Don't do the bathing! If you are uncomfortable it will show and the
patient will also be uncomfortable, and I'm sure she is also quite
uncomfortable.
Suggestions:
1. Simulate the entire bathing process. It's what I call a dry
run. Go over dressing/undressing, ambulation, transfers,
bathing, but do it all clothed.
2. Get another OT to do the job and you supervise outside the
room.
3. Get an aide to do the work and you supervise again
4. What is the kids d/c environment? If it's home, get the
parents involved with doing the bathing. Teach them so they can
teach their daughter.
In my opinion, having another female present will serve to only protect
you from any allegations but it will NOT make you any less
uncomfortable.
Thanks for bringing up this question!!!
Ron
----- Original Message -----
From: Curtis Marti <[email protected]>
Sent: Wednesday, April 22, 2009
To: [email protected] <[email protected]>
Subj: [OTlist] Difficult issue
CM> Dear Listserve,
CM>
CM> In my 13 years as an OT, I've never been confronted with this situation.
CM> I have worked with adults and geriatric patients throughout my career.
CM> In my best attempt to cover for a pediatric OT several days this week, I
CM> have a treatment plan for a 15 year old girl that involves bathing. I'm
CM> a guy, a guy that feels uncomfortable working on this activity with a
CM> girl of that age group, where modesty is even more of an issue than is
CM> in for older females. It goes without saying that I would have a female
CM> present throughout the entire treatment involving bathing. But in this
CM> situation, no other OT's are any more experienced in pediatrics than I
CM> am and this patient has been assigned to me. Would I defer the bathing
CM> to a non-OT? In so doing, I would not be following the treatment plan
CM> and I would be deferring the training to a non-skilled professional. I
CM> would appreciate any timely guidance that anyone could offer me.
CM>
CM> Thank you,
CM> Curtis
CM>
CM> -----Original Message-----
CM> From: [email protected] [mailto:[email protected]] On
CM> Behalf Of [email protected]
CM> Sent: Tuesday, April 21, 2009 7:23 PM
CM> To: [email protected]
CM> Subject: OTlist Digest, Vol 65, Issue 1
CM>
CM> Send OTlist mailing list submissions to
CM> [email protected]
CM>
CM> To subscribe or unsubscribe via the World Wide Web, visit
CM> http://otnow.com/mailman/listinfo/otlist_otnow.com
CM> or, via email, send a message with subject or body 'help' to
CM> [email protected]
CM>
CM> You can reach the person managing the list at
CM> [email protected]
CM>
CM> When replying, please edit your Subject line so it is more specific
CM> than "Re: Contents of OTlist digest..."
CM>
CM>
CM> Today's Topics:
CM>
CM> 1. Re: A Typical Day, Is this Normal? (Carmen Aguirre)
CM> 2. promoting OT (Alayna Adams)
CM> 3. Welcome to Our Newest Member(s) (Ron Carson)
CM> 4. Breaking the Bonds of Upper Extremity OT; Is it even
CM> Possible? (Ron Carson)
CM> 5. Re: Breaking the Bonds of Upper Extremity OT; Is it even
CM> Possible? (Audra Ray)
CM> 6. Re: Breaking the Bonds of Upper Extremity OT; Is it even
CM> Possible? (Lucy Simpson)
CM> 7. Re: Breaking the Bonds of Upper Extremity OT; Is it even
CM> Possible? (Ron Carson)
CM> 8. Re: Breaking the Bonds of Upper Extremity OT; Is it even
CM> Possible? (Carmen Aguirre)
CM> 9. Re: Breaking the Bonds of Upper Extremity OT; Is it even
CM> Possible? ([email protected])
CM> 10. Re: Breaking the Bonds of Upper Extremity OT; Is it even
CM> Possible? (Ron Carson)
CM>
CM>
CM> ----------------------------------------------------------------------
CM>
CM> Message: 1
CM> Date: Thu, 16 Apr 2009 01:53:51 +0000
CM> From: Carmen Aguirre <[email protected]>
CM> Subject: Re: [OTlist] A Typical Day, Is this Normal?
CM> To: <[email protected]>
CM> Message-ID: <[email protected]>
CM> Content-Type: text/plain; charset="iso-8859-1"
CM>
CM>
CM> If you are expected to be at 90% , 435 minutes will do it. It is
CM> possible to do it if you do some indiv tx in am, for instance, and some
CM> concurrent with some in the afternoon on certain days. On the other days
CM> concur some of the others or designate those appropriate for a group
CM> session. The extra time may help gain some "quiet" time for some
CM> uninterrupted notes... Not easy though...
CM>
CM>
CM> Carmen
CM>
CM>
CM>
CM>
>> To: [email protected]
>> Date: Wed, 15 Apr 2009 12:54:42 -0400
>> From: [email protected]
>> Subject: Re: [OTlist] A Typical Day, Is this Normal?
