Cones, Pegs and other OT bad words
I recently received information from AOTA, American Occupational Therapy Association, regarding 5 areas of which to warn OTs on best practices. Now I have been a National Board Certified Occupational Therapist and Texas State Licensed Occupational Therapist for going on 22 years and I was taken back by the need for AOTA to send out such a letter. I was even more surprised by my colleagues response to the 5 areas of caution. All of the areas have to do with tools and modalities being used in the course of a client's/patient's treatment.
"The core foundational principle of occupational therapy is to treat the areas that have inhibited one's ability to perform activities of daily living in both functional and purposeful performance areas. We address performance areas, performance components and the performance context. " (AOTA, 2018)
Back to my surprise at this warning notice... My colleagues, old and new, seem to have forgotten who we are and what makes us OTs. We do not do "arms" or "upper body" and we do not put people on the arm bike, use pegs, cones or putty and bill for therapeutic activities. Those items are tools used to target the underlining area(s) that is(are) causing the individual to be unable to perform a purposeful and functional outcome.
So why the warning letter of caution?
When documenting for reimbursement or even in explaining to patients and doctors what we are doing, OTs fail to fully share WHAT they are doing!! I am not having you stack cones for the sake of stacking cones or to bore the living hell out of you. I am having you stack cones to retrain your muscles, reduce your pain, re-educate your nerves, get your internal system to work together, increase your core strength and activity tolerance, improve your breathing capacity, increase your circulation, decrease your flight/fight response, facilitate your body's own healing abilities, all so that you can reach up behind you, while you are in the bathroom, to grab the roll of toilet paper in the cabinet behind the commode, as you notice now that you are done with going that there is no toilet paper because no one else ever changes the roll. For documentation, we should be writing therapeutic activities (therapeutic modality, physical agent modality, therapeutic exercise, etc.) facilitating neuromuscular reeducation with proprioceptive input in 3 planes with dynamic sitting and standing balance, integration of crossing midline, functional grasp and release, and trunk rotation to complete toileting with 100 % safety and independence. Stop using the bad words and start showing what OTs really know and do.