Other OT-Related Information OT versus PT

[SnakePlissken]

Hello everyone,

I know, the question that already has so many threads. However I feel that all of them were unfulfilling to me. For every difference i've heard, I could come up with a counterargument. For instance, it's widely regarded that OT's work on ADL's while PT's focus more on mobility, balance and gait. However, both are trained in those same areas, and aren't PT's essentially improving ADL's anyway when fixing gross motor issues? The only difference that really stuck with me was within a recently published video that stated PT's ask "what can I fix?" while OT's ask "what do you want or need to fix?" Even so, i'm sure there are settings out there where PT's work more holistically and it's supported by the insurance company and state laws. Maybe i'm being too hopeful, but perhaps with enough people this could be the end all "PT vs. OT" thread? I think this is a huge problem, otherwise why would OT school interviewers ask "describe OT in your own words?"

Another reason I ask is because I guess that I seek a more personal answer as well. Like many PT students I graduated with an Ex Sci. degree and currently work for a rehab company doing personal training for seniors. I am very passionate when learning about gait and mobility in my personal life when I seek to repair myself after strength training. I would love to learn the hard science behind such topics and teach them to real life patients, but at the same time I would rather do so in a holistic fashion and not ignore the cognitive side of the picture. I was and still am prepared to apply to OT school because that's how my pre-reqs were designed after becoming passionate about OT after multiple observation settings. With that said, I think subconsciously I might also be leaning towards OT school more just because it's easier, and in some settings OT's and PT's do the exact same thing anyway. One OT even told me she's seen PT's do hand therapy, so what's the difference? Thanks for reading, and I hope there will be some replies here that spark a greater understanding between the two occupations, which may help other people and myself to decide which route is the best one to take.

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[Kidamnesiac]

It's hard to answer (at least for me) because I'm not sure about a PT's scope of practice. Probably, like OT, it's hard to define unless you look at it in situ. I know that rehab is too big a field for just one or the other, and that we each bring something really important to the table. I think that OT's have done a great job of bringing the top-down approach, task analysis, and employing the PEO model. I would imagine that our field is pretty strong in those, and that we have a bit more reach than PT (like mental health, ID/DD, or friend for example), but PT's are much more equipped for areas like sports. I think of OT's as advocates of the occupation...we help identify, uncover, analyze, and establish/reestablish occupation. I know that sounds redundant, but it is unique to our field. Doctors, nurses, PA's, PT's, SLP's, etc...have their own strengths and emphases, and thus, it is our job to advocate for occupation on the team.

 

[SnakePlissken]

It's hard to answer (at least for me) because I'm not sure about a PT's scope of practice. Probably, like OT, it's hard to define unless you look at it in situ. I know that rehab is too big a field for just one or the other, and that we each bring something really important to the table. I think that OT's have done a great job of bringing the top-down approach, task analysis, and employing the PEO model. I would imagine that our field is pretty strong in those, and that we have a bit more reach than PT (like mental health, ID/DD, or friend for example), but PT's are much more equipped for areas like sports. I think of OT's as advocates of the occupation...we help identify, uncover, analyze, and establish/reestablish occupation. I know that sounds redundant, but it is unique to our field. Doctors, nurses, PA's, PT's, SLP's, etc...have their own strengths and emphases, and thus, it is our job to advocate for occupation on the team.

Thanks for your response. Yes I think it really is as simple as the title of the job states, dealing with Occupation, and I may be thinking about it too deeply. Another great way to tell the difference is going through any schools' course curriculum and look at PT vs. OT, which I did. It looks like that unlike PT's, OT's will learn Occupational science first and then the subsequent physical and psychiatric disabilities that would hamper those specific occupations, whereas PT's learn on a more superficial level about the neurological and musculoskeletal conditions that hamper basic mobility and gait. I see mention of only 1 or 2 courses involving psychological issues in the PT curriculum, and it looks like they involve how physical disability affects emotional wellbeing rather than the treatment of the psychological issues themselves.

 

[resot]

For instance, it's widely regarded that OT's work on ADL's while PT's focus more on mobility, balance and gait. However, both are trained in those same areas, and aren't PT's essentially improving ADL's anyway when fixing gross motor issues?

Hi, snake. I want to weigh in on this.

It seems to me that you have a fair understanding of what PT is, but not quite as good of a grasp of what OT is. And that isn't necessarily your fault because superficially the two can come across as very similar, but as someone who recently graduated from a program, let me share my thoughts with you.

