Ron....I was just going to let it go, but, I got to thinking about what you said in response to my Movement-Strategy-Impairment approach to examination. You said you have the client perform occupation activities to determine the deficits you need to work on, right? I think we do the same thing. I termed the movements I assess first as functional tasks, you called them occupational tasks. Same dif.....
I think what is important here is that we do not assess numerous impairments (i.e. strength, ROM, coordination, proprioception, cranial nerves, etc.) just because they are impairments on an examination form. We assess these impairments because we hypothesize they are contributing to the faulty movement and we may need to address them directly to improve the movement (function, occupation). That said, I also believe we are on the same page in that not only can we address impairments directly to improve function, but, we also can have the patient perform the task specifically, providing guidance, facilitation, cues for better performance, and that by doing functional training, we indirectly affect the impairments. So, I guess I am not sure where we differ. In regards to the PT saying she could not do anymore because of the UE/LE divide....what a shame.....a PTs (and OTs) role is to be able to go beyond impairment driven therapy and to address functional limitations through education of different strategies, compensations, assistive aids, etc. I don't want to get into the ole' turf war issue here, but, a good PT or OT is better than what you described. Granted, the forces of our medical model may prevent the PT from addressing function, but, that is the problem, right.....we have split the body to increase revenue...... David A. Lehman, PhD, PT Associate Professor Tennessee State University Department of Physical Therapy 3500 John A. Merritt Blvd. Nashville, TN 37209 615-963-5946 [EMAIL PROTECTED] Visit my website: http://www.tnstate.edu/interior.asp?mid=2410&ptid=1 This email and any files transmitted with it may contain confidential information and is intended solely for use by the individual to whom it is addressed. If you receive this correspondence in error, please notify the sender and delete the email from your system. Do not disclose its contents with others. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Wednesday, October 22, 2008 6:56 AM To: Mary Alice Cafiero Subject: Re: [OTlist] Clearly DelineatingOT and PT? Mary Alice, I'm sorry if I've left an impression that OT should not help patients identify occupational goals. In reality, I think getting the correct goals is one of the most important aspect of our jobs. If you've ever had the displeasure of working on goals that are unimportant to the patient, you know what I mean. But, there is a difference in helping people identifying THEIR goals and generating goals bases on what WE think is important. Also, I strongly believe that patients should be 100% invested in their therapy and their outcomes. When therapy gets "tough" for patients, I remind them that we are working on THEIR goals. I also try to reinforce that the identified goals are still important. Case in point; "Martha" (the case study I posted) told me on monday that getting her underwear on/off is no longer important. This was one of her original goals, but she now feels it is unattainable. My response is "fine, we will no longer address it". And in all honesty, my "addressing" the goal was simply verbal prompting to perform the goal and follow up to identify her progress. And this brings me to another point. Addressing performance barrier to occupation has global impact on patients. I believe that by facilitating patients to improve occupation, we are truly impacting almost all areas of their lives: physical, mental, cognitive, environmental and social. Occupation is TRULY empowering to patients. And in the case of Martha, it helps her identify what is and isn't important from a therapeutic and thus a life perspective. Finally, I honestly feel that since focusing treatment on occupation, my practice has GREATLY expanded, not narrowed. To me, OT is GREATLY narrowed when it focuses on the UE. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Mary Alice Cafiero <[EMAIL PROTECTED]> Sent: Tuesday, October 21, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Clearly DelineatingOT and PT? MAC> I have mostly kept quiet and just observed all the dialogue on this MAC> issue. I do feel the need to speak up now though. I see absolutely MAC> nothing wrong with asking a patient about different areas of MAC> occupation or observing different areas of occupational performance MAC> and then asking the patient if the areas where there are deficits are MAC> goals. We all know that the core definition of occupational therapy is MAC> hard to pin down even with other health care professionals. How much MAC> harder is it, then, for a patient to understand the difference in OT/ MAC> PT or just understand OT? I think expecting the patient to identify an MAC> area of occupation or occupational performance is unrealistic. MAC> By the same token, I don't mean that an OT should have the same goals MAC> for every total hip replacement patient that they see. The goals MAC> absolutely need to be important to the patient. BUT the therapist may MAC> need to guide the discussion based on input from the eval to that MAC> point. When it gets down to specific goals, the OT says something MAC> like, "We have seen that it hard for you to do x,y, or z. Is that MAC> something that you want to work on during OT?" MAC> I have had home health patients say that they really just want to be MAC> able to change the sheets themselves. They are shocked when I say that MAC> is something we can work on in OT. Too many patients don't know the MAC> scope of what we do or can do unless we guide them based on their MAC> input to us. MAC> Ron, I love hearing your ideas and in many ways I agree with you. I do MAC> think you are painting yourself into an awfully small corner if you MAC> don't lead the discussion with the patient on how to get from the MAC> physical impairment level to an occupational goal. MAC> Respectfully, MAC> Mary Alice MAC> Mary Alice Cafiero, MSOTR, ATP MAC> [EMAIL PROTECTED] MAC> 972-757-3733 MAC> Fax 888-708-8683 MAC> This message, including any attachments, may include confidential, MAC> privileged and/or inside information. Any distribution or use of this MAC> communication by anyone other than the intended recipient(s) is MAC> strictly prohibited and may be unlawful. If you are not the recipient MAC> of this message, please notify the sender and permanently delete the MAC> message from your system. MAC> 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> -- >> 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] MAC> -- MAC> Options? MAC> www.otnow.com/mailman/options/otlist_otnow.com MAC> Archive? MAC> 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 Archive? www.mail-archive.com/[email protected]
