Today, I discharged a patient from home health and I want to briefly
share my treatment. This e-mail will NOT capture the myriad of nuances
associated with performance driven outcomes, but it will give some idea
of how occupation-based therapy may look.
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Hx:
The patient is a 78 year old female. She is diagnosed with
multiple symptoms including: history of TIA; COPD; Hemplegia and
early-stages Parkinsons. She has also been in several motor
vehicle accidents with orthopedic injury. The patient lives with
her husband and disabled granddaughter.
Eval:
Patient requires assistance with all daily living occupations.
She has decreased STM; decreased motivation and increased fear.
The patient has adequate strength in her extremities. She
requires min-mod assist for sit/stand from her wheelchair. She
ambulated with a 4-wheel rolling walker with min asst. Patient
has a long and recent history of falling.
Goals:
The patient desires to increase her ability to use her regular
toilet. She is currently using a bedside commode placed in the
living room.
Treatment:
Initial treatment started with transfer training from her
wheelchair. Patient appeared to put forth very little effort and
verbalized "I can't do it". Transfer training continued for
several treatment sessions with the patient showing little
effort and even less progress. The patient verbalized that she
was trying but both her husband and therapist agreed that this
effort was not evident in our treatment sessions. The patient
was advised the skilled OT would not continued if effort was not
evident and progress was not made.
For whatever reasons, from this point on, the patient began
making good progress. She soon was able to stand with
SBA-supervison. A new wheelchair was ordered and set to the
proper height, further enabling the patient's ability to stand
without help. The next step was addressing the patient's
abililty to ambulate to/from her bathroom.
In an effort to increase the patient's ability while
marginalzing her fall risk, several different walker were tried.
A 2-wheel walker was decided as the best aid for this patient.
Over the course of many weeks, the patient showed steady
progress with using her walker to ambulate to the bathroom and
transfer on/off the toilet. Treatment for the patient included
sit to stand from multiple surfaces, outdoor mobility and
transfer training. During the course of this treatment, the
patient experienced several falls, all outside of OT.
To make a long story short, during today's treatment session, I
observed that the patient's bedside commode was no longer in the
living room. The patient confirmed my suspicion that she no
longer used the BSC during the day. She is no ambulating with
her walker and using the toilet with supervision.
The patient had met her initial goal and since she failed to
identify further occupational goals, the patient was discharged.
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For me, this cases study highlights some of the hows of occupation
therapy looks. Almost all treatment was focused on improving the
patient's occupations. She was unable to identify additional
occupational deficits, so she was discharged.
I hope this brief cases study helps others realize occupation's
potential and practice.
Thanks,
Ron
--
Ron Carson MHS, OT
www.OTnow.com
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