Tuesday, April 19, 2011

The Framework vs. The Real World

Today we had a guest speaker come and lead a meeting about the Framework. I thought this was interesting since as a student that's ALL we do is talk about the Framework--we eat, breathe, sleep and poop the Framework. But what I hadn't considered is that the Framework hasn't been around forever, haha. There are OTs for whom the Framework is a new document and learning all the pieces of the Framework is a new process.

Today's speaker discussed how students come into fieldwork with Framework terminology swimming in their heads and, because of this, it's important for clinicians to regurgitate these terms as often as possible so that the Framework makes sense and so that students can relate what they've learned to what their actually doing in the clinic. I thought this meeting was very interesting because I'm certainly seeing the difference between how academia sees implementing OT interventions and how it's actually done.

To be clear, there are no significant differences, however, I've found the emphasis to be different. In school, the emphasis is often on occupation-based intervention, but sometimes this is just not possible in every session. Many times clients need skill-based exercises to build their strength; they need a clinician to guide, pace and review the exercises with them. Also, if the clinic environment is not built for a true occupation based intervention due to a lack of tools or time then sometimes performing 'rote' exercises (known as preparatory exercises in the Framework) is the best way to accomplish your goals.

I've found that many OT instructors I've run across (to clarify--this is not just at my school but at other institutions as well) discourage 'exercise' per se and place extreme emphasis on occupation based intervention. For the purposes of this discussion exercises are not just lifting weights but are also activities such as working with putty, thermal modalities, ROM, using thera bands, etc. There are clinicians and educators out there who frown on using these forms in treatment, especially for extended periods of time.

Thankfully, I'm in an awesome place that has WONDERFUL facilities but in speaking with others some clinics are not as well-prepared. As a result, some tasks, such as performing a kitchen task, are just not feasible. You may not be able to see how your client cooks in real time, or if they remember to turn the stove off, or if they note that the recipe calls for leaving the cake in the oven for only 10 minutes, or WHATEVER the case may be. This where that good ol' OT creativity comes in and you have create/simulate the environment as best you can.

So, please no one take this post OUT OF CONTEXT and get all argumentative on me, because I can certainly see someone doing that; please try to see the point. I hope I've been pretty clear in expressing that OT interventions encompass a good mix of preparatory (warm-up), purposeful (activity simulation) and occupation based intervention (real time intervention). Exclusively using one over the other only disservices your clients.

Also, in regard to that last post--after cooking the food, we placed a tablecloth on the table, set the table with plastic silverware and glass bowls and plates and we ate the spaghetti and garlic bread and it was delicious!

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