Bear with me folks, I couldn't resist. Something Ron said, highlighted below, hearkens back to a keynote speech from then AOTA president Barbara Kornblau (circa 2003).
Ron Carson wrote: *"But it's HOW and WHY we apply these skills that separate us from PT. And, there MUST be a clear line between OT and PT, otherwise we are going to get gobbled up."* Barbara Kornblau (an excellent speaker/presenter) talked about the APTA's "Vision 2020" initiative. For those of you not familiar with that plan, the intent is raise the entry level degree for PTs to DPT from 2020 forward. So, for instance when you enter into any medically-based setting, in year 2020 where there may be OT, PT, ST (who *all* may have less than a year's experience each) unless *all clinicians *in that setting have a doctoral-level degree, you'll have for example, Mr. Smith, MS, SLP-CCC, Mrs. Jones, OTR, and Dr. Johnson (the PT, nudge-nudge, wink-wink). Hypothetically, for purposes of my illustration, as a consumer and not knowing anything else about these three clinicians other than their names/titles, if you could only pick *one *of these therapists to work with your loved one, which one would you chose? I hope you get my point. During that conference, we had one memorable group activity (you know, the ones where you all get together, cuss and discuss, then elect a group spokesperson) where I was the lucky spokesperson. We were asked to brainstorm some less traditional OT roles/ideas for practice, and then discuss a theoretical base for our decisions. I don't recall everything I said, but one thing in particular drew stares at me as if I had suddenly sprouted wings. Feeling the influence of the moment, I said something to the effect of "We must find a way to offer uniquely relevant service if we are to survive as a profession." Overwhelmingly, what I was hearing and observing for that group activity was psych-based practice ideation. In fact, although it wasn't marketed that way, the entire conference was practically themed "getting back to our roots." No one was saying it directly but *unequivocally* indicating (if you were paying attention and reading between the lines) that we need to do exactly what Ron is saying in order to survive long term. If we are "copy cats" of another profession, they are going to prove, through an advanced degree program and being called "doctor" in *our* workplace (or at least the one we think we have a right to) that they can do it better. Is any of this making sense to anyone else out there, or am I just some random 26-year-in-the-profession clinician out here invisibly and irrelevantly waving my arms, jumping up and down and shouting, "Hey, wake up, pay attention?" Respectfully and thoughtfully, Bill Maloney, OTR On Sun, Aug 31, 2008 at 3:59 PM, <[EMAIL PROTECTED]> wrote: > Send OTlist mailing list submissions to > [email protected] > > To subscribe or unsubscribe via the World Wide Web, visit > http://otnow.com/mailman/listinfo/otlist_otnow.com > or, via email, send a message with subject or body 'help' to > [EMAIL PROTECTED] > > You can reach the person managing the list at > [EMAIL PROTECTED] > > When replying, please edit your Subject line so it is more specific > than "Re: Contents of OTlist digest..." > > > Today's Topics: > > 1. Re: Elbow Break, Referral... (Ron Carson) > 2. Re: Elbow Break, Referral... (Mary Alice Cafiero) > 3. Re: Elbow Break, Referral... (Kari Rogozinski) > 4. Re: Elbow Break, Referral... (Ron Carson) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Sun, 31 Aug 2008 15:04:05 -0400 > From: Ron Carson <[EMAIL PROTECTED]> > Subject: Re: [OTlist] Elbow Break, Referral... > To: L Sloan <[email protected]> > Message-ID: <[EMAIL PROTECTED]> > Content-Type: text/plain; charset=iso-8859-1 > > So you measure knee ROM? If so, you are by far and exception to the > rule. > > Ron > -- > Ron Carson MHS, OT > > ----- Original Message ----- > From: L Sloan <[EMAIL PROTECTED]> > Sent: Sunday, August 31, 2008 > To: [email protected] <[email protected]> > Subj: [OTlist] Elbow Break, Referral... > > LS> actually Ron....I do document limitations with lower extremity > LS> ROM especially of the knees if it affects self-care.... > LS> Lisa > > > > LS> ----- Original Message ---- > LS> From: Ron Carson <[EMAIL PROTECTED]> > LS> To: L Sloan <[email protected]> > LS> Sent: Sunday, August 31, 2008 7:04:12 AM > LS> Subject: Re: [OTlist] Elbow