I couldn't agree more!! The key word in my email was "appropriate".
I have GREAT concerns about treatment that is done to capture minutes for the rehab company! ( I see this EVERY DAY, and it bothers me enough that I have thought about becoming a whistle-blower.) And I am not suggesting using a reacher in this manner. It is therapeutic in that it enables SOME to engage in practice to develop the coordination skills needed to effectively use a reacher for functional activity. Your point about cost containment is brilliant and oh so relevant. I just wish there were a way to communicate this to the powers that push efficiency and profit. Barb Howard ----- Original Message ----- From: [email protected] To: [email protected] Sent: Wednesday, February 4, 2009 9:51:54 PM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] Game using reacher As long as the patient knows why they are practicing a specific skill then I am all for it.? In my experience it usually takes the cognitively intact clients a few activities to understand how to use a reacher, not an entire session.? They then can borrow a reacher to use in their room so they can practice for real, and then ask questions when issues arise.? Now for the cognitively impaired (primarily moderate to severe dementia) the practice of a reacher is a waste of time because patients at that level have the inability to learn new information.? The emphasis of treatment should at that point be on family training and maximizing their physical abilities, not on cognitive restoration.? Cognitive compensation might be an option, but don't count on it. For the mildly impaired I think practice in this area is critical, especially if they are going to be living by themsolves or not receiving 24 hour supervision. What I see in practice is therapists completing? non?therapeutic games and splinter skills that have no relevance except to capture minutes for a higher payment level.?Do not get me wrong, ?I am all for activities that promote social interaction and higher level balance improvement, those activities sounded outstanding.? In fact I might steal that one for clinical use, since it deals with dual task challenges, which is supported in the research.? The grim reality is this: if our profession as a whole continues to complete treatment interventions that have no relevance to the patients' improvement, then through the very nature of cost containment we will be phased out.? Pick up a new book in OT, read a new research article, go to a course, by all means do all you can to provide relevance to the patient's care and improvement. Chris Nahrwold MS, OTR -----Original Message----- From: Diane Randall <[email protected]> To: [email protected] Sent: Wed, 4 Feb 2009 7:10 pm Subject: Re: [OTlist] Game using reacher Very well said!!! -----Original Message----- From: [email protected] [mailto:[email protected]]on Behalf Of [email protected] Sent: Wednesday, February 04, 2009 18:16 To: [email protected] Subject: Re: [OTlist] Game using reacher If someone is going to be using a reacher for the foreseeable future after D/C because of medically established precautions against trunk flexion, etc. then this kind of practice with a reacher is medically beneficial. Call it whatever perjorative name you like, patients enjoy activities that are entertaining as well as medically necessary/useful/goal-directed. I am certainly not going to sit with a patient and make him/her take her pants on and off interminably just because that is how the goal is worded - LB ADL Indep using AE... Come on, people. Lighten up! And as far as social interaction is concerned, there is NOTHING that is more conducive to helping patients progress, especially those in SNFs, than interaction with the therapist or with other patients. You don't need a goal. It is ALWAYS a factor, hence it is therapeutic to the goals you are working on. Just today, I had a patient who more easily lost his balance because of laughter. He is a funny guy and likes to joke around. Because I engaged with him, I was able to observe this phenonmenon directly. I then suggested that we should have him watch funny videos standing so that he can practice his dynamic balance. This was a direct result of social interaction. Social interaction is an integral part of any occupation, and I mean that in the broad OT sense of the word. Well, I guess not for hermits, or possibly accountants and others whose goals are impeded by interaction. But you get the drift. Thanks for your suggestion, Barbara. I may try this with appropriate patients. I have a few on my caseload with precautions like these. I find that competitive games are very helpful in supporting patients by giving them tangible evidence that they are not the only person in the world struggling to recover/adapt to a ne w medical condition. Barb Howard ----- Original Message ----- From: "Neal Luther" <[email protected]> To: [email protected] Sent: Wednesday, February 4, 2009 8:33:02 AM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] Game using reacher Could not agree more. In addition, this just simply sounds juvenile...pediatric. Neal C. Luther,OTR/L Advanced Home Care, Burlington Office 1-336-538-1194, xt 6672 [email protected] Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of [email protected]. If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Ron Carson Sent: Tuesday, February 03, 2009 5:50 AM To: Barbara H. Hale Subject: R! e: [OTlist] Game using reacher I don't want to sound negative, but I can't help wondering what patient's think about using what should be medically necessary equipment to play "games". What "message" might this send to patients, other professionals and payers? Finally, should social interaction only be considered as therapeutic if it's an actual goal? Just some random questions. Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: Barbara H. Hale Sent: Monday, February 02, 2009 To: [email protected] Subj: [OTlist] Game using reacher BHH> I have a bean bag tic tac toe game that I use for a reacher training BHH> activity. The grid for the game is painted on a fabric square that I place BHH> within reach on the floor. Each bean bag has an X or an O painted on it. All BHH> the items fit into a tote bag and I usually hold the bag for the patient to BHH> clean up our game at the end by placing the bean bags in the tote bag. BHH> It is engaging for the pa! tient and I can use it for social interaction BHH> also. BHH> -- BHH> Options? BHH> www.otnow.com/mailman/options/otlist_otnow.com BHH> Archive? BHH> 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] -- 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]
