>From my previous post: "However, the very word "occupational" added to therapy, should enable us and the public to view it as interventions to facilitate any and all activities/ functions done to "occupate" one-self *appropriately* in selfcare, work, play or leisure....."
Hi Ron: I agree not everything is occupation (some could be 'incubation' or 'dissipation!), hence, I was careful to use the word "appropriately" before the occupational tasks as selfcare, work, play or leisure... Considering your example of PT students being trained more on pelvis and below versus OTs on upper extremities (with the cervical and trunk being the common ground/ common discard); if I remember my myology correctly, out of the 620+ muscles in our body, the upper accounted more than the lower extremities.....again, would that mean OTs have more knowledge on the physical dysfunctions. Just kidding :-) My true belief is that PTs and OTs are equally trained or should be on physical dysfunctions which doesn't only involve the biomechanical aspects involving strength and ROM, but also sensori-motor functions, edema/ skin integrity, coordination/ balance, reflexes, etc- etc. (all physical/ physiological aspects of functioning). Though equally trained, you would see certain OTs better in these areas when it comes to practice and vice-versa. The clinicians develop skills individually during and after training. In my disability evaluations for the State, I perform tests to identify spinal impingements such as SLR, Laseuge's, Bowstring's etc., also I do muscle/ ROM for the whole body. I strongly believe that is required to understand the underlying functional deficits, whether some body is faking 'disability', and what is the impact of the functional loss. I was personally taught all my basic sciences- anatomy, physiology, biomechanics/ kinesiology, medicine, surgery, pathology, microbiology, biochemistry, psychiatry/ abnormal psychology, orthopedics, neurology, PMR, communication disorders, OB/ GYN, etc. etc. sitting alongside the PTs throughout my curriculum, and all my teachers were medical doctors for the medical subjects, all with post graduate degrees. All my coursework/ examinations were absolutely the same as the PTs in my class. My OT classes involved muscle testing/ arthrometric testing of the lower extremity/ trunks as well, as PTs had the uppers. I was a little taken aback by the division of the body in the U.S., the at times overzealous use of PAMs by both PTs and OTs, the OTs that became ADL or kitchen queens or, super handymen, and, the PTs ability to do it all including recommending AEs, after I migrated here. I really would like to know what kind of "true" physical dysfunctions, would not cause an occupational limitation. By true, I do not mean mere loss of a few degrees of ROM, or a subjective 4 minus versus 4/5 muscle strength (because that is still WFL- Within Functional Limits, and the patient still is able to carry out his functions as needed. As clinicians, especially as OTs, we all know that 'normal' is a relative term. As OTs, PTs or what not, we probably have different techniques that we are more comfortable or better at- e.g., contrast bath, versus ultrasound for the hand... My personal knowledge to address a LBP would be to teach the patient proper body mechanics,/ avoid stressful positions, modify his/ her environment, ensure safe selfcare/ work/ play techniques; while a PT might perform interferential treatments or soft-tissue manipulations (the great word for "massage") and a DC provide spinal manipulations (per practice acts, the only ones in the US allowed to do it, besides the DOs and MDs). What individual approach works and provides/ facilitates 'meaning' is certainly dependent upon the individual ( hey, a new saying , "...the bearer knows where the back glitches" !). Or may be, all the treatment approaches is required at the same time. Academicians- are there any outcome studies based upon disciplines intervening or even on individual treatment approaches used by different professions, including placebo studies- how do you do a placebo spinal manipulation, or a placebo intereferential? How do you 'place- a- boo' with body-mechanics education? I hope you are getting my drift. My view: if there is a true 'dysfunction', it will transcribed into an occupational deprivement or limitation, OT would be indicated. What OT approach/ modality is used should be based upon the 'clinical judgement' of the clinician concerned. Obviously, although I know OTs performing driver rehab, I am not trained/ comfortable in it. Hence, ethically if I do get a referral it would go to another OT. Similarly, although I know that OTs may do incontinence therapy, since I have no interest/ skills in it, I will refer it to my PT who is specially trained in it. To make an already long story, longer- although, I feel OT would be indicated in almost all physical dysfunction cases; I do not always think everybody is capable to handle everything (based upon individual comfort and knowledge).....that is why, we have specialists within our own discipline and outside of ours and, clients most often need the services of more than one discipline simultaneously. Hence, "we treat the whole person, just don't do the whole treatment".... Just my thoughts! ----- Original Message ----- From: "Ron Carson" <[EMAIL PROTECTED]> To: "Joe Wells" <[EMAIL PROTECTED]> Sent: Thursday, August 07, 2003 8:49 PM Subject: Re: [OTlist] what is OT? > Hello Joe: > > I imagine that the number of PT's billing under self-care and community > re-entry is very small. But maybe you are correct. > > Everything done to occupy ourselves is not occupation. Much of what we > do during our days/nights is not significant or personally meaningful. > > I whole-heartedly disagree that OT's are equally trained to handle > physical dysfunction. I how for a fact, that PT students at the > University that I previously taught at received much more advanced > training in physical dysfunction. I may be wrong, but I bet that the OT > and PT students on this list