Client Ida Deen

1. Client Ida Deen Anna Suchy, Sheena Marquez, Grace Kim, Lisa Le

2. Occupational Profile • Ida Deen • 55 year old female • Orlando, Florida • Elementary school teacher. • Loves to bake • Lives with her retired husband • She has two children who lives within 30 miles. • 4 grandchildren

3. Why Is She Seeking Services? • Ida fell at her work place on September 20th, 2011 and fractured her humerus at the mid-humeral level. • Pain in her upper right arm ( pain level as a 6 on a scale of 0 to 10). • Pain increases as she gets out of bed, up and down from the toilet, and in and out of the car. • She also complains of pain when the sling is removed for bathing, especially when she tries to straighten her elbow. • Moderate edema in her right hand which restricts her ability to make a tight fist. Her lateral RUE is ecchymotic. • AROM on her right wrist is WFL. • AROM on her right elbow is 75 to 115 degrees. • The strength and AROM in Ida’s left arm is WNL.

4. Strengths and Weaknesses • Physical • Cognitive • Psychological Lisa Le Lisa Le • Environmental • Cultural • Social • Emotional

5. Physical Strengths Weaknesses • Has full ROM in her unaffected arm. • No significant health problems or side effects from medication • Can use the restroom without assistance . • Can dress her lower limbs. • Able to self feed. • Functionally mobile around the house. • Cannot move her shoulder or elbow joint ( Doctor’s orders ). • She is right hand dominate so when using her left arm to compensate it will be weak and uncoordinated. • Her whole body has been weaker and is experiencing lower energy. • Needs assistance undressing and dressing her upper limbs. • Needs some assistance transferring into the shower and rinsing herself. • Edema of the right hand due to the injury.

6. Cognitive Strengths Weaknesses • She is alert and oriented so she is able sustain attentiveness during performance of her daily occupations. • Can communicate her wants and needs. • Is able to preform her daily chores and cook with adaptive devices and assistance. • Fears that her age will affect her healing process. • Disappointed because she has just gone through menopause and now has to recover from falling. • Developed a fear of fallingor reinjuring her shoulder.

7. Psychosocial Strengths Weaknesses • Ida responds well with interactions among family members and friends. • Able to express her feelings and physical condition to family members, doctors, and work. • Fears that her work will replace her because of her age and health. • Difficulty sleeping, anxiety, fear of falling, headaches from stress, the inability to concentrate at times, and loss of appetite.

8. Environment Strengths Weaknesses • Ida sees her doctors regularly. • Her home is a spacious one story home, which makes it easy to maneuver around. • Her husband assistances her with any demand she has. • She is surrounded by positive friends and family constantly offering their help. • Her kitchen is vast with high selves. • Her husband does not know how to cook and clean.

9. Cultural Strengths Weaknesses • Ida is heavily involved with her church. • Ida and her church pray which gives her faith that she will recover. • Is unable to stay for a full day of ceremony or sing due to exhaustion. • Unable to shake people’s hands or give/receive a hug.

10. Social Strengths Weaknesses • Ida is well liked amongst her students. • Ida is part of her church’s choir as lead vocalist. • She receives food from her family and church members. • She cannot see her students during her recovery. • Not being able to use both hands for gestures. • Cannot attend a function and stay too long due to pain and weakness.

11. Emotional Strengths Weaknesses • Ida has a strong emotional connection with her family and her faith. • Has faith that she will have a full recovery. • Ida gets frustrated when her things are out of place in the house and cannot clean or do laundry. • Feels useless because she cannot cook as frequently for her husband, family, and for church. • Misses her students.

12. Ida’s Concerns • How she will care for herself • How she will manage her household activities • How she will manage her work responsibilities when she returns to the classroom in two weeks. -Anna Suchy

13. ADL Evidence Based Article • MEASUREMENTS: Outcome measures included self-rated difficulties with ambulation, IADLS, ADLs, fear of falling, confidence performing daily tasks, and use of adaptive strategies • RESULTS: At 6 months, intervention participants had less difficulty than controls with IADLs and ADLs. Greater self-efficacy, less fear of falling, fewer home hazards, and greater use of adaptive strategies. Benefits were sustained at 12 months for most outcomes. • CONCLUSION: A multicomponent intervention targeting modifiable environmental and behavioral factors results in life quality improvements in community-dwelling older people who had functional difficulties, with most benefits retained over a year.

14. Relating the ADL to Ida • Rehabilitative Approach • At 6 months, intervention participants had less difficulty with bathing, which Ida needs maximal assistance to complete. • Improvements in people who had functional difficulties (as Ida does) with most benefits retained over a year • Cost Effective (Ida is a teacher)

15. Client Factors A. Values Commitment to family Honesty with self and others Educating children Personal religious commitment B. Beliefs She has a powerful influence on her family and students. Hard work pays off “Home is where the heart is”. Ida loves her family and it is her love that drives her to want to take care of them

16. C. Spirituality • She has a purpose in life to better the lives of her family as well as others. • She is a valued member of her family, workplace, and church.

17. Body Functions A. Mental Functions • Cognitive • Ida must use good judgment, insight, attention and awareness when she cooks/bakes for her family. • Ida must not let the pain in her arm distract her or overly guard her arm while attempting to complete tasks. • Attention • Ida must pay attention to the task at hand when she is cooking to avoid further injuries. • Emotional • Emotional regulation • She will need extra help/assistance. • Activities will take longer than usual.

