1. OCCUPATIONS OF ADULTS AND SENIORS I
MRS. K
a case study by
SARAH JANE CALUB
VANESSA MAE CARZON
RAFAEL GARCIA
2. WHO is MRS. K?
• 63 y/o woman.
• Married
• Lives with husband
• Works part time (clerical work) & babysits
grandchildren.
• Independent w/self-care & work tasks.
• Enjoys: gardening, knitting, quilting.
• Used to attend weekly luncheons w/her friends.
3. Nature of
REFERRAL Arthritis
Insulin-dependent
OT evaluation for diabetes
tx, pain at R
thumb OCD
Relevant Medical
HISTORY
4. OT
 EVALUATION
• Pain Scale
• Reported 9/10 initial evaluation
• ROM
• Bilateral shoulder/elbow ROM are WNL
• Grip/Pinch Strength
• Weak hand grasp, especially in pinches
• Instability of CMC & MCP, limited R thumb
opposition
5. OT
 Evalua)on
 Ccontinued
OT
 EVALUATION ont.
• Sensory Assessments
(Pin Stick & Temperature)
• Impaired sensation for light touch, sharp/
dull, hot/cold in both hands
• Arthritic Deformities
• Multiple swan neck: L hand digits 2 & 4, R
hand digits 3-5
• Multiple RA nodules on both hands
6. Func)onal
 Problems
Functional
 PROBLEMS
1 Pt. is always tired & depressed
2 Unable to bathe & perform self-groom tasks
3 Unable to carry out household chores
4 Difficulty preparing meals
5 No longer attends weekly luncheon with her
friends
7. Long-Term
 GGoal
 #1
Long
 Term
 OAL #1
Client will be independent with all hygiene/
self-care activities in own home, using A/E
and energy conservation strategies with a
fatigue level of 5 or less in 4 weeks to
increase functional independence and
decrease fatigue.
8. Short-term
 GOAL 1a
Short
 Term
 Goal
 1a
Client will tolerate 20 minutes of ADL
activity, taking 2-minute breaks every 10
minutes with 0/10 pain in R and L upper
extremities during rest and activity, 3x/week
for 3 weeks.
9. Short-term
 GOAL 1b
Short
 Term
 Goal
 1b
Client will demonstrate independence with
brushing hair and teeth using built-up
handles on her hairbrush and toothbrush to
compensate for weakened grasp after
education for five minutes, 2x/week for 2
weeks.
10. Long-term
 GOAL #2
Long
 Term
 Goal
 #2
Client will be able to independently self-feed
for 15 minutes, using built-up utensils,
compensatory movements, and UE joint
protection strategies without VCs 1x/week
for 4 weeks to increase functional
independence.
11. Short-term
 GOAL 2a
Short
 Term
 Goal
 2a
Client will independently self-feed using
built-up utensils for 10 minutes after
instruction 1x/week for 2 weeks to increase
functional independence.
12. Short-term
 GOAL 2b
Short
 Term
 Goal
 2b
Client will tolerate 10 minutes of wrist and
hand exercises to increase strength, ROM,
and endurance, which will improve feeding
and other ADLs, 3x/week for 3 weeks.
13. OT
 Treatment
 Plan
OT
 TREATMENT PLAN
• Educate client:
• Energy conservation & ECWS techniques
• Fall risk & prevention strategies
• Joint protection
• Stress management & relaxation
techniques
14. OT
 Treatment
 Plan
OT
 TREATMENT PLAN continued
• ADL/IADL training
• A/E to improve grasp & compensate for
muscle atrophy
• Pain management techniques
• Train in safe/efficient transfers
15. OT
 Treatment
 Plan
OT
 TREATMENT PLAN continued
• Splints:
• Rest/working hand splint
• Wrist cock-up
• Finger splint
• Ulnar deviation splint
• Tri-point splint
• Thumb Spica
16. Frames
 of
 References
Frames of
 REFERENCE
MOHO
Understanding her habits according to her roles.
Looking at her volition to make her more self-sufficient in
her daily tasks.
PEO
Changing the environment to create a greater fit w/the
client & occupation to improve occupational performance.
EHP
Establish/restore intervention addresses inability to self-
feed.
Adapting/modifying the above task addressed by adding
built up handles.
Prevent/create intervention will be addressed by the home
exercise program.
17. the
 ACTIVITY
Client will work on multi-step food preparation in own
kitchen by participating in graded cooking tasks to
improve safety and independence in meal
preparation.
Client will prepare dinner for two (her and her
husband) using pre-prepared meals.
Client will prepare dinner for two using pre-cut
vegetables and meat.
Client will prepare dinner for two with only one
pre-prepared item, utilizing A/E (e.g. rocking
knife) to cut vegetables.
17
18. Home
 Program
Home
 PROGRAM
• Practice energy conservation, work
simplification, & safety techniques
• Wear working splints during day activities &
resting splint at night.
• Use built up padding for tools during ADL’s.
19. Discharge
 Summary
Discharge
 SUMMARY
Client achieved all long & short term goals.
Pain reduced from 9/10 to 2/10 &
occasionally 7/10.
Fatigue level decreased from 10/10 to 5/10.
Grip strength improved from 42lbs to 50lbs
on the R hand and 50lbs to 51lbs on L hand.
