Case Study

Presentation

Colin Jones

Occupational Therapy Student

Mercy University Hospital

5th March 2015

Occupational Therapy Process

Referral

Information Gathering

Initial Interview

Goal Setting & Occupational Therapy Plan

Assessment

Intervention

Discharge Planning & Review

PEOP

Client-Centred

PsychodynamicRehabilitative/ Compensatory

Biomechanical

Paradigm

Model

Frames of Reference

• Curtin et al (2009)

• Christiansen et al (2005)

Referral

Eileen (68)

Guillain-Barré

Syndrome (GBS)

ADL, Cognitive & Perceptual Assessment

Information Gathering

Chart Review

Guillain-Barré

Syndrome (GBS)

Multi-Disciplinary

Team

Guillain-Barré Syndrome (GBS)

Rare disorder that causes your immune system to attack your peripheral nervous system.

Sometimes preceded by an infection, for example, gastroenteritis.

Distal to proximal progression with potential respiratory complications.

Symptoms usually worsen over a period of weeks, then stabilize. Recovery can take a few weeks to a few years.

Treatment options during the symptom period include medicines or a procedure called plasma exchange.

• International Classification of Diseases (2015)

• Pulivarthi & Gurram (2014)

Eileen’s Initial

Interview

Living alone, two-storey house, Cork

Bathroom downstairs (shower),

bedroom upstairs

Dependant mobilizing, hoist to

commode

Ind. feeding, dependant for

majority of PADL’s

Patient concerned re: future use of

stairs

Support from son and daughter

Independent prior to admission, no

services

Goal Setting and Occupational Therapy Plan

Goal: Improve functional independence in PADL’s, transfers and mobility. Plan: Conduct assessments, provide advice on adaptive and safe techniques. Discuss adaptive equipment to improve independence.

Goal: Improve ROM, strength and dexterity in upper limbs (patient left hand dominant). Plan: Upper limb assessments and biometric training.

Goal: Return to home, use stairs independently. Plan: Liaise with Physio re: stairs assessment. Recommend patient for St. Finbarr’s rehabilitation.

Multi-

Disciplinary

Team

Eileen

Occ. Therapist

Physio

D/C Liaison

Social Work

Dietician

Doctor

Nursing

Assessment

PADL

Transfers/Mobility

Kitchen Assessment (Occupation focused)

Montreal Cognitive Assessment

Pegboard

9 Hole Peg Test

Biometric Testing

Grip Strength

Observation

Patient reports

Evidence-Based Practice

Nine Hole Peg Test – Suitable to detect changes in dexterity over the course of interventions post-stroke (Lin et al, 2010).

Montreal Cognitive Assessment – Provides reasonable estimate of general intellectual abilities in older adults (Sugarman & Axelrod, 2014). – Suitable screening tool for haemodialysis patients, 76-78% correlation with test battery (Tiffin-Richards et al, 2014).

Dynamometer – Jamar Dynamometer allows a valid and constant grip force measurement. Manugraphy provides more information on load distribution. But overall, there is a high correlation between scores (Mühldorfer-Fodor et al, 2014).

Intervention

Discharge Planning & Review

Transfer to St. Finbarr’s Hospital for rehabilitation. Complete transfer letter.

Continue to review ADL’s and upper limb function prior to discharge.

Perceptual Assessment?

Home visit if rehab place does not become available.

References Christiansen, C., Baum, C. M., & Bass-Haugen, J. (Eds.). (2005). Occupational

therapy: Performance, participation, and well-being. Slack Incorporated.

Curtin, M., Molineux, M. and Supyk-Mellson, J. (Eds.) (2009) Occupational therapy and physical dysfunction: enabling occupation, 6th ed., Edinburgh: Churchill Livingstone Elsevier.

International Classification of Diseases. (2015). Guillain-Barré Syndrome. Available: http://www.icd10data.com/ICD10CM/Codes/G00-G99/G60-G65/G61-/G61.0. Last accessed 3rd March 2015.

Lin, K., Chuang, L., Wu, C., Hsieh, Y., & Chang, W. (2010). Responsiveness and validity of three dexterous function measures in stroke rehabilitation. Journal Of Rehabilitation Research & Development, 47(6), 563-571.

Mühldorfer-Fodor, M., Ziegler, S., Harms, C., Neumann, J., Cristalli, A., Kalpen, A., & ... Prommersberger, K. (2014). Grip force monitoring on the hand: Manugraphysystem versus Jamar dynamometer. Archives Of Orthopaedic & Trauma Surgery, 134(8), 1179-1188.

Pulivarthi, S., & Gurram, M. K. (2014). A young patient with multisystem complications after cytomegalovirus infection. Journal of neurosciences in rural practice, 5(1), 59.

Sugarman, M. A., & Axelrod, B. N. (2014). Utility of the Montreal Cognitive Assessment and Mini-Mental State Examination in predicting general intellectual abilities. Cognitive And Behavioral Neurology, 27(3), 148-154.

Tiffin-Richards, F. E., Costa, A. S., Holschbach, B., Frank, R. D., Vassiliadou, A., Krüger, T., & ... Reetz, K. (2014). The Montreal Cognitive Assessment (MoCA) - A Sensitive Screening Instrument for Detecting Cognitive Impairment in Chronic Hemodialysis Patients. Plos ONE, 9(10), 1-9.