Hello All: I thought some more about this situation and I'm more comfortable with my decision to not treat this patient's shoulder. It is true that his wife said she was having difficulty bathing under the arm, and that's why I initiated contact with the PT. But, if I would have treated the patient what is an appropriate goal?
Based on my treatment philosophy, ALL goals must be occupational. So, in this case, my goal would have been: "Pt will be able to bathe under right arm pit with assistance and no self-reported pain". To me, this is a great OT goal. But, when this goal is reached, which probably wouldn't take too long, what would be the outcome of the patient's shoulder. He may have gained 20 - 30 degrees of pain free passive ROM, allowing him to bathe under his armpit, but by my goal, the OT would have stopped. Is that really what is best for this patient? I don't think so. What I think he needs is SKILLED and focused treatment on his UE to reduce the pain and increase his PROM. But, for me, this is NOT the role of OT, it's the role of PT! Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: Ron Carson <[email protected]> Sent: Tuesday, April 21, 2009 To: Audra Ray <[email protected]> Subj: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Possible? RC> Thanks for writing. RC> Maybe this is one of the cases were I was over zealous about NOT RC> treating someone's arm. But, I truly feel that PT is much better trained RC> and in my case, licensed, to treat bio-mechanical issues. It just floors RC> me that a PT would refer back to OT for shoulder treatment. RC> Here's some things to consider: RC> 1. Why do OT's treat arms and not legs? RC> 2. Aren't MOST PT's better trained to treat physical dysfunction? RC> 3. Where is the line between focused treatment on an UE and focused RC> treatment on occupation? Can both co-exist with the same RC> patient/therapist? RC> This is a very confusing case for me! RC> Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