Break, Referral... > > LS> Hello Lisa: > > LS> Why? take? measurements if they aren't part of the goal? I do document > LS> when a patient has limited ROM, but I don't measure it. > > LS> Don't? you measure ROM when a patient has a lower extremity impairment > LS> affecting function? Why not???? > > LS> Ron > LS> -- > LS> Ron Carson MHS, OT > > LS> ----- Original Message ----- > LS> From: L Sloan <[EMAIL PROTECTED]> > LS> Sent: Saturday, August 30, 2008 > LS> To:? [email protected] <[email protected]> > LS> Subj: [OTlist] Elbow Break, Referral... > > LS>> Ron...did i understand you to say you don't take ROM > LS>> measurements...why not????? I do take measurements or approximate > LS>> on every patient with Upper extremity impairment affecting their > function????? Lisa > > > > LS>> ----- Original Message ---- > LS>> From: Ron Carson <[EMAIL PROTECTED]> > LS>> To: Kari Rogozinski <[email protected]> > LS>> Sent: Saturday, August 30, 2008 7:54:38 PM > LS>> Subject: Re: [OTlist] Elbow Break, Referral... > > LS>> Call? me? think-headed,? but? I? don't? see? how? those? goals are any > LS>> different? than? PT.? When I read the goals I see the primary focus on > LS>> decreasing? pain and increasing ROM and the "functional" stuff is just > LS>> thrown in. And that's primarily what PT does. > > LS>> OT? knows? there's? a? lot? more? to? dressing? than? just? physical > LS>> dysfunction..? There's? the? environment, cognition, motivation, > family > LS>> issues,? etc.? With your goals, what happens if ROM is increase so > LS>> the? patient? SHOULD be able to dress but they still can't because the > LS>> family? doesn't? feel? they? are? safe?? According? to your goals, the > LS>> patient is d/c. Either that or you'll need some new goals! > > LS>> I? will? also? suggest? that goals should not be written unless it has > LS>> been? assessed.? In? other? words,? I don't write ROM goals, because I > LS>> don't? take ROM measurements. I do assess occupation and those are the > LS>> goals that I write. > > LS>> Again,? what the therapists assess should be the goals. And > conversely, > LS>> if? it's not assessed then it shouldn't be a goal. Also, goals must be > LS>> measurable? and? progress? must? be? made. How can a therapist measure > LS>> progress? towards? a? goal? that? is not initially measured? And, what > LS>> measure? is? going? to? be? used?? I will say the "increase functional > LS>> performance with bilateral UE tasks" is not exactly a measurable goal? > > LS>> Now,? if? you? assessed that the patient required mod assist to donn > LS>> her? bra? and the goal was "Pt will independently donn/doff bra", then > LS>> that's? an? OT? assessment? and goal. However, can you see this ladies > LS>> face? when? I ask her about how much assistance she need to put on her > LS>> bra,? or? pull up her underwear? She's going to think I'm nuts because > LS>> she? wants? me? to? fix? her? arm, not worry about teaching her to get > LS>> dressed! > > LS>> Gosh, I hate long messages..... > > LS>> <Sorry for typos/graphos> > > LS>> Ron > LS>> -- > LS>> Ron Carson MHS, OT > > LS>> ----- Original Message ----- > LS>> From: Kari Rogozinski <[EMAIL PROTECTED]> > LS>> Sent: Saturday, August 30, 2008 > LS>> To:? [email protected] <[email protected]> > LS>> Subj: [OTlist] Elbow Break, Referral... > > KR>>> I agree 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 will 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>>>? ? ? > > > > LS>> -- > LS>> Options? > LS>> www.otnow.com/mailman/options/otlist_otnow.com > > LS>> Archive? > LS>> www.mail-archive.com/[EMAIL PROTECTED] > > > > LS>>? ? ? > > > > LS> -- > LS> Options? > LS> www.otnow.com/mailman/options/otlist_otnow.com > > LS> Archive? > LS> www.mail-archive.com/[email protected] > > > > LS> > > > > > > ------------------------------ > > Message: 2 > Date: Sun, 31 Aug 2008 14:34:16 -0500 > From: Mary Alice Cafiero <[EMAIL PROTECTED]> > Subject: Re: [OTlist] Elbow Break, Referral... > To: [email protected] > Message-ID: <[EMAIL PROTECTED]> > Content-Type: text/plain; charset=US-ASCII; format=flowed; delsp=yes > > I agree, Lisa. I was taught, both in school and on the job, that a > goal should include what you are improving and what the functional > outcome of that improvement will be. That doesn't mean that the > treatment I do will be an exercise routine to improve strength (though > sometimes