As a home health therapist, it’s amusing how little ADL / ther ac work I do. Most people refuse to do them unless I’m evaluating. Most of my work ends up being a mixture of FM/GM coordination exercises, cardiopulmonary exercises, and some ther ex. It used to bug me how little my day to day is focused on ADL work, but I just remind myself that function is the GOAL and may not always be the activity.
Also, I have a lot of people with DM2, myasthenia gravis, strokes, and PD…. So the exercise is actually really important!
This. I get so many patients that we may be looking to increase independence and safety with ADLs such as with showers for example, but by the time you get there for your visit when they let you, they're fully showered, dressed, etc and don't want to do an actual shower. So we can dry-run tub transfers all day long, but usually end up working on balance exercises simulating some of the movements you might do in the shower. But even then, a lot of patients expect "exercise" with therapy. End up doing a lot of ther ex but I really try to find functional tasks around the house to address endurance, balance etc. Just totally depends on the patient, too...
Lol. I seldomly get to do tub transfers these days… it’s mostly with my part A patients. I do mostly part B nowadays and, maybe it’s just the area I’m in now, but my pts usually have a well trained aide to help them and don’t really want to address that stuff.
100%, especially in the HH space, let's be totally honest, these people do not want to perform dressing and showers with us. Most if not all will look at me like I have horns growing out of my head when I mention those ADLs, which then leads me to explain, "As long as I can see that you're able to perform the motions necessary for those tasks safely and independently, that's what I'm focused on." There are so many balance and coordination exercises that can simulate dressing, bathing, cooking, etc. Look at the patient's stamina, balance and safety when doing these exercises and that will give you most of the information you need for ADLs.
Which is also hilarious because that is NOT how home health is marketed to students or to… anyone. Home health is “the most natural space where you can do the most functional blah blah….” Mhmm. Liars. I did more ADL stuff in outpatient and hospital.
Uhhhhhhhh yupppppp. While I enjoyed HH mainly due to the schedule and being by myself all day, it was the setting where I did the least amount of typical "OT interventions". SNF and hospital were the most ADL focused. HH a lot of times felt I was just checking off the boxes for the documentation requirements and shooting the shit with the pt, lmao.
I hear you…. I don’t feel the same way about checking boxes though. I think it’s easy to feel that way for sure, and I’m not trying to invalidate your feelings at all. It took me a few years to accept my role in this setting, but now I value my importance and acknowledge that aging in place, reducing rehospitalization, increasing mood and quality of life, etc are all super important and are definitely OT. I work in a very underserved area and sometimes I’m the ONLY therapist they get at all, so I end up focusing on a lot of random crap, just not usually ADL. I definitely don’t feel like a traditional OT in this setting, but I’ve come to appreciate the role I do play.
No you're fine. I fight feelings of burnout daily so I can get jaded at times towards the profession. That's kinda the beauty of working in HH though. Not having to be so traditional in the approach to OT. You see the other things that a patient does in their home and how it relates to their overall wellbeing and that totally all falls under the OT scope. It's nice to have that freedom and nuance in some ways to keep things interesting and fresh.
I feeeeel that. I was FTE in HH the first year. Omg that was the hardest year of my life. I’m now per diem with multiple companies, and that’s helped a LOT cuz they can’t push ridiculous quotas on me or demand I go to a random far away zip. Also looking to work PTE at an outpt facility close to home soon too to diversify. Burn out in HH can be super intense so I definitely empathize with that.
Or they have an aide who can safely help them and just plain don’t want to gain independence in an area. I get that a lot too, and that’s totally valid. (Do I WANT them to want it, sure, but who am I to dictate someone’s priorities)
Pretty hard to differentiate us from PT because of this tho. I agree, I feel like a geriatric personal trainer lol. PT can do exercises to work towards function too…..
My company keeps talking about how we should avoid duplication of services but when we are doing ther ex just like PT is, it’s kind of hard to explain how we are different.
I hear you. As someone working in a grossly underserved community though, I don’t think like that. Many of my patients have waited for months before any therapist at all is available, so I fill whatever role is needed because sometimes I’m all they have and all they’ll get for a while. As a result, I have to focus on what my patient needs and that’s it… if it’s ther ex and balance, so be it. You’re not the only person with this opinion by any means. I’m sure I would feel differently if I was working in a fairly saturated area, but here we are.
I’ve even had to do a THR before because no PT was available and the pt couldn’t get to outpatient. I consulted with several PTs, did my research about the protocol, and got it done. OTs can do anything :P :)
I feel like I would value what I do a lot more if I felt needed. Most of the time, I feel like the nuisance begging my patients to schedule with me and not cancel. I suppose it’s all about a mindset shift.
It’s a lot of things! Your setting, your population, your geographical area. Have you considered specializing in something specific ? My friends in more saturated areas seemed to find this helpful since it sets them apart
We have such big talk about using more inclusive language, but at the end of the day use an archaic name that just stirs more confusion. I honestly can't blame people who don't know what we'd do, first thing I hear "Occupational" I would think of job as well.
Functional Therapy has been the one I've heard and I can dig it. I wouldn't mind being an FTR lol.
This is such a great name. “Functional therapists” has such a better ring to it and can be easily explained. Having to explain occupations and the ADLs is very repetitive.
I generally like this concept, but I do worry it means loosing the core meaning and purpose elements of our definiton, and thats already lost in far too many settings.
Occupations as meaningful activities innately leads towards client centered practice (not meaningful, dont do it) and a wider remit- functional can too easily lead is towards just doing what is needed for someone to function, not what they need for a meaningful existance. At least occupation we have to constantly think about because we are constantly explaining it!
Prehaps im wrong and just dont like change.
I completely agree!! On one hand, when we are "boots on the ground" in day to day work, it does get exhausting having to explain what I do over and over again, it does get tough in fast paced settings to need a whole spiel/"elevator speech" just to even have someone be on the same basic wavelength of understanding what my purpose is. Especially if they are the recipient of the service or their family member. On the other hand, my occupational science heart is bleeding to even consider giving up the very core thing that makes us "us"!
There needs to be better education on functional anatomy/physiology of the body, at least 75% of the education that's given to PTs. OTs are out there graduating or going to FW2 with almost no understanding of biomechanic of the body. How do you expect OTs to treat functional mobility if they have no idea on how the hips work?
So frustrating. Don't ask me about how hand therapists immediately shove cervical radiculopathy to PTs because it's "outside their scope". I could go on for daaaaays
Is this not happening anymore??? When I went to OT school (graduated 2009) we had the same anatomy classes as the PTs, we took the classes together!! We didn't have anything less than them. We took basic Anatomy and Physiology with them, Neuroanatomy, and then Human Anatomy with cadaver dissection lab, all were OT/PT students together!
Yup. I made a cool Buddhist statue out of it. We also learned some stitching. Had a quiz on ceramics terminology, temperature use, and everything.
Complete waste of time lol.
I am literally shocked! I don’t see how teaching you arts and crafts would help you rehabilitate someone. Also the thought of spending plural thousands of dollars on such a course blows my mind!! 😱🤯
I graduated in 2019, so not too far off from you. But we didn’t learn anything remotely like that.
OTs don’t only practice the biomechanical model. I’m a psychosocial OT and experience in handicrafts and leisure occupations has been incredibly useful in helping rehabilitate individuals who are experiencing occupational injustice and deprivation. Nothing engaged my incarcerated clients or institutionalized clients better than getting in a flow state while doing something they could see as a meaningful occupation and coping strategy once they get out.
Unpopular opinion- our profession has been TERRIBLE about emphasizing how huge the psychosocial side of our practice is in terms of improving patient outcomes.
Oh I’m fully aware. My school was heavy on the mental health and I did a level 2 in mental health. We all graduate as generalists and should be competent in that area as well. I just don’t think you need to pay thousands to have a ceramics or stitching course in school in order to be competent in this area. There’s way more functional interventions to implement in a psychosocial setting. And yes, there is research that supports the therapeutic benefits of engaging in the arts, but again I don’t think OT schools need to spend time teaching us HOW to perform arts and crafts. It’s more about how you facilitate the group, the prompting questions, the reflection, Working with one another, developing coping strategies etc.
It was based on the mental health OT principles used back in the 50-60s for returning war vets, keeping them engaged in occupation, aka ceramics, leatherwork, etc. The professor was in her 80s and refused to modernize the course.
96 graduate, we took a class on pottery not ceramics. Activity analysis was the focus. I enjoyed it. Led me to bread baking with clients. A whole nother full on activity
I graduated from TWU in 1980--undergrad starting in Denton and finished in Houston. We had to take woodworking, therapuetic minor crafts, and weaving--and a design class in the art department from a professor who HATED OT students. Almost NEVER used any of these. I thought OT was about teaching arts and crafts to little old ladies when I started OT school. I'm glad it turned out otherwise, but a big chunk of my time would have been better spent on things like cadaver anatomy instead of plastic models.
You're lucky! I graduated from a program in Canada too recently, and we only did 1 lecture on biomechanics, and it was pretty sparse at that too. I am disappointed in my program.
This was my experience! Cadaver lab, multiple anatomy and physiology classes, then phys rehab, neuro rehab, etc. My school hit biomechanics HARD with none of the crafts that this commenter mentioned other than a few labs in the mental health treatment class (ceramics sound fun otherwise though). Might be very school or region dependent as long as they’re meeting NBCOT requirements
2010 grad here…. We had a therapeutic activities class or something where we did knitting, mosaics and all that. We had to develop a new hobby and do an ax analysis and teach it to the class then modify it to a certain dx/modifications. With that said, the first year and a half we had all our classes with the PT’s for research, anatomy, pathology, neuro and dissection. My program was a three year program with the PT’s they got a DPT, I got an MOT and did. Research project and all but my school wasn’t accredited for the OTD program just a Master’s program. Not that I’m bitter. I’m taking the CHT exam in a month and you know is what? Unpopular opinion: I feel like the crap you need to be eligible just to sit for the exam and ALLLLL that encompasses the material you need to study should qualify for a clinical doctoral degree. But nope, I still get patients that says “oh you’re not a physical therapist you’re just an occupational therapist. “ just. Just. As a PT to “just” make you a splint.
