Hello All: Chris, so of what you say is correct, but much isn't.
I am 100% for treating physical disabilities as they impair occupation. However, my experience is that MOST (almost 100% is my guess) ONLY TREAT the UE as it relates to occupation. That to me is WRONG for patients and wrong for our profession. I agree that "true" hand therapy is a gray area and as you mention, can be done by OT or PT. In these cases I prefer to think the person is doing hand therapy, not OT or PT. At some point, any professional can move so far away from their practice paradigm that they are no longer practicing their profession. This is almost never a clear cut line. However, hand therapy is not a real concern for me. What does bother me is that most OT's who I know that work in adult phys dys practice like hand therapists, but without the advanced skills. In my experience, OT is known as UE hand therapy. Almost EVERY experience that people relate to me about OT is hand/UE related. I almost NEVER hear about an OT giving people back their lives, or restoring occupation, etc. In my opinion, despite a significant change in AOTA's literature, almost nothing has changed in adult phys dys practice. Today, OT use the word occupation, but that's about it. They don't really practice occupation based therapy because if they did, most of them would not be focused on the UE. In my home health company, I refuse to treat UE injury UNLESS the patient is FOCUSED ON IMPROVING OCCUPATION. Initially this caused a significant rift for my employer but they have accepted it and worked around it by referring such patients to other OT's. But, this does not mean I don't treat PEOPLE with UE injury. In fact, I just d/c'd such a person. It is my SINCERE (and I mean SINCERE) desire to see the profession of OT embrace occupation. I will continue beating this "horse" until I give up or die. And I mean that with all my heart. ----- Original Message ----- From: [email protected] <[email protected]> Sent: Saturday, June 13, 2009 To: [email protected] <[email protected]> Subj: [OTlist] Dental Hygienst Knows About OT... cac> I see the horse is not dead yet!!!! cac> This age old debate revolves around the top down approach and the cac> bottom up approach to treatment, or the occupation as a means or an cac> end. We as OTs in physical disabilities can choose either to treat cac> occupational dysfunction in two ways a) Use occupations as the cac> treatment modality to combat the issue of occupational dysfunction cac> either through restoration or compensation or b) Treat the underlying cac> impairment. In my opinion it simply depends on what is causing the cac> occupational dysfunction. If an occupational takes an interest in hand cac> therapy and they decide to specialize in this area (PTs can do this cac> too) then I would say that the occupational therapist is doing hand cac> therapy. I would not state that they are doing physical therapy cac> because this is a gray area. Perhaps a physical therapist takes an cac> interest in visual perceptual training ( my PT friend did) because of cac> their strong background in neurorehabilitation. When they utilize this cac> training during treatment sessions to facilitate better outcomes with cac> gait and balance, would they state that they are doing occupational cac> therapy? What if a PT takes a liking to driving evals and training cac> (IADL),. Would they call it occupational therapy or drivers training? cac> What Ron is simply trying to do is change the paradigm of occupatonal cac> therapy and simply rewrite the textbooks we once read in school, by cac> erasing the biomechanical model. I applaud him to a certain extent, cac> but at times I an confused by his reasoning. cac> Hand Therapy does not necessarily mean a cone or peg pusher therapist. cac> A Hand therapist does not necessarily give the pubilic a certain image cac> of what OT is , but it is the misguided therapist that provides OT cac> without meaning in order complete enough time to reach a certain RUG cac> level or complete the "Three hour rule". I do not think it is Ron's cac> intent to upset all of the OTs who practice hand therapy, but to guide cac> phys dys OTs to provide meaning during their therapy sessions in order cac> to clean up the public perception of what we do. cac> Chris Nahrwold MS, OTR.. -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