will confirm my statement. Also, OT's at my > previous place of employment are primarily trained in the upper > extremity, not the pelvis, spine or lower extremity. So, in my > experience, OT's are less trained in physical dysfunction than PT's and > especially in LE's. Which lends further stamina to my disagreeing with > Estelle B. about OT's treating the whole body. > > Ron > > As for mock cases I can pretty much tell you how I will treat. > > 1. Use the OPPM (occupational perfomance process model) to guide > intervention, outcomes and treatment > > 2. Use the COPM as my outcome measure. > > 3. Accordingly, if the client doesn't have occupational issues, send > them to someone else. > > Ron > > ============================================= > > On 8/7/2003,[EMAIL PROTECTED] wrote: > > JW> I believe that the use of the word 'function' in the realms of PT is > JW> strictly related to physical/ physiological functioning. PTs use CPT > JW> codes 97535, 97537 for their clients as well, as they do address > JW> self care needs or community/ work integration needs with activities > JW> such as, donning/ doffing a BK prosthesis, or wheelchair mobility at > JW> work/ mall, etc.. > > JW> However, the very word "occupational" added to therapy, should > JW> enable us and the public to view it as interventions to facilitate > JW> any and all activities/ functions done to "occupate" one-self > JW> appropriately in selfcare, work, play or leisure.....this includes > JW> not only physical functioning, but mental and emotional functioning > JW> as well, to live life wholly. I do not believe that OTs are any less > JW> trained to handle the physical dysfunctions than any other > JW> professionals. OTs are equipped with the skills and, must look > JW> further than the physical aspects of dysfunctions that lead to > JW> occupational limitations/ deprivation. By sheer census, most OTs > JW> today work with physical dysfunctions versus psychiatry or > JW> developmental disorders. To address the "occupational dysfunctions" > JW> due to physical causes, one has to address those as well. > > JW> I am with Jimmie and Lori and agree that modalities/ tools of any > JW> kind- exercise, PAMS, splinting, AE should be encompassed to > JW> facilitate the client to function in an "occcupationally > JW> independent" and safe environment. Modalities/ tools are just > JW> that...they cannot be the sole treatment by themselves. > > JW> Ron et al: maybe we can discuss mock cases and then put forward our > JW> arguments as why or why not OT is needed and how to diffferentiate > JW> between an OT and an UE PT? ( How come LE OTs do not exist?) > > JW> ----- Original Message ----- From: "Jimmie Arcenaux" > JW> <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: > JW> Thursday, August 07, 2003 1:56 PM Subject: RE: [OTlist] what is OT? > > >> Lori, I too use modalities infrequently (approximately less than 10% > >> of my patients), but feel the use of modalities can be incorporated > >> into OT practice. In fact, at my work site I am in the process of > >> training our PT staff to properly utilize therapeutic modalities. We > >> have had a > JW> reoccurring > >> problem with patient's requesting early d/c from therapy secondary to pain > >> complaints. Under further review I noted that the PTs and OTs were not > >> addressing the pain prior to attempting tasks which would undoubtedly > >> increase the severity of pain complaints. I am addressing this with pain > >> management instruction which includes the use of modalities, relaxation > >> training, energy conservation, work simplification, joint protection, > >> posture, and body mechanics. > >> Jimmie > >> -----Original Message----- > >> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] > >> Sent: Thursday, August 07, 2003 11:21 AM > >> To: [EMAIL PROTECTED] > >> Subject: Re: [OTlist] what is OT? > > >> Dear Jimmie- I told you this was an issue in the past. Now, you see > >> what I mean. I > JW> say > >> we are trained in school and licensed in our states to do it, then it is > JW> OT. > >> AOTA approves, NBCOT approves, states approve(of course some require > >> additional training). So, it is OT!!!! > >> Lori > > >> In a message dated 8/7/2003 8:07:29 AM Eastern Daylight Time, > >> [EMAIL PROTECTED] writes: > > >> > I really struggle with OT's using thermoelectric modalities. > > >> > Please understand that I have used e-stim, tens, hot/cold, etc as > >> part > of my treatment plans. And as you say, all of these were > >> intended to > improve function. Of course, the PT's doing similar > > >> treatments also > said that they were trying to improve function. > > >> *****************************��********************************** > > >> To remove yourself from the OTnow mail list, 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] > > >> *****************************��*********************************** > > >> *****************************��********************************** > > >> To remove yourself from the OTnow mail list, 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] > > >> *****************************��*********************************** > > JW> *****************************��********************************** > > JW> To remove yourself from the OTnow mail list, send a message to: > > JW> [EMAIL PROTECTED] > > JW> In the message's *body*, put the following text: > > JW> unsubscribe OTlist > > JW> - > > JW> List messages are archived at: > > JW> http://www.mail-archive.com/[EMAIL PROTECTED] > > JW> *****************************��*********************************** > > > *****************************��********************************** > > To remove yourself from the OTnow mail list, 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] > > *****************************��*********************************** > *****************************��********************************** To remove yourself from the OTnow mail list, 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] *****************************��***********************************
