Hello All:
A couple weeks ago, I worked with a CVA patient who despite having
multiple occupational deficits, he was unwilling to verbalize any
OT-related goals. And after a couple of weeks, the patient was d/c'd.
The patient's UE and LE were compromised by the CVA. He had almost no
active movement in his affected arm. His shoulder was extremely painful
during any AROM.
I initially told the patient that as an OT, I would address his most
important occupations but that I could do nothing about his arm. Over
the course of treatment, his wife reported having difficulty bathing
under the patients arm. After doing some gentle PROM, I concluded that
there was a possible impingement. I believed an orthopedic appointment
was necessary. I conferred with the PT and she concurred. I also
confirmed that the treating PTA would address the shoulder
ROM/Pain.
Last Friday, I received a new referral for this same patient. When I
questioned it, I was told that:
"...[PT saw the patient] and he has some issues so nursing
went back in and she felt OT needed back in also so we received
an order to do an eval and treat."
Based on this my ever so sweet scheduler made an appt with the patient.
At this point I had no idea why OT was called back in but suspected it
was an arm "thing".
Just by coincidence, before my scheduled appointment, I ran into the
treating PTA. When I asked her about the referral she confirmed that the
PT wanted OT to address the patient's arm. The PTA said that they
thought a different OT than myself would be sent to the patient. And if
fact, I was later called by my homehealth office and "advised" that I
didn't need to see the patient because it was an shoulder thing and they
understood that I don't do shoulders.
I've written countless paragraphs about breaking the 'band of UE
therapy', but at this point, I'm thinking it may not even be possible.
What is the message when one OT says "no" to focused shoulder treatment
while others cordially say "yes". Heck, at this point I'm confused!
Sadly yours,
Ron
~~~
Ron Carson MHS, OT
www.OTnow.com
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