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SOLVING A COMPLEX CLINICAL CASE 56 y.o. male sustained a TBI after MVA …
SOLVING A COMPLEX CLINICAL CASE 56 y.o. male sustained a TBI after MVA Currently Ranchos level II and recently transferred to SNF after one month inpatient rehab
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Tier 3: Evaluation tools
Modified Ashworth Scale: This scale determines the level of resistance (spasticity) present in the client's joints with a rapid passive stretch (Radomski & Latham, 2014). Client was tested to have a slight catch/release for his UE ROM (+1) and increased muscle tone during ROM in LE (Radomski & Latham, 2014).
Coma Recovery Scale: This scale will measure the client's response to different types of sensory stimuli (Radomski & Latham, 2014). The therapist can track the client's progress throughout his session and determine what stimuli he responds to the most and utilize that during sessions.
Ranchos Los Amigos Scale: This is a medical sclae that assess an individuals level and rate of recovery after sustaining a TBI (Hagen, 1997). The client was determined to be at Ranchos level II, generalized response, with no voluntary movement (Hagen, 1997). Client may respond to noxious stimuli and perform involuntary gross movement (Hagen, 1997).
References
McMillan, I. R. (2011). The biomechanical frame of reference in occupational therapy. In E. A. S. Duncan (Ed.), Foundations for practice in occupational therapy (5th ed., pp. 179-194). Edinburgh: Churchill Livingstone.
Allen, C. K. (1992). Cognitive disabilities. In N. Katz (Ed.), Cognitive rehabilitation: Models for intervention in occupational therapy (pp. 1-21). Stoneham: Butterworth-Heinemann.
Radomski, M. & Latham, C. (2014). Occupational therapy for physical dysfunction (7th ed.) pp.1-1426. Lippincott Williams & Wilkins.
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American Occupational Therapy Association. (2014). Occupational therapy practice framework:
domain and process. American Journal of Occupational Therapy, 68(Supplement 1), S1-S51.
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Model/FOR
Allen's Cognitive Disabilities Model: This model focuses on cognition and how it applies to functional skills used in everyday tasks (Allen, 1992). This model focuses on six functional cognitive levels that correlate with certain areas of performance that range from automatic reflexes to planned actions (Allen, 1992). This model fits with the Ranchos Los Amigos scale and this client because they both are measuring the clients ability to make voluntary purposeful movement. As the client progresses in therapy the therapist can evaluate which level he is on and modify the task to fit the level he is currently at.
Biomechanical FOR: This FOR focuses on the client regaining voluntary motor skills that are necessary to engage in occupations and ADLs (McMillan, 2011). This client sustained a TBI that has rendered him to be immobile and this FOR focuses on re-mediating his ROM, muscle strength and endurance (McMillan, 2011). Right now the client is at risk for contractures and losing his ROM due to his immobile state.
Tier 4: Intervention Approaches (AOTA, 2014).
Education: Therapist will educate client's wife and daughter about family member's condition and ways to engage with him.
Establish:Therapist will work with client's family to establish a daily regulated routine for assisting in client care and goals.
Maintain : Therapist will maintain range of motion in extremites and create orthotics to help reduce tone/spasticity.
Prevent:Therapist will help prevent bed sores and contractures by utilizing bed positioning techniques.
Client Strengths
Client will receive skilled OT, PT, and SLP services at SNF.
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