OTs and PTs are NOT trained in the same areas. Yes, in OT school we study gait during kinesiology courses (at least, that's how it was in my program). But I would not say that I was "trained." Yes, we talk about balance and mobility, but we are not "trained" in all of the nuances; we learn (relatively briefly) about those topics from the perspective of functional balance and functional mobility.

From the PT perspective, they are not trained in the same areas (ADLs) like OTs are either. ADLs are more complex than just mobility, balance, and gait. There are cognitive components (is the patient sequencing an ADL task like brushing their teeth properly?), visual perceptual components (teaching and practicing strategies to decrease left side neglect for one example), and more. Yes, PTs will cross into these areas directly (just like OTs cross into PT areas like balance and mobility), but it is in OT that we can focus and really develop these skills. Or that's what we are hypothetically trained to do, anyway.

Now, are there exceptions? Of course. I've seen experienced PTs who work hard to integrate their goals into functional tasks. And I've seen experienced OTs who have learned more about gait than a new grad PT does. But the point is, we are not "trained" in all these areas.

Also, hand therapy is a specific specialization that is open to either PTs OR OTs. We cannot claim it as our own territory. Most hand therapists tend to be OTs, but I've met many PT hand therapists as well. This is the only setting where the two disciplines are identical. However, I think that a new grad PT is better prepared than a new grad OT is if they wanted to freshly enter this specialization because PT training is more biomechanics/anatomy/kinesiology specific.

 

[Should_I_continue_OT]

One thing I've heard is that PT's act like dads (tough love, pushing you) and OT's act like moms (nurturing, supportive, more attuned to emotions).

SnakePlissken wrote: PT's learn on a more superficial level about the neurological and musculoskeletal conditions...

At least at my school, I'd say the PT's learn as much if not more than OT's about those two things.

 

[SnakePlissken]

Hi, snake. I want to weigh in on this.

It seems to me that you have a fair understanding of what PT is, but not quite as good of a grasp of what OT is. And that isn't necessarily your fault because superficially the two can come across as very similar, but as someone who recently graduated from a program, let me share my thoughts with you.

OTs and PTs are NOT trained in the same areas. Yes, in OT school we study gait during kinesiology courses (at least, that's how it was in my program). But I would not say that I was "trained." Yes, we talk about balance and mobility, but we are not "trained" in all of the nuances; we learn (relatively briefly) about those topics from the perspective of functional balance and functional mobility.

From the PT perspective, they are not trained in the same areas (ADLs) like OTs are either. ADLs are more complex than just mobility, balance, and gait. There are cognitive components (is the patient sequencing an ADL task like brushing their teeth properly?), visual perceptual components (teaching and practicing strategies to decrease left side neglect for one example), and more. Yes, PTs will cross into these areas directly (just like OTs cross into PT areas like balance and mobility), but it is in OT that we can focus and really develop these skills. Or that's what we are hypothetically trained to do, anyway.

Now, are there exceptions? Of course. I've seen experienced PTs who work hard to integrate their goals into functional tasks. And I've seen experienced OTs who have learned more about gait than a new grad PT does. But the point is, we are not "trained" in all these areas.

Also, hand therapy is a specific specialization that is open to either PTs OR OTs. We cannot claim it as our own territory. Most hand therapists tend to be OTs, but I've met many PT hand therapists as well. This is the only setting where the two disciplines are identical. However, I think that a new grad PT is better prepared than a new grad OT is if they wanted to freshly enter this specialization because PT training is more biomechanics/anatomy/kinesiology specific.

Thanks for your input. I know the programs are academically rigorous and that there's so much information crammed in that students only briefly learn certain areas. I was surprised when you said you weren't trained, however. Do you not prefer the term "trained" because it doesn't represent the learning process? Certainly you must have been trained in hands-on techniques such as crutches, transferring, massage, ice baths, functional movement screening etc. otherwise where would you learn it, on the job?

 

[Chanandler Bong]

I think this is a huge problem, otherwise why would OT school interviewers ask "describe OT in your own words?"

When people ask what I'm applying to grad school for, I say, "Occupational therapy -- it's a lot like physical therapy," because otherwise they'll think I want to help people find jobs.

 

[resot]

Do you not prefer the term "trained" because it doesn't represent the learning process? Certainly you must have been trained in hands-on techniques such as crutches, transferring, massage, ice baths, functional movement screening etc. otherwise where would you learn it, on the job?

