I don't want to "pick" on our esteemed PT colleague because I so greatly appreciate his presence on this forum. For those of you who don't know, David and used to teach together.
I've clipped a comment from Dr. Lehman's earlier message because I think it highlights a hallmark differences between impairment-based and occupation-based approaches. I don't want to speak for David, but it appears that his approach, which I believe is also commonly used by OT's, uses a "functional" task to identify impairment problems. Once identified, intervention is directed at improving these impairments. Personally, I think this is a GREAT approach IF the goal is improving impairments, but it's not an optimal approach IF the goal is improving occupation. In my opinion, an occupation approach uses "functional" (really occupation, but I use "function" because it's more common) task to identify task that the patient can not do in a way that is satisfactory to them. The approach ALSO identifies impairments which contribute to the occupational problems. Once identified, intervention is directed to improving occupation. Let me try a case example with a fictitious patient named "Polly Anna" Miss Polly Anna: Has had a recent shoulder replacement secondary to RA. She is just out of her splint and the MD has ordered AROM as tolerated and PROM to 90 degrees in all planes, except 20 degrees for extension. The patient has increased pain during AROM. She is unable to feed herself, dress or toilet using her affected extremity. The patient has a recent fall history. In the impairment approach, the therapist may identify weak rotator cuff muscles, tight shortened elbow flexors and weak triceps as a primary reason the patient can not do her daily activity. As such, the therapist will begin treatment to address these issues with the goal that improving the impairments will improve the patient's independence and safety. In an occupation approach, a therapist may identify the patient is unable to independently care for herself because of her recent surgery and decreased safety while ambulating. The occupation-based therapist may recommend several environmental modifications, alternative dressing strategies, (including use of family/aides). The occupation-based therapist may also recommend the patient see an impairment-based therapist. So, in a brief and incomplete nutshell, this is an overly simplistic description of the difference between impairment-based and occupation-based approaches to the same problem. I want to add that neither approach is inherently better, they are just different. Both add outcomes and interventions that are needed by the patient and insurance companies. It should come as not surprise that in my "warped" world, OT is the profession for occupation-based treatment, while PT is the profession for impairment-based treatment. Lastly, Polly Anna is an UE case and in my opinion, occupation-based treatment for UE is not very complex. Should we discuss a LE case, or an UE case with LE involvement (i.e. CVA, Parkinson's, etc), occupation-based treatment is significantly more complex. The "Martha" case example highlights this point. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Lehman, David <[EMAIL PROTECTED]> Sent: Tuesday, October 21, 2008 To: [email protected] <[email protected]> Subj: [OTlist] UE Evauation Yesterday... LD> I first observe the patient perform functional tasks, decide if LD> the strategy is faulty, and then hypothesize why (i.e. what LD> impairments cause the faulty strategy in functional movements). -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
