OCCUPATIONS OF ADULTS AND SENIORS I MRS. K a case study by SARAH JANE CALUB VANESSA MAE CARZON RAFAEL GARCIA
WHO is MRS. K?• 63 y/o woman.• Married• Lives with husband• Works part time (clerical work) & babysits grandchildren.• Independent w/self-care & work tasks.• Enjoys: gardening, knitting, quilting.• Used to attend weekly luncheons w/her friends.
Nature ofREFERRAL Arthritis Insulin-dependent OT evaluation for diabetes tx, pain at R thumb OCD Relevant Medical HISTORY
OT EVALUATION• Pain Scale • Reported 9/10 initial evaluation• ROM • Bilateral shoulder/elbow ROM are WNL• Grip/Pinch Strength • Weak hand grasp, especially in pinches • Instability of CMC & MCP, limited R thumb opposition
OT Evalua)on Ccontinued OT EVALUATION ont.• Sensory Assessments (Pin Stick & Temperature) • Impaired sensation for light touch, sharp/ dull, hot/cold in both hands• Arthritic Deformities • Multiple swan neck: L hand digits 2 & 4, R hand digits 3-5 • Multiple RA nodules on both hands
Func)onal Problems Functional PROBLEMS1 Pt. is always tired & depressed2 Unable to bathe & perform self-groom tasks3 Unable to carry out household chores4 Difficulty preparing meals5 No longer attends weekly luncheon with her friends
Long-Term GGoal #1 Long Term OAL #1Client will be independent with all hygiene/self-care activities in own home, using A/Eand energy conservation strategies with afatigue level of 5 or less in 4 weeks toincrease functional independence anddecrease fatigue.
Short-term GOAL 1a Short Term Goal 1aClient will tolerate 20 minutes of ADLactivity, taking 2-minute breaks every 10minutes with 0/10 pain in R and L upperextremities during rest and activity, 3x/weekfor 3 weeks.
Short-term GOAL 1b Short Term Goal 1bClient will demonstrate independence withbrushing hair and teeth using built-uphandles on her hairbrush and toothbrush tocompensate for weakened grasp aftereducation for five minutes, 2x/week for 2weeks.
Long-term GOAL #2 Long Term Goal #2Client will be able to independently self-feedfor 15 minutes, using built-up utensils,compensatory movements, and UE jointprotection strategies without VCs 1x/weekfor 4 weeks to increase functionalindependence.
Short-term GOAL 2a Short Term Goal 2aClient will independently self-feed usingbuilt-up utensils for 10 minutes afterinstruction 1x/week for 2 weeks to increasefunctional independence.
Short-term GOAL 2b Short Term Goal 2bClient will tolerate 10 minutes of wrist andhand exercises to increase strength, ROM,and endurance, which will improve feedingand other ADLs, 3x/week for 3 weeks.
OT Treatment Plan OT TREATMENT PLAN• Educate client: • Energy conservation & ECWS techniques • Fall risk & prevention strategies • Joint protection • Stress management & relaxation techniques
OT Treatment Plan OT TREATMENT PLAN continued• ADL/IADL training • A/E to improve grasp & compensate for muscle atrophy • Pain management techniques • Train in safe/efficient transfers
OT Treatment Plan OT TREATMENT PLAN continued• Splints: • Rest/working hand splint • Wrist cock-up • Finger splint • Ulnar deviation splint • Tri-point splint • Thumb Spica
Frames of References Frames of REFERENCEMOHO Understanding her habits according to her roles. Looking at her volition to make her more self-sufficient in her daily tasks.PEO Changing the environment to create a greater fit w/the client & occupation to improve occupational performance.EHP Establish/restore intervention addresses inability to self- feed. Adapting/modifying the above task addressed by adding built up handles. Prevent/create intervention will be addressed by the home exercise program.
the ACTIVITYClient will work on multi-step food preparation in own kitchen by participating in graded cooking tasks to improve safety and independence in meal preparation. Client will prepare dinner for two (her and her husband) using pre-prepared meals. Client will prepare dinner for two using pre-cut vegetables and meat. Client will prepare dinner for two with only one pre-prepared item, utilizing A/E (e.g. rocking knife) to cut vegetables. 17
Home Program Home PROGRAM• Practice energy conservation, work simplification, & safety techniques• Wear working splints during day activities & resting splint at night.• Use built up padding for tools during ADL’s.
Discharge Summary Discharge SUMMARYClient achieved all long & short term goals.Pain reduced from 9/10 to 2/10 &occasionally 7/10.Fatigue level decreased from 10/10 to 5/10.Grip strength improved from 42lbs to 50lbson the R hand and 50lbs to 51lbs on L hand.