Occupational Therapy Report
Table 1
Client Details
| Client Name: | Brian miller | Client Address | 6 Tottenham Place, Glenfield, NSW 2167 |
| Date of Birth: | 2/11/1958 | Phone Number | 0299123456 |
| Diagnosis | Stroke | Date of Onset | 19/9/14 |
| Funding Body | NDIS | Claim/ID Number | B/06568 |
| Contact of Funding Body | Gayle Johnson | Funding Body Phone | 94567890 |
| Date of Assessment | Date of Report |
Background
Mr. Miller is a fifty-seven-year-old male who had a left-sided stroke approximately two years ago. The stroke left him with a number of physical impairments as will be discussed in this part of the report.
First, Mr. Mille suffered contralateral hemiplegia which caused him to have right-sided hemiparesis of both the lower and upper limbs. His hands have a muscle power grade of three since he can flex his elbows against gravity up to about 45 degrees. Despite this, Mr. Miler struggles with fine finger movements. The subject also has reduced sensation on the right side. Secondly, Mr. Miller has partial upper right-sided quadrantanopia and right-sided neglect. Mr. Miller is, however, able to overcome these visual deficits while at home by means of scanning. Mr. Miller also has mild expressive aphasia which does not limit his ability to communicate. This can be predicted by a left-sided stroke in a right-handed person like Mr. Miller (Geranmayeh, Leech, and Wise 2016). The subject’s cognition is fairly good except when handling issues requiring one to master multiple steps. Lastly, the subject complains of unusual fatigue. Mr. Miller did not have neurofluctuation. Neurofluctuation is usually as a result of subcortical ischemia and can be a massive therapeutic problem (Vahidy, Hicks, and Acosta et al 2014). Patients without neurofluctuation are likely to do better.
Goals
This section of the report discusses the goals that we would like to achieve in three months of physiotherapy. First, the physiotherapy program aims at improving or eliminating the sensori-motor deficits that Mr. Miller faces:
- Ensuring that the subjects adheres to drugs that have been prescribed to him
- Prevention of further complication like bed sores, complete paralysis or other strokes
- Treatment of complications in case some inevitably occur
- Improving his visual field and eliminating his right-sided visual neglect.
Second, it is important that the independence and functional mobility of the patient be improved:
- Improvement of his standing balance to a point where he could lift an item with his left hand while standing.
- Improvement of the distance Mr. Miller is able to walk using his walking stick to 200m or more on level ground and at least one flight of stairs
- Improvement of intricate finger functioning that can allow Mr. Miller to hold a small item, for example, a deck of cards using his right hand.
Thirdly, the physiotherapy program is aimed at integrating Mr. Miller back to the society. After personal rehabilitation, it is important to reintegrate the subject into society (Cella, Lai, Nowinski, Victorson et. al 2012):
- Improve the patients scanning strategies so that the same strategies can aid his visual independence while he is outside his home
- Promotion of safety and health so as to prevent further predispositions to accidents and poor health
- Enhancement of the function of the family and other caregivers in the community
Assessment
Mr. Miller was initially assessed on arrival to hospital. This initial assessment included demographics, history of his illness, inquiry into prior physical activity and social life. The findings of the initial assessment are included in the background. Later, the caregiver characteristics and characteristics of the family were assessed so as to tell their ability to take good care of Miller in his condition. It was found that the caregivers of Mr. Miller were able to give him proper physical support and but were quite inadequate financially. In hospital, Mr. Miller was assessed for the physical impairments and the findings recorded as outlined in background section.
In terms of physiotherapy, Mr. Miller was assessed in his home to find out his ability to communicate, move, use technical aids, and use devices that could assist him (Radomski and Trombly 2008). A single tip cane was the only mobility device that was tested since it had been established that Mr. Miller did not have balance problems. Having been a right-handed person before the stroke, a power grade of three in both right upper limbs and lower limbs with relative weakness of his less-dominant left side, Mr. Miller did not require hemi-walkers or quadri-canes for mobility. A tub bench was also tried. A tub bench was first placed appropriately with one pair of its supports in the tub and the other pair outside. Mr. Miller was asked to first sit on the bench then move slowly until he was able to enter the birth tub. Mr. Miller’s ability to use raised toilet seats was also assessed. This was done by asking Mr. Miller to seat at different heights until his most comfortable height of sitting was determined.
