Audra/Ron I appreciate Ron that you feel as OT's we should not look at UE exclusively e.g. to increase ROM or reduce pain, but is it ever exclusive?? As, with Audra's example the outcome of addressing reduced ROM and pain is likely to be an increase in independence, quality of life and participation in occupations. Effective UE's are the pre-requisite for participating in activities so if not addressed, alongside functional goals we miss a huge area of potential in our patients. There are times that the pain and movement issues need to be addressed before we can attempt effective participation in activities. Certainly in the UK we have OT's working in critical care ensuring patients are positioned and passively moved through ROM to reduce contractures, and to maintain ROM with the expectation that this gives them the optimal chance of participating in occupation in the future, once they are medically stable........ I am seeing a lady who has had a stroke currently who has made great progress from being bed bound, disorientated and flat affect - walking short distances with no aid, completeing personal care tasks independently and preparing and planning simple meals. She has memory, behavioural and cogntive deficits which we are developing strategies to manage and she has reduced ROM in her shoulder, reduced fine motor control and sensation in her hand. This is limiting her ability to reach up to cupboards, shelves (e.g. when shopping), she struggles to dry and dress herself and it affects her ability to write. Now that many of this lady's deficits have been addressed (rehabbed or compensated for) it is apparent that the reduced efficiency of her UE is playing an important part in her continued deficits. In order for her arm and hand to be effective her shoulder needs to be stable, and strengthened, she currently is following a program of shoulder exercises in supine, provided by Physio and OT in collaboration. Along with this she continues to be encouraged to use her Right UE in functional activities, and activities are set up to encourage reach, grip and fine motor control, and normal movement is promoted. In this case do you feel Ron that it is the physio's role to work on the base of UE strength and ROM, and the OT to take over and promote normal movement in functional activities?? I am not sure, in my experience joint OT/PT working is often effective (if possible!), certainly this lady requires specific UE exercises as purely using arm in function is not making a significant difference......... Kind Regards
Lucy Simpson For Quality Stationery and Greetings Cards check out this website: www.phoenix-trading.co.uk/web/lucysimpson Save it in your favourites for the next time you need cards. --- On Tue, 21/4/09, Audra Ray <[email protected]> wrote: From: Audra Ray <[email protected]> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? To: [email protected] Date: Tuesday, 21 April, 2009, 3:17 AM 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] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
