case study presentation
TRANSCRIPT
Case Study
Presentation
Colin Jones
Occupational Therapy Student
Mercy University Hospital
5th March 2015
Occupational Therapy Process
Referral
Information Gathering
Initial Interview
Goal Setting & Occupational Therapy Plan
Assessment
Intervention
Discharge Planning & Review
PEOP
Client-Centred
PsychodynamicRehabilitative/ Compensatory
Biomechanical
Paradigm
Model
Frames of Reference
• Curtin et al (2009)
Guillain-Barré Syndrome (GBS)
Rare disorder that causes your immune system to attack your peripheral nervous system.
Sometimes preceded by an infection, for example, gastroenteritis.
Distal to proximal progression with potential respiratory complications.
Symptoms usually worsen over a period of weeks, then stabilize. Recovery can take a few weeks to a few years.
Treatment options during the symptom period include medicines or a procedure called plasma exchange.
• International Classification of Diseases (2015)
• Pulivarthi & Gurram (2014)
Eileen’s Initial
Interview
Living alone, two-storey house, Cork
Bathroom downstairs (shower),
bedroom upstairs
Dependant mobilizing, hoist to
commode
Ind. feeding, dependant for
majority of PADL’s
Patient concerned re: future use of
stairs
Support from son and daughter
Independent prior to admission, no
services
Goal Setting and Occupational Therapy Plan
Goal: Improve functional independence in PADL’s, transfers and mobility. Plan: Conduct assessments, provide advice on adaptive and safe techniques. Discuss adaptive equipment to improve independence.
Goal: Improve ROM, strength and dexterity in upper limbs (patient left hand dominant). Plan: Upper limb assessments and biometric training.
Goal: Return to home, use stairs independently. Plan: Liaise with Physio re: stairs assessment. Recommend patient for St. Finbarr’s rehabilitation.
Multi-
Disciplinary
Team
Eileen
Occ. Therapist
Physio
D/C Liaison
Social Work
Dietician
Doctor
Nursing
Assessment
PADL
Transfers/Mobility
Kitchen Assessment (Occupation focused)
Montreal Cognitive Assessment
Pegboard
9 Hole Peg Test
Biometric Testing
Grip Strength
Observation
Patient reports
Evidence-Based Practice
Nine Hole Peg Test – Suitable to detect changes in dexterity over the course of interventions post-stroke (Lin et al, 2010).
Montreal Cognitive Assessment – Provides reasonable estimate of general intellectual abilities in older adults (Sugarman & Axelrod, 2014). – Suitable screening tool for haemodialysis patients, 76-78% correlation with test battery (Tiffin-Richards et al, 2014).
Dynamometer – Jamar Dynamometer allows a valid and constant grip force measurement. Manugraphy provides more information on load distribution. But overall, there is a high correlation between scores (Mühldorfer-Fodor et al, 2014).
Discharge Planning & Review
Transfer to St. Finbarr’s Hospital for rehabilitation. Complete transfer letter.
Continue to review ADL’s and upper limb function prior to discharge.
Perceptual Assessment?
Home visit if rehab place does not become available.
References Christiansen, C., Baum, C. M., & Bass-Haugen, J. (Eds.). (2005). Occupational
therapy: Performance, participation, and well-being. Slack Incorporated.
Curtin, M., Molineux, M. and Supyk-Mellson, J. (Eds.) (2009) Occupational therapy and physical dysfunction: enabling occupation, 6th ed., Edinburgh: Churchill Livingstone Elsevier.
International Classification of Diseases. (2015). Guillain-Barré Syndrome. Available: http://www.icd10data.com/ICD10CM/Codes/G00-G99/G60-G65/G61-/G61.0. Last accessed 3rd March 2015.
Lin, K., Chuang, L., Wu, C., Hsieh, Y., & Chang, W. (2010). Responsiveness and validity of three dexterous function measures in stroke rehabilitation. Journal Of Rehabilitation Research & Development, 47(6), 563-571.
Mühldorfer-Fodor, M., Ziegler, S., Harms, C., Neumann, J., Cristalli, A., Kalpen, A., & ... Prommersberger, K. (2014). Grip force monitoring on the hand: Manugraphysystem versus Jamar dynamometer. Archives Of Orthopaedic & Trauma Surgery, 134(8), 1179-1188.
Pulivarthi, S., & Gurram, M. K. (2014). A young patient with multisystem complications after cytomegalovirus infection. Journal of neurosciences in rural practice, 5(1), 59.
Sugarman, M. A., & Axelrod, B. N. (2014). Utility of the Montreal Cognitive Assessment and Mini-Mental State Examination in predicting general intellectual abilities. Cognitive And Behavioral Neurology, 27(3), 148-154.
Tiffin-Richards, F. E., Costa, A. S., Holschbach, B., Frank, R. D., Vassiliadou, A., Krüger, T., & ... Reetz, K. (2014). The Montreal Cognitive Assessment (MoCA) - A Sensitive Screening Instrument for Detecting Cognitive Impairment in Chronic Hemodialysis Patients. Plos ONE, 9(10), 1-9.