Hi Ron: I am enjoying this discussion. Would like more folks to put down their perspectives/ what they are used to.
In your question, you stated "professional organizational perspective". Do you mean the professional organizations- AOTA and APTA, or the work place? If you were referring to AOTA and APTA- I guess both probably claim equal foothold. However, the difference of wordings state OTs domain in terms of function (ADL independence, while it is totally acceptable to work on the performance components), PTs use the word 'movement dysfunction'- I guess basing that synthesis of movement occurs through muscle strength, range, and coordination. The PT practice act allows ADL retraining. >From a work place standpoint, I will refer the case to an OT myself. ( Until tomorrow, I work as a rehab services director at a nursing home. After tomorrow, I join my own home health and therapy contract company of 1 year). I have always followed ( for simplicity of referrals mainly) where OTs got to treat all UE dysfunctions. My basis was that if UE performance (ROM, coordination, strength, sensation, tonicity) is impaired, it directly affects the clients ability to indulge in ADLs safely or independently. Thus, it is most appropriate for the OTs to see the clients. PTs (although their practice act allow) rarely indulge in ADL/ functional training beyond mobility needs- ambulation, transfers, stair negotiation. The 'typical' PT goal in a case such as elbow dysfunction would be to achieve elbow flexion to 130 degrees, and/ or extn. to 0 ( ofcourse, assuming no distal involvement/ nr. injury, etc.). They really would venture into ability to feed, dress, bathe, work on the computer, or look at adapting the work station or golf clubs, etc. This will only cause the use of another discipline to do that, while PTs can focus on the 'movement' alone. This global outlook of OT is what I believed in and marketed. In the last 3 years, I may have had to reclarify less than 5 orders by doctors that referred an UE case to a PT. If there are no functional limitations or safety concerns even though the elbow may have an extension lag of 10 degrees or cannot flex beyond 120, I am sure no insurance companies would like to cover it- whether it is PT or OT. Joe ----- Original Message ----- From: "Ron Carson" <[EMAIL PROTECTED]> To: "Joe Wells" <[EMAIL PROTECTED]> Sent: Monday, March 10, 2003 8:18 PM Subject: Re[4]: Fwd: Treatment for a Fractured Elbow > Hello Joe: > > Again, thanks for writing.... > > In your below message, in part, you state: > > JW> Without infringing or challenging any discipline's domain or scope > JW> of practice, we must arrive at a facility-specific policy. > > Will you provide comments about referrals to OT or PT from a domain or > scope of practice perspective? In other words, from professional > organizational persepective, which discipline is the best referral for a > fractured elbow. Why? > > Thanks, > > Ron Carson > > P.S. IF ANY OTHER READERS WANT TO JOIN IN ON THIS 'DISCUSSION', PLEASE > DO SO. THERE ARE MANY NEW SUBSCRIBERS TO THE LIST AND THEIR COMMENTS ARE > ENCOURAGED AND WELCOMED. > > ============================================= > > On 3/10/2003,[EMAIL PROTECTED] wrote: > > JW> Hi Ron: > > JW> Without infringing or challenging any discipline's domain or scope > JW> of practice, we must arrive at a facility-specific policy. This is > JW> needed to ensure easy understanding for the referral sources, and > JW> the clients themselves. > > JW> You can choose to state that XYZ Care Center's policy is: > > JW> 1. OTs treat UE dysfunction (since the upper extremity basically > JW> performs all functional tasks), while LE/ back dysfunctions are > JW> treated by PT (as they work on mobility). > > JW> 2. PTs work on muscle strength/ ROM/ pain/ balance, OT works on fine > JW> motor coordn and ADL functions/ adaptations/ compensation. > > JW> However, while these are policies basically to educate the referral > JW> systems, as an OT I strongly believe in the offerings of > JW> occupational therapy as a stand-alone rehabilitation discipline that > JW> can address a condition such as elbow fracture by itself. At the > JW> same time, I realize, the truth of the matter is the PTs were also > JW> trained to handle it appropriately. And, that is why it is muddy- PT > JW> and OT do not have real delineated roles. Since physical limitations > JW> result in functional loss/dysfunction, PTs claim the head of the > JW> problem (physical limitations) as their domain, while we claim the > JW> tail (the functional loss). Although, we are essentially talking the > JW> same body. > > JW> Taking another analogy: you have a choice between an allopath (the > JW> modern day M.D.) or a naturopath (a ND), or a D.O.. All claim they > JW> can treat a disease. Whom will you choose? I would choose based upon > JW> the person's reputation, and personal knowledge about the condition. > JW> Above all, as a consumer who I feel comfortable to go. Will the > JW> public choose the MD because of the market recognition of the degree > JW> as compared to the other medical degrees? Will the public choose the > JW> OT for the elbow? > > > > JW> ----- Original Message ----- > JW> From: "Ron Carson" <[EMAIL PROTECTED]> > JW> To: "Joe Wells" <[EMAIL PROTECTED]> > JW> Sent: