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Transcript of OCCTH 540
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.
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