Ron,
I agree with with 95% of what you are saying the only things that I
disagree with are: I concede that it is not occupational therapy, but
we should not call it PT either. Gray area of practice.
1. It is not UE PT. It is UE therapy. I concede that it is not
occupational therapy, but we should not call it PT either. Gray area
of practice.
2. It is not always a waste of time, but I agree that most of the time
for most clinicians it is a waste of time. It is only meaningful if
the therapist knows what they are doing and only does it when there is
an impairment, and not to fill time.
Chris
-----Original Message-----
From: Ron Carson <[email protected]>
To: [email protected] <[email protected]>
Sent: Sun, Jun 14, 2009 5:41 am
Subject: Re: [OTlist] Dental Hygienst Knows About OT...
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]
--
Options?
www.otnow.com/mailman/options/otlist_otnow.com
Archive?
www.mail-archive.com/[email protected]