Friday, March 07, 2003 2:17 AM > JW> Subject: Re[2]: Fwd: Treatment for a Fractured Elbow > > > >> Hello Joe: > >> > >> I appreciate your answer. However, in some ways you have muddied my > >> thinking because what I am trying to understand is this; what is the > >> dilenation, if any, when someone should be referred to OT or PT. In > >> some facilities this is done by upper extremity versus lower extremity. > >> > >> Thanks, > >> > >> Ron > >> > >> ============================================= > >> > >> On 3/7/2003,[EMAIL PROTECTED] wrote: > >> > >> JW> Ron: > >> > >> JW> Hopefully, the doctor's verdict is not final- it is not that > >> JW> unusual for it to change. What is the extent/ nature of your > >> JW> injury? > >> > >> JW> I agree with Maria. The practitioner should be confident/ > >> JW> knowledgable in his area of practice. I don't believe in segregation > >> JW> of body parts or roles for physical and occupational therapy. > >> JW> Following-up from my last mailing, I would find it hard to > >> JW> comprehend an occupational therapist who says he is working on > >> JW> function, and not working directly or indirectly with its > >> JW> performanace components such as ROM/ ms. strength/ endurance (good > >> JW> buzz: activity tolerance), i.e, using the biomechanical FOR in > >> JW> orthopedic cases such as this. Hopefully not, otherwise any > >> JW> functional approach without keeping the biomechanical/ > >> JW> kinesiological aspects in mind, could be detrimental. Or, find me a > >> JW> PT that is applying the biomechanical FOR but is in no way > >> JW> facilitating the "functional independence" of his patient. However, > >> JW> I am an OT myself, and believe in the global impact and range of > >> JW> services we offer. Especially, when you expect residual deficits, I > >> JW> believe the OT takes on a more crusading role as the > >> JW> adaptor/facilitator, teaching or ensuring optimal > >> JW> adaptations/compensation to minimize the disability to the best it > >> JW> can be. Can a PT do it, too? I am sure we all know of some PTs that > >> JW> could do it better than some OTs, and some OTs that can do a better > >> JW> job in gait analysis and training than some PTs. For those OTs AND > >> JW> PTs that are ready to mark their boundaries, isn't ambulation a part > >> JW> of basic ADLs? Both APTA's and AOTA's practice guidelines claim and > >> JW> cover this as their domain. > >> > >> JW> Am I proposing a merger of titles of physical/occupational > >> JW> therapist? No as there are certainly other aspects to this, we are > >> JW> not prepared or trained for this yet, at least not yet. What would > >> JW> insurance companies think of this? What impact will it have on > >> JW> medicare dollars? What will our associations do even at the thought > >> JW> (it sure as occured to others)- laugh? Ron you are an enlightened > >> JW> health professional. What do you think the doctor, or the general > >> JW> public would do in your case- who should they choose? With out > >> JW> really knowing the difference or with out there being a real > >> JW> difference of professional expertise (just the difference of > >> JW> individual practitioner's expertise)? > >> > >> JW> Joe > >> > >> > >> > >> > >> > >> JW> ----- Original Message ----- > >> JW> From: Maria Aguilera > >> JW> To: [EMAIL PROTECTED] > >> JW> Sent: Sunday, March 02, 2003 1:00 PM > >> JW> Subject: Re: Fwd: Treatment for a Fractured Elbow > >> > >> > >> JW> Hi Ron: > >> > >> JW> Hope your elbow is recovering nicely. I am a OTR who injuried her > JW> dominant elbow (non work related)many years back while practicing in Upper > JW> extremity/Hand Rehabilitation. I felt pretty > >> JW> comfortable self treating until I realized that I needed further > JW> intervention ie,MRI and a clinician who was experienced with my specific > JW> injury(Tricep tear). It was interferring with the > >> JW> quality of my clients' care. I looked in my area and located a PT who > JW> was very instrumental in my successful outcome. I think it is dependent on > JW> your comfort level and knowing when to seek > >> JW> assistance. I feel it does not matter PT vs. OT if the clinician is > JW> working within their knowledge and practice base. Hope this helps. > JW> Maria > >> > >> JW> Ron Carson <[EMAIL PROTECTED]> wrote: > >> > >> JW> Hello Biraj and others: > >> > >> JW> My original question about seeing an OT or PT is really more of a > >> JW> hypothetical question. While I really did fracture my elbow, it is > >> JW> doubtful that I will need any therapy. The reason I was asking the > >> JW> question was to hear readers opinions on when and why to refer to > JW> OT > >> JW> versus PT. > >> > >> JW> Thanks, > >> > >> JW> Ron > >> > >> JW> ************************************************* > >> > >> JW> On 3/2/2003,you wrote: > >> > >> JW> RC> Sorry to hear about your elbow Ron. Hope you feel better soon. > >> > >> JW> RC> As for seeing an OT or PT, won't this depend upon whom you are > JW> referred to > >> JW> RC> by your Orthopedic Specialist. As well as what will your > JW> insurance carrier > >> JW> RC> pay you for. > >> > >> JW> RC> Take care, > >> > >> JW> RC> Biraj > >> > >> JW> *********��*********** > >> > >> JW> Unsubscribe? 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