Here's another old message I just found. You'll need to read the original message to make sense of my comments.
Ron ==============================================================>>>> Yep, I was trained the same way. But that is not the way I practice because practicing that way doesn't make sense to me! What a therapist measures is what they consider important, right? If ROM/PAIN is the outcome then measure away. If occupation is the outcome, they why measure? If an OT can see that decreased elbow ROM prevents someone from dressing and the goal IS dressing, what are the advantages of measuring ROM? I do think it's important to document ROM, strength, sensation, etc, but ONLY as it relates to preventing SPECIFIC occupation. For example, if a patient's goal is dress themselves and they can't because of pain, they document that patient is unable to dress lower body secondary to self-reported elbow pain at 3/10. And, if you as an OT can do something about the pain, then go ahead and treat it. But as I've stated, reducing pain should NOT be the goal of OT, increasing occupation should be. Reducing pain (strength, ROM, etc) is a PT thing, increasing occupation is an OT thing. Despite all my ranting, I understand that the line between occupation and physical factors can be blurry. For example. I just d/c a patient who was s/p lung cancer . She was very short of breath and unable to carry out ANY occupation in her home. Initially, we started with just standing then progressed to ambulation with a walker with a focus on decreasing her oxygen flow while increasing her endurance. We had hoped to get her on a demand-flow system but that didn't work out. I had the patient keep a log of her daily walks and actually charted them. As she progressed we moved to working in the kitchen, going in/out of the house, up/down steps, in/out of her car, driving a golf cart and even went for a drive in her car. There were other things we did but these are some of the highlights. In this case there is a specific and direct link between the patient's occupational deprivation and her decreased pulmonary function. I measured and tracked her pulmonary function (i.e. self-reported fatigue, oxygen sats, pulse rate) but these were never part of our goals. In fact here are the goals: 1. Patient will safely ambulate in/out of home w/ portable oxygen tank including up/down steps while maintaining adequate oxygen sats 2. Safely place/remove portable oxygen tank in/out of car 3. Independently complete simple meal prep without a rest break 4. Independently complete personal care without a rest break. So, while I did monitor the sats, (because you can't SEE oxygen sats without measuring) they weren't a direct goal. And that's how I feel all OT should be. Sure, we need to monitor and maybe even measure ROM, but that should never be our goal. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: L Sloan <[email protected]> Sent: Sunday, August 31, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Elbow Break, Referral... LS> Sorry Ron...I totally disagree...in my 20 years I have always LS> included ROM, pain with function....that is how I was LS> trained...maybe school has changed since then........to me the ROM LS> and pain has everything to do with the function...I have always LS> assessed it when doing an evaluation...that is part of my LS> assessment as sensation is, coordination, cognition etc. I do not consider that PT.... LS> Lisa LS> ----- Original Message ---- LS> From: Ron Carson <[email protected]> LS> To: L Sloan <[email protected]> LS> Sent: Sunday, August 31, 2008 7:09:48 AM LS> Subject: Re: [OTlist] Elbow Break, Referral... LS> If the goal is increased ROM or decreased pain, why include the LS> "functional" component? It seems obvious to me that if ROM/pain are LS> the ONLY things preventing the patient from doing self-care, then LS> positively impacting these area will directly improve self-care. So, LS> why even include the the "function". LS> If the goal is occupation, then I see no reason for the ROM/pain LS> component. As and OT, I strongly believe that occupation should be the LS> goal, but occupation is not always the goal of the patient or MD. And LS> it's these situations where OT is out on a limb, because we are truly LS> practicing OT, but PT. LS> Ron LS> -- LS> Ron Carson MHS, OT LS> ----- Original Message ----- LS> From: L Sloan <[email protected]> LS> Sent: Saturday, August 30, 2008 LS> To: [email protected] <[email protected]> LS> Subj: [OTlist] Elbow Break, Referral... LS>> How About.... LS>> Patient will demonstrate increased active range of motion to ____ LS>> during upper and lower body dressing activities.....or... LS>> Patient will demonstrate increased AROM to ___ to allow patient LS>> to complete upper and lower body selfcare activities safely... LS>> Patient will demonstrate a decrease in pain from ___ to ___ to LS>> enable her to complete her dressing activities. LS>> ??? Lisa LS>> ----- Original Message ---- LS>> From: Ron Carson <[email protected]> LS>> To: OTlist <[email protected]> LS>> Sent: Saturday, August 30, 2008 3:48:47 PM LS>> Subject: [OTlist] Elbow Break, Referral... LS>> Received a new referral for a elbow fracture. I shouldn't have taken LS>> it but I did. LS>> And here is the dilemma facing our profession. The patient is 95, LS>> previously living independently. Fractured elbow in a fall. Now living LS>> with daughter. She is in a large amount of pain. Obviously, she is LS>> dependent for most of her occupations. She currently uses a cane but LS>> is not safe. LS>> The patient's immediate concerns are her elbow. When pressed, she of LS>> course wants to go back home, but that is not an immediate goal. LS>> So what do I write for goals? For example should I write: LS>> Patient will self-report pain as 3 out of 10 LS>> Patient's will increase active elbow extension to -20 degrees LS>> These goals seem to direct the patients and doctor's concerns but are LS>> not occupationally oriented. So, should I write: LS>> Patient will safely and independently dress lower body LS>> Patient will safely and independently ambulate to the bathroom LS>> using the least restrictive mobility aid LS>> I like these goals but they don't address the immediate concerns. LS>> Ron LS>> -- LS>> Ron Carson MHS, OT LS>> -- LS>> Options? LS>> www..otnow.com/mailman/options/otlist_otnow.com LS>> Archive? LS>> www.mail-archive.com/[email protected] LS>> LS> -- LS> Options? LS> www.otnow.com/mailman/options/otlist_otnow.com LS> Archive? LS> www.mail-archive.com/[email protected] LS> -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