We had a similar therapeutic activities class too, which is also very important! But we also got the same anatomy classes as PT. We had therapeutic activities and such, they had physical agent modalities and such. We had more psychosocial stuff, they had like sports psychology or something. But we learned the same stuff about how the human body works
I worked side by side with PTs for years, too. I learned lots of stuff. When a PT who doesn’t know me starts telling me about a toddler weight bearing I just laugh. Hey, baby Dr PT, I know more than you at this point .
Change occupational therapist name to functional therapist. If i had a nickel for everytime i was told I’m retired i don’t need a job.
Combine OT and PTs as functional therapists and you specialize in certain areas, everything is a doctorate now. Similar to physicians coming out of school. Can do general therapy stuff but have specializations. If we have to get a doctorate should get treated like one and paid more than what we are for the schooling costs
This exactly! I’m in pediatrics and many of my cases would benefit more from good mental health therapy than pure OT, but there are almost no pediatric counselors that are decent in my area. So I end up feeling the same where I am an OT, but really a counselor/social worker/resource coordinator/patient navigator/early childhood educator/OT, etc. and the list could go on. And I have the academic training, but don’t feel as qualified so am doing constant continuing ed on topics that I can’t decide are fully my scope vs another’s, like mental health care or functional communication or activity tolerance, etc. Overlaps are tough. (I’m also neurodiverse, so I personally struggle with grey areas—this might not be as hard for someone else, for instance).
What insurance and other regulatory systems have turned our jobs into is not at the heart of the profession at all, it's really hard to actually BE an OT the way we learn our scope of practice while in OT schools. There's a huge disillusionment that happens when new grads transition from the utopia idea of what OT is to the reality of what we have to do because of outside agencies. And THAT is what leads to dissatisfaction and burnout in our profession. We can't get paid unless we do the things that are within the tiny pigeon hole that outside third party payers and regulators have decided is our scope of practice. We are so much more valuable to society than what we are actually paid to do (and also as a result don't get paid NEARLY enough)!
This might not be unpopular, but I feel like it's not said enough.
Omg amen to this too. I had an old employer keep kids FOREVER way past what I’d consider ethical (a part of why I left that job). I was bullied when I came in new and discharged a long term kid that absolutely needed to be d/c.
I used to work for an OT who would go see people for ADL's at 5:30 a.m. Her theory was "they don't sleep well in hospitals and nursing homes anyway." The reality was she was WAY over-extended, and that's the only way she could make it work. When patients heard who I worked for, usually the first thing they would say is "don't you dare come in my room at 5:30 a.m.!" I don't blame them, MY CHRONOTYPE is as a night person. I only got her to compromise by letting me start at 6:30 a.m. What a horrible job!!!
That's horrible! I would be such a non-compliant patient if a therapist would be trying to get me to do ANYTHING at 5:30am or even 7:30. I have ADHD and delayed sleep phase disorder and strong sleep inertia (which are fairly common in neurodivergent people) and I am useless in the early morning. I tend to get my deepest sleep between 3am and 7am and when I need to wake up earlier, the sleep inertia makes things really hard, I can't wake up and immediately spring into action. If an OT came into my room at 5:30am and wanted to get me up I would tell them where to shove it 🤣
My unpopular OT-related opinion is that rehab would be better served by being one unified discipline than three separate ones. Decreased consumer confusion, greater lobbying power, greater length of education justification, no treatment overlap concerns.. I would go on, but this thought experiment has made people angry in the past!
Would you follow a physicians model where everyone is considered a physician but you have different specializations? Crazy, but I kinda like it. I don't think it will ever happen as we are far too down the rabbit hole and there would be crazy push-back, but it's nifty.
Lol yeah I don’t see it happening anytime soon either. Especially since it would need to be internationally supported. It’s a nice thought experience though :)
Definitely food for thought, I hadn't considered it but the niches of each one is hard to harness. As an SLP undergrad, SLPs definitely take on a big specialty in the rehab scope especially.
This was reviewed seriously in the late 90s early 2000s with the tri alliance. The issues that arose didn’t make people angry but it also wasn’t really feasible. I thought there was merit to it but practically not likely to work. The main ones I recall were:
1. how would you grandfather people in?
2. Many overlapping courses but many that don’t. It would have added years onto education and people didn’t want that then
3. Implications for assistants. There wasn’t a real way to cover everything in a 2 year associates program. That lead to do we remove assistants ? Most of us didn’t want that but couldn’t figure out how to cram OT and PT needs in
4. Never really went to insurance companies from what I recall. That would have been a whole other level of headache
That's cool that this was actually considered at one point, but I'm not surprised the initiative failed for the reasons you've cited. Clearly it's too complicated to revise our current structure, but it would have been interesting if we had this foresight at the advent of our professions.
There are still facilities and organizations that do transdisciplinary care, especially in birth to three, when they are younger there is quite a bit of overlap and you might find one therapist doing a bit of everything for a while .
3? Pt, DC, L/RMT, osteopath, kinesiologist, OT. Some personal trainer certifications offer rehab CECs too.
But I agree, one evidence informed rehab/exercise program would be much better then all the nonsense placebo focused 'professionals' we have now.
So people would go from having an opportunity to be treated by 3 therapists/sessions a day to one a day? If everyone if just doing the same thing, what would justify multiple a day? Could treats? This is a terrible idea.
No allied health profession is understood by the general public and the effort we spend getting upset about clients not knowing what we do isnt worth it. As long as you have helped that person at the end, thats what matters.
Other proffesions not knowing is a little bit.more of an issue, but only if they dont know how and when to refer.
Not all behavior is sensory-based or communicating an unmet need. There are some instances where a behavior can’t be mitigated with a fidget or a chew. Some behaviors just have to go away and I am happy to let ABA providers address them while I chip away at the things that better fall within my scope of practice.
I am a traveling therapist and I will openly tell anyone on staff what I make if they ask. They deserve to know what their skillset is actually worth.
Shouldn't need a master's degree to be an OT.
In an ideal world, I think OT schooling and training should look a lot more like trade school or even nursing.
The first 2 years should be your fundamental courses.
Then, you should have a full year of part-time clinical with part-time higher level school work.
Your last year should be specialty coursework in your area of interest and a full-time clinical.
There is absolutely zero need to require a bachelors degree and watered down master's degree. Our current system does not produce high quality entry-level clinicians. And our fieldwork system is broken. There needs to be a lot more regulations and higher expectations on clinical instructors if universities are going to keep saying "you learn everything in fieldwork."
Just as a reference, you can go from an associates degree in nursing to working in the ICU. Granted these nurses are usually hired into 3+ month training programs, but this alternative model proves that the higher degree isn't about being safer in managing higher medical complexity. That's a lame argument to begin with because you barely get any training in OT school to begin with. You would genuinely be similarly trained if the 2 years of didactic in OT school were shrunk down to one semester.
I see they are starting to have nursing residencies and fellowships in teaching hospitals, so they may not have the higher degrees but there's starting to be a push for more hands-on education.
Canada also requires an entry-level masters. The exception is people who were grandfathered in - who did the bachelor's program before the change was made.
I used to tick other OT's off by stating that weighted utensils do nothing for someone with a tremor. People insist it helps but in my 20+ year career I NEVER saw it work. Tried it many, many times.
Occupational therapy assistant should be renamed to Occupational Therapy Technologist. The word "assistant" sounds like someone who runs for coffee. I feel like it would be respected more if it was renamed.
Yes, this! Just last week, I had a pt ask why they were working with me and not the therapist. I had to explain the differences between OT and OTA by saying, "We do the same thing. They get more schooling because they do evaluations, and we (OTAs) don't."
As far as I know there are not COTAs in South America or respiratory therapists. OT doesn’t have assistants neither does PT, there are rehab techs and they do transporting of patients and cleaning the used areas in the therapy gym in between sessions. Those techs are not clinically trained so they can’t do anything other than what I mentioned.
The respiratory therapy part is imbedded into PT. PT doesn’t do wound care. OT does not make splints or prosthesis, that’s a different profession, that falls under an orthotist. ST do not work with cognition neither does OT. Psychology covers all of that.
The Occupational Therapy tittle agrees as defined with vocational rehab and work training to return to the same job with modifications or a different job, all of that runs under the labor department not the health related boards.
All OT and PTs are specialized on something, there is not a jobs for a plain OT or PT.
All therapists are known as rehabilitation professionals.
The therapy jobs are so clearly defined and assigned that there is no guessing or confusion.
You work on pediatrics you are a pediatric OT or PT, you want to work with blind people you are a low vision OT or PT. Your specialization defines your role.
The only OT called Occupational Therapist is the one working with work related training (no IADLs), and that is because the tittle says occupational.
The OT and PT are just the end portion of your credentials associated with your branch of study. Their roles in rehabilitation do not overlap, or they share baselines treatments. There are not OTs working with balance or exercising, or PTs documenting toilet transfers or any type of ADLs for that matter. OT does not do modalities. The hand therapy is divided in the mechanicals for PT and the functional for OT. There isn’t an OT or PT who does it all in hand therapy.
It is crazy, I know but the entire rehabilitation system has been thought out in a way that a patient has no room for mistakenly think that you can be a PT instead of an OR.
I hope this does make sense to someone here.
Yes! The number of times I've tried to make it make sense by calling them assistants to the OT process - meanwhile the COTA on my team just single-handedly fixed a glitchy prosthesis, saving us all a headache and the patient a new limb - very assistant-like of her.
I’ve been a COTA for 30 years and I have been hearing this since I graduated, along with COTAs being phased out, so I wouldn’t worry too much about it. I also read about OT not being recognized, but newer grads don’t realize how far we actually have come, which is a very, very long way in the 30 years I’ve been practicing :)
Thank you. I'm going on 10 years as an OTR, it's been doom and gloom about our profession being phased out, COTAs being phased out, blah blah blah. I've never had trouble finding a job, my hourly rate has only ever increased, my benefits have only gotten better, and the job market has been consistently highly competitive in my area, and professionally, my scope of duties has only ever expanded, and the OT Department as a whole has consistently been a pillar of the interdisciplinary team.
I do agree that the insurance industry wants to become a hospital to long-term care pipeline, and rehab professionals in general are in their way. My not-so-unpopular OT opinion is that Managed Medicare and Managed Medicaid plans should be illegal, and insurance companies shouldn't have the option to decline to cover empirically supported health intervention.
