I think absolutely yes. I do find it interesting that this post is
from you though, Ron. And here's why....
A lot of your comments and thought-provoking questions relate to
working on the specific activity that is the ultimate goal the entire
time rather than breaking down an activity into different components
and working on the component parts separately.
Isn't this case a similar thing? I realize that there are differences
since clearly standing is part of walking and you were following the
natural progression of her recovery. Still, in a "whole picture" way,
you were working first on a small piece of the activity that was the
ultimate goal.
I haven't replied to a lot of these types of cases just cause I like
seeing what everyone else says. I do think that there is a reason we
learn activity analysis and how to pick activities that work on the
different skills required to reach an ultimate goal. I don't agree
that "making up" an activity to work toward a goal is not OT or is bad
OT. Certainly, it can be bad OT if it isn't done with thought and
planning.
For example...... working with a male patient who has cognitive issues
post whatever neuro incident happened. Typically in his life, he does
not do a lot of cooking. He does, however, really like cupcakes. If
you use a box mix or a recipe and have him make cupcakes, you are
hitting many areas of cognition that are involved in every day
activities that most people don't ever stop and think about. You've
got sequencing, visual scanning, visual perception, judgement, safety
awareness, etc, etc. His goal may not be ultimately to make cupcakes.
You do need to know if he uses reasoning and safety awareness while
doing an activity that could be dangerous. Maybe he has poor endurance
from a long hospitalization. You have him stand for some of this
activity and are working on endurance while doing an activity. The
component pieces of the activity are addressing his current deficits
and providing a vehicle for real-world evaluation.
I still think that is OT and is occupation. What do other people
think? I am not trying to be ornery.... just truly curious about how
different people view these different scenarios. Also apologize that
it is somewhat rambling. I'm very tired and up too late again.
Mary Alice
Mary Alice Cafiero, MSOT/L, ATP
[email protected]
972-757-3733
Fax 888-708-8683
This message, including any attachments, may include confidential,
privileged and/or inside information. Any distribution or use of this
communication by anyone other than the intended recipient(s) is
strictly prohibited and may be unlawful. If you are not the recipient
of this message, please notify the sender and permanently delete the
message from your system.
On Feb 3, 2009, at 9:40 PM, Ron Carson wrote:
A while back on an AOTA forum, I was "criticized" for
working on
mobility when there were not obvious occupational forms present
(i.e.
toilet, shower, chairs, etc). At least one person's contention was
that
working on mobility in the absence of an occupational form is not
OT. I
want to share a quick case study which highlights why I take
exception
with the person's comments.
For the sake of brevity, I'll keep "Jane's" case study as
simple as
possible.
####################################################################
Jane has a spinal condition leaving her with partial lower
extremity
paralysis. The patient's initial goals are of course to walk but
also to
transfer to her toilet, shower, etc. Again for brevity, she
wants to
learn "skills for the job of living".
Initially, the patient was unable to stand, so we began
working on
standing. This required maximum, and I mean max, assistance x1. At
this
early stage, the patient was unable to use a walker. After a week or
so,
I progressed the patient to a walker, but she still required
knee
blocking to stand. Eventually, the patient was able to stand
without
knee blocking and finally began taking steps. After she was able to
walk
10-15 feet with a rolling walker, we tried transfers from
wheelchair to
wheelchair. This was very difficult and required continuing
practice.
After approximately 6 weeks of almost daily OT, TODAY, the
patient
transferred from her w/c to her toilet using a walker. She
required
assistance with sit to stand and cuing with the transfer but it
was
essentially her doing the transfer. This is a huge milestone for
this
patient and made her VERY happy and optimistic that her life was
going
to again have some semblance of "normal".
##################################################################
Now, in my opinion, I have been working on occupation from day ONE!
The
patient had occupation-related deficits, her barriers were
identified I
was competent to address those barriers and the patient had
good
potential to make significant progress towards her goals.
So what do you think? Should OT work on mobility/ambulation in
the
immediate absence of occupational forms? Should OT address mobility
from
the very beginning, if mobility is a barrier to occupational goals?
I'm interested to hear what other's say!
Thanks,
Ron
--
Ron Carson MHS, OT
www.OTnow.com
--
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]
