Hello Jody:
In part, I might agree that a PT referral is most appropriate for this
patient. As usual, it boils down to the reason why OT is seeing the
client and the reason why hand strengthening is being done.
I always tell my students that they must build bridges between clients
and therapy. The primary bridge is that of occupational deficits and
occupational therapy.
For EVERY client I see, I try to build a bridge between occupational
deficits, causes of the deficits, and treatment designed to improve the
deficits (either, occupational deficits or causes of the deficits). If
a therapist does not do this then I don't see how they are doing
occupational therapy.
For example: A patient with a stroke who can't dress himself is
referred to OT with an order of eval and treat.
At this point, there are two questions to consider:
1. IS OT appropriate for this client
2. If so WHAT is/are the problem(s) and what can I do about it/them
The only way to determine if OT is appropriate it to determine if there
are occupational deficits. Of course, there are several options for
assessing occupational deficits, but the COPM is probably the best. At
this point, there is not an obvious reason to suspect that this client
is in need of OT. Just because the client can't dress himself doesn't
mean that OT is indicated and certainly he may not be appropriate just
because of his stroke symptoms.
Note, that this client's appropriateness is NOT determined by
performing an ADL assessment. (ADL is what I tell students is the "A"
word. There's also the "F" word and "N" word) ADL's and occupations are
related but are not the same, primarily because ADL assessments (e.g.
FIMS) don't look at personal factors such as motivation, satisfaction,
compensation, etc.
During the evaluation,I determine the following:
1. The client can not dress himself in a manner which is acceptable to
himself and that he is highly motivated to increase his dressing
abilities (COPM)
2. The primary reasons the client can't dress himself are:
a. Increased tone in UE and LE
b. Inappropriate support of wife (i.e. not allowing
client to perform this occupation)
c. Poor choice of clothing options
d. Decreased problem solving abilities
e. Lack of self-efficacy
f. Decreased strength in affected hand
At this point, I ask myself what, if anything,is the most important
thing that I can do, to facilitate change in this man's occupational
performance deficits? In other words, of ALL the known factors
contributing to the occupational deficits, which factor(s) will provide
the client with the greatest amount of (+) improvement in occupational
performance in the limited amount of time I have to provide services?
If adapting clothing is the most relevant choice, then I would NOT work
on hand strengthening. If self-efficacy is the problem the I would give
the client multiple opportunities to improve is perceptions. If hand
strength is the issue with the greatest impact on his occupations, then
I would do hand strengthening. Which ever I choose, the most important
concept is that I am doing occupational therapy to improve occupation
and my treatment is directed at the issues which are most likely to
improve occupation.
Next it's appropriate to begin formulating goals at this point.
Long-term goals are based on the occupational deficits and short-term
goals are based on improving those issues which are impeding
occupational performance and for which I plan to treat.
For me, this is a rough example of 'building a bridge' between
occupational performance deficits, issues contributing to these
deficits and the treatment which I'm providing. Seeing a patient
because they have hand dysfunction which MAY be contributing to
occupation issues is NOT occupational therapy. Treating occupational
dysfunction because of a hand injury is occupational therapy. In both
these scenarios, the therapist may in fact carry out the same
treatment, but the reason for treatment in the second example is much
clearer (to the therapist and patient) and it more closely resembles a
type of OT which our professional literature claims we do.
So, Jody, if I am seeing this patient because of hand dysfunction that
MAY contribute to occupational issues, then I'm doing treatment more
closely related to PT. But, if I'm seeing the patient for occupational
issues resulting from hand dysfunction, then I'm doing treatment more
closely related to OT. I guess the only way to know the appropriateness
of the treatment is know why the therapist is seeing the client and to
know that the therapist has demonstrated a causal link between hand
dysfunction, client's occupational deficits and treatment to improve
the occupation.
Ron
P.S.
"A" word = ADL
"F" word = Function
"N" word = non-compliance
================================================
On 10/4/02, [EMAIL PROTECTED] said:
Sac> In a message dated 10/03/2002 8:10:03 PM Central Daylight Time,
Sac> [EMAIL PROTECTED] writes:
>> I am currently practicing in the Home Health arena and unfortunately have
>> very few resources to pull from. Was wondering if anyone had cheap ideas
>> for hand strengthening?
>>
Sac> Well, per Ron refer to PT
Sac> But my ideas are: Pipe insulation. A six inch long piece of this is real
Sac> cheapm( enough so that I give out several, one to stay in the chair close to
Sac> the TV, one on the table in the eating area, one on the bedside table, and
Sac> one to lose.
Sac> I also like these " splash balls" that are pool toys. Foam balls with bright
Sac> cloth covers.
Sac> This next idea is fine motor, not strength but its cheap.
Sac> An empty 2 liter bottle on the table calls for 80 to 90 degrees shoulder
Sac> flexion when dropping objects into it. Dry chick peas or garbanzo beans (
Sac> depending where you're from ) are cheap and I like them because they are
Sac> bumpy and easy to get hold of for FM retraining.
Sac> BTW, I don't spend a lot of my visit time on these. I give instructions and
Sac> I give them the cheap equipment and suggest an every day schedule, maybe
Sac> leave written instructions. I spend most of my visit time on ADLs and IADLs.
Sac> -- Jody
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