I think treating the shoulder seemed to be warranted given the limitations it brough about to pt's and caregiver routines at home. It seemed to be related to safety, prevention of further limitation in his adl's or caregivers ability to care for him appropriately. Techniques applied such as bilateral integration, re-education during those adl tasks the caregiver seemed to be having difficulty with.
Thanks Carmen > Date: Mon, 20 Apr 2009 19:06:29 -0400 > From: [email protected] > To: [email protected] > Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even > Possible? > > 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] _________________________________________________________________ Windows Live™ Hotmail®:…more than just e-mail. http://windowslive.com/online/hotmail?ocid=TXT_TAGLM_WL_HM_more_042009 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
