The more I practice occupation-based OT, I notice an area of "concern". I believe that OT should address the most important concerns of patients within our scope of practice and personal expertise. However, I find that doing this very frequently takes me into the realm of what has traditionally been PT. For example, I have a CVA patient with hemiplegia who really wants to get to working around his home. In order to address this goal, I find myself challenging the patient's safety and independence without the use of his cane. For yesterday's treatment, we practiced transfers and use of an adult 3-wheel bike. Today, he walked outside on the ground, up/down stairs, across rocks, etc without his cane. He also walked into his shop and took laundry out of the dryer, something he previously did. And, before going outside, I asked for a glass of water from the refrigerator. I didn't really want water but I did want to challenge him to do familiar things without his cane. All of these were very successful, at least from my perspective. And, all of this is leading the patient down the path of "living life to the fullest". BUT, I am stepping on PT's traditional turf, and in a big way.
I find this is frequently the case. Patients want to be able to carry out mobility related occupations. They want to walk to the bathroom, get on/off the toilet, in/out of the shower, cook, clean, etc. And they want to do like they did before they got sick. So, I find myself constantly facing the "problem" of encroachment. Almost all the PTA's have complained to the PT about my treatments. I always tell the PT's that I'm not addressing gait, although walking obliviously involves gait. My goals are occupation-based and I do think "best practice" means appropriately challenging patients so that they reach their goals as quickly and safely as possible. But, it's a "problem". And, if that's not enough, I do NOT focus treatment on patient's UE. This same CVA patient has a "dead" arm. I've told him that I can do nothing to "fix" or make a significance difference in this situation. I did advise him that he may want to seek treatment from a CHT. Today, the wife told me that the patient's arm pain makes it difficult for her to clean his armpit. Immediately, I ranged the patient's arm and found it to be extremely tight in the joint and very painful. I suspected an impingement and while I could have done some ROM to his shoulder, I opted to call the PT. I told her my findings and that I wanted to sent the patient to an ortho doctor. She agreed and advised that the PTA was previously instructed to treat the patient's shoulder. On monday, I will refer the patient to the ortho. I seems that my preferred practice pattern is about 180 degrees from the norm. But, I find that it is the only pattern that fits occupation-based treatment. As I previously stated, I do NOT believe that OT should treat acute injuries. So, when a patient has an injury or surgery, regardless if it's an shoulder or knee, I leave the treatment of that body part to the PT. But, this approach is so non-traditional, it throws a kink in the works. So, I'm find that occupation-based practice is good for patients and it's good for me, but it's a problem for the rest of the "community". Just wanted to share. Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
