Re: Re[4]: [OTlist] Army OT/PT Descriptions

Tue, 12 Jul 2005 01:25:44 -0700 

"I  like  what  you've written in your second paragraph, however, I

don't  believe  it  stands  up  in the real-world perceived needs of the
majority  of  our patients/clients....."


Ron:


I believe, I agree with you in my first paragraph of my earlier e-mail. I 
was merely trying to jot down an essence/ the final titer of our work (the 
common thread) in my second paragraph. I agree with the AOTA framework that 
OTs may use occupation as the "means" (page 610, 1st column- last 
paragraph), but as also suggested by the framework on page 611 ("...no one 
aspect outline in the domain...is considered more important than 
another..."), I also do not believe that it is the ONLY MEANS to achieve the 
"end" which is "engagement in meaningful occupations" (page 610, 1st column- 
last paragraph and 2nd column- 1st paragraph). My last e-mail talks about my 
thoughts on 'meaningful'. It is beyond just an  articulation by a client, it 
can be present even without his/her input. It is thus, the expertise of the 
OTs to determine what is occupationally dysfunctional/ deprived or, 
maladapted. lf I may speculate the future, based upon the ICF model, OTs can 
emphasize on 'diagnosing'/ identifying the "activity" and "participation" 
aspects and to a lesser extent the "body functions" and "body structure" 
aspects, which will primarily be a more physician oriented area (WHO, 2002). 
The scope of OT and the framework clearly articulates that one may address 
the different aspects of reaching the "end" product and use tools (which I 
see as the other "means" also available to therapists) for health promotion, 
remediation/ restoration of lost/ diminished skills (muscle strength, ROM, 
tone, coordination, balance, etc.), maintenance of skills or prevention from 
disability (page 627 of the framework).



Most clients (as they should) look at the root cause of the problem example- 
weakness, stiffness, pain, etc.. I so agree with you that we should not just 
start with the "end" but start from the seed/ root cause and work upwards. I 
guess when my 40 year old client says they have shldr. movt. limitations 
and, my assessment confirms that and, I also realize that due to their 
physical limitation (an activity demand) they cannot dress. My goals 
includes 'remediation' by strengthening techniques, if I know that can be 
restored which in turn should address the dressing aspects as well (it will 
certainly be a goal as they have demonstrated an 'occupational dysfunction', 
and my intervention should address the transfer of learning). In this case, 
I would not make the patient just dress day after day (or worse still, go in 
and let him do 1/4th of the task in 3/4th of my time, and end up finishing 
it off for him/ her and, then rush off to do another "ADL" session) without 
addressing his underlying "activity demand"/ performance component. However, 
if my client has no remedial potential, my goals will then be one for 
compensation (and, not one that focuses on sitting around a circle working 
on bicep curls while the client has difficulty pushing up from his bed). I 
guess, we lose credibility because of this- we are neither able to portray 
ourselves as healthcare experts nor as sweet/ helping aides. In both the 
cases, "occupationally appropriate behavior" is important to me, per "the 
power vested on me as thy OT :-)" (just kidding),  my 40 year old client 
should be able to dress himself (per socio-culturally accepted norms), be 
pain free and move his joints (per biologically accepted norms), be able to 
complete his task in a "normal" time and "normal" pattern in a 'least' 
restrictive way- i.e., as gadget free as possible (per socially accepted 
norms). (I like gadgets too, but when restoration potential is not 
adequate). My thoughts are simple- we must practice holistically and accept 
and use all tools toward optimizing occupational performance. Each of us may 
have different skills (physical rehab, mental health, ergonomics) and may 
specialize on different phases of the life-span ( pediatrics, adolescence, 
geriatrics) but are "threaded" together through our expertise to address the 
external features of human functioning....optimizing occupational 
performance whether as toddler or as a retiree. Sorry, I enjoy this topic. 
Will shut-up now.

