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DIAGNOSIS 1: Raynaud Syndrome (PROBLEM 1: Performance skills (Difficulty…
DIAGNOSIS 1: Raynaud Syndrome
PROBLEM 1: Performance skills
Difficulty moving and transporting
FIMS
Barthel Index Assessment
Intervention (Modify): Activity modification (Pergolotti, 2016)
Activities of Daily Living (ADL) Index
Difficulty pacing
Fatigue Scale
Intervention (Maintain): energy conservation techniques
Difficulty organizing
Intervention (Establish): Visual Maps (Pergolotti et al., 2016)
Decreased muscle tone and strength
Grip/pinch Test
Intervention (Modify): Activity modification
Decreased endurance with family and work
COPM (Law et al., 2014)
Intervention (Modify): activity modification (Pergolotti, Williams, Campbell, Munoz, & Muss, 2016)
Intervention (Maintain): Energy conservation techniques
Difficulty attending
Cognitive strategies
PROBLEM 2: Client factors
Loss of sensation in hands
Semmes Weinstein
Sharp/Dull
Intervention (Modify): Wear gloves (Herrick, 2017)
Difficulty determining what he is doing when he's working with his hands
Pinch/grip strength test
Stereognosis
Numbness and tingling in hands
Semmes Weinstein Assessment
Wear gloves (Herrick, 2017)
PROBLEM 3: Context/Env.
Lives in a two story house
Intervention (establish): Increase home of temperature to a higher degree (Herrick, 2017)
Home Assessment
Works at a facility that requires heavy lifting
Strength/Grip Test
COPM (Law et al., 2014)
Intervention (maintain): Activity modification
Intervention (Maintain): Energy Conservation Techniques
Intervention (Establish): Dress warmly (Herrick, 2017)
Home assessment/work assessment
FIMS
Barthel Index Scale
COPM (Law et al., 2014)
Intervention (establish): Increase temperature at work and at home (Herrick, 2017)
Intervention (establish): Dress warmly (Herrick, 2017)
PROBLEM 4: Performance patterns
Father of two girls
COPM (Law et al., 2014)
Husband
Warehouse manager
Cancer patient
Outcome:
Outcome: Client will play with children.
Client will play cards with grandchildren with mod I using energy conservation techniques within 1 month.
Outcome: Client can participate in work activities.
Outcome: Client will type on the computer for 30 min. using energy conservation techniques and by wearing gloves within 3 weeks.
Outcome: Client will lift 10 lb. objects at work with mod I using energy conservation techniques and AD within 2 months.
Outcome: Client will perform ADLs
Client will complete laundry activities with mod I using energy conservation techniques and by wearing gloves within 2 months.
Client will complete toileting activities with mod I by using extra times and utilizing grab bars within 1 month.
Client will feed self with mod I using modified utensils within 2 weeks
References
Pergolotti, M., Williams, G. R., Campbell, C., Munoz, L. A., & Muss, H. B. (2016).Occupational therapy for adults with cancer: Why it matters. The Oncologist, 21(3). 314-319. [doi:10.1634/theoncologist.2015-0335
Law, M., Baptiste, S., Carswell, A., McColl, M. A., Polatajko, H., & Pollock, N. (2014). The Canadian Occupational Performance Measure. Ottawa, ON: CAOT Publications.
Mendoza, T. R., Wang, X. S., Cleeland, C. S., Morrissey, M., Johnson, B. A., Wendt, J. K., & Huber, S. L. (1999). The rapid assessment of fatigue severity in cancer patients: Use of the Brief Fatigue Inventory. Cancer, 85, 1186-1196.
https://doi.org/10.1002/(SICI)1097-0142(19990301)85
: 5<1186::AID-CNCR24>3.0.CO;2-N
Braveman, B., Robson, M., Velozo, C., Kielhofner, G., Fisher, G., Forsyth, K., & Kerschbaum, J. (2005). Worker Role Interview (WRI) (Version 10.0). Chicago: Model of Human Occupation Clearinghouse, University of Illinois at Chicago
Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., ... Brannon, J. (1993). The Functional Assessment of Cancer Therapy Scale: Development and validation of the general measure. Journal of Clinical Oncology, 11, 570-579.
https://doi.org/10.1200/JC0.1993
. 11.3.570
Zhao, I., & Yates, P. (2008). Non-pharmacological interventions for breathlessness management in patients with lung cancer: A systematic review. Palliative Medicine, 22, 693-701.
https://doi.org/10.1177/0269216308095024
Chien, C. H., Liu, K. L., Chien, H. T., & Liu, H. E. (2014). The effects of psychosocial strategies on anxiety and depression of patients diagnosed with prostate cancer: A systematic review. International Journal of Nursing Studies, 51, 28-38.
https://doi.org/10.1016/j.ijnurstu.2012.12.019
Cramer, H., Lauche, R., Paul, A., & Dobos, G. (2012). Mindfulness-based stress reduction for breast cancer--A systematic review and meta-analysis. Current Oncology, 19, e343-e352.
