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OCCTH 540

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Joelle Lappala

on 4 March 2013

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Transcript of OCCTH 540

Ethan Miller: Young Adult with Cerebral Palsy OCCTH 540 - Corbett Clinic Client Learning Objectives Apply the Canadian Practice Process Framework to a client with cerebral palsy (CP)

Highlight some challenges faced by young adults with CP

Identify assessments, interventions, and outcome measures that may be used with these individuals Meet Ethan Miller Ethan Miller 24 years old

Recently graduate from the University of Alberta with a Bachelor of Science

Currently lives at home with parents and younger brother

Referred to occupational therapy because he has recently become interested in increasing his independence Enter/Initiate Ethan is being seen in an outpatient clinic

Referral was from neurologist after Ethan expressed interest in increasing independence at yearly appointment

Referral deemed appropriate because Ethan's concerns relate to occupational goals

Role of OT explained - Ethan receptive
to process Set the Stage Agree on Objectives Implement Plan Evaluate Outcome Conclude/Exit Revisiting the Canadian Practice Process Framework We will use the CPPF to guide our process in working with Ethan. The CPPF facilitates client-centered, evidence-based practice, and helps clinicians reflect on their practice. Investigate Ethan's potential to drive - assess abilities and determine next steps

Recommend appropriate equipment that will allow Ethan to drive safely
i.e) left gas pedal, left steering knob or hand controls

Discuss Ethan's interests (ie: hockey)
Education about how physical activity could help him connect with peers and promote self-esteem

Use cognitive behavioral therapy with Ethan
Identify negative thought patterns
Homework activities Re-administer to determine if improvements have been made in the performance and satisfaction scores. COPM Offer Ethan sufficient support and a chance to follow up with any future concerns

Offer existing community programs that will continue to help Ethan reach his goals (specifically job search support)

Discuss with Ethan any further concerns that were not addressed during treatment COPM Main findings: Rosenberg Self-Esteem Scale 10-item scale that measures global self-worth by measuring both positive and negative feelings about the self.

Ethan's total score: 12/30 with scores below 15 representing low self-esteem.

10 (Driving) 28 (socializing) 5 (Part-time work) = 43/3



20 (Driving) 49 (Socializing) 30 (Part-time work) = 99/3 Performance score Satisfaction score 14 33 Driving Assessment Motor-Free Visual Perception Test ROM/MMT COPM Standardized test of visual perception that has evidence to support predicting of road driving performance
Cut off score of 30
Ethan's score = 32/36 Rosenberg Self-Esteem Scale To identify most important problems areas to help determine treatment plan Ethan had limited right ankle ROM and strength, limited right shoulder ROM and strength and right hand is sightly fisted
Neck ROM within normal limits
Left side ROM/Strength within normal limits To determine baseline self-esteem as patient reports low confidence. Low self-esteem may impact success in other areas. Motor-Free Visual Perception Test Cognitive (Spatial ability) screen that is predictive of on road driving skills Performance score 50 (Driving) 42 (socializing) 5 (Part-time work) = 97/3 Satisfaction score 70 (Driving) 56 (socializing) 30 (Part-time work) = 156/3 52 32 1. Ethan will be able to drive independently (driver training) with the use of vehicle adaptations that were identified through a driving assessment in 3 months.

2. Through physical activity/leisure and a self-esteem intervention, Ethan will show improved scores on the Rosenberg Self-Esteem Scale after 8 weeks. Ethan is nervous - he makes little eye contact and provides brief one word answers to questions

Therapist finds common ground with Ethan when they discuss his interest in hockey and Ethan starts to open up

Ethan states he wants to make change, but is worried he might not succeed Assess & Evaluate Assist Ethan in identifying other activities he could participate in

Monitor Ethan's progress with driving

If Ethan feels that the first two goals are met, his next goal was to begin looking for employment Monitor/Modify 1. Enter and initiate
2. Set the stage
3. Assess and evaluate
4. Agree on objectives and plan
5. Implement plan
6. Monitor and modify
7. Evaluate outcomes
8. Conclude/exit Ethan's History Questions Diagnosed with right-sided hemiplegic cerebral palsy at 24 months.