>>
>> Sounds like some overtime to me. Not appropriate to complete within a
>> 8 hour work day with time for notes and conferences.
>>
>> -----Original Message-----
>> From: Brent Cheyne <[email protected]>
>> To: Ron Carson <[email protected]>
>> Sent: Wed, 15 Apr 2009 6:53 am
>> Subject: [OTlist] A Typical Day, Is this Normal?
>>
>> There have been some very excellent and insightful posts recently and
CM> I
>> need to go back and read them a second time before I respond..very
>> thought provoking....
>> Over the past "busy season" at my place of work I've been having a
CM> very
>> challenging caseload. Please review the circumstances and decide if it
>> is a normal/comfortable work condition
>>
>>
>> In an 8 hour day I have to treat and do daily notes, 1 weekly note,
>> attend 1 weekly staff meeting and attend 1-2 care plan meetings.
>>
>> 1. 91 yo female, femur fx nwb-max assist ADL, wants to go home
>> alone-60min
>> 2 91 yo female, sternal fx max assist ADL, want to go home alone-60
CM> min
>> (Eval today)
>> 3 85 yo female, total knee replacement ADL with supervision but
>> encouragement 45min
>> 4 82 yo female, distal radial fracture-ADL with minimal assit-home
>> alone-60 min
>> 5 81 yo male, total hip revision-ADL with minimal assist and encourge-
>> to live alone 60 min
>> 6 77 you female, CVA Aphasic right hemi- max assist self care- to live
>> with spouse -60 min
>> 7 63 yo female, Multiple sclerosis, max assist ADL, home with spouse,
>> 60 min
>> 8 74 yo fe
>> mal, CVA right hemi-max assist ADL, r/oSNF placement , 60
>> minutes
>> 9 65 yo male, Parkinson stand by assist ADL, home with spouse who
>> works, 60 min
>>
>> So I'm scheduled to see these people today... about 465 minutes of
>> treatment,5/9 patiens are maximal assist, all this week, did this
CM> all
>> last week
>> Does this sound like a reasonable and appropriate schedule?
>> Am I going to be able to get through it and still provide that
>> meaningful and effective, individualized treatment that will create a
>> great public relations image?
>> Give me some feedback
>> Brent
>>
>>
>>
>>
>>
>> --
>> 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]
CM>
CM> _________________________________________________________________
CM> Rediscover Hotmail?: Get quick friend updates right in your inbox.
CM> http://windowslive.com/RediscoverHotmail?ocid=TXT_TAGLM_WL_HM_Rediscover
CM> _Updates1_042009
CM>
CM> ------------------------------
CM>
CM> Message: 2
CM> Date: Sun, 19 Apr 2009 18:51:30 -0700 (PDT)
CM> From: Alayna Adams <[email protected]>
CM> Subject: [OTlist] promoting OT
CM> To: [email protected]
CM> Message-ID: <[email protected]>
CM> Content-Type: text/plain; charset=iso-8859-1
CM>
CM> Hi everyone,I am going to write a letter to the editor of my local
CM> newspaper to promote OT for OT month. I would appreciate any feedback.
CM> Sorry about the format being off.?To celebrate Occupational Therapy (OT)
CM> month, I would like to inform our community on what OT is and how it
CM> benefits residents. OT is a type of rehabilitation that aims to help
CM> people with a physical, developmental, or cognitive disability increase
CM> independence with everyday occupations including but not limited to
CM> dressing, cooking, bathing and leisure. Occupational therapists work in
CM> hospitals, nursing homes, schools, rehabilitation facilities, mental
CM> health facilities and a variety of other settings with people of all
CM> ages and abilities.??????????? OT benefits patients and family members
CM> by improving their ability to take care of themselves and live more
CM> independently. OT treatment consists of adapting the environment and
CM> recommending equipment such as tub benches,
CM> reachers and magnifiers to enable a person to complete activities of
CM> daily living. OT will work with patients to improve moibility,
CM> cognition, and activity tolerance to regain function in order to live as
CM> independently as possible. ??????????? Many of our elderly community
CM> members have received OT and are able to return home without services or
CM> significant help from family or caregivers. Occupational Therapists can
CM> complete home evaluations and recommend adaptations as necessary. OT
CM> will train and educate caregivers to enable them to help their loved
CM> ones live a life with dignity and independence. ??????????? Infants and
CM> children are able to reach developmental milestones and perform better
CM> in school with the skilled treatment of OT. People with a mental illness
CM> can learn new habits and roles to enable them to contribute to society.
CM> A teenager with a spinal cord injury could learn of adaptations to allow
CM> them to go to college and
CM> complete self care. ??????????? Many people are unaware of what
CM> occupational therapy is because of the title. Occupation is what we do
CM> everyday of our lives, what makes our life meaningful to us.
