This has brought back so many memories of "old strokes " which, in my experience, hit a plateau in improvement at around three months were discharged and stayed at that level because there was no one around to pick up on the "flickers" that may have been apparent much later. I'm guessing that this man has useful if not functional cognition, the use of his extremities on one side and that he can see, hear and talk. I'm also guessing that his dominant hand was affected. I'm curious how his home environment has adapted to his needs. He can stand to transfer but how does he stand? If his standing pattern is of poor quality I would start there as far as mobility is concerned. But he has withdrawn from engagement in his own life so will he be at all interested in improving his standing pattern. How will you engage him? Many people like this have become accustomed to physical care and have no interest in ADLs. They also have no knowledge or understanding of the productivity possibilities open to people with similar impairments. What was his life before the stroke? What dreams and expectations were shattered? What knowledge does he have from that former life? Is there something there that interests you that he has to offer to you? (I don't know how you would hold this kind of discussion for Medicare) Has the world convinced him that he has nothing to offer?
I was a volunteer aid in a nursing home in order to get a rehabilitation setting referral for my application to occupational therapy. One patient was a man in his early forties, I think, with no family and no friends who had stayed around after the stroke. He had been a stevedore working on the docks. With no advocate he believed he was trapped in the nursing home for the rest of his life. Listening to his story I had the kind of vision that you described, Ron. A year later he was a fellow student in the college where I was taking my qualifying year to enter occupational therapy. Go with the vision, Ron. Blessings, Joan -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Ron Carson Sent: July 5, 2009 3:42 PM To: [email protected] Subject: Re: [OTlist] A Vision For Patients? Very Cool! Sounds like you and I have similar practice pattens and ideals. I hope others reply.... ----- Original Message ----- From: [email protected] <[email protected]> Sent: Sunday, July 05, 2009 To: [email protected] <[email protected]> Subj: [OTlist] A Vision For Patients? cac> Ron and the gang, cac> Yes, I would work on mobility and functional ambulation. I choose to cac> complete them in a "functional dynamic", in which the patient clearly cac> knows why we are working on walking (example walking from the family cac> room recliner to the kitchen so the patient can cook, etc etc). Yes, I cac> would trail them with different mobility aids if the mobility aids in cac> which they currently have are not helping to advance the patient in cac> their personal goals of occupaton. I work with a physical therapist in cac> a rehab hospital, so I always communicate with her what I am doing, so cac> carry over can be best assured. She also talks to me when she thinks a cac> certain mobility aide will work best for walking. We usuaally are on cac> the same page, since we have worked with each other for a while now. cac> -----Original Message----- cac> From: Ron Carson <[email protected]> cac> To: [email protected] <[email protected]> cac> Sent: Sun, Jul 5, 2009 6:12 am cac> Subject: Re: [OTlist] A Vision For Patients? cac> Good deal! Thanks Chris!! cac> If you don't mind, here's another loaded question. <smile> And not just cac> for you but for ALL OTlist readers.... cac> You mention standing balance, do you also work on mobility/ambulation? cac> For example, would you work on mobility/ambulation for a patient cac> currently using a wheelchair, stands and transfers with mod A but is cac> unable to ambulate? Would you trial them with different mobility aids? cac> ----- Original Message ----- cac> From: [email protected] <[email protected]> cac> Sent: Saturday, July 04, 2009 cac> To: [email protected] <[email protected]> cac> Subj: [OTlist] A Vision For Patients? cac>> I most certainly address the LE. Usually it is through practice cac> of cac>> occupations, but occasionally I will work on specific leg cac> movements and cac>> standing balance in order to eventually achieve an occupational cac> goal. cac>> I only mentioned flaccid arm, because that is what the prior OTs cac> worked cac>> on with the patient you mentioned. cac>> Chris 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] Checked by AVG - www.avg.com Version: 8.5.375 / Virus Database: 270.13.5/2219 - Release Date: 07/05/09 05:53:00 Checked by AVG - www.avg.com Version: 8.5.375 / Virus Database: 270.13.5/2219 - Release Date: 07/05/09 05:53:00 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
