Final Case StudyJessica Lumsden, OTASOTA 140Jefferson College of Health Sciences
Occupational Profile JJ is a married 76 year-old female 15 year gun shop owner Lives independently with husband, drives self, attends support groups 5x/wk. Interests include going to peer support groups and reading History Suffers from depression, anxiety, bipolar disorder, as well as chronic pain caused bysciatica- severe to moderate- “never goes away” Currently taking Selective Serotonin Reuptake Inhibitors (SSRIs) an antidepressant &Geodon, an antipsychotic Hospitalized 3 times since her 60’s due to the severity of her mental illnesses Has appointments 1x/3wks with doctor regarding chronic pain and 1x/wk with psychologist
Areas of Dysfunction Motor and Praxis Skills- bending, maintaining balance Emotional Regulation Skills- controlling and responding to feelings, displayingappropriate emotions, utilizing relaxationstrategies, persistence Cognitive Skills- multitasking, creating different activities Communication and Social Skills- Initiating and answering questions,acknowledging others & their feelings.Impact on Areas of Occupation ADLs & IADLs- functional mobility, caring for others, communicationmanagement, financial management, meal preparation and cleanup, shopping Rest & Sleep- Sleep, Sleep participation Leisure- Leisure exploration, Leisure participation Social Participation- Community, Family, Peer, Friend
Problem : DepressionLong Term Goal : Client will develop theability to recognize, acceptand cope with feelings ofdepression within 12 weeks.Short Term Goals:1. Client will be able to describe at leastfive effective coping strategies fordealing with stressful situations in 4weeks.2. Client will learn to identify negativethoughts & how to replace them withmore positive, adaptive thoughts within 6weeks.Problem : Chronic PainLong Term Goal: Client will minimize impactof chronic pain on life domainswithin 12 weeks.Short Term Goals:1. Client will learn progressiverelaxation and distractiontechniques to manage painwithin 4 weeks.2. Client will increase physicalstrength and stamina during occupationalactivities within 6 weeks.Treatment Goals
Short-Term Goals Treatment Activity Rationale Contextual ConsiderationsClient will be able to describe atleast five effective copingstrategies for dealing withstressful situations in 4 weeks.Relaxation activity of deepbreathingThe more oxygen you inhale the lesstense, short of breath and anxiousyou feel, which can be a effectivecoping methodClient will learn to identifynegative thoughts & how toreplace them with more positive,adaptive thoughts within 6 weeks.Keeping daily journal ofnegative thoughts andexperiencesWe can review and identify thenegative thoughts associated witheach experience and thedepressive impact that resultedfrom the clients interpretationEducating the client on Depressionillness, monitor medication foreffectivenessClient will learn progressiverelaxation and distractiontechniques to manage pain within6 weeks.Visual Imagery &Distraction techniquesImagery involves concentrating onmental pictures of pleasant thingsor mentally repeating positivewords to reduce pain anddistraction techniques focus yourattention away from negative orpainful images to positive mentalthoughts.Refer client to pain managementfor adequate pain control. Discussimportance of rest, sleep &nutrition for managing chronicpainClient will increase physicalstrength and stamina duringoccupational activities within 6weeks.Task Analysis and TaskSequencingThis would still allow andenable the client to participateand use their level of function,as much as they were able to inactivities, and over time buildup their stamina.Research adaptations withinhomes, specifically geared towardschronic pain
Treatment Activity Grading/AdaptationRelaxation activity of deep breathing This can be graded up or down by increasingor decreasing the duration of the activity. Itcan be adapted or by changing theenvironment or positioning the bodydifferently.Keeping daily journal of negativethoughts and experiencesThis can be graded up by increasing theamount written, and include positivethoughts to replace negative ones. It can beadapted to typing on a computer or voicerecording.Visual Imagery & DistractiontechniquesThis can be graded up and down by increasingand decreasing the duration of the activity. Itcan be adapted by changing theenvironment/surroundings/peopleTask Analysis and Task Sequencing This can be graded up by increasing ordecreasing the amount of steps, increasingweight of objects, etc. It can be adapted byletting the client use adaptive equipment.
Rehabilitative Frame of Reference• Philosophy: To enable a person with physical or mental disability ofchronic illness to achieve maximum function in the performance of hisor her daily activities• Helps individuals perform in his or her social roles and daily activities• Focuses on adaptive and assistive devices and environmentalmodifications.• Therapist works on skills and abilities, level of assistance or supervisionfor client• Includes purposeful activities and evaluates client’s interests, roles,resources, environments, and support systems.
References American Occupational Therapy Association. (2008). Occupational therapypractice framework: Domain and process (2nd ed). American Journal ofOccupational Therapy, 62, 628-659. Hofmann, A. (2010,01 19). Living life to its fullest: Managing chronic pain withoccupational therapy. Retreived from http://www.aota.org/ Consumers/Professionals/WhatIsOT/PA/Articles/Chronic-Pain.aspx