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)
Ok, say this patient is not highly motivated to increase his dressing abilities - he expresses that when he gets home, he will (magically) be able to do this, or he says, "Oh, my wife can help me with that" while she is standing behind him shaking her head no. She has told you, or maybe another member of the team, that she can not bring him home if he can't do certain things like dressing for himself. Would you say that this man is not an OT candidate? To whom would you refer him instead?
You go on to say:
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
....If adapting clothing is the most relevant choice, then I would NOT work
on hand strengthening....
Why would you choose to limit your program, when addressing ALL of the identified problems gives your patient the greatest chance of achieving his goals related to his occupational deficit?
Ann
