A while back on another list serve, I must have been ranting about OT's and UE practice because someone asked me "why don't you find another profession". I just found the following draft which is a reply to their comment.
It's not very eloquent but I think it gets the point across. I didn't send it to the "other list" but in light of my recent questions about mobility, I want to send it to the OTlist. Ron *********************************************************************** Another OT suggest that I should move to another profession because in my experience, meaningful return of an UE shortly after a CVA is unlikely. As I've already said, this is my experience and it's how I practice. But why would another OT think that my experience is indicative of being a "poor" therapist or being in the wrong profession. Well, as you can imagine, I have an opinion. Probably another one that's going to raise a few eyebrows. In my years as a therapist, I observe that in adult physical dysfunction, OT's do one of two things: UE rehab and/or ADL's. Personally, I don't agree with either of these roles. In my opinion, within the confines of our State practice acts, scope of practice and personal experience/training, our role is to facilitate occupational performance. Our role is not to teach people how to dress themselves, or how to better use their arm after a stroke. Our role is to FOCUS treatment (i.e. the outcome) on improving peoples' quality of life by improving their ability to engage in occupation. Let me explain then why I think that FOCUSING treatment on an UE is not best practice. Firstly, return of arm function after a stroke is notoriously poor. Often, the return that comes is independent of any treatment intervention. And yet, many OT's labor away at doing exercises, treatments and interventions to facilitate UE return. Evidence does support that some return does occur because of early intervention, but I know of no evidence showing that early intervention makes a significant difference in patient's ability to utilize their arm for taking care of themselves, being productive or having fun. When working in stroke rehab, it is rare to have a patient with only UE involvement. Primarily, pt's with sensory/motor symptoms have it in both UE and LE. When facing patient's with this "global" involvement, OT seem to pigeonhole themselves into working only on patients UE. The obvious explanation for this phenomena is that in rehab where there is both OT and PT, the old adage holds true: "OT, above the waist, PT, below the waist". I have never agreed with this concept because I think following it does the patient a great disservice. So, what should we do? In my experience, the vast majority of patients with new CVA's want to be able to re-engage in their occupations, not from a wheelchair, but while standing and walking. In my experience, if you ask a CVA patient if they want to work on their arm or their mobility, they almost always answer with mobility. I understand this! If I lost use of both my arm and leg because of a stroke, I would be most concerned with my leg! After all, a person can eat with 1 1/2 arms, but they can't very effectively walk with 1 1/2 legs. OT's are not gait experts, all though I think we should be, but we are experts in occupation. And we are supposed to be client-centered. So, when faced with patients who want to engage in mobility related daily living skills, what should an OT do? Should they work on their arm with the pretense that doing so is going to improve their mobility? Or should they get right to work addressing the very issues that prevent the patient from engaging in occupation in a way that is both desired and achievable? To me the answer is obvious! We need to address patient's where they are at and where they want to be! I understand that "turf" issues associated with what I'm saying, but that's just part of treating patients from an occupational perspective. I understand that many OT's are uncomfortable trying different ambulatory aids but with training and practice, their comfort level with increase. There are so many goals that OT's can address that include mobility, something important to patients, without actually stepping on other professions' toes. But they must be willing to address patient's mobility related goals. I think that a disclaimer is order. What I've written is based on my experience and are generalities. With a few exceptions, there are almost no guarantees, certainties or "rules" when it comes to patient's with CVA. ~The End~ -- 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 **************************************************************************************