Joe Wells



----- Original Message ----- 
From: "Ron Carson" <[EMAIL PROTECTED]>

To: "Joe Wells" <[email protected]>
Sent: Monday, July 11, 2005 9:11 PM
Subject: Re[4]: [OTlist] Army OT/PT Descriptions



Hello Joe and others:

I hope readers enjoy these discussions!

Joe,  I  like  what  you've written in your second paragraph, however, I
don't  believe  it  stands  up  in the real-world perceived needs of the
majority  of  our patients/clients. What we have is a dichotomoy between
our  theory  and the perceived needs of clients and referral/pay sources
we serve.

Clients  seek  care/therapy  because they perceive or are told that they
have  a  problem.  They  seek  skilled  intervention to ameliorate their
problems. So, what are some typical perceived problems that our client's
have.  Well,  certainly  they have muscle weakness, paralysis, cognition
deficits,  reduced  ROM, decreased mobility, poor eyesight, shortness of
breath,  decreased  endurance,  etc.  This list can go on for ever but I
think you get my point.

What  is noticeably missing from the above list are the things that OT's
will  often  theorize about. Things like occupation, activity, dressing,
grooming, self-care, productivity, etc.

So  what we have is some gobble-gook theory (please don't misunderstand,
I LOVE theory and have written several theory courses) that just doesn't
mesh  with  the perceived needs of our clients. I mean, how many clients
think  that  they  have  problems  with  "the external features of human
functioning,  i.e.,  the  physical/  emotional-  mental/ socio-cultural/
spiritual aspects of living as an "occupational" being"

In  all the patients that I have treated over 8 years, I bet I can count
on  one  hand  the number of patients saying their *primary* concern was
one  of  the  things  that OT theory talks about. Now, I know that we do
treat  the basics in order to address the loftier goals, but much of our
rhetoric  is  not  about  the basics but about the loftier goals. Again,
this  is  the  dichotomy of OT - we say one thing but do another. Why is
that?

Well,  the  reality  is that most practicing OT understand that clients
and  payers  want  therapy  that  addresses  what  is perceived as being
broken.  So,  they  go  about doing that. Unfortunately, in an effort to
remain  an OT, they begin crossing-over some of the theory which doesn't
fit  in the first place. The end result is bunches of OT's addressing UE
function using a variety of contrived treatments.

As  I'm  typing I just want to mention that I am growing to believe that
there  is  a  large  segment of OT practitioners not suffering from the
woes  that  are  often  discussed  on  OTnow.  These  practitioners  are
pediatric therapists!

Like  I  said, I love theory. Ever profession needs a strong theoretical
base.  BUT,  the  theory  must  fit  with the mode/method/environment of
delivery,  and  vise versa. The absence of congruity between theory and
practice is killing our growth and maybe even survival!

Ron

----- Original Message -----
From: Joe Wells <[EMAIL PROTECTED]>
Sent: Monday, July 11, 2005
To:   [email protected] <[email protected]>
Subj: [OTlist] Army OT/PT Descriptions


JW> Jimmie: ."....you poll nurses, you will generally get those that feel 
OT

JW> does the upper body and those that feel OT does ADL"


JW> I like that comment. I do see us at times 'pigeon-holing' either in 
just
JW> biomechanical aspects without respecting the "occupational" needs of 
the
JW> patient (sorry, "client") or just at times not even training but 
performing
JW> the "true occupations" (ofcourse, you have known those AM care OTs 
that

JW> nurses love, too) with utter disregard to the biomechanical or other

JW> performance componential/ skills (motor, process, comunication/ 
interaction
JW> skills), patterns, context, activity demands or client factors that 
are
JW> required to do that function/ occupation in an 'appropriate' manner. 
In this
JW> process, we either become a glorified nurse's aide or, a bad imitation 
of a
JW> 'non-function oriented' PT, may be more like a non-skilled activities 
person
JW> doing one of those "sit-ercies" with colorful bands and those pink 
"dumb"
JW> bells. Could this also be because we do not always ask our clients  or 
we
JW> (when they cannot tell us,  based upon our professional 'expertise' on 
human

