There is a tool called The DASH, an occupationally- based assessment tool that attempst to merge physical dysfuntion and decreased occupational engagement. I would have use it in the scenario you presented. There is an area of occupation we many times don't address: Health Maintenance skills.
Perhaps looking a increased competency in this area may increase your comfort level in treating it as it relates to occupational dysfunction. I know that is what i did to be able to understand the implications of the hemi shoulder and then begin to explore the many possibilities to enhance occupation. i had to start with the components of arm use before before addressing the actual task at the begining but pretty soon most of the treatments become occupationally based . Carmen > Date: Tue, 21 Apr 2009 20:22:34 -0400 > From: [email protected] > To: [email protected] > Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even > Possible? > > 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] _________________________________________________________________ Rediscover Hotmail®: Get e-mail storage that grows with you. http://windowslive.com/RediscoverHotmail?ocid=TXT_TAGLM_WL_HM_Rediscover_Storage2_042009 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
