Hi Carmen, Well, the example isn't specific enough to provide that kind of detail, however with these very same patients I document specific skilled interventions. An example might be a patient with the immediate need to address limitations in self care independence due to hemiparesis and sensory/perceptual impairments associated with a CVA. Typically I read the OT eval and some of the more recent OT notes to get a sense of the patient's current treatment needs. Usually these notes go something like this: 1) A list of UE exercises, 2) Possibly reports weight bearing on the affected UE, 3) Reports self care tasks and the assist level required to perform. The last one bears a more specific example: It generally will read: Patient performed upper body dressing with whatever assist and lower body dressing with this and that piece of adaptive equipment and whatever asset, etc. This is not skilled intervention! An aide can perform rote exercises, let a person weight bear on their UE and perform self care tasks. If I were to do exercise with a patient, I would document the reason why I had to be their for them to successfully complete the exercise. Did they require verbal/tactile/proprioceptive/kinesthetic cues to limit substitution patterns that would preclude the development of strength in the targeted musculature? If I were trying to facilitate normalization of tone or movement patterns in a hemiparetic extremity, I would surely do more than just have them weight bear on the extremity. I would then document those intervention (i.e. reflex inhibitory positioning, rhythmic stabilization, rhythmic rotation, deep tendinous pressure, etc, etc. If I were to do self care tasks with a patient, I would document what intervention I was providing to improve the patient's ability to complete the task. Examples of this: Instructing on compensatory techniques, the prior mentioned techniques for tone normalization and proximal stabilization, mass practice of graded activity in example task analysis followed by segmental instruction and practice of portions of the task (like backward chaining), etc. Jimmie
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Carmen Aguirre Sent: Wednesday, April 13, 2005 9:40 PM To: [email protected] Subject: Re: [OTlist] One D/C planner's Understanding of OT Hello Jimmie, How would you write the note from the example you gave, to reflect skilled OT intervention? Thanks, Carmen ----- Original Message ----- From: Jimmie Arceneaux<mailto:[EMAIL PROTECTED]> To: [email protected]<mailto:[email protected]> Sent: Wednesday, April 13, 2005 7:02 AM Subject: RE: [OTlist] One D/C planner's Understanding of OT Hello Ron, Well, as I've said before, OTs (in general, not referring to any specific individual) are to blame for this. Corporate entities for years have tried to pigeon hole OT into the UE thing, so that they can easily market the "difference" between OT and PT and to, in their minds, provide differentiation of service. The problem is that the OT profession, at least in this country, has been too willing to comply. There are many OTs who during a typical workday practice in a matter that perpetuates the above myth. Other professionals, consumers and casual observers can't help but come up with the conclusion that OTs are upper extremity therapists if all they ever see is OTs performing UE exercise. It is shameful, from what I hear, that some OT schools also perpetuate this (i.e. providing education only on UE anatomy, discussing only UE orthopedics, etc). I can remember from my own college experience, although I received the same anatomy, physiology, orthopedics and neuroanatomy classes as the PTs of the same year; that especially two teachers preached an UE agenda. It was consistent with the last statement that both of those teacher were CHTs. I have heard many an OT explain OT to non OTs as we work on the UE, fine motor, ADL. The same thing goes with the myth about OTs being the ADL therapists. I do prn weekend coverage at a hospital and I can't tell you how many times I have been presented with nurses who ask me questions like, "so your going to get everyone bathed today" or proposing that it is my job to get everyone cleaned, dressed and out of bed. I must add that the notes from OT during the weekdays report UE exercise and ADL tasks at relative assist levels. For one, UE exercise and performance of an ADL with a patient isn't OT. Secondly, it doesn't sound like a skilled intervention to me. An example, if one writes that they performed UE AROM exercises in all planes (lets not even go into the all planes thing) and the patient performed supine to sit with moderate assist, dressing with maximum assist and so on. What skill is evident in that documentation.....The answer is none. Is it any wonder that a nurse reading or viewing this may tend to view an OT as sort of on the line of a nursing aide? Is it likewise any wonder that OTs aren't a qualifying service in home health care when the same nurses are the driving force behind home health care and its policy/regul;ation. Jimmie -----Original Message----- From: [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> [mailto:[EMAIL PROTECTED] Behalf Of Ron Carson Sent: Tuesday, April 12, 2005 4:55 PM To: [email protected]<mailto:[email protected]> Subject: [OTlist] One D/C planner's Understanding of OT I was doing some marketing to a SNF d/c planner today. I was telling her that the hardest "sell" is OT. In other words, it's very difficult trying to get people to understand OT and what is an appropriate OT referral. Well, she says that she knows what OT is .... upper extremity!!! Gotta' love it - well, not really!! Ron -- Unsubscribe? 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