Name: SALADAGA, Kean Debert T. ID No.

: 19-80155 Date: 7/6/2020

Sample Study 1

 KP is a 45 y/o women war veteran. KP lives with her husband, Sam, in a two-story house with no
elevator. They have no children or pets. They live 3 hours from their closest family members. KP has
a close group of friends that she goes out for lunch with and long walks frequently. Though, she
fears that, with her amputation and mental health issues her friends are beginning to avoid her
more. They have a cleaning woman that cleans the entire house and does the laundry once a week.
Frustrated with current ADL performance, anxious for LE (lower extremity) prosthesis and not
sleeping well. Emotional and unsure of future career status.

Physical Assessment

 Primary dx: s/p R trans-radial BEA (below elbow amputation) and L trans-femoral AKA (above the
knee amputation), Amputation conducted at hospital
 Secondary dx: possible mild acquired brain injury (TBI) and/or PTSD
 Precautions/contraindications: None

Subjective

 Patient complains of phantom limb pain and weakness. The patient hopes to successfully use a
prosthetic limb to ambulate at a high fitness level and reduce or eliminate the phantom limb pain.
Patient is currently working with PT, doctors, OT, Prosthesist, social worker and nursing staff.
Frustrated with current ADL performance, anxious for LE prosthesis and not sleeping well. Emotional
and unsure of future career status.

OT Analysis

 In this case, It is best to use the Rehabilitation frame of reference since the condition of KP about
her amputation is stabilized and can no be longer altered by any forms of medical or surgical
methods. She always gets frustrated with her current ADL performance, and thus affecting the
client’s capacity to function. However, it can be changed through the use of compensatory methods
and adaptive equipment, it includes: Prosthetic training and ADL and mobility retraining—to
successfully use the prosthetic limb and increase independence with the areas of occupation. Our
goals of intervention are to restore self-care skills, establish transfer skills, and regain social
cognition skills.

Sample Intervention

 Educate on hygiene for residual limbs - Demonstrate how to clean skin and had her practice
 Educate on dressing for residual limbs - Demonstrate how to properly dress and have him practice
 Functional transfers independence will increase -Transfer training
 Educate patient on prosthesis usage and management - Prosthetic training
 Sample Study 2

 Sally is a 30-year-old woman who works as administrator, and lives with her husband and 3-month
old daughter in a rural town on the outskirts of Ennis. Sally enjoys cooking, going to the gym,
walking and swimming. Following the birth of her daughter, Sally experienced severe joint pain and
swelling, making it extremely difficult to look after her baby. Following assessment with a consultant
rheumatologist, Sally was diagnosed with rheumatoid arthritis. Sally is very concerned about how
she is going to manage mothering, family life and returning to work, particularly as her husband
travels abroad regularly for work.

Physical Assessment

 Primary dx: Rheumatoid arthritis

Rheumatoid arthritis

Rheumatoid arthritis is defined as a chronic inflammatory disorder as it affects joints causing pain,
swelling, stiffness and fatigue (possible sporadic fever). It can be further classified as an autoimmune
disease, as the body’s immune system attacks its own connective tissues. As it progresses it greatly
reduces mobility and functioning. It mainly affects joints in the hands and feet, through thickening of
articular cartilages, which become eroded. The inflammation often presents in a symmetrical pattern.
These symptoms are most often heightened after periods of rest. Rheumatoid arthritis is often chronic
but can exhibit periods of exacerbation and remission (Ryan 2014). Causes are unknown but it has been
hypothesized to be a result of genetics and possible bacteria and viruses (Klareskog et al. 2009; Carmona
et al. 2010; Scott et al. 2010). Because of this uncertainty no cures have been discovered. However,
therapies, anti-inflammatory medicines and possible surgeries are used to reduce symptoms in-order to
delay the progression (Lau 2015). Women are commonly more prone to developing rheumatoid arthritis
which occurs more frequently between the ages of 30 to 50. An environmental factor such as smoking is
believed to increase rick of developing the condition (Scott et al. 2010).

Subjective

 Sally is concerned and anxious about caring for her daughter; this anxiety could be heightened if she
is experiencing extreme fatigue and pain. Sally find it difficult to have the energy to engage in these
activities as they are physically demanding. Adapting her kitchen environment and food preparation
steps alleviate the physical burden.

OT Analysis

In this case, it’s suitable to use the biomechanical frame of reference to frame the understanding of
Sally’s narrative, and guide her treatment. The occupational therapist may choose to follow these
models as it encourages holistic engagement and holds emphasis on Sally’s autonomy and physiology.
Energy conservation is a central theme of treatment when living with rheumatoid arthritis. Approaches
based on these frames of reference would include providing techniques to conserve energy and joint
protection
Sample Intervention

Sally has expressed an interest in physical activity and swimming. Aerobic exercises have shown to
improve physical function and flexibility in people with rheumatoid arthritis. Regular aerobic sessions
also have shown to alleviate symptoms of fatigue and stiffness. Alleviating physical fatigue will reduce
her emotional stress and anxieties which will help improve her overall wellbeing (Neill et al. 2006;
Hurkmans et al. 2009). Swimming has also proven to alleviate the symptoms, as the water buoyancy
creates an ideal environment for relieving arthritis pain and stiffness. Immersing one’s self in warm
water also raises one’s core body temperature, resulting in dilating blood vessels, thus increasing
circulation. Water allows for gentle exercises of joints and muscles as it encourages free movements,
while also acting as a resistance to help build and maintain muscle strength and balance (‘Arthritis
Today’ 2016).