It's not perfect but it's the only thing that I know to do. No matter
though because the reason for the treatment is still the occupation.
I really feel that Ron is taking a narrow view of OT ( I know, I know, he thinks mine is narrow) He seems to be such an idealogue, with no room for compromise. One of my teachers was Gary Kielhofner - a big proponent of " we are not upper extremity PTs" but I don't remember him preaching limiting OT practice to referrals generated BECAUSE OF Occupational Deficits, and then only when the patient is ready to work on that Occupation. What about the therapeutic use of self? I have had many patients like this hypothetical oner who doesn't want to do self care, but often when they see that it might be possible, they are more willing to speak the words - yes, I want to dress by myself. And what about the side of OT that says that engaging in occupation is healing - Mary reilly's , " Man through the use of his hands can influence the state of his own health." The pioneer OTs used real serious crafts - yes even basketweaving - engag! ing in the craft was and is healing - but the OT pioneers' patients didn't have an occupational deficit in basket making, they had some type of psych diagnosis or some debilitating condition like TB. So I know Ron doesn't think I am a real OT, but I am out there doing it, I am not just an upper extremity PT, and I choose home health as my practice setting because people at home really need to do their own ADLs and care about recovering the ability to do them and the environment is more conducive and inducive to recovering ADL independence than a nursing home. He can call ADLs the A word but they are primary occupations to may people who come to me as home health referrals. And I even claim one more ADL - carrying things. People who get around with assistive devices have special challenges in carrying things, and carrying things causes many falls in those who use ADs for getting around. And yes I am client centered too - I don't force ADLs ! down their throats, I ask my home health clients, "What do you want to do that you can't do now?" And then I use every means to get there - not just one. If the patient's goal is making cornbread ( and we use heavy cast iron skillets here in Mississippi ) I approach the goal in at least 4 ways: improving motor skills, adapting the task, adapting the environment, and practicing the task. I think if we just adapted the task that would be a narrow view of OT. I know I am just ranting on and on here and I do realize that I am not an academic and will never be half the theorist Ron is or Gary Kielhofner is, I am just kind of an intuitive technician, but I know I am in the trenches providing a needed service, which Ron thinks is not OT-- Jody
