You know Chris, this list, in its various incarnations over the past
10 years, is my effort to "spread the word about occupation". I can't
even begin counting the number of messages I've type about this
subject. It would probably make several volume of books. But, our
profession still remains engrained in UE practice. Change is occurring
but agonizingly slow. The Practice Framework is a good start, but it's
not enough. To me, the real solution lies with each one of us who
wants change.
With all my heart I believe in two things about my profession:
1. It has great capacity to positively impact people's lives
in ways that other professions can't understand, much less
appreciate.
2. It is grossly mispracticed.
When I was guest teaching the other day, a student asked me if I loved
OT. My response was: "No, I live it". Truly, hardly a day goes by that
I'm not pondering, "preaching" plodding, mindmapping, discussing,
"disgusting", OT. Much to my lovely wife's disbelief, OT is part of
who and what I am. I say all this because many times I've considered
doing on-line education or CE courses but I truly think there is no
demand. Therapists don't want to pay for theory, a way to "think" or a
way to "be". They want hands-on skills that are tangible and
reimbursable. Am I wrong?
I've said this before but I'll repeat it here. When AOTA's practice
framework was initially published, overnight OT's became experts in
occupation. I balked then and still do at this idea. How did OTs, who
have never be trained in occupation, become experts? Truth is they
didn't and most still aren't. This is evident because there's a
"watering down" of "occupation" into "function", "ADL's", "UE
impairment", etc. Occupation is none of these things but how can OT's
know this? And yet, there are very few courses on occupation.
When the Practice Framework was initially published, I was teaching at
a university. One of the courses I had developed was "Human
Occupation". As you can imagine, it was a theory course. While my
teaching methods didn't always win student's approval, with very few
exceptions, the course material was VERY well received. Student's
commented that it was the one course that helped them differentiate
between OT and PT. Or, it was the course that helped them finally
understand OT. When I was laid off by the university, the Human
Occupation course was absorbed by another professor, and to this date,
the course does not appear in the curriculum.
So, I ask, how can OT's be EXPERTS in occupation when they are not
trained in it? Often times we complain that PT's can't do ADL's
because they aren't "trained" to do them. So, how can OT's do
occupation when they aren't trained?
If I could make a living teaching human occupation, I would. I love
teaching and I especially love teaching about occupation, but I just
don't think there is any demand. In fact, I don't think OT's even
realize what they are missing.
Ron
--
Ron Carson MHS, OT
----- Original Message -----
From: [EMAIL PROTECTED] <[EMAIL PROTECTED]>
Sent: Friday, October 24, 2008
To: [email protected] <[email protected]>
Subj: [OTlist] Thoughts on Limiting Our Practice
cac> I do not think an occupation-based approach to evaluation,
cac> treatment and outcomes limits the practice of OT.? I only think
cac> giving up on UE treatment in hand clinics and with stroke
cac> patients would debilitate the field of OT.? I have not disagreed
cac> on very many of your specific case studies that you have provided
cac> in which you have DC'd a patient from OT.? I would have probably
cac> done the same thing.? I primarily work in an acute rehab unit,
cac> and taking an occupation based approach is the only way to go
cac> when the patient's goal is to make it back home.? I can totally
cac> see your point of view when trying to totally get away from UE
cac> treatment based on a?large sample of rehab hospital/nursing home
cac> therapists who provide only UE "treatment" to pass time without
cac> any purpose or meaning.?I strongly agree that OT would be much
cac> more of a?solidified profession if all of the OTs?in?acute rehab,
cac> home health, and?nursing homes would take an occupation based
cac> approach. ?I do not think this should ruin the reputation of all
cac> of the hard working OTs in hand therapy and neuro clinics who
cac> provide a critical service to patient's with UE dysfunction.? I
cac> continue to believe that these therapists are OTs and they are
cac> providing OT services that impact the patient's personal occupations.
cac> I hope there is a solution?for all of the therapists whom give
cac> us OTs a poor reputation.? I have worked with individuals like
cac> this and they more often than not are oblivous to the fact that
cac> what they are doing is not really OT or therapy at all for that
cac> matter.? Somtimes a simple talking to works, sometimes it
cac> doesn't.? I think one step we can take is to try to be a mentor
cac> for individuals whom are stuck in an OT rut.?Another step that I
cac> think would be of value would be more continuuing education
cac> involving OT and occupation.? There are so many courses out their
cac> taught by PT focusing on body functions/structures, it is to no
cac> wonder that?therapists are focusing primarily on these issues.? I
cac> think we need more on occupation, practical solutions for
cac> impairments from top notch green thumb therapists.?Perhaps with
cac> a?major push in this we would see a "trickle down effect" in the
cac> quality of care. ?Ron have you ever thought about taking your act
cac> on the road and teaching on the continuuing ed circuit?
cac> Chris Nahrwold MS, OTR
cac> -----Original Message-----
cac> From: Ron Carson <[EMAIL PROTECTED]>
cac> To: [email protected]
cac> Sent: Thu, 23 Oct 2008 7:16 pm
cac> Subject: [OTlist] Thoughts on Limiting Our Practice
cac> It's been suggested that a occupation-based approach to evaluation,
cac> treatment and outcomes limits the practice of OT. I want to suggest
cac> that such an approach does just the opposite.
cac> First, there is NO profession addressing occupation. There are some
cac> professions, namely PT, SLP, Aides, RN, OT, that address PARTS of
cac> occupation, but no profession sees the entire picture from start to
cac> finish. And because of this, many, many patients never truly achieve
cac> their highest potential!
cac> Second, facilitating occupation is excruciating difficult. But,
cac> because of this, it's wonderfully rewarding. Case in point, is
cac> "Martha". One of her goals is independently getting on/off the toilet.
cac> Over the course of her treatment, Martha has been able to transfer
cac> to/from the toilet. And she has even successfully used her OLD toilet.
cac> I say "old" because in an effort to make transfers easier, a higher
cac> toilet was installed. BUT, the new toilet has a different seat in
cac> which Martha sinks into. Thus, while she can easier sit on her new
cac> toilet, she can not TURN while sitting to allow her to grad installed
cac> hand rails. Thus, the new toilet seat doesn't work well. You know, who
cac> would think that the shape of a toilet seat is the difference between
cac> independence and dependence. So, the observation skills, problem
cac> solving, environmental awareness, biomechanics, and even common sense
cac> that goes into occupation-based practice is anything but limiting.
cac> And while occupation-based practice does exclude some practice areas,
cac> notably acute injury, there are many more areas and patients who
cac> benefit from these services.
cac> Sorry for typos/graphos; I'm typing about as fast as I'm thinking!
cac> Ron
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