I totally agree with Jimmie and believe that OTs do have a place in acute care. If "occupation" is deprived/ hindered momentarily, intermittently, on a long-term basis or permanently, I believe that it is within the scope and is the duty of the OT to correctly identify and address the deficits accordingly. Examples:
1. NICU: The whole process of facilitating the normal development 2. Cardio-pulmonary: Appropriate activity selection/ pacing, gradation/ training and facilitation of occupations based on MET levels/ precautions. I will be scared to see these clients performing strenuous resistive exercises at this stage. 3. Burns: Optimizing client factors- body functions/ structures (using the Framework terminology) via contracture management techniques/ splinting/ pressure garments, etc., including addressing psychosocial issues such as self-esteem, training and facilitation of occupations. 4. Orthopedics: Education of precautions with ADLS/ IODLS (now also being called ODLs/ IODLS, with activities being replaced by occupation), recommendation/ training with atypical occupational forms (adaptive/ supportive devices), addressing occupational issues (I agree, that I too have witnessed and question UE strengthening with 5/5 strength of all muscle groups on MMT on a client w/ hip replacement just so that "we have something to do". But that is the shortcoming of the practitioner not the profession). 5. Neurology: Acute stroke/ TBI: Optimal positioning to facilitate sensory registration/ modulation, and regulation at a pre-occupational stage, and gradation/ training and facilitation of sub-occupations and occupations 6. Acute Psych: Hopefully, we didn't leave this area already. Hopefully, we still have our roots in addressing issues that impact the "whole" person (mental, physical and social functioning) that was supposed to separate us from the other "reconstruction aides" (now called PT) at the first place. 7. Post- surgical: Precautions with ADLs, adaptations as needed, gradation/ training and facilitation of occupations. I strongly believe that OTs should practice across all age groups and in all settings (since occupations- healthy or pathological occur in all humans). As many, I do not believe that "function" is our unique domain since that is what's aimed by all healthcare providers, and neither do I believe that it is our modalities (since we do not have any restricted practice acts, such as a arthroplasty is to an orthopedist). Also, by the nature of our profession (as in all other healthcare professions) we have role/ scope overlaps with others: e.g., PT, SLP, recreation therapists, art therapists, music therapists, nurses/ aides, rehabilitation teachers, teachers of the visually handicapped, special educators, lifestyle trainers, life coaches, companions of the disabled, massage therapists, etc. I believe it is the philosophical basis (our focus) that separates us; our focus on occupational functioning based on volition, habituation, performance capacity (physical, mental/ social) and context (including role expectations). I am hoping that we as a profession will stop fighting over whose modality is what, but use all tools available to us to best serve our client needs to the best of our individual capacities and together as a profession. If we must become a "good to great" profession/ professionals, we must be able to serve our clients based on our strengths/ ambitions as we best believe in them. As an OT I should practice and defend my scope as I best understand it. If shoulder external rotator strengthening/ increased ROM are indeed required to help my client to comb his hair or wear his shirt, then I may use the "remedial" technique of strengthening/ increasing ROM as an adjunct with the true occupation of dressing versus simply slapping “compensatory strategies or equipment” straightaway. If my client demonstrates difficulty with lower body dressing and demonstrates the potential to benefit with remediation/ restoration of standing balance and tolerance, I feel, it is lazy and unethical on my part to teach him to compensate by dressing on the bed/ bedside when he could regain his so-called culturally accepted normal way of lower body dressing. If only we could practice the profession holistically with all the tools and treatment approaches available to us (create/ promote, restore/ establish, maintain, modify, prevent) and using all intervention types as applicable to our clients (therapeutic use of self, therapeutic use of occupations and activities- preparatory methods, purposeful activities/ sub-occupations, occupation-based, and education/ consultation), we could all feel so much better! I agree that we really should not be competing with other professions; we are already too busy competing within ourselves. Let us forget the other professions; are we practicing our profession to the fullest extent of our scope ourselves? If not, why do we expect others will let us? Sorry again for my long posts (was traveling and meant to send this before in 2 or 3 e-mails but they didn’t post for some reason). Next time will "post-segment" it appropriately. Joe Wells, OTD, OTR/L -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jim Arceneaux Sent: Thursday, January 11, 2007 8:34 PM To: [email protected] Subject: Re: [OTlist] Acute Care OT? One caveat though: Please don't get stuck in the ADL/function thing as well. OTs are too often identified as the ADL guys. This places us, in the eyes of non-rehab. disciplines, as glorified aides. Plus, the PT practice framework, or whatever they call it, states that PT's address ADL and function. OT is more complex than ADL or function. Also, in the "rants," as people called them, several individuals mentioned OTs need to stop doing exercise. I argue that exercise is no worse than doing mindless activities like bouncing around a balloon or digging pennies out of therapy putty. Neither is truly OT. But, we must understand that OT practice must utilize occupation as its treatment medium of choice while also employing other learned techniques to facilitate return to the patient's desired occupation. It is not a sin against the OT gods to do an exercise, but it is also not OT if your primary focus is exercise. If you had a patient that couldn't put his sock on because of hip capsular tightness following an ORIF (that had the potential to do this without a sock aid) would you run to the PT to ask them to improve the range for you so you can meet your goal. I hope not! It would be best to find a way through participation in an occupational task to improve this range, but if necessary why can't you provide service to meet an establihed OT goal. AS Chuck stated, there is nothing in my practice act that says I can't and the practice framework from AOTA supports the addressing of client factors (i.e. ROM) in meeting occupational goals. I'm not certain why so often fellow OTs will look at another OT performing an exercise as something akin to a PT, but state another OT is a fine example while watching them play balloon volleyball as I mentioned above. You also don't here OTs often stating that NDT is not OT. Well, really it isn't, but it can be utilized by an OT to facilitate participaton in occupation. The NDT is no different than an exercise. Another rant...Wow! Jimmie Chris Smith <[EMAIL PROTECTED]> wrote: bHalleujah--so many PT wannabees in the field. I have only worked in one LTC facility out of five that addressed Adls in an appropriate manner and by only one of the COTA not the other two. Where I am now the OT who does the majority of the evals and writes an obligatory ADL goal rarely addresses them herself. I do home health for a company owned by the LTC facility and work both in house and in HH. After I complained to the rehab director (a PTA of course) that by pts coming out of the facility couldn't do ADLS she told everyone they had to do one adl "run through" before DCing--what an attitude. If all we ever bill is 97110 why do they need us? They can just hire PTs. Sorry for the rant. Chris _______________________________________________ Join Excite! - http://www.excite.com The most personalized portal on the Web! -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] **************************************************************************** ********** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **************************************************************************** ********** --------------------------------- Everyone is raving about the all-new Yahoo! 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