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Therapy Skills Too Complex To Combine
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
Letters to the editor may be edited for space and
clarity. 
Table Of Contents - April 2004
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