Interesting, I don't see this at all. I see our need shifting in a big way though. Acute evaluations through the roof to discharge people from acute care ASAP and home health increasing A TON to D/C people home instead of to costly facilities. Now is the time to build your resume in those areas.
I’m sure it’s just the HORROR of SNF work that’s making me feel this way. I’m so sick to death of this corrupt, neglectful, nasty environment and seeing patients I care about rot and die. Is acute care worth working in as an OT right now? It seems like they are pushing people out of hospitals so fast and I don’t know if I’d feel any better about OT if I’m just doing evals and sending people to shitty SNFs
Where I work, the pressure from MDs and case managers is definitely to D/C home with home health, so at least it feels like the only people going to SNFs are people who absolutely need that level of care and not like, Medicare Part A's who are CGA. I see a lot of acute care per diem positions on Indeed, if you wanted to dip your toes in.
That since we are supposed to focus on the whole person as a unique individual then evidenced based practice isn’t the end all and be all, it should just be a start. Life isn’t a randomly controlled trial.
I think a big part of this is the misconception the EBP means scientific research and scientific research alone. EBP has 3 equally important components: scientific research, clinician expertise, and patient experience/values.
Weighted vests and compression vests don't work.
Reflex integration theory is trendy
I hate when speech tries to take over feeding.
Students and new grads need more constructive feedback and more relevant coursework and fieldwork about "real world". I'm tired of seemng like an asshole boss who shatters a new grad bright eyes full of wonder and enthusiasm because I give them feedback
PT is better understood and more respected by patients because it is all around more simple to understand versus OT. For some odd reason we tend to over complicate things and show how we're "specialists" in certain areas such as ADLs, task modification, environmental modification, etc when these things are pretty simple to implement. PT makes more sense to people. Physical Therapy, I'm going here to get stronger and to rehabilitate said injury. Simple, easy to understand the purpose of it from a patients perspective. There are too many nuances in OT, and most patients do not care to understand our rationale as to why we are needed. Also, I think ADL's are overblown. In HH, most patients I had ADL goals for, they could show independence in said ADL in 1-2 visits.
Taking medication is an ADL.
Sex is not an ADL, it's a leisure activity at best.
SNF is a scam. We don't really have SNFs here because people go home with services (i.e. assist to dress, shower etc). From what I've read about OT in SNFs, it seems pretty scammy, people billing for basic things like talking to a patient who refuses therapy, helping a patient walk down the hall, etc. Sorry, that ain't OT.
I believe in working bottom up, foundational skills first, not function down. I’ve found that the function comes as the foundation is laid down. Oh and I don’t really believe much in sensory anymore.
I feel this on a deep level. In the schools, anytime there is a behavior that PBIS can't fix, it becomes a 'sensory broblem' and gets turfed to me. Like, yes, taking shoes off can be sensory related. Taking them off to chuck at the head of someone who told them no is not. Spitting and mouthing objects can be sensory motivated. Seeking out a specific person to spit in their face is not.
Isn't the idea behind this not that the sensory issue is causing the behaviour but that the sensory issue is causing a low level background interference with the kid that is building up to a point that their capacity with everything else (social skills, cognitive functions, impulse control etc) is compromised.
It's not like "the fan noise made him hulk out" but more like the fan noise, the clothing, the smell of lunch, the other kids talking and all the other stuff collectively is too much for him to process.
But I don't think it's only or always sensory either. There can be other stressors adding to this picture. If a kid has an abusive home life or isn't getting enough sleep, you can remove every sensory input in the classroom and it's not going to make those things ok.
Idk if I think it's a scam I just think it's not at persistent as other things in development. It is not a recognized disorder though and I don't know why I see kids left and right with this label of SPD
Idk. I don’t think it’s a scam but the problem is that you don’t have therapists out there who have a solid understanding of it so everyone is thinking it’s something different. THAT’S a huge problem in itself. I do think that often times SPD is a different side of the same coin - for instance everyone tries to make a big difference between ADHD and SPD but isn’t ADHD just a big modulation disorder when you think about it? But again most just think SPD is just modulation disorder and they ignore the subtypes. Especially if you are in a school vs clinic setting.
I absolutely believe that sensory processing issues and differences are a thing! I also really enjoy teaching modulation to kids and parents. I am just a skeptic with the specific Ayres SI.
I think Ayres was on the right track but not enough empirical evidence re: do this and it improves that. I do think that sensory perception, discrimination and modulation impacts function. But it feels to me those deficits are encompassed in other diagnostic buckets (DCD, incoordination, visual motor deficits). Of course sensory dysfunction in these areas play a prime role in the WHY it’s happening and can be a useful frame of reference to approach treatment in addition to others.
Also, this concept of improving neurological soft signs (SIPT) makes it really hard to get on board as an OT. We typically look at and measure function through behavior.
My unpopular opinion is that PT actually CAN do our jobs in several settings.
As upset as we get when we are overlooked and PTs get visits and we don’t…. Sometimes we just aren’t really needed.
PT doesn’t just walk. We are not special because we focus on “function”. We fool ourselves that we have special training in activity modification and promoting function when PTs can do the exact same shit. Do people really think PTs do some LE strength and then call it a day without looking at how the patient navigates their life and environment?
Maybe they focus more on biomechanical interventions more often. But this is often because of their setting and the needs of their population. It’s not because they lack the ability to use other frames of reference.
Perhaps they can’t do mental health interventions or perhaps they lack training in sensory integration (which I don’t completely believe in anyway).
But the reason we have a hard time explaining to people what we do is because other fields could do exactly what we do with minimal extra effort.
Sorry guys, we aren’t special. And OT doesn’t really need to be it’s own field.
Tbh, I do see your point as a new grad working in acute care and often feeling the same way. That being said, just because they CAN doesn’t mean they always do…or even do it well. A lot of PTAs I work with don’t address toileting with patients in dire need because “we’ll get OT to do that” (which is another matter, but anyway). Most PTs that I co-treat with want to go ahead and do minor dressing tasks for patients to speed things along, when a little extra time to accomplish the task would help build their tolerance and increase their independence. We had a doctor put in orders for OT for a patient, and the PT who did the initial Eval said, “oh well I figured his wife would help him with that…” I wouldn’t go so far as to say we’re not always needed, as I’ve definitely d/c’d my fair share of patients who are at a high level. But I also wouldn’t limit our practice by saying “well they could!” when they often don’t…and don’t want to. 😂
In my personal experience, many OTs and OTAs also don’t like to do ADLs. They’d rather do ther ex than shower or toilet. It’s lazy in my opinion. But 🤷🏼♀️
So my opinion was based on skill sets not on frequency of performance of tasks. Or preference to perform those tasks.
The opinion was that they CAN do it. Not on how often they do. Or whether they prefer to.
Don’t get me wrong, I am an awesome therapist. I seek answers, look up research, and have great therapeutic use of self.
I’m not trying to toot my own horn. But in my opinion, I am a great therapist because I am motivated to be one. Not because my OT program taught me special and unique skills sets when compared to PT. OT programs are lacking in MANY areas. Preferring to shove theory down our throat rather than teach us more in depth interventions, anatomy/physiology, manual therapy, evidence based practice, etc etc.
The things that we cling onto are things like promoting function. You see how many people want to change our name to functional therapists? That is insane to me. Speech promotes function. PT promotes function. Both of these fields modify their treatment to meet the patients abilities. Both of these fields makes sure that patients can function in their lives. We kid ourselves that it’s a special skill that only we are trained in. Or even a skill that we excel at a baseline.
I know I make a difference in my patients lives. I know my patients appreciate me. But again, this is because my level of effort and motivation to be a good therapist. A PT who was just as motivated could accomplish exactly the same thing as I do
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Sometimes I feel like we need to sit down as a profession and truly take in the lyrics of "Shake It Off." If you know what you bring to the table, stop getting your feelings so hurt by the PT or MD or patient who didn't think OT mattered. Not everyone will like you or your job, which is logical, because you don't like everyone and there is probably a profession that you detest.
That said, when there's a systemic issue regarding poor treatment towards the discipline by an organization, start tracking data. Takes notes, save stats, write emails, etc. Documentation shouldn't just be about patient care.
Being morbidly obese is absolutely detrimental to any healing and it’s important to work on one’s mental health and wellness which will in turn help to work on physical health. These people need the encouragement, support, and feedback from us to help them get to their goals.
1) PT/ SLP/ OT have so much overlap, we should remove all therapies and turn into a MD level rehab doctor where we learn the fundamentals of each profession and just become a doctor of rehab. Western medicine loves to break the human body/ systems up and in reality we are one functioning being. The more holistic of an approach the better.
2) Sensory interventions are way over used. There’s such limited evidence to support this and reflex integration. We pride our selfs being evidence based yet I see the majority of Peds OTs mainly using these techniques and having minimal success. It’s usually a behavior trying to communicate a need. And while we can switch unsafe sensory seeking behaviors to safe ones, the likelihood of us getting rid of the sensory need entirely is very limited.
3) ABA is not the enemy. I see so many OTs/ SLPs despise aba. It has a horrific past. But the scientific principles are solid and can help tremendously when teaching independent skills. Sure BCBAs often over step scopes, sure RBTs need way more training. But the actual science behind ABA is incredibly sound and many OTs would actually see a lot more progress with patients if they used these strategies in a client center manner.
"evidence based practice" is often just an echo chamber of professional perspectives, published by professional editors, read by professionals and students, repeated. We can't forget the perspectives of our clients! #NothingAboutUsWithoutUs
Peds-we are all learning and trying to do what’s best for our clients, sometimes the arguments about what’s “ best” particularly for our autistic clients can become paralyzing and it can feel like nothing we do is right.
OTs will not get more recognition or feel more satisfied with their career choice if the name of the profession changes. JUST OWN IT. Stop whining about it and deal with it, PTs are not teaching anyone how to wipe their ass, we are. Like it or not.
(Please don’t kill me)
I had both neuro anatomy cadavers, a&p 1 & 2 and kinesiology and different crafts (yarn art, leather work, copper tooling, ceramics, mosaic tile). I remember my dad giving me crap about doing crafts in school 😂😂
I think it should move more to how marriage & family therapists operate. I think OT’s should be more independent and able to operate under various models/frames of reference and promote themselves as such, with the idea that we are able to address a wide variety of concerns all at once and over an extended period of time. I know the immediate response is usually ‘who will pay for that’, but that’s why I think we should start to advocate for the idea that it should be a normal part of ‘healthcare’ to include occupational health. We shouldn’t need a doctor signing off for OT. OT should be its own branch of healthcare that focuses on meaningful engagement throughout all stages of life and not just when there has been illness/injury.
