April is Occupational Therapy Month. But what is occupational therapy, and how does it compare to physical therapy? Andrew Morgan, PT, DPT, MBA, COS-C from Homecare Dimensions, breaks down everything you need to know.
April 24, 2024
Docs in a Pod focuses on health issues affecting adults. Providers and partners discuss stories, topics and tips to help you live healthier with hosts Ron Aaron, Dr. Audrey Baria and Dr. Tamika Perry.
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Show transcript
Podcast transcript
INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts, Dr. Tamika Perry, and award-winning veteran broadcaster Ron Aaron, will share information to improve your health and well-being. Now, here are Ron Aaron and Dr. Tamika Perry.
RON AARON
Well, thank you so much for joining us today on the award-winning Docs in a Pod. We're available wherever you get your podcasts. We're on the radio as well in a number of markets in Texas and Florida; I'm Ron Aaron. Our co-host, Dr. Tamika Perry is with us. Dr. Perry is an associate medical director and physician at Wellman at Redbird Square in Dallas. She completed her master's degree at the University of North Texas Health Science Center in Fort Worth. Earned her medical degree at Philadelphia College of Osteopathic Medicine in Philadelphia. Also earned her master's in public health from the University of North Texas. Dr. Perry is a graduate, has a graduate degree, undergraduate degree from Prairie View A&M University. She also on the side, loves to travel and has been to seven continents looking to get to Antarctica, Australia and South America to complete that commitment. Dr. Perry, it's great to have you with us.
DR. TAMIKA PERRY
I've been to four of the seven. Wait, I think I only have two left. I have been to South America, so I have Australia and Antarctica left. I'm excited about that. I haven't really got many of my friends to sign on because in a few years, believe it or not Ron, I'll be 50, so that's what I want to do for my 50th. If I have to do it by myself, I'm going to do it.
RON AARON
What would you do there?
DR. TAMIKA PERRY
Take a selfie so my iPhone proves that I was there and then get back on the plane or boat and go back to South America.
RON AARON
How do you do in cold weather?
DR. TAMIKA PERRY
I've learned to appreciate skiing, but you know, I think I do much better in warmer weather.
RON AARON
Well, unfortunately, the Earth is warming, so by the time you get to Antarctica, it may be okay.
DR. TAMIKA PERRY
It may be okay, but I still don't think it's going to be swimsuit season in Antarctica anytime soon.
RON AARON
Probably not. Well, this month is occupational therapy month, and I'm assuming that among your patients, frequently you are referring a patient for occupational therapy.
DR. TAMIKA PERRY
I am so excited to have our guest today because I have to admit, y'all don't tell anyone, it wasn't until I was in medical school that I knew what an occupational therapist actually did. I'm like, why is that different than physical therapy? But yes, I use occupational therapy quite often, so I am excited to hear about the nuances of the profession.
RON AARON
Well, let's introduce Andrew Morgan. Dr. Morgan has a doctorate in physical therapy. He's had over 20 years or more of clinical experience; earned his bachelor of science of education degree from Baylor University and his master's and doctorate degrees in physical therapy from UT Health Science Center in San Antonio, and he has worked for Home Care Dimensions under the WellMed banner in UnitedHealthcare Group. He has spent a lot of time in the field, not only as a practitioner, but as a supervisor, as a manager and a teacher. He's a regular contributor to Docs in a Pod and other WellMed radio opportunities, and he has given talks at WellMed Senior Centers in Texas and elsewhere. We are delighted, Andrew Morgan, to have you with us.
DR. ANDREW MORGAN
Hey, Ron, thank you for having me again. Always look forward to getting to chat with you.
RON AARON
Let's begin with what Dr. Perry was dancing around. What is occupational therapy and how does that compare with and differ from physical therapy?
DR. ANDREW MORGAN
I'll begin with, there are a lot of similarities. There's a lot of crossover between what a physical therapist does and what an occupational therapist does. I'd say when you really start to get to some of the nuanced differences, especially for the listeners, if you think about gross motor movements; walking, getting in and out of a car, so transfers, big motor movements, that's probably going to fall under physical therapy. With occupational therapy, you're looking at a lot more of the fine motor stuff; activities of daily living, like brushing your hair, brushing your teeth, dressing, that's going to more fall under occupational therapy. There's been plenty of times if occupational therapy is not available, I may wind up working on the activities of daily living and an occupational therapist, if physical therapy is not available, may wind up working on something like ambulation or gait training.
