What do you mean 'such recommendations are not warranted'? If they are feasible even on a temporary basis, won't they help? Did you ask what her living situation was like? How did she damage her shoulders? Was it repeated strain over time, result of a fall, what? Is she short or tall? Is the rod in her closet actually too high for her? or is she trying to reach a higher shelf? Is a lower shelf available or feasible? What is it she cannot reach on the table? Can you help her think about her living environment and how it might be adapted so she could manage with less pain? Does the culture of the Assisted Living Facility allow her to ask for help? Is she willing to do so or is she forcing her shoulders to show she can manage? Is she cognitively able to understand consequences in the future? Are there requirements for independent abilities to stay there? Is she afraid of transfer to Long Term Care? What do you think her prognosis for biomechanical recovery is? Depending on the injury sometimes older people have to adapt to loss of range with rotator cuff injuries. Is her medication adequate for pain control? Is she taking it? Does she understand about maintaining a therapeutic level? Is there any reason to be concerned about the side effects of medication? Does she get up to go to the bathroom in the night? Is her way lighted? I assume that when a doctor refers to OT it is because that is what is expected. The reason OT is needed may be an injury but the physician expects us to mitigate to the best of our ability and with all the resources we can muster the occupational effects of that injury. Of course they don't refer for difficulty in ADLs they don't assess for the practical consequences of injury but they certainly expect us to do so. Try to let go of your semantic preoccupation with occupation. Look at people and ask yourself and them what they want, need or are expected to do and what you know that may help them. You'll find you are writing notes about restored occupation. (normal life - thanks Carmen) Stop telling yourself that there is nothing you can do that isn't PT and just do it. Joan (with some irritation)
> -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf > Of Ron Carson > Sent: Wednesday, April 26, 2006 8:21 PM > To: Joan Riches > Subject: Re: [OTlist] Occupation > > Hello Joan: > > It's funny how things sometimes fall into place. Just today, I evaluated > an older adult living in an ALF. The referral was secondary to a > doctor's report of bilateral rotator cuff injuries. Notice that the > referral wasn't for difficulty bathing, eating, dressing, etc. > > Anyway, in talking with the client we identified obvious limitations > with ROM and she reported quite a bit of pain. BUT, she also stated that > she had difficulty obtaining clothes from the closet and reaching items > on the dining room table. So, like you said, in listening to the > patient, she identified occupational deficits. But, here's the confusing > part. > > If the goal is occupation, then I only need recommend a higher > chair/lower dining table and that she place her clothes on a lower > shelf. Thus, her occupational performance is restored. Obviously, such > recommendations are not warranted but isn't this what you are > saying? > > Instead, shouldn't I address the cause of her occupational limitation > which of course are biomechanical in nature. But addressing her > biomechanical problems so that she might better complete her occupations > is no different than what a PT or in the case you gave, an RT might do. > They might not call them occupations but that isn't the point. > > It seems that looking at these situations kind of leaves OT stuck in a > vise. We say we are about occupation but when the rubber hits the road, > we are only about occupation as an ancillary byproduct of our therapy. > > Ron > > ----- Original Message ----- > From: Joan Riches <[EMAIL PROTECTED]> > Sent: Wednesday, April 26, 2006 > To: [email protected] <[email protected]> > Subj: [OTlist] Occupation > > JR> Do you see your clients in their homes? Most people will tell their > JR> troubles to an empathetic listener and even if the problem is a > JR> 'medical' one the 'troubles' will include the things they are > JR> prevented from doing. > > > > -- > Unsubscribe? > [EMAIL PROTECTED] > > Change options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] > > Help? > [EMAIL PROTECTED] > > -- > No virus found in this incoming message. > Checked by AVG Free Edition. > Version: 7.1.385 / Virus Database: 268.4.6/324 - Release Date: 4/25/2006 > -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.385 / Virus Database: 268.4.6/324 - Release Date: 4/25/2006
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