Hello Arley:
Good questions.
Here's my approach regarding the mobility aides. If I'm seeing
patients in my private practice, I assume all responsibility for
progressing patients' mobility aides. IF I'm seeing patients under
home health, I generally leave the mobility aides to the PT. I only do
this because it's traditionally what they do and I very new with my
company and don't want to step on toes. Plus, it can be very confusing
to the patient if I'm using a cane and the PT is using a walker. But,
I can't say that I always do this, because I'm currently seeing a
patient who has been using a walker to stand but the we've been
ambulating with hand-held assist.
Progressing patients to their goals starts at the least common
denominator that is keeping them from reaching their goals AND that
I'm able to positively affect. Without doubt, the most common areas
that I address are:
1. Motivation
2. Fear
3. Environment
4. Lower extremity strength/ROM
5 Endurance
6. Family
My approach generally involves engaging the patient in the desired
outcome at the greatest level they can sustain. For example:
1. A current patients goal is to pun on her own underwear.
Her greatest limitation is LE strength, fear of falling,
endurance and maybe even motivation. So, we have started
standing beside with her walker, recording the length of time
she can stand. Initially, it was 15 secs and on Friday, it was
over 2 minutes.
I've been encouraging her to take a step. Once she is
comfortable with her standing, she will and then we will
progress to walking to her dresser to get her clothes.
Once she is able to get her clothes, I will probably need to
provide some adaptive equipment to extend her reach to start
her underwear over her feet.
2. Another patient (s/p total hip replc) needs to be independent in
her apartment. Specific goals are outlined below. I evaluated her
last Wednesday and on Friday, here's what we did:
1. Using her walker, the patient ambulated to her car in the
garage and we discussed and practiced car transfers.
2. We did a "dry run" for shower transfers and discussed grab
rail placement and the need for different equipment
3. We practiced bed transfers and reviewed hip precautions
4. We spent a GREAT deal of time working on proper techique
for sit/stand. The patient tends to over use her arms (a
learned habit to avoid pain in her hip) and now I'm trying to
teach her the old "nose over the toes" approach to standing
while extending her affected hip.
Does this help?
Ron
--
Ron Carson MHS, OT
----- Original Message -----
From: Johnson, Arley <[EMAIL PROTECTED]>
Sent: Saturday, September 06, 2008
To: [email protected] <[email protected]>
Subj: [OTlist] Advance for OT Article: Point #3
JA> Ron:
JA> Just curious, with the below patient, what is your intervention
JA> to facilitate progression towards these goals?
JA> In regards to the simple meal prep goal, did your patient define
JA> independence without mobilty aide when navigating around the
JA> kitchen? If so, do you stay on the case until this is achieved?
JA> And if so, how do you progress them off of the mobility aide to
JA> head towards this goal during your sessions?
JA>
JA> No harm, I'm sincerely just trying to understand how you would approach
this common situation.
JA>
JA> Arley Johnson, MS, OTR/L
JA>
JA> ________________________________
JA> From: [EMAIL PROTECTED] on behalf of Ron Carson
JA> Sent: Sat 9/6/2008 8:23 AM
JA> To: Neal Luther
JA> Subject: Re: [OTlist] Advance for OT Article: Point #3
JA> Hello Neal:
JA> If OT's would adopt occupational goals then patients would be d/c when
JA> those goals are achieved. For example, if the goal is:
JA> "By d/c, patient will safely and independently transfer
JA> to/from car"
JA> Once the goal is best achieved the patient is discharged. Of course,
JA> patients have multiple goals but the concept is the same.
JA> Just last week, I evaluated a patient with total hip replacement. The
JA> evaluation resulted in 5 goals (in abbreviated format):
JA> 1. In/out shower
JA> 2. In/out of car
JA> 3. On/off toilet
JA> 4. Simple meal prep
JA> 5. Lower body dressing
JA> Using the above approach, it's easy to tell when the goal(s) are
JA> achieved. If additional goals are not established, the patient is
JA> discharged. Also, this approach empowers the patient because they
JA> generate their own goals.
JA> I strongly believe that my job is NOT making goals, but facilitating
JA> the patient to achieve them. Of course, there are exceptions.
JA> Ron
JA> --
JA> Ron Carson MHS, OT
JA> ----- Original Message -----
JA> From: Neal Luther <[EMAIL PROTECTED]>
JA> Sent: Friday, September 05, 2008
JA> To: [email protected] <[email protected]>
JA> Subj: [OTlist] Advance for OT Article: Point #3
NL>> Arley
NL>> I could not agree more! You are making some of the same points
NL>> that I believe Dr. Sorenesen has made recently with regard to EI
NL>> (quite a broohaha). We simply don't know how/when to D/C I
NL>> believe in part because we have not established plans of care
NL>> based on sound clinical reasoning. We confuse altruism with
NL>> therapeutic intervention (give a man a fish vs. teach a man to
NL>> fish). This results in treating everyone and everything and if
NL>> done so long enough even the smallest changes/improvements are
NL>> claimed to be as result of treatment. My two cents.
NL>> Neal C. Luther,OTR/L
NL>> Rehab Program Coordinator
NL>> Advanced Home Care
NL>> 1-336-878-8824 xt 3205
NL>> [EMAIL PROTECTED]
NL>> Home Care is our Business...Caring is our Specialty
JA> --
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