs have been succesful and have made money within the medical arena, addressing impairment (e.g. hand therapists). Medicare directs the practioner to focus treatmen upon function (disability) and areas deemed "medically necessary". Money is a reality. I believe that should OTs wish to move to develop their influence upon "handicap", that they learn to cultivate public opinion that would demand payment for minimizing handicaps. Or help to develop an interest in the public that would encourage private payment for services. How well are OTs educated about the WHO's delinations of impairment/disability/handicap? How much of the OT curriculum addresses handicap, disability and so on? How many working OTs are quite satisfied with addressing imapairment or disability? (a lot I would venture) What incentives exist for an OT practioner to expand or emphasize handicap in their treatment? Aaron Eakman ----- Original Message ----- From: "Ron Carson" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, June 27, 2002 3:59 PM Subject: Framing the Problem > 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 > > *********��*********** > > Unsubscribe? Send a message to [EMAIL PROTECTED] > > In the message's *body*, put the following text: unsubscribe OTlist > > ** List messages are archived at: > > http://www.mail-archive.com/[email protected] > > *********��*********** > *********��*********** Unsubscribe? Send a message to [EMAIL PROTECTED] In the message's *body*, put the following text: unsubscribe OTlist ** List messages are archived at: http://www.mail-archive.com/[email protected] *********��***********
