THANKS Joan! Has me wondering: When we succeed - with the "just one goal" - approach - is it because we actually "educate" the patient to be their own OT - aka "Lifestyle Redesign"? And when we don't - and/or patient prefers PT - the underlying hunch of the patient is something along this line: "But life is so much more than this.. - and what about what I might want/need to do tomorrow?"
Warmly susanne, denmark ---- Original Message ---- From: "Joan Riches" <[email protected]> To: <[email protected]> Sent: Sunday, February 22, 2009 12:42 AM Subject: Re: [OTlist] Puposeful activity (snip) 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............ (snip) -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
