UNIVERSITY OF ST. AUGUSTINE For Health Sciences Institute of Occupational Therapy MOT/OTD Programs A

UNIVERSITY OF ST. AUGUSTINE For Health Sciences Institute of Occupational Therapy MOT/OTD Programs Assignment: Domain of Occupational Therapy Review the following case: Case Study: Harris Jones—T-3 Incomplete Spinal Cord Injury Harris Jones is a 22-year-old African American man with a diagnosis of incomplete spinal cord injury at T3 and resultant paraplegia due to an auto accident. Harris also fractured his right tibia and fibula and right proximal radius and ulna in the accident. Harris was admitted to the rehabilitation hospital from the acute care hospital, where he stayed for 2.5 weeks after his accident. Harris lives with his fiancée, Marsha, on the 15th floor of a new apartment complex in the city. It is a small one-bedroom apartment. They intend to be married after his graduation from college. Harris has one more semester to complete for his baccalaureate degree in computer science. He also works full-time as a bookkeeper for this brother’s plumbing business—work that he can do on his computer at home or at his brother’s office (which is in his brother’s home). His brother lives five miles away by car, in a home that has six steps at the entrance and no ramp. During the little free time he has, Harris likes to travel with Marsha and golf with his friends. They like to entertain and enjoy going to the movies for their weekly date night. Marsha works as a dental hygienist at a busy dental practice. Harris had no functional deficits before the accident. Harris’s family is extremely supportive and visits daily. His brother, Jeff, calls frequently, and his mother cooks his favorite meals, which she brings in for the nurses as well as for Harris. Harris’s father is not well and cannot visit as often because of respiratory distress, but he telephones his son regularly. Marsha has taken time off work to be with Harris every day at the rehabilitation hospital. She wants to be involved in learning as much as she can to help Harris “get better.” Harris was admitted to the rehabilitation hospital with the goal of returning home, finishing his degree, and graduating on time (in four months). He is eager to get started and tells the admission nurse, “the more therapy, the better.” Harris will be evaluated by PT, OT, nursing, social work, and the physiatrist. Upon evaluation, Harris was talkative and motivated. He is in a wheelchair with lateral supports. His right upper extremity (UE) is in a full-arm cast, and his right lower extremity (LE) is in an Air cast from the toes to the knee. Harris is right-handed. When asked how he has been feeling since the accident, his reply is “fine.” When the question is rephrased regarding his emotional state, his response is the same. Harris has no cognitive, perceptual, visual, or hearing deficits. He has no sensation in either LE and reports no sensation in his buttocks either. His UE sensation is intact, as is the sensation in his superior trunk region. His sensation is impaired in his inferior trunk region. Harris’s low-back area could not be assessed during the evaluation because of his position in the chair. Harris has no complaints of pain except for stiffness in his neck. Harris’s unsupported sitting balance is poor to fair, and he is unable to sit up independently without minimal assistance or lateral supports. He does attempt to correct himself when leaning but lacks the strength to maintain upright posture without external assistance. He is independent in sitting with the lateral supports in the wheelchair. Harris requires occasional assistance to propel himself in a wheelchair because of his inability to use his right arm due to the cast. He can perform bathing tasks sitting in front of the sink in his wheelchair and can wash his face, hands, and chest with setup. He requires total assistance for back, buttocks, and legs. He requires maximum assistance for dressing himself. Harris reports feeding himself without help, although “it’s messy sometimes.” Harris has a catheter for urination and has had bowel incontinence since the accident. Harris wants to get started with therapy right away. He says his goals for rehabilitation are to “walk out of here and get on with my life.” Based on the Occupational Therapy Practice Framework: Domain and Process, 4th Edition (OTPF-4), complete the following tables: Limited Occupations (Table 2) Identify the occupations that Mr. Jones is struggling with. In the first column, identify which category that occupation falls under, with the subcategory identified in the second column. Provide a brief description of the occupation and how it is impaired in the last column titled “Rationale” Occupation Category E.g., Activities of daily living Specific subcategory E.g., Dressing Rationale E.g., The client is unable to complete fasten buttons during upper body dressing due to bilateral hand osteoarthritis. Successful Occupations (Table 2) Identify the occupations that Mr. Jones is successful with. In the first column, identify which category that occupation falls under, with the subcategory identified in the second column. Provide a brief description of the occupation and how it is successful in the last column titled “Rationale” Occupation Category E.g., Activities of daily living Specific subcategory