I have mostly kept quiet and just observed all the dialogue on this
issue. I do feel the need to speak up now though. I see absolutely
nothing wrong with asking a patient about different areas of
occupation or observing different areas of occupational performance
and then asking the patient if the areas where there are deficits are
goals. We all know that the core definition of occupational therapy is
hard to pin down even with other health care professionals. How much
harder is it, then, for a patient to understand the difference in OT/
PT or just understand OT? I think expecting the patient to identify an
area of occupation or occupational performance is unrealistic.
By the same token, I don't mean that an OT should have the same goals
for every total hip replacement patient that they see. The goals
absolutely need to be important to the patient. BUT the therapist may
need to guide the discussion based on input from the eval to that
point. When it gets down to specific goals, the OT says something
like, "We have seen that it hard for you to do x,y, or z. Is that
something that you want to work on during OT?"
I have had home health patients say that they really just want to be
able to change the sheets themselves. They are shocked when I say that
is something we can work on in OT. Too many patients don't know the
scope of what we do or can do unless we guide them based on their
input to us.
Ron, I love hearing your ideas and in many ways I agree with you. I do
think you are painting yourself into an awfully small corner if you
don't lead the discussion with the patient on how to get from the
physical impairment level to an occupational goal.
Respectfully,
Mary Alice
Mary Alice Cafiero, MSOTR, ATP
[EMAIL PROTECTED]
972-757-3733
Fax 888-708-8683
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On Oct 21, 2008, at 9:26 PM, Ron Carson wrote:
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> --
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