Received OT services from kindergarten to grade 6. As he got older, frequency of treatment became less.

No additional medical concerns, relatively healthy childhood

Parents are very supportive and encourage his independence

Has few friends and spends most time at home with parents. Learning Outcomes Refreshed knowledge of CPPF

Awareness of potential assessments and treatment options

Increased awareness of potential psychosocial issues in young adults Why Ethan? Cerebral palsy is a prevalent condition that we will come across in practice

Our course content has not focused on young adults with this disability

Highlight psychosocial issues that may be experienced by this age group Frames of Reference Neurodevelopmental and Biomechancial Cognitive Behavioural Incorporates principles of motor learning.

Driving is a new task for Ethan and motor learning principles could be applied to this task.

Biomechanical - being used to evaluate Ethan’s physical abilities to drive and provide adapted equipment that compensates for his physical deficits. Cognitive behavioral approach assumes a person's cognitive function and beliefs influence their behaviour References Baptise, S. (2005). Spirituality in occupational therapy. In Meier, A., O`Connor, T., & VanKatawky, P. (Eds.), Spirituality and health: multidisciplinary explorations. (pp. 139-148).Waterloo, Ontario: Wilfrid Laurier University Press.

Berry, J., & Ryan, S. (2002). Frames of reference: their use in paediatric occupational therapy. British Journal of Occupational Therapy, 65(9), 420-427.

CAOT. (2002). Enabling occupation: An occupational therapy perspective (rev. ed.).Ottawa, Ontario: CAOT ACE

Colarusso, R., & Hammill, D. (1996). Motor free visual perceptual test, examiner's manual, Novato, CA: Academic Therapy Publications, Inc.

Law, M., Baptiste, S., Carswell-Opzoomer, A., McColl, M.A., Polatajko, H., & Pollock, N. (1991). Canadian Occupational Performance Measure. Toronto, ON: CAOT Publications ACE.

Oswanski, M., Sharma, O., Raj, S., Vassar, L., Woods, K., Sargent, W., & Pitock, R. (2007). Evaluation of two assessment tools in predicting driving ability of senior drivers. American Journal of Physical Medicine & Rehabilitation, 86(3), 190-199.

Robins, R., Hendin, H., & Trzesniewski, K. (2001). Measuring global self-esteem: Construct validation of a single-item measure and the Rosenberg Self-Esteem Scale. Society for Personality and Social Psychology, 27(2), 151-161
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Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.

StrokEngine. (2013). Motor-Free Visual Perception Test (MVPT) evaluation summary. StrokEngine-Assess. Retrieved from http://strokengine.ca/assess/module_mvpt_quick-en.html.

Berry, J., & Ryan, S. (2002). Frames of reference: their use in paediatric occupational therapy. British Journal Of Occupational Therapy, 65(9), 420-427.

Bruce, M. A., & Borg, B. (2002). Psychosocial frames of reference : core for occupation-based practice (3rd ed.). New Jersey: Thorofare.

Falkmer, T., Henriksson, P., Gregersen, N.P, & Bjurulf, P. (2000). Driver education for persons with cerebral palsy – a retrospective study of educational problems. Transportation Research Part F: Traffic Psychology and Behavior, 39(1), 15-27.

Magill-Evans, J. E., & Restall, G. (1991). Self-esteem of persons with cerebral palsy: From adolescence to adulthood. The American Journal of Occupational Therapy.: Official Publication of the American Occupational Therapy Association, 45(9), 819-825.

Sobus. K. & Karkos, J. (2009). Rehabilitation care and management for the individual with cerebral palsy, ages 13 through early adulthood. Critical Reviews in Physical and Rehabilitation Medicine, 21(2), 117-165.

Specht, J., King, G., Brown, E., & Foris, C. (2002). The importance of leisure in the lives of persons with congenital physical disabilities. American Journal Of Occupational Therapy, 56(4), 436-445.

Wiegerink, D., Roebroeck, M., Donkervoort, M., Stam, H., & Cohen-Kettenis, P. (2006). Social and sexual relationships of adolescents and young adults with cerebral palsy: a review. Clinical Rehabilitation, 20. Kayla Bekolay, Joelle Lappala, Erin Pickard, and Mimi Raymond
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