13 Mar Short term goals and Long EBP Case Study OTA 110: OT Treatment Planning & Techniques for Traditional & Emerging Practice Areas

Case Study: Evidence – Based Practice

PowerPoint presentation

Name:____________________________

Date:______________________

Course: OTA 110: OT Treatment Planning & Techniques for Traditional &Emerging Practice Areas

Course objectives:

UNIT TWO: Collaborating with Occupational Therapists on Therapeutic Interventions

Upon successful completion of this unit on written examination and demonstration the student will demonstrate principles, roles and responsibilities of working collaboratively with occupational therapists throughout the OT intervention process. The following documents will be used as resources to the students:

1. AOTA Guidelines for Occupational Therapy Service Delivery

2. Supervision Guidelines During the Therapeutic Intervention Process

UNIT THREE: Demonstrate selected practice skills

Upon successful completion of this unit on written examination and demonstration the student will demonstrate principles and concepts of selected practice skills. The student will demonstrate sound judgment in regard to safety of self and others, and adhere to safety regulations throughout the occupational therapy process.

1. Categories of Physical Agents

a. Thermal Agents

b. Mechanical Agents

c. Electromagnetic Agents

2. Static Orthotics

a. Purpose and type of splints

b. Fabrication of splints

c. Follow up procedures

3. Therapeutic Exercise

a. Passive Range of Motion

b. Active-Assistive Range of Motion

c. Active Range of Motion

d. Progressive Range of Motion

e. Precautions and Adaptations for Implementing Therapeutic Exercise

4. Dysphagia

a. Types of dysphagia

b. Basic compensatory and rehabilitative strategies

c. Appropriate treatment interventions

5. Balance Training

6. Advanced Positioning techniques

7. Compensatory Strategies OT for Physical Dysfunction, Radomski pg. 855

a. Limited ROM

b. Weakness and low endurance

c. Unilateral loss of motor control and limb function

d. Incoordination

e. Visual Impairments

f. Cognitive Limitations

g. Principles of Work Simplification and Energy Conservation

8. Training in self-care, self management, home management and community and work integration

9. Home Management and Community Integration and the Workplace

a. Guidelines, Standards, and Regulations of Accessible Design

b. Universal design

c. Age in Place

d. Interventions

i. Universal design and other accessible design

ii. Environmental modifications

iii. Assistive technology

iv. Task modification strategies

e. Consulting with Consumers to Facilitate Community and Workplace Participation

10. Prosthetic Devices

a. Types of Prostheses

i. Body Powered (BP) Prosthesis

ii. Externally Powered Prosthesis

iii. Myoelectric Prosthesis

iv. Hybrid Prosthesis

b. Prosthetic Training Program

c. Emerging Trends in Prosthetics

11. Feeding and Eating Performance

12. Superficial Thermal and Mechanical Modalities

a. Definition

b. Indications and contraindication

c. AOTA’s position on physical agents

Curriculum thread(s) addressed:

· Occupation centered practice

· Role Acquisition

Assignment Objective (s): Each student will be assigned a case study from Case Studies Through the Health Care Continuum: A Workbook for the Occupational Therapy Student, and will:

· develop a treatment plan with selected practice skills and based on the client’s problems.

· research and obtain three evidence – based practice health care or AJOT journals that will support the decisions in the designated treatment session (to be presented in the class)

· demonstrate how enhancement of functional ability and independence is achieved for the client in the traditional and emerging practice areas in Occupational Therapy

· demonstrate instances of collaboration with the Occupational Therapist, e.g. the implementing of a discharge plan from occupational therapy services that was developed by the occupational therapist in collaboration with the client and members of the interprofessional team by reviewing the needs of the client, caregiver, family, and significant others; available resources; and discharge environment.

·

Procedure:

1. Explain clinical picture of patient and establish an Occupational Therapy prioritized client problem list.

2. Student will obtain three evidence – based practice articles from health care or AJOT journals to support practice decisions and practice areas and exemplify collaboration with the Occupational Therapist in the practice decisions.

3. Write 2 LTG and 2 STG that directly relate to Client problem list. Remember to keep the focus on what you are looking for in outcomes.

4. Design a 60 minute treatment session. Demonstrate the progression of adjunctive to purposeful activity. Explain your rationale for choices of interventions.

5. Demonstrate selected practice skills (e.g., compensatory strategies, positioning, safety regulations, balance training, contracture management, edema management, subluxation management, orthotics, prosthetic training, thermal modalities, physical agents, ADL training, work simplification and energy conservation) based on the needs of the client in the case study.