E.g., Dressing Rationale E.g., The client is successful with lower body dressing due to adequate hip flexibility and strength. Client Factors which hinder engagement in occupations (Table 9) Identify which of Mr. Jones’ client factors are impaired and have an impact on occupational performance. List the category in the first column, with the exact specific client factor or body function in the second column. In the last column, explain how the impairment in the client factor/body function impacts engagement in occupations. Client Factor/Body Function Category E.g., Sensory Functions Specific Client Factor or Body Function E.g., Pain Direct Occupational Impact e.g., The presence of pain in the client’s low back impacts their leisure participation of gardening. Client Factors which support engagement in occupations (Table 9) Identify which of Mr. Jones’ client factors are intact and support occupational performance. List the category in the first column, with the exact specific client factor or body function in the second column. In the last column, explain how the client factor/body function supports engagement in occupations. Client Factor/Body Function Category E.g., Sensory Functions Specific Client Factor or Body Function E.g., Proprioception Direct Occupational Impact E.g., The client’s proprioception is intact enabling the client to be successful with the ADL of shaving their face without looking. Performance Skills which hinder engagement in occupations (Tables 7 & 8) Identify which of Mr. Jones’ performance skills are impaired and have an impact on occupational performance. List the category in the first column, with the exact specific performance skill in the second column. In the last column, explain how the impairment in the performance skill impacts engagement in occupations. Skill Category E.g., Motor skills Specific Skill Within category E.g. Manipulates Direct Occupational Impact e.g., The client is unable to manipulate a pencil which hinders formal education participation. Performance Skills which support engagement in occupations (Tables 7 & 8) Identify which of Mr. Jones’ performance skills are intact and have an impact on occupational performance. List the category in the first column, with the exact specific performance skill in the second column. In the last column, explain how the performance skill supports engagement in occupations. Skill Category E.g., Social Interaction Skills Specific Skill Within category E.g. Produces Speech Direct Occupational Impact e.g., The client is able to produce speech using ASL during peer group social participation. Performance Patterns (Person) which are hindered and limiting engagement in occupations (Table 6) Identify which of Mr. Jones’ performance patterns are impaired and have an impact on occupational performance. List the category in the first column, with the exact specific performance pattern in the second column. In the last column, explain how the impairment in the performance pattern impacts engagement in occupations. Performance Pattern Category E.g., Habit Specific Pattern Within Category E.g., Checking cell phone continuously Direct Occupational Impact e.g., The client’s habit of continuously checking their phone hinders their job performance. Performance Patterns (Person) which are a support for engagement in occupations (Table 6) Identify which of Mr. Jones’ performance patterns support occupational performance. List the category in the first column, with the exact specific performance pattern in the second column. In the last column, explain how the performance pattern supports engagement in occupations. Performance Pattern Category E.g., Role Specific Pattern Within Category E.g., Mother Direct Occupational Impact e.g., The client is successfully fulfilling the role of mother, supporting the IADL of child rearing. Context: Environmental Factors & Context: Personal Factors which hinder engagement in occupations (Tables 4 & 5) Identify which of Mr. Jones’ contexts or environments limit or hinder occupational performance. List the category in the first column, with the exact context or environment condition in the second column. In the last column, explain how the context or environment will impact engagement in occupations. Environmental Factor or Personal Factor Category E.g., Natural Environment and human made changes to the environment Specific Component E.g., Physical geography Direct Occupational Impact e.g., The client’s ADL of functional mobility is hindered due to uneven terrain on the playground. Contextual & Personal factors which support engagement in occupations (Tables 4 & 5)Identify which of Mr. Jones’ contexts or environments support occupational performance. List the category in the first column, with the exact context or environment condition in the second column. In the last column, explain how the context or environment will support engagement in occupations. Environmental Factor or Personal Factor Category E.g., Cultural Attitude Specific Component E.g., Deaf culture attitude of collectivism Direct Occupational Impact e.g., The client’s cultural attitude that being deaf connects them to other deaf people in an interconnected group supports their social participation with peers. American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74 (Suppl. 2). 