A referral should be made a.s.a.p. to an ophthalmologist or neurologist for further intervention. Double vision, diplopia is an impairment of the musculature that controls the eye and is commonly the result of a cranial nerve disorder. Depending on the location/nature of the surgery this may be a known result, or not. Either way, the physicians need to be alerted to this condition. Again, depending on the etiology of the diplopia it may spontaneously resolve or the patient may be given eye exercises, prisms, patch, etc. However, if it is anticipate that spontaneous resolution will occur, then the patient may be given nothing for compensation. In this event, although it is difficult and disruptive for the patient and rehabilitation, a patch should not be used unless okayed by the medical team and used in strict accordance to their prescription lest it interfere with resolution of the diplopia. As for intervention, you might want to do some investigation/testing to determine if there are any areas of convergence/monocular vision in any gaze direction or length & then utilize this as much as possible during therapy. Hope that helps. Deann
-----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of [email protected] Sent: Monday, February 16, 2009 8:10 AM To: [email protected] Subject: OTlist Digest, Vol 56, Issue 1 Send OTlist mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com or, via email, send a message with subject or body 'help' to [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of OTlist digest..." Today's Topics: 1. Re: The Saddest OT Statement I've Ever Heard (Ron Carson) 2. 6 weeks of function? (Charles Sullivan) 3. Re: 6 weeks of function? (Diane Randall) 4. Double vision (Diane Randall) 5. Re: Double vision (Ron Carson) 6. Re: The Saddest OT Statement I've Ever Heard ([email protected]) 7. Re: Double vision (ehthiers) 8. Re: Double vision ([email protected]) 9. Occupation as THE goal: Does it matter (Ron Carson) 10. Re: Double vision (Diane Randall) 11. Re: Double vision (Diane Randall) ---------------------------------------------------------------------- Message: 1 Date: Fri, 13 Feb 2009 15:24:42 -0500 From: Ron Carson <[email protected]> Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard To: "[email protected]" <[email protected]> Message-ID: <[email protected]> Content-Type: text/plain; charset=utf-8 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] ------------------------------ Message: 2 Date: Fri, 13 Feb 2009 18:46:03 -0500 From: Charles Sullivan <[email protected]> Subject: [OTlist] 6 weeks of function? To: [email protected] Message-ID: <[email protected]> Content-Type: text/plain; charset=iso-8859-1 Hey Diane...What do you mean by 6 wks of function?? "Been there six weeks and everything revolves around function." ------------------------------ Message: 3 Date: Sat, 14 Feb 2009 09:12:49 -0500 From: "Diane Randall" <[email protected]> Subject: Re: [OTlist] 6 weeks of function? To: <[email protected]> Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" I just meant that I have only been there for six weeks and I feel I have been taught to focus on funtional activites for the entire time I have been there. ( I was responding to Ron's experience with a PTA who said he had not witnessed OT's doing anything functional just UE exercises.) -----Original Message----- From: [email protected] [mailto:[email protected]]on Behalf Of Charles Sullivan Sent: Friday, February 13, 2009 18:46 To: [email protected] Subject: [OTlist] 6 weeks of function? Hey Diane...What do you mean by 6 wks of function?? "Been there six weeks and everything revolves around function." -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ------------------------------ Message: 4 Date: Sat, 14 Feb 2009 11:23:21 -0500 From: "Diane Randall" <[email protected]> Subject: [OTlist] Double vision To: <[email protected]> Message-ID: <[email protected]> Content-Type: text/plain; charset="iso-8859-1" My supervisor is just finishing up an eval on a patient who has double vision secondary to brain surgury. Has anyone had a patient with this particular deficit and can offer ideas on compensation strategies to perform adls/safe functional mobility. etc? Thanks ------------------------------ Message: 5 Date: Sat, 14 Feb 2009 15:38:31 -0500 From: Ron Carson <[email protected]> Subject: Re: [OTlist] Double vision To: Diane Randall <[email protected]> Message-ID: <[email protected]> Content-Type: text/plain; charset=windows-1252 The only compensation that I know of for double vision is patching one eye. Of course, there are complications associated with patching. Ron ----- Original Message ----- From: Diane Randall <[email protected]> Sent: Saturday, February 14, 2009 To: [email protected] <[email protected]> Subj: [OTlist] Double vision DR> My supervisor is just finishing up an eval on a patient who has double DR> vision secondary to brain surgury. Has anyone had a patient with this DR> particular deficit and can offer ideas on compensation strategies to perform DR> adls/safe functional mobility. etc? Thanks DR> -- DR> Options? DR> www.otnow.com/mailman/options/otlist_otnow.com DR> Archive? DR> www.mail-archive.com/[email protected] ------------------------------ Message: 6 Date: Sat, 14 Feb 2009 22:02:45 +0000 (UTC) From: [email protected] Subject: Re: [OTlist] The Saddest OT Statement I've Ever Heard To: [email protected] Message-ID: <190487452.1531551234648965974.javamail.r...