OSC 604 Health and Occupational Participation of the Older Adult PDF

OSC 604: Health and occupational participation of the older adult SHARON MONTGOMERY, OTD, OTR/ L, CHT, CEAS CEREBRAL VASCULAR ACCIDENT, PART 2 Objectives Describe and discuss prevention and medical management of key stroke comorbidities with application to clients Describe and discuss contracture...

OSC 604: Health and occupational participation of the older adult SHARON MONTGOMERY, OTD, OTR/ L, CHT, CEAS CEREBRAL VASCULAR ACCIDENT, PART 2 Objectives Describe and discuss prevention and medical management of key stroke comorbidities with application to clients Describe and discuss contracture management, skin breakdown, splinting/orthotic needs and concerns with orthosis fabrication review. Discuss other stroke effects and application to occupational performance  Post stroke Comorbidities Residual stroke complica tions https://www.youtube.com /watch?v=TOvNlMRTKY s What client factors may be affected by a CVA? What occupations? What are some of the associated effects of a CVA? Note: some of these effects are covered in other units and will not be discussed here. Shoulder subluxation Commonly inferior subluxation post stroke as humeral head drifts inferior to the glenoid fossa d/t malalignment of scapula and trunk Weight of arm combined with instability and malalignment contributes to subluxation Can also occur anteriorly or superiorly Does not always lead to pain Management of subluxation video- shoulder subluxation https://www.youtube.com/watc h?v=2--ukB6d7IM Protection of unstable joints Flaccid extremities- ICE video: Upper Extremity Assessment: Acute Care https://www.icelearningcenter.com/ice-video-li brary **** what about neglect patients? Tone-Virgil Virgil and management of spasticity via botox Virgil What did you notice about Virgil? Botox overview video- for reference Maintaining soft tissue length Affects both low tone and high tone clients 24 hour program to maintain Frequent position changes Appropriate ROM techniques Low load/prolonged stretch (LLPS) submaximal stretch for prolonged time Management with Splinting, casting, positioning Orthotics Need must be individually assessed Low tone stage: maintaining joint alignment, protect tissues from shortening or overstretching, prevent injury to extremity, control edema Spasticity: maintain soft tissue length, provided low load prolonged stretch, place muscles at resting lengths on both sides of joints, attempt distal relaxation by promoting proximal alignment https://www.bls.gov/ooh/healthcare/orthotists-and-prosthetists.htm Orthoses as management of tonal changes in the UE Indications for resting hand orthosis with CVA? To immobilize, to position in functional alignment and to prevent further deformity Coppard, B., & Lohman, (2019) Introduction to Orthotics 5th ed., Mosby.: ISBN: 978032353615 Apraxia Apraxia is the reduced ability to coordinate, perform, plan or carry out specific movements even when there is no paralysis https://www.stroke4carers.org/?p=366 Apraxia Apraxia is the reduced ability to coordinate, perform, plan or carry out specific movements even when there is no paralysis https://www.stroke4carers.org/?p=366 ◦Ideomotor Apraxia ◦Ideational Apraxia Ataxia: describes a lack of muscle control or coordination of voluntary movements, such as walking or picking up objects. Perceptual deficits after stroke How do the following deficits interfere with function?- look at these now… ◦Agnosia ◦Visual spatial loss ◦Inattention/neglect https://www.stroke4carers.org/ Agnosia Auditory Tactile Visual Body Agnosia https://www.stroke4carers.org/?p=4974 Agnosia simulation Visual spatial skills- simulation activities Spatial awareness Figure ground Visual closure Visual memory Visual discrimination Why are these skills important? Activity 1 Get a piece of paper out. Follow my instructions. What is it? What visual perceptual skills are used in this task? Does yours look like…. Activity 2 How many can you find?- next slide What visual perceptual skills are used in this task? https://www.rd.com/article/15-hidden-objects-picture/ https://www.shutterstock.com/search/hidden+object Activity 3 https://www.rd.com/list/everyd ay-objects-close-up/ What is it? What visual perceptual skills are used in this task? Activity 4 https://m.youtube.com/watch?fea ture=youtu.be&v=6zPoJv_UB88 What visual perceptual skills are used in this task? Activity 5 What visual perceptual skills are used in this task? https://www.aviva.ie/insurance/home-articles/spot-the-difference/ Inattention or Neglect Peggy https://www.youtube.com/watch?v=ymKvS0XsM4 w https://www.stroke4carers.org/?p=4967 For reference Perseveration “getting stuck” A person repeats a word or phrase, action or behavior or emotion. https://www.youtube.com/watch?v=jCbfXR03mY4 Relate deficits to function Discuss how do the following deficits interfere with function? ◦Agnosia ◦Spatial awareness ◦Figure ground ◦Visual closure ◦Visual memory ◦Visual discrimination ◦Neglect ◦Perseveration Time to apply-Ellanora Initiating Treatment Bedside, Part 3: Self-Care In what position does the client typically keep her head? 2. Does she pay attention the left side of her body? Her arm? Her hair? Her face? 3. Does she pay attention the left side of her physical environment? The hair brush? The washcloth? 4. What types of cues does the clinician provide to facilitate attention to the left? How does the client respond to these cues? 5. Does the client appear to have a visual field cut (hemianopsia) or visual neglect? Why is it difficult to tell based on this observation? 6. What further assessments could you do to help determine if she has a hemianopsia versus visual neglect? How will this help guide your theoretical approach? 7. What other component skills is the clinician challenging in this treatment session? 8. What other kinds of activities might be useful to do with this client to encourage attention to the left? Describe what her next treatment session might look like. Stroke survivor stories https://www.youtube.com/watch?v=Nw Pxy5SZA80 -joe Again, what is the impact of stroke effects on occupation? Team questions In preparation for next week’s guest, each team must provide five questions to ask our guest. Submit your team’s list of questions on Canvas. Discharge summary documentation On Canvas, find 2 files for Homer: OT evaluation and additional information Using this information, you will open up DocuLearn and create a d/c note. ◦Use “free text note” ◦Select: Discharge note ◦No billing required since you are not treating the client for this note (sometimes you will do both treatment and discharge) ◦Use a previous subjective statement ◦Submit to Canvas by next class SOAP note discharge documentation guide Discharge summary example of contents: Example of d/c summary note: p. 235 Gateley, C. (2024). Documentation Manual for Occupational Therapy (5th ed.). Taylor & Francis. https://bookshelf.vitalsource.com/ books/9781040138045 Next: OSC 605 OT process for CVA, part 2 OSC 604 next topic coming up: Parkinson’s Disease- progressive neurodegenerative disorders Siena Hall 1115 (peds room) Monday 9/30 (quiz, guest speaker)