Hello Chis, Ron and others: Thanks for the stimulating discussion, which is really an already articulated issue discussed years ago by Grey, Wilcock, and others., the occupation as end versus occupation as mean argument.
My own belief is that just because an OT does something does not make it 'occupational therapy'. Further, the basis of a true profession is that it is theory driven and in a constant reflective state to assess what is current best knowledge. Educational programs change to reflect current best practice for entry level. If you look back over the history of the profession, we have again and again added content and dropped content to meet the continual challenge of staying current. Our biggest mistake in my opinion was losing our connection to the fundamental philosophy of occupation as means during the 70's thru the early 90's. Most of us practicing with 15-20 years experience are the victims of the over emphasis on the medical model which held up the occupation as end argument, at the expense of occupation as the means of the profession. We got away with it because at the time no one else was explicitly concerned with overall function like we were. However, when things tightened up and everyone became concerned with function, we started losing ground because we cannot complete on fixing parts, even if the justification behind it it that the client will in the end be able to engage in occupation. The goal today is to graduate therapists grounded in occupation who can also work with body structures and functions to facilitate engagement in occupation,not just isolated occupational performance. Below is a reference list from a doctoral course paper I wrote about about this subject--older but still very interesting articles. Terrianne Jones, MA, OTR/L Faculty University of Minnesota Program in Occupational Therapy Fischer, (1998). Uniting practice and theory in an occupational framework. In R. Padilla Ed.), A professional legacy: the Eleanor Clark Slagle Lectures in occupational therapy, 1955-2004 (2nd ed., pp. 554-575). Bethesda, MD: AOTA press. Friedland, J. (1998). Occupational therapy and rehabilitation: an awkward alliance. In R. P. Cottrell (Ed.), Perspectives on purposeful activity: foundation and future of occupational therapy (2nd ed., pp. 69-75). Bethesda, MD: AOTA press. Gutman, S. (1998). The domain of function: Who’s got it? Who’s competing for it? In R.P. Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 555- 560). Bethesda MD: AOTA press. Meyer, A. (1920). The philosophy of occupational therapy. In RP Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 25-28). Bethesda MD: AOTA press. Nelson, D. (1997). Why the profession of occupational therapy will flourish in the 21st century. In R. P. Cottrell (Ed.), Perspectives for occupation-based practice (2nd ed, pp. 113-126). Bethesda, MD: AOTA Press. Peloquin, S. (1991). Occupational therapy service: individual and collective understandings of the founders. American Journal of Occupational Therapy, 45, 33-744. Reilly, M. (1962). Occupational therapy can be one of the great ideas of 20th century medicine. In RP Cottrell (Ed.), Perspectives for occupation based practice (2nd ed.pp. 77-84). Bethesda MD: AOTA press. Trombly, C. (1995). Occupation: purposefulness and meaningfullness as therapeutic mechanisms. In RP Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 159-171). Bethesda MD: AOTA press. West, W. (1984). A reaffirmed philosophy and practice of occupational therapy for the 1980’s. The American Journal of Occupational Therapy, 38, 15-23. Wilcock, A. (1998). An occupational perspective of health. Thorofare: Slack Incorporated. Yerxa, E. (1991). Seeking a relevant, ethical and realistic way of knowing for occupational therapy. The American Journal of Occupational Therapy 45, 19 Gray, J. (1998). Putting occupation into practice: occupation as ends, occupation as means. In R.P. Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 149-158).Bethesda MD: AOTA press. Gutman, S. (1998). The domain of function: Who’s got it? Who’s competing for it? In R.P. Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 555- 560). Bethesda MD: AOTA press. Howard, S. (1991) How high do we jump? The effect of reimbursement on occupational therapy. In R.P. Cottrell (Ed.), Perspectives for occupation based practice (2nd ed., pp. 519-526). Bethesda MD: AOTA press. To: [email protected] Date: Sunday, August 31, 2008, 7:48 PM Who says we are practicing PT, and not OT?.? My credentials states OTR/L so therefore it is OT.? I don't know about you, but taking ROM measurements and treating the UE was taught in the OT education in which I went to school.? How do you comment on the OT guide to practice and our practice acts?? In my opinion it is dangerous to be that?narrow in our definition in what we do as OTs.? I certainly understand and respect your opinions, because they do make sense on paper, but when actually practicing we do have to address body functions/structures at times to help the patient make further progress.? I noticed a post that you made?in the AOTA listserve under the physical section.? In it you were giving advise about an individual with guillen barre (spelling?), and you of course talked about ADL performance, but then you gave an example of practicing sit to stands and unilateral reaching without being in the context of an ADL.? Isn't this the same as helping a patient with their arm functions through ther ex to facilitate a positive outcome with functional reaching?? Thanks again for the great discussion. Chris Nahrwold MS, OTR St. John's Hospital Anderson, Indiana -----Original Message----- From: Ron Carson <[EMAIL PROTECTED]> To: L Sloan <[email protected]> Sent: Sun, 31 Aug 2008 6:09 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 goal s? 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] --- On Sun, 8/31/08, [EMAIL PROTECTED] <[EMAIL PROTECTED]> wrote: From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Subject: Re: [OTlist] Elbow Break, Referral... To: [email protected] Date: Sunday, August 31, 2008, 7:48 PM Who says we are practicing PT, and not OT?.? My credentials states OTR/L so therefore it is OT.? I don't know about you, but taking ROM measurements and treating the UE was taught in the OT education in which I went to school.? How do you comment on the OT guide to practice and our practice acts?? In my opinion it is dangerous to be that?narrow in our definition in what we do as OTs.? I certainly understand and respect your opinions, because they do make sense on paper, but when actually practicing we do have to address body functions/structures at times to help the patient make further progress.? I noticed a post that you made?in the AOTA listserve under the physical section.? In it you were giving advise about an individual with guillen barre (spelling?), and you of course talked about ADL performance, but then you gave an example of practicing sit to stands and unilateral reaching without being in the context of an ADL.? Isn't this the same as helping a patient with their arm functions through ther ex to facilitate a positive outcome with functional reaching?? Thanks again for the great discussion. Chris Nahrwold MS, OTR St. John's Hospital Anderson, Indiana -----Original Message----- From: Ron Carson <[EMAIL PROTECTED]> To: L Sloan <[email protected]> Sent: Sun, 31 Aug 2008 6:09 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 goal s? 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] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
