That's a tough one!  Are there any other professionals involved? Can her 
balance difficulties be addressed by someone else?  She can't be left like 
that!  some education is required re falls prevention! Are there any falls 
groups that she can join? Maybe it's an educational thing where she doesn't 
understand the relevance of OT to her situation and a falls prevention group 
may help educate her about how OT can help.  Anyway, if she is not identifying 
any Occupational dysfunction areas as something that needs to be addressed OT 
cannot really be justified at present (or that's my opinion anyway), maybe she 
needs a bit of time to see what areas she is struggling with.  
 
A useful tool that I was recently shown (to use in Paeds but I think it is 
applicable accross the board) involves the client writing up a log of 
activities that they do daily.  From getting up in the morning, brushing their 
teeth, walking to the bathroom, etc. and then using that with the COPM to 
identify degrees of satisfaction with tasks.  It helped the client understand 
what was ment by OP tasks.  In addition there is a standardized assessment (for 
Paeds not adult services - don't know if there's anything similar for adult 
services) called the PACS (Paediatric Activity Card Sort) that uses photos to 
help the child to identify what activities are more challenging.
 
Hope this helps!
Veronica

Ron Carson <[EMAIL PROTECTED]> wrote:
If we see a client that has physical dysfunction but *they* do not
identify occupational dysfunction, is there a role for OT? Case in
point:

A client has a recent fall history. During the eval, the client scores
very low on the Berg Balance test (indicative of increased fall risk).
However, the client reports no difficulty using ambulating in her room
or going to the dining room in her ALF. In other words, despite her
fall, she does not readily feel she had difficulty with mobility related
occupations.

Now, I could probably pry it out of her that she has difficulty with
going to/from the bathroom because she in fact fell coming back from the
bathroom. But the *client* only sees that balance is her problem, not
the balance-related activity.

So, what to do? The client doesn't see occupation as the problem, she
sees balance as the problem.

Maybe I have analysis paralysis!! 

Ron


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