Ron, A brain surgeon is without question a specialization, but they still call him a doctor, right?? A hand therapist is without question a specialization, but they still can be called an OT.
I certainly agree that our field would open up even more if all therapists would take an occupation-based approach with their patients.? However, I believe it woud be unwise to have the therapists that?happen to specialize in UE rehab to form their own proffession.? I think we need to embrace our specializations whether it be 1) lymphedema trained folks 2) UE neuro re-education 3) hand therapy 4) burn therapy.? In fact I believe that these specialization can be occupationally based if they choose to do so, and within the limitations of an outpatient facility of course.? The splitting of the proffesion would be a horrible idea in this age of? poor economics, ?the baby boomers, therapy staff shortages, and the strength in numbers for our national organization AOTA. How did you form such a definition of occupation and this rigid form of who we are as a profession?? Historically speaking the type of "occupations" involving ADL/IADL that you are speaking of did not hit main stream OT until we became involved in physcial disabilities after the World War.? In fact during the World War we treated the wounded patients with arts and crafts to help them with their arm functions.? I doubt if any of the patient's prior "occupations" were in fact arts and crafts. We were in fact?a subspeciality of physical therapy in the military.? So to say that hand therapists are not OTs is wrong, just look at the roots of our proffesion.? Instead we need to embrace where we came from and respect?the specialties found in our proffession.? Chris Nahrwold MS, OTR -----Original Message----- From: Ron Carson <[EMAIL PROTECTED]> To: [EMAIL PROTECTED] <[email protected]> Sent: Wed, 8 Oct 2008 10:40 pm Subject: Re: [OTlist] Best Practice Chris, I'm not quite sure what solutions to discuss, but here's a venture. If the concern is that some OT's will lose their jobs, I believe that many more OT positions will open up if OT's will change their practice patterns. On the flip side, hand therapists might be best served if they form their another profession. I truly think that hand therapy is so specialized that much of the practice of "general" OT is lost. This is similar to a brain surgeon. While he's been through med school, he probably is not a good general practitioner, right? Also, I take exception that my philosophy is narrow. In fact, adopting an occupation-based approach to treatment significantly widens treatment options and venues. An occupation-based approach moves OT away from it's well-engrained pattern of UE therapy into a new an wonderful world. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Sent: Wednesday, October 08, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Best Practice cac> Any concrete solutions? cac> Chris Nahrwold MS, OTR cac> -----Original Message----- cac> From: Ron Carson <[EMAIL PROTECTED]> cac> To: [EMAIL PROTECTED] <[email protected]> cac> Sent: Wed, 8 Oct 2008 8:31 pm cac> Subject: Re: [OTlist] Best Practice cac> I agree about the negativity of "contrived". But, I don't think cac> "enabling" or "shaping" is what I'm talking about. cac> I have never believed that hand therapy is occupational therapy. cac> Ron cac> -- cac> Ron Carson MHS, OT cac> ----- Original Message ----- cac> From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> cac> Sent: Wednesday, October 08, 2008 cac> To: [email protected] <[email protected]> cac> Subj: [OTlist] Best Practice cac>> Ron, cac>> I think the?phrase "contrived OT" is a very negative term to cac>> describe what you are going for.? I think a better phrase could cac>> be "shaping OT" or "enabling OT".? Your perspective of what OT is cac>> is very narrow and boxed in.? Sure at it's worst a therapist can cac>> take advantage of the system while having the patient perform cac>> meaningless exercises and activities that will not have any cac>> impact of the patient's daily occupations.? This as a result cac>> makes our profession look horrible and uneducated.???But at its cac>> best a highly skilled therapist can make a huge difference in an cac>> individuals occupational needs?by means of "shaping or enabling cac>> OT".? Lets not forget our highly skilled OTs that can make a cac>> difference in the neuro population, burn patients, hand trauma, cac>> etc etc.? You make it sound like these therapists are not OTs. cac>> I think that you are good at identifying the problems in our cac>> proffession, but can you offer?concrete solutions?? What do we do cac>> with the therapists who help neuro patients regain function in cac>> their UEs, or even?the typical hand therapists.? Some of us have cac>> become experts