May I also add that you need to explain and demonstrate the concept of training specificity. A swimmer can do all the exercises he/she wants, but, will never be a good swimmer unless he/she swims. Same thing with function/occupation. The muscles, ROM, coordination, etc. needed to be able to do life skills are best improved through the actual performance of the skills themselves.
I call it functional exercising., David A. Lehman, PhD, PT Associate Professor Tennessee State University Department of Physical Therapy 3500 John A. Merritt Blvd. Nashville, TN 37209 615-963-5946 [EMAIL PROTECTED] Visit my website: http://www.tnstate.edu/interior.asp?mid=2410&ptid=1 This email and any files transmitted with it may contain confidential information and is intended solely for use by the individual to whom it is addressed. If you receive this correspondence in error, please notify the sender and delete the email from your system. Do not disclose its contents with others. ________________________________________ From: [EMAIL PROTECTED] [EMAIL PROTECTED] On Behalf Of Ron Carson [EMAIL PROTECTED] Sent: Sunday, August 24, 2008 5:34 PM To: Brent Cheyne Subject: Re: [OTlist] Occupation Frustration Brent, I know what's wrong with your program... <LOL> Well, at least I think I know what's wrong. And the reason is because I once had the same problem. My conclusion is that from patients' perspective, what you are offering is all wrong. Listen to what they say: "I'm here for the exercises", "I'm here for therapy, not cooking". Your patients are right, they are not there for cooking! What MUST happen, is that patients: 1. Must be educated, from day one, that they are NOT there for exercises. They are there for rehabilitation, which by one definition is: "The process of helping a person achieve the highest level of function, independence, and quality of life possible" 2. Patient MUST understand that cooking, cleaning, bathing, getting in/out car, up/down steps, in/out of the shower, to/from the food line, etc IS THERAPY. In fact, it's OCCUPATIONal therapy. In my experience, until the above conditions are met, you and your staff are barking up the wrong tree. Also, if the OT staff is spending much of their therapy time doing pegs, putty, hand exercises, sanding board (hate that thang), shoulder arc (hate that thang even more)and then decide to take patients on an outing, of course the patients are going to want to go. They are going to feel weird, like why am I doing this cooking while everyone else is exercising??? Also, most patients in rehab really aren't focused on shopping because it's not a priority. However, they do want to be able to get in/out of their homes, cars, tubs, etc. And they do want to be able to get from point A to point B without assistance. I bet that occupation-based assessments (COPM, or just asking), will help identify what is important to patients and will better direct the staff to which patients most want and outing and thus will most benefit. It will also better direct therapists to provide optimal treatment, assuming that the therapist listens to the patient and actually follows up on what they say. In rehab, what I think ALL OT's should do is HOME EVAL w/ the patient. There is SOOOOO much information to be gleaned by taking the patient into their home. And, the eval needs to be done way before the patient is discharged. That way, the OT can address real-world deficits within the confines of the rehab setting. Ron ----- Original Message ----- From: Brent Cheyne <[EMAIL PROTECTED]> Sent: Sunday, August 24, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Occupation Frustration BC> Hi Ron, BC> I'm hoping for some input and commentary on my experience in practice: BC> The Progam BC> I work in a SNF in Sarasota and we have ar really busy and BC> dynamic rehab team. Last year I started a community re-entry BC> program where the rehab patients that are preparing for discharge BC> get an opportunity to go on an outting to practice grocery BC> shopping, car transfers, navigating the sidewalks and crowds and BC> planning a menu, the whole nine yards! We have a van to transport BC> the participants, a budget of cash, the time, the staff to do it. BC> and a ADL apartment and a rehab kitchen to prepare the meal with people. BC> The Problem BC> The frustration is in how many people who would benefit BC> from participation in this program refuse to do it! A lot of the BC> patients seem resistant to doing these real world activites even BC> though, when they are discharged ,they will be doing it in some BC> capacity. Some will be returning to live alone. Some seem BC> threatened by the program, as if the therapist will take away BC> their independence if they struggle with the task. In reality we BC> are trying to help them maintain their independence. BC> THe Excuses BC> I often hear excuses like...."I'm just here for the BC> exercises, I already know how to shop and cook." " I've shopped BC> and cooked for years, why would I want to go and do that now." BC> "I'm here for the therapy not for cooking... and who wants to do BC> housework..I hate housework." " I eat all my meals at Dennys" BC> People who need it the most ,want it the least BC> Usually it is the client that is in most need of BC> involvement in the community task that is the most resistant. I BC> have many clients that take great pleasure in participating and BC> see the value in doing it but oftern they are less in need of the BC> service ore are already more functional. It is the individual who BC> needs more training and needs to implement adaptive strategies and equipment that is resistant. BC> Promoting The Progam Outside and Inside BC> This makes for hard work and a high tolerance for BC> frustration from the OTs. It takes a lot of explaining, promoting, BC> and internal marketing and generating enthusiasm to get BC> particiapants to buy into the program. THere is a lot of education BC> involved. And there are many PT colleagues that had to be won over BC> because they also viewed it as a waste of time or "just fun time" BC> but not useful therapy. We continue to work and energize and BC> improve this program. Luckily the rehab company we work for is BC> very supportive in terms of money and resources for the program. BC> It is very validating that the company sees the value in the progam as a service BC> A Matter of Perceptions and Concepts BC> How do we overcome this misconception in the geriatric BC> population about Occupation Based treatment? Why do so many of our BC> clients not take advantage of beneficial services that are BC> functionally based? How do we educate and motivate seniors to BC> buy-in to the value of purposeful activities that meet their BC> demands for return to prior level of function? On my evaluations, BC> I ask my patients what their goals are and they say "I just need BC> to get stronger and walk." or " I want to build up my BC> strength"..."Can you teach me some exercises that will help me get BC> better?" These people think therapy is like personal training or something BC> Some clients will say" I need to go home and get back to my BC> regular routine"...I love these patients cause I know theyalrady get the OT concept. BC> Does America look down its nose at ADL? BC> THe last comment I'll make is that there seems to be a BC> overall loss in the American culture for basic everyday tasks. BC> Most ADLs are seen as a time consuming inconvenience or an BC> aggravating hassle....not a life affirming means to return to BC> health. THe commercial culture in North America tells us that BC> things should be hassle free, quick, or dealt with a new product BC> or service "so that you don't have to deal with it". BC> Honesly, many of my clients don't have many occupations or BC> routines to get back to doing, they've deligated them to family BC> caregivers or services. THey suffer from a major deficiency of BC> meaningful activities...which may, in part, explain their BC> dysfunction and health issues. Without a doubt, motivating the BC> Geriatric client is often the biggest challenge of my practice. BC> Thanks for keeping the OTList going BC> Brent Cheyne OTR/L BC> -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
