Here are some pretty cool songs written by OT students that I found on You Tube. They actually do a pretty good job of explaining the profession! 2 more exams and I'm done for the year!!!
Monday, April 26, 2010
Friday, April 16, 2010
An Ethical Dilema: Do Not Resuscitate Orders
Type of Dilemma: Do not resuscitate orders (DNRs), are orders found in patients’ medical charts, which tell health care practitioners not to perform cardiopulmonary resuscitation (CPR) (Braddock, 1998). A patient with a DNR order in his or her chart has either personally chosen not to be resuscitated, or a family member has chosen for them in the event that they are not capable of making the decision independently (NYS Department of Health, 2010). The main dilemma surrounding DNR orders lies within the issue of autonomy, or an individual’s right to make decisions for him or herself (Crabtree, 1999). More specifically, most cases may involve a conflict between professional autonomy and client autonomy; that is, the health care professional’s knowledge and thoughts on what is best for the patient may differ from those of the patient (Crabtree, 1999). For the professional, underlying principles of justice, veracity and duty may also apply depending on the specific case.
Relevant Information: Typically, when an individual goes into cardiac or respiratory arrest, health care practitioners will resuscitate him or her to restore function of the arrested system (Cleveland Clinic, 2010). Not only does this include manual CPR, but resuscitation drugs, artificial airways, respiratory assistance, cardiac monitoring, and others are considered forms of resuscitation (Cleveland Clinic, 2010). However, CPR has been minimally successful with certain diagnoses and conditions, and patients may choose to sign DNRs based on this information. See Table 1 for more information:
Table 1:
| Diagnosis or Condition | Probability of Success |
| Septic Shock | 0% |
| Acute Stroke | 0% |
| Metastatic Cancer | 0% |
| Severe Pneumonia | 0% |
| Hypotension | 2% |
| AIDS | 2% |
| Renal Failure | 3% |
| Homebound Lifestyle | 4% |
| Age Greater Than 70 | 4% (Survival to Discharge) |
(Braddock, 1998)
The problem: The problem again, lies within the concept of autonomy. With end of life care, there will always be conflicts between the autonomy of the professional, the patient, and the patient’s family, all of which can potentially have different views of how the issue should be handled. A patient may be ready to let go, or he or she may be determined to fight until the end. The family’s feelings on the issue can range across the same continuum. These views will greatly affect the patient/family’s willingness to sign a DNR order. Under the principle of autonomy, the clients should be the ultimate decision makers, choosing what is best for themselves or their loved ones. For the health care professional, a much more complicated ethical dilemma is involved with DNRs. First, the professional has a duty to disclose accurate information about the patient’s condition to him or her. This duty lies under the ethical principle of veracity, which is truth telling (Crabtree, 1999). The professional also has a duty to respect the autonomy of the patient, allowing him or her to make decisions on his or her care if possible. Yet another duty of the professional is to allocate healthcare resources effectively and efficiently, demonstrating the ethical principle of justice (fairness) (Crabtree, 1999). For example, an individual who is not likely to survive cardiac or respiratory arrest should not receive CPR as it may be a waste of precious healthcare time and dollars. DNRs are complicated ethical dilemmas; each differs greatly depending on the case. Doctors and Nurses work closest to DNRs, however, therapy professionals may be involved in DNR dilemmas as well.
Type of Setting or Practice: Because DNRs are used to prevent unnecessary and unwanted end-of-life treatment, they will most likely be seen when working with the elderly populations. Therefore, occupational therapists would most likely encounter DNRs in skilled nursing facilities and inpatient rehabilitation settings. Therapists working with these clients need to be aware of whether their patients have or have not signed DNR orders. If a therapist were to ignore a DNR order or neglect to resuscitate an individual who has not signed a DNR, a serious malpractice lawsuit might ensue.
Six Step Process for Ethical Decision Making: Purtilo’s (2005) six step process for ethical decision making provides therapists with a process for making appropriate decisions in ethical scenarios. The six steps are as follows: gather relevant information, identify the type of ethical problem, analyze the problem using ethics theories or approaches, explore the practical alternatives, act, and evaluate the process and outcome (Purtilo, 2005). This process allows therapists to slow down, think through their actions, and make the best choice for themselves and their patients.
