Hello Arley and Others:
What I envision for OT is that specific treatment is directed to
improving SPECIFIC occupational performance. What I fear happens is
that OT's provide specific treatment to address GENERAL occupational
performance goals. For example, a therapist will improve UE strength
so the patient can do UE dressing. To me this is an upside-down
approach that has very little place within the practice of OT. What's
wrong with this approach is that it's no different than PT and also it
I find that most OT's practicing this way LIMIT THEIR TREATMENT TO THE
UE.
Now, IF a patient identifies a goal of dressing (AND THE OT WRITES A
DRESSING GOAL, NOT something like the "patient will improve strength
to dress upper body") and UE strength is a limiting factor for
dressing, then UE strengthening is indicated. Let me try further
explaining an occupational approach to OT.
Long ago, I stumbled upon the Canadian OT Associations' seminal work
called: Enabling Occupation: An Occupational Therapy Perspective. This
book is OUTSTANDING for developing and implementing an
occupation-based perspective and treatment approach. Within this book,
readers find the frequently cited COPM (Canadian Occupational
Performance Measure) AND the much less cited OPPM (Occupational
Performance Process Model) The OPPM outlines 7 MAJOR steps of
implementing an occupation-based approach to treatment:
1. Name, validate & prioritize issues relating to occupational
performance areas
2. Select appropriate theoretical approaches
3. Identify OP components and environmental issues contributing to
previously identified performance areas
4. Identify strengths and resources
5. Develop outcomes & action plan (i.e. LTG, STG and treatment plan)
6. Implement Plans
7. Evaluate outcomes
Notice the VERY FIRST thing is identifying occupational performance
deficits. This is the first thing, because remediating the deficits
becomes the goals. This approach is not about remediating the
underlying causes (although that is done to achieve the goals), it's
about improving occupational performance. In this approach, occupation
is ALWAYS the written goal and not some sort of backhanded outcome.
So, to answer your 1st question. If a patient states a desired
occupation and that occupation is hindered by balance, then what else
should you work on? Conversely, just because someone has a balance
issue, that doesn't mean they have occupational deficits and in that
case I think an OT working on balance is NOT doing OT, they are doing
balance training.
Regarding burns, I have a hard time understanding and applying the
role of OT in any acute care setting. I worked in an acute care
hospital for exactly 1/2 day before realizing that this was not
setting for my perspective of OT.
Ron
--
Ron Carson MHS, OT
----- Original Message -----
From: Johnson, Arley <[EMAIL PROTECTED]>
Sent: Sunday, September 07, 2008
To: [email protected] <[email protected]>
Subj: [OTlist] Advance for OT Article: Point #3
JA> This might sound strange, but I think we are saying the same
JA> thing to some degree. Please, correct me if I misunderstand your
JA> below point. My prep work would lead me into practicing a
JA> component or whole of the actual occupational task that has been
JA> identified a a goal during that same session and every session afterwards .
JA> So, you're saying that if impaired balance is the major limiting
JA> factor in achieving independence in item retrieval in ADLS, meal
JA> prep, that I shouldn't try balance training techniques? If not,
JA> what course of action should I try?
JA> Also, do you think OT belongs in the burn units in the early phase?
JA>
JA> Arley
JA> ________________________________
JA> From: [EMAIL PROTECTED] on behalf of Ron Carson
JA> Sent: Sat 9/6/2008 8:13 AM
JA> To: Johnson, Arley
JA> Subject: Re: [OTlist] Advance for OT Article: Point #3
JA> Arley, I appreciate your comments but from my perspective, using
JA> "prep" techniques "enroute to addressing occupation based deficits" is
JA> not much different than what phy dys OT's have been doing for years.
JA> The only thing that I see different is the use of the word
JA> "occupation".
JA> It's my opinion that as OT's, its imperative that treatment be
JA> directed towards empowering patients to engage in SPECIFIC
JA> occupational deficits. There must be a DIRECT corollary between our
JA> goals and our treatment. I do not think that treatment modalities
JA> directed to remediate physical dysfunction so that a person might
JA> engage in occupation is best practice. In fact, that sort upside down
JA> treatment is EXACTLY what OT has been doing for years.
JA> Also, I think the OT perspective should be that "the root of the
JA> problem" is not physical dysfunction but occupational dysfunction.
JA> Ron
JA> Ron Carson MHS, OT
JA> ----- Original Message -----
JA> From: Johnson, Arley <[EMAIL PROTECTED]>
JA> Sent: Friday, September 05, 2008
JA> To: [email protected] <[email protected]>
JA> Subj: [OTlist] Advance for OT Article: Point #3
JA>> I would like to start by asking this question: If an OT is
JA>> treating a stroke patient and uses neurofacilitation strategies in
JA>> their treatment or a peds therapist performs prepping techniques
JA>> prior to her play activities, is there a difference when an OT
JA>> uses PAMs and strengthening exercises with the ortho population en
JA>> route to addressing occupation based deficits? I think we need to
JA>> address the root of the problem by appropriate means and then
JA>> bring it home to the patient during and after every session to a
JA>> functional, meaningful implication/connection.
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