Hello Mike:
Thanks for writing!!
What is is your 'particular field of OT'?
The whole notion of remediation of cognitive deficits is something that I
have struggled with for a long time. When I worked in rehab, OT's and SLP's
were always trying to remediate cog. deficits secondary to stroke, Alz.,
Parkinson's Disease, etc. I don't ever remember one time where I felt that I
nor any other therapist made a significant difference in improving someone's
cognition.
That's not to say that patients' cognition didn't improve while in rehab. I
was just always under the assumption that most, if not all, of this
improvement was due to the body's own natural healing properties or drugs.
This belief is reinforced by Claudia Allen:
Changes in cognitive level are observed in acute conditions. (These
changes are not explained by the patients's experiences in [OT]...
(and) have alternative explanations... the effectiveness of
psychotropic drugs, the natural healing process, and the natural
course of the disease
Source: Bruce & Borg. Psychosocial Frames of Reference, 3rd
Ed. P. 246
Ron
=================================================
Wednesday, December 3, 2003, 3:26:12 AM, you wrote:
M> True but I meant specifically that my particular field of OT has more
M> to offer those with physical dysfunction than those with cognitive
M> dysfunction. I wasn't talking about OT generally, just my own
M> particular service.
M> On Wednesday, Dec 3, 2003, at 03:09 Europe/London, Shona Paterson wrote:
>> I disagree that we can offer more to client's with physical problems
>> than
>> cognitive. As a neuro OT I work primarily with cognitive and perceptual
>> problems. As an OT working with Older people I worked with many
>> parkinson's
>> clients with a recent diagnosis who exhibited mild cognitive
>> impairment.
>> Perhaps in the USA it is different?
>>
>>> -----Original Message-----
>>> From: Mike [SMTP:[EMAIL PROTECTED]
>>> Sent: Wednesday, 3 December 2003 13:33
>>> To: [EMAIL PROTECTED]
>>> Subject: Re: [OTnow] Differences in Alzheimer's and Parkinson's
>>>
>>> In my experience, the differences are enormous (a necessary
>>> generalisation). Cognition is an early and significant problem in
>>> Alzheimer's while physical difficulties usually present later. People
>>> with Parkinson's usually present to us fairly early with problems in
>>> performing certain ADLs and we usually get to know them long before
>>> any
>>> cognitive difficulties manifest themselves significantly. We mostly
>>> treat difficulties resultant from physical disability rather than
>>> cognitive disability. We have few PD clients with significant
>>> cognitive
>>> difficulty or Lewy body dementia but that may be because our
>>> particular
>>> OT role has less to offer those with dementia than it does those with
>>> problems that are more physical in their origin, so that if cognitive
>>> difficulties become the primary problem the client is more likely to
>>> be
>>> helped by the social work (care management) team than by us.
>>>
>>> Having said that, I do often find that people with PD often don't use
>>> complex pieces of equipment like mattress variators and bath lifts,
>>> but, strangely, it seems that although they are able to show that they
>>> know how to use them, they just don't -- it's not at all
>>> straight-forward and can be difficult to get a handle on.
>>>
>>> I would like to think that we don't vary our treatment approach based
>>> solely on the disease but on our understanding of the problems and
>>> strengths of each individual -- though we do obviously have to
>>> consider
>>> the likely impact of cognitive loss on the person's ability to use
>>> equipment, adaptations or new techniques if it is a part of their
>>> diagnosis. For instance, there would be a need for a thorough risk
>>> assessment if considering the recommendation of a stair lift for
>>> someone with either Alzheimer's or Lewy body dementia, even if it's in
>>> its early stages. We would probably need to be sure that a carer will
>>> always be on hand to assist with its safe use or ensure that the case
>>> would be reviewed regularly to ensure the person remains able to use
>>> the equipment.
>>>
>>> For what it's worth, it seems to me that in advanced cases of any
>>> dementia it is difficult to disentangle the cognitive component of the
>>> problem from the movement disorder aspect. Don't the two almost always
>>> coexist?
>>>
>>> Bear in mind that the above comments come from a setting where we
>>> mostly remediate occupational dysfunction using equipment, home
>>> adaptations or task modification. People with Alzheimer's rarely
>>> present to us until fairly late, when difficulties in transfers or
>>> moving and handling issues emerge because whilst there's a role for
>>> OT,
>>> there's not much of a role for OT as it manifests itself in my
>>> particular service setting and this is largely due to the fact that
>>> our
>>> treatment modalities require the person to be able to understand their
>>> use and learn new techniques, though adaptations like stair rails and
>>> toilet frames present themselves fairly intuitively to people with
>>> cognitive dysfunction.
>>>
>>> Cheers,
>>> Mike (London, UK)
>>>
>>> On Tuesday, Dec 2, 2003, at 11:59 Europe/London, Ron Carson wrote:
>>>
>>>> Hello:
>>>>
>>>> What differences if any do you all see in the way that Alzheimer's
>>>> versus
>>>> Parkinson's diseases manifest themselves in your clients?
>>>>
>>>> Are your treatment approaches different based solely on the disease?
>>>>
>>>> Thanks,
>>>>
>>>> Ron
>>>>
>>>>
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