it is). It does mean that the goal reflects what is > improving in order to meet the functional outcome. > I don't consider that PT. > Mary Alice > > Mary Alice Cafiero > [EMAIL PROTECTED] > 972-757-3733 > Fax 888-708-8683 > > This message, including any attachments, may include confidential, > privileged and/or inside information. Any distribution or use of this > communication by anyone other than the intended recipient(s) is > strictly prohibited and may be unlawful. If you are not the recipient > of this message, please notify the sender and permanently delete the > message from your system. > > > On Aug 31, 2008, at 8:09 AM, L Sloan wrote: > > > Sorry Ron...I totally disagree...in my 20 years I have always > > included ROM, pain with function....that is how I was > > trained...maybe school has changed since then........to me the ROM > > and pain has everything to do with the function...I have always > > assessed it when doing an evaluation...that is part of my assessment > > as sensation is, coordination, cognition etc. I do not consider > > that PT.... > > Lisa > > > > > > > > ----- Original Message ---- > > From: Ron Carson <[EMAIL PROTECTED]> > > To: L Sloan <[email protected]> > > Sent: Sunday, August 31, 2008 7:09:48 AM > > Subject: Re: [OTlist] Elbow Break, Referral... > > > > If the goal is increased ROM or decreased pain, why include the > > "functional" component? It seems obvious to me that if ROM/pain are > > the ONLY things preventing the patient from doing self-care, then > > positively impacting these area will directly improve self-care. So, > > why even include the the "function". > > > > If the goal is occupation, then I see no reason for the ROM/pain > > component. As and OT, I strongly believe that occupation should be the > > goal, but occupation is not always the goal of the patient or MD. And > > it's these situations where OT is out on a limb, because we are truly > > practicing OT, but PT. > > > > Ron > > -- > > Ron Carson MHS, OT > > > > ----- Original Message ----- > > From: L Sloan <[EMAIL PROTECTED]> > > Sent: Saturday, August 30, 2008 > > To: [email protected] <[email protected]> > > Subj: [OTlist] Elbow Break, Referral... > > > > LS> How About.... > > LS> Patient will demonstrate increased active range of motion to ____ > > LS> during upper and lower body dressing activities.....or... > > LS> Patient will demonstrate increased AROM to ___ to allow patient > > LS> to complete upper and lower body selfcare activities safely... > > LS> Patient will demonstrate a decrease in pain from ___ to ___ to > > LS> enable her to complete her dressing activities. > > LS> ??? Lisa > > > > > > > > LS> ----- Original Message ---- > > LS> From: Ron Carson <[EMAIL PROTECTED]> > > LS> To: OTlist <[email protected]> > > LS> Sent: Saturday, August 30, 2008 3:48:47 PM > > LS> Subject: [OTlist] Elbow Break, Referral... > > > > LS> Received a new referral for a elbow fracture. I shouldn't have > > taken > > LS> it but I did. > > > > LS> And here is the dilemma facing our profession. The patient > > is 95, > > LS> previously living independently. Fractured elbow in a fall. Now > > living > > LS> with daughter. She is in a large amount of pain. Obviously, > > she is > > LS> dependent for most of her occupations. She currently uses a > > cane but > > LS> is not safe. > > > > LS> The patient's immediate concerns are her elbow. When pressed, > > she of > > LS> course wants to go back home, but that is not an immediate goal. > > > > LS> So what do I write for goals? For example should I write: > > > > LS> Patient will self-report pain as 3 out of 10 > > > > LS> Patient's will increase active elbow extension to -20 > > degrees > > > > > > LS> These goals seem to direct the patients and doctor's concerns > > but are > > LS> not occupationally oriented. So, should I write: > > > > > > LS> Patient will safely and independently dress lower body > > > > LS> Patient will safely and independently ambulate to the > > bathroom > > LS> using the least restrictive mobility aid > > > > LS> I like these goals but they don't address the immediate concerns. > > > > LS> Ron > > LS> -- > > LS> Ron Carson MHS, OT > > > > > > LS> -- > > LS> Options? > > LS> www..otnow.com/mailman/options/otlist_otnow.com > > > > LS> Archive? > > LS> www.mail-archive.com/[email protected] > > > > > > > > LS> > > > > > > > > -- > > 