Once again- frustrated with how OTs are not taught how to treat the neck! It just doesn’t make any sense to me!
I had to pass one of my patients off to a physical therapist – ONCE AGAIN- today due to her new cervical pain.
I don’t get how we are allowed to treat the “upper quarter” – but our profession does not consider the neck the “upper quarter”!!!
Does anyone else get frustrated with this? Sometimes I run into the patient who – over the phone will set up an evaluation because “my shoulder hurts”- so they are scheduled with me. Then- when they get here- it turns out the real problem is in their neck…ugh! So- of course the patient and my time is waisted because I can’t treat them since they didn’t know that they had a neck problem..
They have to be rescheduled at a time when one of the physical therapists can see them…
Comments?
Annie
Hi Annie, I just found your blog! Really intersested to hear about the hippotherapy – the other side of the coin for me as I work in EAT! I wanted to let you know about the new OT blog carnival and to ask you for a submission
you can learn more about it on my blog http://e-nableot.blogspot.com/
Thanks for your post!
I went to your website to check out the carnival idea! I will look into it more so I can submit something.
Please forgive me- but what does EAT stand for? I’m sure if I racked my brain I could remember- but it escapes at this moment.
I will post everything I can once I start working at the stables about hippotherapy in April! I am very excited to start!
I’m reading Annie’s blog with some amusement and concern. I’ve been keeping in touch with rehabilitation issues for over 35 years. PT’s vs. DC’s. and Physiatrists vs. PTs. and ATC’s vs. PTs. and Nurses vs. PTs in home care, and of course OTs vs. PTs. Well, you know, its all about turf more than skill, medicine, or rehabilitation. Of all the State and Federal laws I have watched in combat with my state and national associations, it never really comes down to Health alone. There’s good and bad everything; not to sound like Donald Rumsfeld, but there are good good professionals and bad bad professionals, there are good professional professionals and bad non-professional professionals.
So how about this OT-PT issue Annie raises in relation to the cervical spine?. For perspective, can we even define adjustment, manipulation, and mobilization based on osteopathic, chiropractic, and PT/OT definition of terms? Heck, the physical therapy profession can’t even decide if there are 3 or 4 mobilization grades (and manipulation or grade 5). What is a certified manual therapist (CMT) orthopedic manual therapist (OMT) certified orthopedic manual therapist (COMT), fellow of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT), Rocabado Certified Manual Therapist (RCMT), Mechanical Diagnosis and Therapy® (MDT Cert), and many more?
So please feel free to go to my blog: http://www.suburbantherapy.com/blogs/peter for a more in depth commentary from me about this. I just want to thank Annie for bringing this up.
We can also see all professions have “doctors”: PhD’s, DEd’s, DSc’s, MD’s, DPT’s, OTD’s (doctor of occupational therapy), DO’s DC’s, DPM’s, OD’s; and not one of those degreed professions can argue infallibility in degree bestowing. (Don’t get me started on Harvard MBA’s.)
I can see how CHT may be perceived to pertain only to the wrist and hand; but does it include the elbow? the shoulder? Well, excerpting from the Hand Therapy Certification Commission (HTCC) web site: http://www.htcc.org/about/index.cfm :
OT’s are allowed by law in New Jersey, and many other states: http://www1.aota.org/state_law/lawprofile.asp?QStatus=Y&ST=Y , to treat the upper extremity regardless; even without the CHT guidelines. One can not fulfill the law unless it is so, as stated in the NJ practice act: “purposeful, task-oriented activities for the client to improve, restore and/or maintain optimal performance of life skills roles and functions including work, recreation, leisure skills and activities of daily living; ”
So I am given to wonder why the OT profession has not sought to also include the cervical spine in its syllabus; in so far as it pertains to UE function as part of the upper quarter. Certainly to screen the shoulder as part of the upper quarter, screening the cervical spine is de rigueur. With weakness (radiculopathy), one’s “functions including work, recreation, leisure skills and activities of daily living”, would require knowing something about that. If I may be so brash as to suggest, many professionals licensed to treat the cervical spine have regularly missed a lot of symptoms before their patient gets to Suburban.
I am confident a random check of many providers would not pass nerve root testing of the upper extremity, even though it must have been covered in their formal education. Therefore it is about what a profession is trained to do, and what measure(s) can be taken to ensure competence. Many CHT’s I know, and Annie at Suburban, would not have to defend their upper quarter screening abilities. This of course gets a little sticky because we all know the neck bone’s connected to the back bone.
Thank you Peter, for your excellent remarks. You bring up many great points about so many different professions. I am doubtful, in this lifetime, I will see any changes added into the scope of practice in OT. Not to mention the fact that most of my graduate professors did not think I should go into orthopedics at all. Many of them asked why I didn’t go to PT school, since my interest was in orthopedics.
This alone I believe speaks for itself with the lack of support by my own colleagues. Many people in the OT world supposedly go into this field to work with the neurological populations both young and old. Not that I have any discouragement with this, as I will be starting as a hippotherapist with children in one month as part time work. I just do not understand the division with neck and shoulder.
I am enlightened when I hear from other orthopedic OTs or anyone who supports the fact OTs should be able to orthopedically treat the neck!
Thank you greatly for your response!
Annie,
Interesting point. Orthopedics appeals me too. I feel the same way about lot of things we are not trained for or somehow do not fall within our purview. Like, we can do feeding and swallowing but know nothing about TMJ dysfunction. Sometimes it is hard to understand and even explain to patients the arbitrary demarcations we have. As in rehab that I work, I will do bathroom transfers but not car transfers, or PT will do floor to mat transfers? A while back when I did OP, we eevn referred shoulder cases to PT and OT only did below elbow/??? Or, that is how certain insurances reimbursed it.
This is my first time blogging….
Thank you for your post Rashmi..
Those points you bring up about TMJ – are so important! You are absolutely right- it is ridiculous we are not trained in TMJ dysfunction- especially when you are working on feeding!
It baffles my mind when you say the one place you worked- only had OTs treat below the elbow?!?! Why should that be legal? Not only does it not make sense- but it also strips people of their “once known” skills of shoulders. I feel sorry for PTs who are stuck in that kind of job where they don’t treat elbows- because if they end up leaving that place- it really puts them at a disadvantage for when they go out to find more work. They will have lost so much skill in one area!
Thank you for your agreement- it’s really great to know I am not the only OT who realizes all of this…
Annie