Ron, I work in an inpatient rehab facility for adults with neurological impairments. Usually stroke, traumatic brain injury, tumour, demyelinating illnesses - all sorts really. We follow an interdisciplinary model where we don't get too caught up on professional boundaries so that if I have a particular skill in an area I will treat and vice versa with physios etc despite traditional roles. For example treatment of the upper limb is shared between physio and OT depending on who has the skill and/or time. Most often we both treat with the physio doing the biomechanical things and the OT doing a more practical, occupational based session. Saying that, our PT's are big believers in treating using real tasks and often try and make it a bit more functional.
To comment on the role of OT where I work, I would say that it is to enable my clients to achieve their occupational goals which is usually to get back to living in the community as close to previous function as possible. That usually entails PADL and DADL retraining, cognitive and visual perception ax and rx, fatigue management, home environment modifications, wheelchair and seating assessments, UL therapy, driver assessment. We don't usually look at return to work at this stage but have done for higher functioning clients. Angela -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of [email protected] Sent: Monday, 15 June 2009 14:38 To: [email protected] Subject: OTlist Digest, Vol 67, Issue 5 Send OTlist mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com or, via email, send a message with subject or body 'help' to [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of OTlist digest..." Today's Topics: 1. Re: W/C evals (Mary Alice Cafiero) 2. Re: Functional Therapist? (Ron Carson) 3. Re: Dental Hygienst Knows About OT... (Ron Carson) 4. Re: Dental Hygienst Knows About OT... (Ron Carson) 5. Re: Dental Hygienst Knows About OT... ([email protected]) 6. Re: Dental Hygienst Knows About OT... (Ron Carson) 7. Re: Dental Hygienst Knows About OT... ([email protected]) 8. Re: Dental Hygienst Knows About OT... (Ron Carson) 9. Re: Dental Hygienst Knows About OT... ([email protected]) ---------------------------------------------------------------------- Message: 1 Date: Fri, 12 Jun 2009 08:20:04 -0500 From: Mary Alice Cafiero <[email protected]> Subject: Re: [OTlist] W/C evals To: [email protected] Message-ID: <[email protected]> Content-Type: text/plain; charset=US-ASCII; format=flowed; delsp=yes I don't have the actual reference close at hand. This was something I learned at a course when I first started billing on my own. The course was done by either Permobil or Pride. If you look at the list of CPT codes that are applicable to OT, it shows the code, the definition, and what it can be billed with, can't be billed with, and is suspect if it is billed with. I will do my best to find it later. I do know that it works to bill both on the same day as that is how I am getting reimbursed. That is Medicare. Private insurance and Medicaid are a totally different ballgame and vary wildly. Juan-- If I saw a patient for only an hour (never happens), I would bill the eval code and then 2 or 3 units of 97542, depending on how much time I felt was dedicated to chair discussion/decisions only. Just FYI, the Medicare evaluation I use is 12 pages long and includes a place to justify everything that is not an included item in the base price of the chair. Most Medicare evals take a minimum of 1 1/2 hours and as long as 3, depending on the complexity and circumstances. I also use my eval only and don't do an additional LMN. Good day, all. Mary Alice Mary Alice Cafiero, MSOT/L, ATP [email protected] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Jun 11, 2009, at 7:53 PM, Ron Carson wrote: > Good conversation. > > Mary, will you provide a reference for this statement: > >>> It is also true that the 97542 wheelchair management and > training code is the only code that can be billed for > treatment > on the same day the MAC evaluation code is used. << > > > > > ----- Original Message ----- > From: Mary Alice Cafiero <[email protected]> > Sent: Thursday, June 11, 2009 > To: [email protected] <[email protected]> > Subj: [OTlist] W/C evals > > MAC> It is also true that the 97542 wheelchair management and > training code > MAC> is the only code that can be billed for treatment on the same > day the > MAC> evaluation code is used. This makes it possible to do the OT > eval/ > MAC> Whelchair assessment on the same day. I procure the doctor's > order for > MAC> eval and tx ahead of time. > MAC> It's all a work in progress on my part because it is a very new > field > MAC> to be doing only w/c evals in patients' homes but not as part > of a > MAC> home health agency. Believe me, it confounds all of the funding > MAC> sources when I call with ?S. > MAC> Sure is fun, though! > > MAC> Your explanation of the 7 minute rule is what I understood..... > but it > MAC> needs to be clear that an hour long treatment is 4 units, not 8 > units > MAC> (as it would be if it were a true "per 7 minute unit"). > > > MAC> Mary Alice > > MAC> Mary Alice Cafiero, MSOT/L, ATP > MAC> [email protected] > MAC> 972-757-3733 > MAC> Fax 888-708-8683 > > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] ------------------------------ Message: 2 Date: Fri, 12 Jun 2009 17:08:57 -0400 From: Ron Carson <[email protected]> Subject: Re: [OTlist] Functional Therapist? To: "Angela King (ADHB)" <[email protected]> Message-ID: <[email protected]> Content-Type: text/plain; charset=windows-1252 Angela, will you comment on the role of OT where you work? Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: Angela King (ADHB) <[email protected]> Sent: Friday, June 12, 2009 To: [email protected] <[email protected]> Subj: [OTlist] Functional Therapist? AKA> I really don't get this issue very much in my place of work and that is AKA> because all members of our team have good understanding and great AKA> respect for the role of OT so the client gets it from all corners. We AKA> also provide written information explaining the role of each member of AKA> the team. ------------------------------ Message: 3 Date: Fri, 12 Jun 2009 17:10:54 -0400 From: Ron Carson <[email protected]> Subject: Re: [OTlist] Dental Hygienst Knows About OT... To: Miranda Hayek <[email protected]> Message-ID: <[email protected]> Content-Type: text/plain; charset=iso-8859-1 Miranda, to me what you describe is NOT occupational therapy. I see it more as PT. Sorry, I know that statement won't be well received. Thanks, Ron ----- Original Message ----- From: Miranda Hayek <[email protected]> Sent: Thursday, June 11, 2009 To: [email protected] <[email protected]> Subj: [OTlist] Dental Hygienst Knows About OT... MH> I agree with Kristin. I work in outpatient and treat many UE MH> injuries. Although I do manual therapy, exercises, etc....I also MH> discuss during each session how their occupations are affected, what MH> is becoming easier, how we can modify current occupations to be more MH> successful, and ways to incorporate use of UE into functional MH> activities to be get more use. So I think we should be continue to have this specialty! MH> ~ Miranda ~ ------------------------------ Message: 4 Date: Fri, 12 Jun 2009 23:04:46 -0400 From: Ron Carson <[email protected]> Subject: Re: [OTlist] Dental Hygienst Knows About OT... To: Kristin <[email protected]> Message-ID: <[email protected]> Content-Type: text/plain; charset=iso-8859-1 Kristin, I don't really know where to start, so let me just jump in. In my opinion, the BIGGEST problem facing OT is that we do not do what we say we do. Comparing AOTA's rhetoric and practice patterns of adult phys dys OT's does not paint a congruent picture. On paper, the OT profession is all about occupation. In practice, adult phys dys is all about UE rehab. For me, this inconsistency is killing our profession! I'm going to disagree with some of what you've written: 1) A broken finger may or may not cause occupational deficits. And even if it does, these deficits may not require the skill of an OT. 2) I don't care if the hygienist had a good or bad experience. I do care if the experience revolved around occupation. 3) Occupation should NOT be things talked about during rote therapy. Occupation should be the FOCUS and outcome of treatment. 4) The profession needs therapists who are experts in occupation. Leave the UE specialization to PT. Disclaimer: My comments are not directed towards YOU. They are just general comments about how I feel towards OT. Everyone is welcome to join this conversation. Only through honest and logical dialogue will we better understand and appreciate everyone's viewpoints. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: Kristin <[email protected]> Sent: Thursday, June 11, 2009 To: [email protected] <[email protected]> Subj: [OTlist] Dental Hygienst Knows About OT... K> I guess I dont understand why it's such a horrible thing for OT's to K> be knowledgeable and profiecient in treating UE ailments. I agree K> that shouldn't be the only area for the profession to focus on, but K> having a broken finger causes dysfunctional occupational performance! K> At least the dental hygenist had a good experience with OT as opposed K> to the 'cone therapists'. I would be interested to hear if the K> therapist discussed what the patient could do at home to reduce pain K> and improve function. The things we should be talking about when K> performing more rote therapy techniques. K> I think the profession needs OT's who are UE specialists! We don't K> want to loose that specialty area! K> Kristin ------------------------------ Message: 5 Date: Sat, 13 Jun 2009 00:07:44 -0400 From: [email protected] Subject: Re: [OTlist] Dental Hygienst Knows About OT... To: [email protected] Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii"; format=flowed I see the horse is not dead yet!!!! This age old debate revolves around the top down approach and the bottom up approach to treatment, or the occupation as a means or an end. We as OTs in physical disabilities can choose either to treat occupational dysfunction in two ways a) Use occupations as the treatment modality to combat the issue of occupational dysfunction either through restoration or compensation or b) Treat the underlying impairment. In my opinion it simply depends on what is causing the occupational dysfunction. If an occupational takes an interest in hand therapy and they decide to specialize in this area (PTs can do this too) then I would say that the occupational therapist is doing hand therapy. I would not state that they are doing physical therapy because this is a gray area. Perhaps a physical therapist takes an interest in visual perceptual training ( my PT friend did) because of their strong background in neurorehabilitation. When they utilize this training during treatment sessions to facilitate better outcomes with gait and