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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
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
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:
•Intervention
•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.
Evaluation of Edna's Home
OT will recommend that Mrs. Speltz make some modifications to her home by:
Goal: Client will demonstrate in home safety awareness by implementing 1 recommended home modification a week over the next 4 weeks.
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
Intervention
Three part proximal humeral fracture:
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.
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.
Role of the therapist: Facilitator
Role of the client: Agent of change
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.
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
Edna: use adaptive equipment for gardening, baking, and needlework to decrease pain and effort needed to complete the tasks.
Edna: Find the best environment where she can perform her tasks with minimal pain and effort and be safe as well.