CM> Occupational Therapy is a profession that can help people regain
CM> function to live life to the fullest.Alayna Adams,Occupational Therapist
CM>
CM>
CM>
CM>
CM> ------------------------------
CM>
CM> Message: 3
CM> Date: Mon, 20 Apr 2009 06:59:32 -0400
CM> From: Ron Carson <[email protected]>
CM> Subject: [OTlist] Welcome to Our Newest Member(s)
CM> To: [email protected]
CM> Message-ID: <[email protected]>
CM> Content-Type: text/plain; charset=windows-1252
CM>
CM> Welcome to our newest member(s):
CM>
CM> #####################################
CM>
CM> [email protected]
CM>
CM> [email protected]
CM>
CM> Tiffany <[email protected]>
CM>
CM> Donna <[email protected]>
CM>
CM> Colleen <[email protected]>
CM>
CM> Shannon Brown <[email protected]>
CM>
CM> [email protected]
CM>
CM> Terri <[email protected]>
CM>
CM> Aadil <[email protected]>
CM>
CM> [email protected]
CM>
CM>
CM> #####################################
CM>
CM> I want to personally welcome our 10 newest members!! Thanks for joining
CM> and please feel welcome to post messages on any topic relating to
CM> occupation or occupational therapy.
CM>
CM> Keep spreading the word!
CM>
CM> Thanks,
CM>
CM> Ron
CM>
CM> ~~~
CM> Ron Carson MHS, OT
CM> www.OTnow.com
CM>
CM>
CM>
CM>
CM> ------------------------------
CM>
CM> Message: 4
CM> Date: Mon, 20 Apr 2009 19:06:29 -0400
CM> From: Ron Carson <[email protected]>
CM> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even
CM> Possible?
CM> To: [email protected]
CM> Message-ID: <[email protected]>
CM> Content-Type: text/plain; charset=windows-1252
CM>
CM> Hello All:
CM>
CM> A couple weeks ago, I worked with a CVA patient who despite having
CM> multiple occupational deficits, he was unwilling to verbalize any
CM> OT-related goals. And after a couple of weeks, the patient was d/c'd.
CM>
CM> The patient's UE and LE were compromised by the CVA. He had almost no
CM> active movement in his affected arm. His shoulder was extremely painful
CM> during any AROM.
CM>
CM> I initially told the patient that as an OT, I would address his most
CM> important occupations but that I could do nothing about his arm. Over
CM> the course of treatment, his wife reported having difficulty bathing
CM> under the patients arm. After doing some gentle PROM, I concluded that
CM> there was a possible impingement. I believed an orthopedic appointment
CM> was necessary. I conferred with the PT and she concurred. I
CM> also
CM> confirmed that the treating PTA would address the shoulder
CM> ROM/Pain.
CM>
CM> Last Friday, I received a new referral for this same patient. When I
CM> questioned it, I was told that:
CM>
CM> "...[PT saw the patient] and he has some issues so nursing
CM> went back in and she felt OT needed back in also so we received
CM> an order to do an eval and treat."
CM>
CM> Based on this my ever so sweet scheduler made an appt with the patient.
CM> At this point I had no idea why OT was called back in but suspected it
CM> was an arm "thing".
CM>
CM> Just by coincidence, before my scheduled appointment, I ran into the
CM> treating PTA. When I asked her about the referral she confirmed that the
CM> PT wanted OT to address the patient's arm. The PTA said that they
CM> thought a different OT than myself would be sent to the patient. And if
CM> fact, I was later called by my homehealth office and "advised" that I
CM> didn't need to see the patient because it was an shoulder thing and they
CM> understood that I don't do shoulders.
CM>
CM> I've written countless paragraphs about breaking the 'band of UE
CM> therapy', but at this point, I'm thinking it may not even be possible.
CM> What is the message when one OT says "no" to focused shoulder treatment
CM> while others cordially say "yes". Heck, at this point I'm confused!
CM>
CM> Sadly yours,
CM>
CM> Ron
CM>
CM> ~~~
CM> Ron Carson MHS, OT
CM> www.OTnow.com
CM>
CM>
CM>
CM>
CM>
CM>
CM>
CM>
CM> ------------------------------
CM>
CM> Message: 5
CM> Date: Mon, 20 Apr 2009 19:17:32 -0700 (PDT)
CM> From: Audra Ray <[email protected]>
CM> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
CM> even Possible?
CM> To: [email protected]
CM> Message-ID: <[email protected]>
CM> Content-Type: text/plain; charset=iso-8859-1
CM>
CM> Ron,
CM> ?
