Mr.jones.PEOP theory applied to treatment
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    Mr.jones.PEOP theory applied to treatment Mr.jones.PEOP theory applied to treatment Presentation Transcript

    • MR. JONES: A CASE STUDY USING THE PEOP MODEL. BY MOIRA SMALL, GINA STANGO, KARI VITORIA, AND JENN PHILLIPS
    • WHO IS MR. JONES? ..
    • A FAMILY MAN
    • FISHERMAN
    • FARMER
    • CHURCH MEMBER
    • LIKES ANIMALS
    • GARDNER
    • LOVES TO DRIVE HIS TRACTOR
    • LOVES TO COOK
    • MR. JONES EXPERIENCED A RIGHT CEREBROVASCULAR ACCIDENT , RESULTING IN: SOME CHANGES TO HIS HOME AND FARM
    • PERSON ENVIRONMENT OCCUPATIONAL PERFORMANCE MODEL (PEOP) “a client-centered model organized to improve the everyday performance of necessary and valued occupations of individuals, organizations and populations, and their meaningful participation in the world around them.” (Smith, Hudson, 2012)
    • 4 MAJOR COMPONENTS • Occupations- self directed activities that occupy ones time(Smith, Hudson, 2012) • Performance-The ability to preform needed skills of occupation and the occupation itself (Occupational-Based Hand Therapy!-PEOP Model, 2012). • Top- down approach- the components that make an individual • Personal- Intrinsic factors that make a person, an individual • Psychological/emotional, physiological, cognitive, spiritual and neurobehavioral. (Occupational-Based Hand Therapy!-PEOP Model, 2012). • Environment- Environmental factors are what allows or hinders the individual in completing their Occupations • Social support, societal stigmas and attitudes, cultural, values that can support or enable, community support, built environments, economics, technology and natural environments (Smith, Hudson 2012)
    • PERSON • • • • • • • • • • • • • • • 72 year old male Prefers to wear bib overalls Prefers to dress up for church Prefers to soak in the tub Mr. Jones likes family photos, collectables and vintage rugs Prefers to watch tv in his “favorite” chair Likes raising hay, cows, pigs, fish and chickens Likes to ride tractor Likes fresh eggs, catfish, milk, and vegetables (especially tomatoes) Likes to can peaches Likes dogs Tolerates entertaining in the home (wife’s quilting bee) Religious Loves to maintain a spectacular yard Right hand dominant
    • OCCUPATIONS • Husband • Father • Farmer • • • • • • • • • • Grows hay for Raises cows, pigs, and chickens Milks the cow Maintains and operates a tractor to care for the land Fisherman Gardner and lawn keeper Cook Care taker of animals Driver for himself and his wife Attends church
    • PERFORMANCE The tasks and subtasks to Mr. Jones Occupations. For example: • Cooking • • • • Cognition to follow directions Bilateral Upper Extremity movement and strength Safety awareness Dynamic standing balance. (just to name a few subtasks)
    • ENVIRONMENT • Strong community ties (lived in the same town his whole life) • Son and neighbors help care for the land and bail the hay • Loving family • Wife-he lives with • Two sons and daughter that work full time • Has land that he raises cows, chickens, pigs, catfish and grows hay • Large garden • Fruit trees • Landscaped yard
    • ENVIRONMENT (CONTINUED) • House • • • • • • • • Older style One story farm house 4 concrete steps to enter with no railings 3 bedroom 2 ½ bathrooms with a claw foot tub Lots of vintage rugs Lots of collectables in the home Chair that is low to the ground
    • OCCUPATIONS THAT ARE IMPORTANT TO ME:
    • PEOP MODEL Identify occupational strengths and problems In occupational performance Assess performance components Assess occupation, activities, tasks Assess environmental conditions
    • PEOP MODEL • Smith-Fess Vocational Rehabilitation Act • Focus: clinical impairments and management
    • PEOP MODEL • Environment is the problem! • A.N.S.I. • Buildings accessible to and usable • Unemployment • Architectural Barriers Act
    • PEOP MODEL • Education • Transportation • Education for all Handicapped Children Act • Uniform Federal Accessibility Standards • Air Carriers Act
