Hello Diane:
Here would be my approach:
1. Identify the patient's occupational goal(s)
a. What does he want/need to do in order to live as safely and
independently as reasonably possible
2. Identify underlying barriers:
a. Physical
b. Cognitive
c. Mental
d. Social
e. Environmental
3. Prioritize the goals/barriers
4. Address those barriers that are within your scope of practice and
expertise.
Forget about the UE, LE stuff. Focus on the occupational needs/desires
of the patient. If it's endurance, then work on endurance. If it's fear,
then work on fear. If it's motivation, then work on motivation.
The BIGGEST challenge is knowing the occupations and barriers to address
On a final note. It may be time to d/c the patient if:
1. There are no occupational goals
2. The goals have been met
3. You are unable to address the causes leading to the occupational
dysfunction.
4. The patient does not desire to address his occupational need.
In my opinion, you must not let yourself be pigeon-holed into the UE
therex mentality. Expand your horizons. Meet the patient where THEY are.
Figure out who and what they are about. Develop rapport with him so that
you can be of greatest therapeutic benefit.
Remember, the goal is to improve occupational performance.
Stay in touch, keep us informed and keep asking questions. You are 100%
on the right track to becomming a "non-UE therex occupational
therapist."
Gotta love it!
Ron
----- Original Message -----
From: Diane Randall <[email protected]>
Sent: Monday, July 13, 2009
To: [email protected] <[email protected]>
Subj: [OTlist] Why OT's Should NOT Focus on the UE
DR> Being that I am new to this and my employment forces me to live in "UE
DR> therex" land....perhaps you could give me an indication as to what I can do
DR> with this person. Others more experienced than me in the dept go with the
DR> flow. He is 500 pounds...can now walk about 50ft with someone following him
DR> in a W/C and he is able to stand aboout 2-3 min in a RW.
DR> I have done all ADL's..and although he is able to life weights in all planes
DR> he does not have the arm length to bipass his midsection to do LE dresssing.
DR> He has serious LE PN issues so he cannot use a sock aid. he has refused both
DR> a dressing stick and reacher.
DR> I have done transfers with him from W/C to bed, W/C to toilet, W/C to shower
DR> I have done standing tolerance...he likes to draw so I have him stand in
DR> front of a white boards and he draws murals for the department.
DR> He does W/C pushups.
DR> He lives alone, rarely ever left his home due to his weight, microwaves all
DR> his meals, and lives on disbaility.
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