I think the message here limits the power of task analysis and task equivalency. There a MANY times when a client will need physical agent modalities/ neuromuscular re-education, lymphedema treatment , etc to prepare a body segment to perform then or later, a desired occupation. The role of OT is important to id. those components that would facilitate the occupational outcome. I would not ID those physical agent modalities, refer my patient to PT, wait until I'm told "they are ready" and then work with my patient on the occupation. It is a segmented approach and unnecessary in my opinion. We are competent to see the process from beginning to end. Carmen
---------------------------------------- > Date: Sun, 5 Oct 2008 20:17:43 -0400 > From: [EMAIL PROTECTED] > To: [email protected] > Subject: [OTlist] Best Practice > > I just posted the following on AOTA's Phy-Dys list serve and wanted to > get OTnow.com readers' opinion. As usual, it's lengthy: > > ###################### START ############################## > > I have always believe that OT intervention and goals must be a > straight and direct line. In other words, what OT does MUST have a > DIRECT effect on the patient's occupational deficits. To accomplish > this intervention, I've sort of developed an "outline" which is > primarily based on the Canadian Model of Occupational Performance. > What follows is a simplified model which helps establish the DIRECT > LINE between goals and treatment: > > 1. Help the patient figure out what they want or need to do > (i.e. occupation) > > 2. Figure out what is keeping the patient from doing their > identified occupations: > > a. Environmental > b. Cognition > c. Physical > d. Social > e. Emotional > 1. Fear > 2. Motivation > > 3. Prioritize the above into those things that can be changed > and THEN GET BUSY CHANGING THEM! Don't waste therapist or > patient time addressing those issues which can not be changed. > > Now this is simple and incomplete, but it works because outcomes and > treatment focus on occupation. Recently, it's been suggested, both on > this list and in print, that quality OT must include occupation into > treatment sessions. I do not feel that such an approach is mandated by > AOTA's Framework, not is it always appropriate. > > Here are several passages from the OT Framework, Rev 2 collaborating > this concept: > > {EVALUATION} > > Occupation-based activity analysis places the person [client] > in the foreground. It takes into account the particular > person’s [client’s] interests, goals, abilities, and contexts, > as well as the demands of the activity itself. These > considerations shape the practitioner’s efforts to help > the…person [client] reach his/her goals through carefully > designed evaluation and intervention. (Crepeau, 2003, p. 193) > (P. 651) > > Analyzing occupational performance requires an understanding > of the complex and dynamic interaction among performance > skills, performance patterns, contexts and environments, > activity demands, and client factors. (P. 651) > > {INTERVENTION} > > The intervention process consists of the skilled actions taken > by occupational therapy practitioners in collaboration with > the client to facilitate engagement in occupation related to > health and participation. (P. 652) > > The intervention focus is on modifying the > environment/contexts and activity demands or patterns, > promoting health, establishing or restoring and maintaining > occupational performance, and preventing further disability > and occupational performance problems. (P. 652) > > Intervention implementation is the process of putting the plan > into action. It involves the skilled process of altering > factors in the client, activity, and context and environment > for the purpose of effecting positive change in the client’s > desired engagement in occupation, health, and participation. > (P. 656) > > Nothing in these passages suggests that occupation (or more often > contrived occupation) must or should be a part of each and every > treatment session. What does stand out is the concept that OT is about > occupation as an outcome and as a measure. If an OT's therapy is > DIRECTLY connected to a SPECIFIC occupational goal, then I believe > that quality occupational therapy is being performed. Remember, > quality OT is not about what's being done, it's WHY! > > Why are you doing e-stim? Why are you ambulating with your patients? > Why are you stacking cones? Is it so the patient will regain function? > Is it so the patient can move their arm with less pain so that they > can get dressed? Or is it because the treatments are DIRECTLY > addressing a SPECIFIC barrier to a SPECIFIC occupation? If it's > anything but the later, I suggest that something other than > best-practice is being applied to your patients. > > Sincerely and Respectfully, > > Ron > > -- > Ron Carson MHS, OT > www.OTnow.com > > ############################# END ############################### > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] _________________________________________________________________ Want to read Hotmail messages in Outlook? The Wordsmiths show you how. http://windowslive.com/connect/post/wedowindowslive.spaces.live.com-Blog-cns!20EE04FBC541789!167.entry?ocid=TXT_TAGLM_WL_hotmail_092008 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
