So, you are limiting your self to people who are only cognitively able to express those ideas? What about mental health patients? People with learning disabilities? Low cognintion? Do you help set safe levels of supervision and set up with a OT style cognitive behavioral assessment?
Elizabeth Thiers, OTR/L FECTS [email protected] > -----Original Message----- > From: [email protected] > [mailto:[email protected]] On Behalf Of Ron Carson > Sent: Wednesday, July 01, 2009 9:32 AM > To: Diane Randall > Subject: Re: [OTlist] Just About To Give UP............ > > Hello Diane and other: > > Diane, I strongly believe that when a patient has no > identifiable occupational goals, then they should not be > seen by OT. After all, if the goal of OT is enabling people > to engage in occupation and yet there are no occupational > goals, then what is OT doing? More likely than not, they are > doing exercises, which is wrong on two levels: > > 1. Does not REQUIRE the skills of a therapist 2. Is not OT > > Here's two patients I have today: > > 1. Patient is unable to care for himself because of weakness > and fear of falling. We will work on standing, transfers and mobility. > > 2. Patient is unable to care for herself and carry out daily > occupations related to her role as a wife. We will work > on standing, transfers, mobility, etc. > > > None of my interventions include focused treatment on UE, > LE, strength, etc. Instead the focus is on restoring lost > occupation. This is done by addressing SPECIFIC and > IDENTIFIABLE problems which are preventing SPECIFIC and > IDENTIFIED occupational goals. It really is a practical > approach that I liken to learning to ride a bike. If a > person wants to ride a bike the best way is to practice, > practice, practice. Like wise, if a person wants to dress, > toilet, bathe, shower, cook, clean, laundry, etc, the best > approach is practice, practice, practice. > > I want to address some other things, but I'm off to work. > > Ron > > ~~~ > Ron Carson MHS, OT > www.OTnow.com > > > ----- Original Message ----- > From: Diane Randall <[email protected]> > Sent: Tuesday, June 30, 2009 > To: [email protected] <[email protected]> > Subj: [OTlist] Just About To Give UP............ > > DR> Hello, As a new OTA/L a week into my first job in a SNF, I have > DR> become well acquainted with the UE focus of OT. But, I think the > DR> most frustrating part of the process is not some much the > DR> interventions but the fact that so many of my patients > have really > DR> no "occupation" to look forward to when discharged from > rehab. It is > DR> no wonder we may be tempted to stick with just UE exercises. ( > DR> besides ADL's we do in rooms) > > DR> Question...tell me about a typical day you spend at home? > > DR> Replies (paraphrased) > > DR> Patient A- "I just watch Soaps..my daughter does everything > DR> (cooking, cleaning)" > DR> Patient B- "I have not worked since I gained > weight...have not left > DR> the house except to come here for 2 weeks...thank god for > disability." > DR> Patient C- "I don't want therapy and you can't make me go". > DR> patient D- " The nurses do everything for me...why should > I dress myself" > > DR> How can we motivate patients to value "occupation" when > thier goals > DR> are to just get strong enough to go back to their lives which in > DR> many cases is totally dependent on others. Even simple > ADL's do not > DR> seem to be a goal of some patients? > > DR> I also see in some ways why UE has become so popular in > DR> SNF's....it's easy, it looks productive, and it can be > done simultaneously with others. > DR> Productivity expectations have created UE ther-ex focused > treatment. > DR> It is almost impossible to individualize OT treatment > when you have > DR> 5-6 or more patients seeking your attention all at one time. In > DR> addition , I have noticed PT/OT /Speech seem to be in > melting pot of > DR> therapy. I see speech do cognitive activities I learned > in school. > DR> Sometimes the only difference you can really tell between > an OT and > DR> PT in the gym setting is where they focus patient work (above or > DR> below the belt) > > DR> HH is a little different..I would expect a HH agency to value > DR> occupation. I mean...it is one on one therapy for gods sakes. So > DR> much can be done in that setting. I would be frustrated > too. We have > DR> to make a commitment to see UE ther-ex as a means to an end. > DR> Strength to transfer to a toilet independently-standing > tolerance to > DR> create a simple meal in the kitchen from a recipe chosen by the > DR> patient). But is should never be the "only" focus or we have > DR> essentially become PT's..we all need to educate our > patients about what we do...and sadly other professionals around us. > > DR> -----Original Message----- > DR> From: [email protected] [mailto:[email protected]]on > DR> Behalf Of Ron Carson > DR> Sent: Tuesday, June 30, 2009 20:28 > DR> To: [email protected] > DR> Subject: [OTlist] Just About To Give UP............ > > > DR> I am just about at the end of a very long road of trying to > DR> change my profession. > > DR> No one seems to value occupation as an outcome. > I refuse to > DR> see patient's with the purpose of improving UE function so my HH > DR> agency just calls other OT's who will. PT's don't > appreciate > DR> occupation but it encroaches on their treatment. My agency is > DR> clueless about occupation and has no reason to learn about it. > > DR> I so value what I do and I believe that most of my > patient's do as well. > DR> Most of them can not articulate occupation or > occupational therapy > DR> but they do know that I'm there to teach them two things: > > DR> 1. How to take care of themselves > > DR> 2. How to be productive > > DR> I almost cried when I left my agency's staff meeting today. > DR> EVERTHING is about PT, PT, PT, and how wonderful they are. There > DR> must be like 15 PT's while there is only 3 OT's. It's > really a > DR> sad state of affairs. I am tired of going from "hero to > zero". Hero > DR> with patients and zero with my agency and other therapists. > > DR> The other day a nurse with 24 years experience told a patient > DR> that OT was about small muscles and PT was about gait and large > DR> muscle groups. I promptly called the nurse and > explained that OT > DR> is about occupation - i.e. take care of yourself and being > DR> productive. She said, that she didn't know and that > even after all > DR> these years she really has no idea what OT does. She > suggested that I call my agency and do an inservice. > DR> Now can you even imagine that a home health agency needs an > DR> inservice on the role of OT!! Sad state of affairs. > > DR> Am I the ONLY OT who experiences and feel these > emotions??????????????? > DR> Gosh, I hope not. But then on the other hand, maybe it's > just me. > DR> Maybe I just refuse to accept the way things are. Maybe > DR> I'm just a self-centered egotist who is totally > clueless about OT. I truly, truly > DR> don't understand WHY "things" are the way they > are. And more > DR> importantly, what can be done, if anything, to change the > DR> direction of UE physical dysfunction OT. > > > DR> -- > DR> Options? > DR> www.otnow.com/mailman/options/otlist_otnow.com > > DR> Archive? > DR> www.mail-archive.com/[email protected] > > > > DR> -- > DR> Options? > DR> www.otnow.com/mailman/options/otlist_otnow.com > > DR> Archive? > DR> www.mail-archive.com/[email protected] > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