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] > > > > ------------------------------ > > Message: 3 > Date: Sun, 31 Aug 2008 12:07:27 -0700 (PDT) > From: Kari Rogozinski <[EMAIL PROTECTED]> > Subject: Re: [OTlist] Elbow Break, Referral... > To: [email protected] > Message-ID: <[EMAIL PROTECTED]> > Content-Type: text/plain; charset=iso-8859-1 > > Measuring ROM and MMS is still very much a part of the curriculum in OT > school.? My colleague teaches the phys/dys course at the local university > and they spend ample time making sure the students can take these > measurements, not sure why they would spend so much time on it if we weren't > supposed to be doing them?? I have been practicing for almost 8 years now > and i too? take?measurements at eval and find they have everything to do > with function.? > ? > Ron, it really seems to bother u that other OT's use these measurements or > include what they were trained to do , why is that??Do you feel that PT's > are the only onces that should be taking measurements?? > ? > ?IMO, I don't find that there is a clear cut example of specific OT patient > or specific PT patient. PT and OT can and will overlap in many instances but > can work in conjunction with one another to make the clients as functional > and safe as possible.? I've never really seen a patient and thought to > myself only a PT can help them, rather the opposite.? I have found that most > clients that are being treated by a physical therapist have functional > limitations that can be addressed by OT.?? > ? > Just my thoughts, > ? > Kari, OTR/L > ? > ? > ? > > --- On Sun, 8/31/08, L Sloan <[EMAIL PROTECTED]> wrote: > > From: L Sloan <[EMAIL PROTECTED]> > Subject: Re: [OTlist] Elbow Break, Referral.. > To: [email protected] > Date: Sunday, August 31, 2008, 9:09 AM > > Sorry Ron...I totally disagree...in my 20 years I have always included ROM, > pain > with function....that is how I was trained...maybe school has changed since > then........to me the ROM and pain has everything to do with the > function...I > have always assessed it when doing an evaluation...that is part of my > assessment > as sensation is, coordination, cognition etc.? I do not consider that > PT.... > Lisa > > > > ----- Original Message ---- > From: Ron Carson <[EMAIL PROTECTED]> > To: L Sloan <[email protected]> > Sent: Sunday, August 31, 2008 7:09:48 AM > Subject: Re: [OTlist] Elbow Break, Referral... > > If? the? goal? is? increased? ROM? or? decreased pain, why include the > "functional"? component?? It? seems obvious to me that if ROM/pain > are > the? ONLY? things? preventing? the? patient from doing self-care, then > positively? impacting? these area will directly improve self-care. So, > why even include the the "function". > > If? the? goal? is? occupation,? then? I see no reason for the ROM/pain > component. As and OT, I strongly believe that occupation should be the > goal,? but occupation is not always the goal of the patient or MD. And > it's? these situations where OT is out on a limb, because we are truly > practicing OT, but PT. > > Ron > -- > Ron Carson MHS, OT > > ----- Original Message ----- > From: L Sloan <[EMAIL PROTECTED]> > Sent: Saturday, August 30, 2008 > To:? [email protected] <[email protected]> > Subj: [OTlist] Elbow Break, Referral... > > LS> How About.... > LS> Patient will demonstrate increased active range of motion to ____ > LS> during upper and lower body dressing activities.....or... > LS> Patient will demonstrate increased AROM to ___ to allow patient > LS> to complete upper and lower body selfcare activities safely... > LS> Patient will demonstrate a decrease in pain from ___ to ___ to > LS> enable her to complete her dressing activities. > LS> ??? Lisa > > > > LS> ----- Original Message ---- > LS> From: Ron Carson <[EMAIL PROTECTED]> > LS> To: OTlist <[email protected]> > LS> Sent: Saturday, August 30, 2008 3:48:47 PM > LS> Subject: [OTlist] Elbow Break, Referral... > > LS> Received? a? new referral for a elbow fracture. I shouldn't have > taken > LS> it but I did. > > LS> And? here? is? the? dilemma? facing our profession. The patient is > 95, > LS> previously living independently. Fractured elbow in a fall. Now living > LS> with? daughter.? She? is? in a large amount of pain. Obviously, she > is > LS> dependent? for? most of her occupations. She currently uses a cane but > LS> is not safe. > > LS> The? patient's? immediate concerns are her