As part of the assessment, Mr. Miller’s ability to maintain himself and his personal hygiene was also assessed. Generally, Mr. Miller maintains himself quite well. Mr. Miller’s ability to work and maintain social relationships was found to have been compromised. Environmental factors such as assistance and social support to the subject were assessed.
Recommended Equipment
Equipment help patients who have suffered stroke to recover quickly. However, purchase of these equipment can be costly. This is where health insurance and organizations like NDIS come in. As it is rightly pointed out by Skolarus, Meure and Burke et al (2012), lack of health insurance interferes greatly with post-acute care of stroke patients. Mr. Miller is lucky to have NDIS supporting him.
The following equipment were recommended for use by Mr. Miller after in-depth investigation or trial:
Table 2
Recommended Equipment
| Item | Description | Supplier Details | Cost |
| Raised Toilet Seats | The assessment of Mr. Miller revealed that the patient has had problems with squatting. His power grade of 3 could not allow Mr. Miller to squat without losing balance. Raised toilet seats make it far more easily for the patient to go for long or short call. The Frugo raised toilet seat has aluminum rails which can help stabilize the person while in a seated position. For instance, Mr. Miller, has both limb weakness and needs to support himself while having his long call. The aluminum rails have plastic non-slip grip handles and is molded to allow the patient sit in comfortably. The toilet seat raiser is white in color. | Frugo is a company that supplies numerous bathroom accessories in Australia and other nearby countries. The company dispatches the products within twenty-four hours of ordering and costs $139.77 in Australia. The company supplies high quality products which are supplied from manufacturers in United States. | $59.00 |
| Single tip cane | The cane is slightly more than one meter in length and is a little bend at the top. The height of the cane can, however, be adjusted based on the user’s preferences. The tip is wider than the stalk to ensure it is easy to stabilize the tip on the ground whenever the patient is moving. The bend at the top is to ensure that a patient with slightly weakened upper limbs like those of Mr. Miller which have a power grade of three and hold onto it properly. The handle is made of insulating material unlike the stalk which is mostly metallic to ensure comfort of the patient when grasping it. The handle also has special features that enhance grip. The single tip cane is suitable for patients in rehabilitation who still have weakness of one side of the body but can maintain balance and can stand firmly on the unaffected side. The cane is also easy to use as it is so natural. The stick is light and the bases can be replaced easily in case a need to do so arises. This stick is also suitable for Mr. Miller since he weighs less than 110 kg. | MLE Walking Stick Comfort Ergo Green is sold online by Pharmacy Central. The company can be contacted via 1300884329. This supplier is based in Australia and has offices in Perth. If the stick is bought with some other commodities, shipping services can be provided. | $25.95 |
| D 09 Power Wheelchair | Mr. Miller has had problems with mobility within the house. Social assessment also revealed that Mr. Miller’s wife is not always at home since she works for three days in a weak, Mr. Miller’s children are only available in the weekend. It is prudent for Mr. Miller to have an electric wheelchair which can allow him to make quick transitions in the house and to run quick errands (Stenberg, Henje, Levi, and Lindström 2016). D 09 Power Wheelchair has been described as the perfect travel companion. The wheelchair is light and portable. Moreover, this wheelchair can be folded when need be to ensure that it occupies as little space as possible. Its portability can allow the user to move with it to wherever he wants to go. In addition, this power wheelchair is available in five different colors thus giving the user the chance to choose is favorite color. | JBH Wheelchair is a wheelchair manufacturer which is based in China. The company makes a number of products apart from the wheelchair including mobility scooters. The products sold by this company are FDA approved. Suppliers of products made by this company are available in many countries including Australia. The company can be contacted via their website and orders placed. Delivery is free. | $2000 |
