Case Study

Case A-10 Mr. McMasters

Since the removal of his tumor, Mr. McMasters has been going through quite a few developmental changes. He has experienced a loss of short term memory and attention span, as well as difficulty with multi-step commands and sequencing. He has also been having trouble telling his left from his right, and is also seeing a significant decrease in strength, sensation, and range of motion of his right upper extremity.

Mr. McMasters is a retired social-studies teacher, who enjoys several activities including hunting, fishing, gardening, playing cards, and more. These few tasks in particular, will require the use of his right arm, and it will be essential to restore as much function as possible to this extremity. At the age of 58, it will be very unlikely that Mr. McMasters will be able to restore much function because of the lack of plasticity in his brain. Where function can not be regained, it will be important for Mr. McMasters to be able to adapt to using his right arm within limitations, or in some cases using his left arm more predominately. For his occupation of hunting, Mr. McMasters will be required to load a gun, hold it steady, and pull the trigger. He will most likely need to be able to field dress his kill as well, which involves the use of a knife to skin and eviscerate the animal.

Because Mr. McMasters has full passive range of motion and good finger flexion, I would suggest that he remain shooting right-handed. He should practice target shooting using a table or bench to assist him in holding his arm up and stabilizing the gun. We would be able to use a toy gun in the clinic to practice adaptive positioning, gradually adding weight to the gun and eventually simulating a “kick” by jolting the gun while he was holding it.

I would also have him working on strengthening and steadying his grip and pulling a “trigger” using a “Digi-flex” isolated finger exerciser, gradually increasing the difficulty as Mr. McMaste

rs strength improves. We would work on stimulating his trigger finger in attempt to improve the sensation necessary for pulling the trigger on time and steadily.

If possible, and after improvements have been made in the clinic, I would take Mr. McMasters to a shooting range to practice the necessary adaptations that shooting would require with a working gun. This is where we would be able to work with professionals on the dynamics of loading a gun, and extra safety precautions we may need to take into account.

I would be sure to suggest to Mr. McMasters that he bring along a friend or relative when he goes hunting, someone who would be able to keep his attention focused on the task at hand and help him safely dress his kills. Another option would be to take the animals to a meat processor or a taxidermist to perform the task for him. Although Mr. McMasters has seen a significant loss in the function of his dominant hand and arm, I believe that with some assistance and adaptive equipment, he will be able to continue his occupation of hunting.

More School Work

***It has been a busy couple of weeks, so I have been forced to use my writing assignments as updates. Hopefully I will be able to present some more interesting material soon.***

The Question: What can history teach us in dealing with the challenging, changing, and competitive healthcare market place of today?

My Answer: The healthcare system is an ever-changing entity. Costs are always rising; services are always changing, and so is the availability of those services to the public. Especially with the recent election of a new democratic president, we are sure to see some major changes in the near future of healthcare. From an economic standpoint, the healthcare field is in need of professionals that will be able to create and maintain useful members of society. Those individuals who cannot make their own living have contributed in part to the escalating cost of healthcare. They can’t get insurance because they are not employed, they can’t buy their own insurance because they don’t have an income; we can’t refuse to give them care and have to make up for costs they incurred when paying customers come in for services. While we cannot promise to restore all individuals to economic productivity, as a profession, we need to focus on proving that occupational therapy can provide services with this potential.

In the past, occupational therapy has been a part of this restorative process (Ambrozi & Schwartz 1995). In fact, the profession practically rooted itself in this concept. Injured veterans in particular were originally discarded and thought to never be able to become productive members of society again (Ambrozi & Schwartz 1995). The media pressed the issue of restoring these people to functional economic status, and recognized occupational therapy as being vital to this process. However, at the time, occupational therapy was focused on “internal concerns [and] may have missed an opportunity to promote occupational therapy to the general public by aligning itself with a theme that the media valued” (Ambrozi & Schwartz 1995).

In the future, the profession of occupational therapy needs to be aware of the public’s focus. We need to advocate for ourselves and advertise our services based on what the public is interested in, while maintaining integrity in our profession. We need to keep up with changes in politics and continue to prove to the general public, politicians, and other healthcare professionals that our services are a vital part of rehabilitation and could be a large contributor to our country's economy.

References:

Ambrosi, E., & Schwartz, K. (1995). The Profession's Image, 1917-1925, Part II:

Occupational Therapy as Represented by the Profession. American Journal of

Occupational Therapy, 49: 8, 828-831.

Another OT Assignment

The Question:

How can we present OT to the public so that we can gain greater public recognition of our services?

My Response:

In order for OT to accurately represent itself to the public as a profession we first need to be able to define who we are and what we do within our profession. We provide a very diverse group of services, and the public can not translate that back to our professional roots, which are based on holism and occupation. The problem here does not lie in the hands of the public understanding, it lies internally – within our own understanding.

