Ron, I would have been one of those OTs that treated the patient. His caregiver had a goal to bathe under the patient's arm. As an OT trained in physical disabilities, I know how to treat a shoulder impingement and would have. I know I'll probably get railed at, but this is how my treatment plan would have gone: the patient has pain with ROM, so treat the pain; strengthen what can be strengthened to also reduce pain and probably fix a possible subluxation; patient/caregiver education to continue home exercise program to maintain what is gained. By doing these things, the patient/caregiver is now able to meet his occupational goal of washing under his arm. The goal would have been written as follows: The patient/caregiver will bathe under affected arm without pain or discomfort. I had a patient recently discharged that came to me saying her arm/neck was killing her. Her goals were as follows: -decrease pain. -be able to use arm in daily occupations without discomfort. I helped her do just that. We used PAMs to decrease her pain, which took over a month to do. She used to have a flat affect and slept alot because of all the pain medicine she took. Now she is smiling, going to activities frequently, and has 0/10 pain with daily occupations. I did my job as an OT to make someone's life better. Audra Ray, OTR/L What I don't understand is why you only follow one Model: MOHO? There are many models that we base treatment on.
--- On Mon, 4/20/09, Ron Carson <[email protected]> wrote: From: Ron Carson <[email protected]> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? To: [email protected] Date: Monday, April 20, 2009, 4:06 PM 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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
