Chris stated, "I have decided will no longer be an Upper Extremity PT. I
continue to tell folks no one cares how you achieve good standing balance
whether standing at the stove to make muffins or standing at a counter to
plant bulbs or decorate a Christmas tree "
____________________________________________________________________________
Well said, Chris. And, I probably would personally engage in planting bulbs
versus standing at the stove! I guess that brings us back to the earlier
discussion. As Jimmie and someone else in one of earlier posts stated (and I
conferred), it is not the activity/ modality that automatically qualifies as
occupational therapy but the underlying focus on occupational performance.
(After all, the balloon activity is no more OT than PT, or recreational
therapy, unless qualified to the right context). And, again while it is a
great activity in the geriatric or pediatric population, it may not be quite
so engaging and meaningful to a recovering athlete wanting to get back to
competitive sports, or industrial worker returning to his labor-intensive
employment. 

After being an OT for the past 12 years (yes, I am an old one, too) and
having supervised a few students, I am convinced that our educational system
needs overhauling. We cannot expect the 2-3 years of graduate school can
automatically provide a "universally suited" OT, and likewise for the OTAs. 
My personal thoughts:
1. Standardize our pre-professional and entry-level education with strong
foundation in basic sciences including occupational science, biomedical
sciences, behavioral sciences and allied subjects such as ergonomics,
biomechanics and kinesiology, etc. 

2. Compulsory rotation during fieldwork in all traditional settings- acute,
sub-acute, long-term, outpatient, home health, etc., and other
non-traditional settings as much as possible 

3. Practice must be based on setting-specific (entry-level and continued)
demonstrated competency (parallels may be drawn with psychologists, i.e,
school, industrial, clinical, social, behavioral, etc., and physicians based
on specialty areas). This may be done initially be adding a residency for
the therapist first entering the field.  That is, for example, a LTC or
psych-based therapist must demonstrate competency in occupation-based
treatments, and a hand-therapist demonstrating competency in the
biomechanical aspects as well (may I add that the biomechanical approach by
itself does not qualify as OT any more than the craft sessions with acute
psych). 

In my opinion, the field and scope of OT is too wide for all of us to have a
consensus on the competency level of an OT suited for all settings, but with
setting specific competency we will be able to draft a context-based
expectation for both the professionals and our consumers. This will also
help us to upgrade our services and practice our profession as intended by
our scope.


Joe Wells, OTD, OTR/L




 

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