Braddock, C. H. (1998). Do not resuscitate orders. Ethics In Medicine. Retrieved from http://depts. washington.edu/bioethx/topics/dnr.html.
Cleveland Clinic. (2010). Policy on do not resuscitate. Retrieved from http://www.clevelandclinic.org/ bioethics/policies/dnr.html
Crabtree, J. L. (1999). Ethics of culture in rehabilitation. In M. Royeen & J. Crabtree (Eds.), Culture in rehabilitation: From competency to proficiency (59-71). Upper Saddle River, NJ: Pearson.
NYS Department of Health. (2010). Deciding about CPR: A guide for patients and families. Retrieved from http://wings.buffalo.edu/bioethics/dnr-p.html
Purtilo, R. (2005). Ethical dimensions in the health professions. 4th ed. Boston: Elsevier Saunders.
Monday, April 12, 2010
Spinal Cord Injury Case Study
I was assigned a number of large projects this semester on the topic of spinal cord injuries. I am interested in working in the field, so I chose the topic hoping to learn more about it. We had to interview an individual with our specific disability and do a psychosocial case study presentation on him or her. Along with the presentation, we had to write a paper, which is the main topic of this post. The man I chose was an acquaintance of mine, who was injured in a body surfing accident 6 years ago. He had a strong pre-injury identity as an athlete, and misses that piece of his life quite a bit. The paper I wrote below shows just a small part of my presentation: one intervention that I chose to help improve this loss of identity. It's also a good way for my few readers to get an idea of what OT can do in the mental health setting.
Spinal Cord Injury Psychosocial Intervention Paper
Client Diagnosis: C4/C5 incomplete lesion spinal cord injury
Psychosocial Need: Loss of identity as an athlete after spinal cord injury
Sample Goal: Client will be able to participate in half of a wheelchair rugby game after 8 therapy sessions and extensive practice outside of therapy.
Occupational Intervention:
Therapist will provide client with practice of wheelchair rugby ball handling skills. Based on the results of range of motion and manual muscle testing, therapist will determine the client’s approximate wheelchair rugby classification and accompanying maneuvers (according to the International Wheelchair Rugby Federation, www.iwrf.com). The client being seen is most likely at level 0.5, and practice maneuvers will be as follows:
• Trapping direct passes on lap
• Batting close-range passes into lap
• One-handed under-hand “volleyball” pass
• Two-handed side “scoop” pass
(International Wheelchair Rugby Federation, 2010a)
As client masters the above skills, therapist will practice maneuvers with weighted balls of similar size. Supplies needed are as follows:
• One manual wheelchair (preferably of lighter, athletic style)
• One volleyball (beach ball if first time practicing)
• Medicine balls of light weights (2-4lbs, depending on the results of manual muscle tests)
• Ample space for physical activity
Theoretical Basis of Intervention:
The client’s previous identity as a collegiate athlete and his lifelong hobby of playing sports provide the rationale for this intervention. According to the Model of Human Occupation (MOHO), volition, habituation, and performance capacity are the three interacting components to an individual’s occupational well-being (Keilhofner, 2009). Volition is an individual’s motivation or desire to participate in a specific occupation (Keilhofner, 2009). Habituation, which consists of a person’s roles and habits, refers to the way in which an individual organizes actions (Keilhofner, 2009). The third component, performance capacity, is the individual’s actual ability to perform a task, physical or mental (Keilhofner, 2009). Due to his injury, the client at hand has extensive physical limitations, and no longer has the performance capacity necessary to play football. Before his accident, however, his role as an athlete was his main identity, and several other active sports filled his leisure time. This fact alone creates in the client a strong desire to be involved in competitive sports again, a void he wishes to fill with wheelchair rugby, a fast-paced, full contact sport for those who have impairments in all four limbs.
Objectives of Intervention:
By practicing ball-handling skills with the client, which are appropriate to the sport of wheelchair rugby, the therapist hopes to instill a new sense of self confidence in the client. The opportunity to fill the void left by football in the client’s life is motivating to the client, and once the new set of rugby skills are acquired, the client should feel empowered to get involved with the sport competitively. The therapist would like to see the client act on this confidence by becoming familiar with the sport, becoming part of a competitive team, and competing in officiated games.