RON AARON
So you're really cross-trained?
DR. ANDREW MORGAN
There is a bit of crossover. Some people think that it's a misnomer out there that the occupational therapist, they work on the upper body and PTs only work on the lower body. I jokingly will tell people, yeah, that's right. I remember when I was in physical therapy school, when we were working on doing cadaver lab, we had a curtain that just was from the waist down. We weren't allowed to look at anything from the waist up, so that's not the case. In fact, occupational therapists, they work on the legs just like PTs will work on the arms.
RON AARON
All right. Stay with us for just a minute. I want to let folks know who may have just joined us. You're listening to the award-winning docs in a pod. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry, and our special guest today is Andrew Morgan. Has a doctorate in physical therapy, works for Home Care Dimensions, a WellMed company, and we're talking about, in honor of occupational therapy month, what it's all about and how it works. I can remember Andrew, after I had knee replacement surgery, you were assigned to come out as my physical therapist to get that knee working again and to get me up and moving about. When you address those kinds of surgical challenges, especially with older people, what are you looking for? What are your concerns?
DR. ANDREW MORGAN
When somebody asks me, what is a physical therapist? A physical therapist is a movement scientist so I'm looking at how you're moving. I am an expert in normal human movement, so is an occupational therapist. Even a speech, a speech language pathologist, all of us are really focused on how the human body is supposed to move normal human movement. Therefore we spot things that are abnormal, so like in your case, since you brought it up, no violating HIPAA.
RON AARON
I wave my HIPAA. I'm a HIPAA waver.
DR. ANDREW MORGAN
When somebody has a knee replacement, they're going to have limitations in range of motion, and that's going to be the very first thing that we want to focus on is restoring that normal motion to the knee. What that's going to do is then allow you to be up and moving around, start walking. Some of the things that I'm going to look at, is your foot clearing enough? Is it so that you're not at a risk for falling? An occupational therapist, when it comes to a knee replacement may look at something like you're not able to bend your knee as much, so therefore you're having difficult with bathing and reaching certain areas. They might come in with some adaptive equipment and teach you how to use that so that you're able to wash all of those difficult to reach places.
RON AARON
I can remember when I was about to have my surgery, Dr. Uvopadhyas was my surgeon. He's now retired, but I asked him what in hindsight was a pretty silly question, but he didn't laugh. I said, okay, so you're putting in this metal chunk that becomes my new knee joint. How does it know to move? What makes it understand how to do the stuff knees do?
DR. ANDREW MORGAN
The human body is a remarkable thing. I remember my former neighbor, he's an ENT, and he was really interested in orthopedics until he observed his first hip replacement. His wife is a physical therapist as well and he said, I don't know how people walk after that. Let alone everything else. I don't know how you walk. He had a respect for what it is that therapists do.
DR. TAMIKA PERRY
Absolutely. The signal to tell that what to do isn't cut off, the actual joint itself has been replaced. Dr. Morgan, I agree with that whole orthopedic situation. When I was in med school as a med student, when something is getting amputated, your job is to hold the extremity until it's cut off. Then you're holding someone's leg there, right? Orthopedic surgery is extremely, and I love all my orthopedic surgeons, but it looks brutal when you're in there. The first time I saw a replacement of a joint, I'm like, that's the same thing my dad has in his toolbox. That's literally like a drill, a chisel. My hats off to those professions, but a bigger hat off to you guys to help us cope with those joint replacements afterwards and help us do things like bathe our parts and walk to the kitchen. Really, isn't that a major difference in occupational and physical therapy? You're teaching me how to move so I can do my activities of daily living. I can get my life back the way that it used to be. Like, if I've had a stroke or had a joint replacement.
DR. ANDREW MORGAN
Yes, that's the big thing, we're both focused on movement. Since you mentioned walking to the kitchen, as an instructor, I've had so many say, gait training is just for physical therapy. And I said, really? OTs work on cooking, how are you going to get to the kitchen if you don't work on the gait training. Some of it comes down to how we document, but really, I look at these things as patient-centered goals. What are the things that we need to address with you as a patient? I'm less concerned about, oh, this is the OT scope of practice. This is PT scope of practice. If it's speech, I probably feel the least comfortable going into there. I really want to look at what is the patient's concern?
