Great posts Carmen and Ron,
I also have been wondering for a while when an occupation based
approach is needed. Is it only needed when an exercise/medical model approach
cant "cure the impairments ?" (ex: complete spinal cord injury or head inury
with chronic memory loss..) Is an occupation based approach needed when a
patient is not interested in exercise/medical model approach? (very rare in my
practice!)?
Part of my job is covering the swing unit in a critical care
hospital and I get a lot of hip fx's, TKR, genral deconditioning...in most
cases once the impairments/compenents are improved pt's are quite happey with
thier level of independence. When given the choice of brushing thier teeth
standing at the sink perfoming resistive standing exercises in paraleel bares
in most cases pt choose the exercises. If i had a dollar for every time a
patient gave me a goal of "walking by my self" I could pay of my car loan!
Again in my experience at the orthopedic/geriatric popualtion pt's want thier
treatment at the impariment compenent level.
On the flip side another part of my job that I have somewhat
success with Occupation based approach is with my pediatric/school based kids.
for ex: third grader with high level CP. failed at home/school learing how to
tie shoe laces he was . I helped him spray paint a pair of payless sneakers
bright gold, one lace got applied glitter glue and worked on reverse chaining
with "magic shoes"..you peds OT know the rest of the story after 3 weeks he
was successful.
To make a long rant short, about 75 percent of my job I am not
using an occupation based approach but my patients still percieve success and
indepedence in their routine. Am I practicing like a AOTA OT...No...does this
bother me...sometimes..am I worried about the my future in OT sometimes.
Mike Butterfield
Ron Carson <[EMAIL PROTECTED]> wrote:
Yes, we see a dentist because of the toothache, not so we can eat corn
on the cob! We call the electrician because we have an electrical short,
not so we can watch TV. We take our care to a mechanic because it's
broken, not so we can drive to a movie.
We call an OT because because we can't wash our feet....
Now, who thinks of OT like that?? NO ONE, well almost no one!
About the only time that I hear mention of OT (keep in mind that I work
in an outpatient private practice setting) is for fine motor, UE, and
cognition. Once, I had a referral from a chiropractor to do a home
safety assessment for his Dad, also a chiropractor. But by far, OT is
normally referred to for anything OTHER than occupation. And that's a
problem!
In my opinion, we MUST:
1. Change our message
2. Change our delivery
3. Or a combination of the two
----- Original Message -----
From: Carmen Aguirre
Sent: Wednesday, April 26, 2006
To: [email protected]
Subj: [OTlist] Occupation
CA> Ron...
CA> When we get sick, have a tooth ache, bleeding, etc we seek a
CA> doctor to stop/cure/remediate the cause in order to restore "normal"
CA> life (occupation). Why would it be different for patients who need
CA> our services...I truly don't see the dis-articulation. Help?
CA> Carmen
CA> ----- Original Message -----
CA> From: Ron Carson
CA> To: [EMAIL PROTECTED]
CA> Sent: Wednesday, April 26, 2006 11:17 AM
CA> Subject: Re: [OTlist] Occupation
CA> Yes, I agree 100% with your statement. BUT most patients that I see are
CA> not at the point of compensation. And besides, I don't think that
CA> compensation is really a big part of medicine. I just can't see me going
CA> to a doctor and saying;
CA> " If you have any patients who can't use their arms, hands, legs,
CA> etc. then send them to me so I can teach them how to compensate"
CA> Maybe this SHOULD be the role of OT but it is one role that in my
CA> opinion is not highly promoted, practiced or warranted for many of our
CA> patients.
CA> Ron
CA> ----- Original Message -----
CA> From: [EMAIL PROTECTED]
CA> >
CA> Sent: Wednesday, April 26, 2006
CA> To: [email protected]
CA> >
CA> Subj: [OTlist] Occupation
CA> Enrc> Ok - I understand what you're saying, but let's just say that it was
CA> Enrc> not possible that this person receive a lens replacement and
everything
CA> Enrc> did not get better and the problem could not be fixed. In this case,
CA> Enrc> occupation and compensation WOULD come to the forefront, no?
CA> Enrc> ----- Original Message -----
CA> Enrc> From: Ron Carson
CA> >
CA> Enrc> Date: Wednesday, April 26, 2006 7:34 am
CA> Enrc> Subject: [OTlist] Occupation
CA> Enrc> To: [email protected]
CA> >> Hello All:
CA> >>
CA> >> Recently Biraj pointed out that I:
CA> >>
CA> >> > always championed and advocated, very strongly I might
CA> >> add,> occupation-based practice but now it seems [I am]
CA> >> extremely> disappointed of anything the term has to do with in the
CA> >> OT profession.
CA> >>
CA> >> Biraj is correct about my past vocalizations but today I don't
CA> >> feel that
CA> >> I am disappointed about occupation. I still feel the same
CA> >> aboutoccupation but I think that I am becoming a bit jaded
CA> >> at trying to
CA> >> integrate occupation into my private practice. You see,
CA> >> occupation is
CA> >> important, it's important to ALL of us, but what I am
CA> >> discovering is
CA> >> that treating occupational deficits does not fit well with my
CA> >> clientsbecause clients don't consider occupational deficits to be
CA> >> the problem.
CA> >> Here's a non-OT story to make my point.
CA> >>
CA> >> Recently, someone I know was diagnosed with cataracts. The
CA> >> cataractsaffected his vision to the point that modifications were
CA> >> needed to read,
CA> >> work and play. Now, what do you think this person saw as the
CA> >> problem;cataracts or occupations. Obviously, the impact on his
CA> >> occupation is
CA> >> what brought the cataracts to the forefront and motivated him to
CA> >> seek a
CA> >> lens replacement, but cataracts are the problem, not the
CA> >> loss of
CA> >> occupation. So, the person received a lens replacement and
CA> >> everything is
CA> >> getting better. Well, how does this 'story' apply to OT.
CA> >>
CA> >> Simple, our clients are seeking answers to problems. They want
CA> >> theseproblems fixed. But the problems are not occupation, the
CA> >> problems are
CA> >> things like weakness, loss of balance, developmental delay,
CA> >> depression,etc. Clients see these 'components' as the problem and
CA> >> this is what they
CA> >> expect their therapist to address. This is the way the entire
CA> >> world of
CA> >> medicine works and for OT to be any different just doesn't work.
CA> >>
CA> >> What I think needs to be done is for our patients to recognize
CA> >> loss of
CA> >> occupation as the primary problem. Then, they recognize the need
CA> >> for an
CA> >> occupational therapist. And as far as I can tell, the ONLY way
CA> >> that this
CA> >> is going to happen on a large scale is for AOTA to put
CA> >> together a
CA> >> NATIONAL ad campaign directed at educating people about
CA> >> occupation and
CA> >> thus occupational therapy.
CA> >>
CA> >> Finally, there are settings were occupation is the concern but
CA> >> about the
CA> >> only one that I know of is long-term mental health. And
CA> >> given that
CA> >> therapeutic occupation is rooted in mental health, this makes
CA> >> perfectsense. But for the majority of OT's working in the US,
CA> >> I think that
CA> >> trying to integrate occupation as our main form and outcome is
CA> >> a lost
CA> >> battle, unless patients are EDUCATED, INTEGRATE and
CA> >> EXPERIENCEoccupation-based therapy.
CA> >>
CA> >> Ron
CA> >>
CA> >>
CA> >>
CA> >>
CA> >> --
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