Therapy Skills Too Complex To Combine

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By Denise D. Shalonis, MS, OTR/L

I am an occupational therapist in New Jersey and just finished reading Jeffrey M. Arnette's article on combining occupational therapy and physical therapy as one animal [" New Professional Standards To Enter O&P: A Plan," February 2004]. Although I can see how he could make the assumption that this idea may save on Medicare costs, I do not think that he fully understands what goes into a person's rehabilitation. For example, if a person has a stroke, it is likely that he will need occupational therapy, physical therapy, and speech therapy. Medicare would have to put out the same amount of money to rehab this person secondary to the amount of therapy needed.

This person could conceivably need balance training, lower-extremity strengthening, upper-extremity strengthening, vision therapy, sensory reeducation, neuromuscular reeducation, cognitive therapy, fine motor/gross motor control retraining, self-care training, driver reeducation/therapy, adaptations to one's home, vestibular rehab, relaxation technique training, energy-conservation/work-simplification training, joint-protection education, body-mechanics training, a work-hardening program--need I go on?

To think that all of this could be achieved by one person is hard to believe. Without even considering the insurance aspect, a person would need to spend as much time in school as an MD to be able to perform all of these services to one person. This would, in turn, require raising a person's salary (because of the money spent for schooling), and therefore raising rates of rehab for Medicare. I also left out all of the speech therapists' duties, which include swallow evaluations, speech retraining, etc.

To say that an occupational therapist and a physical therapist could combine professions to save money is like saying that a gynecological MD and an urologist could combine professions to save money.

It's all the same, right?

Denise D. Shalonis, MS, OTR/L

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