elbow. When pressed, > she of > LS> course wants to go back home, but that is not an immediate goal. > > LS> So what do I write for goals? For example should I write: > > LS> ? ? ? ? Patient will self-report pain as 3 out of 10 > > LS> ? ? ? ? Patient's will increase active elbow extension to -20 > degrees > > > LS> These? goals seem to direct the patients and doctor's concerns but > are > LS> not occupationally oriented. So, should I write: > > > LS> ? ? ? ? Patient will safely and independently dress lower body > > LS> ? ? ? ? Patient? will safely and independently ambulate to the > bathroom > LS> ? ? ? ? using the least restrictive mobility aid > > LS> I like these goals but they don't address the immediate concerns. > > LS> Ron > LS> -- > LS> Ron Carson MHS, OT > > > LS> -- > LS> Options? > LS> www..otnow.com/mailman/options/otlist_otnow.com > > LS> Archive? > LS> www.mail-archive.com/[email protected] > > > > LS>? ? ? > > > > -- > 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] > > > > > > ------------------------------ > > Message: 4 > Date: Sun, 31 Aug 2008 16:59:23 -0400 > From: Ron Carson <[EMAIL PROTECTED]> > Subject: Re: [OTlist] Elbow Break, Referral... > To: Kari Rogozinski <[email protected]> > Message-ID: <[EMAIL PROTECTED]> > Content-Type: text/plain; charset=iso-8859-1 > > Kari, I think it's a good thing for OT students to learn ROM, MMT, > joint gliding, etc. All that biomechanical stuff certainly has a role > in the OT practice arena. But, I am opposed to two things: > > 1. OT's learning and applying those bio skills ONLY to the UE > > 2. OT's making those bio measurements their goals > > There is clearly a need to take ROM measurements for such things as > splints, w/c seating, etc. And, I do MMT to help establish medical > necessity for power w/c. > > So, I'm not against OT's learning these skills at all. In fact, I > think we should learn more of them. But it's HOW and WHY we apply > these skills that separate us from PT. And, there MUST be a clear line > between OT and PT, otherwise we are going to get gobbled up. > > I am not now nor have I ever been anti-PT. But, there is "writing on > the wall" that OT is moving in the wrong direction, and has been for > many years. In my opinion, we are trying to compete with PT in the > phys-dys realm and frankly we can't. > > At our fingertips is one thing that separates us from ALL other > professions, and yet we seem so blind. > > Man, I love these questions and discussions. My brain is on fire and I > am ever thankful to those who are posting questions and challenging my > statements. > > Ron > -- > Ron Carson MHS, OT > > ----- Original Message ----- > From: Kari Rogozinski <[EMAIL PROTECTED]> > Sent: Sunday, August 31, 2008 > To: [email protected] <[email protected]> > Subj: [OTlist] Elbow Break, Referral... > > KR> Measuring ROM and MMS is still very much a part of the curriculum > KR> in OT school.? My colleague teaches the phys/dys course at the > KR> local university and they spend ample time making sure the > KR> students can take these measurements, not sure why they would > KR> spend so much time on it if we weren't supposed to be doing them?? > KR> I have been practicing for almost 8 years now and i too? take > KR> measurements at eval and find they have everything to do with > function.? > KR> ? > KR> Ron, it really seems to bother u that other OT's use these > KR> measurements or include what they were trained to do , why is > KR> that??Do you feel that PT's are the only onces that should be taking > measurements?? > KR> ? > KR> ?IMO, I don't find that there is a clear cut example of specific > KR> OT patient or specific PT patient. PT and OT can and will overlap > KR> in many instances but can work in conjunction with one another to > KR> make the clients as functional and safe as possible.? I've never > KR> really seen a patient and thought to myself only a PT can help > KR> them, rather the opposite.? I have found that most clients that > KR> are being treated by a physical therapist have functional > KR> limitations that can be addressed by OT.?? > KR> ? > KR> Just my thoughts, > KR> ? > KR> Kari, OTR/L > KR> ? > KR> ? > KR> ? > > KR> --- On Sun, 8/31/08, L Sloan <[EMAIL PROTECTED]> wrote: > > KR> From: L Sloan <[EMAIL PROTECTED]> > KR> Subject: Re: [OTlist] Elbow Break, Referral.. > KR> To: [email protected] > KR> Date: Sunday, August 31, 2008, 