Posts filed under ‘treatment’

Ethical Dilemma with Treating Unethical Patients

I have been struggling with an ethical dilemma ever since my Level I fieldwork assignment, where I was doing my clinical at an outpatient facility within a hospital located near one of the local jails.

Since this hospital was affiliated with the city, we often got the prisoners that needed occupational therapy at this facility.  If a prisoner is scheduled to come in for an appointment, they are accompanied by two police officers and their hands and feet are both shackled.

As part of our assessments, we typically ask our patients what their own goals are for therapy.   Unfortunately, I had one patient (who had had an ulnar nerve and tendon injury from a knife fight) tell me that his goal for therapy was “to be able to close my hand into a fist so that I can fight again.”

When I hear something like that, I think to myself, “Why do I want to treat this person?  Why do I want to help this person meet his goals?”

This question bothered my enough that I knew right away that I would never want to work with forensic patients.  As an occupational therapist, I know that we have to work with patients to meet their goals and increase their occupational well-being.  But if that involves beating up other people and doing illegal things, how can I, in good faith, treat this type of patient?

March 3, 2008 at 11:51 pm 10 comments

Educating Patients with Amputations

Aside from educating an amputee about phantom limb pain, what else do occupational therapists have to teach patients?  The things I can think of are: skin checks, wound care, ace wrapping, and splint education.  Anything else?

(My question refers to on top of the usual ADL training that we would do)

February 13, 2008 at 9:28 pm 11 comments

Open Heart Surgery

I really want to see an open heart surgery. Until that happens, I’ll have to be happy with treating patients that have had open heart surgery; the most common of which I see is coronary artery bypass grafts (CABG).

Patients undergoing CABG usually have complicated heart problems and arteries that are blocked. The procedure basically reroutes some of the blood vessels, thus enabling better blood flow to the heart. Chest pain is also reduced.

As occupational therapists, one of the big things we do with open heart patients is review sternal precautions (I just wrote that paragraph on the precautions for this blog post – yay for Wikipedia!). It is amazing how people are so different in this area. For some people, after hearing the precautions once, they automatically start following the precautions with no difficulty. These patients tend to recover much more quickly than patients who do not (that isn’t scientific, just something I’ve picked up on. Then, there are patients who no matter how many times you go over the precautions, they still don’t follow them. It can be very frustrating at times.

While writing this, I was struck by an interesting thought. When working with hip replacements, I almost never have a problem with people not following their precautions. I have the most difficulty with sternal precautions. People with spinal precautions tend to be very good about their precautions, unless they’ve had a minor spinal surgery, such as a laminectomy. If I had to guess, I’d say the reason is that with hip and spine surgeries, doing the things that you’re not supposed to do directly impacts the joint/vertebrae, and is therefore a lot more painful, which is why they usually adhere to the precautions. However, with sternal precautions, patients do not necessarily feel anything wrong with what they are doing, so they’ll be more likely to not adhere to the precautions.

Addendum: Here is the paragraph I wrote on Wikipedia:

Patients undergoing coronary artery bypass surgery will have to avoid certain things to avoid opening the incision. These are called sternal precautions. First, patients need to avoid using their arms excessively, such as pushing themselves out of a chair or reaching back before sitting down. To avoid this, patients are encouraged to build up momentum by rocking several times in their chair before standing up. Second, patients should avoid lifting anything in excess of 5-10 pounds. A gallon of milk weighs approximately 8.5 pounds, and is a good reference point for weight limitations. Finally, patients should avoid overhead activities with their hands, such as reaching for sweaters from the top shelf of a closet or reaching for plates or cups from the cupboard.

February 10, 2008 at 4:29 pm 23 comments

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.

December 16, 2007 at 10:30 pm Leave a comment

Helpful Guide for Planning OT Treatments

Jenna from OTplan.com sent me the link to her website yesterday, and after having a quick look through the website, it looks like it can be a very useful source for treatment ideas. The site is obviously geared towards working with the pediatric population, so if anyone is in that field, you should definitely check it out.

The way the site works is you choose a skill you want a child to work on (i.e. tripod grasp, sequencing, cutting, intrinsic muscle development, etc.) followed by selecting what materials you have available in your clinic, house, or treatment setting. After selecting the materials, a list of activities (treatments) show up, and you can click each one for easy and understandable directions. The entire site is very straightforward, which I like a lot.

So check it out!

June 28, 2007 at 2:33 pm 13 comments


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