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Homer, 82 y.o. (Interventions (Intervention 3: Family/caretaker Education…
Homer, 82 y.o.
Interventions
Intervention 3: Family/caretaker Education and involvement in meal time--Educate on swallowing techniques to remind Homer, and educate on proper positioning during feeding (Beavan, 2015). Have his wife participate in a meal to remind him that feeding has a social component. Having the wife watch will help educate her in his new feeding techniques and adaptive devices
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Intervention 4: Adaptive technology--Provide him with a rocker knife for L hand, plate with lip for easier one-handed scooping (Beavan, 2015). Practice using tools with putty and then real food.
Grade up
If he masters the skill of scooping, remove the plate with the lip and use a regular plate. Use real food.
Grade down
Provide him with built up handle utensils if he is having trouble gripping. Use play dough because it is softer.
Intervention 2: Retraining (Paul & D'Amico, 2013)--Simulate feeding, bring food to mouth, cut food--use putty to practice cutting with L hand using rocker knife and stabbing with fork using L hand, have him pretend to eat it by bringing it up to his mouth (but don't put it in his mouth).
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Intervention 5: Swallowing techniques--
Teach him chin tuck, head turn, effortful swallowing while swallowing his thickened liquid (Paul & D'Amico, 2013).
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Grade down
Provide him with a handout or worksheet with information on each technique and how to do each of them
Intervention 1: Strength and coordination of getting fork/spoon to mouth with L hand (especially important if he is right-handed, this may be a new skill) (Paul & D'Amico, 2013) --For coordination have him practice moving L hand from table to mouth. For strength, have him do resistance band exercises with L hand in elbow flexion and extension
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Grade down
remove cup and/or resistance band and have him practice moving his L hand to his mouth from the table without missing his mouth.
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Problems & Strengths
Problems:
Swallowing dysfunction (dysphagia) (Yi-Hui, Hsiu-Yueh & Shun-Te, 2014).
PEG tube
R Hemiplegia
Fever
Lethargy
Weight loss
HTN
Constipated
Gen weakness
Poor memory
Strengths: Married, has been extubated, communication in tact but currently limited w/ fatigue, can follow commands
Goals
LTG 1: In 60 days, client will use the effortful swallow technique for 50% of swallows while drinking 8 oz of thickened liquid independently.
STG: In 30 days, client will use effortful swallow technique for 25% of swallows while drinking 4 oz of thickened liquid with verbal cueing
LTG 2: In 60 days, client will use the rocker knife with his L hand to cut food into small bites independently.
STG: In 30 days, client will use the rocker knife with his L hand to cut food into small bites with min assistance from therapist.
Client Priorities
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Leisure participation
Fishing, model cars and reading