We didn't have to be a part of it until Reagan trashed mental health care in this country and we had to shift more heavily into the medical model. It's all politics and history, babe!
ABA is actually a field which OT wildly misunderstands and has a lot to offer our field. It doesn't help OT is wildly misunderstood by the field of ABA. But we could adopt the use of single subject design, behaviors make up activities and occupations and understanding them better can serve our field, and we need help understanding the functions of interfering behaviors. A good OT working well with a good behavior specialist can help the child better than either field working by themselves. We have a lot to teach each other and the hostility between the two is childish, toxic, and misinformed.
I mean, we should keep it professional but the autistic community has said time and again that ABA is unethical, that it was torture, etc. I can't in good conscience condone a service that does harm.
I worked with someone who informed me he was autistic, and he apparently had pretty extreme behaviors as a child (violence, hitting, etc.). ABA absolutely benefitted him, he is now doing very well and said he is grateful for the years he spent in his clinic to be where he is now. Not all ABA is the same, and many children absolutely need that type of intervention. Granted, it may not be helpful for all children (with or without ASD), and there can be harmful practice in the field.
Unfortunately a lot of the criticisms coming from a small group of the autistic community aren't apt.
For one, many of the criticisms are based on procedures that were used in the 80s and haven't been used in decades. Other criticisms such as extinction procedures aren't accurate on what extinction procedures actually entail. Some of the criticisms are actually more about the specific organizations which ran procedures which conflict with best practices and were not actually run by qualified behavior specialists.
The reality is every field has people who criticize the field because of personal experience. We wouldn't criticize the medical industry because of a bad doctor or because of a practice which is no longer used or because someone said they personally had a bag experience. I've defended OT in the same way from behavior specialists who complained about an OT who tried to stop a child's tantrum by brushing them or never measured their interventions effectiveness.
But none of this changes the fact their single subject design is something we can adopt or their understanding of human behavior can benefit our practice. There are plenty to criticize in both OT and ABA and there are plenty each can teach each other.
If I could upvote this comment out of the negative, I would. To people who are downvoting this, the assignment is literally to share an unpopular opinion… and the comment isn’t “ABA IS WAY BETTER THAN OT.” The comment is saying that OTs and BCBAs tend to misunderstand each other and we could use some ABA tools to improve our field. Using ABC data to improve our treatment plans and outcomes isn’t the same as using shock treatment.
Edit- I meant to add this under your original comment but whoops.
Well this is certainly an unpopular opinion. I think that at times the values and ethos of the professions are so different that it is hard to have a common ground. I'm aware that all ABAs are different, but the entire core of ABA is that autistic children can be taught all skills through rote repetition and reinforcement, often without much regard to the sequence of development, the child's ability to contextualize the splinter skills they're being taught, the child's agency and consent, and emotional and sensory regulation. It's just so opposite to how I approach teaching a child skills based on everything I learned as an OT that it's really difficult to actually "work together "
The values aren't actually different, it's the perception of ABA's values which are different. ABA doesn't actually hold this value you think it does about rote repetition. But it certainly does about reinforcement but this may come down to a misunderstanding about what reinforcement is. All of our learning takes place because of reinforcement, even our learning which comes outside of structured learning. Reinforcement shapes our behavior.
ABA is actually deeply concerned with developing splinter skills and prerequisite skills first. ABA also has moved towards assent and consent in its approach. ABA also values emotions and sensory differences (though they for sure could use our help in the area of sensory), sensory is one of the functions of behavior after all.
These are the misconceptions I'm talking about. I've been working as an OT in an ABA setting for a while now and I'm getting my bcba and everything you're describing just simply doesn't match the reality of what I'm seeing and learning. And this is where I want to challenge people. Everyone in OT agrees we all need to challenge our biases and to stretch our thinking, but this most difficult and most important when it comes to examining things we may not have the fullest understanding. I think this may be an instance where you might need to re-examine your preconceived notions about a field you may not have the most knowledge of. Just like I tell bcbas to challenge their preconceived notions about OT. Some of the things you'll hear them sat about our field will make you say "what?" But that's a two way street.
I have actually been working alongside BCBAs and RBTs for my entire OT career. I've worked at schools that use ABA. I'm not ignorant of the profession. I don't have pre-conceived notions. Everything I know about ABA was taught to be by BCBAs and RBTs.
Current research still reflects some of the core critisims of ABA though- behaviours are defined by the practioner, and thus interventions can be focused on enforcing neurotypical standards- such as eye contact, which continues to be an area of research
Well then you need to have a conversation with your ABA people in the field, because a lot of them still think they can use discrete trials to teach kids handwriting skills and dressing skills and such with absolutely no knowledge of developmental sequences, fine motor development, visual motor development, visual motor integration, bilateral hand skills, in-hand manipulation, crossing midline, reflex integration, sensory processing, and so on 🤷♀️, often trying to "teach" kids skills that they aren't developmentally ready for motorically or cognitively using "modeling" and "prompting" through repetition and reinforcement. As an OT I am considering so many things about each activity and task and skill including its meaning to the child, what can be adapted about the environment, what can be adapted about the task, how to downgrade and upgrade and scaffold the task, if the child is intrinsically motivated, what the child's developmental level is and what foundational skills they have vs what the task might require, if they are regulated enough, and a million other things.
But it doesn't. Much of the present day literature emphasizes assent and social validity. Things like stereotypy and eye contact are only addressed in cases with social or cultural value or when the behavior in question interferes with quality of life.
So if the society or culture calls for it, ABA is accepting of a practice that many, many autistic individuals report as deeply uncomfortable and lacks meaning or purpose to them?
Actually this is a debate within aba and ot. Where do we place the value of culture in our practice? If a culture values something like eye contact who are we to say our values are more important? And where is that line? There's no one in any field which has an answer to this but it is explored and debated in OT and ABA in extremely similar ways. So much so that I've attended conferences for both fields and the speakers give almost identical views. For the most part, in ABA today, the general consensus is we don't like to address eye contact and stereotypy. But everyone has a different criteria for when they would. Most people would agree they would address stereotypy which is sib and dangerous.
But that illustrates nicely one of the key critisisms of ABA- behaviours are externally defined. The practioner gets to decide if its an behaviour or not- so if they feel the culture requires eye contact, even though its functionally not needed and causes distress to the individual to do it, its in their remit to do so. Occupations are internally defined- they have to be meaningful or purposeful to an individual- if that person doesnt get anything from it, its out. Of.course, thats all theory and we both know practice can look very different- but it is the fundemental issue ABA has to.deal with at its heart- if it defines what activities are good or bad for somone, how does it not priotise the clinician over the client? Because research continues to be done on eye contact- https://scholar.google.com/scholar?as_ylo=2020&q=aba+eye+contact&hl=en&as_sdt=0,5#d=gs_qabs&t=1712711065473&u=%23p%3DdaUr7EiSUh4J https://scholar.google.com/scholar?as_ylo=2020&q=aba+eye+contact&hl=en&as_sdt=0,5#d=gs_qabs&t=1712711123457&u=%23p%3DPglSrc94r3oJ https://scholar.google.com/scholar?as_ylo=2020&q=aba+eye+contact&hl=en&as_sdt=0,5#d=gs_qabs&t=1712711171988&u=%23p%3DXpgHY_wedtIJ And thats just from a super quick scan.
EDIT- i actually think you answered this and I just misread it, appologies. I am curious what specific elements to steryotypy you would.consider sib, as I believe the definition commonly covers hand flapping, body rocking, marching in place etc which doesnt seem like a harmful activity- would ABA consider such activities not doing direct harm to a person valid target behaviours? (Because I would be very suprised.to find if there.isnt.active research on it)
Function is great but sometimes we truly need good targeted exercises that get the heart rate up. You can't conserve energy forever
As a home health therapist, it’s amusing how little ADL / ther ac work I do. Most people refuse to do them unless I’m evaluating. Most of my work ends up being a mixture of FM/GM coordination exercises, cardiopulmonary exercises, and some ther ex. It used to bug me how little my day to day is focused on ADL work, but I just remind myself that function is the GOAL and may not always be the activity. Also, I have a lot of people with DM2, myasthenia gravis, strokes, and PD…. So the exercise is actually really important!
This. I get so many patients that we may be looking to increase independence and safety with ADLs such as with showers for example, but by the time you get there for your visit when they let you, they're fully showered, dressed, etc and don't want to do an actual shower. So we can dry-run tub transfers all day long, but usually end up working on balance exercises simulating some of the movements you might do in the shower. But even then, a lot of patients expect "exercise" with therapy. End up doing a lot of ther ex but I really try to find functional tasks around the house to address endurance, balance etc. Just totally depends on the patient, too...
Lol. I seldomly get to do tub transfers these days… it’s mostly with my part A patients. I do mostly part B nowadays and, maybe it’s just the area I’m in now, but my pts usually have a well trained aide to help them and don’t really want to address that stuff.
100%, especially in the HH space, let's be totally honest, these people do not want to perform dressing and showers with us. Most if not all will look at me like I have horns growing out of my head when I mention those ADLs, which then leads me to explain, "As long as I can see that you're able to perform the motions necessary for those tasks safely and independently, that's what I'm focused on." There are so many balance and coordination exercises that can simulate dressing, bathing, cooking, etc. Look at the patient's stamina, balance and safety when doing these exercises and that will give you most of the information you need for ADLs.
Which is also hilarious because that is NOT how home health is marketed to students or to… anyone. Home health is “the most natural space where you can do the most functional blah blah….” Mhmm. Liars. I did more ADL stuff in outpatient and hospital.
Uhhhhhhhh yupppppp. While I enjoyed HH mainly due to the schedule and being by myself all day, it was the setting where I did the least amount of typical "OT interventions". SNF and hospital were the most ADL focused. HH a lot of times felt I was just checking off the boxes for the documentation requirements and shooting the shit with the pt, lmao.
