Patient is a 45-year-old female who sustained a left-sided CVA with right-sided hemiparesis. She lives in a 3-story house with her daughter. She is currently on medical leave from her job as human resources manager. She has prior history of CVA and she is also diabetic. She plans on returning to her job and regain her independence. She also expressed that she want to live close to normal life. After her hospitalization, the patient has been receiving occupational therapy services at a skilled nursing facility. The rehab program will last for 12 weeks addressing any deficits so that that patient can be functionally independent again. The patient is currently on the third week of the rehabilitation program.
Current level of function: Right side function is slowly coming back. Patient is able to perform ungraded upper extremity function. Patient is able to grasp objects and can isolate finger movements, although weakness is observed and noted. The patient has poor standing balance. Treatment Precautions • Fall risk • Sensation on the RUE is diminished • Proprioception on the right side is impaired • Visual impairment (hemianopsia) • Constructional apraxia • Paresis on the right side of the body. …show more content…
• Patient tends to choke on liquids
• Patient displays impulsivity.
Occupational Therapy Problems & Treatment Goals
1. Dressing – UE/LE dressing is one of the areas that should be addressed. Due to weakness on the right side and moderate dressing apraxia, donning and doffing of clothing will be difficult for the patient.
• Goal: Patient will complete UE/LE dressing in a sitting position with the use of assistive devices with minimum assistance to regain independence.
2. Grooming and hygiene – Involved side of the body is still weak and doing hygiene and grooming task will also be a challenge for the patient.
• Goal: Patient will be independent with grooming tasks for the purpose of regaining independence in home environment.
3. Transfers – most transfers will be difficult for the patient (ex. w/c to bed, bed to w/c, toile transfers). Due to paresis, maximum assistance is required during transfers.
• Goal: Patient will be able to transfer on/off (toilet, chair, w/c) with minimum assistance and with the use of AE/DME to regain independence in bathroom activities. Occupational Therapy Interventions Dressing Current Intervention: Patient is educated and trained in the use of adaptive equipment (sock aid, long shoe horn, reacher, etc.) to perform upper and lower extremity dressing techniques. Closure management (use button hook) is also part of the treatment. Recommendation: Since the patient is able to perform some function on the involved side, constraint-induced movement therapy (CITM) might be able to augment the treatment. Patient will be forced to use the involved side in doing functional task such as dressing. The current and the recommended intervention supports client centered, occupation based, and evidence-based approach. Client’s goal to regain functional independence such as dressing is reflected in the goal and interventions that were stated. Evidence suggest that CITM had favorable results when used in treatment for stroke patients. The only barrier is that, not a lot of therapist use this technique because it’s time consuming and the protocol is very structured lack of information about CIMT. Grooming and hygiene: Current intervention: As part of ADL training, the patient performs hygiene/grooming task in her room early in the morning. The therapist go to her room and observe her perform grooming
Current level of function: Right side function is slowly coming back. Patient is able to perform ungraded upper extremity function. Patient is able to grasp objects and can isolate finger movements, although weakness is observed and noted. The patient has poor standing balance. Treatment Precautions • Fall risk • Sensation on the RUE is diminished • Proprioception on the right side is impaired • Visual impairment (hemianopsia) • Constructional apraxia • Paresis on the right side of the body. …show more content…
• Patient tends to choke on liquids
• Patient displays impulsivity.
Occupational Therapy Problems & Treatment Goals
1. Dressing – UE/LE dressing is one of the areas that should be addressed. Due to weakness on the right side and moderate dressing apraxia, donning and doffing of clothing will be difficult for the patient.
• Goal: Patient will complete UE/LE dressing in a sitting position with the use of assistive devices with minimum assistance to regain independence.
2. Grooming and hygiene – Involved side of the body is still weak and doing hygiene and grooming task will also be a challenge for the patient.
• Goal: Patient will be independent with grooming tasks for the purpose of regaining independence in home environment.
3. Transfers – most transfers will be difficult for the patient (ex. w/c to bed, bed to w/c, toile transfers). Due to paresis, maximum assistance is required during transfers.
• Goal: Patient will be able to transfer on/off (toilet, chair, w/c) with minimum assistance and with the use of AE/DME to regain independence in bathroom activities. Occupational Therapy Interventions Dressing Current Intervention: Patient is educated and trained in the use of adaptive equipment (sock aid, long shoe horn, reacher, etc.) to perform upper and lower extremity dressing techniques. Closure management (use button hook) is also part of the treatment. Recommendation: Since the patient is able to perform some function on the involved side, constraint-induced movement therapy (CITM) might be able to augment the treatment. Patient will be forced to use the involved side in doing functional task such as dressing. The current and the recommended intervention supports client centered, occupation based, and evidence-based approach. Client’s goal to regain functional independence such as dressing is reflected in the goal and interventions that were stated. Evidence suggest that CITM had favorable results when used in treatment for stroke patients. The only barrier is that, not a lot of therapist use this technique because it’s time consuming and the protocol is very structured lack of information about CIMT. Grooming and hygiene: Current intervention: As part of ADL training, the patient performs hygiene/grooming task in her room early in the morning. The therapist go to her room and observe her perform grooming