Just another idea from my OT researcher mind. I have been observing stroke patients for many years. Many patients can function well to complete their basic self care tasks one handed. The meaning of having both arms able to function well goes beyond the basic self care tasks we tend to focus on. The concepts of communication (how many of us talk with our hands), self esteem and sense of social acceptance (not being seen as disfigured or disabled), and interpersonal expressions of caring (eg hugs etc) are ones that I am currently observing as strong dissatisfiers for clients post stroke who have otherwise mastered basic self care but are still unhappy with their current performance levels or the upper extremity function. I am currently designing a research study to further investigate these concepts. But where does that take us as OTs with treatment? Just to spin the record at a slightly different speed. Sue> Date: Tue, 21 Oct 2008 22:26:59 -0400> From: [EMAIL PROTECTED]> To: [email protected]> Subject: Re: [OTlist] Clearly DelineatingOT and PT?> > 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] -- Options? www.otnow.com/mailman/options/otlist_otnow.com
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