@sz0065a.emeryville.ca.mail.comc ast.net> Content-Type: text/plain; charset=utf-8 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] ------------------------------ Message: 7 Date: Sun, 15 Feb 2009 20:55:41 -0500 From: "ehthiers" <[email protected]> Subject: Re: [OTlist] Double vision To: <[email protected]> Message-ID: <be40cabe96094b6d8db380897a762...@bethslaptop> Content-Type: text/plain; charset="us-ascii" Besthing to do is find a neuro optometrist. Let them help the person first. I know we work with developmental/ neuroptometrists in our area. First see if they can correct for it, prisms, special patiching, etc. Does the person get it all the time? Is it just from vision or also from vestibular issues? Elizabeth Thiers, OTR/L FECTS [email protected] > -----Original Message----- > From: [email protected] > [mailto:[email protected]] On Behalf Of Ron Carson > Sent: Saturday, February 14, 2009 3:39 PM > To: Diane Randall > Subject: Re: [OTlist] Double vision > > The only compensation that I know of for double vision is > patching one eye. Of course, there are complications > associated with patching. > > Ron > > ----- Original Message ----- > From: Diane Randall <[email protected]> > Sent: Saturday, February 14, 2009 > To: [email protected] <[email protected]> > Subj: [OTlist] Double vision > > DR> My supervisor is just finishing up an eval on a patient who has > DR> double vision secondary to brain surgury. Has anyone had > a patient > DR> with this particular deficit and can offer ideas on compensation > DR> strategies to perform adls/safe functional mobility. etc? Thanks > > > > DR> -- > DR> Options? > DR> www.otnow.com/mailman/options/otlist_otnow.com > > DR> Archive? > DR> www.mail-archive.com/[email protected] > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] ------------------------------ Message: 8 Date: Sun, 15 Feb 2009 21:11:21 -0500 From: [email protected] Subject: Re: [OTlist] Double vision To: [email protected] Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" One?technique that I use is partial patching of the eye by using transpore tape (found in most nursing stations)? I simply place the tape on the medial aspect of the patient's pair of glasses.? This will compensate for the double vision but at the same time allow stimulation to the eye to prevent problems and lack of peripheral vision. Chris Nahrwold MS, OTR -----Original Message----- From: ehthiers <[email protected]> To: [email protected] Sent: Sun, 15 Feb 2009 8:55 pm Subject: Re: [OTlist] Double vision Besthing to do is find a neuro optometrist. Let them help the person first. I know we work with developmental/ neuroptometrists in our area. First see if they can correct for it, prisms, special patiching, etc. Does the person get it all the time? Is it just from vision or also from vestibular issues? Elizabeth Thiers, OTR/L FECTS [email protected] > -----Original Message----- > From: [email protected] > [mailto:[email protected]] On Behalf Of Ron Carson > Sent: Saturday, February 14, 2009 3:39 PM > To: Diane Randall > Subject: Re: [OTlist] Double vision > > The only compensation that I know of for double vision is > patching one eye. Of course, there are complications > associated with patching. > > Ron > > ----- Original Message ----- > From: Diane Randall <[email protected]> > Sent: Saturday, February 14, 2009 > To: [email protected] <[email protected]> > Subj: [OTlist] Double vision > > DR> My supervisor is just finishing up an eval on a patient who has > DR> double vision secondary to brain surgury. Has anyone had > a patient > DR> with this particular deficit and can offer ideas on compensation > DR> strategies to perform adls/safe functional mobility. etc? Thanks > > > > DR> -- > DR> Options? > DR> www.otnow.com/mailman/options/otlist_otnow.com > > DR> Archive? > DR> 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] ------------------------------ Message: 9 Date: Mon, 16 Feb 2009 07:52:59 -0500 From: Ron Carson <[email protected]> Subject: [OTlist] Occupation as THE goal: Does it matter To: [email protected] Message-ID: <[email protected]> Content-Type: text/plain; charset=windows-1252 Hello All: What follows are thoughts and opinion about using occupation as *THE* goal for OT treatment. Here's is the premise for my arguments: (1) When occupation is *THE* goal, outcome statements may be written in concise occupation-based outcomes. For example: Patient will safely and independently ambulate to/from toilet with RW and perform all hygiene without assistive equipment. Patient will transfer from w/c to bed using slide board transfers Patient will dress self using adaptive equipment as necessary (2) Conversely, when occupation is not *THE* goal, outcomes may be written so that occupation is a desired outcome but is based on improving underlying impairment(s). For example: Patient will increase UE elbow ROM to 115 degree active flexion to all for donning/doffing of shirt Patient will increase standing endurance/balance to allow them to safely and independently carry out toileting hygiene. -------------------------------------------------------------------- Some argue there is little difference in the above approaches. However, I believe these approaches frame patient problems very differently. This is important because how we frame a problem drives our treatment. The first example clearly identifies that occupation is the goal. There is no expressed concern for underlying factors impairing occupation. However, and this if often overlooked, it is IMPLIED that all factors impairing the goal will be treated