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Skills and abilities in sensorimotor, cognitive & psychosocial domains

Edna:

Before accident: skills & abilities as a homemaker, ability and knowledge to care for farm animals and her grandchildren, skills required to tend to a garden, needlework & knitting skills

After accident: intact long term memory, oriented to person and place, verbal expression, follows verbal commands, fair endurance & she has the ability to feed herself if food is cut for her

The person's surroundings- temporal (including age, developmental stage, life cycle & disability status) & environmental (including physical, social, and cultural)

Edna:

Temporal: 72 year old female, mother, wife, grandmother

Environmental: farm, garden, two story home with four bedrooms and 2 ½ baths that includes photos, rugs & collectables & the hospital setting

Objective behaviors needed to accomplish end goal; unlimited

Edna: Farm & garden work, homemaking chores, caregiving to her two grandchildren, baking, needlework, knitting, dressing, bathing, ambulating, transfers & activities of daily living

The process of engaging in a task; interdependent factors

Due to Edna’s accident, her performance in meaningful and purposeful tasks range is narrowed. She values her independence and expresses that she would like to get back to her regular lifestyle. Her usual personal, context and task transaction has been disrupted and has caused her a sense of hopelessness. Therefore, she must adapt/modify her context that matches her level of functioning. This model doesn’t focus on changing the person aspect, but her meaningful tasks and context will be modified.

Edna would like to get back to her lifestyle as it was. Due to her injury, not everything will be the same and a cognitive FOR would be useful to change her beliefs about doing all the tasks she did before her injury.

Edna's endurance is fair and she has pain in her left shoulder. A biomechanical FOR would be useful to decrease pain and increase ROM, endurance, and strength so that she can engage in the occupations she enjoys.

Questions to ask the client

  • What do you like to do?
  • What are the life experiences that contribute to or interfere with occupational performance?
  • Are friends and family available to provide support for you?
  • Does the built environment or the natural environment create barriers to your performance?
  • How much time do you have to perform important tasks or occupations?
  • What would you like of feel that you need to do?
  • What occupations or tasks give meaning to the your life?

Activities that the client might do as part of the evaluation process

1. Gardening

2. Yard work

3. Household chores

4. Baking

5. Needlework

6. Knitting

Assessment tools

1. Task analysis worksheet

2. SAFER Home

Intervention sessions should include:

Biomechanical/Rehabilitative Model

Frames of Reference

Cognitive Behavioral Frame of Reference

Context of Eval

•BFOR applies principles of physics to human movement and posture with respect to the forces of gravity

•RFOR is aimed at making people independent as possible in spite of any residual impairment. Consists of mainly environmental adaptation and compensatory strategies. -Looks at both physical and mental features of occupational performance

•Evaluation includes:

  • ROM, Strength, Endurance, Pain ( OT are concerned with pain bc it often presents as a barrier to the use of biomechanical capacities)
  • OT evaluates the body fx within the context of the clients occupations, fx movements using purpose of a task to organize mvmnt.

•Intervention

  • Focuses on the clients identified roles and priorities for task performance. Methods of intervention include activity adaptation , application of compensatory strategies or techn. And physical reconditioning.
  • Traditional rehab approach leans towards adaptation and compensation, beginning where skills have leveled off.

•Focuses on beliefs and how they affect engagement in occupation. The goal is to change attitudes and beliefs to realistic options.

•This FOR offers useful techniques for self-management that can be used in addressing these barriers to occupational performance.

•Function and disability are defined as characteristics of the person, task, and environment that can be observed and measured.

  • Foundational agent of change is reinforcement. Clients are motivated by both external and internal reinforcement

Evaluation of Edna's Home

  • O.T. will conduct an 45 minute in home evaluation along with Edna
  • OT will walk through the home and help identify safety concerns for her
  • Edna will assist the OT with the evaluation process
  • OT will create a home modification Report

OT will recommend that Mrs. Speltz make some modifications to her home by:

  • Installing railing at the entrance of her home
  • Remove all the rugs in her home
  • Organize/Remove most of her collectibles
  • Purchase a new chair for more support
  • Consider installing a walk-in shower instead of a bath

Goal: Client will demonstrate in home safety awareness by implementing 1 recommended home modification a week over the next 4 weeks.

References

Brown, C. (2009). Ecology models in occupational therapy. In E.B. Crepeau, E.S. Cohn, & B.A.B.

Schell (Eds.), Willard and Spackman's occupational therapy (11th ed., pp. 435-445).

Philadelphia: Lippincott Williams & Wilkins.

Cole, M. B., & Tufano, R. (2008). Applied theories in occupational therapy, a practical

approach. Slack Incorporated.

Dunn, W., Brown, C., & McGuigan, A. (1994). The ecology of human performance: A framework

for considering the effect of context. The American Journal of Occupational Therapy,

48(7), 595-607.

