Hi Ron and Diane! I still think Diane is onto something - when doing something meaningful, or interesting, or fun, at least two things IMO are likely to happen:
1: You'll have your attention a bit off your standing problem, and thus may be able to stand for longer. 2: You're in a more realistic situation than when just working on the standing - there may be some reaching etc to do to accomplish the task. Could make the timed standing result better - or worse - but still, valuable information for both patient and therapist. (This may be neither OT, nor PT - but more like bits of movement science, which could be applied to both?) Also - your take on the situation, Ron, to me seems to require that the therapist can uncover, and then cover, all the things the patient actually wants and needs to do in the future. I suggest this is not always possible, and we sometimes need to also look at some commonly occurring situations (IN the patient's desired occupations and lifestyle) - of which doing things while standing at a tabletop just might be one - and then find the most representative examples we can come up with in the current setting. I have a patient with hemiplegia - with me chooses to work on involving his left hand in his ADL's - like supporting dish and food with it while he eats - braking/unbraking wheelchair - supporting pants during toileting, dressing/undressing/transfers - plus I generally help him fine tune transfers, toileting, night routines, whatever comes up - plus some assisted walking to the dining room whenever he feels like. I'm employed in the evening care team of this NH department. Same time he's genuinely happy with his OT in the training team - who has him play board games using his left hand (although he's right-handed) - and, I know, lots of other things that I build on - but he really focuses on this - he likes the fact that he can train while using his still strong skills at these board games, and wants board games for Christmas. He is way over 90, and is in the NH to stay - his wife visits every day for many hours - he is a pleasure to be around, an interesting conversation partner with much concern for other people and world events - and I suspect his deepest goal is to continue to be just that - a person who fulfills his life roles, as a partner, friend, companion, resident, patient, citizen - still growing and contributing, so not dead yet! Does he have any occupational problems not addressed - yes - as a partner where his wife so wishes she could take him more out, or home for the day, but is afraid to because of things like frequent episodes with his catheter, and not sufficient care offered outside the NH. He suffers, mostly because she suffers, that he can't fulfill the role of companion and partner outside the NH. That is a barrier I only know how to work on more generally and long term - by being an engaged citizen and OT, who cares about care politics and tries to raise awareness of the many needs not yet addressed. warmly susanne, denmark ---- Original Message ---- From: "Ron Carson" <[EMAIL PROTECTED]> To: "Diane Randall" <[email protected]> Sent: Sunday, November 30, 2008 1:14 PM Subject: Re: [OTlist] AARGH! > Hello Diane: > > Thanks for writing. > > I want to encourage you to try and see things a little > differently. > > You said: > > "Instead of timing someone with a stopwatch > for standing balance, I find out what table top > activities are meaningful to them and have > them stand while engaging in those > activities. " > > Unless a particular activity is a patient's stated goal, > I suggest NOT having patients standing at table doing > activities. Instead, engage patients in those > occupations which are impeded by decreased standing > balance, endurance, etc. For example, if a patient > can't get their clothes from the closet because they > can't stand with their walker, > then work on standing with a walker. If a patient > can't ambulate to > get their clothes, then work on mobility with a walker. > Get away from > the table top and move out into the "real world"! <smile> > > I also think that using a stop watch has merit because > it gives the patient tangible and visual feedback on > improvement. While standing > for a certain amount of time should NEVER be a goal, > patients can be highly motivated by seeing > improvement in standing endurance. (snip) -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