Diagnostic Considerations:
The intervention itself is purely physical, using modified techniques to allow the client to catch and pass the ball. It addresses the following symptoms:
• Muscular weakness
• Muscular coordination
• Decrease/lack of muscular function
However physical, the intervention also addresses the psychological symptoms listed below, as it is a large contributor to the client’s perceived quality of life.
• Depression
• Loss of identity
• Anger
• Low self-esteem
• Loss of friends/social supports
Precautions:
Safety concerns include client’s limited ability to manage physiological responses to physical exercise, such as body temperature and respiratory functions. Client is unable to sweat below the level of injury, and may experience excessive sweating above (Atchison & Dirette, 2007). The client also may display respiratory impairments, such as shallow breathing (Atchison & Dirette, 2007). The therapist will watch for signs of overheating and provide ample water and rest breaks. Also, because of the level of injury, the client has limited to no trunk control (Atchison & Dirette, 2007). The therapist will make sure his manual chair fits appropriately and that he is properly strapped in. Also, practice of ball handling will begin with the wheelchair brakes locked and will not proceed until the client has practiced.
From a psychosocial standpoint, it will be important for the therapist to inform the client of the amount of time and effort it will take to gain the skill needed to play in a competitive rugby game. The client needs to be given the opportunity for small successes, building up his confidence over time. This will keep him from being discouraged and giving up on the sport all together.
Methods and Interpersonal Strategies:
Because this intervention and the ultimate goal are so important to the client, the therapist will employ Taylor’s (2008) collaborating mode during treatment. This will allow the client to feel as though he is a part of the therapy process, making him accountable for the results of his therapy (Taylor, 2008). It will also allow the therapist to receive feedback from the client, giving her the information she needs to keep therapy client-centered (Taylor, 2008). The therapist may also need to employ Taylor’s (2008) encouraging mode, in times when self-esteem is low and the client becomes discouraged.
Relationships:
The client would expect to experience a collaborative relationship with his therapist. He is a highly motivated individual who knows exactly what he wants to do. He is merely lacking the skills to do those things and therefore needs the assistance of the therapist. Although he would like to have control over his therapy plan, he is a respectful individual who will take the advise and expertise of the therapist seriously. Aside from personality, several other factors may affect the therapist-client relationship in this case. Among those factors are age and gender. The therapist and client are of similar age and opposite sex, which in some cases may entice inappropriate relationships to form. It will be important for the therapist to address the client as a peer, being sure to set boundaries where necessary, keeping the relationship professional.
Family and Significant Others:
The person closest to the client’s medical care is his mother. She lives in the same city and visits often. She has been involved in his medical care since the accident, however, unless the client gives permission, the therapist is legally obligated to keep all information about care confidential. If the client approves, then it will be important for the therapist to keep the client’s mother informed and collaborate with both of them on treatment options, goals, and progress.
The therapist will also need to keep in mind the client’s family history and other related issues when providing treatment. The client’s mother and father are divorced and his sister passed away from a car accident just a few months before his own accident. The family has experienced a lot of trauma and is most likely struggling to adjust, even five years later.
Cultural Factors:
The client is a Caucasian man, who values education, hard work, and leisure time. His whole life has revolved around on his athletic career, so this intervention and the possible results coincide with his values. His mother has always been supportive of his athletics, and made it a priority to make it to his games. The opportunity to compete again will provide the pair with new opportunities to bond and reminisce.
Environment:
This specific intervention requires a relatively large amount of open space, ideally with appropriate hard flooring to allow for wheelchair mobility. The client’s apartment is small, and it would be difficult for him to practice ball handling at home. The client currently lives in a community with ample resources for individuals who are interested in adapted sports. However, because he does not drive, he struggles to find transportation to facilities where he can access these resources. The therapist may be interested in researching and recommending driver rehabilitation for the client, which will be able to fit him for an adapted vehicle. In the meantime, the university he attends has an accessible recreation facility that is close enough to the client’s home for him to access without a car.
