Fuentes, Sophie Alena A.

19-79926
BSOT 1A

A Case Study by Rachael Hargreaves of The OT Practice UK

Wendy, a 46-year-old mother of two, was walking along a pavement when she was struck by a
motor vehicle. She sustained multiple fractures including; a fractured right tibia and fibula, a complex
right glenoid fracture and bilateral rib fractures. She underwent surgery to insert an intra-medullary nail
into her right fibula and to insert three pins into her fractured glenoid. Wendy was discharged home non
weight bearing through her right leg and was therefore set up to live on the ground floor of her three-
storey property. She was reliant on her husband to assist her with strip washing and she was unable to
access her bathing and toileting facilities which were situated on the second and third floor of the family
home. Wendy expressed that her main concern was not being able to get into her bath to shower. She
explained that she found stepping into the bath painful and was too frightened to attempt this without
support. She had reduced range of movement in her right shoulder meaning that she was unable to use
this arm to reach out and support herself when transferring into the bath, thus adding to her
anxiety. Wendy’s friend had suggested that she may require major works to take the bath out and put a
level access shower in, although Wendy was not keen on this idea.

In Wendy’s case, it is best to use the Biomechanical frame of reference. It was stated that the
client had multiple fractures and underwent a surgery to somehow remediate her situation. Wendy did
not completely lose her function but was unable to do certain activities and roles because of the illness
that she sustained. That being said, her condition is not permanent and with accurate and adequate
interventions, Wendy can still restore her functionality. As mentioned, the client was concerned about
bathing since her bathroom is located on the second floor of her place. Since, the client did not concur
to the suggestion of making another bathroom on her ground floor, it is best to work with her
capabilities. The occupational therapist could provide her with a walker or a walking stick for the
meantime, while recovering from her surgery. Furthermore, the therapist should work on regaining
Wendy’s bone stability and strength by giving her therapeutic activities, exercises and training.
 Case study lower limb amputation: Amputee Case Study

Nishan S. is a 10-year-old boy from Nepal. He lives in a children's home designed for
disabled children, but goes to a normal public school. Nishan was born with Spina Bifida, most
likely in the form of Aperta Meningocele according to his conditions: a paralyzed left lower leg, left
club foot and incontinence. His detailed medical file from birth is unknown at the children's home.
It is known that he was operated after birth to remove the sensitive fluid bulge on his back. This
area is still sensitive to this day for Nishan. There is little communication with Nishan's parents and
the children's home, as the parents do not want to keep in contact. He was abandoned after his
disability became clear. Nishan is very happy in the children's home and does not want to leave. He
says this is his new family. He is a very chatty boy and even though he has trouble keeping up with
his friends in running, he still tries and wants to participate.

Nishan's left foot was amputated, as his gait was disturbed and other problems, such as his left
knee and hip, started to diminish as well. The operation was postponed for a long time, as the parents
needed to give their permission. After months to years of trying, the parents did give their consent to
amputate his left foot. The main aim of amputation for the children's home was to increase his
independence level. Nishan had trouble walking and running with the club foot and had a lot of pressure
sores on this foot. He had trouble putting on shoes and walking on the stairs. He falls often because of
his imbalance, but can stand up by himself individually. Furthermore, he has trouble with his
incontinence and has to wear a diaper throughout the day. It is impairing him in his daily life, but he is
accustomed to it and knows how to change diapers and keep himself hygienic.

Rehabilitative frame of reference is suitable for Nishan’s case. The client was born with an
impairment that affects his mobility and his toileting needs. Because of his condition, there is a need for
his leg to be amputated. The amputation caused an added disruption to his daily activities. Nishan, due
to his condition has trouble with his gait patterns as well toileting and the amputation disrupted his play
participation. The occupational therapist can provide crutches or leg prosthetics to enhance Nishan’s
functionality. Given these adaptive devices, the therapist should also train the client how to use them,
from proper hand placement on the crutches to putting on and taking off the prosthetics. Nishan should
also be assisted while he is still adapting to his new devices. The therapist could provide balance
strategies for Nishan.
References:

Hargreaves, R. (n.d.). Case Study: Functional rehabilitation. Retrieved July 16, 2020, from
https://www.theotpractice.co.uk/news/our-experts-blog/case-study-functional-rehabilitation

Case study lower limb amputation: Amputee Case Study. (2020, April 11). Physiopedia,  . RetrieveD
08:03, July 16, 2020 from https://www.physio-pedia.com/index.php?
title=Case_study_lower_limb_amputation:_Amputee_Case_Study&oldid=235249.