CM>
CM> I would have been one of those OTs that treated the patient. His
CM> caregiver had a goal to bathe under the patient's arm. As an OT trained
CM> in physical disabilities, I know how to treat a shoulder impingement and
CM> would have. I know I'll probably get railed at, but this is how my
CM> treatment plan would have gone:?? the patient has pain with ROM, so
CM> treat the pain; strengthen what can be strengthened to also reduce pain
CM> and probably fix a possible subluxation; patient/caregiver education to
CM> continue home exercise program to maintain what is gained. By doing
CM> these things, the patient/caregiver is now able to meet his occupational
CM> goal of washing under his arm.
CM> The?goal would have been written as follows: The patient/caregiver will
CM> bathe under affected arm without pain or discomfort.
CM> ?
CM> I had a patient recently discharged that came to me saying her arm/neck
CM> was killing her. Her goals were as follows:
CM> -decrease pain.
CM> -be able to use arm in daily occupations without discomfort.
CM> I helped her do just that. We used PAMs to decrease her pain, which took
CM> over a month to do. She used to have a flat affect and slept alot
CM> because of all the pain medicine she took. Now she is smiling, going to
CM> activities frequently, and has 0/10 pain with daily occupations.
CM> I did my job as an OT to make someone's life better.
CM> ?
CM> Audra Ray, OTR/L
CM> ?
CM> What I don't understand is why you only follow one Model: MOHO?? There
CM> are many models that we base treatment on.
CM> ?
CM>
CM>
CM> --- On Mon, 4/20/09, Ron Carson <[email protected]> wrote:
CM>
CM>
CM> From: Ron Carson <[email protected]>
CM> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even
CM> Possible?
CM> To: [email protected]
CM> Date: Monday, April 20, 2009, 4:06 PM
CM>
CM>
CM> Hello All:
CM>
CM> A? couple? weeks? ago,? I? worked? with a CVA patient who despite having
CM> multiple? occupational? deficits,? he? was? unwilling? to? verbalize any
CM> OT-related goals. And after a couple of weeks, the patient was d/c'd.
CM>
CM> The? patient's? UE? and LE were compromised by the CVA. He had almost no
CM> active? movement in his affected arm. His shoulder was extremely painful
CM> during any AROM.
CM>
CM> I? initially? told? the? patient that as an OT, I would address his most
CM> important? occupations? but? that I could do nothing about his arm. Over
CM> the? course? of? treatment,? his wife reported having difficulty bathing
CM> under? the? patients arm. After doing some gentle PROM, I concluded that
CM> there? was? a possible impingement. I believed an orthopedic appointment
CM> was? necessary.? I? conferred? with? the? PT? and? she? concurred. I
CM> also
CM> confirmed???that???the???treating???PTA???would???address? the? shoulder
CM> ROM/Pain.
CM>
CM> Last? Friday,? I? received? a new referral for this same patient. When I
CM> questioned? it, I was told that:
CM>
CM> ? ? ? ? "...[PT? saw the patient] and he has some issues so nursing
CM> ? ? ? ? went? back in and she felt OT needed back in also so we received
CM> ? ? ? ? an order to do an eval and treat."
CM>
CM> Based? on this my ever so sweet scheduler made an appt with the patient.
CM> At? this? point I had no idea why OT was called back in but suspected it
CM> was an arm "thing".
CM>
CM> Just? by? coincidence,? before? my scheduled appointment, I ran into the
CM> treating PTA. When I asked her about the referral she confirmed that the
CM> PT? wanted? OT? to? address? the? patient's? arm. The PTA said that they
CM> thought? a different OT than myself would be sent to the patient. And if
CM> fact,? I? was? later called by my homehealth office and "advised" that I
CM> didn't need to see the patient because it was an shoulder thing and they
CM> understood that I don't do shoulders.
CM>
CM> I've? written? countless? paragraphs? about? breaking? the? 'band? of UE
CM> therapy',? but? at this point, I'm thinking it may not even be
CM> possible..
CM> What? is the message when one OT says "no" to focused shoulder treatment
CM> while others cordially say "yes". Heck, at this point I'm confused!
CM>
CM> Sadly yours,
CM>
CM> Ron
CM>
CM> ~~~
CM> Ron Carson MHS, OT
CM> www.OTnow.com
CM>
CM>
CM>
CM>
CM>
CM>
CM> --
CM> Options?
CM> www.otnow.com/mailman/options/otlist_otnow.com
CM>
CM> Archive?
CM> www.mail-archive.com/[email protected]
CM>
CM>
CM>
CM>
CM>
CM> ------------------------------
CM>
CM> Message: 6
CM> Date: Tue, 21 Apr 2009 11:03:20 +0000 (GMT)
CM> From: Lucy Simpson <[email protected]>
CM> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
CM> even Possible?