    • AMERICANS WITH DISABILITIES ACT 1990
    • STRENGTHS • • • • • • • Social Support Fulfilling/Active Life Intact Value System Community Involvement Stimulating Natural Environment Meaningful Activities Loving Partner
    • CHALLENGES • • • • Children: Full Time Jobs Wife: Glaucoma/Arthritis Particular Large Property/Upkeep
    • DIAGNOSTIC STRENGTHS Alert and Oriented x Person and place LTM Intact Verbal Expression Attend to Task 30min. Occasional re-direct Good Sitting Balance Right Hand Dominant Follows Most Commands Motivated Strong PLOF
    • DIAGNOSTIC CHALLENGES Not Oriented to Time STM Impaired Mildly Left Inattention Left Upper Extremity Impaired Pattern Movement Present Poor Gross and Fine Motor Coordination Impulsive/Poor Safety Awareness Light Touch Superficial Pain Stereognosis Prefers His Way of Doing Things
    • OCCUPATIONAL PERFORMANCE • Creating function from a place of dysfunction utilizing this flexible model to adapt all 3 variables.
    • MOTIVATION AND CHANGE Motivation Intrinsic and extrinsic Change Physical changes More support of family/friends Opportunities to develop new interests
    • INTERVENTION APPROACH • Home Modifications • Patient Education • Home Safety checklist
    • INTERVENTION STRATEGIES
    • PERSON Recommend methods of assessment to acknowledge Mr. Jones’ preferences in daily occupational tasks. Wear life alert necklace Educate Medication client/family/friends for management support system Give client a cell phone or have phones in most rooms in case of emergency. Stroke support group
    • ENVIRONMENT Make environmental adaptations to the kitchen and yard to assist in ADLs, and IADLs. Provide social supports Adequate lighting in all rooms. Add railing to front steps. Take up all the “rag” rugs. Provide sturdy chair in kitchen, outside near chicken coop Move chicken coop closer to house Clear counters of collectibles Add cushions to his existing favorite chair.
    • OCCUPATION No driving, set up rides to church, etc. IADLS ADLS Feeding chickens Baking biscuits Dressing, Fasteners Fishing, Gardening Operating tractor Bathing
    • PERFORMANCE Home health to maximize performance potential Adaptive equipment for dressing Utilize a different bathroom for bathing, unless sons are able to lower him in to the claw foot bathtub. Mirror for when shaving Provide cut up foods or finger foods or utilize rocker knife Durable medical equipment to assist with ADLs. Utilize non-skid mats in kitchen and bathroom
    • SPECIFIC CHALLENGES FACED BY MR. JONES AND HOW THEY WERE ADDRESSED IN TREATMENT UNDER THE PEOP MODEL.
    • QUALITY OF LIFE AND CONTINUED OCCUPATION, FIRST AND FOREMOST. • Mr. Jones significant responsibilities in caring for the farm presented a challenge in terms of safety, energy conservation, and pain management. • However, as the PEOP model distinguishes itself from other models, by looking at occupation and performance as way of fitting the person to the environment. Within this model, the environment (his home and farm) and what needs to change to enhance performance, not necessarily Mr. Jones as PEOP draws heavily from the disability rights movement and utilizes a top down approach when working towards enhancing client participation. (Baum and Christiansen, 2005)
    • ADAPTATIONS • Although Mr. Jones was not yet ready for driving, to increase visual and sensory inattention on the left side, the O.T practitioner was looking in to ways to adapt the tractor. In the meantime, drawing on community support from the church, Mrs. Jones created a volunteer system for a young man from the church to drive the tractor while Mr. Jones rode in order to continue his role as the breadwinner. The rehab team felt that as there was no risk of traffic while operating the tractor, that being able to drive the tractor independently given adaptations would be possible. However, for now the extra community help would continue his participation.
