A.K. A Peop Presentation

1. Amanda Barr – OCCT 657A A.K. A Peop Presentation

2. Demographics • 42 year old wife and mother • Part time work in Law office • Lives in 2 story home with husband and teen son • 5 foot 1 inches tall and roughly 104 lbs. • Health conscious • Unremarkable medical history • Active in snow sports, competes in triathlons, loves to travel

3. Hospitalization • Suffered a fall from a 2nd story bay window, landed in the bushes of her front yard. • Complete SCI at the level of L3-L4 • L1 –S1 Complex spine surgery • 2 wks Post op transferred from General Hospital to Acute Rehabilitation hospital • Pt fitted for TLSO – ThoracolumbosacralOrthosis • Doctors orders to wear when patient is upright

4. Evaluation Methods • Prior level of function • Establish length of stay; rehabilitation potential • Discuss Home environment • Entry, Bathroom, number of steps, • FIM scores: 8 areas • Self care: Eating, Grooming, Bathing, shower t/f, Dressing UE & Dressing LE • Functional transfers: Shower and toilet • Manual Muscle Testing for UE • Determine strength, endurance and tone • Testing LE Sensation • Track presence or absence (compare with Acute hospital)

5. Person – Intrinsic factors • Physiological • Sensori-motor deficits - flaccidity and minor spasticity • Sensory system – tactile and proproception • LE muscle atrophy • Bowel and Bladder control • Neurobehavioral • No behaviors found based on neurological condition • Cognitive • Actively engaged & memory intact • Able to perform multi-sequence tasks • No limitations noted that impair performance

6. Person – Intrinsic factors • Psychological • Depression* • Decreased sense of self worth and purpose • Emotional conflict - desire to be self sufficient but feels hopeless • Spiritual • Stated she is spiritual but is not affiliated to a church • No specific beliefs that would interfere with standard medical practice.

7. Environment – Extrinsic Factors • Social support • Son and 2 close friends visit daily • Husband attends therapy sessions in afternoon • Social and Economic systems • Lives in small community, close to neighbors • Middle class family – Husband works 6 months of out year as civil engineer • Using savings for home modifications • Culture and Values • Core values in relationships with family and friends • Culture of an athlete: father was a professional skier – hardworking nature and dedication to goals

8. Environment - Continued • Built Environment and Technology • Home is a 2 story, 16 steps into entry, planning to use garage as entry; 1st floor bathroom with tube • Pt utilizes her IPhone to communicate with family and friends • Pt stated she is well versed in computer from her job • Natural Environment • Positive feelings and emotions when outdoors; especially vivid stories about her training routine for triathlons • Pt asked for a window bed in her room to view the snow falling and the sun in the morning

9. Occupations • Basic ADLs • Pt stated more important focus on transfers, bathing and toileting • Work • Possible return to Paralegal for Real Estate, Water Law & Environmental Law office • Play/Leisure • Physical Activity – dedicated daily routine • Reading • Social Participation • Nurture relationships with son, husband and close friends • Education • Newly acquired tasks, compensatory strategies and health related training

10. Performance • Patient able to maneuver wheelchair in hallways and into bathroom at slower speed. • Reduced strength and endurance with transfers - use of upper body • Motivated for physical activity – requested therapy target cardiovascular exercise and strength training of UE • Minimal social interaction with residents and staff; noticeable change in demeanor after therapy

11. Goals Initial: • To transfer ModA from Bed ↔ w/c using slideboard • Perform UE and LE dressing ModA supine in bed • Bathing and shower t/f ModA using AE Progressed: • Perform laundry task with ModI • Prepare a stovetop meal with supervision • Independently return to w/c from ground level

12. Occupational performance & participation • Personal care • Motivated to overcome limitation from injury and handle the environmental barriers for her own expectations • Productive activities • Initial environmental constrict regarding w/c use and accessibility • Emphasis on developing skills for patient to engage in meaningful activities in hospital setting • Home maintenance • Home modifications to alter environment to allow patient to enter home, work at in kitchen and get in and out of 1st floor bathroom • Simulated tasks during therapy

13. Occupational Performance & Participation • Recreation • Balance of personal factors and environment regarding outdoor leisure for meaningful activity; spoke with Disabled Sports of America • Leisure • Continued leisure activities through physical activity in therapy and reading in her room. Patient has healthy balance of her

14. Interventions • Development of patient–therapist relationship through basic skill development in self care • Supine dressing in bed using AE • Daily routine of shower and dressing (Hall, 1999) • Improve UE strength and endurance for through patient directed activity • Upper Extremity bike with moderate resistance • Environmental obstacles and weighted item retrieval (Hammell, 2009)

15. Interventions • Enhance new identity by overcoming insecurities and apprehension that limits social interaction. • Core training on mat in therapy gym • Group therapy for UE exercises (Isaksson, 2007) • Focus on the rewarding activities that enhance the patient’s perspective of their abilities. • Functional transfer in transitional living room (bed and bath) • Home management tasks; stovetop cooking and laundry (Donnelly, 2004)

16. Transition to Home • Family training • Car transfers • At home consultation • OT and Physical Therapist visit • Fall training • Patient and therapist create best fit technique for patient to return to wheelchair from ground

17. References American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domains & process (2nd ed.). The American Journal of Occupational Therapy, 62, 625-683. \ Cole, M.B. & Tufano, R. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated. Donnelly, C., Eng, J. J., Hall, J., Alford, L., Giachino, R., Norton, K. & Kerr, D. S. (2004). Client-centred assessment and the identification of meaningful treatment goals for individuals with a spinal cord injury. Spinal Cord , 42, 302–307. Hall, K.M., Cohen, M.E., Wright, J., Call, M. & Werner, P. (1999). Characteristics of the functional independence measure in traumatic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 80, 11, 1471-1476 Hammell, K.W., Miller, W.C., Forwell, S.J., Forman, B.E. & Jacobsen, B.A. (2009). Managing fatigue following spinal cord injury: A qualitative exploration. Disability and Rehabilitation, 31, 17, 1437–1445. Isaksson, G., Josephsson, S., Lexell, J. & Ska, L. (2007). To regain participation in occupations through human encounters – narratives from women with spinal cord injury. Disability and Rehabilitation, 29, 22, 1679–1688.