The ‘Co-Treat' Therapy Team
Last month, I began working with a unique and challenging patient at my facility. The person in question had not been out of bed since early spring, had serious comorbidities including permanent ROM limitation of most joints, chronic pain and (not surprisingly) was of a bariatric size. Having read this patient's POC goals, I was already frustrated without even one treatment session being completed.
Bed mobility without hand rail assistance? Static seated balance -- edge of bed? This person was a two person max assist for log rolling in bed with trace trunk stability -- how was I going to help him meet this goal? Obviously, this treatment session was a bigger undertaking than I could handle, literally. I would need a second and possibly third person to assist me with providing just functional (and safe) positioning techniques in supine.
The understaffed and overworked CNAs would help of course, but didn't have the luxury of an hour to assist with the patient's seated balance. However, very often I'll incorporate the patient's bed mobility training with functional tasks such as donning/doffing clothes and hygiene care along with the aide staff -- who are more than delighted to have an extra hand offered by therapy.
In this case, I tapped my colleague in the gym office, a COTA who was just as frustrated with how she was going to approach this patient's treatment. Interestingly enough, she told me that she had not participated in many co-treatment sessions with PT in her career. I was stunned because it was a daily occurrence for me at my former facility.
This patient was the perfect candidate for a PT/OT co-treat: significant weakness both in upper and lower extremity, low endurance to complete two separate skilled therapies in one day and the multiple-person assist he required. I reviewed what my focus would be for that treatment (bed mobility and LE therapeutic exercise) and she communicated the OT goals (increase UE ROM and core strength). With this clear delineation between our goals, we were able to assist each other when necessary and offer an effective co-treatment session that served the patient and both therapy disciplines' POC.
As this patient became stronger, his pain was reduced and his activity tolerance increased. After a few weeks, the COTA and I began initiating our treatment sessions separately in the morning (occupational) and afternoon (physical therapy). Had our two therapy disciplines not joined forces in those early weeks, the patient wouldn't have progressed as far as he has today or perhaps not at all. Every patient has individual challenges when it comes to therapy, but I've found (when appropriate) that teaming up with other therapists (whether OT or speech) can lead to successful outcomes for everyone.