I can totally see Ron's point now.? I work in acute rehab and we actually have them undress and dress,?so it is easy for me.? To make things more functionally based in outpatient or home health I think I would trial the DASH.? This is an upper extremity assessment tool that is a pre and post treatment?survey of what functional problems the patient is encountering.? This will give the therapist a better idea of what to focus on based on the patients survey results.? Check it out on Google.? Based on a good description of what we do in OT?for the patient, I don't think they will have a problem talking about their occupational dysfunctions.? I would use both a therapeutic exercise/splinting/ and ADL practice/compensation approach.
Chris Nahrwold MS, OTR St. John's Hospital Anderson, Indiana -----Original Message----- From: Ron Carson <[EMAIL PROTECTED]> To: Kari Rogozinski <[email protected]> Sent: Sat, 30 Aug 2008 6:54 pm Subject: Re: [OTlist] Elbow Break, Referral... Call me think-headed, but I don't see how those goals are any different than PT. When I read the goals I see the primary focus on decreasing pain and increasing ROM and the "functional" stuff is just thrown in. And that's primarily what PT does. OT knows there's a lot more to dressing than just physical dysfunction. There's the environment, cognition, motivation, family issues, etc. With your goals, what happens if ROM is increase so the patient SHOULD be able to dress but they still can't because the family doesn't feel they are safe? According to your goals, the patient is d/c. Either that or you'll need some new goals! I will also suggest that goals should not be written unless it has been assessed. In other words, I don't write ROM goals, because I don't take ROM measurements. I do assess occupation and those are the goals that I write. Again, what the therapists assess should be the goals. And conversely, if it's not assessed then it shouldn't be a goal. Also, goals must be measurable and progress must be made. How can a therapist measure progress towards a goal that is not initially measured? And, what measure is going to be used? I will say the "increase functional performance with bilateral UE tasks" is not exactly a measurable goal? Now, if you assessed that the patient required mod assist to donn her bra and the goal was "Pt will independently donn/doff bra", then that's an OT assessment and goal. However, can you see this ladies face when I ask her about how much assistance she need to put on her bra, or pull up her underwear? She's going to think I'm nuts because she wants me to fix her arm, not worry about teaching her to get dressed! Gosh, I hate long messages..... <Sorry for typos/graphos> Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Kari Rogozinski <[EMAIL PROTECTED]> Sent: Saturday, August 30, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Elbow Break, Referral... KR> I ag ree with Chris, I would take this patient and right all 4 KR> goals.? The only exception is i would state why i was going to KR> decrease the pain or increase ROM.? I would probably say something KR> like: ? Pt. will increase active elbow extension to -20 degrees to KR> allow for increased independence with upper body dressing or KR> decrease reports or pain to increase functional performance with KR> bilateral upper extremity tasks (grooming, bathing, dressing, etc.)? KR> ? KR> Ron, you have now given us examples of 2 patients you would not KR> treat, I too am wondering what kind of patient would you see?? KR> ? KR> ? KR> Kari, MOT, OTR/L KR> Hollywood, Florida KR> --- On Sat, 8/30/08, [EMAIL PROTECTED] <[EMAIL PROTECTED]> wrote: KR> From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> KR> Subject: Re: [OTlist] Elbow Break, Referral... KR> To: [email protected] KR> Date: Saturday, August 30, 2008, 5:21 PM KR> I would write all 4 goals.? Why in the world would you not take this patient?? KR> "I shouldn't have taken it but I did."? What patient's do you KR> take? KR> Chris Nahrwold MS, OTR KR> St. John's Hospital KR> Anderson, Indiana KR> -----Original Message----- KR> From: Ron Carson <[EMAIL PROTECTED]> KR> To: OTlist <[email protected]> KR> Sent: Sat, 30 Aug 2008 2:48 pm KR> Subject: [OTlist] Elbow Break, Referral... KR> Received a new referral for a elbow fracture. I shouldn't have taken KR> it but I did. KR> And here is the dilemma facing our profession. The patient is 95, KR> previously living independently. Fractured elbow in a fall. Now living KR> with daughter. She is in a large amount of pain. Obviously, she is KR> dependent for most of her occupations. She currently uses a cane but KR> is not safe. KR> The patient's immediate concerns are her elbow. When pressed, she of KR> course wants to go back home, but that is not an immediate goal. KR> So what do I write for goals? For example should I write: KR> Patient will self-report pain as 3 out of 10 KR> Patient's w ill increase active elbow extension to -20 degrees KR> These goals seem to direct the patients and doctor's concerns but are KR> not occupationally oriented. So, should I write: KR> Patient will safely and independently dress lower body KR> Patient will safely and independently ambulate to the bathroom KR> using the least restrictive mobility aid KR> I like these goals but they don't address the immediate concerns. KR> Ron KR> -- KR> Ron Carson MHS, OT KR> -- KR> Options? KR> www.otnow.com/mailman/options/otlist_otnow.com KR> Archive? KR> www.mail-archive.com/[email protected] KR> -- KR> Options? KR> www.otnow.com/mailman/options/otlist_otnow.com KR> Archive? KR> www.mail-archive.com/[email protected] KR> -- 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]
