Transcribed Image Text from this Question
Frank: Rignt Cerebrovascular Accident, Left Hemiplegia, Left Neglect Kathryn Prizio, MS, OTR/L OCCUPATIONAL PROFILE with some of their neighbors, but others are new to the neighborhood and they do not know them well. Frank has Frank is a 68-year-old White man with a diagnosis of wife does the meal preparation and laundry. Frank will always done all the maintenance tasks on his home. Frank’s right cerebrovascular accident (CVA) of the internal carotid sometimes do the grocery shopping or go with his wife on artery with left neglect. In addition, he has coronary artery this errand. He makes his own breakfast and lunch if his disease and diabetes. Two weeks ago, Frank was brought to wife is not at home. the emergency department by his wife complaining of an Frank has many friends from the post office, and he unbearable headache, with slurred speech and loss of con- has maintained his weekly bowling night with them after trol on his left side. He was admitted to the acute care hos- retirement. He and his wife have a strong marriage. They pital and was stabilized; after 5 days, he was transferred to are planning on his return home after his discharge from the rehabilitation hospital for more extensive rehabilitation, the rehabilitation hospital. Their goal is for him to return Before his CVA, Frank had been a very active man. He home and resume his hobbies. He looks forward to picking recently retired from his job as a postal worker and is look up his life where it was before it was disrupted by the CVA. ing forward to traveling with his wife and tending to his Frank’s wife is supportive of these goals and will do what- garden. He is an avid gardener and woodworker and antici- ever it takes to get him home to live life as before. pates enjoying his two hobbies more extensively, He will be seen by OT, PT, speech therapy, and recre- Frank has a son from a previous marriage who does not ational therapy. He will also be seen by nursing, dietary, live nearby and with whom he has a strained relationship, and physiatry. His expected length of stay is 3 weeks Frank and his wife live in a ranch-style home in a suburban neighborhood. There are five steps into the front door, and the garage is not attached to the house. They are friendly Chapter 8 ANALYSIS OF OCCUPATIONAL PERFORMANCE Frank is amiable and likes the staff members. He teases them and is good at involving humor in interactions with others. He does not understand why he needs so much therapy or why he has to be in the rehabilitation hospital His wife told him that the doctor said he needed to be here and that is why he stays OT evaluation took place over two intervention sessions through observation, interview, manual muscle testing, perceptual and sensory testing, and the Barthel Index of ADLS (Mahoney & Barthel, 1965), on which Frank scored a 10 of 20. He has no deficits in his hearing or vision, aside from wearing glasses for distance. He does have deficits in perception, with difficulty in figure-ground and spa tial relations. He demonstrates right-left confusion and a profound left neglect. Observation of Frank completing his daily routine showed cognitive deficits, including poor attention span, insight. judgment, and safety awareness. He has difficulty maneuvering around his room and the hospi tal environment and is constantly bumping into things on the left side Sensation testing finds impaired sensation for light touch and sharp-dull, as well as impaired stereognosis on his affected side. Frank has no AROM or sensory deficits in his right UE. He is right handed. He presents with weakness in his left UE and LE. has poor dynamk sitting and standing balance. and his static standing balance is fair with good static sit ting balance His PROM in his left UE is shoulder flexion to 85 degrees, abduction to 70 degrees, and elbow flexion to 100 degrees. His wrist and hand have PROM within normal limits (WNI), but he has muscle tone of 2 on the Asworth Scale in his fingers and wrist. He presents with tone of 2 on the Ashworth Scale throughout the UE, neck, and trunk, and I on the Ashworth Scale in his LE. His left UE has AROM as follows shoulder flexion/extension: 0 to 50 degrees adductionlabduction: 0 to 45 degrees, internal rotation to 5 degrees external rotation: 0 to 15 degrees elbow nexion/extension to supiration: 0 to 15 degrees pronation: WNL wrist extension: 0 to 10 degrees wrist flexion 0 to 45 degrees, finger Mexion half normal range. His finger extension is weak. He is unable to release objects His strength w not being tested because of his increased one Courdination on the leftis umpaited for both fine and motor During the ADL evaluation. Frank demonstrates del ficulty with right left discrimination. He has a great deal of difficulty managing his doing Heinale to figure out the front from the back of deve hole from the neck hole and needs animem assistance with all drengtas He appears to have dressing praxi Bathing pleted while sitting the Benelected his left side completely did not Altend to be on the left side of the ink, and need great verbalong and physical undance to complete the tak He ambulate with him wallet and minimum because of poor N He transles with uni and moderate ver can be use of y awarene som 1 Draw Design Layout Mailinge Rovi Vine Hello Sha 10. How would you address Frank’s left neglect during his ADLs? How would you set up the activity? 11. What intervention techniques would you use to normalize tone in the Left UE and trunk? 12. Name two ways you would incorporate purposeful activity into your treatment session. 13. How would you support Frank psychologically to help him deal with his decreased abilities? 14. List 3 ways in which you would educate Fank’s wife?
(Visited 3 times, 1 visits today)
