Hello Mike: The International flavor is one of the things I like best about this list. Messages such as yours have really helped improve my understanding of how OT is practiced in different parts of the world.
Thanks, Ron ======================================================= On Wednesday, December 3, 2003, @ 6:06 PM, you wrote: M> My particular field of OT: I work with a local authority (local M> government -- not sure of the US equivalent) social services department M> in London, so we deal with mostly non-acute physical disability-related M> problems, adults and elders. If there are problems with performing a M> particular ADL, anyone can get referred to us and we look at how we can M> remediate it. M> The majority of our referrals are for problems with getting in and out M> of the bath, toileting, eating, cooking, dressing, sensory impairment, M> moving and handling, etc. Hospital OTs deal with clients who are in M> hospital for medical reasons but if a person is at home with no M> hospitalisation necessary, perhaps with a degenerative condition, the M> referral will usually come to us. Our particular speciality is major M> home adaptations and we install stair lifts, level access showers, M> platform lifts, etc. It's quite good fun and being able to do scale M> drawings and read architects' plans is a definite asset. It's M> definitely proper OT, as our concern is always remediating occupational M> dysfunction, but we don't really do proper rehab in the sense of using M> occupation as a treatment modality, I suppose. There are also community M> rehab teams from the National Health Service who see the clients who M> are more in need of rehab rather than remediation. M> So, mostly, we visit someone in their home, do an assessment of all M> their ADLS, maybe order some equipment or adaptations or show them how M> to do something in a different, more manageable way. When the equipment M> has arrived or the adaptation done, we go in and do a check visit, M> close the case if the problem has been sorted or prescribe something M> different if the first attempt has failed. Some clients we'll only see M> twice, and close in a month. Others require regular input and stay on M> the caseload for years. M> It suits me. Central London has a high population density, particularly M> in my area, so none of my clients are more than 15 minutes walk away. M> Added to that, it takes me only 5 minutes to cycle home, which in M> London is sheer luxury as many people face an hour and a half journey M> each way. I guess I won't be changing jobs anytime soon, then. M> I'm not aware of any effective means of treating cognitive deficits per M> se, but we can use all sort of aides memoire to cope with the M> deficiency and increasing numbers of smart gadgets to compensate. M> Cheers, M> Mike M> 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] >> =============================================== >> 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] ===============================================
