Ron, PTs would love what you just said. Not all impairments are within the PT education and practice scope. Though I think they would love to think so. The areas of visual perception, cognition, are two component areas that I can think of where their skill level and training are limited. (Though so are some OTs.) PTs are strongly arguing to increase their scope of practice without the base. But how does that argument flow for OTs? What truly is our base? If Occupation how do we address the impairments that impact? And really given what we know about motor control and motor relearning and cognition and generalization can we treat impairments successfully outside of the context? Just some early morning ramblings?> Date: Fri, 24 Oct 2008 09:00:39 -0400> From: [EMAIL PROTECTED]> To: [email protected]> Subject: Re: [OTlist] UE Evauation Yesterday...> > 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] -- Options? www.otnow.com/mailman/options/otlist_otnow.com
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