CM> To: [email protected]
CM> Message-ID: <[email protected]>
CM> Content-Type: text/plain; charset=iso-8859-1
CM>
CM> Audra/Ron
CM> ?
CM> I appreciate Ron that you feel as OT's we should not look at UE
CM> exclusively e.g. to increase ROM or reduce pain, but is it ever
CM> exclusive??
CM> ?
CM> ?As, with Audra's example the outcome of addressing reduced ROM and pain
CM> is likely to be an increase in independence, quality of life and
CM> participation in occupations. Effective UE's are the pre-requisite for
CM> participating in activities so if not addressed, alongside functional
CM> goals?we miss?a huge area of potential in our patients.
CM> ?
CM> There are?times that the pain and movement issues need to be addressed
CM> before we can attempt effective participation in activities. Certainly
CM> in the UK we have OT's working in critical care ensuring patients are
CM> positioned and passively moved through ROM to reduce contractures, and
CM> to maintain ROM with the expectation that this gives them the optimal
CM> chance of participating in occupation in the future,?once they are
CM> medically stable........
CM> ?
CM> I am seeing a lady who has had a stroke currently who has made great
CM> progress from being bed bound, disorientated and flat affect?- walking
CM> short distances with no aid, completeing personal care tasks
CM> independently and preparing and planning simple meals.
CM> ?
CM> She has memory, behavioural and cogntive deficits which we are
CM> developing strategies to manage and she has reduced ROM in her shoulder,
CM> reduced fine motor control and sensation in her hand. This is limiting
CM> her ability to reach up to cupboards, shelves (e.g. when shopping), she
CM> struggles to dry and dress herself and it affects her?ability to write.
CM> ?
CM> Now that?many of this lady's deficits have been addressed (rehabbed or
CM> compensated for) it is apparent that?the?reduced efficiency of her?UE is
CM> playing an important part in her continued deficits. In order for her
CM> arm and hand to be effective her shoulder needs to be stable, and
CM> strengthened, she currently is following a program of shoulder exercises
CM> in supine, provided by Physio and OT in collaboration. Along with this
CM> she continues to be encouraged to use her Right UE in functional
CM> activities, and activities are set up to encourage reach, grip and fine
CM> motor control, and normal movement is promoted.
CM> ?
CM> In this case do you feel Ron that it is the physio's role to work on the
CM> base of UE strength and ROM, and the OT to take over and promote normal
CM> movement in functional activities??
CM> ?
CM> I am not sure, in my experience joint OT/PT?working is often effective
CM> (if possible!),?certainly this?lady requires specific UE exercises as
CM> purely using arm in function is not making a significant
CM> difference.........
CM> ?
CM> Kind Regards
CM>
CM> Lucy Simpson
CM>
CM>
CM> For Quality Stationery and Greetings Cards check out?this website:
CM> www.phoenix-trading.co.uk/web/lucysimpson
CM> Save it in your favourites for the next time you need cards.
CM> ?
CM>
CM> --- On Tue, 21/4/09, Audra Ray <[email protected]> wrote:
CM>
CM> From: Audra Ray <[email protected]>
CM> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
CM> even Possible?
CM> To: [email protected]
CM> Date: Tuesday, 21 April, 2009, 3:17 AM
CM>
CM> Ron,
CM> ?
CM>
CM> I would have been one of those OTs that treated the patient. His
CM> caregiver had
CM> a goal to bathe under the patient's arm. As an OT trained in physical
CM> disabilities, I know how to treat a shoulder impingement and would have.
CM> I know
CM> I'll probably get railed at, but this is how my treatment plan would
CM> have
CM> gone:?? the patient has pain with ROM, so treat the pain; strengthen
CM> what can
CM> be strengthened to also reduce pain and probably fix a possible
CM> subluxation;
CM> patient/caregiver education to continue home exercise program to
CM> maintain what
CM> is gained. By doing these things, the patient/caregiver is now able to
CM> meet his
CM> occupational goal of washing under his arm.
CM> The?goal would have been written as follows: The patient/caregiver will
CM> bathe
CM> under affected arm without pain or discomfort.
CM> ?
CM> I had a patient recently discharged that came to me saying her arm/neck
CM> was
CM> killing her. Her goals were as follows:
CM> -decrease pain.
CM> -be able to use arm in daily occupations without discomfort.
CM> I helped her do just that. We used PAMs to decrease her pain, which took
CM> over a
CM> month to do. She used to have a flat affect and slept alot because of
CM> all the
CM> pain medicine she took. Now she is smiling, going to activities
CM> frequently, and
CM> has 0/10 pain with daily occupations.
CM> I did my job as an OT to make someone's life better.
CM> ?
CM> Audra Ray, OTR/L
CM> ?
CM> What I don't understand is why you only follow one Model: MOHO?? There
CM> are
CM> many models that we base treatment on.
