RE: Ron is driving me CRAZY

[Dr. Estelle Breines]

Bravo, Biraj!  Dr. Estelle Breines   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Incandescent Sent: Tuesday, October 08, 2002 12:52 AM To: [EMAIL PROTECTED] Subject: Re: Ron is driving me CRAZY   Ron, I think it might be helpful if you were able to move from the specific to the abstract, as easily as you dwell in the abstract idea of occupation.  There is a lot of documented evidence which is indicative that ADLs are subsumed within the idea of occupation.  To name two such sources: 1. The annotated bibliography titled, "Theoretical Basis of Occupational Therapy" by McColl, Law & Stewart (1993) SLACK: It states on page 4, "Occupation comprises the three areas of self-care, productivity and leisure (or Activities of Daily Living [ADL], work and play), undertaken in a balance that is consistent with health and satisfying to the individual". 2. The CAOT text "Enabling Occupation: An Occupational Therapy Perspective" (1997): It states on page 34, "Occupation refers to groups of activities and tasks of everyday life, named, organized and given value and meaning by individuals and a culture.  Occupation is everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities (productivity)". Personally I think your getting overly focused on the issue of UE being an OT domain, has led you to ignore the integral relationship between performance components and occupation.  They are not mutually exclusive categories, unless the OT or OTA providing services is ignorant of the interrelationship between the two.  It boils down to a matter of perspective. Another issue that I take strong exception to, and which you constantly bring up is your ad nauseum focus on the notion of occupation.  I use the term ad nauseum advisedly, because I am no stranger to abstraction, and feel passionately about the idea of occupation.  However, occupation is ubiquitous, it exists in everything human beings do, whether it is what they want to do, are expected to do, required to do and enjoy doing.  This includes virtually every fragment of an activity that contributes to the overall idea of occupation, because the whole cannot exist without its parts.  For the sake of clarity I once again repeat that (in my opinion) only when an OT or OTA lacks the understanding or appreciation of how a particular activity is linked to a person's or client's occupation, only in that circumstance can one say that that particular activity is not occupationally relevant (even if in reality as far as the client is concerned it will continue to be relevant). Incidentally, I have said this before on this listserv and I will say it again, the concept of occupation, no matter how powerful and wide, it is perfectly appropriate for us OTs to have a full appreciation of it; but we need not stuff it down everyone's throats as an intellectual idea.  I believe as OTs it is incumbent on us to make the idea of occupation transparent to those whom we work with, and those whom we serve.  If we can relate to the occupational needs of our clients, they may not know our jargon and terminology, but they will know in a tangible way that we have enabled them to do what they want to do, need to do or are required to do.  It is this abilty to make our appreciation of a powerful idea like occupation transparent to our clients that will work wonders for us and our profession.  Not standing on a pulpit and touting terminology.  Occupation when made transparent, by those initiated into it, is a powerful idea and will always remain so.  But ironically it is a disservice to the profession which we claim to serve, if because we are lost in fragmented categories and terminology, we are unable to see how occupation is related to a client who has suffered from a CVA, or has functional limitations in her or his UE. This is my perspective of this discussion thread which keeps re-surfacing.  Hope it is in some way helpful, whether remotely or substantively.  I also hope this post will not be taken as a flame. Best, Biraj Khosla OT - Reg. (Ont.) Toronto, Canada   [EMAIL PROTECTED] wrote: In a message dated 10/07/2002 8:15:53 PM Central Daylight Time, [EMAIL PROTECTED] writes:     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