Chris, after thinking about your question, I conclude that the best I
can offer is a hypothetical situation. So, here goes....
Take my patient today. A CVA patient. He has a flaccid UE with no
functional use. He requires assist for sit/stand and ambulates with a
quad cane with supervision.
IF the goal is improving the occupation of self-care to the
supervision/setup level, treatment might look like this:
Therapeutic activity to include: sit/stand and transfer
training. Balance training without UE support. Hemi dressing
techniques training
IF the goal is improving UE ROM to increase ability to perform self-care
with supervision/setup, the treatment might look like this:
Therapeutic exercise to the affected UE. Self-care training in
hemi-dressing.
=================================================================
For the record, the patient verbalized mixed goals. Of course he said he
wants to get his arm working but he also wants to reduce the strain on
his wife by increasing his ability to sit/stand without assistance from
her.
Look forward to feedback and comments from you and EVERYONE else! In my
opinion, the issues and topics being discussed are too important to not
be involved! <smile>
Ron
----- Original Message -----
From: [email protected] <[email protected]>
Sent: Monday, February 16, 2009
To: [email protected] <[email protected]>
Subj: [OTlist] Occupation as THE goal: Does it matter
cac> Ron,
cac> Great outline.? Can you next explain how the treatment will differ?
cac> Chris
cac> -----Original Message-----
cac> From: Ron Carson <[email protected]>
cac> To: [email protected]
cac> Sent: Mon, 16 Feb 2009 7:52 am
cac> Subject: [OTlist] Occupation as THE goal: Does it matter
cac> Hello All:
cac> What follows are thoughts and opinion about using occupation as *THE*
cac> goal for OT treatment.
cac> Here's is the premise for my arguments:
cac> (1) When occupation is *THE* goal, outcome statements may be written in
cac> concise occupation-based outcomes. For example:
cac> Patient will safely and independently ambulate to/from toilet
cac> with RW and perform all hygiene without assistive equipment.
cac> Patient will transfer from w/c to bed using slide board
cac> transfers
cac> Patient will dress self using adaptive equipment as necessary
cac> (2) Conversely, when occupation is not *THE* goal, outcomes may be
cac> written so that occupation is a desired outcome but is based on
cac> improving underlying impairment(s). For example:
cac> Patient will increase UE elbow ROM to 115 degree active flexion
cac> to all for donning/doffing of shirt
cac> Patient will increase standing endurance/balance to allow them
cac> to safely and independently carry out toileting hygiene.
cac> --------------------------------------------------------------------
cac> Some argue there is little difference in the above approaches. However,
cac> I believe these approaches frame patient problems very differently. This
cac> is important because how we frame a problem drives our treatment.
cac> The first example clearly identifies that occupation is the goal. There
cac> is no expressed concern for underlying factors impairing occupation.
cac> However, and this if often overlooked, it is IMPLIED that all factors
cac> impairing the goal will be treated within the therapist's abilities.
cac> This is true because occupation includes the following factors:
cac> Physical, emotional, mental environmental, behavioral, social
cac> Thus, as OT's and within our scope of practice, occupation-based
cac> outcomes address all factors impairing the desire occupations.
cac> While the second example does include occupation as an outcome, only
cac> factors addressed in the goals are included for treatment. This severely
cac> limits treatment and
cac> in my opinion indicates that remediation of
cac> underlying impairments is the real goal. The implication is that if
cac> underlying impairments are remediated, occupation will improve. However,
cac> is inconsistent with OT theory because occupation is ALWAYS more than
cac> physical. In my opinion, the second example is much more like a PT
cac> rather than an OT goal!
cac> In closing, writing occupation-based goals is important for us and for
cac> the patient. These goals allow us to focus on occupation's many elements
cac> and complexity to best enable our patients.
cac> Thanks,
cac> Ron
cac> --
cac> Ron Carson MHS, OT
cac> www.OTnow.com
cac> --
cac> Options?
cac> www.otnow.com/mailman/options/otlist_otnow.com
cac> Archive?
cac> www.mail-archive.com/[email protected]
cac> --
cac> Options?
cac> www.otnow.com/mailman/options/otlist_otnow.com
cac> Archive?
cac> www.mail-archive.com/[email protected]
--
Options?
www.otnow.com/mailman/options/otlist_otnow.com
Archive?
www.mail-archive.com/[email protected]
