Diane,
I hate to be the devil's advocate, but because I veiw you as a very
compassionate young clinician, I think you might benefit from my
suggestions. With that being said, I am not sure that your UE strength
exercises helped this person with their ability to transfer into a
shower or complete bathing and dressing easier. Now I am not saying
that the UE strength program had no therapeutic benefits whatsoever,
like for overall strength and possibly functional endurance, but I
doubt if it helped him in the way that you think.
If this was the patient's first time with you in the shower, how do you
know that he couldn't have done this his first week? I think I remember
you saying that you are a COTA. If this is true, did the OT
specifically evaluate these abilities or did the therapist simulate or
extrapolate concepts during the evaluation?
What UE strength exercises did you work on in treatment? I am assuming
that you worked on the typical theraband, dowel rod, or dumbell
exercises that focus on isotonic strength. If this is true, then based
on the literature there is no established evidence or even any
associations for functional improvements in this area. And practically
speaking, most clinicians do not strengthen the correct muscles that
are even in the ball park when talking about functional mobility. When
I strengthen for functional mobility, I work on the patient's core
stability, the scapular depressors, and the triceps. Now when you
work on such muscle groups it is wise to strengthen the antagonist
muscle groups as well so you do not end up with muscle imbalance. This
is still just thinking practically, it still does not have any support
in the research.
If you want to go by the book, then you have to key into the concept of
task specific training. This is usually an easy concept for new
clinicians. If you want to get better at walking go ahead and walk, if
you want to get better at getting into a shower go ahead an get into a
shower, if you want to get better at bathing and dressing go ahead and
practice this as well.
Hope this helps,
Chris
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