Expected Outcome:
Upon receiving this practice (ball handling), the client will experience an increase in strength and ability to perform the sport. However, this alone will not allow him to play in an actual wheelchair rugby game. The therapist will also work with him on maneuvering his manual wheelchair, and establishing a regular exercise routine which will help him improve and maintain upper body muscle strength. Along with these physical interventions, the therapist will provide other psychosocial interventions, which will help the client develop and improve the communication and interaction skills he needs to be part of a team or start up his own team. The ultimate goal of all of these interventions is to fill the void left by football in the client’s life. He will build the strength, endurance, and confidence necessary to compete as an athlete again.
Curious about wheelchair rugby? Watch the movie "Murderball." It is intense (as you can only imagine by the title). The film is a documentary featuring the USA Paralympic Quad Rugby Team. It is full of amazing input on society and disability and spills over with inspiration. I own it if you would like to borrow it. Pictured right is Mark Zupan, one of the main characters from the movie.
Spinal Cord Injury Psychosocial Intervention Paper
Client Diagnosis: C4/C5 incomplete lesion spinal cord injury
Psychosocial Need: Loss of identity as an athlete after spinal cord injury
Sample Goal: Client will be able to participate in half of a wheelchair rugby game after 8 therapy sessions and extensive practice outside of therapy.
Occupational Intervention:
Therapist will provide client with practice of wheelchair rugby ball handling skills. Based on the results of range of motion and manual muscle testing, therapist will determine the client’s approximate wheelchair rugby classification and accompanying maneuvers (according to the International Wheelchair Rugby Federation, www.iwrf.com). The client being seen is most likely at level 0.5, and practice maneuvers will be as follows:
• Trapping direct passes on lap
• Batting close-range passes into lap
• One-handed under-hand “volleyball” pass
• Two-handed side “scoop” pass
(International Wheelchair Rugby Federation, 2010a)
As client masters the above skills, therapist will practice maneuvers with weighted balls of similar size. Supplies needed are as follows:
• One manual wheelchair (preferably of lighter, athletic style)
• One volleyball (beach ball if first time practicing)
• Medicine balls of light weights (2-4lbs, depending on the results of manual muscle tests)
• Ample space for physical activity
Theoretical Basis of Intervention:
The client’s previous identity as a collegiate athlete and his lifelong hobby of playing sports provide the rationale for this intervention. According to the Model of Human Occupation (MOHO), volition, habituation, and performance capacity are the three interacting components to an individual’s occupational well-being (Keilhofner, 2009). Volition is an individual’s motivation or desire to participate in a specific occupation (Keilhofner, 2009). Habituation, which consists of a person’s roles and habits, refers to the way in which an individual organizes actions (Keilhofner, 2009). The third component, performance capacity, is the individual’s actual ability to perform a task, physical or mental (Keilhofner, 2009). Due to his injury, the client at hand has extensive physical limitations, and no longer has the performance capacity necessary to play football. Before his accident, however, his role as an athlete was his main identity, and several other active sports filled his leisure time. This fact alone creates in the client a strong desire to be involved in competitive sports again, a void he wishes to fill with wheelchair rugby, a fast-paced, full contact sport for those who have impairments in all four limbs.
Objectives of Intervention:
By practicing ball-handling skills with the client, which are appropriate to the sport of wheelchair rugby, the therapist hopes to instill a new sense of self confidence in the client. The opportunity to fill the void left by football in the client’s life is motivating to the client, and once the new set of rugby skills are acquired, the client should feel empowered to get involved with the sport competitively. The therapist would like to see the client act on this confidence by becoming familiar with the sport, becoming part of a competitive team, and competing in officiated games.
Diagnostic Considerations:
The intervention itself is purely physical, using modified techniques to allow the client to catch and pass the ball. It addresses the following symptoms:
• Muscular weakness
• Muscular coordination
• Decrease/lack of muscular function
However physical, the intervention also addresses the psychological symptoms listed below, as it is a large contributor to the client’s perceived quality of life.