RON AARON
Now stay with us, we're going to come right back to you. We're talking about occupational therapy month. Talking about both physical therapy and occupational therapy, and speaking personally, not being able to walk into the kitchen would not have hurt me. I'm Ron Aaron along with our co-host. Dr. Tamika Perry and our special guest. Dr. Andrew Morgan. You're listening to the award-winning Docs in a Pod.
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RON AARON
Well, thank you so much for sticking with us right here on Docs in a Pod. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry, the award-winning Docs in a Pod, available wherever you get your podcasts and on the radio as well in a number of markets in Texas and in Florida. Our special guest today in honor of occupational therapy month is Andrew Morgan, a doctorate in physical therapy, and we're talking about what occupational and physical therapists do. Dr. Morgan, I want to go back to the beginning. How and why did you choose this profession?
DR. ANDREW MORGAN
I always knew that I wanted to do something in the medical field. In middle school and in high school, I was an athlete. Actually, in college, too, I was an athlete. At some point, I can't remember exactly when, I discovered the field of physical therapy. At first, I thought I wanted to go work with athletes, and then I realized that I did not want to work with athletes. They're probably one of the most difficult populations to work with. I really, I fell in love with working with geriatrics, and I take a sports medicine approach into the home with our geriatric patients.
RON AARON
I heard you say early on, you're trying to find what their goals are versus what your goal might be.
DR. ANDREW MORGAN
It has to be centered on what the patient wants.
DR. TAMIKA PERRY
What you said earlier really resonated with me. You said you're a doctor of movement or mechanics, and we're not talking about prescribing medicines or rubbing on, but really talking about how your body moves and how you can help individuals move their body, right?
DR. ANDREW MORGAN
That's correct. Sometimes I'll liken what I do to being a car mechanic. Most people, when they go see a physical therapist, it's probably because of some sort of pain and I'm concerned about the pain to the extent that I can figure out what causes it. Pain is a symptom of an underlying problem, and if it's something that is musculoskeletal in origin, then my goal at first is to reproduce the pain, and then that tells me what it is that I need to correct. I'm really trying to correct that movement dysfunction so that our patients don't have that pain.
RON AARON
And when you see somebody walking on the street, or wherever you may be, can you spot people who, if they walked a little differently, they would do so much better?
DR. ANDREW MORGAN
My wife has to stop me from doing it sometimes. This is a true story. One of the things we learned, I think it was my first year in physical therapy school, it's called observational gait analysis. It's how you walk. That's a fancy way of saying how you walk. My professor told us all go to the mall. He said, go to North Star Mall, watch how peak people walk, get behind somebody and try to mimic what they're doing and that'll help you really figure out that that's a good way to learn gait analysis. He was joking, I think, when he told us that, but I actually did it.
RON AARON
And you were arrested as a stalker?
DR. ANDREW MORGAN
No, but it really did help me. The instruction was actually a good instruction to learn what is going on mechanically with somebody. The problem is, even today without realizing it; sometimes I'll be watching somebody and my wife will catch me starting to walk like them. I don't even do it on purpose anymore and she'll kind of elbow me and tell me to knock it off.
DR. TAMIKA PERRY
Dr. Morgan, when you were doing your exercises, did you go as far as to put on the type of shoes? Would you put on the ladies high-heel shoes? Because I promise I walk differently in high heels than I do in my flats. To get a true analysis now, you know what I mean? You really want to see a gait, you gotta walk the walk for real.
DR. ANDREW MORGAN
If you were to ask any, physical therapist or OT is going to tell you don't wear heels. They're, just a problem.
DR. TAMIKA PERRY
You would probably go bananas if you open up my closet.
DR. ANDREW MORGAN
I mean, from one respect, I could say, well, that's job security for me because I can see all the problems you're going to have later on.
DR. TAMIKA PERRY
Yes, yes. You made a great point about looking at someone and analyzing, reproducing your pain and how could you fix the pain? I want to say how your profession 100% complements my profession. The two professions are intimately tied together. We don't necessarily as clinicians want you to take medicine appeal for everything. If you repeatedly take insets, they're like, nonsteroidal, anti-inflammatories. Regular Ibuprofen, Motrin, Alive that you get over the counter, you could knock out your kidneys. You take regular old Tylenol that you get over the counter. If you take too much of it, you can knock out your liver. We want to utilize every modality possible to help you alleviate pain, suffering and maintain your normal activities of daily living.