CM> ?
CM>
CM>
CM> --- On Mon, 4/20/09, Ron Carson <[email protected]> wrote:
CM>
CM>
CM> From: Ron Carson <[email protected]>
CM> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even
CM> Possible?
CM> To: [email protected]
CM> Date: Monday, April 20, 2009, 4:06 PM
CM>
CM>
CM> Hello All:
CM>
CM> A? couple? weeks? ago,? I? worked? with a CVA patient who despite having
CM> multiple? occupational? deficits,? he? was? unwilling? to? verbalize any
CM> OT-related goals. And after a couple of weeks, the patient was d/c'd.
CM>
CM> The? patient's? UE? and LE were compromised by the CVA. He had almost no
CM> active? movement in his affected arm. His shoulder was extremely painful
CM> during any AROM.
CM>
CM> I? initially? told? the? patient that as an OT, I would address his most
CM> important? occupations? but? that I could do nothing about his arm. Over
CM> the? course? of? treatment,? his wife reported having difficulty bathing
CM> under? the? patients arm. After doing some gentle PROM, I concluded that
CM> there? was? a possible impingement. I believed an orthopedic appointment
CM> was? necessary.? I? conferred? with? the? PT? and? she? concurred. I
CM> also
CM> confirmed???that???the???treating???PTA???would???address?
CM> the? shoulder
CM> ROM/Pain.
CM>
CM> Last? Friday,? I? received? a new referral for this same patient. When I
CM> questioned? it, I was told that:
CM>
CM> ? ? ? ? "...[PT? saw the patient] and he has some issues so nursing
CM> ? ? ? ? went? back in and she felt OT needed back in also so we received
CM> ? ? ? ? an order to do an eval and treat."
CM>
CM> Based? on this my ever so sweet scheduler made an appt with the patient.
CM> At? this? point I had no idea why OT was called back in but suspected it
CM> was an arm "thing".
CM>
CM> Just? by? coincidence,? before? my scheduled appointment, I ran into the
CM> treating PTA. When I asked her about the referral she confirmed that the
CM> PT? wanted? OT? to? address? the? patient's? arm. The PTA said that
CM> they
CM> thought? a different OT than myself would be sent to the patient. And if
CM> fact,? I? was? later called by my homehealth office and "advised"
CM> that I
CM> didn't need to see the patient because it was an shoulder thing and they
CM> understood that I don't do shoulders.
CM>
CM> I've? written? countless? paragraphs? about? breaking? the?
CM> 'band? of UE
CM> therapy',? but? at this point, I'm thinking it may not even be
CM> possible..
CM> What? is the message when one OT says "no" to focused shoulder
CM> treatment
CM> while others cordially say "yes". Heck, at this point I'm
CM> confused!
CM>
CM> Sadly yours,
CM>
CM> Ron
CM>
CM> ~~~
CM> Ron Carson MHS, OT
CM> www.OTnow.com
CM>
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CM> ------------------------------
CM>
CM> Message: 7
CM> Date: Tue, 21 Apr 2009 07:32:47 -0400
CM> From: Ron Carson <[email protected]>
CM> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
CM> even Possible?
CM> To: Audra Ray <[email protected]>
CM> Message-ID: <[email protected]>
CM> Content-Type: text/plain; charset=iso-8859-1
CM>
CM> Thanks for writing.
CM>
CM> Maybe this is one of the cases were I was over zealous about NOT
CM> treating someone's arm. But, I truly feel that PT is much better trained
CM> and in my case, licensed, to treat bio-mechanical issues. It just floors
CM> me that a PT would refer back to OT for shoulder treatment.
CM>
CM> Here's some things to consider:
CM>
CM> 1. Why do OT's treat arms and not legs?
CM>
CM> 2. Aren't MOST PT's better trained to treat physical dysfunction?
CM>
CM> 3. Where is the line between focused treatment on an UE and focused
CM> treatment on occupation? Can both co-exist with the same
CM> patient/therapist?
CM>
CM> This is a very confusing case for me!
CM>
CM> Ron
CM>
CM> ----- Original Message -----
CM> From: Audra Ray <[email protected]>
CM> Sent: Monday, April 20, 2009
CM> To: [email protected] <[email protected]>
CM> Subj: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even
CM> Possible?
CM>
AR>> Ron,
AR>> ?
CM>
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
CM> 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
CM> 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>> ?
CM>
CM>
AR>> --- On Mon, 4/20/09, Ron Carson <[email protected]> wrote:
CM>
CM>
AR>> From: Ron Carson <[email protected]>
AR>> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
CM> even Possible?
