A gift in a question... what have you always wanted to do?

We have long had "Patient Goals" on all our assessment documentation. We always ask patients what they want to acheive in their therapy. As an OT and RFT we would still get the most common answer "I want to be able to walk." Instead of ever being discouraged by this response (and especially if ambulation seemed like a distant possibility) I would try to get the functional aspects of why the patient wants to walk. The patient's goal would rapidly become "to be able to walk into the kitchen and make myself a sandwich" or up to "walk into the woods to sit by a stream". Then if ambulation was a long way off I'd see if there were a way to meet the functional need from another level, hence independent at wheelchair level could be more palatable. Again, if ambulation was appropriate and the functional barrier to the goal, it has always seemed that functional mobility is right up OT's alley.

I was reading a thread on the OTNow list about a particular patient's goals when I recalled an old lesson that I have incorporated many times since. When the patient cannot come up with any goal, or only states a raw task like walking with no functional reason for it, I've asked the more "bucket list" type question. "What is something you always wanted to do?" It had been put to me in university as "what is something you've always wanted to do before you die?" I haven't always used the weight of "before you die" but having it in my mind keeps me focused on what I want them to think about. What a gift if we can get someone out of ruminating on the physical limitations and seeing the possibilities.

In particular this has played out in patients with paraplegia/quadriplegia. Where the "I just want you to get me walking again!" can really turn into a new and positive direction if we open up this type of conversation. Also, having it can remind people that they always wanted to play an instrument or write a book.

We have so much to offer, sometimes it may just be a simple question that helps someone think about a future that isn't dealing with an acute illness or injury.

Yours,

Ed Kaine, OTR, RFT
President of the League of Functional Therapists
http:www.FunctionalTherapist.org

Functional Therapy... the Next Generation of Occupational Therapy!