One of the major problems leading to a lack of public recognition is that there is a huge disparity between the definitions taught to occupational therapy students and what is seen in clinics across the country. As students, we are being taught that occupational therapy is a unique and creative profession; it is client centered and based on those occupations that are most meaningful to the client. However, in clinics, we see something totally different. We see almost no difference between occupational and physical therapy. We see the same, monotonous techniques used day in and day out, and very little patient interaction in goal setting and therapy choices. Most importantly, we rarely see meaningful occupations being used as therapy. This is supposedly the whole backbone of occupational therapy, yet most of our currently practicing therapists do not reflect it. A change needs to be made in therapy so that, during practice, we actually show people what it is that makes us unique and the creativity we are really capable of. Once we can get on the same page as therapists, once we can truly define ourselves as one profession, public recognition will come naturally. People will finally be able to understand what we can do for them, and why it is different from and more meaningful than the services available from physical therapists.

Another major factor preventing us from gaining deserved public recognition is that we are unable to back up many of our treatments with research. We have this attitude that our treatments work, but we do have no idea why, and we lack proof. It is important that we, as a profession, really begin to criticize and revise our own theories and studies. We need to make sure that our treatments are effective before we actually put them to use clinically. Especially with the current availability of information (true or false) on the internet, not many people just believe what they are told. If we are not careful, if we do not prove our services, we could fall right out of the circle of western medicine and become an alternative treatment, such as aroma therapy or acupuncture, which most people only use if they believe it works, or as a last result. When we can back up our profession with scientific research and evidence, the general public, as well as other medical professions will be more likely to recognize our services.

The future of occupational therapy depends completely on what other people – the general public, other health care professionals, politicians – perceive it to be. If they begin to doubt us and continue to misunderstand our profession, occupational therapy is in trouble. I am a firm believer that if we fix these two major internal problems, recognition will come naturally. It is then that we will be able to truly advocate for ourselves and advertise our services.

The Final Product

Class of 2011 T-Shirts

As a part of our study of the "design process," one of our professors, Dr. Chris Raber had us create a class t-shirt. We got the assignment on the first week of class and we are to wear the shirts to class on Tuesday, September 15th. The design process consists of eight steps: motivation, investigation, definition, ideation, idea selection, implementation, and evaluation. After we go through all the steps, we will "evaluate" the final product, which will be a screen printed tye-dye t-shirt. The shirt will say SSU Occupational Therapy on the front, and the saying "OT makes every day independence day!" on the back.

The posted pictures are from class today, when we dyed the shirts. Tomorrow they will be printed, and we will wear them to class on Tuesday.

OT Quote of the Day

"Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health."

Biomechanical Theory Journal

The Assignment: Use this area to Journal your thoughts concerning your life stages through discovery and understanding of the OT theories.

Background: The Biomedical frame of reference, as it relates to occupational therapy, is focused mainly on the physical deficits of the injured or disabled client. It is based on muscle, bone, and joint integrity, range of motion, strength, and endurance.

My Entry: Since I have never been injured any more seriously than a scrape on the knee, I initially had a hard time relating my life to the biomedical model. I wanted to think about it in terms of therapy. People go to get therapy when a bone, muscle, joint, or any combination therein is limited in motion in one way or another. Then I came across a statement made in Aaron and Tiffany’s power point presentation which noted that prevention is done by making the client aware of motions that could jeopardize the structure, strength, and/or endurance of the body segment in question. This is when it clicked: maybe I’ve never really been injured because I have avoided those types of motions that could cause damage to my joints all along.

In my life, I can see the prevention aspect of the biomedical model. I have been a swimmer since 5th grade. The low impact nature of the sport did not cause any wear and tear on my hips, knees, shins, and ankles that a sport like running would. It is also an individual sport where, as opposed to football, there is little to no physical contact that could cause breaks, tears, strains, cracks, and who knows what else? Swimmers, however, typically develop shoulder problems very quickly in their careers. Our coaches provided us with stretching and strengthening exercises, specifically for the shoulder, that would help to prevent injury and pain in the future. I also remember very vividly them telling us that we needed to take our breaths from both sides, as to prevent one shoulder from providing all of the extra strength needed to pull our bodies out of the water. I took this very seriously, and immediately formed the habit of breathing on both sides, something I still do today when I swim.

Another aspect of the biomechanical model that I can relate to is that working on endurance, strength, and range of motion can not only maintain a person’s performance in those areas, but continuous working of them can actually increase performance. When I started swimming in 5th grade I was TERRIBLE! I had no natural ability whatsoever. I couldn’t even finish my first 50 yard race; I got out half way through red-faced and sobbing. My parents have even told me before that it was “tough to watch” me swim. Over the years, I slowly gained coordination, endurance, and strength, from practicing hard and learning the technique. By the end of my high school career, I qualified for districts in the 500 and 200 yard races. On the other hand, “if you don’t use it, you lose it.” I found that out really quickly when college came along and I was no longer swimming. Today I swam for the first time in months, and I got out of the pool after an easy 30 minute work out. Needless to say, that is quite a short time compared to when I peaked in high school.

As much as I would love to get back into swimming, it is really difficult for me to get in the water and find out how out of shape I am. I want to be swimming 500’s in 5 minutes and 45 seconds like I used to. I can see how someone who has been injured would struggle with a loss and the therapy following. Even though the medical model takes the reductionistic standpoint that fixing the musculoskeletal issue will fix the functional deficit, complete restoration is not always possible. At least I know that I did this to myself, and that the structure and capabilities are still there. I just need to work for them!