    • SPECIFIC O.T. INTERVENTIONS TO ADDRESS DRIVING AND COMMUNITY MOBILITY • To address the person, Mr. Jones practiced using a visual scanning board in his home based therapy sessions as well as a computerized driving simulator. • To address the driving occupation, Increased mirrors were planned to be adapted, as well as a tractor shorter to the ground with extra padding and postural supports were added. • In order to continue occupational participation in his valued role as a church and community member, the OT practitioner worked with the family to arrange rides to and from church, and arranged the weekly men’s bible study group to be held in the Jones’s home. • The practitioner also provided the Jones’s with the Area Agency on Aging (AAA) to provide transportation alternatives if any of their transportation fell through.
    • CONTINUED INTERVENTION TO ADDRESS THE CHALLENGE OF THE FARM AND GARDEN • The PEOP based practitioner places emphasis on quality of life and participation, so provided continued adaptation to the garden, which included low tech solutions such as placing boards along the path to the garden, as well as to the chicken coop and barn to ensure that Mr. Jones would not fall while ambulating with his cane. • Because he was very particular about his garden, it was decided that large sections of the garden would be replanted within raised beds. This way he could retain participation, while the practitioner was able to continue to provide a NDT and sensory motor based treatment. Mr. Jones was able to use trunk rotation and incorporate his left extremity into gardening tasks following scapular protraction and elevation facilitated from the practitioner.
    • Although Mrs. Jones was not on the caseload, the practitioner knew that in order to maintain their quality of life, which for them meant staying independent on the farm for as long as possible she recommended that Mrs. Jones: • As her hobby was canning peaches, a wall mount can opener was recommended and she was taught techniques to prevent further ulnar drift. She was also advised to seek a referral from her doctor for O.T to address low vision modifications if the time should come secondary to her glaucoma. Many of the modifications made for Mr. Jones would help the couple retain their quality of life.
    • CONCLUSION “The PEOP (model) reflects the philosophy of occupational therapy in its consideration of the interactive nature of the person, environment, and of the complexity of the tasks and ability to perform these tasks necessary for the occupation of managing health.” (Smith, Hudson, 2012)
    • REFERENCES • Brown, C.(2009). Ecological Models in Occupational Therapy. In Willard & Spackman's occupational therapy. E.B. Crepeau, E.S. Cohn, and B.A Boyt-Schell)s. (Eds )11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009. Print. • Buam, C, and Christiansen, C. (2005) Person-environment-occupationperformance: An occupation based framework for Practice. (In Christiansen, C., Baum, C, and Bass-Haugen, J (Eds.) Occupational Therapy: Performance, participation, and well-being. 3rd. Ed. Thorofare: NJ: Slack. • Howlett, Fiona. (2012). Citing website. In Person Environment Occupational Performance Model. Retrieved Oct. 1, 2012, from www.yorksj.ac.uk. • • Letts, L., Law, M., Rigby, P., Cooper, B., Stewart, D., & Strong, S. (1994). Personenvironment assessments in occupational therapy. American Journal of Occupational Therapy, 48(7), 608-618. “ • Occupation-Based Hand Therapy! - PEOP Model." Occupation-Based Hand Therapy! - Home. N.p., n.d. Web. 12 Oct. 2012. <http://handtherapycanbefun.weebly.com/peop-model.html>. • Smith, D., & Hudson, S. (2012). Using the Person-Environment-Occupational Performance conceptual model as an analyzing framework for health literacy. Journal Of Communication In Healthcare, 5(1), 3-11. doi:10.1179/1753807611Y.0000000021 • Welch, Polly. (2012). Citing website. A Brief History of Disability Rights Legislation in the United States. Retrieved Oct. 25, 2012, from www.udeducation.org/resources/61.html.