Barb, I don't think using cones/pegs/ etc should make you feel "not good enough". Heck, at least you are looking for a different way of being an OT. I'm sure that many OT's realize that cones and pegs isn't the best way to deliver services, but there are probably just as many who really don't even care. To me, it's the "non-caring" OT's who are the profession's biggest stumbling block.
Maybe your setting does allow "best practice" for all patients, Maybe though, you can slip in some occupation-based treatment every now and then. And that's not a bad way to start, because changing treatment focus is bound to stretch your comfort zone. Hang in there! Ron -- Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: [email protected] <[email protected]> Sent: Saturday, February 21, 2009 To: [email protected] <[email protected]> Subj: [OTlist] Puposeful activity bcn> Hello Ilene, bcn> Your post was satisfying to me, as I work in the same setting and bcn> am faced with the same concerns re tx. Put my reaction down to bcn> "misery loves company", although I am not miserable in my position. bcn> What I do with patients may not be strictly OT as defined by most bcn> of those who contribute to this site, but I have made peace with bcn> that because I know that I am definitely helping my patients heal bcn> and return to a higher level of function in their daily lives. I, bcn> too, have been asking for more concrete suggestions as to how this bcn> is done in the SNF/subacute world which is so focussed on profit. bcn> Thanks for sharing a similar concern. It is so easy to feel alone, bcn> and not good enough with regard to the cones and pegs controversy! bcn> Barb Howard COTA bcn> ----- Original Message ----- bcn> From: [email protected] bcn> To: [email protected] bcn> Sent: Wednesday, February 18, 2009 7:00:20 PM GMT -05:00 US/Canada Eastern bcn> Subject: Re: [OTlist] Puposeful activity bcn> Hi Joan and thanks for your insight! May I ask what you would want bcn> an OT to work on with you though before bcn> you had sufficient range to fasten your bra behind your back, if bcn> increasing the range of motion or adapting the task (i.e fastening bcn> int he front) were not options you would want? bcn> IMO, when therapists resort to cones, etc, it is not because they bcn> are lazy, it is because they don't know what else to do, either bcn> because they only have experience in work settings where cones and bcn> pegs were used, or they are in a subactute setting where they are bcn> seeing multiple people at once. Of course that is not ideal, but it bcn> is reality. I for one would like to move into this more ideal realm bcn> and change the way I practice, but there is precious little bcn> practical "how to's" for doing this, especially in settings like bcn> mine, where there is no kitchen, ADL suite, etc, and it is bcn> impossible to see everyone one on one for ADL's. There is no course bcn> that I can find on taking OT back to the functional in today's bcn> money-driven practice settings, in fact I have never seen a bcn> shoulder course for OT that doesn't focus on increasing range and bcn> other medically-based PT-type interventions. Even here, many people bcn> say "do this" but very few say specifically HOW or offer any bcn> practical ideas for the therapists stuck in peg/cone world who want bcn> to be more functional but are up against a practice world that just bcn> wants numbers. If you or anyone can offer any practical advice, bcn> point to a book or course to help therapists work more functionally bcn> with patients (who often, in a nursing home setting, can't even bcn> come up with goals of their own or answer "nothing" or "watch TV" bcn> when asked what they would like to be able to resume doing) I would be most appreciative. bcn> Thanks, bcn> Ilene Rosenthal, OTR/L bcn> Message: 1 bcn> Date: Tue, 17 Feb 2009 11:30:40 -0700 bcn> From: "Joan Riches" <[email protected]> bcn> Subject: Re: [OTlist] purposeful activity bcn> To: <[email protected]> bcn> Message-ID: bcn> <!~!uenerkvcmdkaaqacaaaaaaaaaaaaaaaaabgaaaaaaaaaqpieeyoaqeeuzxp6qay++8kaaaaqaaaa8ulnq9shyumb39sehxogoqeaa...