Hi Mike, I guess this just highlights the diversity of what we can do. At the end of the day we are all striving to improve a person's functional independence. Whether that be through equipment, rehab or a combination.
Shona > -----Original Message----- > From: Mike [SMTP:[EMAIL PROTECTED] > Sent: Thursday, 4 December 2003 12:06 > To: [EMAIL PROTECTED] > Subject: Re: Re[2]: [OTnow] Differences in Alzheimer's and > Parkinson's > > My particular field of OT: I work with a local authority (local > government -- not sure of the US equivalent) social services department > in London, so we deal with mostly non-acute physical disability-related > problems, adults and elders. If there are problems with performing a > particular ADL, anyone can get referred to us and we look at how we can > remediate it. > > The majority of our referrals are for problems with getting in and out > of the bath, toileting, eating, cooking, dressing, sensory impairment, > moving and handling, etc. Hospital OTs deal with clients who are in > hospital for medical reasons but if a person is at home with no > hospitalisation necessary, perhaps with a degenerative condition, the > referral will usually come to us. Our particular speciality is major > home adaptations and we install stair lifts, level access showers, > platform lifts, etc. It's quite good fun and being able to do scale > drawings and read architects' plans is a definite asset. It's > definitely proper OT, as our concern is always remediating occupational > dysfunction, but we don't really do proper rehab in the sense of using > occupation as a treatment modality, I suppose. There are also community > rehab teams from the National Health Service who see the clients who > are more in need of rehab rather than remediation. > > So, mostly, we visit someone in their home, do an assessment of all > their ADLS, maybe order some equipment or adaptations or show them how > to do something in a different, more manageable way. When the equipment > has arrived or the adaptation done, we go in and do a check visit, > close the case if the problem has been sorted or prescribe something > different if the first attempt has failed. Some clients we'll only see > twice, and close in a month. Others require regular input and stay on > the caseload for years. > > It suits me. Central London has a high population density, particularly > in my area, so none of my clients are more than 15 minutes walk away. > Added to that, it takes me only 5 minutes to cycle home, which in > London is sheer luxury as many people face an hour and a half journey > each way. I guess I won't be changing jobs anytime soon, then. > > I'm not aware of any effective means of treating cognitive deficits per > se, but we can use all sort of aides memoire to cope with the > deficiency and increasing numbers of smart gadgets to compensate. > > Cheers, > Mike > > > > On Wednesday, Dec 3, 2003, at 13:59 Europe/London, Ron Carson wrote: > > > 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 > >>>>> > >>>>> > >>>>> _______________________________________________ > >>>>> To unsubscribe, visit: > >>>>> http://otnow.com/mailman/listinfo/otlist_otnow.com > >>>>> > >>>>> The OTnow Mail Archive: > >>>>> www.mail-archive.com/[EMAIL PROTECTED] > >>>>> =============================================== > >>>>> > >>>> > >>>> > >>>> _______________________________________________ > >>>> To unsubscribe, visit: > >>>> http://otnow.com/mailman/listinfo/otlist_otnow.com > >>>> > >>>> The OTnow Mail Archive: > >>>> www.mail-archive.com/[EMAIL PROTECTED] > >>>> =============================================== > >>> > >>> _______________________________________________ > >>> To unsubscribe, visit: > >>> http://otnow.com/mailman/listinfo/otlist_otnow.com > >>> > >>> The OTnow Mail Archive: > >>> www.mail-archive.com/[EMAIL PROTECTED] > >>> =============================================== > >>> > > > > > > M> _______________________________________________ > > M> To unsubscribe, visit: > > http://otnow.com/mailman/listinfo/otlist_otnow.com > > > > M> The OTnow Mail Archive: > > M> www.mail-archive.com/[EMAIL PROTECTED] > > M> =============================================== > > > > > > > > _______________________________________________ > > To unsubscribe, visit: > > http://otnow.com/mailman/listinfo/otlist_otnow.com > > > > The OTnow Mail Archive: > > www.mail-archive.com/[EMAIL PROTECTED] > > =============================================== > > > > > _______________________________________________ > To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com > > The OTnow Mail Archive: > www.mail-archive.com/[EMAIL PROTECTED] > =============================================== _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] ===============================================
