If I evaluated a CVA patient (new or old) and they were unable to identify occupation goals, they I would d/c them. Recommending PT might or might not be indicated.
No, I do not think we should use "common sense" to coerce goals. Occupational goals are not about your or me, they are about a patient's perceived needs and values. Just because we think something is important, that is no indication that a patient will agree. Especially were patients face catastrophic loss of occupation. What we value may be meaningless to our patients. Thus, using a "common sense" approach can create more harm than good and leave patient's feeling utterly frustrated. On the other hand, a skilled OT may need to enlighten a patient as to the realities of life with a CVA. Often this is done during the eval, either through questioning or actual performance. After a comprehensive occupation-based evaluation, it's is my opinion and experience that an OT has a very good understanding of a patient's concerns and thus their motives. I think a LOT of OT success lies in the timing of our services. If patients are not willing or able to focus on occupation then our success in improving occupation may be greatly diminished. However, when patients are focused on lost occupation, and in the hands of a skilled occupation-based OT, improvement in occupation performance is almost guaranteed. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Sent: Tuesday, October 21, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Clearly DelineatingOT and PT? cac> What should an OT do if the patient identifies that they want to cac> be able to look to the left (attention?=body?function)?because of cac> a right CVA?to their parietal lobe (body structure)?? They cac> unfortunately do no personally state any occupations that they cac> want to address in particular.? Should we pass the patient to cac> physical therapy or should we "coerce" a few occupational goals?through common sense? cac> Chris Nahrwold MS, OTR cac> -----Original Message----- cac> From: Ron Carson <[EMAIL PROTECTED]> cac> To: [EMAIL PROTECTED] <[email protected]> cac> Sent: Tue, 21 Oct 2008 7:59 pm cac> Subject: Re: [OTlist] Clearly DelineatingOT and PT? cac> I've been spinning this "record" for 10+ years and I'm not about to cac> stop now! <smile> cac> I also want to add that I have absolutely NO PROBLEM with OT's cac> addressing physical limitation. Like you said, we are shooting cac> ourselves in the proverbial foot if we stop treating physical cac> limitations. However, I have two "buts" to add this statement: cac> But 1: OT must NOT address ONLY upper extremity physical function. As cac> occupational experts, we MUST learn to address the musculoskeltal cac> function of all extremities. I'm not sure about the spine, but cac> definately we must address the LE. cac> But 2: OT must NOT address physical function for the sake of physical cac> function. That is what PT does. OT's must address physical function cac> from an "empowering occupation" perspective. In other words, OT's ONLY cac> address physical function when improving occupation is the WRITTEN cac> GOAL of treatment and a specific physical function is a CLEARLY cac> identified barrier to a SPECIFIC occupation. cac> For example, if my UE eval had stated something like: "You know, I cac> spill food with my left hand and I can't get my right elbow to bend cac> far enough to get food in my mouth and I so want to eat with my right cac> hand!" Then, Bam! we have a SPECIFIC occupation that is clearly cac> limited by physical function. cac> However, OT's must not "coerce" or draw parallels between ABSTRACT cac> occupational goals and physical barriers. Goals must be identified by cac> the patient, often with the help of the OT. After all, goals should cac> state what's important to the PATIENT, not what's important to the cac> therapist, or the referring MD. If it's not important to the patient, cac> then I don't think OT should be addressing it in therapy. Again, that cac> should be a hallmark difference between OT and other professions. cac> Ron cac> -- cac> Ron Carson MHS, OT cac> ----- Original Message ----- cac> From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> cac> Sent: Tuesday, October 21, 2008 cac> To: [email protected] <[email protected]> cac> Subj: [OTlist] Clearly DelineatingOT and PT? cac>> I agree with the delineation provided by Ron.? As OTs though, we cac>> need not be afraid to address the physical limitation that is a cac>> barrier to the person's occupational profile.? Funny how we spend cac>> 100s of dollars a year on continuuing education that mainly focus cac>> on the impairment level, also I might add that these courses are cac>> usually endorsed by AOTA.?Funny how AOTA has this article called cac>> the practice framwork in which the restoration of?client factors cac>> a) body functions b) body structures is clearly outlined. cac>> I think the UE/LE divide has evolved out of professional cac>> courtesy over the years mainly in the relm of outpatient cac>> clinics.? I would have no objections for a PT to treat a UE/hand cac>> if they are skilled to do so.? I would have no objections for an cac>> OT to treat the LE if they are skilled to do so (I have?seldom cac>> heard of this happening though).? I think the complexeties of the cac>> of body functions and structures are large enough that both cac>> disciplines should share in the workload of research and cac>> treatment.? Again, I strongly believe that to stop treating the cac>> UE would be professional suicide for Occupational Therapy, as Ron cac>> is unfortunately experiencing firsthand in his quest to become an cac>> "occupation as an only?means" therapist. cac>> Is this record player broken?? I keep hearing the same song over and over cac> again.? Smile! cac>> Chris Nahrwold MS, OTR cac>> -----Original Message----- cac>> From: Ron Carson <[EMAIL PROTECTED]> cac>> To: [email protected] cac>> Sent: Tue, 21 Oct 2008 4:47 pm cac>> Subject: [OTlist] Clearly DelineatingOT and PT? cac>> Our most recent discussion leads me to ask this question: cac>> Can you CLEARLY delineate the role between PT and OT? cac>> My Answer: cac>> PT is most indicated when the FOCUS of concern (by referral cac>> source and/or patient) is on body parts or body processes. OT cac>> is most indicated when the FOCUS of concern is on human cac>> oc cac> cupation. cac>> Ron 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]
