Lets face the facts. Most PTs do not know how to treat stroke shoulder
dysfunction. Most OTs do not know how to properly treat stroke
shoulder dysfunction. They think they can, but most of them do a
botched up waste of time job. It is a specialized skill, that warrents
continued education. It is beyond crazy busy for an OT with education
in this area, because most clinicians in both the field of OT and PT do
not feel comfortable with it and will gladly refer their patients to
you.
-----Original Message-----
From: Carmen Aguirre <[email protected]>
To: [email protected]
Sent: Tue, 21 Apr 2009 6:12 pm
Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
even Possible?
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
=0
A> 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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