AR>> To: [email protected]
AR>> Date: Monday, April 20, 2009, 4:06 PM
CM>
CM>
AR>> Hello All:
CM>
AR>> A? couple? weeks? ago,? I? worked? with a CVA patient who despite
CM> having
AR>> multiple? occupational? deficits,? he? was? unwilling? to? verbalize
CM> any
AR>> OT-related goals. And after a couple of weeks, the patient was
CM> d/c'd.
CM>
AR>> The? patient's? UE? and LE were compromised by the CVA. He had
CM> almost no
AR>> active? movement in his affected arm. His shoulder was extremely
CM> painful
AR>> during any AROM.
CM>
AR>> I? initially? told? the? patient that as an OT, I would address his
CM> most
AR>> important? occupations? but? that I could do nothing about his arm.
CM> Over
AR>> the? course? of? treatment,? his wife reported having difficulty
CM> bathing
AR>> under? the? patients arm. After doing some gentle PROM, I concluded
CM> that
AR>> there? was? a possible impingement. I believed an orthopedic
CM> appointment
AR>> was? necessary.? I? conferred? with? the? PT? and? she? concurred. I
CM> also
AR>> confirmed???that???the???treating???PTA???would???address? the?
CM> shoulder
AR>> ROM/Pain.
CM>
AR>> Last? Friday,? I? received? a new referral for this same patient.
CM> When I
AR>> questioned? it, I was told that:
CM>
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
CM> received
AR>> ? ? ? ? an order to do an eval and treat."
CM>
AR>> Based? on this my ever so sweet scheduler made an appt with the
CM> patient.
AR>> At? this? point I had no idea why OT was called back in but
CM> suspected it
AR>> was an arm "thing".
CM>
AR>> Just? by? coincidence,? before? my scheduled appointment, I ran into
CM> the
AR>> treating PTA. When I asked her about the referral she confirmed that
CM> the
AR>> PT? wanted? OT? to? address? the? patient's? arm. The PTA said that
CM> they
AR>> thought? a different OT than myself would be sent to the patient.
CM> And if
AR>> fact,? I? was? later called by my homehealth office and "advised"
CM> that I
AR>> didn't need to see the patient because it was an shoulder thing and
CM> they
AR>> understood that I don't do shoulders.
CM>
AR>> I've? written? countless? paragraphs? about? breaking? the? 'band?
CM> of UE
AR>> therapy',? but? at this point, I'm thinking it may not even be
CM> possible..
AR>> What? is the message when one OT says "no" to focused shoulder
CM> treatment
AR>> while others cordially say "yes". Heck, at this point I'm confused!
CM>
AR>> Sadly yours,
CM>
AR>> Ron
CM>
AR>> ~~~
AR>> Ron Carson MHS, OT
AR>> www.OTnow.com
CM>
CM>
CM>
CM>
CM>
CM>
AR>> --
AR>> Options?
AR>> www.otnow.com/mailman/options/otlist_otnow.com
CM>
AR>> Archive?
AR>> www.mail-archive.com/[email protected]
CM>
CM>
CM>
AR>>
AR>> --
AR>> Options?
AR>> www.otnow.com/mailman/options/otlist_otnow.com
CM>
AR>> Archive?
AR>> www.mail-archive.com/[email protected]
CM>
CM>
CM>
CM>
CM> ------------------------------
CM>
CM> Message: 8
CM> Date: Tue, 21 Apr 2009 23:12:07 +0000
CM> From: Carmen Aguirre <[email protected]>
CM> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
CM> even Possible?
CM> To: <[email protected]>
CM> Message-ID: <[email protected]>
CM> Content-Type: text/plain; charset="Windows-1252"
CM>
CM>
CM> I think treating the shoulder seemed to be warranted given the
CM> limitations it brough about to pt's and caregiver routines at home. It
CM> seemed to be related to safety, prevention of further limitation in his
CM> adl's or caregivers ability to care for him appropriately. Techniques
CM> applied such as bilateral integration, re-education during those adl
CM> tasks the caregiver seemed to be having difficulty with.
CM>
CM> Thanks
CM>
CM>
CM>
CM> Carmen
CM>
CM>
CM>
CM>
>> 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
CM> 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
CM> 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
CM> 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
CM> 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
CM> 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
CM> 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
CM> 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]
CM>
CM> _________________________________________________________________
CM> Windows Live? Hotmail?:?more than just e-mail.
CM> http://windowslive.com/online/hotmail?ocid=TXT_TAGLM_WL_HM_more_042009
CM>
CM> ------------------------------
CM>
CM> Message: 9
CM> Date: Tue, 21 Apr 2009 19:28:49 -0400
CM> From: [email protected]
CM> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
CM> even Possible?