within the therapist's abilities. This is true because occupation includes the following factors: Physical, emotional, mental environmental, behavioral, social Thus, as OT's and within our scope of practice, occupation-based outcomes address all factors impairing the desire occupations. While the second example does include occupation as an outcome, only factors addressed in the goals are included for treatment. This severely limits treatment and in my opinion indicates that remediation of underlying impairments is the real goal. The implication is that if underlying impairments are remediated, occupation will improve. However, is inconsistent with OT theory because occupation is ALWAYS more than physical. In my opinion, the second example is much more like a PT rather than an OT goal! In closing, writing occupation-based goals is important for us and for the patient. These goals allow us to focus on occupation's many elements and complexity to best enable our patients. Thanks, Ron -- Ron Carson MHS, OT www.OTnow.com ------------------------------ Message: 10 Date: Mon, 16 Feb 2009 08:09:28 -0500 From: "Diane Randall" <[email protected]> Subject: Re: [OTlist] Double vision To: <[email protected]> Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" Thnak you ..I will pass this along. -----Original Message----- From: [email protected] [mailto:[email protected]]on Behalf Of [email protected] Sent: Sunday, February 15, 2009 21:11 To: [email protected] Subject: Re: [OTlist] Double vision One?technique that I use is partial patching of the eye by using transpore tape (found in most nursing stations)? I simply place the tape on the medial aspect of the patient's pair of glasses.? This will compensate for the double vision but at the same time allow stimulation to the eye to prevent problems and lack of peripheral vision. Chris Nahrwold MS, OTR -----Original Message----- From: ehthiers <[email protected]> To: [email protected] Sent: Sun, 15 Feb 2009 8:55 pm Subject: Re: [OTlist] Double vision Besthing to do is find a neuro optometrist. Let them help the person first. I know we work with developmental/ neuroptometrists in our area. First see if they can correct for it, prisms, special patiching, etc. Does the person get it all the time? Is it just from vision or also from vestibular issues? Elizabeth Thiers, OTR/L FECTS [email protected] > -----Original Message----- > From: [email protected] > [mailto:[email protected]] On Behalf Of Ron Carson > Sent: Saturday, February 14, 2009 3:39 PM > To: Diane Randall > Subject: Re: [OTlist] Double vision > > The only compensation that I know of for double vision is > patching one eye. Of course, there are complications > associated with patching. > > Ron > > ----- Original Message ----- > From: Diane Randall <[email protected]> > Sent: Saturday, February 14, 2009 > To: [email protected] <[email protected]> > Subj: [OTlist] Double vision > > DR> My supervisor is just finishing up an eval on a patient who has > DR> double vision secondary to brain surgury. Has anyone had > a patient > DR> with this particular deficit and can offer ideas on compensation > DR> strategies to perform adls/safe functional mobility. etc? Thanks > > > > DR> -- > DR> Options? > DR> www.otnow.com/mailman/options/otlist_otnow.com > > DR> Archive? > DR> 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] ------------------------------ Message: 11 Date: Mon, 16 Feb 2009 08:08:53 -0500 From: "Diane Randall" <[email protected]> Subject: Re: [OTlist] Double vision To: <[email protected]> Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" Thank you. I believe the double vision is a direct result of the surgery. I will have to talk to my supervisor. thanks -----Original Message----- From: [email protected] [mailto:[email protected]]on Behalf Of ehthiers Sent: Sunday, February 15, 2009 20:56 To: [email protected] Subject: Re: [OTlist] Double vision Besthing to do is find a neuro optometrist. Let them help the person first. I know we work with developmental/ neuroptometrists in our area. First see if they can correct for it, prisms, special patiching, etc. Does the person get it all the time? Is it just from vision or also from vestibular issues? Elizabeth Thiers, OTR/L FECTS [email protected] > -----Original Message----- > From: [email protected] > [mailto:[email protected]] On Behalf Of Ron Carson > Sent: Saturday, February 14, 2009 3:39 PM > To: Diane Randall > Subject: Re: [OTlist] Double vision > > The only compensation that I know of for double vision is > patching one eye. Of course, there are complications > associated with patching. > > Ron > > ----- Original Message ----- > From: Diane Randall <[email protected]> > Sent: Saturday, February 14, 2009 > To: [email protected] <[email protected]> > Subj: [OTlist] Double vision > > DR> My supervisor is just finishing up an eval on a patient who has > DR> double vision secondary to brain surgury. Has anyone had > a patient > DR> with this particular deficit and can offer ideas on compensation > DR> strategies to perform adls/safe functional mobility. etc? Thanks > > > > DR> -- > DR> Options? > DR> www.otnow.com/mailman/options/otlist_otnow.com > > DR> Archive? > DR> 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] ------------------------------ -- Unsubscribe? [email protected] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [email protected] End of OTlist Digest, Vol 56, Issue 1 ************************************* -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
