Pat, I think there are always OUTLIERS in what a specific OT practitioner might do. And your situation is a perfect example. I also have an example, because I am trained in lymphedema care. When treating lymphedema, I consider myself to be an OT doing lymphedema. I do NOT consider what I do as true OT. But, what I'm striving for is not examples like ours, but mainstream OT. OT that is practiced by the vast majority of practitioners. OT that is recognized by referral sources and that they fully comprehend what OT does.
Right now, I think the vast majority of OT referrals sources (adult phys-dys) see OT as UE PT or ADL trainer. Frankly, I am much more pleased with the ADL trainer perspective, but what I really hope is that referral sources, and other professions such as PT, see us as occupation experts. And it's precisely this reason that I think AOTA MUST start a national campaign ad promoting occupation. I know a lot of people jump on the backpack awarness ad, but I for one, do not think it serves our profession very well. On the other hand, if AOTA put advertising dollars into promoting occupation, the profession as a whole would benefit. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Pat <[EMAIL PROTECTED]> Sent: Friday, October 10, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Best Practice and OT expertise P> Ron, P> You say "I don't take ROM or muscle strength measures." In my P> setting (chronic pain management/functional restoration), I can't get P> away with not doing that. I do a complete Physical Performance Test, P> including ROM and static and dynamic strength testing, before, P> during, and after the program... because the insurance companies I P> deal with demand them. P> Just this week a patient was denied an extension of services because P> their increases in ROM and strength, and their decrease in pain P> levels, were minimal... despite the fact that this patient had P> significantly improved in function. The peer review dr was totally P> disinterested in function, despite that returning patients to work P> was one of the insurance companies main goals. The dr said he P> wouldn't approve more days because they didn't benefit from the days P> they already had, despite all my concrete examples of how they HAD P> improved. All they cared about were the numbers. P> The ODG guidelines require baseline measurements (I don't know if P> that is just a Texas thing, or not), yet they deny coverage for P> intake testing (to GET the baseline measurements) as being medically P> unnecessary! They force us to do the initial eval for free, and then P> base the number of days they get in the program strictly on the P> numbers, and if and how they change. (Scores on the BAI and BDI and P> pain scales are numbers we also use). Fortunately, they do pay for P> the subsequent PPTs. P> Despite the fact that they only "cover" specific body parts, it is a P> "full body" program, both physically and psychologically... but we P> can only document the covered parts. P> I am certain that what I do at work would be not be considered to be P> "true" OT, and certainly not "best practice" as you define it. All I P> can do is MY best to help my patients regain as much function, in the P> form of occupation, as possible. P> I think "best practice" is meaningful only to us, as OTs. If we do P> our best we darn sure aren't going to get paid for it! P> Pat P> At 04:23 AM 10/10/2008, you wrote: >>Then adaptation and education might be indicated. >> >>Joan, in using the approach I outlined, there isn't a difference >>between treating people with cog deficits and phy deficits. In fact, >>that's the beauty of the approach; The focus is occupational >>performance, not underlying issues. And because the focus is on the >>universal phenomena of occupation performance, it applies to all >>people having occupation deficits. >> >>Of course, that does not mean we don't treat those underlying issues, >>it simply means that issues aren't our measure. For example, I don't >>take ROM or muscle strength measures. To be sure, I range limbs and do >>manual muscle testing, but I almost never record measurements. Why? >>Because improving these measurements is not my goal. However, I may >>assess range and strength because these may be barriers to occupation. >>In practice, however, I usually have patients attempt desired >>occupational goals or preliminary steps to those goals. My observation >>of the patient's occupational performance gives me a much better >>picture of occupation barriers than simple strength/rom measurements. >> >>In summary, using the outline I provided, really serves to unify OT >>across its diverse treatment spectrum. Peds, adults, gero, neuro, etc. >>can all use a similar approach. As I was typing this another example >>of this model popped into my head. >> >>I just started treating a man with what is essentially fatigue. He's >>had lots of medical issues and was hospitalized for a long time. He >>just came home and I picked him up on home health. During my eval, the >>patient presented with Parkinson's like symptoms; slow speech, >>tremors, flat affect, etc., however, there was no neuro diagnosis. I >>wanted a better idea of his cognitive status, so I whipped out my >>trusty MMSE. Surprisingly, he scored 27/30, which is normal. So, why >>did I do the MMSE? >> >>Simply put, I wanted to see if cognition was a possible barrier to his >>occupational performance. In this case it wasn't. But if it were, I >>would have probably use his goals as treatment. Again, the goal, and >>hence the measurement, is not remediating the underlying issue but >>improving occupation. >> >>So, an occupation-based approach applies to OT working in phys-dys, >>cognition, pediatrics, neuro, etc. But unlike other approaches, an OT >>using an occupation-based approach has one single purpose and reason >>for being, and that is improving occupational performance. >> >>Thanks, >> >>Ron >>-- >>Ron Carson MHS, OT >> >>----- Original Message ----- >>From: Joan Riches <[EMAIL PROTECTED]> >>Sent: Friday, October 10, 2008 >>To: [email protected] <[email protected]> >>Subj: [OTlist] Best Practice and OT expertise >> >>JR> .........and if cognition cannot be remediated? >>JR> Joan >> >> >> >> >>-- >>Options? >>www.otnow.com/mailman/options/otlist_otnow.com >> >>Archive? >>www.mail-archive.com/[email protected] P> -- P> Options? P> www.otnow.com/mailman/options/otlist_otnow.com P> Archive? P> www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
