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Case 4 (Problem list (Dysphagia (Currently on PEG Tube), Homer has lost…
Case 4
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Intervention
Preparatory exercises prior to a meal (AOTA, 2018)
Grade down: Puree food/ soft food that does not require extensive effort to swallow
Grade up: differerent texture food that involves more chewing and swallowing**
Modified Diet textures (AOTA, 2018)
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Positioning of body when engaged in feeding (AOTA, 2018)
Grading down : Sitting up supported on a bed with side rests .
Grading up: Sitting up on the chair and eating from the tabletop.
**Compensatory Strategies for Dysphagia: Game-based biofeedback (Li et al., 2016)
Compensatory Strategy: Using Sensory Enhancements (Lazarus, 2017))
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Strength
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Hobbies include fishing, reading, and building model cars
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Frames of Reference
Sensory Integration FOR- Focuses on the way the brain receives sensory input from the environment and then it organizes it in a way the body can respond with an action. By using sensory intergrative strategies, some occupation difficulties such as attention, poor postural control, balance, hypersesnsitivity. This can influence both sensory and behavioral responses in relation to everyday occupations (Cole & Tufano, 2008).
Rehabilitative Frame of Reference - Focus on getting Homer to become independent as much as possible despite his dysfunctions. This FOR focuses on adaptation as means to promote independence (Cole & Tufano, 2008).
PEOP Model - The interaction between Homer’s abilities, the environmental and the demands of different occupations which influences the performance outcome. This can apply to Homer's occupation/ADL of feeding. This can help therapist with the treatment session in a holisitic way (Cole & Tufano, 2008).
Goals:
Long Term Goals
LTG 1 : Within 12 weeks, Homer will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function during P.O. intake, without overt signs and symptoms of aspiration, with the least restrictive diet consistency reducing patients complaints from a level 6 (with 1 being the best and 7 being the worst) to a 4 or less using the Dysphagia Patient Complaint Scale.
LTG 2 : Within 12 weeks, Homer will utilize compensatory strategies with optimum safety and efficiency of swallowing function during P.O. intake without overt signs and symptoms of aspiration with the least restrictive diet consistency reducing patients complaints from a level 6 (with 1 being the best and 7 being the worst) to a 4 or less using the Dysphagia Patient Complaint Scale.
Short Term Goals
STG 1.2: Within 6 weeks, Homer will utilize safety techniques for efficient swallowing function, showing no more than minimally overt signs and symptoms of aspiration,with a minimally restrictive diet consistency, reducing his complaints from a level 6 to a level 5 or less using the Dysphasia Complaint Scale.
STG 2.1: Within 4 weeks, Homer will learn compensatory strategies for safety and efficiency of swallowing functions, with moderate assistance and no more than 6 verbal cues, in order to address swallowing/eating and feeding.
STG 1.1: Within 6 weeks, Homer will maintain adequate hydration/nutrition for a full week, with moderate assistance and no more than four verbal cues or reminders per day, in an effort to increase feeding/eating performance.
STG 2.2: Within 6 weeks, Homer will utilize compensatory strategies for safe and efficient swallowing functions, showing no more than minimal signs and symptoms of aspiration, with a moderately restrictive diet consistency, in an effort to reduce his complaints from a level 6 to a level 5 or less.
References AOTA. (2018). Occupational Therapy: A Vital Role in Dysphagia Care. Retrieved from https://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/Dysphagia%20fact%20sheet.pdfBurks, C., Jones, C., Braz, V., Swor, R., Richmond, N., Hwang, K., ...Platts-Mills, T. (2017) Risk factors for malnurtrition among older adults in the emergency department: A multicenter studt. Journal of the American Geriatrics Society, 65, 1741-1747. Cole, M. and Tufano, R. (2008). Applied theories in occupational therapy. Thorofare: SLACK.Occupational Therapy Practice Framework: Domain and Process (3rd Edition). (2014). American Journal of Occupational Therapy, 68(Supplement_1), pp.S1-S48.Pacian, A., Kulik, T., Bednarz, J., Kaczoruk, M., & Kawiak-Jawor, E. (2018). Quality of Life Assessment in Post-Stroke Patients. Pielegniarstwo XXI Wieku / Nursing In The 21St Century, 17(2), 12-22. doi: 10.2478/pielxxiw-2018-0015Melody Sheldon, C. (2018). Dysphagia | Rehab Insider. Retrieved from http://rehab-insider.advanceweb.com/patient-centered-dysphagia-care/Lazarus, C. (2017). History of the Use and Impact of Compensatory Strategies in Management of Swallowing Disorders. Dysphagia, 32(1), 3-10. doi: 10.1007/s00455-016-9779-6Li, C., Wang, T., Lee, H., Wang, H., Hsieh, S., Chou, M., & Jason Chen, J. (2016). Swallowing Training Combined With Game-Based Biofeedback in Poststroke Dysphagia. PM&R, 8(8), 773-779. doi: 10.1016/j.pmrj.2016.01.003
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