Thanks for writing. Maybe this is one of the cases were I was over zealous about NOT treating someone's arm. But, I truly feel that PT is much better trained and in my case, licensed, to treat bio-mechanical issues. It just floors me that a PT would refer back to OT for shoulder treatment.
Here's some things to consider: 1. Why do OT's treat arms and not legs? 2. Aren't MOST PT's better trained to treat physical dysfunction? 3. Where is the line between focused treatment on an UE and focused treatment on occupation? Can both co-exist with the same patient/therapist? This is a very confusing case for me! Ron ----- Original Message ----- From: Audra Ray <[email protected]> Sent: Monday, April 20, 2009 To: [email protected] <[email protected]> Subj: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? AR> Ron, AR> AR> I would have been one of those OTs that treated the patient. His AR> caregiver had a goal to bathe under the patient's arm. As an OT AR> trained in physical disabilities, I know how to treat a shoulder AR> impingement and would have. I know I'll probably get railed at, but AR> this is how my treatment plan would have gone: the patient has AR> pain with ROM, so treat the pain; strengthen what can be AR> strengthened to also reduce pain and probably fix a possible AR> subluxation; patient/caregiver education to continue home exercise AR> program to maintain what is gained. By doing these things, the AR> patient/caregiver is now able to meet his occupational goal of washing under his arm. AR> The goal would have been written as follows: The patient/caregiver AR> will bathe under affected arm without pain or discomfort. AR> AR> I had a patient recently discharged that came to me saying her AR> arm/neck was killing her. Her goals were as follows: AR> -decrease pain. AR> -be able to use arm in daily occupations without discomfort. AR> I helped her do just that. We used PAMs to decrease her pain, which AR> took over a month to do. She used to have a flat affect and slept AR> alot because of all the pain medicine she took. Now she is smiling, AR> going to activities frequently, and has 0/10 pain with daily occupations. AR> I did my job as an OT to make someone's life better. AR> AR> Audra Ray, OTR/L AR> AR> What I don't understand is why you only follow one Model: MOHO? AR> There are many models that we base treatment on. AR> AR> --- On Mon, 4/20/09, Ron Carson <[email protected]> wrote: AR> From: Ron Carson <[email protected]> AR> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? AR> To: [email protected] AR> Date: Monday, April 20, 2009, 4:06 PM AR> Hello All: AR> A couple weeks ago, I worked with a CVA patient who despite having AR> multiple occupational deficits, he was unwilling to verbalize any AR> OT-related goals. And after a couple of weeks, the patient was d/c'd. AR> The patient's UE and LE were compromised by the CVA. He had almost no AR> active movement in his affected arm. His shoulder was extremely painful AR> during any AROM. AR> I initially told the patient that as an OT, I would address his most AR> important occupations but that I could do nothing about his arm. Over AR> the course of treatment, his wife reported having difficulty bathing AR> under the patients arm. After doing some gentle PROM, I concluded that AR> there was a possible impingement. I believed an orthopedic appointment AR> was necessary. I conferred with the PT and she concurred. I also AR> confirmed that the treating PTA would address the shoulder AR> ROM/Pain. AR> Last Friday, I received a new referral for this same patient. When I AR> questioned it, I was told that: AR> "...[PT saw the patient] and he has some issues so nursing AR> went back in and she felt OT needed back in also so we received AR> an order to do an eval and treat." AR> Based on this my ever so sweet scheduler made an appt with the patient. AR> At this point I had no idea why OT was called back in but suspected it AR> was an arm "thing". AR> Just by coincidence, before my scheduled appointment, I ran into the AR> treating PTA. When I asked her about the referral she confirmed that the AR> PT wanted OT to address the patient's arm. The PTA said that they AR> thought a different OT than myself would be sent to the patient. And if AR> fact, I was later called by my homehealth office and "advised" that I AR> didn't need to see the patient because it was an shoulder thing and they AR> understood that I don't do shoulders. AR> I've written countless paragraphs about breaking the 'band of UE AR> therapy', but at this point, I'm thinking it may not even be possible.. AR> What is the message when one OT says "no" to focused shoulder treatment AR> while others cordially say "yes". Heck, at this point I'm confused! AR> Sadly yours, AR> Ron AR> ~~~ AR> Ron Carson MHS, OT AR> www.OTnow.com AR> -- AR> Options? AR> www.otnow.com/mailman/options/otlist_otnow.com AR> Archive? AR> www.mail-archive.com/[email protected] AR> AR> -- AR> Options? AR> www.otnow.com/mailman/options/otlist_otnow.com AR> Archive? AR> www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
