I teach entry level students in OT to generate hypotheses that link participation problems in areas of occupation to underlying client factors, performance skills, performance patterns, context, that may be compromising optimal performance, etc., using the new framework. However, they begin from a client-centered perspective, that is, what does the client view as concerns. Perhaps, being entirely physically independent is not the client's goal. That way, students look at the concerns from a multi-dimensional perspective, not just the biological issues. The educational challenge for us is that many practicing clinicians, who supervise students in the field, operate primarily from the biological perspective. The students don't find many holistic role models out in practice in so-called traditional settings. > ---------- > From: Ron Carson > Reply To: [EMAIL PROTECTED] > Sent: Thursday, June 27, 2002 4:59 PM > To: [EMAIL PROTECTED] > 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] > > *********��*********** > > >
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