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Case: Winston
Date: 4/21/2014
Page 1 of 8
Resources:
Conditions class
Heart.org
Mayo clinic
Pedretti
Revised 1/7/13
Rationale
Outcome of the model is to obtain congruence
between person, occupation, and environment for
maximal performance. Allows for changes to be
made in the environment, with the individual, or
to the occupation. We would be able to make
changes to context or optimize his environments,
address his needs and to build the skills he needs
by providing him with supports and strategies for
performance (such as energy conservation), or
modify the task for him to be able to perform
better have maximum satisfaction in his
occupational performance and be able to function
more independently.
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Revised 1/7/13
2. Biomechanical
3.
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Revised 1/7/13
14. Evaluation: What Assessment tools and other means of assessment will you use?
Top Down Assessment: Prioritize one Occupation to observe the client perform
Observed Occupation
Meal preparation/cooking
Method/Tool
1. MMT
2. Stereognosis assessment
3. Activity Checklist
4. AROM/PROM
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Revised 1/7/13
5. Vision screen
Goals
1. LTG:
In 3 weeks, client will implement use of adaptive strategies
for decreased sensation and endurance to complete complex
meal preparation with modified independence.
STG:
In 2 weeks, client will use at least one energy conservation
strategy with minimal verbal cueing to complete simple meal
preparation.
PEO, Biomechanical
PEO, biomechanical
STG:
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Revised 1/7/13
2. LTG:
In 3 weeks, client will use adaptive strategies and equipment
as needed to complete dressing, including donning coveralls.
STG:
In two weeks, client will independently zip up coveralls using
adaptive strategies and equipment as needed due to decreased
sensation and fine motor.
STG:
In one week, client will independently implement at least one
energy conservation strategy during dressing to keep fatigue
no higher than baseline.
3. LTG:
In three weeks, client will shower with modified independence
using adaptive strategies and equipment for fatigue and safety.
PEO, biomechanical
PEO, biomechanical
PEO, biomechanical
PEO, biomechanical
PEO, biomechanical
STG:
In two weeks, client will use adaptive equipment and strategies PEO, biomechanical
for safety with minimal cueing during shower due to decreased
strength, sensation and vision.
STG:
In one week, client will complete shower using at least one
energy conservation strategy with minimal cueing to maintain
fatigue no higher than baseline.
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PEO, biomechanical
Revised 1/7/13
18. Treatment Sessions: Plan for first two 45 minute treatment sessions:
1. What will you do?
Identify Approaches
The session will focus on working on client
completing meal preparation. The session will begin
with preparatory activities to work on strength and
endurance. Client will perform various repetitions
using free weights to strengthen UE and improve
endurance. Exercises can include bicep curls,
pronation supination, forward punches, etc. Client
will then be taken to kitchen to aide in meal
preparation. Client will be reminded of healthy
options and recommendations for meals and the
importance of learning to prepare meals keeping in
mind his diabetes. The client will be asked to
prepare whole wheat pasta and fruit salad. Client
and therapist will discuss and review energy
conservations strategies such as organization,
pacing, taking breaks, etc. Client will be asked to
implement strategies that work for him as needed
and to identify verbally to the therapist when he is
feeling fatigued. Client will boil water, add and
cook pasta. While patient is waiting for water to
boil and pasta to cook, client will cut various fruit to
make a small fruit salad. Client will drain pasta and
warm up sauce in the microwave. Client will
identify moments of fatigue and implement energy
conservation strategies throughout task as needed.
Client will use adaptive strategies during cutting to
compensate for decreased sensation and fine motor.
Therapist will provide cueing and physical assist as
needed. Adaptive equipment will be available as
needed. Following task, client and therapist will
discuss how things went and identify strengths and
areas of improvement. Therapist and client will
discuss strategies used and their effect during the
task. Client will be reminded about importance of a
diabetic conscious meal and maintaining portion size
that is appropriate. Client will be able to enjoy meal
prepared.
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Based on which
goal(s)?
LTG 1
Revised 1/7/13
Identify Approaches
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Based on which
goal(s)?
LTG 3
Revised 1/7/13