6. Selected practice skills should demonstrate how enhancement of functional ability and independence is achieved for the client in the traditional and emerging practice areas in Occupational Therapy.

7. Articulate when and how to use the consultative process with specific consumers or consumer groups as directed by an occupational therapist : (e.g. “It involves; educating school personnel, demonstrating techniques or supports, and providing consultation in the form of occasional visits or phone/e-mail contacts…where the condition is long-standing (such as ASD) and must be managed day-to-day by other personnel e.g. parents, teachers and aides”).

8. APA format: Paper should be comprehensive, organized and easy to follow.

Grading Rubric:

Top of Form

Evaluation: Evidence – Based Practice
	Poor (1)	Fair (2)	Good (3)
Occupational Therapy prioritized problem list	Poor Lacks complete holistic view of client's current state. Focus more on medical past history rather than aspects from the domain.	Fair Addresses 60-75% of the client's factors, performance patterns/skills and occupational performance.	Good Address the whole person in a holistic manner with use of the OT Practice Framework noted.
Demonstration of Practice Skills	Poor Missing, does not relate to practice of OT or functional/occupation based. Lacks clear understand of what the client and/or therapist is completing. Lacking demonstrated evidence of collaboration with the Occupational Therapist in the practice decisions.	Fair Does not related to practice of OT or functional/occupation based. Lacks clear understand of what the therapist is completing. Some demonstrated evidence of collaboration with the Occupational Therapist in the practice decisions.	Good Relates to practice of OT or functional/occupation based. Demonstrates clear understand of what the therapist and client are completing. Exemplifies collaboration with the Occupational Therapist in the practice decisions.
Articulate when and how to use the consultative process with specific consumers or consumer groups as directed by an occupational therapist : (e.g.“ It involves; educating school personnel, demonstrating techniques or supports, and providing consultation in the form of occasional visits or phone/e-mail contacts…where the condition is long-standing (such as ASD) and must be managed day-to-day by other personnel (e.g. parents, teachers and aides”).	Does not make mention of the need for additional consultative processes for OT services. Does not address who else would benefit from consultation.	Fair attempt at articulating and identifying the need for additional consultative processes for OT services. May or may not address who else would benefit from such consultation.	Good articulation and identification of the need for additional consultative processes for OT services. Addresses who else would benefit from such consultation.
Evidence Based Practice	Poor Less than two health care or AJOT journals to support Occupational Therapy treatment session	Fair Two health care or AJOT journals to support Occupational Therapy treatment session	Good Three or more health care or AJOT Journals to support Occupational Therapy treatment session
Goals	Poor Goals are not measurable and/or objective; lack standards for goal structure; do not apply towards selected treatment activities.	Fair Goal structure needs clarification regarding main elements and being functional/occupation based.	Good All goals are function/occupation based and meet standards for goal structure.
PowerPoint Treatment session	Poor Does not address the client and is not an appropriate practice skill(s). Time allotted for treatment session is insufficient with limited, inappropriate use of equipment, modalities, and practice skills.	Fair Additional clarification required. Treatment session executed with of some equipment, modalities, practice skills that is supported by EBP.	Good Addresses the whole person and Occupational Therapy prioritized client problem list; includes 60 min treatment session with use of equipment, modalities, practice skills that is supported by EBP.
Discharge planning collaboration	Does not evidence discharge planning collaboration	Additional clarification is required	Effectively addresses discharge planning collaboration
Spelling and Grammar, APA Format	Poor Multiple errors with spelling, grammar and sentence structure. Little or no evidence of proof reading.	Fair Minimal errors with spelling, grammar, sentence structure and APA Formatting. Some proof reading required, however, can be comprehended.	Good Zero issues with spelling, grammar, sentence structure, thought process or general APA format.

Grade____________

Instructor comments:__________________________________________________________________

______________________________________________________________________________

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ACOTE Standards: ACOTE Standards for an Accredited Educational Program for the Occupational Therapy Assistant:

(B. 4.10. , B.4.16. , B.4.19. , B.4.27. , B.4.28, B.6.1.)

Revised 12/13/2021 JM

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Case Study: Evidence – Based Practice For PowerPoint Presentation

Case Study 1

A 54-year-old female childcare worker with 1-year history of lower back pain was diagnosed with degenerative spondylolisthesis and received a L4-L5 spinal fusion with instrumentation (interbody device, screws, rods). She was transferred from the hospital to a skilled nursing facility and evaluated by an occupational therapist. Information from evaluation revealed the client lives alone with a history of depression and anxiety, obesity, and COPD. The client was deconditioned and weak with poor motivation to get out of bed but upset and stressed about her disability. The goal was for the client to successfully return home alone safely and resume work as soon as possible. Client rapport was built by discussing her love of children and her job at a childcare, as well as by verifying her goals for increased independence, and reviewing the treatment plan, rehabilitation process, and the benefits of activity.

