Ron, ?I am so glad that you asked me that question.? The night before I wrote that response I was up late googling the "history of occupational therapy".? It was a very late night of reading.? Unfortunately, I did not tag any of my references, but I was able to check the history of my computer to determine the differenct websites that I visited on Wed night.? I think the statement came from: http://www.newfoundations.com/History/OccTher.html.? Mistakingly, though I believe I may have mispoke from my late night of reading.? Reading it again I found that the specialists of physical medicine attempted to take over the education of occupational therapy to enhance the practice of physical medicine.? I could of sworn that I read something about OT/PT in the military after World War II and that OT was a sub speciality of PT because OT was not at that time, because they?did not have military status but only worked as civilians.? But please strike that comment I made, because I cannot back it up now, and I have been trying to find it for two hours.
Does anyone know how and why OTs became involved in UE rehabilitation?? During the World war II I wonder if because of our close location to physical therapy in medical hospitals that we colaborated with them in some way.? Since we used leather, art projects, and work projects?for the mental health of the soldiers, I wonder if the physical therapists saw this as a potential modality for the soldiers with UE dysfunction.? And because of the overwhelming amount of injuried patients, I wonder if the OTs then joined to help with physical dysfunction.? As a natural line for treatment (UE/LE) I wonder if that just stuck.? Also in my reading, I noticed that there was a huge job shortage of physical therapists in 1956. http://www.recreationtherapy.com/history/rthistory3.htm.? I can't hep but to wonder if this was the time when OTs really went forward in the relm of UE dysfunction because of our huge involvement in helping individuals with polio. ?http://www1.aota.org/ajot/abstract.asp?IVol=39&INum=12&ArtID=5&Date=December%201985? And because of the PT shortage we as OTs were required to step it up and help with the UE dysfunction side of things, if not it possibly would not have gotten done.? Because of this special specialization we of course gained expertise over the following decade and our involvement in UE dysfunciton has remained to this day.? This perspective is of course all speculation based on bits and pieces of our history on the net. This discussion has been good for me and it has made me reflect on my own practice patterns when I work in the outpatient setting.? I help with a lot of outpatient stroke rehab.? Most of the time the client centered goals of the stroke patient are to "Move my arm more".? When asked why they state "So I can do more stuff with it".? With more probing into the specifics they look at me like I am a idiot and often state "Of course I want to use it to dress more effeciently, what kind of question is that?"? But over the course of their therapy, often times new occupation goals emmerge from increases in their abilities to move their arms.? What I struggle with in outpatient is the short term goals.? As we know, the stroke population often progress slowly with the functional use of a hemiplegic arm.? It may be multiple months of tough OT before we even begin to see a positive change on an activity level spectrum.? That is why it is so hard to write short term goals with occupations in the relm of stroke rehab, because insurance companies demand to see measureable improvements quickly or they will deny services.? That is the reason why I take range of motion measurements, grip strength, coordination testing, because this is the only way I know to quantify gains on the short term.? And occupational treatment options using occupations as a therapeutic challenge are limited at first when the patient can only move in gravity elminated positions, and?are often a waste of time and only frustrate the patient. ?But as soon as?complex movements emmerge from graded therapeutic exercise/?neuromotor training, ?I think occupations are the best?next step, and in fact the ultimate goal. And occupations are certainly?a great way?for the patient to?complete a?contraint induced movement program at home, the problem is they have to be able to move so much for it to be worthwhile. ?Should I refer all of those patients to physical therapy for PT arm rehab, until they have enough functional movement to engage in occupations? Most PTs in the clinic I work with do not know how to help an individual with UE hemiplegia, and they would problably refer back to me because I have more experience with it.Perhaps I am acting like a PT at first during the initial stages of a patient stroke rehab, but I do not know what else to do, and the outcomes?have been on?the positive side the majority of the time. ?Any suggestions for my thinking? Chris Nahrwold MS, OTR -----Original Message----- From: Ron Carson <[EMAIL PROTECTED]> To: [EMAIL PROTECTED] <[email protected]> Sent: Sat, 11 Oct 2008 6:49 am Subject: Re: [OTlist] Best Practice Chris, do you have a reference for the below??? Thanks, Ron ----- Original Message ----- From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Sent: Thursday, October 09, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Best Practice cac> We were in fact a subspeciality of physical therapy in the cac> military. -- 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]
