The patient was unable to bear weight on his legs due to PN and did not have the strength to hold his weight up in a RW, he also could not stand beyond 5 seconds without his knees buckling as he is close to 500 pounds. He worked up from 5 to 10 llb weights in all planes per day and he was a very debilitated when he arrived, using a hoyer. The UE therex at least boosted his confidence to be able to do this transfer along with improvemnents in standing tolerance and walking with PT. UE therex is not all he does in therapy but I have noticed, especially with men, that they tend to perform ADL's better when they feel therapy includes an overall strengthening program. He even keeps some weights in his room. There is something about lifting weights that increases self-esteem and the hope is that overall conditioning exercises will continue when he is discharged since I do believe an overall weight lifting program will benefit his continued weight loss over time. He has lost a significant amount of weight and he seems very motivated. Straight ADL's can be a source of stess for very proud men. Most of my patients are in therapy for debility. While it is not appropriate for everyone, I feel that in this case it was justified, even if as you say the UE program did not contribute significantly to his ability to transfer when is comes to to strength alone. It my opinion, the UE program is more of a holistic approach than a biomechanical one in this case.
-----Original Message----- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com]on Behalf Of cmnahrw...@aol.com Sent: Sunday, July 12, 2009 07:32 To: OTlist@OTnow.com Subject: Re: [OTlist] Why OT's Should NOT Focus on the UE 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 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