Family Practice Notebook. (2012). Proximal humerus fracture. Retrieved from

http://www.fpnotebook.com/ortho/shoulder/PrxmlHmrsFrctr.htm

Motivation & Change

Intervention

  • Motivation
  • Client: Frustrated, discouraged, feelings of hopelessness
  • Enriched by asking the individual what they want & need
  • Change
  • Client: Old ways of doing everything are no longer working
  • When changes in the person are no longer an option, change the environment

  • Occupational Therapist approach:
  • Learn about & respect the clients opinions, values, & beliefs
  • Advocate for the client
  • Act as a facilitator
  • Enhance independence

Function- Person with adequate human performance

  • Abilities: Interests:
  • Homemaking chores -Gardening
  • Preserves Vegetables -Baking
  • Tends to chickens -Needlework
  • Cares for grandchildren -Knitting

  • Expectations Barriers
  • Husband -Arthritis
  • Childcare -Glaucoma
  • Homemaking chores -Three part proximal
  • Gardening Humeral fracture

Three part proximal humeral fracture:

  • Most common in elderly women.
  • Risk factor: osteoporosis.
  • Etiology: fall on an outstretched hand.
  • Symptoms: severe pain at the upper arm, which is provoked by arm movement.
  • Includes the humeral head and shaft and one of tuberosities.
  • Complications: axillary nerve or axillary artery injury, brachial plexus injury, brachial artery injury, non-union or malunion, or posterior dislocation.
  • Prognosis: shoulder stiffness, which could result in disability; permanent shoulder abduction; and full ROM may take months to return.

  • Decreased performance possibly due to environmental factors

Disability

Disability- Faulty human performance

The Context

Intervention Sessions

Performance

  • Skills lost due to injury
  • Sensorimotor
  • Decreased AROM in LUE
  • Balance & Equilibrium
  • Cognitive abilities
  • Difficulty planning, sequencing, and executing tasks with injury
  • Impulsive
  • Lacks safety awareness

Ecology of Human Performance

[Case Study]

The Person

Session Two: Energy Conservation Techniques

Occupational Therapist will introduce and educate Edna on energy conservation techniques that will allow her to engage in activities she previously participated in before her humeral fracture. Previously activities were physically demanding and include; yard work, gardening, and various household chores. Therapist will provide Edna with an energy conservation handout as a reminder of the strategies she should be using on a daily basis.

  • LTG: By the end of four weeks, Edna will show knowledge and demonstrate competency in energy conservation techniques and apply them to daily routines.
  • STG: By week two, Edna will demonstrate knowledge of energy conservation techniques and apply them when gardening 65% of the time.

Role of the therapist: Facilitator

Role of the client: Agent of change

Session one: Establish and Restore ADLs:

Occupational Therapist will introduce and educate Edna on numerous adaptive equipment that will assist her when completing ADLs she has difficulty with.

These include: difficulty with donning and doffing clothes, managing clothes closures, bathing brushing dentures, and combing hair. The occupational therapist will first introduce the different equipment to Edna, and then educate her on how to use them while she completes her ADLs. Adaptive Equipment will include; button hook, dressing stick, long handle shoe horn, long handle sponge, shower bench, suction tooth brush and long handle comb.

  • LTG: By week four, Edna will be able to don and doff clothing by using various adaptive equipment tools with min. verbal cues.
  • STG: By week two, Edna will demonstrate competency in using Adaptive Equipment for dressing 75% of the time.

Role of the therapist: Facilitator

Role of the client: Agent of change

Michele Buenaventura

Kimberly May

Jennifer Molina

Jessica Scott

Kelsey Weisheit

Tasks

this strategy's focus is to promote enriching and complex performance in one’s context.

focus is to enhance a person’s ability by teaching skills not previously learned or restoring lost skills due to illness or disability.

the focus of this strategy is on the practitioner’s ability to modify the context or task for successful performance.

focus is to minimize risks and avoid the development of performance problems.

Edna: create or join a knitting, gardening, or baking club.

focus of this strategy is

on the context. Practitioner uses his/her assessment of the person’s variables in three areas, sensorimotor, cognitive, and psychosocial to seek the best match for the persons context.

Function

Assumptions

Edna: Restore or establish endurance, ROM, and safety awareness

Edna: remove rugs and clutter to prevent falls, teach joint protection to prevent reinjury of left shoulder.

Role Task Requirements

  • Roles: wife, mother, grandparent, childcare provider, homemaker, and gardener
  • Following injury: can not fulfill roles due to pain, mildly impaired short term memory, lack of orientation (Ox2), impulsivity, lack of safety awareness, decreased endurance, & moderate to maximum assistance for ADLs

Edna: use adaptive equipment for gardening, baking, and needlework to decrease pain and effort needed to complete the tasks.

  • Uses prevention, health promotion, and a rehabilitative perspective.
  • The targeted area is the context
  • People and the context are both unique and always changing
  • Performance depends on the interaction between the person and the context

Edna: Find the best environment where she can perform her tasks with minimal pain and effort and be safe as well.

Disability

  • Performance range narrowed due to limited abilities
  • Restricted due to injury
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