M R S . Ka case study by

SARAH JANE CALUBVANESSA MAE CARZONRAFAEL GARCIA

OCCUPATIONS OF ADULTS AND SENIORS I

is MRS. K?• 63 y/o woman.• Married• Lives with husband• Works part time (clerical work) & babysits

grandchildren.• Independent w/self-care & work tasks.• Enjoys: gardening, knitting, quilting.• Used to attend weekly luncheons w/her friends.

W H O

OT evaluation for tx, pain at R thumb

REFERRALNature of

HISTORYRelevant Medical

Arthritis

Insulin-dependent diabetes

OCD

OT  EVALUATION

• Pain Scale• Reported 9/10 initial evaluation

• ROM• Bilateral shoulder/elbow ROM are WNL

• Grip/Pinch Strength• Weak hand grasp, especially in pinches• Instability of CMC & MCP, limited R thumb

opposition

OT  Evalua)on  Cont.OT  EVALUATIONcontinued

• Sensory Assessments (Pin Stick & Temperature)• Impaired sensation for light touch, sharp/

dull, hot/cold in both hands• Arthritic Deformities• Multiple swan neck: L hand digits 2 & 4, R

hand digits 3-5• Multiple RA nodules on both hands

Func)onal  Problems

Pt. is always tired & depressed

Unable to bathe & perform self-groom tasks

Unable to carry out household chores

Difficulty preparing meals

No longer attends weekly luncheon with her friends

Functional  PROBLEMS

1

2

3

4

5

Long  Term  Goal  #1

Client will be independent with all hygiene/self-care activities in own home, using A/E and energy conservation strategies with a fatigue level of 5 or less in 4 weeks to increase functional independence and decrease fatigue.

Long-Term  GOAL #1

Short  Term  Goal  1a

Client will tolerate 20 minutes of ADL activity, taking 2-minute breaks every 10 minutes with 0/10 pain in R and L upper extremities during rest and activity, 3x/week for 3 weeks.

Short-term  GOAL 1a

Short  Term  Goal  1b

Client will demonstrate independence with brushing hair and teeth using built-up handles on her hairbrush and toothbrush to compensate for weakened grasp after education for five minutes, 2x/week for 2 weeks.

Short-term  GOAL 1b

Long  Term  Goal  #2

Client will be able to independently self-feed for 15 minutes, using built-up utensils, compensatory movements, and UE joint protection strategies without VCs 1x/week for 4 weeks to increase functional independence.

Long-term  GOAL #2

Short  Term  Goal  2a

Client will independently self-feed using built-up utensils for 10 minutes after instruction 1x/week for 2 weeks to increase functional independence.

Short-term  GOAL 2a

Short  Term  Goal  2b

Client will tolerate 10 minutes of wrist and hand exercises to increase strength, ROM, and endurance, which will improve feeding and other ADLs, 3x/week for 3 weeks.

Short-term  GOAL 2b

OT  Treatment  Plan

• Educate client:• Energy conservation & ECWS techniques• Fall risk & prevention strategies• Joint protection• Stress management & relaxation

techniques

OT  TREATMENT PLAN

OT  Treatment  Plan

• ADL/IADL training• A/E to improve grasp & compensate for

muscle atrophy• Pain management techniques • Train in safe/efficient transfers

OT  TREATMENT PLANcontinued

OT  Treatment  Plan

• Splints:• Rest/working hand splint• Wrist cock-up• Finger splint• Ulnar deviation splint• Tri-point splint• Thumb Spica

OT  TREATMENT PLANcontinued

Frames  of  ReferencesFrames of  REFERENCEMOHO

Understanding her habits according to her roles.Looking at her volition to make her more self-sufficient in her daily tasks.

PEOChanging the environment to create a greater fit w/the client & occupation to improve occupational performance.

EHPEstablish/restore intervention addresses inability to self-

feed.Adapting/modifying the above task addressed by adding

built up handles.Prevent/create intervention will be addressed by the home

exercise program.

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the  ACTIVITY

Client will work on multi-step food preparation in own kitchen by participating in graded cooking tasks to improve safety and independence in meal preparation.

Client will prepare dinner for two (her and her husband) using pre-prepared meals.

Client will prepare dinner for two using pre-cut vegetables and meat.

Client will prepare dinner for two with only one pre-prepared item, utilizing A/E (e.g. rocking knife) to cut vegetables.

Home  Program

• Practice energy conservation, work simplification, & safety techniques

• Wear working splints during day activities & resting splint at night.

• Use built up padding for tools during ADL’s.

Home  PROGRAM

Discharge  Summary

Client achieved all long & short term goals.

Pain reduced from 9/10 to 2/10 & occasionally 7/10.

Fatigue level decreased from 10/10 to 5/10.

Grip strength improved from 42lbs to 50lbs on the R hand and 50lbs to 51lbs on L hand.

Discharge  SUMMARY

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T H E E N D