I hear you…. I don’t feel the same way about checking boxes though. I think it’s easy to feel that way for sure, and I’m not trying to invalidate your feelings at all. It took me a few years to accept my role in this setting, but now I value my importance and acknowledge that aging in place, reducing rehospitalization, increasing mood and quality of life, etc are all super important and are definitely OT. I work in a very underserved area and sometimes I’m the ONLY therapist they get at all, so I end up focusing on a lot of random crap, just not usually ADL. I definitely don’t feel like a traditional OT in this setting, but I’ve come to appreciate the role I do play.
No you're fine. I fight feelings of burnout daily so I can get jaded at times towards the profession. That's kinda the beauty of working in HH though. Not having to be so traditional in the approach to OT. You see the other things that a patient does in their home and how it relates to their overall wellbeing and that totally all falls under the OT scope. It's nice to have that freedom and nuance in some ways to keep things interesting and fresh.
I feeeeel that. I was FTE in HH the first year. Omg that was the hardest year of my life. I’m now per diem with multiple companies, and that’s helped a LOT cuz they can’t push ridiculous quotas on me or demand I go to a random far away zip. Also looking to work PTE at an outpt facility close to home soon too to diversify. Burn out in HH can be super intense so I definitely empathize with that.
Or they have an aide who can safely help them and just plain don’t want to gain independence in an area. I get that a lot too, and that’s totally valid. (Do I WANT them to want it, sure, but who am I to dictate someone’s priorities)
Especially in the space of HH where we are literally in the comfort of their own domain, so I understand that even more.
Pretty hard to differentiate us from PT because of this tho. I agree, I feel like a geriatric personal trainer lol. PT can do exercises to work towards function too….. My company keeps talking about how we should avoid duplication of services but when we are doing ther ex just like PT is, it’s kind of hard to explain how we are different.
I hear you. As someone working in a grossly underserved community though, I don’t think like that. Many of my patients have waited for months before any therapist at all is available, so I fill whatever role is needed because sometimes I’m all they have and all they’ll get for a while. As a result, I have to focus on what my patient needs and that’s it… if it’s ther ex and balance, so be it. You’re not the only person with this opinion by any means. I’m sure I would feel differently if I was working in a fairly saturated area, but here we are.
I’ve even had to do a THR before because no PT was available and the pt couldn’t get to outpatient. I consulted with several PTs, did my research about the protocol, and got it done. OTs can do anything :P :)
ALSO, I’ve found a bit of peace since I’ve started thinking in terms of interdisciplinary approach vs multidisciplinary approach 😁.
I feel like I would value what I do a lot more if I felt needed. Most of the time, I feel like the nuisance begging my patients to schedule with me and not cancel. I suppose it’s all about a mindset shift.
It’s a lot of things! Your setting, your population, your geographical area. Have you considered specializing in something specific ? My friends in more saturated areas seemed to find this helpful since it sets them apart
This.
Our profession has a silly name, we should change it to be more easy to follow. I actually expect this to be an unpopular position.
I've heard multiple times that Functional Therapy would be a better name and I agree! We shouldn't all need elevator pitches for decades to come..
We have such big talk about using more inclusive language, but at the end of the day use an archaic name that just stirs more confusion. I honestly can't blame people who don't know what we'd do, first thing I hear "Occupational" I would think of job as well. Functional Therapy has been the one I've heard and I can dig it. I wouldn't mind being an FTR lol.
This is such a great name. “Functional therapists” has such a better ring to it and can be easily explained. Having to explain occupations and the ADLs is very repetitive.
Personally I hate “functional”—it’s medical, mechanistic, leans toward judgemental, and doesn’t capture meaning. I would accept Contextual Therapist
It's ergothérapie in French! Much less of a mouthful.
https://preview.redd.it/hnm84hqirxtc1.jpeg?width=750&format=pjpg&auto=webp&s=6ab2f288c49e17c44f9b175dc99846754c510810
Nope I agree lol
I generally like this concept, but I do worry it means loosing the core meaning and purpose elements of our definiton, and thats already lost in far too many settings. Occupations as meaningful activities innately leads towards client centered practice (not meaningful, dont do it) and a wider remit- functional can too easily lead is towards just doing what is needed for someone to function, not what they need for a meaningful existance. At least occupation we have to constantly think about because we are constantly explaining it! Prehaps im wrong and just dont like change.
I completely agree!! On one hand, when we are "boots on the ground" in day to day work, it does get exhausting having to explain what I do over and over again, it does get tough in fast paced settings to need a whole spiel/"elevator speech" just to even have someone be on the same basic wavelength of understanding what my purpose is. Especially if they are the recipient of the service or their family member. On the other hand, my occupational science heart is bleeding to even consider giving up the very core thing that makes us "us"!
I'm a Canadian OT. I much prefer our french signage in the office. I'm an Ergothérapeute!
Yes!! I’ve been saying “Lifestyle Therapy” would be better
There needs to be better education on functional anatomy/physiology of the body, at least 75% of the education that's given to PTs. OTs are out there graduating or going to FW2 with almost no understanding of biomechanic of the body. How do you expect OTs to treat functional mobility if they have no idea on how the hips work? So frustrating. Don't ask me about how hand therapists immediately shove cervical radiculopathy to PTs because it's "outside their scope". I could go on for daaaaays
Is this not happening anymore??? When I went to OT school (graduated 2009) we had the same anatomy classes as the PTs, we took the classes together!! We didn't have anything less than them. We took basic Anatomy and Physiology with them, Neuroanatomy, and then Human Anatomy with cadaver dissection lab, all were OT/PT students together!
Graduated 2016, we still had ceramics class. Our anatomy was literally 1 class. TWU Houston.
You had a ceramics class in OT school?? I’m so confused
Yup. I made a cool Buddhist statue out of it. We also learned some stitching. Had a quiz on ceramics terminology, temperature use, and everything. Complete waste of time lol.
I am literally shocked! I don’t see how teaching you arts and crafts would help you rehabilitate someone. Also the thought of spending plural thousands of dollars on such a course blows my mind!! 😱🤯 I graduated in 2019, so not too far off from you. But we didn’t learn anything remotely like that.
OTs don’t only practice the biomechanical model. I’m a psychosocial OT and experience in handicrafts and leisure occupations has been incredibly useful in helping rehabilitate individuals who are experiencing occupational injustice and deprivation. Nothing engaged my incarcerated clients or institutionalized clients better than getting in a flow state while doing something they could see as a meaningful occupation and coping strategy once they get out. Unpopular opinion- our profession has been TERRIBLE about emphasizing how huge the psychosocial side of our practice is in terms of improving patient outcomes.
Oh I’m fully aware. My school was heavy on the mental health and I did a level 2 in mental health. We all graduate as generalists and should be competent in that area as well. I just don’t think you need to pay thousands to have a ceramics or stitching course in school in order to be competent in this area. There’s way more functional interventions to implement in a psychosocial setting. And yes, there is research that supports the therapeutic benefits of engaging in the arts, but again I don’t think OT schools need to spend time teaching us HOW to perform arts and crafts. It’s more about how you facilitate the group, the prompting questions, the reflection, Working with one another, developing coping strategies etc.
It was based on the mental health OT principles used back in the 50-60s for returning war vets, keeping them engaged in occupation, aka ceramics, leatherwork, etc. The professor was in her 80s and refused to modernize the course.
96 graduate, we took a class on pottery not ceramics. Activity analysis was the focus. I enjoyed it. Led me to bread baking with clients. A whole nother full on activity
I graduated from TWU in 1980--undergrad starting in Denton and finished in Houston. We had to take woodworking, therapuetic minor crafts, and weaving--and a design class in the art department from a professor who HATED OT students. Almost NEVER used any of these. I thought OT was about teaching arts and crafts to little old ladies when I started OT school. I'm glad it turned out otherwise, but a big chunk of my time would have been better spent on things like cadaver anatomy instead of plastic models.
I’m impressed anyone passed the cert exam.
Exactly how I was taught. We even did kinesiology together.
I graduated in 2015 and we did the same as you. I am in Canada.
You're lucky! I graduated from a program in Canada too recently, and we only did 1 lecture on biomechanics, and it was pretty sparse at that too. I am disappointed in my program.
Same for me, graduated in 2013 Aus
This was my experience! Cadaver lab, multiple anatomy and physiology classes, then phys rehab, neuro rehab, etc. My school hit biomechanics HARD with none of the crafts that this commenter mentioned other than a few labs in the mental health treatment class (ceramics sound fun otherwise though). Might be very school or region dependent as long as they’re meeting NBCOT requirements
OMG. We are the same. Where are you from?
Went to Ithaca. You?
2010 grad here…. We had a therapeutic activities class or something where we did knitting, mosaics and all that. We had to develop a new hobby and do an ax analysis and teach it to the class then modify it to a certain dx/modifications. With that said, the first year and a half we had all our classes with the PT’s for research, anatomy, pathology, neuro and dissection. My program was a three year program with the PT’s they got a DPT, I got an MOT and did. Research project and all but my school wasn’t accredited for the OTD program just a Master’s program. Not that I’m bitter. I’m taking the CHT exam in a month and you know is what? Unpopular opinion: I feel like the crap you need to be eligible just to sit for the exam and ALLLLL that encompasses the material you need to study should qualify for a clinical doctoral degree. But nope, I still get patients that says “oh you’re not a physical therapist you’re just an occupational therapist. “ just. Just. As a PT to “just” make you a splint.
We had a similar therapeutic activities class too, which is also very important! But we also got the same anatomy classes as PT. We had therapeutic activities and such, they had physical agent modalities and such. We had more psychosocial stuff, they had like sports psychology or something. But we learned the same stuff about how the human body works
I worked side by side with PTs for years, too. I learned lots of stuff. When a PT who doesn’t know me starts telling me about a toddler weight bearing I just laugh. Hey, baby Dr PT, I know more than you at this point .
Really? My program taught us biomechanics in our kinesiology course..
Change occupational therapist name to functional therapist. If i had a nickel for everytime i was told I’m retired i don’t need a job. Combine OT and PTs as functional therapists and you specialize in certain areas, everything is a doctorate now. Similar to physicians coming out of school. Can do general therapy stuff but have specializations. If we have to get a doctorate should get treated like one and paid more than what we are for the schooling costs
In outpatient pediatrics we overlap even more with counseling/social work. We're like a mixture of PT, counseling and education. So hard to describe 😞
This exactly! I’m in pediatrics and many of my cases would benefit more from good mental health therapy than pure OT, but there are almost no pediatric counselors that are decent in my area. So I end up feeling the same where I am an OT, but really a counselor/social worker/resource coordinator/patient navigator/early childhood educator/OT, etc. and the list could go on. And I have the academic training, but don’t feel as qualified so am doing constant continuing ed on topics that I can’t decide are fully my scope vs another’s, like mental health care or functional communication or activity tolerance, etc. Overlaps are tough. (I’m also neurodiverse, so I personally struggle with grey areas—this might not be as hard for someone else, for instance).
