Seems like I am nodding with each post. Totally agree with your Carmen. To me what makes us an occupational therapist is our focus on "occupation". Occupation consists of self-care, leisure, work, and contributing to society (Christiansen, 1999; Law, 1998). The focus implies that we must be concerned about how do we impact these areas versus the increase in hemoglobin (MD/DO), spinal alignment (DC), associated depression (Psy.D.), drug interaction/ side-effects (Pharm. D.), muscle strength/ endurance or ROM (PT), vocalization/ communication/ swallowing (SLP), etc. Now since we do have role overlaps with PT and SLP (since many of the same areas impact occupational performance as well), we may be seen working on the biomechanical aspects or using preparatory methods to positively impact occupational performance. And, there is absolutely nothing wrong with it as to my understanding occupational therapy was meant to encompass the holistic performance addressing physical, pyschosocial and emotional needs of clients. I don't see a need to stand out and mast my flag all by myself. I believe that as the other professions I have a role to play at all levels- impairment, disability or handicapped. As the expert, I need to know what my focus is and what my personal abilities are. If I feel that although my scope states that I can do manual therapies but I am not comfortable personally, I will refer the client to another OT or PT who is. If I feel I am not good at enhancing oro-motor skills or cognitive treatments, I will send the case to an OT/ SLP. Ofcourse, can't presecribe B-complex or Fe or do spinal manipulations yet :-)
The profession currently views occupation both as a process (means) of intervention or active doing, and as the goal (ends) or the product of the action (Christiansen & Baum, 1997; Gray, 1998). Occupation-based practice advocates incorporating occupation as the "means". However, as well illustrated by Mike in an earlier post, best practice lies in knowing the clientele and their unique needs. The participation in "exercises" per the client's choice and customary lifestyle to improve his ability with mobility issues/ ADL after a TKR is very much an "occupation" and certainly qualifies as "occupation-based practice" as well. Preparatory/ pre-occupation tasks used facilitates occupation as its "ends". For a definition, I personally go with- "Occupation is all things that people do to occupy themselves (Enabling Occupation, 1997)". I think this is powerful and, if we don't see ourselves/ what we do as adjunct to, (a team player yes but) not ancilliary to other remedies. The OT Framework (AOTA, 2002) clearly states OT approaches include remediation/ restoration (and when that is not possible), compensation by modifications/ adaptations alongwith prevention and health promotion. OT intervention types include using self as a therapeutic medium (hopefully we do), preparatory methods (physical agent modalities, NDT, PNF, etc), therapeutic activities (pre-occupations), and true occupations. To me, let's start practicing as professionals that can- 1. "Diagnose" the occupational dusfunction- Clients don't go to an MD and state " I have low hemoglobin", they find through tests after the client says "I fatigue easily'', etc. 2. Use all tools available to us (within our scope and personal competence) to enhance occupations. 3. Become ' autonomous' experts in " functioning" as it impacts occupations across all ages. 4. Market to our referral sources, i.e. MD/ DOs on how we contribute beyond just the "internal functioning (anatomical/ physiological aspects)"- ofcourse, we may have to also work on physiological aspects, i.e., tone regulation to increase sitting balance to allow bedside self-care. 5. Not to introduce "occupation" as a new word/ mantra, just build on its power as an "all occupying" word. 6. Update our educational preparation that we may indeed play "equal" roles and be able to converse in the same language- medical model or otherwise. I love the topic and can just go on but better shut-up. Sorry, just had to put in my two cents and too many sentences. Joe ----- Original Message ----- From: "Carmen Aguirre" <[EMAIL PROTECTED]> To: <[email protected]> Sent: Wednesday, April 26, 2006 11:54 PM Subject: Re: [OTlist] Occupation > Maybe the disconnect is more setting-specific Vs. a generalized problem. > I work in Sub-acute-SNF/LTC; the referrals are biomechanical and medical > in nature ( underlying impairments per our old terminology); we > immediately make the correlation for the client re: occupational self > performance, and use occupationally relevant assessments/activities to > either restore/compensate/adapt and discharge to prior living environment. > I don't do PT treatments when I use modalities to help alleviate pain so > my client can proceed to cook/bake a cake; I don't do PT just because I am > using spasticity-inhibiting techniques with their hand/wrist/shoulder to > facilitate dressing at end of session. I have to address these > anatomical/physiological factors to maximize self-performance. Why isn't > that occupational therapy. I feel that I'm missing your point...I just > don't get your conflict with Occupation. Help > carmen > ----- Original Message ----- > From: Ron Carson<mailto:[EMAIL PROTECTED]> > To: Carmen Aguirre<mailto:[email protected]> > Sent: Wednesday, April 26, 2006 6:00 PM > Subject: Re: [OTlist] Occupation > > > 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 <[EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]>> > Sent: Wednesday, April 26, 2006 > To: [email protected]<mailto:[email protected]> > <[email protected]<mailto:[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<mailto:[EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]>> > CA> To: > [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]<mailto:[EMAIL > PROTECTED]<mailto:[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]<mailto:[EMAIL PROTECTED]<mailto:[EMAIL > PROTECTED]<mailto:[EMAIL PROTECTED]>> > CA> > <[EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]<mailto:[EMAIL > PROTECTED]<mailto:[EMAIL PROTECTED]>>> > CA> Sent: Wednesday, April 26, 2006 > CA> To: > [email protected]<mailto:[email protected]<mailto:[email protected]<mailto:[email protected]>> > CA> > <[email protected]<mailto:[email protected]<mailto:[email protected]<mailto:[email protected]>>> > 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> > <[EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]<mailto:[EMAIL > PROTECTED]<mailto:[EMAIL PROTECTED]>>> > CA> Enrc> Date: Wednesday, April 26, 2006 7:34 am > CA> Enrc> Subject: [OTlist] Occupation > CA> Enrc> To: > [email protected]<mailto:[email protected]<mailto:[email protected]<mailto:[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> >> -- > CA> >> Unsubscribe? > CA> >> > CA> > [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]<mailto:[EMAIL > PROTECTED]<mailto:[EMAIL PROTECTED]>> > CA> >> > CA> >> Change options? > CA> >> > CA> > www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com>> > CA> >> > CA> >> Archive? > CA> >> > CA> > www.mail-archive.com/[email protected]<http://www.mail-archive.com/[email protected]<http://www.mail-archive.com/[email protected]<http://www.mail-archive.com/[email protected]>> > CA> >> > CA> >> Help? > CA> >> > [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]<mailto:[EMAIL > PROTECTED]<mailto:[EMAIL PROTECTED]>> > CA> >> > > > > CA> -- > CA> Unsubscribe? > CA> > CA> > [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]<mailto:[EMAIL > PROTECTED]<mailto:[EMAIL PROTECTED]>> > > CA> Change options? > CA> > CA> > www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com>> > > CA> Archive? > CA> > CA> > www.mail-archive.com/[email protected]<http://www.mail-archive.com/[email protected]<http://www.mail-archive.com/[email protected]<http://www.mail-archive.com/[email protected]>> > > CA> Help? > CA> > [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]<mailto:[EMAIL > PROTECTED]<mailto:[EMAIL PROTECTED]>> > > > -- > Unsubscribe? > [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> > > Change options? > > www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com> > > Archive? > > www.mail-archive.com/[email protected]<http://www.mail-archive.com/[email protected]> > > Help? > [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> > -- > Unsubscribe? > [EMAIL PROTECTED] > > Change options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] > > Help? > [EMAIL PROTECTED] > > -- Unsubscribe? 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