in this relm of OT, and to pass the patients to cac>> the PTs in this area would be a large injustice to the patient.? cac>> In fact we would probably work ourselves out of a job if we cac>> followed your narrow philisophy.? In fact there would be no more cac>> hand therapists.? What would happen to all of those therapists?? cac>> Would they all go back to school and become PTs??I believe that cac>> would cause a bunch of problems in our profession. cac>> Chris cac> Nahrwold MS, OTR cac>> St. John's Hospital cac>> Anderson, Indiana cac>> -----Original Message----- cac>> From: Ron Carson <[EMAIL PROTECTED]> cac>> To: Neal Luther <[email protected]> cac>> Sent: Wed, 8 Oct 2008 8:03 am cac>> Subject: Re: [OTlist] Best Practice cac>> Thanks Neal. cac>> I want to "pick apart" the below two statements: cac>> ================================= RC>>> "Is it so the patient will regain function? Is it so the patient RC>>> can move their arm with less pain so that they can get dressed? RC>>> Or is it because the treatments are DIRECTLY addressing a SPECIFIC RC>>> barrier to a SPECIFI C occupation? NL>>> [the above] seems to be saying the same thing. If the barrier is NL>>> pain then one would address as appropriate. cac>> ================================== cac>> I think these statements can be explained using a continuum. Draw a cac>> line and place opposing statements at each end: cac>> X <------------------------------------> X cac>> Tx to regain function Tx to regain specific occupation cac>> [contrived OT] [pure OT} cac>> For me, the hallmark of OT, and what separates us from other cac>> professions, is occupation. To the best of my knowledge, we are the cac>> only profession that claims occupation as an outcome and as treatment. cac>> On an unrelated side note, while claiming occupation sounds good, it's cac>> essentially meaningless because other professions have no knowledge of cac>> occupation. None, the less, I believe that occupation is our claim to cac>> fame. As such, it's my opinion that "pure OT" occurs when: cac>> 1. Goals are written as occupational measures, (i.e. "By d/c cac>> patient will safely and independently ambulate and transfer to cac>> standard toilet and perform all toileting tasks"). cac>> 2. Treatment is given to specific barriers which inhibit the cac>> specific occupational measure. In this case, ALL treatment is cac>> given with the assumption that improvement cac> in the treated area cac>> results in improved occupational performance. In this approach, cac>> success is measured NOT in the treated area but in occupational cac>> performance. cac>> The other end of the continuum is "treatment to regain function" or cac>> "contrived" OT. First, I think we must recognize that OT does not own cac>> function. Other therapy professions provide treatme cac>> nt to "regain cac>> function" and function is a nebulous term that is hard to define. cac>> Secondly, I use the word "contrived" because: cac>> In this app roach, OT treatment is not DIRECTLY connected to cac>> specific occupation. The OT has NOT drawn a direct line between cac>> stated occupational deficits and the treatment to improve these cac>> deficits. In this approach, the OT may do e-stim and then have the cac>> patient pickup cones, pegs, or do something like fold clothes. cac>> This is "contrived" because it may not address the "real world" cac>> demands of the patient's specific occupational demands. cac>> At its worst, "contrived" OT is a "joke" because patients are cac>> engaged in essentially meaningless and child-like games that are cac>> an embarrassment to patients and our profession. cac>> In theroy, the differences between "contrived OT" and "pure OT" are cac>> clear-cut. However, in practice, the differences can be harder to cac>> tease apart. cac>> Thanks, cac>> Ron cac>> -- cac>> Ron Carson MHS, OT cac>> ----- Original Message ----- cac>> From: Neal Luther <[EMAIL PROTECTED]> cac>> Sent: Monday, October 06, 2008 cac>> To: [email protected] <[email protected]> cac>> Subj: [OTlist] Best Practice NL>>> Your statement "Is it so the patient will regain function? Is it NL>>> so the patient can move their arm with less pain so that they can NL>>> get dressed? Or is it because the treatments are DIRECTLY NL>>> addressing a SPECIFIC barrier to a SPECIFIC occupation? If it's NL>>> anything but the later, I su cac> ggest that something other than NL>>> best-practice is being applied to your patients"...seems to be NL>>> saying the same thing. If the barrier is pain then one would NL>>> address as appropriate. cac>> -- cac>> Options? cac>> www.otnow.com/mailman/options/otlist_otnow.com cac>> Archive? cac>> www.mail-archive.com/[email protected] cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> 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]
