William - CVA
William - CVA
- Client has a diagnosis of CVA
- Resulted in Left Hemiparesis
- Client has normal strength in UE and LE
- Client has an interest in art and is a very good artist
- Has a large family
- Client is a retired school teacher and has traveled throughout the world.
- Client is an active member in his church
- Volunteered at a school prior his CVA incident
- Post CVA, client only leaves home for Dr. appointments and therapy.
- Client requires mod A for stand pivot transfers.
- Client's wife is the primary caregiver.
- Client also has a paid caregiver for 8hr/day
- Client is a 65yr old male, middle class with a bachelors degree.
- Recently retired
- Client receives good support from church
- Client lives in a single story home which has a ramp at front door.
- Client has not attended church since CVA incident
- Client's wife is unable to perform transfer successefully.
- For communication, client uses email to remain in touch with his extended family. He does not use cellphone or social media.
- Home is small with a lot of furniture which makes it difficult for the client to navigate around the house.
- Client has not attended church post CVA
- Wife is unable to perform transfer for client successfully
- William is currently using a power wheelchair.
- Wheelchair helps him to move around the house and in the community.
- The kind of Wheelchair suitable for William is an M3 Corpus by Permobil.
- Using his wheelchair will give him access to get back into his community and also go back to atteding church and becoming an active member again.
- To prevent fall risk for both his wife and William an AT device which can be implimented here is the Super Pole by Health Craft Products.
- Health Craft
- Since William has normal strength and ROM on his Right U/L extremity he has weakness on his Left side and therefore requires a Mod assist with stand pivot transfer.
- Keeping his age in mind it is important to simplify AT modes for him instead of making it hard and complicated.
- SuperPole is a good fit because he can use this pole as something to hold onto when standing and help position himself before transferring.
- William's wife will still be there to support him and help him transfer by providing standby assist while William uses the SuperPole to support himself and transfer onto bed, bathroom, or living room.
- The Super Pole is held in place by tension between the floor and the ceiling and it can be used anywhere in the home.
Modify Home Environment
- William currently lives in a small home crowded with furniture which presents as a barrier to engage in occupations.
- Since William is in a wheelchair it is important to create space in areas around the house such as kitchen, living room, bedroom, bathroom, and closet.
- By creating space and redesigning his home will help William gain the independence he wants and will not have to be dependent on his wife.
- It is important to follow ADA guidelines when creating space and removing walls or doors for easy access.
- According to ADA doorways have to be 32" wide - this will allow William to go in and out of his home and pass through other doors in his home.
- It is important to make sure that there are no obstacles in the way as William moves around his home.
- When doing home evaluation it is important to ask the client about his daily routine and get an understanding of his daily pattern in order to make environmental changes necessary.
- To help William become more functional and feel independent when performing bathroom ADLs, a good AT device is a Roll In Shower Multi Chair.
- This multi-chair will help William transfer on his own from toilet to tub also using his Super Pole as a tool for support.
- This is a multi purpose chair which can be adapted to his bathroom environment and will make it possible for him to make transfers from toilet to tub.
- William experiences hearing difficulties and therefore is using a sensory device - hearing aid to help him with his hearing.
- This is an Air Conduction hearing aid which is placed behind the ear.
- With the help of this hearing aid, William is able to hear the sounds around him and can stay alert to what is going on around his environment and also help communicate with his wife and caregiver effectively.
- Google home is a great device for William and his wife.
- The goal is to simply AT for William and his wife. They are an older age couple so it is important to focus on simplifying technology rather than making it complicated.
- Using a google home will help William to control many features around his house such as controling lights, opening doors, calling family, friends, his wife, caregiver, and 911.
- Using this device will help William feel independent and self-sufficient at home.
- William does not use a cell phone or social media. He uses email to communicate with his extended family.
- Due to his L hemiparesis, he is not able to type on his computer.
- By using UD accessibility on his electronic device he is able to say commands which will help him type and access apps on his electronic device such as an ipad or iphone or macbook.
- He can use Siri to help him navigate through different features and have Siri type out or read out texts or emails as he speaks voice commands to his device.
- When assessing William's home it is important to collaborate to understand his goals and priorities.
- Important to evaluate his home environment inside and out for safety purposes.
- when conducting an assessment to assist with occupational engagement it is important to ask William open-ended questions to get a sense of what he really wants and the outcome he wants to achieve in the end.
- The information obtained during an assessment would include asking questions about personal interests, daily routines and habbits, how William goes about his day, and how independent he wants to feel currently due to his diagnosis.
- Important factors to consider when doing an home assessment include:
- Level of assistance received at home
- Transfer technique
- Emergency contact/exit
- Information about mobility device
- Client functional limitations/barriers
- Home Layout
- Moving between different floor surfaces such as bathroom to room to kitchen etc.
- Enterance to home, and access to doorways.
- Bathroom and toileting access/needs
- The client wants to attend church and get back into the community.
- Client wants to become independent within his home environment.
- Client wants to become as functional as possible because he does not want to burden his wife.