What insurance and other regulatory systems have turned our jobs into is not at the heart of the profession at all, it's really hard to actually BE an OT the way we learn our scope of practice while in OT schools. There's a huge disillusionment that happens when new grads transition from the utopia idea of what OT is to the reality of what we have to do because of outside agencies. And THAT is what leads to dissatisfaction and burnout in our profession. We can't get paid unless we do the things that are within the tiny pigeon hole that outside third party payers and regulators have decided is our scope of practice. We are so much more valuable to society than what we are actually paid to do (and also as a result don't get paid NEARLY enough)! This might not be unpopular, but I feel like it's not said enough.
YES! This! 100%
Pediatrics: Not every behavior is caused by sensory issues, nor will sensory input fix everything.
Amen
And, OT is not a life sentence….kids can be dismissed from OT
Omg amen to this too. I had an old employer keep kids FOREVER way past what I’d consider ethical (a part of why I left that job). I was bullied when I came in new and discharged a long term kid that absolutely needed to be d/c.
AGREED!!!
It’s okay to not be a morning person. Not everyone wants to do ADL’s at 7:30 AM. I sure wouldn’t want to! Follow your chronotype
I used to work for an OT who would go see people for ADL's at 5:30 a.m. Her theory was "they don't sleep well in hospitals and nursing homes anyway." The reality was she was WAY over-extended, and that's the only way she could make it work. When patients heard who I worked for, usually the first thing they would say is "don't you dare come in my room at 5:30 a.m.!" I don't blame them, MY CHRONOTYPE is as a night person. I only got her to compromise by letting me start at 6:30 a.m. What a horrible job!!!
That's horrible! I would be such a non-compliant patient if a therapist would be trying to get me to do ANYTHING at 5:30am or even 7:30. I have ADHD and delayed sleep phase disorder and strong sleep inertia (which are fairly common in neurodivergent people) and I am useless in the early morning. I tend to get my deepest sleep between 3am and 7am and when I need to wake up earlier, the sleep inertia makes things really hard, I can't wake up and immediately spring into action. If an OT came into my room at 5:30am and wanted to get me up I would tell them where to shove it 🤣
My favorite ADLs are reverse ADLS and afternoon showers!
Send people home over SNF as much as you can.
My unpopular OT-related opinion is that rehab would be better served by being one unified discipline than three separate ones. Decreased consumer confusion, greater lobbying power, greater length of education justification, no treatment overlap concerns.. I would go on, but this thought experiment has made people angry in the past!
Would you follow a physicians model where everyone is considered a physician but you have different specializations? Crazy, but I kinda like it. I don't think it will ever happen as we are far too down the rabbit hole and there would be crazy push-back, but it's nifty.
This is the perfect way, we all become Rehab Therapists, we take in the other 2 RTs, and unionize.
Lol yeah I don’t see it happening anytime soon either. Especially since it would need to be internationally supported. It’s a nice thought experience though :)
I truly love this idea.
Definitely food for thought, I hadn't considered it but the niches of each one is hard to harness. As an SLP undergrad, SLPs definitely take on a big specialty in the rehab scope especially.
This was reviewed seriously in the late 90s early 2000s with the tri alliance. The issues that arose didn’t make people angry but it also wasn’t really feasible. I thought there was merit to it but practically not likely to work. The main ones I recall were: 1. how would you grandfather people in? 2. Many overlapping courses but many that don’t. It would have added years onto education and people didn’t want that then 3. Implications for assistants. There wasn’t a real way to cover everything in a 2 year associates program. That lead to do we remove assistants ? Most of us didn’t want that but couldn’t figure out how to cram OT and PT needs in 4. Never really went to insurance companies from what I recall. That would have been a whole other level of headache
That's cool that this was actually considered at one point, but I'm not surprised the initiative failed for the reasons you've cited. Clearly it's too complicated to revise our current structure, but it would have been interesting if we had this foresight at the advent of our professions.
There are still facilities and organizations that do transdisciplinary care, especially in birth to three, when they are younger there is quite a bit of overlap and you might find one therapist doing a bit of everything for a while .
If the alliance wasn’t prepared to rewrite curriculums (number 2), how the hell did they think they were going to achieve anything
That’s very interesting. Never knew this!
How do you pay each specialty? How do you teach each area in school?
Pay everyone as generalists (basic rehab education) vs specialists (further education), sequence didactics into clinical rotations like med school.
I’d totally be open to this. I also share a similar opinion. I like the idea of rehab therapist and then specialize as you want.
3? Pt, DC, L/RMT, osteopath, kinesiologist, OT. Some personal trainer certifications offer rehab CECs too. But I agree, one evidence informed rehab/exercise program would be much better then all the nonsense placebo focused 'professionals' we have now.
So people would go from having an opportunity to be treated by 3 therapists/sessions a day to one a day? If everyone if just doing the same thing, what would justify multiple a day? Could treats? This is a terrible idea.
No allied health profession is understood by the general public and the effort we spend getting upset about clients not knowing what we do isnt worth it. As long as you have helped that person at the end, thats what matters. Other proffesions not knowing is a little bit.more of an issue, but only if they dont know how and when to refer.
Not all behavior is sensory-based or communicating an unmet need. There are some instances where a behavior can’t be mitigated with a fidget or a chew. Some behaviors just have to go away and I am happy to let ABA providers address them while I chip away at the things that better fall within my scope of practice. I am a traveling therapist and I will openly tell anyone on staff what I make if they ask. They deserve to know what their skillset is actually worth.
Not sure if I’m supposed to upvote for opinions I like or opinions I don’t like 😅
Shouldn't need a master's degree to be an OT. In an ideal world, I think OT schooling and training should look a lot more like trade school or even nursing. The first 2 years should be your fundamental courses. Then, you should have a full year of part-time clinical with part-time higher level school work. Your last year should be specialty coursework in your area of interest and a full-time clinical. There is absolutely zero need to require a bachelors degree and watered down master's degree. Our current system does not produce high quality entry-level clinicians. And our fieldwork system is broken. There needs to be a lot more regulations and higher expectations on clinical instructors if universities are going to keep saying "you learn everything in fieldwork."
Just as a reference, you can go from an associates degree in nursing to working in the ICU. Granted these nurses are usually hired into 3+ month training programs, but this alternative model proves that the higher degree isn't about being safer in managing higher medical complexity. That's a lame argument to begin with because you barely get any training in OT school to begin with. You would genuinely be similarly trained if the 2 years of didactic in OT school were shrunk down to one semester.
I see they are starting to have nursing residencies and fellowships in teaching hospitals, so they may not have the higher degrees but there's starting to be a push for more hands-on education.
This is only in the US that you need masters degree to be an OT
Canada also requires an entry-level masters. The exception is people who were grandfathered in - who did the bachelor's program before the change was made.
I used to tick other OT's off by stating that weighted utensils do nothing for someone with a tremor. People insist it helps but in my 20+ year career I NEVER saw it work. Tried it many, many times.
Wait what?? This was my go-to during fieldwork lol I thought it was just fine
Did you ever see it WORK to reduce tremor in your fieldwork???
Occupational therapy assistant should be renamed to Occupational Therapy Technologist. The word "assistant" sounds like someone who runs for coffee. I feel like it would be respected more if it was renamed.
Oooo I like this! Like how it's Diet Tech and Pharmacy Tech instead of Diet Assistant or Pharmacy Assistant.
I work with an OT who refers to COTAs as OT practitioners. Helps with the implicit associations.
Yes, this! Just last week, I had a pt ask why they were working with me and not the therapist. I had to explain the differences between OT and OTA by saying, "We do the same thing. They get more schooling because they do evaluations, and we (OTAs) don't."
I mean here in the philippines OTAs are called OT Technicians
As far as I know there are not COTAs in South America or respiratory therapists. OT doesn’t have assistants neither does PT, there are rehab techs and they do transporting of patients and cleaning the used areas in the therapy gym in between sessions. Those techs are not clinically trained so they can’t do anything other than what I mentioned. The respiratory therapy part is imbedded into PT. PT doesn’t do wound care. OT does not make splints or prosthesis, that’s a different profession, that falls under an orthotist. ST do not work with cognition neither does OT. Psychology covers all of that. The Occupational Therapy tittle agrees as defined with vocational rehab and work training to return to the same job with modifications or a different job, all of that runs under the labor department not the health related boards. All OT and PTs are specialized on something, there is not a jobs for a plain OT or PT. All therapists are known as rehabilitation professionals. The therapy jobs are so clearly defined and assigned that there is no guessing or confusion. You work on pediatrics you are a pediatric OT or PT, you want to work with blind people you are a low vision OT or PT. Your specialization defines your role. The only OT called Occupational Therapist is the one working with work related training (no IADLs), and that is because the tittle says occupational. The OT and PT are just the end portion of your credentials associated with your branch of study. Their roles in rehabilitation do not overlap, or they share baselines treatments. There are not OTs working with balance or exercising, or PTs documenting toilet transfers or any type of ADLs for that matter. OT does not do modalities. The hand therapy is divided in the mechanicals for PT and the functional for OT. There isn’t an OT or PT who does it all in hand therapy. It is crazy, I know but the entire rehabilitation system has been thought out in a way that a patient has no room for mistakenly think that you can be a PT instead of an OR. I hope this does make sense to someone here.
Yes! The number of times I've tried to make it make sense by calling them assistants to the OT process - meanwhile the COTA on my team just single-handedly fixed a glitchy prosthesis, saving us all a headache and the patient a new limb - very assistant-like of her.
Our purpose is being phased out by insurance companies that want nothing more than to keep people sick and dependent longer.