18. B. Sensory Functions and pain • Visually aware of the environment to avoid anything that can potentially aggravate her injury. • Aware of her body position in space in order to not bump her arm into anything while completing tasks in the kitchen. • Localize pain C. Neuromusculoskeletal and movement related functions • Functions of joints and bones • Ida will not have adequate range of motion and strength in her shoulder and elbow joints • She will have normal mobility of her wrist, MP, PIP, and DIP joints

19. Ida will not have appropriate muscle strength and endurance needed to lift, pour and mix the batter. • Unaffected arm will fatigue quicker than normal. • Ida must be in control of her voluntary movement for hand eye-coordination, gross and fine motor control but especially her unilateral coordination. D. Skin Functions • Ida has edema in her right hand which causes her hand to appear swollen and glossy.

20. Body Structures • Ida has an intact nervous system. • Eyes • Ears and related structures • Structures involved in voice and speech • Ida has healthy functioning cardiovascular, immunological, respiratory, digestive, metabolic, endocrine, genitourinary, and reproductive systems. • Full use of her unaffected arm • Limited ROM and strength in her injured arm.

21. Ida’s Difficulties with Activity Demands BAKING SUGAR COOKIES -Grace Kim

22. OBJECTS & PROPERTIES • Mixing bowl –heavy, ceramic, smooth, large • Whisk –metal, lightweight • Sifter –metal, cylindrical, lightweight, smooth • Sugar –small granules; dry; can become sticky in warm temperatures • Flour –powder-like and white; lightweight, but can be heavy in package. • Eggs –smooth, oval-shape, small; when cracked, they are slimy and have an odor • Baking powder –lightweight, white • Salt –small granules, white • Butter –yellow, malleable; has a distinct smell • Milk –white, liquid, cool • Powdered sugar –white, powdered, lightweight; can become sticky in warm temperatures • Store-bought icing –malleable, sticky, sweet, • Knife –sharp; has hard handles • Spatula –wooden cylindrical handle; rubber and square shaped on the other end, lightweight • Waxed paper –waxy surface, flat, lightweight, thin • Refrigerator –large, heavy, rectangular; has doors with handles • Counter space for rolling out dough –smooth, flat • Rolling pin –cylindrical, wooden, cylindrical handles, slightly heavy • Baking sheet –metal, flat, smooth, rectangular • Oven –large, with sharp corners; can become hot; has door with a handle • Oven mitt –fabric, fluffy; protects hand from heat • Cooling rack –wire, metal; ventilated flat surface; can become hot • Storage container for transport –plastic, smooth, rectangular; has a lid • Large cutting board (if counter is not flat, smooth surface) –wooden, heavy, smooth, flat • Measuring cup –cylindrical, smooth, glass; has a handle • Measuring spoons –small, metal, lightweight

23. SPACE DEMANDS

24. SOCIAL DEMANDS • Sharing supplies with another person • Sharing responsibilities with another person and working as a team • Conversing with friend while baking • Accommodating requests made by friend while baking • Switching tasks with friend if needed • Showing positive facial expressions and body language

25. SEQUENCE AND TIMING Lack of bilateral coordination • Pouring dry ingredients into measuring cups • opening/unwrapping packages • cracking an egg • whipping ingredients together • Greasing the baking sheet

26. OCCUPATION BASED INTERVENTION EDEMA REDUCTION

27. EDEMA: POSSIBLE COMPLICATIONS • Pain and stiffness, • Formation of adhesions, and shortening of connective tissues • Decreased range of active movement • Loss of hand function

28. MANUAL LYMPH DRAINAGE • METHODS: Both treatment and control groups used conventional methods of edema treatment, including: elevation, active and passive exercises, and compression. In addition, the experimental group received ten treatments of manual lymph drainage using light massage. • RESULTS: Patients were measured four times within a ten month period using a volumeter. The experimental group had better outcomes in edema reduction at each reading. • CONCLUSION: The results indicate that the group treated with MLD will have less edema at an earlier post-traumatic stage compared with the conventionally treated group, which reduces the risks of edema associated complications. MLD is considered a complimentary treatment to conventional edema treatment.

29. FROSTING SUGAR COOKIES

30. PEOP Ida Deen Performance Participation

31. References American Occupational Therapy Association. (2008, November/December). The American Journal of Occupational Therapy. Occupational Therapy Practice Framework: Domain & Process , 62 (6), pp. 625 – 688. Burke, J.. (2010). What's Going on Here? Deconstructing the Interactive Encounter. The American Journal of Occupational Therapy, 64(6), 855-868. Retrieved October 5, 2011, from ProQuest Medical Library. (Document ID:  2193177571). Handicap Cooking and Eating Aids. (n.d.). Handicapped Equipment. Retrieved October 6, 2011, from http://www.handicappedequipment.org/handicap-cooking- and-eating-aids/ 

32. References Moore, L. J., & Ostrander, E. R. (Performer). (1992). In support of mobility: kitchen designs for independent adults [Audio podcast]. Retrieved from http://ecommons.cornell.edu/bitstream/ Saulsbery, C., & Hollister, D. A. (Performer). (n.d.). Lsuhsu occupational therapy treatment of humeral fractures [Audio podcast]. Retrieved from https://docs.google.com/a/nv.touro.edu/viewer?a=v&pid=explore r&c