balance, would they state that they are doing occupational therapy? What if a PT takes a liking to driving evals and training (IADL),. Would they call it occupational therapy or drivers training? What Ron is simply trying to do is change the paradigm of occupatonal therapy and simply rewrite the textbooks we once read in school, by erasing the biomechanical model. I applaud him to a certain extent, but at times I an confused by his reasoning. Hand Therapy does not necessarily mean a cone or peg pusher therapist. A Hand therapist does not necessarily give the pubilic a certain image of what OT is , but it is the misguided therapist that provides OT without meaning in order complete enough time to reach a certain RUG level or complete the "Three hour rule". I do not think it is Ron's intent to upset all of the OTs who practice hand therapy, but to guide phys dys OTs to provide meaning during their therapy sessions in order to clean up the public perception of what we do. Chris Nahrwold MS, OTR.. -----Original Message----- From: Ron Carson <[email protected]> To: Kristin <[email protected]> Sent: Fri, 12 Jun 2009 10:04 pm Subject: Re: [OTlist] Dental Hygienst Knows About OT... Kristin, I don't really know where to start, so let me just jump in. In my opinion, the BIGGEST problem facing OT is that we do not do what we say we do. Comparing AOTA's rhetoric and practice patterns of adult phys dys OT's does not paint a congruent picture. On paper, the OT profession is all about occupation. In practice, adult phys dys is all about UE rehab. For me, this inconsistency is killing our profession! I'm going to disagree with some of what you've written: 1) A broken finger may or may not cause occupational deficits. And even if it does, these deficits may not require the skill of an OT. 2) I don't care if the hygienist had a good or bad experience. I do care if the experience revolved around occupation. 3) Occupation should NOT be things talked about during rote therapy. Occupation should be the FOCUS and outcome of treatment. 4) The profession needs therapists who are experts in occupation. Leave the UE specialization to PT. Disclaimer: My comments are not directed towards YOU. They are just general comments about how I feel towards OT. Everyone is welcome to join this conversation. Only through honest and logical dialogue will we better understand and appreciate everyone's viewpoints. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: Kristin <[email protected]> Sent: Thursday, June 11, 2009 To: [email protected] <[email protected]> Subj: [OTlist] Dental Hygienst Knows About OT... K> I guess I dont understand why it's such a horrible thing for OT's to K> be knowledgeable and profiecient in treating UE ailments. I agree K> that shouldn't be the only area for the profession to focus on, but K> having a broken finger causes dysfunctional occupational performance! K> At least the dental hygenist had a good experience with OT as opposed K> to the 'cone therapists'. I would be interested to hear if the K> therapist discussed what the patient could do at home to reduce pain K> and improve function. The things we should be talking about when K> performing more rote therapy techniques. K> I think the profession needs OT's who are UE specialists! We don't K> want to loose that specialty area! K> Kristin -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ------------------------------ Message: 6 Date: Sat, 13 Jun 2009 16:07:34 -0400 From: Ron Carson <[email protected]> Subject: Re: [OTlist] Dental Hygienst Knows About OT... To: "[email protected]" <[email protected]> Message-ID: <[email protected]> Content-Type: text/plain; charset=windows-1252 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.. ------------------------------ Message: 7 Date: Sat, 13 Jun 2009 16:51:44 -0400 From: [email protected] Subject: Re: [OTlist] Dental Hygienst Knows About OT... To: [email protected] Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii"; format=flowed Ron, Not sure where the disagreement is found "Chris, so of what you say is correct, but much isn't" So it is ok to step out of your traditional role as an OT to complete lymphedma treatment, but it is not ok to step out of the traditional role as an OT to complete UE orthopedic treatment? Seems to me you are on both sides of the fence, but for some reason you cannot stand UE impairment based treatment. Chris -----Original Message----- From: Ron Carson <[email protected]> To: [email protected] <[email protected]> Sent: Sat, Jun 13, 2009 3:07 pm Subject: Re: [OTlist] Dental Hygienst Knows About OT... 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] ------------------------------ Message: 8 Date: Sun, 14 Jun 2009 06:41:52 -0400 From: Ron Carson <[email protected]> Subject: Re: [OTlist] Dental Hygienst Knows About OT... To: "[email protected]" <[email protected]> Message-ID: <[email protected]> Content-Type: text/plain; charset=windows-1252 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] ------------------------------ Message: 9 Date: Sun, 14 Jun 2009 22:37:43 -0400 From: [email protected] Subject: Re: [OTlist] Dental Hygienst Knows About OT... To: [email protected] Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii"; format=flowed 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] ------------------------------ -- Unsubscribe? [email protected] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? 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