CA> We are competent to see the process from beginning to end. Carmen You know Carmen, I really don't think OT's are competent to see the process from beginning to end because it's really two different processes.
CA> There a MANY times when a client will need physical agent CA> modalities/ neuromuscular re-education, lymphedema treatment , etc CA> to prepare a body segment to perform then or later, a desired CA> occupation People perform occupations, not body segments. Your above quote sort of highlights what I'm trying to say about "two different processes". Also, you are advocating something that is no different than PT, except for the use of the word "occupation". This approach has great merit and there are certainly times when a patient needs focused treatment on a "segment". However, I believe these are the patient's best suited for PT. Or for the OT with a focused treatment area, such as the UE or lymphedema. But I think calling such focal treatments occupational therapy, is not consistent with our history, framework, payers, patients and outcomes. CA> The role of OT is important to id. those components that would CA> facilitate the occupational outcome. In my opinion, the role of OT is to identify SPECIFIC components which impede a SPECIFIC occupation. However, the goal is the occupation, not the components. FOCUSED component level treatment is the realm of PT. And if it's not, it should be. Because when the focus of treatment is on the component(s), it can't be also on the occupation. And, I do not think a therapist can mentally switch from component level to occupation level treatment. Maybe I'm wrong, but I think it's one or the other. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Carmen Aguirre <[EMAIL PROTECTED]> Sent: Monday, October 27, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Best Practice CA> I think the message here limits the power of task analysis and CA> task equivalency. There a MANY times when a client will need CA> physical agent modalities/ neuromuscular re-education, lymphedema CA> treatment , etc to prepare a body segment to perform then or CA> later, a desired occupation. The role of OT is important to id. CA> those components that would facilitate the occupational outcome. I CA> would not ID those physical agent modalities, refer my patient to CA> PT, wait until I'm told "they are ready" and then work with my CA> patient on the occupation. It is a segmented approach and CA> unnecessary in my opinion. We are competent to see the process from beginning to end. CA> Carmen CA> ---------------------------------------- >> 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] CA> _________________________________________________________________ CA> Want to read Hotmail messages in Outlook? The Wordsmiths show you how. CA> http://windowslive.com/connect/post/wedowindowslive.spaces.live.com-Blog-cns!20EE04FBC541789!167.entry?ocid=TXT_TAGLM_WL_hotmail_092008 CA> -- CA> Options? CA> www.otnow.com/mailman/options/otlist_otnow.com CA> Archive? CA> www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
