Hello Joan:
Thanks for your personal and professional insight. I hate to only
comment on ONE thing, but something really struck me. You said:
"Any deficit affects so much in present or future occupational
performance that I think some of us shy away from limiting the
reason for working on something to one goal."
I think this is SO true! I don't know why therapist feel the need to
write multiple goals. I frequently have only ONE goal. I'm curious to
read others' comments on the topic of one goal!
Thanks again!!
Ron
--
Ron Carson MHS, OT
www.OTnow.com
----- Original Message -----
From: Joan Riches <[email protected]>
Sent: Tuesday, February 17, 2009
To: [email protected] <[email protected]>
Subj: [OTlist] purposeful activity
JR> Greetings to all
JR> I couldn't resist this one.
JR> In my opinion (like Ron's) all activity has purpose for someone or
JR> something (witness the reproduction of plants) . The OT question re the
JR> activities we use as treatment interventions is: Does this activity have
JR> purpose and therefore meaning for this client in terms of their explicit
JR> and implicit occupational goals?
JR> I absolutely agree with Ron's goal formulation where the only goal is
JR> some form of OCCUPATIONAL performance.
JR> (In the presence of cognitive deficits this becomes a much more
JR> difficult question.)
JR> Below is my personal physical and OT/PT case example.
JR> I've been thinking about it a lot in my present situation and how it
JR> plays out. I am still after 14 months working on the stability of the
JR> hip that was pinned and the range and strength in the shoulder with a
JR> nondisplaced fracture. Although I am determined not to walk or run with
JR> the typical 'hip' gait or to limit my reach and ability with my arm I
JR> find it very difficult to persist in activities that are not useful and
JR> meaningful 'at the time'. Especially now that the physical limitations
JR> are only apparent when I'm challenged - trying to walk a distance across
JR> a large parking lot quickly to keep an appointment for instance or
JR> helping to unload plywood from the truck or screwing a light bulb into a
JR> ceiling fixture - it is easy to have 'life' push out the daily
JR> excercises. I am not of the generation the 'works out for the sake of'.
JR> I have a brilliant and understanding PT. He knows the 30 to 45 straight
JR> minutes a day will just not get done. He knows that I want to recover
JR> not adapt. So he knows what I need to do and collaborates with me to
JR> find ways to incorporate the movements into my regular activities such
JR> as mindfully using the stairs, varying pace, not using the railings to
JR> pull myself up etc. The stairs themselves cue me as do the top shelves
JR> in the kitchen where I store at least three things that I use for
JR> breakfast each morning.
JR> My morning routine now includes an exercise where I need a significant
JR> break between sets. So I do a set and then clean my teeth etc. thus
JR> being purposeful with the 'dead' time. There is an exercise for my
JR> shoulder for which I need help. This has been tacked on to my husband's
JR> regular morning care. I do his compression stockings and he does my
JR> shoulder. Bob checks my style and is available if I have questions but
JR> my next visit will be in eight weeks - down from six the last time -
JR> down from 3X/week when we started.
JR> I have no doubt at all that what Bob does for me is PT. His purpose is
JR> directed to foundation abilities and what else affects my occupational
JR> performance is not his concern. Over time he sees my delighted reporting
JR> of the things I can do as evidence that his treatment of the foundation
JR> skill is effective. I have a good team with a PT and an OT(me).
JR> My occupational goals include all the things that I need to walk or run,
JR> reach, carry or support including the effective use of my hands to be
JR> able to do - however measureable goals are demanded from us. So for the
JR> shoulder I have picked one daily activity - doing up my bra that is a
JR> measureable goal to monitor progress. (can now do effectively but with
JR> some discomfort).
JR> So PT goal - to increase shoulder range and strength to facilitate
JR> dressing.
JR> OT goal - to fasten bra with both hands behind the back without
JR> discomfort. This is a good fit and focus for me - what would work for
JR> someone else in a similar situation will depend on whether it is an
JR> important thing to be able to do. Many women adapt by doing it up in
JR> front and twisting it around.
JR> Conclusion
JR> Any deficit affects so much in present or future occupational
JR> performance that I think some of us shy away from limiting the reason
JR> for working on something to one goal. The progress in the physical
JR> foundational skill is so easy to measure but it leaves out all the other
JR> the factors that also affect occupational performance.
JR> Thanks for reading this far. It has been a joy to see all the new
JR> members coming on. I haven't been at all active on the list lately
JR> partly because to say everything I want to takes me so long to type. I
JR> would very much appreciate your comments and feedback.
JR> So many topics to wade into - the discussions are bearing great fruit, I
JR> think.
JR> Soft theory - so important.
JR> Blessings, Joan
JR> Joan Riches B.Sc.O.T., OT(C)
JR> Specialist in Cognitive Disability
JR> Riches Consulting
JR> High River, Alberta, Canada
JR> 403 652 7928
JR>
JR> -----Original Message-----
JR> From: [email protected] [mailto:[email protected]] On
JR> Behalf Of Ron Carson
JR> Sent: February 17, 2009 4:16 AM
JR> To: Diane Randall
JR> Subject: Re: [OTlist] purposeful activity
JR> In my opinion, all activity has purpose. Lifting weights, pulling pegs,
JR> making cupcakes, bowling, etc. I truly can't think of any activity that
JR> doesn't have a purpose. I think OT's often want to "claim" purposeful
JR> activity as our mantra, but all profession have purposeful activity,
JR> don't they?
JR> Interestingly, when I was teaching a Human Occupation class, there were
JR> 3 words student's could not use in class, the "a" word, the "p" word and
JR> "f" word".
JR> <a> = activity <p> = purposeful <f> = function
JR> Thanks,
JR> Ron
JR> --
JR> Ron Carson MHS, OT
JR> www.OTnow.com
JR> ----- Original Message -----
JR> From: Diane Randall <[email protected]>
JR> Sent: Tuesday, February 17, 2009
JR> To: [email protected] <[email protected]>
JR> Subj: [OTlist] purposeful activity
DR>> In your opinion, what makes an activity purposeful and how would you
JR> go
DR>> about making a non-ADL actvity purposeful? Thanks Diane OTAS
JR> --
JR> Options?
JR> www.otnow.com/mailman/options/otlist_otnow.com
JR> Archive?
JR> www.mail-archive.com/[email protected]
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