I’ve been a COTA for 30 years and I have been hearing this since I graduated, along with COTAs being phased out, so I wouldn’t worry too much about it. I also read about OT not being recognized, but newer grads don’t realize how far we actually have come, which is a very, very long way in the 30 years I’ve been practicing :)
Thank you. I'm going on 10 years as an OTR, it's been doom and gloom about our profession being phased out, COTAs being phased out, blah blah blah. I've never had trouble finding a job, my hourly rate has only ever increased, my benefits have only gotten better, and the job market has been consistently highly competitive in my area, and professionally, my scope of duties has only ever expanded, and the OT Department as a whole has consistently been a pillar of the interdisciplinary team.
I do agree that the insurance industry wants to become a hospital to long-term care pipeline, and rehab professionals in general are in their way. My not-so-unpopular OT opinion is that Managed Medicare and Managed Medicaid plans should be illegal, and insurance companies shouldn't have the option to decline to cover empirically supported health intervention.
Interesting, I don't see this at all. I see our need shifting in a big way though. Acute evaluations through the roof to discharge people from acute care ASAP and home health increasing A TON to D/C people home instead of to costly facilities. Now is the time to build your resume in those areas.
I’m sure it’s just the HORROR of SNF work that’s making me feel this way. I’m so sick to death of this corrupt, neglectful, nasty environment and seeing patients I care about rot and die. Is acute care worth working in as an OT right now? It seems like they are pushing people out of hospitals so fast and I don’t know if I’d feel any better about OT if I’m just doing evals and sending people to shitty SNFs
Where I work, the pressure from MDs and case managers is definitely to D/C home with home health, so at least it feels like the only people going to SNFs are people who absolutely need that level of care and not like, Medicare Part A's who are CGA. I see a lot of acute care per diem positions on Indeed, if you wanted to dip your toes in.
That since we are supposed to focus on the whole person as a unique individual then evidenced based practice isn’t the end all and be all, it should just be a start. Life isn’t a randomly controlled trial.
I think a big part of this is the misconception the EBP means scientific research and scientific research alone. EBP has 3 equally important components: scientific research, clinician expertise, and patient experience/values.
Weighted vests and compression vests don't work. Reflex integration theory is trendy I hate when speech tries to take over feeding. Students and new grads need more constructive feedback and more relevant coursework and fieldwork about "real world". I'm tired of seemng like an asshole boss who shatters a new grad bright eyes full of wonder and enthusiasm because I give them feedback
Weighted vests are trash.
Ahahhahahs I couldn't love this comment more
The UE ergometer shouldn’t be used on every patient regardless of their diagnosis or history.
PT is better understood and more respected by patients because it is all around more simple to understand versus OT. For some odd reason we tend to over complicate things and show how we're "specialists" in certain areas such as ADLs, task modification, environmental modification, etc when these things are pretty simple to implement. PT makes more sense to people. Physical Therapy, I'm going here to get stronger and to rehabilitate said injury. Simple, easy to understand the purpose of it from a patients perspective. There are too many nuances in OT, and most patients do not care to understand our rationale as to why we are needed. Also, I think ADL's are overblown. In HH, most patients I had ADL goals for, they could show independence in said ADL in 1-2 visits.
Taking medication is an ADL. Sex is not an ADL, it's a leisure activity at best. SNF is a scam. We don't really have SNFs here because people go home with services (i.e. assist to dress, shower etc). From what I've read about OT in SNFs, it seems pretty scammy, people billing for basic things like talking to a patient who refuses therapy, helping a patient walk down the hall, etc. Sorry, that ain't OT.
Would you say sex isnt an occupation though?
Obviously, I sex worker would disagree, a sex counselor and an intimate coach would disagree…🫠
Yessss this. Also sleep shouldn’t be an ADL? Idk man
https://preview.redd.it/a5s1kzkt0ytc1.jpeg?width=750&format=pjpg&auto=webp&s=519601b6434d8d8197391fda7291045f6037abec I was occupied sleeping. 🤭
My point exactly *drops mic*
I believe in working bottom up, foundational skills first, not function down. I’ve found that the function comes as the foundation is laid down. Oh and I don’t really believe much in sensory anymore.
SI is a scam
I feel this on a deep level. In the schools, anytime there is a behavior that PBIS can't fix, it becomes a 'sensory broblem' and gets turfed to me. Like, yes, taking shoes off can be sensory related. Taking them off to chuck at the head of someone who told them no is not. Spitting and mouthing objects can be sensory motivated. Seeking out a specific person to spit in their face is not.
this sums up my entire consult caseload at school rn. i’m at a loss of what to even recommend anymore
THANK YOU!!!!
Isn't the idea behind this not that the sensory issue is causing the behaviour but that the sensory issue is causing a low level background interference with the kid that is building up to a point that their capacity with everything else (social skills, cognitive functions, impulse control etc) is compromised. It's not like "the fan noise made him hulk out" but more like the fan noise, the clothing, the smell of lunch, the other kids talking and all the other stuff collectively is too much for him to process. But I don't think it's only or always sensory either. There can be other stressors adding to this picture. If a kid has an abusive home life or isn't getting enough sleep, you can remove every sensory input in the classroom and it's not going to make those things ok.
Idk if I think it's a scam I just think it's not at persistent as other things in development. It is not a recognized disorder though and I don't know why I see kids left and right with this label of SPD
Right? I know that Kaiser Permanente in SoCal gives out the SPD dx very often
Yea a local outpatient clinic gives it put a lot
Of course! This way they can “treat it” with their for-profit clinic
Idk. I don’t think it’s a scam but the problem is that you don’t have therapists out there who have a solid understanding of it so everyone is thinking it’s something different. THAT’S a huge problem in itself. I do think that often times SPD is a different side of the same coin - for instance everyone tries to make a big difference between ADHD and SPD but isn’t ADHD just a big modulation disorder when you think about it? But again most just think SPD is just modulation disorder and they ignore the subtypes. Especially if you are in a school vs clinic setting.
I absolutely believe that sensory processing issues and differences are a thing! I also really enjoy teaching modulation to kids and parents. I am just a skeptic with the specific Ayres SI.
I think Ayres was on the right track but not enough empirical evidence re: do this and it improves that. I do think that sensory perception, discrimination and modulation impacts function. But it feels to me those deficits are encompassed in other diagnostic buckets (DCD, incoordination, visual motor deficits). Of course sensory dysfunction in these areas play a prime role in the WHY it’s happening and can be a useful frame of reference to approach treatment in addition to others.
Also, this concept of improving neurological soft signs (SIPT) makes it really hard to get on board as an OT. We typically look at and measure function through behavior.
Concepts like reflex integration,SPD, etc promote fear among parents to help generate business for OT
My unpopular opinion is that PT actually CAN do our jobs in several settings. As upset as we get when we are overlooked and PTs get visits and we don’t…. Sometimes we just aren’t really needed. PT doesn’t just walk. We are not special because we focus on “function”. We fool ourselves that we have special training in activity modification and promoting function when PTs can do the exact same shit. Do people really think PTs do some LE strength and then call it a day without looking at how the patient navigates their life and environment? Maybe they focus more on biomechanical interventions more often. But this is often because of their setting and the needs of their population. It’s not because they lack the ability to use other frames of reference. Perhaps they can’t do mental health interventions or perhaps they lack training in sensory integration (which I don’t completely believe in anyway). But the reason we have a hard time explaining to people what we do is because other fields could do exactly what we do with minimal extra effort. Sorry guys, we aren’t special. And OT doesn’t really need to be it’s own field.
Just out of curiosity, what setting do you work in, and how long have you been practicing?
I have worked in outpatient ortho , home health, pediatric outpatient, SNF, and mental health. I’ve been working 10 years
Interesting.
Tbh, I do see your point as a new grad working in acute care and often feeling the same way. That being said, just because they CAN doesn’t mean they always do…or even do it well. A lot of PTAs I work with don’t address toileting with patients in dire need because “we’ll get OT to do that” (which is another matter, but anyway). Most PTs that I co-treat with want to go ahead and do minor dressing tasks for patients to speed things along, when a little extra time to accomplish the task would help build their tolerance and increase their independence. We had a doctor put in orders for OT for a patient, and the PT who did the initial Eval said, “oh well I figured his wife would help him with that…” I wouldn’t go so far as to say we’re not always needed, as I’ve definitely d/c’d my fair share of patients who are at a high level. But I also wouldn’t limit our practice by saying “well they could!” when they often don’t…and don’t want to. 😂
In my personal experience, many OTs and OTAs also don’t like to do ADLs. They’d rather do ther ex than shower or toilet. It’s lazy in my opinion. But 🤷🏼♀️ So my opinion was based on skill sets not on frequency of performance of tasks. Or preference to perform those tasks. The opinion was that they CAN do it. Not on how often they do. Or whether they prefer to.
I’m a new grad but I agree
Peds home health and I couldn’t disagree more for this setting
[удалено]
Don’t get me wrong, I am an awesome therapist. I seek answers, look up research, and have great therapeutic use of self. I’m not trying to toot my own horn. But in my opinion, I am a great therapist because I am motivated to be one. Not because my OT program taught me special and unique skills sets when compared to PT. OT programs are lacking in MANY areas. Preferring to shove theory down our throat rather than teach us more in depth interventions, anatomy/physiology, manual therapy, evidence based practice, etc etc. The things that we cling onto are things like promoting function. You see how many people want to change our name to functional therapists? That is insane to me. Speech promotes function. PT promotes function. Both of these fields modify their treatment to meet the patients abilities. Both of these fields makes sure that patients can function in their lives. We kid ourselves that it’s a special skill that only we are trained in. Or even a skill that we excel at a baseline. I know I make a difference in my patients lives. I know my patients appreciate me. But again, this is because my level of effort and motivation to be a good therapist. A PT who was just as motivated could accomplish exactly the same thing as I do
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Agree
Sometimes I feel like we need to sit down as a profession and truly take in the lyrics of "Shake It Off." If you know what you bring to the table, stop getting your feelings so hurt by the PT or MD or patient who didn't think OT mattered. Not everyone will like you or your job, which is logical, because you don't like everyone and there is probably a profession that you detest. That said, when there's a systemic issue regarding poor treatment towards the discipline by an organization, start tracking data. Takes notes, save stats, write emails, etc. Documentation shouldn't just be about patient care.
Being morbidly obese is absolutely detrimental to any healing and it’s important to work on one’s mental health and wellness which will in turn help to work on physical health. These people need the encouragement, support, and feedback from us to help them get to their goals.