@telusplanet.net> bcn> Content-Type: text/plain; charset="US-ASCII" bcn> Greetings to all bcn> I couldn't resist this one. bcn> In my opinion (like Ron's) all activity has purpose for someone or bcn> something (witness the reproduction of plants) . The OT question re the bcn> activities we use as treatment interventions is: Does this activity have bcn> purpose and therefore meaning for this client in terms of their explicit bcn> and implicit occupational goals? bcn> I absolutely agree with Ron's goal formulation where the only goal is bcn> some form of OCCUPATIONAL performance. bcn> (In the presence of cognitive deficits this becomes a much more bcn> difficult question.) bcn> Below is my personal physical and OT/PT case example. bcn> I've been thinking about it a lot in my present situation and how it bcn> plays out. I am still after 14 months working on the stability of the bcn> hip that was pinned and the range and strength in the shoulder with a bcn> nondisplaced fracture. Although I am determined not to walk or run with bcn> the typical 'hip' gait or to limit my reach and ability with my arm I bcn> find it very difficult to persist in activities that are not useful and bcn> meaningful 'at the time'. Especially now that the physical limitations bcn> are only apparent when I'm challenged - trying to walk a distance across bcn> a large parking lot quickly to keep an appointment for instance or bcn> helping to unload plywood from the truck or screwing a light bulb into a bcn> ceiling fixture - it is easy to have 'life' push out the daily bcn> excercises. I am not of the generation the 'works out for the sake of'. bcn> I have a brilliant and understanding PT. He knows the 30 to 45 straight bcn> minutes a day will just not get done. He knows that I want to recover bcn> not adapt. So he knows what I need to do and collaborates with me to bcn> find ways to incorporate the movements into my regular activities such bcn> as mindfully using the stairs, varying pace, not using the railings to bcn> pull myself up etc. The stairs themselves cue me as do the top shelves bcn> in the kitchen where I store at least three things that I use for bcn> breakfast each morning. bcn> My morning routine now includes an exercise where I need a significant bcn> break between sets. So I do a set and then clean my teeth etc. thus bcn> being purposeful with the 'dead' time. There is an exercise for my bcn> shoulder for which I need help. This has been tacked on to my husband's bcn> regular morning care. I do his compression stockings and he does my bcn> shoulder. Bob checks my style and is available if I have questions but bcn> my next visit will be in eight weeks - down from six the last time - bcn> down from 3X/week when we started. bcn> I have no doubt at all that what Bob does for me is PT. His purpose is bcn> directed to foundation abilities and what else affects my occupational bcn> performance is not his concern. Over time he sees my delighted reporting bcn> of the things I can do as evidence that his treatment of the foundation bcn> skill is effective. I have a good team with a PT and an OT(me). bcn> My occupational goals include all the things that I need to walk or run, bcn> reach, carry or support including the effective use of my hands to be bcn> able to do - however measureable goals are demanded from us. So for the bcn> shoulder I have picked one daily activity - doing up my bra that is a bcn> measureable goal to monitor progress. (can now do effectively but with bcn> some discomfort). bcn> So PT goal - to increase shoulder range and strength to facilitate bcn> dressing. bcn> OT goal - to fasten bra with both hands behind the back without bcn> discomfort. This is a good fit and focus for me - what would work for bcn> someone else in a similar situation will depend on whether it is an bcn> important thing to be able to do. Many women adapt by doing it up in bcn> front and twisting it around. bcn> Conclusion bcn> Any deficit affects so much in present or future occupational bcn> performance that I think some of us shy away from limiting the reason bcn> for working on something to one goal. The progress in the physical bcn> foundational skill is so easy to measure but it leaves out all the other bcn> the factors that also affect occupational performance. bcn> Thanks for reading this far. It has been a joy to see all the new bcn> members coming on. I haven't been at all active on the list lately bcn> partly because to say everything I want to takes me so long to type. I bcn> would very much appreciate your comments and feedback. bcn> So many topics to wade into - the discussions are bearing great fruit, I bcn> think. bcn> Soft theory - so important. bcn> Blessings, Joan bcn> Joan Riches B.Sc.O.T., OT(C) bcn> Specialist in Cognitive Disability bcn> Riches Consulting bcn> High River, Alberta, Canada bcn> 403 652 7928 bcn> -----Original Message----- bcn> From: [email protected] [mailto:[email protected]] On -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
