I  think  the  earlier  message presents good arguments for seeing the
patient  in question. However, it seems that this person is suggesting
that advanced training qualifies her for doing the treatment.

But  what  about  the rest of us OT's who do NOT have ortho expertise?
And,  what  about  referral  sources?  In my experience, most referral
sources see OT's as UE ortho people, but that is NOT my expertise. So,
once.

What  I'm trying to do is find "common ground" for phys dys OT so that
AOTA  promotes  what we do and that we do what AOTA promotes.

Thanks,

Ron
--
Ron Carson MHS, OT

----- Original Message -----
From: [EMAIL PROTECTED] <[EMAIL PROTECTED]>
Sent: Tuesday, August 26, 2008
To:   [email protected] <[email protected]>
Subj: [OTlist] Would You Treat For Refer to PT?

cac> Does she?not lift?with her right shoulder because of the high
cac> pain level?? If she lives alone how will she take her trash out??
cac> How will she load and unload her groceries from her car?? How
cac> will she carry her laundry basket to her room to put her clothes
cac> away?? Unless this lady has a fulltime maid, her life is a little
cac> difficult right now.? Perhaps prompting the lady's memory isn't
cac> such a bad idea, considering that her mind is probably focused on
cac> her high pain level, and she is probably thinking to herself "Why
cac> does this guy have to know that information, I just want him to
cac> work on my arm", and she is giving you short answers, probably
cac> unaware that you were going to DC her. ?I would start on goal
cac> oriented compensation techniques to get her through her typical
cac> IADLs and a restorative program for her shoulder involving
cac> modalities, soft tissue mobilization around the coracoid process,
cac> relaxation facilitation techniques for?the shoulder,?and a graded
cac> therapeutic exercise program.? Based on AOTAs position papers
cac> over the years, this is certainly an appropriate?approach.? What
cac> is wrong with a bottom up approach starting with body functions
cac> and gradually improving to graded functional activities when the
cac> pain and the AROM improves significantly.? There is no way a
cac> patient like this would improve based on a top down approach.?
cac> She would learn to compensate, but from your evaluation it sounds
cac> like she wants her pain to improve, and for her shoulder to
cac> improve to her normal baseline.? Why in the world wouldn't a
cac> skilled OT with orthopedic shoulder?experience take this case?

cac> As OTs it is in our scope of practice to treat shoulders, knees,
cac> backs, hips, whatever, from a compensation and a restorative
cac> approach depending on the state in which you practice.? Now based
cac> on our level of education I would not suggest diving into
cac> restorative techniques for these areas unless you have
cac> had?extensive training, and if your PT partner on the other side
cac> of the clinic is working on the same thing.? Team work and
cac> communication is the key for those situations.





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