Hey Ron and group, Here is a case I had this week in home health. Brief history includes a significant emotional trauma about 4 years ago. Apparently the pt. got mixed up in a multi-level/pyramid scheme of some sort and lost lots of money. According to her husband, shortly after she had an emotional break down and has never recovered. Fast forward to the referral... now she has fallen at home with a displaced femoral neck fx. and surgical repair. She is only 68 yo and now has a dx. Of Alzheimer's type dementia for which she is taking Aricept and depression (taking Zoloft). The husband reports the med's have not helped. She is very impulsive, has the "lithium/trazadone stare", is not able to talk and will only occassionally follow directions/cues of any kind. The husband is the primary caregiver and is providing excellent care. What would you do to serve her occupational needs?
P Please consider the environment before printing this e-mail The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of otl...@otnow.com. If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-----Original Message----- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Ron Carson Sent: Thursday, April 23, 2009 9:25 PM To: ocil...@comcast.net Subject: Re: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even Hello Ilene: I appreciate your message! In this case, the pain was caused by probably joint misalignment resulting from paralysis of the shoulder girdle. I believe I did assist this patient by providing him my opinion on his shoulder pain, and referred him to an ortho MD. I am pretty confident that this patient understood occupation and OT. Well, at least it was explained to him. In fact, he was discharged because his only stated goal was, "walking like a man". Thanks again! Ron ----- Original Message ----- From: ocil...@comcast.net <ocil...@comcast.net> Sent: Wednesday, April 22, 2009 To: otlist@otnow.com <otlist@otnow.com> Subj: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even ocn> Ron, IMO there were many things an OT could have done to assist ocn> that patient even without directly treating his arm. Pain disrupts ocn> occupational function in all areas. We can work with chronic pain ocn> patients to learn relaxation techniques. We can educate them and ocn> their caregivers on how to prevent further pain and deformity (many ocn> times CVA patients do make things worse because of dysfunctional ocn> strageties they develop to perfom self-care, poor arm placement ocn> during transfer, etc) We can help them learn how to find a chronic ocn> pain support group or how to find assistive devices on the ocn> internet. I think patients really have no idea all that OT offers, ocn> nor often what "occupation" really is. The best way to get OT's out ocn> of the "UE" box, is to show them what we CAN do for them, rather ocn> than say "there is nothing we can do, refer to PT" for a patient like that. ocn> ~Ilene Rosenthal, OTR/L ocn> From: Ron Carson < rdcar...@otnow.com > ocn> Subject: [OTlist] Breaking the Bonds of Upper Extremity OT; Is it even ocn> Possible? ocn> To: OTlist@OTnow.com ocn> Date: Monday, April 20, 2009, 4:06 PM ocn> Hello All: ocn> A couple weeks ago, I worked with a CVA patient who despite having ocn> multiple occupational deficits, he was unwilling to verbalize any ocn> OT-related goals. And after a couple of weeks, the patient was d/c'd. ocn> The patient's UE and LE were compromised by the CVA. He had almost no ocn> active movement in his affected arm. His shoulder was extremely painful ocn> during any AROM. ocn> I initially told the patient that as an OT, I would address his most ocn> important occupations but that I could do nothing about his arm. Over ocn> the? course of? treatment, his wife reported having difficulty bathing ocn> under the patients arm. After doing some gentle PROM, I concluded that ocn> there was a possible impingement. I believed an orthopedic appointment ocn> was necessary. I conferred? with the PT and? she concurred. I ocn> also ocn> confirmed that the treating PTA would address ocn> the shoulder ocn> ROM/Pain. ocn> -- ocn> Options? ocn> www.otnow.com/mailman/options/otlist_otnow.com ocn> Archive? ocn> www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
