It does help. Thanks! Arley Johnson MS, OTR/L
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Sunday, September 07, 2008 7:41 AM To: Johnson, Arley Subject: Re: [OTlist] Advance for OT Article: Point #3 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> -- JA> Options? JA> www.otnow.com/mailman/options/otlist_otnow.com JA> Archive? JA> www.mail-archive.com/[email protected] JA> The information contained in this e-mail message is intended only JA> for the personal and confidential use of the recipient(s) named JA> above. If the reader of this message is not the intended recipient JA> or an agent responsible for delivering it to the intended JA> recipient, you are hereby notified that you have received this JA> document in error and that any review, dissemination, JA> distribution, or copying of this message is strictly prohibited. JA> If you have received this communication in error, please notify us JA> immediately by e-mail, and delete the original message. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] The information contained in this e-mail message is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify us immediately by e-mail, and delete the original message. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