• Depression
• Loss of identity
• Anger
• Low self-esteem
• Loss of friends/social supports
Precautions:
Safety concerns include client’s limited ability to manage physiological responses to physical exercise, such as body temperature and respiratory functions. Client is unable to sweat below the level of injury, and may experience excessive sweating above (Atchison & Dirette, 2007). The client also may display respiratory impairments, such as shallow breathing (Atchison & Dirette, 2007). The therapist will watch for signs of overheating and provide ample water and rest breaks. Also, because of the level of injury, the client has limited to no trunk control (Atchison & Dirette, 2007). The therapist will make sure his manual chair fits appropriately and that he is properly strapped in. Also, practice of ball handling will begin with the wheelchair brakes locked and will not proceed until the client has practiced.
From a psychosocial standpoint, it will be important for the therapist to inform the client of the amount of time and effort it will take to gain the skill needed to play in a competitive rugby game. The client needs to be given the opportunity for small successes, building up his confidence over time. This will keep him from being discouraged and giving up on the sport all together.
Methods and Interpersonal Strategies:
Because this intervention and the ultimate goal are so important to the client, the therapist will employ Taylor’s (2008) collaborating mode during treatment. This will allow the client to feel as though he is a part of the therapy process, making him accountable for the results of his therapy (Taylor, 2008). It will also allow the therapist to receive feedback from the client, giving her the information she needs to keep therapy client-centered (Taylor, 2008). The therapist may also need to employ Taylor’s (2008) encouraging mode, in times when self-esteem is low and the client becomes discouraged.
Relationships:
The client would expect to experience a collaborative relationship with his therapist. He is a highly motivated individual who knows exactly what he wants to do. He is merely lacking the skills to do those things and therefore needs the assistance of the therapist. Although he would like to have control over his therapy plan, he is a respectful individual who will take the advise and expertise of the therapist seriously. Aside from personality, several other factors may affect the therapist-client relationship in this case. Among those factors are age and gender. The therapist and client are of similar age and opposite sex, which in some cases may entice inappropriate relationships to form. It will be important for the therapist to address the client as a peer, being sure to set boundaries where necessary, keeping the relationship professional.
Family and Significant Others:
The person closest to the client’s medical care is his mother. She lives in the same city and visits often. She has been involved in his medical care since the accident, however, unless the client gives permission, the therapist is legally obligated to keep all information about care confidential. If the client approves, then it will be important for the therapist to keep the client’s mother informed and collaborate with both of them on treatment options, goals, and progress.
The therapist will also need to keep in mind the client’s family history and other related issues when providing treatment. The client’s mother and father are divorced and his sister passed away from a car accident just a few months before his own accident. The family has experienced a lot of trauma and is most likely struggling to adjust, even five years later.
Cultural Factors:
The client is a Caucasian man, who values education, hard work, and leisure time. His whole life has revolved around on his athletic career, so this intervention and the possible results coincide with his values. His mother has always been supportive of his athletics, and made it a priority to make it to his games. The opportunity to compete again will provide the pair with new opportunities to bond and reminisce.
Environment:
This specific intervention requires a relatively large amount of open space, ideally with appropriate hard flooring to allow for wheelchair mobility. The client’s apartment is small, and it would be difficult for him to practice ball handling at home. The client currently lives in a community with ample resources for individuals who are interested in adapted sports. However, because he does not drive, he struggles to find transportation to facilities where he can access these resources. The therapist may be interested in researching and recommending driver rehabilitation for the client, which will be able to fit him for an adapted vehicle. In the meantime, the university he attends has an accessible recreation facility that is close enough to the client’s home for him to access without a car.
Expected Outcome:
Upon receiving this practice (ball handling), the client will experience an increase in strength and ability to perform the sport. However, this alone will not allow him to play in an actual wheelchair rugby game. The therapist will also work with him on maneuvering his manual wheelchair, and establishing a regular exercise routine which will help him improve and maintain upper body muscle strength. Along with these physical interventions, the therapist will provide other psychosocial interventions, which will help the client develop and improve the communication and interaction skills he needs to be part of a team or start up his own team. The ultimate goal of all of these interventions is to fill the void left by football in the client’s life. He will build the strength, endurance, and confidence necessary to compete as an athlete again.
Curious about wheelchair rugby? Watch the movie "Murderball." It is intense (as you can only imagine by the title). The film is a documentary featuring the USA Paralympic Quad Rugby Team. It is full of amazing input on society and disability and spills over with inspiration. I own it if you would like to borrow it. Pictured right is Mark Zupan, one of the main characters from the movie.
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