Hello Ann: Regarding your following comment:
Dac> Why would you choose to limit your program, when addressing ALL of the Dac> identified problems gives your patient the greatest chance of achieving Dac> his goals related to his occupational deficit? I don't see my program as being limiting, in fact I see it as just the opposite. But from a real-world perspective, there just isn't time to adequately address ALL the client's issues. Well, let me correct that. I can address all the issues because the only REAL issue is the client's occupational performance deficits. What I can't address is ALL the possible causes so I must address the most important cause of the dysfunction. Most important means those that are the greatest limiting factors to occupation AND those which I can change in a manner that will improve occupation. If the client's increased tone is limiting his occupation BUT I believe that little can be done to decrease the tone to a degree that it will improve their occupation, I don't believe it's in the client's interest to work on tone reduction. I so ironic that you would even consider my program as limiting. I can't tell you the number of times I wondered the same thing about OT's who's primary focus is on UE rehab. Why in the world do they limit themselves to the very narrow focus of the upper limb? How in the world has our profession become so limited that practitioners look at a person as a physical body with some sort of attached mental body that interacts in the world. IF improving physical function was any type of key to occupational performance than wouldn't it stand to reason that those people with zero physical limitations would be occupational sound. Of course we ALL know of many people, including myself, who are physically sound but who are occupationally unfit. If any people are limiting their program, it is those practitioners who are being sucked into the pervasive medical model of care and following in the footsteps of our PT partners. Leave the PT to the PT's and let's get on with the business (i.e. science and art) of being OT's. Ron ====================================================== On 10/7/2002, [EMAIL PROTECTED] said: Dac> In a message dated 10/5/2002 2:43:59 AM Eastern Standard Time, Dac> [EMAIL PROTECTED] writes: >> 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) >> Dac> Ok, say this patient is not highly motivated to increase his dressing Dac> abilities - he expresses that when he gets home, he will (magically) be able Dac> to do this, or he says, "Oh, my wife can help me with that" while she is Dac> standing behind him shaking her head no. She has told you, or maybe another Dac> member of the team, that she can not bring him home if he can't do certain Dac> things like dressing for himself. Would you say that this man is not an OT Dac> candidate? To whom would you refer him instead? Dac> You go on to say: Dac> 2. The primary reasons the client can't dress himself are: Dac> a. Increased tone in UE and LE Dac> b. Inappropriate support of wife (i.e. not allowing Dac> client to perform this occupation) Dac> c. Poor choice of clothing options Dac> d. Decreased problem solving abilities Dac> e. Lack of self-efficacy Dac> f. Decreased strength in affected hand Dac> ....If adapting clothing is the most relevant choice, then I would NOT work Dac> on hand strengthening.... Dac> Why would you choose to limit your program, when addressing ALL of the Dac> identified problems gives your patient the greatest chance of achieving his Dac> goals related to his occupational deficit? Dac> Ann *********��*********** 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] *********��***********
