Hello Joe: Sorry for taking so long to write back!
I don't feel that a therapist can use both a mechanistic and occupational (i.e. holistic) approach. The two approaches are at opposite ends of the spectrum. Neither do I think that a therapist can selectively or randomly shift back in forth between the two approaches. I believe that a person must preselect how they view people and pathology. Another difference that I feel is in your statement is your comment that "PTs ... address occupation issues as much as us." I firmly believe that occupation is our unique domain. When I say unique, I mean unique. OT's that are trained in occupation have a tremendous asset to offer their clients and an asset that no other discipline can even begin to understand nor practice. Also, while I know of several OT's that exclude physical function from their treatment, I am not such a therapist, nor do I advocate such exclusion. Physical function is a contributor to successful occupation just as much as any other entity and if it is limiting occupation, then it should be addressed. However, I think that physical function is only ONE of many factors that affect occupation. Unfortunately, I feel that some OT's are too focused on the physical function at the expense of occupational function. To focus on physical function is PT (hence the name Physical therapy). To focus on occupational function is OT (hence the name Occupational therapy). Bear in mind that by definition, occupational function includes physical function but physical function does not include occupational function. Also Joe, physical function is not a necessary element for some types of occupation. There are many occupations that involve mental rather than physical function. If this were not true, then our clients with high-level quadriplegia would not have any occupations. And I am confident that Christopher Reeve's life is full of occupation, even though he has almost no physical function. Joe, you make a statement about the power of the occupation. From you perspective, what is that power? Thanks for the dialogue, I truly find it educational and inspiring! Ron =============================================================== On 8/31/2003,[EMAIL PROTECTED] wrote: JW> I agree Ron and I agree. That is why, I believe that as OTs we look and go JW> beyond the realms of physical dysfn., that's why I say we take the holistic JW> view. My only point is that we do look at the 'mechanistic' issue, too, and JW> often the underlying pathology creates the other issues such as the JW> associated mental/ emotional, resulting environmental barriers, etc., which JW> would have otherwise been an non-issue. Sometimes, taking care of those JW> 'mechanistic' issues helps to eliminate or mitigate the rest, and sometimes JW> they don't. My thoughts are when PTs use the powers of their practice acts, JW> take care of those physical issues, use 'seemingly' OT approaches, they too JW> address occupational issues as much as us......I do not agree, what I feel JW> some OTs are confusing with, that OT does not include or should not include JW> addressing the physical issues. JW> My own thoughts are that most OTs I have come across, do practice OT with JW> all the tools available to them- true occupations, activities, exercises, JW> PAMs, splints, AEs, etc. etc.. I have met very-very few OTs that are not JW> addressing the occupational needs (barring the quality of how a few document JW> such issues). To me, occupational performance sprites from activity JW> analysis, physical functioning being a part of it- usually the most visible JW> and objective part. Since, in the world arena, OTs are mainly involved in JW> the medical model/ with physical dysfunction issues, OTs should be in tune JW> to be a holistic practitioner in this arena versus taking a reductionistic JW> approach. I do not see the reason why a OT should wait for the UE strength/ JW> ROM to be increased by a PT before beginning dressing training or, why have JW> two disciplines working together in order to achieve the same 'occupational' JW> outcomes for OTs, and 'physical functioning' outcome for PT- the ability to JW> physically dress.The difference again is in semantics, theorized approach JW> and, underlying principle. I believe with no other complicating factors JW> viz. mental issues, emotional issues, etc., PTs and OTs are equally JW> qualified to address this issue, and both disciplines are not needed JW> simultaneously. JW> To me the issue is not that OTs are trying to be PTs, but that we do not JW> understand the power in the word 'occupation' that entails everything a JW> person should or wishes to do per societal or developmentally accepted JW> norms. JW> I believe OTs should not be further confused in the futile issue of what JW> modalities is whose, rather understand the underlying occupational needs JW> that need to taken care of by taking care of the pathology (impairment) if JW> it can be corrected, disability if that can be changed with 'different' JW> ability, and the accomodations required for the handicap..... JW> Ron, it seems you and I agree for the most part. My major contention is that JW> physical functioning is a very true and major part of occupational JW> functioning and, sometimes in cases of physical dysfunctions with no other JW> overtly mental/ emotional/ social dysfunction, may even become inseperable. JW> In such cases too, while OTs are addressing the physical functioning issues JW> directly, they are certainly addressing the occupational goals of their JW> clients (or should be), helping them to 'occupy' their lives in meaningful JW> activities in a pain free, effective, time-sensitive, aesthetic-deligent JW> world. JW> Sorry, just couldn't keep it short. JW> Joe JW> ----- Original Message ----- JW> From: "Ron Carson" <[EMAIL PROTECTED]> JW> To: "Joe Wells" <[EMAIL PROTECTED]> JW> Sent: Sunday, August 31, 2003 2:20 AM JW> Subject: Re[6]: [OTlist] PT does it all!! >> Hey Joe: >> >> For brevity, I've snipped your message. >> >> The below paragraph is sort of a mechanistic approach to therapy. This >> type of approach assumes that by fixing the person's "broken" pieces, >> the whole person will be restored. For example, if someone loses the >> ability to drive secondary to decreased balance, a mechanistic approach >> assumes that by resorting their balance, their ability to drive will >> also be restored. While for some cases, this approach may be true, for >> others it is just as likely to be false. >> >> Driving, like ALL occupations, is a complex phenomenon that includes >> physical, social, emotional, environmental and mental factors. >> Successful engagement in occupation is not dependent on any one factor >> but on the culmination of ALL the factors. A therapist that assumes a >> mechanistic approach may focus on only the most apparent factors, such >> as physical impairment, and thus may miss other factors that are >> preventing successful engagement in occupation. >> >> It is important to assess occupational dysfunction and then to directly >> document the dysfunction. If occupation is made the goal, then the >> therapist is much more likely to see the whole picture of occupational >> performance rather than seeing only the pieces that make up occupation. >> >> Ron >> >> >> ============================================= >> >> On 8/30/2003,[EMAIL PROTECTED] wrote: >> >> >> JW> Obviously, you realize on further interrogation one may ask- what's >> JW> the end result (goal) for increased tolerance, increased balance, >> JW> decreased pain, decreased stiffness- all would lead to the same >> JW> goal- increased occupational independence, whether or not that is >> JW> addressed directly on paper. >> >> >> *****************************��********************************** >> >> 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: Remove {insert the address that you wish removed} from the OTnow list - List messages are archived at: http://www.mail-archive.com/[EMAIL PROTECTED] *****************************��***********************************