CM> To: [email protected]
CM> Message-ID: <[email protected]>
CM> Content-Type: text/plain; charset="utf-8"; format=flowed
CM>
CM> Lets face the facts. Most PTs do not know how to treat stroke shoulder
CM> dysfunction. Most OTs do not know how to properly treat stroke
CM> shoulder dysfunction. They think they can, but most of them do a
CM> botched up waste of time job. It is a specialized skill, that warrents
CM> continued education. It is beyond crazy busy for an OT with education
CM> in this area, because most clinicians in both the field of OT and PT do
CM> not feel comfortable with it and will gladly refer their patients to
CM> you.
CM>
CM> -----Original Message-----
CM> From: Carmen Aguirre <[email protected]>
CM> To: [email protected]
CM> Sent: Tue, 21 Apr 2009 6:12 pm
CM> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
CM> even Possible?
CM>
CM>
CM> I think treating the shoulder seemed to be warranted given the
CM> limitations it brough about to pt's and caregiver routines at home. It
CM> seemed to be related to safety, prevention of further limitation in his
CM> adl's or caregivers ability to care for him appropriately. Techniques
CM> applied such as bilateral integration, re-education during those adl
CM> tasks the caregiver seemed to be having difficulty with.
CM>
CM> Thanks
CM>
CM>
CM>
CM> Carmen
CM>
CM>
CM>
CM>
>> 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
CM> even Possible?
>>
>> Hello All:
>>
>> A couple weeks ago, I worked with a CVA patient who despite having
CM> =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
CM> 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
CM> 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
CM> the
>>
CM> 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
CM> 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
CM> 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
CM> 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]
CM>
CM> _________________________________________________________________
CM> Windows Live? Hotmail?:?more than just e-mail.
CM> http://windowslive.com/online/hotmail?ocid=TXT_TAGLM_WL_HM_more_042009
CM> --
CM> Options?
CM> www.otnow.com/mailman/options/otlist_otnow.com
CM>
CM> Archive?
CM> www.mail-archive.com/[email protected]
CM>
CM>
CM>
CM>
CM>
CM> ------------------------------
CM>
CM> Message: 10
CM> Date: Tue, 21 Apr 2009 20:22:34 -0400
CM> From: Ron Carson <[email protected]>
CM> Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it
CM> even Possible?
CM> To: Ron Carson <[email protected]>
CM> Message-ID: <[email protected]>
CM> Content-Type: text/plain; charset=iso-8859-1
CM>
CM> Hello All:
CM>
CM> I thought some more about this situation and I'm more comfortable with
CM> my decision to not treat this patient's shoulder. It is true that his
CM> wife said she was having difficulty bathing under the arm, and that's
CM> why I initiated contact with the PT. But, if I would have treated the
CM> patient what is an appropriate goal?
CM>
CM> Based on my treatment philosophy, ALL goals must be occupational. So, in
CM> this case, my goal would have been: "Pt will be able to bathe under
CM> right arm pit with assistance and no self-reported pain". To me, this
CM> is
CM> a great OT goal. But, when this goal is reached, which probably wouldn't
CM> take too long, what would be the outcome of the patient's shoulder. He
CM> may have gained 20 - 30 degrees of pain free passive ROM, allowing him
CM> to bathe under his armpit, but by my goal, the OT would have stopped.
CM>
CM> Is that really what is best for this patient? I don't think so. What I
CM> think he needs is SKILLED and focused treatment on his UE to reduce the
CM> pain and increase his PROM. But, for me, this is NOT the role of OT,
CM> it's the role of PT!
CM>
CM> Thanks,
CM>
CM> Ron
CM>
CM> ~~~
CM> Ron Carson MHS, OT
CM> www.OTnow.com
CM>
CM> ----- Original Message -----
CM> From: Ron Carson <[email protected]>
CM> Sent: Tuesday, April 21, 2009
CM> To: Audra Ray <[email protected]>
CM> Subj: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even
CM> Possible?
CM>
RC>> Thanks for writing.
CM>
RC>> Maybe this is one of the cases were I was over zealous about
CM> NOT
RC>> treating someone's arm. But, I truly feel that PT is much better
CM> trained
RC>> and in my case, licensed, to treat bio-mechanical issues. It just
CM> floors
RC>> me that a PT would refer back to OT for shoulder treatment.
CM>
RC>> Here's some things to consider:
CM>
RC>> 1. Why do OT's treat arms and not legs?
CM>
RC>> 2. Aren't MOST PT's better trained to treat physical dysfunction?
CM>
RC>> 3. Where is the line between focused treatment on an UE and
CM> focused
RC>> treatment on occupation? Can both co-exist with the
CM> same
RC>> patient/therapist?
CM>
RC>> This is a very confusing case for me!
CM>
RC>> Ron
CM>
CM>
CM>
CM>
CM> ------------------------------
CM>
CM> --
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CM> Help?
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CM>
CM> End of OTlist Digest, Vol 65, Issue 1
CM> *************************************
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