Occupational Therapy today isn’t what it used to be 30 years ago. Today more and more OTs are thinking outside the box and finding new ways to make activities more engaging, meaningful and relevant to their clients.
Most Occupational Therapists working in rehab or acute care tend to assist patients with their daily activities by introducing them to activities that promote functional independence.
Sometimes these activities include ambulation and this is where physical therapy may feel that OT is crossing the line.
That brings us to the question; should OTs ambulate their patients?
OTs should not only ambulate their patients, but they should be encouraging physical therapists to be doing ADLs.
In this article, I’ll explain why OTs should be ambulating their patients and what they can say to physical therapists who disagree.
Why OTs need to ambulate their patients
OT should ambulate their patients because most OT goals require ambulation. If an OT is working on goals related to lower body dressing, toileting, showering, or grooming and hygiene they most definitely need to ambulate their patients.
Occupational therapy goals should also be specific to the patients goals. If the patient doesn’t want to practice shower or toilet transfers but has a walking goal, OT should do the activity that is most meaningful for the patient.
Other goals to consider might include
– Walking household distances
– Walking kitchen distances for meal preparation
– Walking to the mailbox
Ambulation is important to recovery. You might say that OTs who don’t ambulate their patients are doing their patients a disservice.
Ambulation can be used in conjunction with activities or it can be used as a preparatory activity.
Ambulation also helps OTs understand how a patient’s blood pressure, oxygen, HR, or respiratory rate change during ADLs or IADLs.
How to write ambulation goals
Ambulation goals should always be specific to function. A goal might include the amount of minutes, level of assistance, or amount of cueing needed. Here are a few examples you might use in your documentation.
1. The patient will be able to walk household distances with Supervision.
2. The patient will be able to walk the distance to the mailbox and back with O2 above 90%.
3. The patient will be able to walk the distance from the car to the doctor’s office without a walker.
4. The patient will be able to walk the distance from their house to their car without postural VC.
Note: I wouldn’t include ambulation distance unless it’s specific to the distance needed for the goal.
Is ambulation in OTs scope of practice?
According to the occupational therapy practice framework (OTPF), functional ambulation is part of OTs scope of practice, and it’s also considered an activity of daily living.
Ambulation is included in almost every ADL and IADL. It can be used to prepare a client for an activity or be the activity for a specific goal.
The conflict of ambulation with PT and OT
When it comes to ambulation, physical therapists are the experts. They can do gait assessments, analysis, and they are usually the preferred choice when a patient has a problem related to gait.
However, that doesn’t give a physical therapist the right to see a patient over an occupational therapist.
In rehab, acute care or other settings, I’ve found that physical therapy will sometimes voice their concern when occupational therapy walks a patient.
This concern is usually taken to the director of rehab (a PT) who usually sides with the physical therapist due to their own biases.
The occupational therapist will usually then be told to only do ADLs in the patient’s room.
As a result, the quality of care decreases, as does the level of physical activity and OT morale.
How OTs should respond when PT disagrees
The best way to respond to PT is by working together. If the PT is concerned that the patient will only tolerate one therapy per day, both PT and OT should do a co-treatment, but it’s perfectly fine for an OT to work on goals related to ambulation.
If the patient has additional needs that can be completed in bed, the OT may want to address these needs while the PT works on ambulation.
Here are a few statements an OT can use when responding to PT
- I’m addressing my ambulation goals for the patient which include…
- The patient already completed their other ADLs so we are working on walking ADLs
- Ambulation is an ADL
- I’m working on the patients goals as part of my client centered approach.
You might also encourage physical therapy to work on ADLs. Ambulation and ADLs are not specific to one discipline. When PT and OT work as a team to meet their patient’s goals, they can greater improve the quality of their care.
Occupational therapy today is based on the idea that meaningful activities improve functional outcomes. What is meaningful to the client should not be the decision of physical or occupational therapy.
However, therapists can be helpful in guiding patients by finding activities that are purposeful and engaging. Most of these activities will require ambulation, and this is why functional ambulation is so important in any rehab setting.
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David is the lead editor of OT Focus. He has been practicing as an Occupational Therapist since 2013. He specializes in acute care, hand therapy, and ergonomics.