JW> occupation/ life- stages) cannot or do not determine as what should be

JW> "occupationally" appropriate for our client and then correctly 
articulate it
JW> to the client/ family/ other health providers/ insurance companies?  I 
know,
JW> I am avoiding the words "asking the patients what is meaningful to 
them"! I

JW> and most in medical settings agree that we need to be paternalistic at

JW> times. An acute TBI cannot tell you what is meaningful, their family 
might
JW> not really know what to expect either. They rely on the doctors, 
nurses and
JW> yes, OTs, amongst others to do what is "meaningful"  for the client 
based
JW> upon what is biologically (age, gender, physically, mentally), 
culturally/
JW> socially thus, also morally appropriate or close to the so called 
"normal"

JW> as possible.


JW> My view of OT is that while physicians/ dentists (MDs, DOs, DPMs, DDS, 
ND)
JW> address the biochemical/ physiological aspects (via 
pharmacotherapeutics/
JW> dietitics, etc.) and anatomical structures (via surgery, radiotherapy, 
etc.)
JW> of human functioning, i.e, internal aspects of life - enabling a 
person to
JW> live as a human being (as defined in all states expect I believe NJ as 
until
JW> the whole-brain ceases to function); OTs addresses the external 
features of
JW> human functioning, i.e.,  the physical/ emotional- mental/ 
socio-cultural/
JW> spiritual aspects of living as an "occcupational" being. (When does 
one

JW> cease to be an "occupational" being,  is a good question for the

JW> philosophers and ethicists). As no one physician can address all 
aspects of
JW> life by himself/ herself, no one OT can possibly handle all aspects of 
human
JW> occupation either. That is why we have formal specialists or at least 
ones

JW> specially trained.

JW> Joe


JW> ----- Original Message ----- 
JW> From: "Jimmie Arceneaux" <[EMAIL PROTECTED]>

JW> To: <[email protected]>
JW> Sent: Monday, July 11, 2005 9:23 AM
JW> Subject: RE: Re[2]: [OTlist] Army OT/PT Descriptions



JW> Hello Joe,


JW> I believe that one of the major obstacles facing OT is that quite a 
few OTs
JW> are providing misleading information to referral sources, patients, 
other
JW> professionals and the general public regarding exactly what they do as 
a
JW> profession.  If you poll nurses, you will generally get those that 
feel OT

JW> does the upper body and those that feel OT does ADL.  It is a direct

JW> consequence of occupational therapists framing themselves in a context 
not
JW> based in the framework of their profession.  How many times have you 
seen
JW> physician referrals regarding OT for upper extremity ROM?  How many 
times

JW> have you heard reports of lackluster interest in past OT coupled with

JW> enthusiasm for PT with the stated reason, "I just want to walk." 
Could it
JW> be that the PT goal of improving the ability to walk has a more 
tangible

JW> benefit to the patient (sarcasm intended)? Don't get me wrong, I'm not

JW> stating that there can't be a tangible beneift to OT, but patient's 
don't
JW> see that benefit if the OT only marches in to do UE exercise and help 
them

JW> get dressed.

JW> Jimmie

JW> -----Original Message-----
JW> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
JW> Behalf Of Joe Wells
JW> Sent: Monday, July 11, 2005 7:42 AM
JW> To: [email protected]
JW> Subject: Re: Re[2]: [OTlist] Army OT/PT Descriptions


JW> Hi Ron:


JW> OTAs can enlist in the army. Additionally, the army does train its own 
OTAs
JW> as well. http://www.cs.amedd.army.mil/dms/otbranch/default.htm. They 
are
JW> usually called OT specialists in the army.  I agree that our product 
is
JW> diverse and thus, the scope is wide. I am convinced that if we all 
accept
JW> that with different settings our practice mode may differ (i.e. one 
aspect
JW> of the domain may take precedence over the other, e.g. a hand clinic 
versus
JW> a shelter-home versus an acute care hospital) although not deviating 
from