Case Study 2

Gail is a 54-year-old nurse who works in the neonatal intensive care unit of a hospital. She is married and the mother of three teenagers. She enjoys gardening, cooking, and crocheting in her spare time. For over a year, she has been experiencing pain in her right (dominant) thumb. She notices the pain during many of her everyday activities including using a syringe, writing, and opening various containers (e.g., medications, supplies) at work. She notices pain when lifting pots and casserole dishes as well as when she is gripping wet clothes to pull them out of the washer. Using her gardening tools has become too painful. She has basically had to give up most of the yard work and even the crocheting she enjoys. Gail discussed her concerns with her family physician during her yearly routine physical. Her physician took x-rays and examined her thumb. She tested positive for the “Grind test” (a provocative test used to determine CMC arthritis). Her physician diagnosed her with right thumb basal joint or CMC joint OA.

Case study 3

Lucille is a 77-year-old retired grade schoolteacher living in a two-bedroom senior housing unit. She became a widow in her 50s and never remarried. Lucille has two cats and occupies her time going to casinos, taking bus trips on weekends, and volunteering at the local library twice a week. One of her three children (her son), who remained single, lives nearby and routinely accompanies her to appointments and assists her with grocery shopping. Lucille had rotator cuff tears in both shoulders and received multiple cortisone injections. Her right (dominant) shoulder progressively worsened with pain and decreased range of motion because of advancing osteoarthritis. She was losing sleep because of pain and anxiety and was increasingly worried about her independence. Although her son was generous with his time, Lucille did not want to place any more burden on him. She and her orthopedic surgeon agreed on a trial of physical rehabilitation before resorting to surgery.

Case Study 4

Mr. Coffman is a 63-year-old male with a history of hypertension, osteoarthritis, and COPD. He recently had a COPD exacerbation and a moderately sized STEMI. Mr. Coffman has been a smoker for the last 40 years, but has recently considered quitting due to his worsening health condition. He is currently being treated in an acute care hospital setting for his recent MI and COPD exacerbation. At home, he wears 2 liters of oxygen at night, but he has been prescribed continuous oxygen at 4 liters since his hospitalization. Mr. Coffman spent 1 day in the intensive care unit and was then moved to the telemetry unit because his condition was improving. His physician has ordered OT evaluation and intervention to address the client’s decreased independence with ADLs and other occupations, shortness of breath, reduced functional activity tolerance, anxiety due to poor breathing patterns, and fatigue with daily activities.

Mr. Coffman has been married for 35 years to his wife Betsy, and they reside in a two-level house with three steps to enter the home. The main bedroom and bathroom are on the first floor, so he does not have to go upstairs when he first discharges home after his hospitalization. He has three children and seven grandchildren. His children live nearby and are willing and able to help him if needed. Mr. Coffman’s parents passed away several years ago, but all four of his siblings are still living and he visits with them often. He enjoys socializing with friends and customers at a local farmer’s market. Mr. Coffman has a high school education and has not completed any college courses.

Mr. Coffman was independent with all self-care activities, functional mobility, and driving until his most recent hospitalization. He was also able to help with light home-management tasks, although his wife does most of the cooking, cleaning, and laundry in their home. Mr. Coffman enjoys yard work, such as mowing and tending to his large garden, but he has found this to be increasingly difficult over the last few years. He enjoys spending time with his grandchildren, and he often attends their baseball games and other activities. Mr. Coffman had to retire early from his factory position due to his health conditions, but he still works for several hours 2 days a week at a local farmer’s market during produce seasons.

Case Study 5

Grace is a 49-year-old female client who is super obese. She was admitted to the hospital from a skilled nursing facility (SNF) where she had resided for the past 5 months. The client presented to the hospital with multiple medical problems that included acute respiratory failure requiring ventilation, obesity hypoventilation syndrome, obstructive sleep apnea, super obese with BMI of 82, sepsis, panniculitis, bipolar disorder, hypertension, chronic pain, and depression with an anxiety component.

