What was the book???
I DO try to focus my tx around the patient's needs/desires. Remediating underlying issues often DOES involve balance and strengthening, especially when you are working with the elderly whose main concern when coming into tx is debilitation and weakness. Anxiety is also often a barrier as well as motivation - do they really want to do for themselves or have they succombed to the cultural prejudice of "you're old and so you just can't do as much anymore." The goals I work on with people are often pretty basic - can you dress, wash and toilet on your own, and is it safe to do so. Productivity is a HUGE issue. If I have to see 12 patients in a day, most of whom have an average of 50 minutes (their RUG level according to the Medicare system), I don't have much time to plan individual tx's. Regardless, I really try to do this, contrived activities and all. Filling up 50 minutes of tx time when you have to work multiple patients and save time for documentation is a challenge, even when I use the contrived activities. I do my best to choose on the basis of the specific goals of the patient, and attempt most days to schedule tx times so that I can work with people who have similar/same issues so that I'm not just providing busy work for one while I work with the other. Many people have combined balance and UE limitations which make it extremely difficult to find any activity to do with them, functional or not. One thing I do accomplish with most patients is meaningful interaction. This is an effective way to find out what their needs/desires are. I say this because it is difficult to do when you feel "rushed" to see many people at one time and to keep up with what you are doing with each. Other therapists do not take the "time" to do this, and sometimes come to me for help in motivating a "difficult" patient. I don't say this as a criticism. I understand exactly the pressure they work under. Hence my obsession with concrete suggestions. And I mean concrete as in... what did you do with patient x to address issues x, y and z. I understand the overarching philosophical importance of functional tx, but it is difficult to be a purist when the work environment makes so many other demands of you, demands that must be met to appease Medicare and your supervisors. Unfortunately, I need a job. And I do like working in rehab. I just need to find a way to juggle all these variables in a way that serves the patient best. I am looking for a different position, but in Michigan, that takes time. Thanks for listening, Barb Howard ----- Original Message ----- From: "Ron Carson" <[email protected]> To: "[email protected]" <[email protected]> Sent: Friday, February 13, 2009 3:24:42 PM GMT -05:00 US/Canada Eastern Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard Barb, I want to offer a suggestion. In my early days as an OT, I worked in adult rehab. It was VERY faced paced and therapists generally had 2 - 3 patient's hour. In the beginning, I was stuck in the peg, cone, etc routine, but one day I read a book that changed my practice. I changed my practice pattern from UE/ADL to occupation-based treatment. In this approach, a patients occupational needs/desires become the ONLY reason for treatment. In the absence of occupational problems that are improvable, there is no role for OT. This approach 100% clarified my treatment for both myself and patients. I no longer wondered what to do with patients. Suddenly, I began stepping away from typical OT activity and began addressing patient's most important needs. My treatment boundaries greatly expanded and I began feeling much better about my treatments. No longer did I do "contrived" OT treatment, instead I addressed the the ACTUAL needs of the patients. Since you asked for concrete ideas here they are: 1. Identify client's needs/desires 2. Identify why the can't do these things 3. Direct 100% of your treatment to: a. Remediating underlying issues b. Compensating for uncorrectable problems c. Changing environments Forget made up activities, forget games and other silly things. YOU CAN DO THIS! Ron -- Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: [email protected] <[email protected]> Sent: Friday, February 13, 2009 To: [email protected] <[email protected]> Subj: [OTlist] The Saddest OT Statement I've Ever Heard bcn> Thanks, Sue, for providing some specifics. I understand the need bcn> for functional tx that is specific to the patient! I just need bcn> some more specific, concrete ideas about how others do this in the bcn> clinic environment. With productivity demands it is even difficult bcn> for me to spend time in a patient's room alone with them. I seem bcn> to be the ONLY OT in my department who takes the time to do ADLs with some of my patients. bcn> So I am looking for more concrete ideas and less philosophical bcn> ranting. I do get that part. I know venting is necessary bcn> sometimes, but I joined this list to get more specific ideas to bcn> help with my tx planning and so that is why I asked the question. bcn> Thanks, bcn> Barb Howard COTA bcn> ----- Original Message ----- bcn> From: "Sue Doyle" <[email protected]> bcn> To: [email protected] bcn> Sent: Friday, February 13, 2009 7:46:09 AM GMT -05:00 US/Canada Eastern bcn> Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard bcn> I am the lead therapist in an inpatient rehab center. We focus on the bcn> clients goals and predominantly use functional tasks. Even spent the bcn> afternoon knitting and compiling emails with a patient. I have a bcn> carburetor that I have had out several times for some of the men to bcn> work on as their goal has been to go back to working on their car. bcn> Sue D >> From: [email protected] >> To: [email protected] >> Date: Thu, 12 Feb 2009 19:46:44 -0500 >> Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard >> >> I do not have alot of experience yet ...I am still a student, but I have >> been in places that simply sit patients up at tables and gave them something >> to do that may or may not be functional for them specifically. For example, >> a patient may get something out of cognitively out of sorting colored pegs >> on a peg board but is has no meaning to their life. Our challenge as >> professionals is to dig deeper and find something that we can do to reach >> the same goal but make it applicable to the patients life. However, I >> understand this has been all but impossible in many rehabs because of >> productivity demands. I happen to be in a rehab setting that is more >> flexible because the we smaller and it is acute rehab vs. SNF. I cannot >> judge how other places are run, in fact, I do feel I am in a unique facility >> and although I may never be employed there, I will take this experience with >> me wherever I go. ADL's are the first priority and ususaly what the patients >> say are goals for themselves but we can make meals, simulate homemaking >> activites, and the list goes on..the point is that is has some functional >> application to the patient...so it is always different and changing. >> >> -----Original Message----- >> From: [email protected] [mailto:[email protected]]on >> Behalf Of [email protected] >> Sent: Thursday, February 12, 2009 19:06 >> To: [email protected] >> Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard >> >> >> >> >> How about sharing some specifics - some typical tx sessions. >> >> When you say adult rehab, do you mean outpatient,..home health...? >> >> >> >> This is becoming a mantra - Productivity requirements impose cookie cutter >> approaches. >> >> Therapists are caught in the middle and many give up swimming upstream. I >> haven't given up, but >> >> I know I have to go elsewhere to accomplish this. I'd like to run my own >> department someday, but >> >> I want to learn as much as I can specifically about functional treatment, >> that is, in addition to doing ADLs >> >> with patients. >> >> Any info would be appreciated. >> >> Barb Howard, COTA >> >> >> >> >> ----- Original Message ----- >> From: "Diane Randall" <[email protected]> >> To: [email protected] >> Sent: Thursday, February 12, 2009 6:31:35 PM GMT -05:00 US/Canada Eastern >> Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard >> >> Wow..I am interning in adult rehab right now and UE therex is only used for >> people who really need it. Been there six weeks and everything revolves >> around function. >> >> -----Original Message----- >> From: [email protected] [mailto:[email protected]]on >> Behalf Of Ron Carson >> Sent: Wednesday, February 11, 2009 18:40 >> To: [email protected] >> Subject: [OTlist] The Saddest OT Statement I've Ever Heard >> >> >> Today, I met a new PT assistant who was just starting with our home >> health company. He was just finishing with a patient as I was starting >> my evaluation. The PTA came from 20 years of geriatric rehab and rehab >> experiences. >> >> About 1/2 through my eval he said to me, and I quote: "I'm not use to >> OT's working on functional things". He went on to say that at his rehab >> facility, the OT's mainly did UE exercises. >> >> "Living life to the fullest". What a crock! >> >> 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] >> -- >> 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]