Andersen, C., Rurth, M., Ejlertsen, B., Stage, M., Muller, T., Midtgaard, J., ... Adamsen, L. (2013). The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue. European Journal of Oncology Nursing, 17, 331-339.
https://doi.org/
10.1016/j.ejon.2012.09.003
Stapleton, S. J., Holden, J., Epstein, J., & Wilkie, D. J. (2016). A Systematic Review of the Symptom Distress Scale in Advanced Cancer Studies. Cancer Nursing, 39(4), E9–E23.
https://doi.org/10.1097/NCC.0000000000000292
Rooney, S., McFadyen, D. A., Wood, D. L., Moffat, D. F., & Paul, P. L. (2019). Minimally important difference of the Fatigue Severity Scale and Modified Fatigue Impact Scale in people with Multiple Sclerosis. Multiple Sclerosis and Related Disorders.
https://doi.org/10.1016/j.msard.2019.07.028
Carpenter, C. R., Bassett, E. R., Fischer, G. M., Shirshekan, J., Galvin, J. E., & Morris, J. C. (2011). Four Sensitive Screening Tools to Detect Cognitive Dysfunction in Geriatric Emergency Department Patients: Brief Alzheimer’s Screen, Short Blessed Test, Ottawa 3DY, and the Caregiver-completed AD8. Academic Emergency Medicine, 18(4), 374–384.
https://doi.org/10.1111/j.1553-2712.2011.01040.x
Robnett, R., & Thomson, L. K. (2017). Updating the Kohlman Evaluation of Living Skills (Fourth Edition): The Beta Testing Process and Outcome. American Journal of Occupational Therapy, 71, 278.
https://doi.org/10.5014/ajot.2017.71S1-PO1073
DIAGNOSIS: Colon Cancer
PROBLEM 2: Client factors
Extreme fatigue
Modified Fatigue Impact Scale (Rooney, McFadyen, Wood, Moffat, & Paul, 2019)
Intervention: Energy conservation strategies (Zhao & Yates, 2008)
Interventions (Restore): tasks related to increasing endurance to be able to play with his children and work
generalized weakness
MMT
Brief fatigue inventory (Mendoza et al., 1999)
Cognitive dysfunction
Functional assessment of cancer therapy (Cella et al., 1993)
Short Blessed (Carpenter, Bassett, Fischer, Shirshekan , Galvin, & Morris 2011)
KELS
Visual Reminders (Pergolotti et al., 2016)
Activity modification (Pergolotti et all., 2016)
Strategies for reducing anxiety and depression over the loss of roles (Chien, Liu, Chien, & Liu, 2014),
Mindfulness-based interventions (Cramer, Lauche, Paul, & Dobos, 2012; Piet, Wurtzen, & Zachariae, 2012)
inability to concentrate for long periods of time
Symptom Distress Scale (Stapleton, Holden, Epstein, & Wilkie, 2016)
catheter/colostomy
PROBLEM 4: Performance patterns
Work
COPM (Law et al., 2014)
Intervention (Modify): Work modifications/task changes
Home
Home assessment/COPM
Intervention (Restore) : Endurance related tasks such as cleaning the dishes
PROBLEM 3: Context/Env.
Lives in a two story house
Works at a facility that requires heavy lifting
Worker role interveiw (Braveman et al., 2005)
COPM (Law et al., 2014)
Activity modification (Pergotti, 2016)
Home assessment
FIMS
Barthel Index Scale
COPM (Law et al., 2014)
Interventions: Home modifications
PROBLEM 1: Performance skills
Decreased Endurance
Planning/cooking meals with family
Decreased paces
Decreased navigaton
Intervention: gross motor tasks such as playing soccer or catch with a soft ball with kids
Decreased ability to manipulate
Restore Intervention: A home exercise, range-of-motion, and stretching program to address fatigue (Andersen et al., 2013; Kangas, Bovbjerg, & Montgomery, 2008; Kuchinski, Reading, & Lash, 2009; McNeely et al., 2006; Wanchai, Armer, & Stewart, 2011)
Outcome:
Clients will perform ADLs: Client will increase activity endurance from 15 min to 30 minutes during grooming and hygeine tasks within the first 30 days
Client will play with children: Client will play with children completing a gross motor activity, such as catch or soccer, with decreased breaks 3/5 in the first 60 days.
Client will participate in work activity: Client will increase endurance in work related task from 20 minutes to 40 minutes within the first 3 weeks.
Model/FOR
Person-Environment-Occupation (PEO)
Adapt his environment (work, leisure) to fit his occupational needs considering conditions
Occupational performance is the interaction between person, environment, and occupation
How individuals complete meaningful occupations with possible modifications in the environment
Client cannot change his current diagnosis, but OT’s can work with him to modify the environment to ease activity performance despite his current limitations.
Biomechanical
The Biomechanical frame of reference is based on Joint range of motion, Muscle strength, and Endurance with the intact central nervous system.
Increase strength and endurance of bilateral hands
Strengthen endurance to eliminate excessive fatigue