In my post, I use "train" versus "learn" differently.
Learn: It is covered in class. Might be for just 30 minutes in all of your OT education from your graduate program. Or it might have been covered in 30 class sessions.
Trained: It is covered and reiterated in class. And not just in class, but in FW by mentors. I am set up with a solid foundation and understanding such that I can go into a work setting and use my "trained" techniques with my patients/clients safely. (Even if it isn't 100% something I know; I can easily pull out an old OT textbook for more info/assistance.)

Let's look at your examples:
Crutches: Nope. Not trained in crutches. Very briefly "learn" about ambulation with canes during coursework. Am I going to be teaching someone how to use a cane as an OT? No. Will I eventually become "trained" through real life experience as I work in a hospital on how to ambulate with a cane? Sure. But we are not set up for it in coursework. And I still would NOT presume it is my job to educate a pt about it (unless its' just review) because it is technically PT domain. And some PTs are territorial.
Transferring: Of course! We need to know how to do this. We are "trained" in this topic at school and FW. You can't get your patient on to a commode or their wheelchair if you don't know how to transfer. But we are not "trained" in depth for all transfers we may encounter in the real world (refer to my example later).
Massage: Nope. Not covered in school. One of my courses briefly taught us how to do retrograde massage on a patient with edema, but that is all. Am I an expert? Hell no. However, I did learn values of soft tissue massage at my hand clinic, and I did a lot of it there. But once again, PT and OT is similar at a hand clinic.
Ice baths: In my program, you are briefly taught modalities. (some of them we got to experiment, some of them we just read about from our text). Would I say I was "trained"? Once again, hell no. Modalities are part of a PT program (I believe). For OTs, we need to do additional education and certification after graduation to use modalities (PAMS certification). At the hand clinic, I did use modalities (while supervised by my CI). At the hospital, I was not allowed to even put a bag of ice on a patient's leg/arm unless I had my PAMS certification.
Functional movement screening: As an OT, we do not focus on movement/mobility itself. As a result, we do not screen for it. That is a PT's job. We might learn a few mobility assessments/screenings in school, but that will be a small percentage of what we learn and it is not going to be emphasized.

You have an excellent understanding of PT (most of your examples are PT related). I think it's making it hard for you to separate the two disciplines. Yes, we look at mobility and movement, but we look at it as a SMALL component that influences our main focus. For example: At a hospital we may have a goal like this: Pt will complete grooming while standing at sink with modified independence. Is mobility a component of the goal? Yes, to be able to stand safely, a patient has to have strong lower extremities and good balance. Are we going to spend our future sessions exercising the patient's legs? No. We may indirectly work on their legs by doing other tasks (standing while folding laundry, playing Wii while standing, etc). But it will not be our focus. That's not what we do.

Where would you learn it, on the job?
OT programs are meant to produce OT generalists. We are taught a lot about OT in general, but to learn specifics... yes. We have to learn it on the job. This is why picking the right FW setting is important, because your FW will continue to build on the foundation that your school program set up. OT is so different in its different settings; there's no way a program can teach and train us on all that content. When I completed my FW at a hand clinic, the only thing my school education really set me up to succeed at was anatomy. All the hands on therapeutic techniques I learned on site. Like I said earlier, we briefly covered ultrasound, TENS, NMES, and other modalities in school. But not enough that I really understood it all until I arrived to the clinic. When I was at the hospital for my FW, I was a little better prepared: I had a good understanding of transfers, ADL training, DME equipment, and neuro. However, I was still jumping around every day learning about how to improve upon what my school taught me and what is actually utilized in the real world.

(Sorry, this is a long post). One thing I did remember thinking during my time at the hospital was: Damn, I wish I knew more PT-related knowledge. For example, I was observing an OT in the acute section of the hospital with a pt who had a hip replacement. The pt wanted to get out of bed and sit in a chair (she had been in her bed for about a week). The pt has not yet received any PT yet, this was her first therapy at all. The OT decided to help her transfer using a front wheel walker; I ran and grabbed one from the supply closet. I came back with the first walker by the door and was quickly informed by the OT that I made a good choice and chose the the right front wheel walker (there's multiple types???). And then she proceeded to teach the patient how to transfer for the first time using the walker (stand pivot). Keep in mind that the patient is completely non-weightbearing on one of her legs and there's a step by step process to do this safely. And when the patient impulsively lurched forward (she's on medication for pain), the OT was right there to catch her and continue coaching her through the transfer.