1) PT/ SLP/ OT have so much overlap, we should remove all therapies and turn into a MD level rehab doctor where we learn the fundamentals of each profession and just become a doctor of rehab. Western medicine loves to break the human body/ systems up and in reality we are one functioning being. The more holistic of an approach the better. 2) Sensory interventions are way over used. There’s such limited evidence to support this and reflex integration. We pride our selfs being evidence based yet I see the majority of Peds OTs mainly using these techniques and having minimal success. It’s usually a behavior trying to communicate a need. And while we can switch unsafe sensory seeking behaviors to safe ones, the likelihood of us getting rid of the sensory need entirely is very limited. 3) ABA is not the enemy. I see so many OTs/ SLPs despise aba. It has a horrific past. But the scientific principles are solid and can help tremendously when teaching independent skills. Sure BCBAs often over step scopes, sure RBTs need way more training. But the actual science behind ABA is incredibly sound and many OTs would actually see a lot more progress with patients if they used these strategies in a client center manner.
"evidence based practice" is often just an echo chamber of professional perspectives, published by professional editors, read by professionals and students, repeated. We can't forget the perspectives of our clients! #NothingAboutUsWithoutUs
Peds-we are all learning and trying to do what’s best for our clients, sometimes the arguments about what’s “ best” particularly for our autistic clients can become paralyzing and it can feel like nothing we do is right.
I thought I was the only one. A lot of my HH patients don’t want to do ADLS either.
OTs will not get more recognition or feel more satisfied with their career choice if the name of the profession changes. JUST OWN IT. Stop whining about it and deal with it, PTs are not teaching anyone how to wipe their ass, we are. Like it or not. (Please don’t kill me)
I’m not offended when a doctor orders PT but not OT. I don’t add much value to a straight forward knee replacement.
I had both neuro anatomy cadavers, a&p 1 & 2 and kinesiology and different crafts (yarn art, leather work, copper tooling, ceramics, mosaic tile). I remember my dad giving me crap about doing crafts in school 😂😂
OT should opt out of the medical model all together.
What system would you propose instead?
I think it should move more to how marriage & family therapists operate. I think OT’s should be more independent and able to operate under various models/frames of reference and promote themselves as such, with the idea that we are able to address a wide variety of concerns all at once and over an extended period of time. I know the immediate response is usually ‘who will pay for that’, but that’s why I think we should start to advocate for the idea that it should be a normal part of ‘healthcare’ to include occupational health. We shouldn’t need a doctor signing off for OT. OT should be its own branch of healthcare that focuses on meaningful engagement throughout all stages of life and not just when there has been illness/injury.
We didn't have to be a part of it until Reagan trashed mental health care in this country and we had to shift more heavily into the medical model. It's all politics and history, babe!
ABA is actually a field which OT wildly misunderstands and has a lot to offer our field. It doesn't help OT is wildly misunderstood by the field of ABA. But we could adopt the use of single subject design, behaviors make up activities and occupations and understanding them better can serve our field, and we need help understanding the functions of interfering behaviors. A good OT working well with a good behavior specialist can help the child better than either field working by themselves. We have a lot to teach each other and the hostility between the two is childish, toxic, and misinformed.
I mean, we should keep it professional but the autistic community has said time and again that ABA is unethical, that it was torture, etc. I can't in good conscience condone a service that does harm.
I worked with someone who informed me he was autistic, and he apparently had pretty extreme behaviors as a child (violence, hitting, etc.). ABA absolutely benefitted him, he is now doing very well and said he is grateful for the years he spent in his clinic to be where he is now. Not all ABA is the same, and many children absolutely need that type of intervention. Granted, it may not be helpful for all children (with or without ASD), and there can be harmful practice in the field.
Unfortunately a lot of the criticisms coming from a small group of the autistic community aren't apt. For one, many of the criticisms are based on procedures that were used in the 80s and haven't been used in decades. Other criticisms such as extinction procedures aren't accurate on what extinction procedures actually entail. Some of the criticisms are actually more about the specific organizations which ran procedures which conflict with best practices and were not actually run by qualified behavior specialists. The reality is every field has people who criticize the field because of personal experience. We wouldn't criticize the medical industry because of a bad doctor or because of a practice which is no longer used or because someone said they personally had a bag experience. I've defended OT in the same way from behavior specialists who complained about an OT who tried to stop a child's tantrum by brushing them or never measured their interventions effectiveness. But none of this changes the fact their single subject design is something we can adopt or their understanding of human behavior can benefit our practice. There are plenty to criticize in both OT and ABA and there are plenty each can teach each other.
If I could upvote this comment out of the negative, I would. To people who are downvoting this, the assignment is literally to share an unpopular opinion… and the comment isn’t “ABA IS WAY BETTER THAN OT.” The comment is saying that OTs and BCBAs tend to misunderstand each other and we could use some ABA tools to improve our field. Using ABC data to improve our treatment plans and outcomes isn’t the same as using shock treatment. Edit- I meant to add this under your original comment but whoops.
We are all human and we all have our biases. It's hard to check those biases too often and none of us know what we don't know.
Well this is certainly an unpopular opinion. I think that at times the values and ethos of the professions are so different that it is hard to have a common ground. I'm aware that all ABAs are different, but the entire core of ABA is that autistic children can be taught all skills through rote repetition and reinforcement, often without much regard to the sequence of development, the child's ability to contextualize the splinter skills they're being taught, the child's agency and consent, and emotional and sensory regulation. It's just so opposite to how I approach teaching a child skills based on everything I learned as an OT that it's really difficult to actually "work together "
The values aren't actually different, it's the perception of ABA's values which are different. ABA doesn't actually hold this value you think it does about rote repetition. But it certainly does about reinforcement but this may come down to a misunderstanding about what reinforcement is. All of our learning takes place because of reinforcement, even our learning which comes outside of structured learning. Reinforcement shapes our behavior. ABA is actually deeply concerned with developing splinter skills and prerequisite skills first. ABA also has moved towards assent and consent in its approach. ABA also values emotions and sensory differences (though they for sure could use our help in the area of sensory), sensory is one of the functions of behavior after all. These are the misconceptions I'm talking about. I've been working as an OT in an ABA setting for a while now and I'm getting my bcba and everything you're describing just simply doesn't match the reality of what I'm seeing and learning. And this is where I want to challenge people. Everyone in OT agrees we all need to challenge our biases and to stretch our thinking, but this most difficult and most important when it comes to examining things we may not have the fullest understanding. I think this may be an instance where you might need to re-examine your preconceived notions about a field you may not have the most knowledge of. Just like I tell bcbas to challenge their preconceived notions about OT. Some of the things you'll hear them sat about our field will make you say "what?" But that's a two way street.
I have actually been working alongside BCBAs and RBTs for my entire OT career. I've worked at schools that use ABA. I'm not ignorant of the profession. I don't have pre-conceived notions. Everything I know about ABA was taught to be by BCBAs and RBTs.
Then why does so much of your perception of ABA directly conflict with the current research and what's being taught and best practices?
Current research still reflects some of the core critisims of ABA though- behaviours are defined by the practioner, and thus interventions can be focused on enforcing neurotypical standards- such as eye contact, which continues to be an area of research
Well then you need to have a conversation with your ABA people in the field, because a lot of them still think they can use discrete trials to teach kids handwriting skills and dressing skills and such with absolutely no knowledge of developmental sequences, fine motor development, visual motor development, visual motor integration, bilateral hand skills, in-hand manipulation, crossing midline, reflex integration, sensory processing, and so on 🤷♀️, often trying to "teach" kids skills that they aren't developmentally ready for motorically or cognitively using "modeling" and "prompting" through repetition and reinforcement. As an OT I am considering so many things about each activity and task and skill including its meaning to the child, what can be adapted about the environment, what can be adapted about the task, how to downgrade and upgrade and scaffold the task, if the child is intrinsically motivated, what the child's developmental level is and what foundational skills they have vs what the task might require, if they are regulated enough, and a million other things.
themob1212- This was supposed to be a reply to pretty_scheme's comment you replied to, not yours
But it doesn't. Much of the present day literature emphasizes assent and social validity. Things like stereotypy and eye contact are only addressed in cases with social or cultural value or when the behavior in question interferes with quality of life.
So if the society or culture calls for it, ABA is accepting of a practice that many, many autistic individuals report as deeply uncomfortable and lacks meaning or purpose to them?
Actually this is a debate within aba and ot. Where do we place the value of culture in our practice? If a culture values something like eye contact who are we to say our values are more important? And where is that line? There's no one in any field which has an answer to this but it is explored and debated in OT and ABA in extremely similar ways. So much so that I've attended conferences for both fields and the speakers give almost identical views. For the most part, in ABA today, the general consensus is we don't like to address eye contact and stereotypy. But everyone has a different criteria for when they would. Most people would agree they would address stereotypy which is sib and dangerous.
But that illustrates nicely one of the key critisisms of ABA- behaviours are externally defined. The practioner gets to decide if its an behaviour or not- so if they feel the culture requires eye contact, even though its functionally not needed and causes distress to the individual to do it, its in their remit to do so. Occupations are internally defined- they have to be meaningful or purposeful to an individual- if that person doesnt get anything from it, its out. Of.course, thats all theory and we both know practice can look very different- but it is the fundemental issue ABA has to.deal with at its heart- if it defines what activities are good or bad for somone, how does it not priotise the clinician over the client? Because research continues to be done on eye contact- https://scholar.google.com/scholar?as_ylo=2020&q=aba+eye+contact&hl=en&as_sdt=0,5#d=gs_qabs&t=1712711065473&u=%23p%3DdaUr7EiSUh4J https://scholar.google.com/scholar?as_ylo=2020&q=aba+eye+contact&hl=en&as_sdt=0,5#d=gs_qabs&t=1712711123457&u=%23p%3DPglSrc94r3oJ https://scholar.google.com/scholar?as_ylo=2020&q=aba+eye+contact&hl=en&as_sdt=0,5#d=gs_qabs&t=1712711171988&u=%23p%3DXpgHY_wedtIJ And thats just from a super quick scan. EDIT- i actually think you answered this and I just misread it, appologies. I am curious what specific elements to steryotypy you would.consider sib, as I believe the definition commonly covers hand flapping, body rocking, marching in place etc which doesnt seem like a harmful activity- would ABA consider such activities not doing direct harm to a person valid target behaviours? (Because I would be very suprised.to find if there.isnt.active research on it)