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Michael (Home modification (Bathroom) (Performance deficits (Decreased…
Michael
Home modification
(Bathroom)
Occupations
Showering
Toileting
Hygiene/grooming
Functional mobility
Information from assessment
Clients shampoo/soaps are on the edges of shower and out of reach, wife assists by putting shampoo/soaps on floor of shower
Sink cabinet makes it difficult for client to get close enough to sink, he has to set his chair perpendicular to sink with R side towards sink
Client requires mod assist to get into tub shower and seated on standard shower chair
Unable to transfer self on toilet without assistance from wife
Performance deficits
Decreased endurance, using primarily R UE/LE
Unable to stabilize self, needs assistance from wife to transfer to shower and toilet
Hemiparesis of L UE and LE
Difficulty reaching toilet paper holder on L side of toilet
Difficulty reaching L sink handle to turn water on/off
Adaptations
Shower
Remove standard shower head and put in retractable shower head
Install grab bars outside and inside shower to increase independence during transfers
Install pocket shelf for shampoo/soaps in middle of shower wall
Put in slide accessible shower chair to increase independence in shower transfer
Toilet
Add standing toilet paper holder on R side of toilet or hanger on wall
Install grab bars on R side of toilet on wall or safety toilet frame to increase independence during toilet transfers
Bathroom vanity/sink
Remove under sink cabinet to allow wheelchair to go under/knee space
Add lever on left sink handle
Adding handles instead of knobs on vanity drawers to easily open and gather hygiene/grooming items
Diagnosis
R CVA
Left hemiparesis
Normal strength and ROM in R UE/LE
Assessments
Interview with Michael and wife
Create occupational profile
Identify occupations, roles, performance patterns
Identify environmental supports and barriers
Understand client priorities, needs, wants
Client wants to be more independent and not rely on wife as much
I-HOPE
In-home occupational performance evaluation
Client ranking activities by difficulty
Ranks satisfaction and performance
Observing client perform activities in specific contexts
HSSAT
Home safety self assessment
Identify hazards in each room
Take into account clients desire to be independent and not rely on wife
Current AT devices
Manual wheelchair with one arm drive system
Ramp at front door
Sensory modification
Auditory
Leisure
Reading
Assistive listening device
amazon echo or tablet
Reads E-books to client
Environmental noises to simulate clients interests, such as traveling to beach
Church
Tablet
Utilize podcasts for church sermons
Age-related hearing loss
Hearing aid
Communication
Intercom system
Intercom system in rooms and to front door
Allows client to communicate to wife in another room
Allows client to communicate with someone at front door when he is unable to see out the peep hole/ in another area of the house
Client has no significant auditory dysfunction from CVA besides age-related hearing loss
Visual
Leisure
Client is an artist
Adjustable magnifier with stand
Increases size of drawing utensils and picture
Lamp with switch at base
Adequate lighting at desk
Client unable to go to church since CVA
Tablet to watch church sermons
Install tablet mount or tablet grabber on wheelchair
Reading
Large print book
Client has no significant visual deficit from CVA but has moderate vision impairment prior to CVA
Client feels he is lacking visual stimulation because he is unable to paint, volunteer, and go to church like he used to
Has glasses but rarely uses them or visits eye doctor
Hygiene and grooming
Small mirror with base to sit on counter
Social participation
Tablet or computer
Utilizing universal design features
Increase text size
Adjust contrast