If I had been on my own in that acute wing with this patient as a new grad, I would have failed miserably if I attempted this (and probably would not have attempted it at all). At that point, I realized I didn't know how a pt was supposed to complete a stand pivot transfer with a front wheel walker when she is non weight bearing. I would have probably chosen the wrong walker (one with wheels which would have been even more dangerous). And I wouldn't have been able to spot her fall. So bad on so many levels. Is this something that I would eventually learn? Probably, because I would be repeatedly exposed to similar situations if I worked in this setting. Am I taught all this stuff in school? Hell no. Do I feel "trained" and qualified to do this technique with my patients as a new grad? Absolutely not.

Keep in mind that I went to a school that emphasizes "hands on" learning about clinical application of therapy versus a school that focuses on theories and frameworks. There are other schools that prepare their students for real world therapy even less.

 

[Should_I_continue_OT]

Keep in mind that I went to a school that emphasizes "hands on" learning about clinical application of therapy versus a school that focuses on theories and frameworks. There are other schools that prepare their students for real world therapy even less.

Resot, is it possible to find out before enrolling whether a program is clinically based vs spending a lot of time on theories and frameworks? What seems to happen is that most schools are swamped with applicants and don't have time to answer questions. I have difficulty even getting questions answered from the admissions department of schools I'm considering transferring to.

 

[sngot]

Thanks for your input. I know the programs are academically rigorous and that there's so much information crammed in that students only briefly learn certain areas. I was surprised when you said you weren't trained, however. Do you not prefer the term "trained" because it doesn't represent the learning process? Certainly you must have been trained in hands-on techniques such as crutches, transferring, massage, ice baths, functional movement screening etc. otherwise where would you learn it, on the job?

Many of the modalities you list are great to use in therapy are great but cannot be done during an OT session alone. It's not about training in crutches but what does using crutches allow you to do. Massage and ice baths are great and can be used but aren't focuses for an OT because it lacks function such as working, playing, eating.

PT and OT can do similar aspect in physical rehabilitation (both can do hand therapy) but it goes beyond that. PT are more concentrated in physical mobility and strengthening. They typically have a better understanding of neurology and kinesiology. OT would focus on independence and executing of what is needed. Someone in a wheelchair. PT would try to get that person get out. If they cannot, then it is about using the wheelchair. OT would help that person cook, work, or other tasks that are meaningful and important. They are some overlap from the outside looking in but the specifics makes all the difference.
Places are using interdisciplinary approach which is great because different profession have different focuses. If you think cognition is important than that would be more OT.

 

[resot]

Resot, is it possible to find out before enrolling whether a program is clinically based vs spending a lot of time on theories and frameworks? What seems to happen is that most schools are swamped with applicants and don't have time to answer questions. I have difficulty even getting questions answered from the admissions department of schools I'm considering transferring to.

That's a great question. I wish I had an easy answer. You're right when you say it is difficult to get an answer from the admissions department about this. And even if you do, it may not be accurate.

One way you can find out is by networking with OTs and therapy facilities near/around the school who have taken their students for FW assignments. These OTs/facilities usually have a feel for what students from different school are like: well prepared vs unprepared. Some sites even have such bad experiences with students at certain schools that they refuse to take any future students from certain schools.

Another way (but less effective than the first way because there might be bias involved) would be to ask new grad OTs how they felt about their schools and how well they were prepared once they entered the workforce.

 

[Should_I_continue_OT]

That's a great question. I wish I had an easy answer. You're right when you say it is difficult to get an answer from the admissions department about this. And even if you do, it may not be accurate.

One way you can find out is by networking with OTs and therapy facilities near/around the school who have taken their students for FW assignments. These OTs/facilities usually have a feel for what students from different school are like: well prepared vs unprepared. Some sites even have such bad experiences with students at certain schools that they refuse to take any future students from certain schools.

That's difficult to do when you aren't in the same part of the country as the school you are considering, or when you have difficulty getting in touch with the OTs locally for shadowing and such. I guess if I went to the AOTA conference, I would have possibly gotten to do that.

From what I heard from one school I considered, it sounded like some of their students were underprepared for fieldwork and so they mostly placed their fieldwork students out of the area or at SNFs.