The occupational therapist used the occupational therapy process model to assess and treat Mr. J, a man with vascular dementia. Through multiple home visits, the therapist gathered information on Mr. J's history and abilities, set goals for improved transferring, and provided equipment like a hospital bed and Sara Steady. The therapist ensured Mr. J's carer was safely transferring him and eventually discharged Mr. J after he reached his rehabilitation potential.

1. CASE
STUDY
M A D I G A N H U G H E S

2. MR J
 Xx year old male
 Lives with wife
 Diagnosis of vascular dementia
 History of Transient Ischaemic Attacks (TIAs) (wife believes Mr J may have had more undetected TIAs -
last confirmed TIA December 2018)
 Dense weakness in right upper limb
 Difficulty coordinating right lower limb
 Good strength in left upper and lower limbs
 Speech difficulties
 Single handed once a day package of care for personal care in the morning
 Riser recliner, sara stedy, wheeled zimmer frame and stair lift in situ

3. FIRST HOME VISIT
Patient was referred to the team as an urgent referral.
We completed a core therapy assessment with Mr J then occupational therapist assessed
his transfer.
Mr J was able to stand with assistance of one and step transfer to his left side to a static
commode with assistance of one. Mr J’s wife reported this was unlike Mr J as he is normally
only able to pivot transfer to his commode.
Mr J’s wife reported to us that she would typically have to manually handle Mr J with
moderate assistance by lifting him under his underarms.
Mr J’s wife reported to us that Mr J was still able to sleep upstairs as she supported him to
transfer on and off his stair lift.
Mr J’s wife reported Mr J struggled to transfer in to bed as it was slightly too high for him.

4. SECOND HOME VISIT
Mr J’s occupational therapist visited with a senior therapy assistant at home to review
him one week later
observed Mr J’s wife transferring Mr J and found that Mr J’s wife was needing to give
Mr J maximum assistance when moving and handling him
Mr J had deteriorated, and he could no longer step transfer and now pivot transferred
with moderate assistance of one.
occupational therapist ordered Mr J a hospital bed and a package of care was set up to
support Mr J with his personal care in the morning.

5. THIRD HOME VISIT
Mr J’s occupational therapist and I visited Mr J to observe Mr J’s first care call with his
new carer to assess his most recent transfer ability and to handover moving and
handling techniques.
Mr J has good standing tolerance and can stand for one minute but with close
supervision of one and tends to lean back, meaning a ross return would be
inappropriate and possibly unsafe, and Mr J does not yet require a hoist.
The occupational therapist agreed to trial Mr J with a sara stedy, however transfers
may be difficult due to the small gaps between furniture.

6. FORTH HOME VISIT
Mr J’s occupational therapist visited to review Mr J’s care calls and transfers with new
sara stedy.
Occupational therapist found some safety concerns with the way Mr J’s carer was
transferring him
Not supporting his weaker right upper limb, which could have caused a shoulder
injury.
Occupational therapist taught the carer a safer manual handling technique.
Mr J’s occupational therapist concluded that Mr J had reached his rehabilitation
potential so they have now discharged him.
They will write up a discharge report outlining their intervention, and any equipment
they provided, which will then be sent to Mr J’s GP.

7. HOW HIS OCCUPATIONAL THERAPIST
USED THE OCCUPATIONAL THERAPY
PROCESS
 Although the majority of patients seen by the rapid response team do not follow
the conventional occupational therapy process, Mr J’s occupational therapy
intervention does follow The Occupational Therapy Process Model.
 The referral was sent to the rapid response team by GP
 Triaged and deemed an appropriate referral
 During the first home visit, Mr J’s occupational therapist gathered a social history
of Mr J using the rapid response team’s core therapy assessment.
 Mr J’s occupational therapist completed a physical assessment of Mr J, assessing
his strength and range of movement.
 Decided on goals for Mr J to achieve during his intervention with the rapid
response team.
 Occupational therapist took action by continuing to visit Mr J at home weekly to
review him, order equipment and organised a package of care.
 Mr J’s occupational therapist continued to assess Mr J’s transfers at every home
visit to measure for improvements or deterioration.
 Mr J has not yet reached his end of intervention and discharge

8. H O W H I S
O CC U PAT I O N A L
T H E R A P I S T
F O L LO W E D T H E P E O P
M O D E L
When planning Mr J’s intervention, the occupational therapist needed to consider
three factors; occupation, environment and the person, which all link together to
support the occupational therapist in focusing on the Mr J’s occupational
performance and participation.
When assessing Mr J’s environment, the occupational therapist must first consider
required physical space; what are the physical environment requirements of the
activity, such as size of space. Objects; what tools, materials or equipment are
required to be used in the process of carrying out the activity? Required social
context; Can the activity be done by one person or does it need more than one
person? Outline the social and cultural expectations, rules and norms. And finally,
Required temporal context; When does the activity take place and with what
frequency? Daily, weekly, monthly, by necessity, by choice, at a particular time of
day.
Mr J’s occupational therapist completed this by assessing firstly if Mr J had enough
space to step transfer between his riser recliner and his commode, and afterwards
when they had to consider if there would be enough turning space for a sara
stedy, as well as who would be available to transfer Mr J on the sara stedy.
Furthermore, the occupational therapist will need to capture a narrative of Mr J to
find out his choices, responsibilities, attitudes, motivations, needs and goals.
Mr J’s occupational therapist captured a narrative by finding out Mr J’s role in the
house, and what motivated him when planning his goals.
Lastly, the occupational therapist needs to consider the occupation itself. They
needed to identify how does the occupation support Mr J’s roles? And how does
he perform it now?
Mr J’s occupational therapist focused on the occupation of transferring, as this was
the concern first addressed in Mr J’s referral, and addressed as a goal by Mr J
himself. Mr J’s occupational therapist supported Mr J with improving his transfers

9. ANY QUESTIONS?

10. REFERENCES
Duncan, E. A., 2017. Skills and processes in occupational therapy. In: E. A. Duncan, ed.
Foundations for Practice in Occupational Therapy. Great Britain: Churchill Livingstone
Elsevier, pp. 33-42.