9:09 AM > > KR> Sorry Ron...I totally disagree...in my 20 years I have always included > ROM, pain > KR> with function....that is how I was trained...maybe school has changed > since > KR> then........to me the ROM and pain has everything to do with the > function...I > KR> have always assessed it when doing an evaluation...that is part of my > assessment > KR> as sensation is, coordination, cognition etc.? I do not consider that > PT.... > KR> Lisa > > > > KR> ----- Original Message ---- > KR> From: Ron Carson <[EMAIL PROTECTED]> > KR> To: L Sloan <[email protected]> > KR> Sent: Sunday, August 31, 2008 7:09:48 AM > KR> Subject: Re: [OTlist] Elbow Break, Referral... > > KR> If? the? goal? is? increased? ROM? or? decreased pain, why include the > KR> "functional"? component?? It? seems obvious to me that if ROM/pain > KR> are > KR> the? ONLY? things? preventing? the? patient from doing self-care, then > KR> positively? impacting? these area will directly improve self-care. So, > KR> why even include the the "function". > > KR> If? the? goal? is? occupation,? then? I see no reason for the ROM/pain > KR> component. As and OT, I strongly believe that occupation should be the > KR> goal,? but occupation is not always the goal of the patient or MD. And > KR> it's? these situations where OT is out on a limb, because we are truly > KR> practicing OT, but PT. > > KR> Ron > KR> -- > KR> Ron Carson MHS, OT > > KR> ----- Original Message ----- > KR> From: L Sloan <[EMAIL PROTECTED]> > KR> Sent: Saturday, August 30, 2008 > KR> To:? [email protected] <[email protected]> > KR> Subj: [OTlist] Elbow Break, Referral... > > LS>> How About.... > LS>> Patient will demonstrate increased active range of motion to ____ > LS>> during upper and lower body dressing activities.....or... > LS>> Patient will demonstrate increased AROM to ___ to allow patient > LS>> to complete upper and lower body selfcare activities safely... > LS>> Patient will demonstrate a decrease in pain from ___ to ___ to > LS>> enable her to complete her dressing activities. > LS>> ??? Lisa > > > > LS>> ----- Original Message ---- > LS>> From: Ron Carson <[EMAIL PROTECTED]> > LS>> To: OTlist <[email protected]> > LS>> Sent: Saturday, August 30, 2008 3:48:47 PM > LS>> Subject: [OTlist] Elbow Break, Referral... > > LS>> Received? a? new referral for a elbow fracture. I shouldn't have > KR> taken > LS>> it but I did. > > LS>> And? here? is? the? dilemma? facing our profession. The patient is > KR> 95, > LS>> previously living independently. Fractured elbow in a fall. Now living > LS>> with? daughter.? She? is? in a large amount of pain. Obviously, she > KR> is > LS>> dependent? for? most of her occupations. She currently uses a cane but > LS>> is not safe. > > LS>> The? patient's? immediate concerns are her elbow. When pressed, > KR> she of > LS>> course wants to go back home, but that is not an immediate goal. > > LS>> So what do I write for goals? For example should I write: > > LS>> ? ? ? ? Patient will self-report pain as 3 out of 10 > > LS>> ? ? ? ? Patient's will increase active elbow extension to -20 > KR> degrees > > > LS>> These? goals seem to direct the patients and doctor's concerns but > KR> are > LS>> not occupationally oriented. So, should I write: > > > LS>> ? ? ? ? Patient will safely and independently dress lower body > > LS>> ? ? ? ? Patient? will safely and independently ambulate to the > KR> bathroom > LS>> ? ? ? ? using the least restrictive mobility aid > > LS>> I like these goals but they don't address the immediate concerns. > > LS>> Ron > LS>> -- > LS>> Ron Carson MHS, OT > > > LS>> -- > LS>> Options? > LS>> www..otnow.com/mailman/options/otlist_otnow.com > > LS>> Archive? > LS>> www.mail-archive.com/[email protected] > > > > LS>>? ? ? > > > > KR> -- > KR> Options? > KR> www.otnow.com/mailman/options/otlist_otnow.com > > KR> Archive? > KR> www.mail-archive.com/[email protected] > > > > KR> > KR> -- > KR> Options? > KR> www.otnow.com/mailman/options/otlist_otnow.com > > KR> Archive? > KR> www.mail-archive.com/[email protected] > > > > KR> > > > > > > ------------------------------ > > -- > Unsubscribe? > [EMAIL PROTECTED] > > Change options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] > > Help? > [EMAIL PROTECTED] > > > > End of OTlist Digest, Vol 41, Issue 26 > ************************************** > -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