| Carex Bathtub Transfer Bench | Mr. Miller finds it difficult to perform intricate and sequenced movements. Mounting a bathtub is both intricate and requires one to follow a careful sequence of limb movement. In performing such movement, the legs may have to be placed at different positions hence causing a loss of balance in the subject. A bathtub transfer bench can help a stroke victim with limb weakness and a likelihood of losing balance when the two feet are at different levels to mount a bathtub without much difficulty (http://www.physiotherapy-treatment.com/). Curex Composite Bathtub Transfer Bench is an ideal equipment which is made of light in weight, made of plastic, and has a backrest on it. The light weight reduces and the plastic material reduces the risk of the equipment causing injury to a clumsy user. The backrest also makes the equipment really good for stroke victims and especially for Mr. Miller who has complained of easy fatigability. The equipment can allow the user to alter the level of his feet while in a seated position and with a backrest. The bench is also specifically suitable for Mr. Miller since it can accommodate persons of up to 136 kg. Mr. Miller weighs less than 136 kg. The sitting level of the equipment has a height that can be adjusted between 0.45 and 0.6 meters thus making it ideal for Mr. Miller whose most comfortable sitting level is approximately 0.5 meters. | Orthocare Pty Ltd is an online supplier of various medical equipment. The supplier is based Burleigh Heads QLD 4220 Australia. They can be contacted on 0756203266 or 0755203666 or 1800226445. The last contact provided is toll free. The sales department of the company can be contacted on their email sales@orthocare.com.au. The company are dealers in very many other products. They are renowned and one can be sure of the authenticity of their products or deals. Orders can be placed online and delivery is free when certain amounts of purchase are achieved. | Not quoted |
Items Not Recommended
There are other items which were thought to be useful to the patient but they were found not to be ideal for Mr. Miller for various reasons. The products are highlighted in the table below:
| Item and Description | Method of evaluation | Approximate cost | Reasons why not recommended |
| Rolling Walkers This equipment is used by subjects who are paralyzed in both limbs and have balance problems. There are several types of rolling walkers – choice of rolling walker depends primarily on the extent of paralysis of a subject. Some rolling walkers are meant for subjects who can only use one arm while others are meant for those who can use both arms. Most rolling walkers have a saddle that can allow the subject to sit. | investigation | $138.50 | The equipment is not recommended for Mr. Miller since he can move independently and run some errands on his own. Moreover, Mr. Miller is comfortable with maintaining his balance. A single-tip cane was deemed to be more suitable. |
| Bedside Commodes This gadget is used for patients who find it difficult to move from their beds to the washrooms for long and short calls. If the assessment of a patient’s environment reveals that bathrooms are not accessible to the patient, then bedside commodes can be a sensible option. | investigation | $49.20 | Mr. Miller did not require a bedside commode. This is because he is able to move from his most comfortable seat of bed to the washrooms. Moreover, environmental assessment of the house revealed that the washrooms in Mr. Miller’s house were easily accessible to him. Buying this equipment would therefore prove to be expensive and pointless. |
| Sock aids These constitute part of dressing aids for stroke patients and other paralyzed patients. The equipment help the person to put on socks quickly and perfectly. The equipment are best suited for patients who have muscle power grade of two or less hence cannot lift their arms or legs against gravity (Campbell and Dejong 2013). | investigation | $10.22 | Mr. Miller has a muscle power grade of 3 which can allow him to lift his arms and legs against gravity up to a certain level. Mr. Miller also gets occasional aid of dressing from his wife and children during weekends. Since, the subject has a muscle power grade that can allow him to put on a pair of socks on his own and can get occasional assistance, a sock aid was not a necessity. |
Recommended Occupational Therapy Services
Mr. Miller will require outpatient occupational therapy services since he is able to live outside a hospital environment comfortably (Chen, Chan, Zagorsk, Parsons, and Colantonio 2014). As Santana, Rente, Neves et. al pointed out in their paper of 2016, starting physiotherapy at home earlier is more beneficial than delaying its transfer to a patient’s most familiar environment. The Occupational therapy services will aim at achieving the goals that have been outlined in the first part of this report. Generally, therapy should allow Mr. Miller move on his own, enjoy leisure and return to work if possible. In the three months of occupational therapy, Mr. Miller will attend five sessions. The duration of each session will vary depending on the activities that are to be done during that particular session.