JW> our core principles that thread us together, we will still be able to

JW> package our product. Our profession may be fluid but we can give it 
the
JW> shape of a container. Barring just a few inconsistencies, I felt the 
AOTA
JW> framework is a commendable tool to introspect our own practice 
similarities
JW> and differences (explain what we do internally), find that 'thread' 
that

JW> binds the OT community together and then externalize it as an easily
JW> identifiable product (1). I hope that this could be a part of the OT
JW> curriculum as well, so that all new grads can identify with a common

JW> practice framework versus what one school wanted to follow over the 
other. I

JW> believe it is now is a part of the ACOTE standards.
JW> Other links:

JW> http://www.goarmy.com/amedd/army_health_care_corps.jsp-  Recruiting as 
an OT
JW> http://usmilitary.about.com/library/milinfo/navynec/blhm8467.htm 
Recruiting

JW> as an OTA

JW> 1. AOTA (2002). Occupational therapy practice framework: Domain and
JW> processs. American Jouranal Occupational Therapy. 56, 609-639.
JW> Joe

JW> ----- Original Message -----
JW> From: "Ron Carson" <[EMAIL PROTECTED]>
JW> To: "Joe Wells" <[email protected]>
JW> Sent: Monday, July 11, 2005 1:56 AM
JW> Subject: Re[2]: [OTlist] Army OT/PT Descriptions



Hello Joe:

Good idea to do further investigating and great links, thanks!

The  Army  brochure that I used for my quoted does contain comprehensive
info  about  OT.  Perhaps I should have included some quotes relating to
group therapy, alcohol rehab, etc.

Maybe  I  missed  it,  but  I haven't read anything about the Army using
OTA's. I am interested to hear if they in fact, they do.

One of the reasons I posted my original message is because of the recent
discussions  about  marketing  "out  product".  I  am convinced that our
product is too diverse, inconsistent and misunderstood to market. Until,
the  profession  of  OT's  internal structure is more clearly defined, I
think that marketing is not a good use of resources.

Somehow,  AOTA  and  practicing OT's, must develop a model of theory and
practice  that  is specialized, understood by both internal and external
audiences,  deliverable  and  practiced. To date, in my opinion this has
not happened.

----- Original Message -----
From: Joe Wells <[EMAIL PROTECTED]>
Sent: Sunday, July 10, 2005
To:   [email protected] <[email protected]>
Subj: [OTlist] Army OT/PT Descriptions

JW> Hi Ron:

JW> Just out of curiousity, I checked the Walter Reed Medical Center
website
JW>
http://www.wramc.amedd.army.mil/departments/Ortho/PhysMed/otscope.htm.
The
JW> OT scope explained there is a little more comprehensive. I also
checked the
JW> PT scope at
JW>
http://www.wramc.amedd.army.mil/departments/Ortho/PhysMed/ptscope.htm
and

JW> found the scopes to have a lot of areas overlapping. In the 
military,

my
JW> guess is that the model is very transdisciplinary. I believe the
student
JW> appointment is an internship (level II fieldwork) affiliation since
there
JW> are no OT academic programs in the Army, although as you mentioned,
they do
JW> have a DPT program at the US Army- Baylor University
JW> (http://www.amsc.amedd.army.mil/training.asp).  The army does train
its own
JW> OTAs. More on the OT internship program
JW> http://www.amsc.amedd.army.mil/Doc/otintership.pdf.  Do we have any
army OTs

JW> on the board ? It would be nice to hear about their army 
expeeiences.


JW> Other Army sites:
JW> http://www.wramc.amedd.army.mil/departments/Ortho/index.htm
JW> http://www.amsc.amedd.army.mil/about.asp

JW> Joe





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