7412410010. https://doi.org/10.5014/ajot.2020.74S2001 UNIVERSITY OF ST. AUGUSTINE For Health Sciences Institute of Occupational Therapy MOT/OTD Programs Assignment: Domain of Occupational Therapy Review the following case: Case Study: Harris Jones—T-3 Incomplete Spinal Cord Injury Harris Jones is a 22-year-old African American man with a diagnosis of incomplete spinal cord injury at T3 and resultant paraplegia due to an auto accident. Harris also fractured his right tibia and fibula and right proximal radius and ulna in the accident. Harris was admitted to the rehabilitation hospital from the acute care hospital, where he stayed for 2.5 weeks after his accident. Harris lives with his fiancée, Marsha, on the 15th floor of a new apartment complex in the city. It is a small one-bedroom apartment. They intend to be married after his graduation from college. Harris has one more semester to complete for his baccalaureate degree in computer science. He also works full-time as a bookkeeper for this brother’s plumbing business—work that he can do on his computer at home or at his brother’s office (which is in his brother’s home). His brother lives five miles away by car, in a home that has six steps at the entrance and no ramp. During the little free time he has, Harris likes to travel with Marsha and golf with his friends. They like to entertain and enjoy going to the movies for their weekly date night. Marsha works as a dental hygienist at a busy dental practice. Harris had no functional deficits before the accident. Harris’s family is extremely supportive and visits daily. His brother, Jeff, calls frequently, and his mother cooks his favorite meals, which she brings in for the nurses as well as for Harris. Harris’s father is not well and cannot visit as often because of respiratory distress, but he telephones his son regularly. Marsha has taken time off work to be with Harris every day at the rehabilitation hospital. She wants to be involved in learning as much as she can to help Harris “get better.” Harris was admitted to the rehabilitation hospital with the goal of returning home, finishing his degree, and graduating on time (in four months). He is eager to get started and tells the admission nurse, “the more therapy, the better.” Harris will be evaluated by PT, OT, nursing, social work, and the physiatrist. Upon evaluation, Harris was talkative and motivated. He is in a wheelchair with lateral supports. His right upper extremity (UE) is in a full-arm cast, and his right lower extremity (LE) is in an Air cast from the toes to the knee. Harris is right-handed. When asked how he has been feeling since the accident, his reply is “fine.” When the question is rephrased regarding his emotional state, his response is the same. Harris has no cognitive, perceptual, visual, or hearing deficits. He has no sensation in either LE and reports no sensation in his buttocks either. His UE sensation is intact, as is the sensation in his superior trunk region. His sensation is impaired in his inferior trunk region. Harris’s low-back area could not be assessed during the evaluation because of his position in the chair. Harris has no complaints of pain except for stiffness in his neck. Harris’s unsupported sitting balance is poor to fair, and he is unable to sit up independently without minimal assistance or lateral supports. He does attempt to correct himself when leaning but lacks the strength to maintain upright posture without external assistance. He is independent in sitting with the lateral supports in the wheelchair. Harris requires occasional assistance to propel himself in a wheelchair because of his inability to use his right arm due to the cast. He can perform bathing tasks sitting in front of the sink in his wheelchair and can wash his face, hands, and chest with setup. He requires total assistance for back, buttocks, and legs. He requires maximum assistance for dressing himself. Harris reports feeding himself without help, although “it’s messy sometimes.” Harris has a catheter for urination and has had bowel incontinence since the accident. Harris wants to get started with therapy right away. He says his goals for rehabilitation are to “walk out of here and get on with my life.” Based on the Occupational Therapy Practice Framework: Domain and Process, 4th Edition (OTPF-4), complete the following tables: Limited Occupations (Table 2) Identify the occupations that Mr. Jones is struggling with. In the first column, identify which category that occupation falls under, with the subcategory identified in the second column. Provide a brief description of the occupation and how it is impaired in the last column titled “Rationale” Occupation Category E.g., Activities of daily living Specific subcategory E.g., Dressing Rationale E.g., The client is unable to complete fasten buttons during upper body dressing due to bilateral hand osteoarthritis. Successful Occupations (Table 2) Identify the occupations that Mr. Jones is successful with. In the first column, identify which category that occupation falls under, with the subcategory identified in the second column. Provide a brief description of the occupation and how it is successful in the last column titled “Rationale” Occupation Category E.g., Activities of daily living Specific subcategory E.g., Dressing Rationale E.g., The client is successful with lower body dressing