Thank  you  Caryn  for  your insightful remarks!! You are a smart woman!

Happy Mother's Day!

Love,

Your Husband

===========> Original Message Follows ....

On5/5/2005, Caryn Carson, <[EMAIL PROTECTED]> said:

 
CC> Hi Ron,

CC> Of course you should be seeing her.  If there is an occupational 
CC> deficit, which there is, it doesn't matter who identifies it.  On the
CC> contrary, you are the professional, you should help her to identify it.
CC> You are the occupational expert, so of course there will be times you
CC> see the deficit even when the patient doesn't.

CC> Caryn

CC> 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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