Hi Ron Of course I agree with Elizabeth's suggestion that you look at cognition with the Allen Cognitive Levels. I guess this is the time to keep my promise to talk about that model. Your difficulty is that "she doesn't identify any occupational goals". With declining cognition one of the first effects is loss of the ability to predict the possible implications of one's actions. These are people who seem just fine - still remembering things - good communication - often pleasant and cooperative - still able to explain proverbs or perhaps a bit concrete. With a difficulty they look for obvious causes ie balance in the case of a fall and want to remediate it. They will know they don't want to fall again however they are likely to be unable or find it very difficult to speculate about the effect on their valued occupation(s) if they do fall (Allen Cognitive Level 5). Identifying an occupational goal is a very sophisticated cognitive activity - think how OT students struggle to develop that point of view. I think you would find these sites interesting http://www.allencogadvisor.com/ and http://www.ot-innovations.com/home.html. The new Allen Cognitive Network site will be up soon and I'll post it to the list as soon as it is available. Joan Riches
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Veronica Sent: Thursday, May 05, 2005 7:22 AM To: [email protected] Subject: Re:[OTlist] What to do? Hi Ron, Didn't mean to cause offence (if I did, apologies!). I did realise that you were seeing the lady from your email, but was wondering if PT was also involved to address purely mobility issues. And I agree that from a philosophical point of view it raises a can of worms! We so often see clients that have 'mobility' difficulties and their main goal is to 'walk'. They don't understand the other factors that need to be addressed at the same time. Similar factors affect the therapy input that we provide for kids (only there you also have the parents and teachers adding their concerns). With kids we end up asking: 'who is the client?' and 'who's goals do you treat?' is it the parent or the teacher who's goals take precedence, or do we listen to what the children say and focus on their desires... I could add my opinion (and the opinion of a number of other OT's that I've spoken to), where the child is our primary client and the one who's wishes should be considered. The problem arises when you have mom who wants little Johnny to write neatly and the teachers who want little Johnny to sit still in class and pay attention. All legitimate concerns but not something that particularly bothers little Johnny and not something that he is particularly keen on or motivated to do!!! Veronica PS in answer to the question 'should you be seeing her' my answer is: what would happen if you DIDN'T see her? Ron Carson <[EMAIL PROTECTED]> 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 --------------------------------- How much free photo storage do you get? Store your holiday snaps for FREE with Yahoo! Photos. Get Yahoo! Photos -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED]
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