Upon medical stabilization, a referral was made for OT to evaluate and treat. Prior level of functioning: Client was able to assist with approximately 50% of ADLs and transfer to wheelchair with Min A. Current level of functioning: Client noted to be dependent for all ADLs, transfers, and functional mobility, fatigue upon minimal exertion, BUE strength 2+/5. The OT course of treatment initially was to address safe handling for staff and client, begin UE ROM and increase to strengthening exercises as tolerated, tolerate EOB sitting for 5-minute intervals, and instruct in energy conservation techniques and adaptive equipment as indicated.

Case study 6

John is a 17-year-old male with a 30% TBSA burns (both deep partial and full-thickness) to chest, abdomen, right side of face, neck, back, and upper arms to wrist bilaterally (hands were spared). He was given fluid resuscitation and a nasogastric feeding tube immediately. The injury occurred at work during a fall on the ice while carrying hot grease to the oil dumpster. John, a high school senior, lives 2 hours from the Level I trauma and burn center and was transported from the local hospital.

The occupational therapists at the burn center completed an evaluation of John’s burn wounds and medical status within the first 24 hours of his arrival. The goal was for John to successfully return to being an independent high school senior. John’s parents were present at his bedside on the burn unit. They were divorced but had a good relationship in caring for their son.

Case Study 7

Pam is a 76-year-old female, diagnosed with stage III colorectal cancer with metastases to the nearby lymph nodes in her pelvis and groin. She is a retired waitress with a history of cigarette smoking (quit at age 50) and a family history of cancer. Pam lives alone in a rural town (except for her beloved pets). She has a two story house with a full bath on the first level, two bedrooms, and one bathroom upstairs. She has a daughter and grandchildren nearby and two daughters who live out of state. She has to travel over an hour to the closest hospital for health-care visits (oncology, radiotherapy, chemotherapy). Due to the location of her cancer, she is not a candidate for surgery and opted for intensive radiation and chemotherapy. Part way through her 6 weeks of almost daily radiation, and after her first week-long chemotherapy infusion, she is extremely fatigued, dehydrated, and has a very low blood pressure. She barely has energy to walk to the bathroom, talk on the phone, and can no longer walk up the stairs to her bedroom. She has no appetite, and is also experiencing very painful blisters in her mouth and throat from the chemotherapy. The home health nurse referred her for home health OT.

Case Study 8

Megan is a 35-year-old woman with CMT who is married, has two children 2 and 4 years of age, and works full time as a cashier at Walmart. She frequently has pain in her hands and feet, some numbness in her fingers and toes, and stands all day at her job. She wears bilateral ankle-foot orthoses and is beginning to have a slight claw deviation in her hands with hyperextension at the metacarpals, and flexion at the proximal and distal finger joints. She is having difficulty with fastening her own clothing as well as her children’s and struggles to perform the evening cooking and other chores after a long day at work. She has messy writing, and her hand cramps when texting or using the computer. She has difficulty opening jars and bottles, and some difficulty bagging heavier items at work such as gallons of milk and juice.

Case Study 9

Marty, a 27-year-old man, was involved in a motor vehicle collision. He was not wearing a seatbelt and was ejected from the vehicle he was driving. Marty’s injuries included a TBI with diffuse axonal injury, right clavicle fracture, right tibia fracture, and vertebral fractures at C4 and C5. He was intubated at the scene and had an initial GCS score of 3. Marty underwent a craniectomy, with the bone flap removed to manage intracranial pressure. A tracheostomy was placed, and Marty was dependent on the ventilator for 4 weeks. A gastrostomy tube was placed for nutrition and medication. Marty had a cervical collar to stabilize his spine and a temporary brace to immobilize his right leg.

Case Study 10

Candace is a 20-year-old college student living at home with her parents. She is in nursing school and a personal trainer at her local gym. She is a weight lifter and exercise enthusiast. During a girls’ night out, Candace and three of her friends were in a motor vehicle collision (MVC). Candace was the restrained driver. During the scene of the accident, it was determined that Candace required specialized medical care, and she was emergently flown to the nearest trauma hospital, 2 hours from her home and the scene of the accident. At the hospital, physicians determined Candace’s injuries resulted in a T5 complete SCI.

Candace’s parents work full time to support their family and remain at her side during her entire acute stay and alternate time staying overnight during her inpatient rehabilitation stay.

During her 4 weeks on the inpatient rehabilitation unit, she works with OT and PT 3 hours or more per day to relearn all aspects of her daily living in preparation for discharge back home.

Case Study 11

Jasmine is an 18-year-old female status post car accident as an unrestrained driver, resulting in subarachnoid hemorrhage, intracranial hemorrhage