due to adequate hip flexibility and strength. Client Factors which hinder engagement in occupations (Table 9) Identify which of Mr. Jones’ client factors are impaired and have an impact on occupational performance. List the category in the first column, with the exact specific client factor or body function in the second column. In the last column, explain how the impairment in the client factor/body function impacts engagement in occupations. Client Factor/Body Function Category E.g., Sensory Functions Specific Client Factor or Body Function E.g., Pain Direct Occupational Impact e.g., The presence of pain in the client’s low back impacts their leisure participation of gardening. Client Factors which support engagement in occupations (Table 9) Identify which of Mr. Jones’ client factors are intact and support occupational performance. List the category in the first column, with the exact specific client factor or body function in the second column. In the last column, explain how the client factor/body function supports engagement in occupations. Client Factor/Body Function Category E.g., Sensory Functions Specific Client Factor or Body Function E.g., Proprioception Direct Occupational Impact E.g., The client’s proprioception is intact enabling the client to be successful with the ADL of shaving their face without looking. Performance Skills which hinder engagement in occupations (Tables 7 & 8) Identify which of Mr. Jones’ performance skills are impaired and have an impact on occupational performance. List the category in the first column, with the exact specific performance skill in the second column. In the last column, explain how the impairment in the performance skill impacts engagement in occupations. Skill Category E.g., Motor skills Specific Skill Within category E.g. Manipulates Direct Occupational Impact e.g., The client is unable to manipulate a pencil which hinders formal education participation. Performance Skills which support engagement in occupations (Tables 7 & 8) Identify which of Mr. Jones’ performance skills are intact and have an impact on occupational performance. List the category in the first column, with the exact specific performance skill in the second column. In the last column, explain how the performance skill supports engagement in occupations. Skill Category E.g., Social Interaction Skills Specific Skill Within category E.g. Produces Speech Direct Occupational Impact e.g., The client is able to produce speech using ASL during peer group social participation. Performance Patterns (Person) which are hindered and limiting engagement in occupations (Table 6) Identify which of Mr. Jones’ performance patterns are impaired and have an impact on occupational performance. List the category in the first column, with the exact specific performance pattern in the second column. In the last column, explain how the impairment in the performance pattern impacts engagement in occupations. Performance Pattern Category E.g., Habit Specific Pattern Within Category E.g., Checking cell phone continuously Direct Occupational Impact e.g., The client’s habit of continuously checking their phone hinders their job performance. Performance Patterns (Person) which are a support for engagement in occupations (Table 6) Identify which of Mr. Jones’ performance patterns support occupational performance. List the category in the first column, with the exact specific performance pattern in the second column. In the last column, explain how the performance pattern supports engagement in occupations. Performance Pattern Category E.g., Role Specific Pattern Within Category E.g., Mother Direct Occupational Impact e.g., The client is successfully fulfilling the role of mother, supporting the IADL of child rearing. Context: Environmental Factors & Context: Personal Factors which hinder engagement in occupations (Tables 4 & 5) Identify which of Mr. Jones’ contexts or environments limit or hinder occupational performance. List the category in the first column, with the exact context or environment condition in the second column. In the last column, explain how the context or environment will impact engagement in occupations. Environmental Factor or Personal Factor Category E.g., Natural Environment and human made changes to the environment Specific Component E.g., Physical geography Direct Occupational Impact e.g., The client’s ADL of functional mobility is hindered due to uneven terrain on the playground. Contextual & Personal factors which support engagement in occupations (Tables 4 & 5)Identify which of Mr. Jones’ contexts or environments support occupational performance. List the category in the first column, with the exact context or environment condition in the second column. In the last column, explain how the context or environment will support engagement in occupations. Environmental Factor or Personal Factor Category E.g., Cultural Attitude Specific Component E.g., Deaf culture attitude of collectivism Direct Occupational Impact e.g., The client’s cultural attitude that being deaf connects them to other deaf people in an interconnected group supports their social participation with peers. American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74 (Suppl. 2). 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

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