Hi Ron,
Of course you should be seeing her. If there is an occupational deficit, which there is, it doesn't matter who identifies it. On the contrary, you are the professional, you should help her to identify it. You are the occupational expert, so of course there will be times you see the deficit even when the patient doesn't.
Caryn
Ron Carson wrote:
Hello Veronica:
I am seeing the patient! However, I am struggling to understand if I should be seeing the patient because she doesn't identify any occupational goals. I used to tell students, if there no occupational goals identified, then there's no role for OT. The goals with the client are mobility related like: "Client will safely ambulate to bathroom using appropriate mobility aid". I am comfortable with the goal IF the client identified the deficit. But she didn't, I did! I know that in some cases, clients are cognitively unable to identify goals, but such is not the case with this client.
What I am asking is more of a philosophical rather than practical question. Of course, the client needs therapy and of course, OT can treat the client but based on our treatment philosophy of being client-centered and addressing occupation, my question is SHOULD I be seeing her?
Ron
===========> Original Message Follows ....
On5/5/2005, Veronica, <[EMAIL PROTECTED]> said:
V> That's a tough one! Are there any other professionals involved?
V> Can her balance difficulties be addressed by someone else? She can't
V> be left like that! some education is required re falls prevention!
V> Are there any falls groups that she can join? Maybe it's an
V> educational thing where she doesn't understand the relevance of OT to
V> her situation and a falls prevention group may help educate her about
V> how OT can help. Anyway, if she is not identifying any Occupational
V> dysfunction areas as something that needs to be addressed OT cannot
V> really be justified at present (or that's my opinion anyway), maybe
V> she needs a bit of time to see what areas she is struggling with.
V> A useful tool that I was recently shown (to use in Paeds but I
V> think it is applicable accross the board) involves the client writing
V> up a log of activities that they do daily. From getting up in the
V> morning, brushing their teeth, walking to the bathroom, etc. and then
V> using that with the COPM to identify degrees of satisfaction with
V> tasks. It helped the client understand what was ment by OP tasks. V> In addition there is a standardized assessment (for Paeds not adult
V> services - don't know if there's anything similar for adult services)
V> called the PACS (Paediatric Activity Card Sort) that uses photos to
V> help the child to identify what activities are more challenging.
V> Hope this helps! V> Veronica
V> Ron Carson <[EMAIL PROTECTED]> wrote: V> If we see a client that has physical dysfunction but *they* do not V> identify occupational dysfunction, is there a role for OT? Case in V> point:
V> A client has a recent fall history. During the eval, the client scores V> very low on the Berg Balance test (indicative of increased fall risk). V> However, the client reports no difficulty using ambulating in her room V> or going to the dining room in her ALF. In other words, despite her V> fall, she does not readily feel she had difficulty with mobility related V> occupations.
V> Now, I could probably pry it out of her that she has difficulty with V> going to/from the bathroom because she in fact fell coming back from the V> bathroom. But the *client* only sees that balance is her problem, not V> the balance-related activity.
V> So, what to do? The client doesn't see occupation as the problem, she V> sees balance as the problem.
V> Maybe I have analysis paralysis!!
V> Ron
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