DON’T HATE ROLLERSKATE
“He is an occupational therapist right? Why is he doing my job as a physical therapist?”
After screening and evaluation, a patient with pronounced left sided spasticity entered the rehab eagerly for the first time. A part of his goals is to improve the functions of his left extremity to be able to perform functional bilateral and isolated activities independently. The therapist handling the patient after the usual introduction and rapport building started working on the patient. He explained to the patient that he is going to stretch the shoulder because tightness is one cause of his limitations among others. The therapist having excelled in anatomy and kinesiology back in the day was well aware that the normal ROM of the shoulder in flexion ranges from 170-180 degrees. He took the patient’s arm, making sure the torso is stable to avoid compensatory trunk movements then slowly worked his way up, halfway through the range though, the patient claimed of discomfort on the shoulder but the therapist told him, “it’s just because of the tightness, it will be better soon as we go along”, and continued yanking the arm up. The patient did not follow-up on his appointment and experienced persistent shoulder pain and possibly had an injury or subluxation.
I’ve seen this a hefty amount of times in my practice as a therapist, and yes, it was done by either an OT or a PT in the rehab setting. I cringe every time but stealing ‘shine’ is not my cup of tea so I keep my mouth shut but make sure practitioners and caregivers working under my supervision are aware to avoid such a thing from happening on our watch. The question that’s creating friction between the two professions is the idea that exercises in general are only within the bounds of physical therapy practice, and if it’s not purposeful or functional, occupational therapists should not involve themselves in doing so. Exercise and training has been around since ancient Greece, way before the professions PT and OT became significant. The application of science in exercise sealed the deal for both making exercise techniques ideal not just for healthy but also ill individuals.
The skills in question based on my experience are the use of ‘adjunctive methods’ defined and provided by Pedretti in her book Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction. It is a level of intervention that ‘are used to prepare the client for occupational performance and include but are not limited to exercise, facilitation and inhibition techniques, positioning, splinting, sensory stimulation, and application of certain physical agent modalities.’ This is followed by other levels of interventions such as: enabling activities, purposeful activities and occupation-based activity. Adjunctive methods are clearly within the bounds of occupational therapy practice supplemented by our background in anatomy, physiology and kinesiology.
Under no means are exercises exclusive to one profession or the other. The sample case above proves how little both professions know about the principles and applications of it in which a patient will benefit from. Here are some ways of good clinical judgement, one can add more. A responsible therapist would look at the big picture and would consider the effect of spasticity not just on the arm but also on the trunk including the scapula that will definitely affect shoulder movements. The therapist will prioritize mobility and control of the axis with a combination of different treatment approaches before even jumping to work on the patient’s shoulder or the rest of the arm cautiously. He or she might consider some compensatory strategies first to promote independence and improve the morale of the patient while slowly working on his limitations progressively. Options are unlimited. Honestly, I’ve met sports trainers and coaches who are unconsciously practising it more effectively than we do, they just lack the units and the degree that we have. The question should not be on how we differentiate PTs from OTs, believe it or not, we have more similarities not just in the clinical sense but most especially, we share the same values of doing our best in the interest of our patients. Truth be told, those people who are loud enough to criticize are nothing but insecure, they also lack competence, knowledge and skills to deliver patients to their end goals. As therapists, we should spend our energy and time learning and honing our skills to be more effective in our vocation than wasting it to hate on others. Stop the culture of division and deal with fixing the real issue that is the speech therapists(JOKE!!!! they are as vital as we all are, maybe even more), the real issue is of inflated ego and how it fuels insecurity, envy and hate. I remember a line in a song and it says ‘Have no envy and no fear’, I think we need a lot of this nowadays and live by it, for it speaks to us as therapists, and it also speaks to us as humans. Let’s make being a therapist fun and exciting again, don’t hate, roller skate.
Ariel Sillano, founder Kilos Davao