Thanks Terrianne for your comments and insights!
I agree with your comments, especially about rehab under Med A and the 
attitude of many OT staff that come to work for the paycheck.  I've been 
an OT 18 years and there have been times I have felt a bit bored--I have 
always come to the decision that it was something I was or wasn't 
doing--and I'd make changes which always bettered the therapy I was 
providing.  I have noticed an even greater desire to engage in evidence 
based practice and really look at what I am doing since going back to 
school.   Being educated in the early 1980's ( at least at my school) 
there wasn't a push per se for research beyond the one class or research 
statistics)  and the goal was to to become a clinician.  Having gone to 
conference in the last few years, talking to and becoming  a student 
again myself, I see the shifts made in education and it is definitely 
for the betterment of the profession.  I hope to see this translate more 
into practice.  It is hard for many new therapists to "buck the system" 
so to speak especially in rehabs that are so unit/time/PPS oriented.  I 
applaud those who right out of school have the vision and do it 
differently then in the past and beyond what is the status quo. 

I have had clients in the hospital adamantly say NO to OT  initially 
(but then they continue to want to chat with me).  I then learn that 
their negative experiences were related to a SNF experience and most 
times, using the reciprocal bike (interestingly enough, most of these 
people were elderly kyphotic women who really didn't need to posture 
themselves in the way a reciprocal  bike would -increasing back pain) . 
Having by this time developed more of a relationship with them ( people 
are drawn to talking to me I have found) I use the opportunity to 
explain my "brand" of Occupational Therapy and assure them they will not 
be put on a reciprocal bike.

I have also experienced the client that had no clue they were to receive 
OT in home-care--I loved Home Health---I could really engage the client 
in real time, real life occuapation.  Sometime in the acute hospital it 
is more difficult and I work hard with my COTA to keep her from falling 
into the doldrums of T band.

I also believe that OT's as a profession have allowed their services in 
rehab to be defined by the payer, not by the scope of practice and the 
OT framework. If this continues, OT will not be seen as a vital service 
different the PT......

Jeanne Marie

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