The table below is a session plan of the first occupational therapy session with Mr. Miller:
| Session Plan |
| Session one of five |
| Time Since Last Session: this is the first session for me and Mr. Miller. He last attended a physiotherapy session with Joe Barnett. Until now, it has been three weeks. |
| Session duration: one hour and thirty minutes |
| Session goals: · To ensure that Mr. Miler can comfortably use a broad based single-cane walking stick to walk a few steps. · To ensure that Mr. Miller is able to dress himself without much assistance · To ensure that Mr. Miller advice that will enable him to live a life that will not predispose him to suffering another stroke and will help him improve before he goes for his next physiotherapy session. · To help Mr. Miller have the ability to perform intricate finger motions that will enable him have a firm grip on an object with his right arm. · To help Mr. Miller learn how to use the bathtub bench. |
| Intervention Strategies · Unveiling of the single cane broad base walking stick. Mr. Miller will then be advised on how to use this equipment and demonstrations done if possible. Mr. Miller will then be required to try and use the equipment and relevant adjustments made. Mr. Miller’s most comfortable height of the stick was determined and set. This will help Mr. Miller to ambulate on his own hence enhancing his independence. · Unveiling of the bathtub bench. Mr. Miller will then be given instructions on how to use this equipment and relevant precautions to observe during use of the equipment. A short demonstration of how to use the bathtub transfer bench will be conducted and Mr. Miller asked to do the same. Mr. Miller’s most comfortable height of the transfer bench was determined and the height set by the occupational physiotherapist. · Mr. Miller will be asked to perform several limb movements from a neutral position. These are meant to enhance his ability to perform intricate movements hence his independence and usefulness to society (Pollock, Baer, Langhorne, and Pomeroy 2008). Moreover, performance of this movements can with time improve muscle strength and coordination. · With the assistance of the physiotherapist, Mr. Miller will be trained on how to dress quickly and without assistance from a person or dressing machines in his condition. This again – Brunnstrom and Proprioceptive Neuromuscular Facilitation are the techniques which were used. · Training in speech will also commence. This is to help Mr. Miller deal with the mild expressive aphasia. · Finally, Mr. Miller will be taken through an interactive session where his current ways of life and diet will be discussed. Relevant adjustments that will forster improvement in health will be pointed out. This is to prevent sedentary lifestyle and poor diet, for instance, excess carbohydrate and lipid intake which can predispose him to further stroke. |
| Observations to be made: · Mr. Miller’s balance · Mr. Millers speech and cognition · Mr. Miller’s ability and ease while using the new equipment. · Mr. Millers ability to move fingers on both hands |
Other Services Required
| Service | Description and Reason | Who | Estimated Cost |
| Psychologist services | The fact that Mr. Miller had to give up his career following his disease and that his wife has been forced to work three days a week so as to make up for this, can make the subject distressed. A psychologist can help Mr. Miller overcome this distress (Willard and Schell 2014). | Hospital psychologist | |
| Nutritionist | Stroke can come due to diet-related complications. Nutritionists can help patients like Mr. Muller to live on diets that do not predispose them to further injury (Wright and Sugarman 2009). Moreover, nutritionists will help patients decide on a diet that will aid their recovery and provide calorie needs for the tedious physiotherapy sessions. | Hospital nutrionist |
Conclusions
Occupational therapy is very important in the process of rehabilitating patients who have suffered strokes. Occupational therapy helps these patients to integrate into the social fabric of society and enjoy their leisure, return to their workplaces and maintain themselves (Punwar and Peloquin, 2000). This occupational therapy report is particularly good for Mr. Miler. This is because the report has comprehensively identified Mr. Miller functional abnormalities and how to manage these to aloe the subject lead normal life. This report is highly recommended for Mr. Miller.
Signed
Janet Farmer
Occupational Therapist
Educational Handout to Mr. Miller
The following set of instructions will help you go through your rehabilitation process under my guidance well:
- Before using any equipment, it is important for you to read the user’s manual that comes with the equipment.
- Always seek a professional to help you set up equipment before use – do not set up the equipment by yourself. In case you have difficulty getting someone to help you with the setup, please contact me.
