Hi Ilene The book Ron Mentioned, "Enabling Occupation: An Occupational Therapy Perspective", as well as "Enabling Occupation II: Advancing an Occupational Therapy Vision for Health Well-being and Justice and Through Occupation" are the official guiding documents for OT in Canada. They are both published and available from www.caot.ca.
You wrote "Hi Joan and thanks for your insight! May I ask what you would want an OT to work on with you though before you had sufficient range to fasten your bra behind your back, if increasing the range of motion or adapting the task (i.e fastening in the front) were not options you would want?" Increasing range, strength and stability as well as adapting the task were all necessary and, of course, increasing range strength and stability improved occupational performance in many other ADL and IADL tasks. What I would have wanted from another OT, if I had not been doing it for myself was good task analysis and grading. Analyzing how I pulled up my pants and to what extent that was facilitating internal rotation is an example of grading toward the ultimate goal of fastening my bra at the back. Pulling up the pants can be graded from starting at the front and wiggling into them to gradually moving both hands further back. It was several months before I could pull up my pants with both hands behind my back. It was also a good way to see progress with my Peete exercises (I can't resist leaving this in. I have just begun to be able to dictate to my computer. It has not yet learned what I'm talking about). I guess in my own case I did have multiple goals because I was analyzing all the things that I had to do differently, how I was doing them, how I wanted to do them and how I could grade the movements I was making to lead toward how I wanted to do things rather than falling into bad habits of accommodation, especially the habit of limiting myself in terms of what I was willing to do. Because I had a hip fracture as well I was particularly concerned about not developing an accommodated gait. However my measurable goal for my hip was to be able to cut my toenails on that foot. I can do it now but it is a real struggle and when I can do it easily I think that the stride of both legs will be equal and my gait will be balanced. The movie a black, This example is only applicable to a client with intact cognition who can look forward and see the implications of the difficulties they are having. In other words they will be able to follow the logic of your reasoning. It is a very different matter when you are working with people who have a cognitive deficit. They are unlikely to understand working toward a measurable goal. The goal in that case may be implicit in terms of comfort so your analysis and grading may lead you toward some motions that can be elicited by an activity, such as balloon ball to encourage reaching up. The Canadian Occupational Performance Measure includes those things that a client wants or needs to do as well as those things that someone else needs or wants wants you to do. In the SNF setting treating a shoulder injury may have the goal of improving comfort during mechanical transfers so the want or need will be expressed by the caregivers not the client. As you well know this is a much more complicated situation in which to try to write a measureable occupational goal. I hope this helps. Please let's continue the conversation. Let the list know if you have been able to apply this. Tell us about your successes or your frustrations and thank you so much for asking. Blessings, Joan -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
