Joan,
No worries at all on the name thing. When you have a double name that
starts with Mary, you learn early on to answer to Mary Ann, Mary Beth,
etc., etc. If someone calls me the wrong name, I just always say that
if that is the worst than anyone calls me then I'm doing pretty good!
8-)
I very much appreciated your comments in your earlier post. It's nice
to know that people are listening and reading. I am pretty bad about
not posting to say that I agree with something as well, so I will try
to be more aware of that in the future.
I have enjoyed all the discussions lately although we need more people
to join in. Please don't be afraid to post! Everyone I've encountered
here is very friendly--- although occasionally a bit passionate about
their own view!
Happy Weekend All!
Mary Alice
Mary Alice Cafiero, MSOT/L, ATP
[email protected]
972-757-3733
Fax 888-708-8683
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On Feb 21, 2009, at 5:42 PM, Joan Riches wrote:
Back again. I didn't catch all the edits I needed to make in my
dictation so I have done that below. I hope you were able to read over
them but if not this may help.
Also I apologise to Mary Alice for getting your name wrong.
Obviously I
have a Mary Catherine in my life. Joan
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. They are good
but do not address the payment and productivity demands of your SNF
practice in the US.
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.
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
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