-PT completes standing challenges so the patient can walk and improve in their balance.? Treatment usually stops when a certain distance has been reached or a certain grade of balance has been achieved.? I have rarely (work hardening is the only example I can think of)?seen a PT use an ADL or an IADL for a treatment modality or a functional outcome unless is is reported from the patient subjectively through oral report or via a standardized functional survey (outpatient).
-OT completes standing challenges so the patient can stand to pull up pants, stand at the sink to groom, stand at the kitchen counter to cook, stand to take out the garbage.? When a therapist uses a standing challenge it should be verbalized as to why it is important to work on standing in order to get to their personal occupational goal.? That is what makes it a "meaningful activity". When safe and physically ready, the actual task should be integrated into the treatment session (as soon as possible), in which at that point the actual task should be performed?and practiced to reinforce learning.??This concept could and should be applied to everything we do as OTs (fine motor, gross motor, strength, vision/perception, soft tissue mobilization, joint mobilization).? That way the patient can actually see the meaning behind the activity so they can see the light at the end of the tunnel.? When we only do things to improve strength, improve coordination, improve standing balance, and not looking toward the big picture,?then what we?are doing is physical therapy in my book.? This concept has been hard for me in outpatient hand?and UE stroke rehab though, but I am constantly trying to make improvements in this area, and have liked the ideas of Ron as these areas being specialized areas in which an OT happens to be working in. As far as the SNF issues, I think seeing that many people at the same time is fraud.? To see a group like that you must bill the patients' with?the group charge and only 25% of the patient's minutes can be group minutes.? I suspect that the patients are being seen for a lesser time than being billed, because of such a huge group.? How can anyone time or watch a clock for 6-8 patients to ensure they are getting the necessary time? I highly doubt if 6-8 stop watches are on for each patient.? I also suspect that therapists are plugging in different times for each patient although they were all seen at the same time.? I know this because I once worked on a SNF and they tried to get me to do this to be more productive.? Needless to say I only worked there for 3 months.? If you don't believe me just call medicare or the group that runs medicare in your area.? I am sure they will give you some answers, but just be prepared to be on the phone for a long time, trust me I know.? And when confronting management do not be surprised if you get fired, but I would certainly let management know that medicare will be getting a call so they should be prepared for an audit.? The only way that this situation will change is if we all stand up for ourselves.? It sounds like more than a verbal discussion needs to take place for your SNF patient population to identify occupational goals.? For the client whom states that they like to sit on their chair and watch TV all day I would work on bed to chair transfers, sit to stands in order to safely get to the TV, walking to get the remote to change the channel, and education about the importance of doing more in life to avoid immobility problems.? I highly doubt if that is the only thing the patient has to do the entire day, doesn't the patient have to eat and use the restroom at least?? I would sit down by yourself on the computer and think of all of the different possible occupations in which a patient has to perform on a daily basis (ranging from getting out of bed to watering the plants).? I would?make this into a checklist format and during the evaluation and re-evaluations I would have the patient fill it out with your assistance depending on their cognitive level.? We have to remember that many of the patients suffer from depression and dementia in this area, so of course they are going to give you an non excited response.? Most of them are so depressed that deep down they all just want to be alone to die.? It is our job to show them that there is someone who cares about their well being and believes in them.? Try to get to know them and talk to them and slowly but surely help them to achieve a few goals.? I think you will be surprised. Chris Nahrwold MS, OTR -----Original Message----- From: Diane Randall <[EMAIL PROTECTED]> To: [email protected] Sent: Sun, 30 Nov 2008 8:33 pm Subject: Re: [OTlist] AARGH! I believe standing is functional...but I am trying to understand how we differ from PT. Pt has already merged with OT in regards to "self-care". I find this all very confusig as a student. Our teacher seems to think clothpins and cones are usually not functional. She would rather us mimic the activity doing something more meaningful to the pt. What? That is the hard part for me. I often wonder how the idealism of our program matches the real world OT experience. I will find out soon. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of [EMAIL PROTECTED] Sent: Sunday, November 30, 2008 18:28 To: [email protected] Subject: Re: [OTlist] AARGH! It is funny in what we consider functional and not functional.? How can standing not be functional but doing a bunch of crafts, reaching for clothes pins and cones is considered functional?? Ninety percent of the clients I see do not like crafts and have no intention of starting crafts, so why is so much time devoted in school?in this?area?? We need?to focus on concrete functional?evaluations and treatments in?schools.?Seventy percent of the clients I see do not have arm dysfunction but I still see therapists whip out the theraband.?? We just need to find?what are the patient's priorities for rehab, the impairments, and the environmental barriers that will prevent progress. ?Most people in acute rehab just want to make it back home, so why not focus on all of the?activities that they have to complete safely to make that a reality?? You have to think beyond just simple bathing and dressing though!? I can certainly understand when a patient is very low level in their abilities a! nd they have to start at the bottom of the ladder, but there comes a point when you have to prepare them for home.? It is so simple and rewarding to take this aproach in occupational therapy. Chris Nahrwold MS, OTR St. John's Hospital of ?Anderson Indiana -----Original Message----- From: Ron Carson <[EMAIL PROTECTED]> To: Diane Randall <[EMAIL PROTECTED] Tnow.com> Sent: Sun, 30 Nov 2008 12:27 pm Subject: Re: [OTlist] AARGH! Thanks to some comments I've read on this list, I've stopped being concerned if what I'm doing "LOOKS" like PT. I sort of laugh at this statement because on Friday a patient asked me: "Now, are you the PT or the OT". Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Diane Randall <[EMAIL PROTECTED]> Sent: Sunday, November 30, 2008 To: [email protected] <[email protected]> Subj: [OTlist] AARGH! DR> I always like to read your take on things. I agree with you. I just had in DR> the back of my mind a COTA I was following who made a woman stand for the DR> sake of standing but did not combine it with anything functional. As a DR> student, this confused me. It looked more like PT. Thanks for your comments. -- 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 Archive? www.mail-archive.com/[email protected] -- 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 Archive? www.mail-archive.com/[email protected]
