Why do occupational therapists splint?

The above title was used as a search engine query to get to this blog.  I think that this is a good question.  Why do we splint?  Why not PT’s?  Or orthopedic technicians?

The obvious answer is that we make splints for functional purposes, whether it is an extension splint for a below knee amputation (I made my second one last week!), or a resting hand splint to prevent hand contractures. But this is not always consistent, as I’ve seen only PT’s making referrals for certain types of splints, such as multi-podus boots to prevent foot drop. The good thing is that when it comes to splinting, the occupational therapists are the ones that get called for the most part.

I enjoy splinting.  Back when I was a student, I made tens of foot-plates.  We had patients who had external fixators attached to their legs, and we would make foot-plates to prevent foot drop (multi-podus boots wouldn’t work as the ex-fix got in the way, see picture for example).  As my experience grows in acute care, I’d like to see my experience in splinting grow as well.  I am even considering specializing in splinting.

Working with comatose patients

Luckily, I don’t work with too many patients who are comatose, but I’ve had weeks where I will suddenly see 3 or 4 patients in one week who are comatose. This usually happens because the patient is for the most part medically stable, and they now need placement. Most facilities won’t accept patients without having some sort of level of care, so they call upon the therapists to determine what the patients can and cannot do.

What I find interesting is that for the most part, the exact same evaluation will take place from OT, PT, and SLP. My hospital seems to favor the JFK Coma Recovery Scale, and both the OTs and PTs use the scale as their evaluation. What ends up happening is that we both do the exact same thing based on the exact same scale, yet bill differently. And Medicare accepts this. If the patient was not comatose, Medicare would never pay for two disciplines to do the exact same thing. Go figure.

When the patient is comatose, it is obviously hard to complete ADLs, but we end up usually seeing what stimuli work to arouse the patient. Can the patient follow a 1-step command consistently (i.e. give a thumbs up)? Do they respond to pain? The link to the scale is here (pdf) and is for the most part self-explanatory, should you want to know more information.

Working with Doctors

I recently had an interaction with a doctor that I wanted to share, as I think that it is important to understand our own role and how we need to educate and interact with doctors.

• I was getting ready to see a patient, but noticed that in the OT orders (everything is on the computer), the order said that the patient was on bedrest. I couldn’t find anything in the chart that would indicate why the patient was on bedrest. Usually, it is obvious; they’re being ruled out for DVT or PE, they’re scheduled to go to the OR, etc. But for this patient, I could not find any reason in the chart as to why the patient was on bedrest, and the nurse herself couldn’t figure it out. Finally, after a half an hour of trying to figure this out, I was able to track down the doctor who had put in the order. Turns out, she was in a lot of pain, and he figured it would hurt even more to get out of bed, so he ordered bedrest. In my mind, I was thinking that if every single patient we saw was put on bedrest because of some pain, I wouldn’t have a job as every one of my patients would be on bedrest. Instead, I had to explain to the doctor that as therapists, it is our job to get them out of bed and be able to work through their pain to be able to ambulate and complete their ADLs. I went on to explain that when we see an order for bedrest, the therapists don’t touch the patient. Needless to say, the doctor was a new grad, but I was happy that I was able to educate and explain our role as therapists. Combined with the fact that I did it nicely, the doctor didn’t feel insulted, and he even asked a few further questions regarding our role.

Traditional OT

What do you think about when you hear the phrase, “traditional occupational therapy?”  To me, the phrase refers to OT’s doing just crafts, be it woodworking, painting, or whatever.  I would picture this traditional OT being given to a psychiatric patient or an injured soldier from World War II.

Interestingly enough, I recently had an elderly patient (in her 80’s!) who told me that she was a retired occupational therapist!  And she told me that back when she was working as an OT, she worked mainly with psychiatric patients doing crafts.

It is hard enough finding patients who even know what occupational therapy is in the first place.  But to get someone who actually was an OT is exciting.

Just thought I’d share

OT/PT

This is a funny story about people who are absolutely clueless as to the role of occupational and physical therapy. Often, when orders are made for OT in acute care, PT is also requested as part of the consult. It doesn’t mean the patient even needs one or the other, but sometimes doctors just check it off as they go down the list of orders on the computer. Also, before some patients can go home, they need to be consulted by OT and PT.

Anyway, a fellow OT co-worker of mine was getting ready to see a patient who was awaiting approval from OT to be able to be discharged home when the nurse saw her coming. She got all excited and said, “OT/PT is here!” Mind you, it was just the OT that was there, but this nurse saw so many patients being treated by both OT and PT, they somehow all got rubbed into one word: OTPT!

I made a splint!

I made my first splint independently last week. I’ve made lots of splints in my time, especially footplates (to prevent foot drop), but every time I ever made a splint before, I had a clinical instructor or someone else right there to help me out. This splint I did all by myself. And I did a really good job, too It was a relatively simple splint, a knee extension splint for a below knee amputee (BKA), but I’m happy that I was able to do is all by my lonesome self.

Identifying Yourself

It is important to always properly identify to your patients who you are, what your role is in the therapeutic process, and what you plan on doing during that treatment session. Sometimes, however, that just isn’t enough.

I am taking a graduate elective that allows me to have 60 hours of extra clinical time so that I can further gain experience in the setting of my choosing before graduating. I have liked acute care for a while now, and I therefore decided to do another clinical in acute care.

My last day was earlier this week. We went in to see an 80+ year old lady who had been admitted for CHF and also had a diagnosis of dementia. While the patient agreed to let me treat her by walking from her bed to the bathroom to do a toilet transfer, she kept asking me over and over again why I was doing this “procedure.” I explained each time that the doctors wanted to know how safe she was so that she could go home. However, no matter how many times I explained it, she kept asking me about the procedure. Before leaving, she asked that we come back so that we could speak to her daughters.

A few hours later, we went back to her room as requested, and her daughters were now there. Turns out that since I wasn’t wearing a formal identification from the hospital (because I was only there for 60 hours), she thought I was someone from some random nursing home. She was afraid that I was assessing her for a nursing home. No matter how many times I told her that we were occupational therapists, she was still worried.

So even if you identify yourself as an occupational therapist, that isn’t always enough. I think it was great that the patient was cognizant of the fact that all hospital employees should have identification, and that she realized that I wasn’t wearing a hospital ID.