- Though you have a powered wheelchair, it is important for you to keep using the walking stick. Walking is very crucial to your rehabilitation program. The reason why the wheelchair was bought for you was for use in emergency situations.
- It is important for you to keep trying to walk for the longest distance you can walk and to keep training your hands to grip items even when you are not in the physiotherapy sessions. Using the weeks that follow a session to repeat and master the various things that you learnt during the session will do much good for your rehabilitation.
- For complete rehabilitation, it is imperative that you do not miss the sessions with the psychologists and nutritionists. Likewise, purpose to attend all occupational therapy sessions that we have planned. Moreover, you should adhere strictly to the medication that was prescribed to you.
- Always be safe. Purpose to call for assistance whenever you have difficulty in doing a particular task. In case there is no one nearby to assist you, it is better to have the idea postponed. Also, do not leave your house alone at this stage. You will only be allowed to leave your house alone once we have concluded that it is safe for you to interact with the community independently.
- The link below can help you find answers to some questions you may wish to ask but lack a close person to ask – http://www.stroke-rehab.com/
Bibliography
Campbell, W. W., and Dejong, R. N. (2013). Dejong’s The Neurologic Examination. Philadelphia, PA, Lippincott Williams and Wilkins.
Cella, D., Lai, J.S., Nowinski, C.J., Victorson, D., Peterman, A., Miller, D., Bethoux, F., Heinemann, A., Rubin, S., Cavazos, J.E. and Reder, A.T., 2012. Neuro-QOL Brief measures of health-related quality of life for clinical research in neurology. Neurology, 78(23), pp.1860-1867.
Chen, A., Chan, V., Zagorski, B., Parsons, D. and Colantonio, A., 2014. Factors associated with living setting at discharge from inpatient rehabilitation after acquired brain injury in Ontario, Canada. Journal of rehabilitation medicine, 46(2), pp.144-152.
Geranmayeh, F., Leech, R. and Wise, R.J., 2016. Network dysfunction predicts speech production after left hemisphere stroke. Neurology, 86(14), pp.1296-1305. http://www.physiotherapy-treatment.com/
Pollock, A., Baer, G.D., Langhorne, P. and Pomeroy, V.M., 2008. Physiotherapy treatment approaches for stroke. Stroke, 39(2), pp.519-520.
Punwar, A. J., and Peloquin, S. M. (2000). Occupational Therapy: Principles And Practice. Philadelphia [u.a.], Lippincott Williams and Wilkins.
Radomski, M. V., and Trombly, C. A. (2008). Occupational Therapy For Physical dysfunction. Baltimore, MD [etc.], Wolters Kluwer/Lippincott Williams and Wilkins.
Santana, S., Rente, J., Neves, C., Redondo, P., Szczygiel, N., Larsen, T., Jepsen, B. and Langhorne, P., 2016. Early home-supported discharge for patients with stroke in Portugal: A randomised controlled trial. Clinical rehabilitation, p.0269215515627282.
Skolarus, L.E., Meurer, W.J., Burke, J.F., Bettger, J.P. and Lisabeth, L.D., 2012. Effect of insurance status on postacute care among working age stroke survivors. Neurology, 78(20), pp.1590-1595.
Stenberg, G., Henje, C., Levi, R. and Lindström, M., 2016. Living with an electric wheelchair–the user perspective. Disability and Rehabilitation: Assistive Technology, 11(5), pp.385-394.
Vahidy, F.S., Hicks, W.J., Acosta, I., Hallevi, H., Peng, H., Pandurengan, R., Gonzales, N.R., Barreto, A.D., Martin-Schild, S., Wu, T.C. and Rahbar, M.H., 2014. Neurofluctuation in patients with subcortical ischemic stroke. Neurology, 83(5), pp.398-405.
Willard, H. S., and Schell, B. A. B. (2014). Willard and Spackman’s Occupational Therapy. Philadelphia, Wolters Kluwer Health/Lippincott Williams and Wilkins.
Wright, R., and Sugarman, L. (2009). Occupational Therapy and Life Course Development: A Work Book for Professional Practice. Chichester, Wiley-Blackwell. http://www.123library.org/book_details/?id=3418.