RON AARON
And for our regular listeners who may know, but others may not know that you have a doctorate in osteopathy, and you look at how the body works as well as the medical ailments that we may face.
DR. TAMIKA PERRY
I do. DOs are trained in something called manipulative medicine, in which much like Dr. Morgan, we look at the body, we try to reproduce that pain and we say, what type of manipulative maneuver can we do to help alleviate that pain? Sometimes we use it solo, sometimes we use it in conjunction with pharmacotherapy, but the point is that any clinician wants you to use as many modalities that causes the least amount of harm to you as possible to get you back to your normal function.
DR. ANDREW MORGAN
That's right, and I'm also trained in joint manipulation and a lot of people like it when we do that, but it's one of those that's not my go-to thing. I will use it if I have to. In the geriatric population, not that often, but I have a couple of times. Even then, we’ve freed up the mechanical restriction, now you've got to move in this new, available range of motion. Otherwise, it's going to go right back to how it was before.
RON AARON
And how do you relearn to move in a different way?
DR. ANDREW MORGAN
Oh, well, to quote Yoda, you must unlearn what you have learned. That that's through repetition. Lots and lots of repetition. When it comes to motor learning, and I used the term musculoskeletal earlier. If any of my professional colleagues are listening, I apologize because I know the new term is neuro musculoskeletal, and this is the neuro part of it. It takes one to three thousand repetitions to learn a motor function, whatever that function is. It could be swinging a golf club, it could be shooting free throws, it could be getting on and off a chair. If you've learned a motor pattern incorrectly, it takes three to five times that to unlearn and then relearn it correctly. That's where having somebody like an OT, like a PT come in and observe how you're doing things, to make the corrections where possible, teach you how to do it correctly. You mentioned earlier about having a stroke. Sometimes, someone may have a stroke and the motor function is just not going to return. Now we have to adapt and that's where teaching somebody how to use adaptive equipment may come in and we modify the movement itself.
DR. TAMIKA PERRY
A lot of times PT and OT, from my experience, will give the patient homework. Like, these are exercises to do on your own after you've taught someone. I try to reiterate, it's so important that you do your homework, you don't just do it three to five times a week.
DR. ANDREW MORGAN
I call it your muscle medicine. You take your blood pressure medicine from your heart doctor or from your primary care physician. I'm your muscle doctor, so you got to take your muscle medicine.
RON AARON
You know, it's interesting. After my knee replacement surgery, a woman who was working with me as an occupational therapist, my wife said, can you help Ron understand how to get in and out of his car without putting stress on his new knee? And she did. We went out to the car, she showed me a way to get in, turn around, sit down, and then swing my legs around that I had never thought about. Of course, I went right back to the old way of doing it, stretching my leg in, reaching in, and kind of hauling myself in. Had I practiced that, it would become a habit.
DR. ANDREW MORGAN
That's called regression to the mean. Nature likes things to be an equilibrium. You've got to be consciously aware and practice doing it correctly. There's a misnomer; practice makes perfect. Practice makes permanent.
DR. TAMIKA PERRY
Yes. Oh, I love that.
RON AARON
It's a bumper sticker, I like that. Before we let you go, tell me when you think you should see and might need a physical therapist. Is there something you can recognize yourself or does it take a PCP to see it?
DR. ANDREW MORGAN
I'll say more often than not, the person that recognizes it is the family member. Patients will tell me, oh, I can do everything. If I ask my patients, half of them will say, oh, yep, I can. I climbed Mount Everest last week and I'm doing the Iron Man triathlon next week. Patients can do everything and they've never had a fall, but family members are usually the ones that'll notice when there's been a change.
RON AARON
Got to stop you right there, Andrew Morgan. Thank you so much, Dr. Andrew Morgan, our special guest today and to our co-host, Dr. Tamika Perry. Thank you all for joining us on the award winning Docs in a Pod.
OUTRO
Executive Producers for Docs in a Pod are Dan Calderon and Lia Medrano. Associate Producers Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. We welcome your emails with suggestions and comments on this program at radio@wellmed.net. Be sure to listen next week to Docs in a Pod.
Appreciate it. Presented by WellMed.
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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