Case Study: Nazareth College OT Clinic

On Wednesday November 12th, 2014 from 12:00pm – 12:45pm I observed a client at the Nazareth College OT Clinic in Carroll Hall. The client that I observed this week was the same client I worked with in the six previous weeks; he is a 50-55 year old white male who had suffered from a stroke on the left side of his brain and has also developed Aphasia as a result of the stroke. The most of the client’s difficulties have to do with the use of his right arm and leg as well as moderate communication issues. This week we worked on functional occupations for the client, such as picking clothes up off the floor and making a bed. In this appointment we also did some stretching with the client and discussed his growths due to the Botox injections he received
two weeks ago.
When we entered the appointment the caregiver of the client had just given his a water bottle, and the therapist asked how the client would get it open. As the therapist was saying this the client, using his teeth, got the water bottle most of the way open then set the bottle down on the mat table next to him and opened it the rest of the way. The therapist expressed some concern with the fact that he uses his teeth to do this task, but she also said that part of being an OT is respecting the way that someone has already learned to do something. Due to the fact that the client has been doing this task this way for so long the odds of changing his way is very unlikely.
After the client had his water open, he expressed his excitement for results of the Botox injections.
The other student and I, as we have in previous weeks, again assessed the additional range of motion and this week we say even more of a change that in the previous week. The therapist then took some time stretching out the client and seeing for herself the growth. The client was very excited with the growth that he is showing in this area was incredibly impressive. The client, again had almost full extension of his elbow, but this week it was considerably easier for him to reach this goal. One of the most major successes was that when the client pulled his fingers open, when he kept his wrist bend, his fingers stayed open. This is an incredibly amazing achievement considering the tightness that the client has on the day of our first appointment. Next the client was actually able to close his fingers, as they were open, without moving his
wrist.
Still looking at the successes of the Botox injections, the therapist began stretching out the client’s shoulder and seeing the increased range of motion in that area.
The client lifted his own shoulder so his arm, which was bent, was just above his eyes, but when the therapist asked if she could see if she could get it to stretch any further he excitedly agreed to try. The therapist then stretched the client’s shoulder so that his arm was even with the top of his head. Next the therapist looked at the client’s elbow and again tested the client’s stretch of the joint, considering we have already seen the great amount of stretch that exists in that area now. The therapist was taking to the client about the progress that he has made through these secessions and asked him if he felt that we had made progress in the secessions, and he proudly agreed that he
had. Once the therapist had given the client a good stretch on his effected side on the affected areas, she began discussing the activities that we could do in the session. The client expressed, out of the list of choices that the therapist gave, he wanted to work on making a bed and picking items off of the floor. We began with the bed task. First the client took off the sheets on the bed, which included a sheet, fitted sheet and a pillow case off of a pillow the client did this with no issue. The client did have to go around to the other side and to the foot of the bed to try and get the fitted sheet off but, still did not have extreme difficulty completing the task. The client, which was another impressive skill of the appointment, ducked his head when I mentioned that he should be careful to not his head on the exercise ball racks. The client realized this and side stepped to the position that he needed to be, keeping his head down and looking for the next exercise ball rack being aware of its location. The client had the most issue with putting the pillow case back on the pillow. The client completed the task of putting the fitted sheet back on the bed with ease and same goes for the flat sheet. The client mentioned that at home that he makes the bed when he wakes up, but someone else changes the sheets for him. The client also mentioned that he has a larger bed at home so a small twin sized bed is easier for him to work with. To put the pillow case back on the pillow, the client sat down on the bed and tried to push the pillow into the pillow case. This strategy did not work. I suggested that the client put the pillow in between his knees and slide the pillow case over top of it, almost like putting a sock on a foot. This process worked better, but was still incredibly difficult. The therapist then suggested that the other student and I try to complete this activity using one hand and after only a few moments I was frustrated. I then found an appreciating for the client always positive attitude and realized how truly hard it is to go from having two functional arms/hands to one. After we got the pillow case on, the client shows great growth from last week in his sequencing skills, he had no problem knowing what came first, second, or third when taking off and putting ths sheets back on the bed. After completing that activity, the therapist put some clothing articles on the floor and had the client try to pick them up. The therapist, to make this activity a little harder, put some clothes under the chairs that we were sitting in. The client picked up the clothes with some difficulty, but he retrieved all of the articles without any hesitation. The client picked up 3 socks, a pair of jeans, a dress shirt, jeans, and a jacket form underneath one of the chairs. We did this activity relatively quickly because the caregiver was a couple minutes early. The client was tired after the activities that we had done and, when asked, he did prove that to be true. The client still never comes right out with whether he is in pain or is tired or not because he is trying to push himself.
Right before the session ended the therapist asked what kind of activity he would like to do for next week, because it is his last week of therapy. He expressed interest in doing another cooking activity.
In this session, the therapist modified a few of our activities to adapt the activities to the needs of the client. The first thing that the therapist did was, while the client was working on the bed activity, she pulled the bed away from the wall so that he could get around the bed to have the best angle at getting the sheets on and off. Another way that the therapist did this was when she left the obstacles in the way for the client to move around when the client was picking up clothes off of the floor. These obstacles gave the client more of a real world example of how he would complete this activity if he were at home.