Chris, I do not feel like I'm straddling the fence. When I do lymphedema treatment, that is EXACTLY what I'm doing. I am NOT doing OT. I feel that same about hand therapy, driver training, etc. These specialized roles (especially ones that are discipline independent (e.g. lymphedema, hand therapy) are so far removed from mainstream OT that they should not be referred to as OT.
I have NO problem with OT's doing UE therapy, but that is what they should call it. My problem is that the vast majority of OT's that I know practice neither impairment-based nor occupation-based therapy. Instead, they practice an amalgam of both which is really just "mush". I ask my patients if they had OT before seeing me. The majority say "yes". I ask them what the OT did. The VAST majority indicate UE function. I ask them if is was effective in helping reach their goals. The majority just sort of "shrug" and roll their eyes. THIS IS MY EXPERIENCE about OT. It is my opinion that the MAJORITY of people having knowledge and interaction with adult phys dys OT think one of two things: 1. It's UE PT 2. It's a waste of time. Neither of these are acceptable to me. I want people to see OT as the profession that restored their lives. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com ----- 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> Ron, cac> Not sure where the disagreement is found "Chris, so of what you say is cac> correct, but much isn't" cac> So it is ok to step out of your traditional role as an OT to complete cac> lymphedma treatment, but it is not ok to step out of the traditional cac> role as an OT to complete UE orthopedic treatment? Seems to me you are cac> on both sides of the fence, but for some reason you cannot stand UE cac> impairment based treatment. cac> Chris cac> -----Original Message----- cac> From: Ron Carson <[email protected]> cac> To: [email protected] <[email protected]> cac> Sent: Sat, Jun 13, 2009 3:07 pm cac> Subject: Re: [OTlist] Dental Hygienst Knows About OT... cac> Hello All: cac> Chris, so of what you say is correct, but much isn't. cac> I am 100% for treating physical disabilities as they impair occupation. cac> However, my experience is that MOST (almost 100% is my guess) ONLY TREAT cac> the UE as it relates to occupation. That to me is WRONG for patients and cac> wrong for our profession. cac> I agree that "true" hand therapy is a gray area and as you mention, can cac> be done by OT or PT. In these cases I prefer to think the person is cac> doing hand therapy, not OT or PT. At some point, any professional can cac> move so far away from their practice paradigm that they are no longer cac> practicing their profession. This is almost never a clear cut line. cac> However, hand therapy is not a real concern for me. What does bother me cac> is that most OT's who I know that work in adult phys dys practice like cac> hand therapists, but without the advanced skills. In my experience, OT cac> is known as UE hand therapy. Almost EVERY experience that people relate cac> to me about OT is hand/UE related. I almost NEVER hear about an OT cac> giving people back their lives, or restoring occupation, etc. cac> In my opinion, despite a significant change in AOTA's literature, almost cac> nothing has changed in adult phys dys practice. Today, OT use the word cac> occupation, but that's about it. They don't really practice occupation cac> based therapy because if they did, most of them would not be focused on cac> the UE. cac> In my home health company, I refuse to treat UE injury UNLESS the cac> patient is FOCUSED ON IMPROVING OCCUPATION. Initially this caused a cac> significant rift for my employer but they have accepted it and worked cac> around it by referring such patients to other OT's. But, this does not cac> mean I don't treat PEOPLE with UE injury. In fact, I just d/c'd such a cac> person. cac> It is my SINCERE (and I mean SINCERE) desire to see the profession of OT cac> embrace occupation. I will continue beating this "horse" until I give up cac> or die. And I mean that with all my heart. cac> ----- Original Message ----- cac> From: [email protected] <[email protected]> cac> Sent: Saturday, June 13, 2009 cac> To: [email protected] <[email protected]> cac> 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 cac> an cac>> end. We as OTs in physical disabilities can choose either to cac> 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 cac> underlying cac>> impairment. In my opinion it simply depends on what is causing cac> the cac>> occupational dysfunction. If an occupational takes an interest in cac> hand cac>> therapy and they decide to specialize in this area (PTs can do cac> this cac>> too) then I would say that the occupational therapist is doing cac> 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 cac> an cac>> interest in visual perceptual training ( my PT friend did) because cac> of cac>> their strong background in neurorehabilitation. When they utilize cac> this cac>> training during treatment sessions to facilitate better outcomes cac> with cac>> gait and balance, would they state that they are doing cac> 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 cac> training? cac>> What Ron is simply trying to do is change the paradigm of cac> occupatonal cac>> therapy and simply rewrite the textbooks we once read in school, cac> by cac>> erasing the biomechanical model. I applaud him to a certain cac> extent, cac>> but at times I an confused by his reasoning. cac>> Hand Therapy does not necessarily mean a cone or peg pusher cac> therapist. cac>> A Hand therapist does not necessarily give the pubilic a certain cac> 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 cac> RUG cac>> level or complete the "Three hour rule". I do not think it is cac> Ron's cac>> intent to upset all of the OTs who practice hand therapy, but to cac> guide cac>> phys dys OTs to provide meaning during their therapy sessions in cac> order cac>> to clean up the public perception of what we do. cac>> Chris Nahrwold MS, OTR.. cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> www.mail-archive.com/[email protected] cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
