April showers bring May flowers aaannndddd . . .OT month! I always wanted part of The PT Page to reflect on what we could do better overall as a profession. April is our often under-appreciated counterpart’s month. I figured now was a perfect time as any to consider what OTs may be doing better than PTs and what we can learn from them.
You might be thinking, “But OT is its own separate discipline. We’re supposed to be different. What can we learn from them that we don’t already know?” Trust me, there’s a lot. I learned this in my first year as a PT. Let me tell you a story . . .
An OT Story
I started my career as a long term care therapist. Our rehab department overall was large, but within we had a little LTC crew of two PTs, an OT, a COTA, and an SLP. Our team was small but mighty. Every single person on that team was an extremely dedicated, smart, and talented clinician and we worked well together.
I look back on that first year of my career and appreciate the members of that LTC team so much because they made it a great learning environment and helped me grow as a new clinician. All the members of that team were adept at their job and genuinely cared about their work. This motivated me every day to do the same. Each of those therapists taught me things I still use to this day, even though I no longer work in LTC, especially the OTs.
We were an LTC, but occasionally would get patients under skilled services. If the patients were good it was awesome. If they weren’t it could really put a damper on your week until they discharged or were taken off skilled services.
One time we had a particularly difficult patient. He wanted to go home and had a qualifying diagnosis for skilled services so we were working with him everyday. The patient however had little to no insights to his deficits. He frequently questioned our treatment activities and insisted he “just needed to work on his walking.” He was also known to take jabs or make snide remarks to staff.
This patient was exasperating for everyone, but he was by far THE WORST to OT. He would often refuse dressing and grooming ADLs because he “could already do that just fine”. Spoiler alert, he couldn’t.
One day after another LONG morning ADL session, our COTA transported him to the gym for his next activity. I watched as the patient transferred to the edge of the mat and the COTA began attaching clothespins and other clips to one sleeve of his shirt. She then instructed him to move the clothespins from where they were and clip them to other parts of his clothes – his pant leg, shoe lace, the other sleeve.
Did he complain once during this activity? Nope. Because that COTA had gotten him to work on dressing without him even realizing it. After seeing this happen two thoughts came to mind. One, that COTA is a genius and talented therapist. Two, would I be able to get the patient to work on a functional task in a different way like the COTA was able to do?
An OT Lesson
So what can we learn from OTs based on that story? In my opinion, OTs are better than PTs at making treatments functional. Oftentimes as PTs we get focused on a specific muscle or joint and give exercises for strength and/or ROM. But how often are we considering the functional context? And then tailoring our treatments to this?
In my story, that patient did have poor dexterity and coordination in his hands that made zippers and buttons difficult for him. That COTA could have easily taken him through some simple exercises or made him pick up marbles or something like that. Instead she put him into a situation that best simulated the functional activity. He was sitting unsupported, had to reach with arms in a similar fashion to dressing, AND still had to use the fine motor control of his hands.
That lesson I learned from the COTA early in my career shapes my practice everyday. For example, I like a SLR with an added hip ABD/ADD component because how often are we laying down and just need to raise our leg straight up in the air? But we do often need to raise that leg and bring it in or out to the side. LAQs are fine, but really what functional activity does it relate to? I’ll progress to some form of a squat as quickly as possible before sticking with LAQ.
Anyone else have examples like this that make a basic therex or activities a little more functional? Or have ideas? Let’s share in the comments section and start being a little more like our OT friends. Thinking and prescribing more for patient-specific function is a valuable lesson to be learned from OTs no matter what setting you work in.
Here’s another example of how learning from that COTA helped me as a clinician. I once had a patient with impaired balance and motion sensitivity after his stroke. One of his biggest rehab goals was to be able to get back on his boat and fish. I could’ve just had him stand on the Airex, try some single leg stance, tandem walking, maybe throw some head turns in there for the motion sensitivity.
Remembering what that COTA did with her patient made me choose differently. Instead I had him stand on the BOSU, figuring it was the closest thing to standing on a boat I could provide. With time we progressed from static standing to dynamic movements. Eventually I had him standing on the BOSU while holding a fishing rod with a small ball attached and “casting” toward a target. He loved it. It was his favorite activity in therapy. It improved his confidence and helped him return to an activity he loves. That patient still sends me photos of him fishing.
The COTA taught me a big lesson that day in LTC. Ever since, I’ve tried to never forget the functional context my patients need to be able to move in and I credit this approach with some of my best outcomes and happiest patients.
An Ode to OT
Happy OT month to all the OTs out there! Thank you for being our better, more patient half. Thanks for co-treating with us. Thanks for teaching my CI who then taught me how to put on a pull-up brief without having to take off the patient’s pants or shoes (that one has saved years of my life). Thanks for never getting mad when you walk into a patient room and they say “but I already had PT today!”. Thanks for dealing with a lot of the shitty stuff (literally). And thanks for teaching us PTs valuable lessons everyday.
PTs send this to your favorite OT to show them some love this April. Share a lesson in the comments section about what an OT has taught you or what you love about them.
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