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Occupational Therapy Case Study

  Setting

Home-based Therapy

  Patient Overview 

The patient is a  77-year-old male s/p diagnosis of progressive neurological condition with generalized mm weakness impacting balance, ambulation, attention, memory, mood, and participation in meaningful activities

Since July 2019, the patient’s caregiver has been concerned about memory deficits and mood changes affecting his ability to be independent or participate in general activity. 

These symptoms have resulted in decreased mobility, increased generalized pain and exacerbations, decreased ability to recall names and faces of familiar people, decreased ability to organize numbers, calculate, and problem solve during card games, shopping, and financial management and decreased desire to engage in social activity previously important to him. It has also increased caregiver burden.

 In November 2019, the patient and caregiver sought official neuropsychological testing…

In December 2019, Caregiver and patient attended…diagnosis where he was given dopezil. He had adverse symptoms (diarrhea and nausea) which led them to discontinue donepezil and prescribe a transdermal patch of Rivastgmine). This left them concerned they would experience side effects from future medications. 

 The patient and caregiver also attended a memory coordination meeting where they were educated on the diagnosis, directed to seek further information and follow-up with primary care. They continue to feel uncertain following basic overview. The patient will follow-up with ….  in 2-3 months. 

  Medical History

  • Generalized Dementia
  • Peripheral Neuropathy BLE
  • Pre-Diabetes
  • Lumbar Spinal Stenosis

  Body Structures

BUE ROM WFL

Exceptions: 

  • LUE FLEXION 90 degrees
  • LUE Abduction 90 degrees 
  • Functional AROM in scaption

Functional Movement Patterns (Strength)

 

  • B Shoulder Flexion 4 / 5
  • Shoulder Extension 4 / 5
  • B Elbow Flexion 4 / 5
  • B Elbow Extension 4 / 5
  • B HIP FLEXION 3 / 5
  • B KNEE EXTENSION 3 / 5

  Assessments

  • Dementia Rating Severity Scale (DSRS) : 10 – mild 
  • Five Time Sit to Stand 27.27 (Goal less than 12) 
  • SLUMS 17/30 
  • TUG 33 (Goal Less than 12) 
  • BERG 31/56

   Performance Deficits According to Occupational Domain

Number

Performance Deficits

Occupational Domain Being Impacted

Restorative/

Habilitative

Potential

Skilled Maintenance Management

Required

1

Increased attention deficits 

Social Participation – Community PAR, Family PAR, Friendships

IADLs – Financial Management, Safety maintenance, Shopping

x

x

  Treatment

Performance Deficits 

 Increased Attention Deficits

Treatment

Pelmanism (Card Matching) 

 

Objective Measures 

How to gauge progress

  • Number of matches
  • Time with visual exposure
  • Time to identify matches
  • Number of Errors 

 

Explanation 

I would begin each session with Pelmanism. It is very important to be consistent with any type of plan of care or intervention program so that you can see progress and know what interventions are helping guide that process. These interventions must be performed for multiple sessions! 

 

I own a pack of cars that I bring to every treatment, but you can also print a matching game using objects relevant to them (or even faces of people the patient knows). It all depends on how much time you have. 

We sat at the kitchen table in a well-lit undistracted environment. I explained the expectations and the rules thoroughly at the start of this activity each time I saw him. He would have time to view the cards, practice mindful visualization, and be required to locate the matches (one at a time). This means that once he flipped over the first card, he must find that match before moving on. Every card he flipped that was not that match, was counted as an error and recorded. The amount of time it took to find all matches + # of errors was considered the outcome of the therapeutic activity.

 I began the process with 4 matches (8) cards face-up. I allowed 30 seconds to review these cards. I had the patient shut his eyes and visualize the cards as I moved them face down. I began the timer once again when he opened his eyes to locate the match. 

When he was successful (without error) at finding all 4 matches, I would increase the amount of matches. We were able to improve working memory to 8 matches (16 cards), by the time of discharge. 

 

Outcomes

According to the subjective feedback of patient and wife, the patient felt as though he was able to attend during conversations better, remember things quicker, and ultimately (along with other interventions described for “DALE”, he improved in his slums by 10 points over 18 weeks.

  References to begin your own critical analysis of this activity:

Wilson, S., S. Darling, and J. Sykes, Adaptive memory: fitness relevant stimuli show a memory advantage in a game of pelmanism. Psychonomic bulletin & review, 2011. 18(4): p. 781-786.

De Simoni, C. and C.C. von Bastian, Working Memory Updating and Binding Training: Bayesian Evidence Supporting the Absence of Transfer. Journal of experimental psychology. General, 2018. 147(6): p. 829-858.

Brown, L.A., et al., Processing Speed and Visuospatial Executive Function Predict Visual Working Memory Ability in Older Adults. Experimental aging research, 2012. 38(1): p. 1-19.

Al-Thaqib, A., et al., Brain Training Games Enhance Cognitive Function in Healthy Subjects. Medical science monitor. Basic research, 2018. 24: p. 63-69.