From the case study use the one from susan Students will better understand the role delineation between OT and OTA practitioners. The OTA students will work together to develop short-t

OT-OTA Collaboration Case Studies

Adolescent with Autism Spectrum Disorder (1)

Clinical Case

Jimmy, a 17-year-old adolescent with Autism Spectrum Disorder (ASD), is a junior at a public school in a general education setting but receives special education support to facilitate social and academic participation. He is in culinary club at school, but often forgets to attend the meetings and events. He likes to write down the recipes but has difficulty with independent meal preparation. He has difficulty making friends as well as organizing and managing his time. He also becomes very focused on specific task, which depending on the context can be a strength or challenge. He received occupational therapy services during elementary school and middle school and his mother is requesting an occupational. therapy evaluation by the school-based therapist. The Individualized Education Plan (I.E.P) team agrees to assist Jimmy with transitioning after high school.

Occupational Therapy Assessments and Findings

The school-based occupational therapist completed an occupational therapy profile with Jimmy using the Canadian Occupational Performance Measure. Four main performance areas were identified as concerns and priorities: 1. Daily living occupation (bathing and dressing) 2. Meal preparation, 3. Developing social skills to make friends 4. Finding a job. The Adolescent/ Adult Sensory Profile revealed that Jimmy scored much higher than most people on Low registration and Sensory Seeking and lower than most people on Sensory Sensitivity and Sensory Avoiding. Other assessments included the Parent and Teacher forms of the Behavior Rating Inventory of Executive Functioning (BRIEF) and the Career Interest, Preferences and Strengths Inventory (CIPSI). Results indicated strengths (90th percentile) in Jimmy's emotional and behavioral regulation. He scored in the 20th on the Metacognition Index of the BRIEF reflected challenges on the Working Memory, Plan/Organize, Organization of Materials and Monitor subscales. Findings on the CIPSI indicated Jimmy preferred careers in the food resources and hospitality /tourism clusters with a common them of occupation in restaurants context.

The occupational therapist reviewed the current transitional plan and the Transitional Planning Inventory that was completed. Jimmy's goals of independent living, vocational training and full or part-time employment served as the focus of the intervention planning. The OT reviewed the evidence from the September/October 2015 issue of the American journal of Occupational Therapy and read the recommendations from the Occupational Therapy Guidelines for Individuals with Autism Spectrum Disorder. She found the following evidence to use as she planned her intervention:

· Strong evidence for group-based social skills training to enhance social skills

· Strong evidence for video modeling, technology enhanced visual supports and prompting to increase functional independence on activities of daily living (ADL) and work performance

· Moderate evidence supporting cognitive-behavioral approaches to improve function in ADL and instrumental activity of daily living (IADL} occupations

· Promising evidence to support the use of interest-based clubs to improve social engagement and interaction.

Long Term Goals

1. Jimmy will increase his attendance at the culinary club to 80% in the first semester of school.

2. Jimmy will be able to plan and prepare a simple meal with supervision and no more than 1-2 verbal prompt.

3. Jimmy will be able to develop a friendship with at least one student in the culinary club.

4. Jimmy will be able to identify and complete a job application for a food industry job.

Adult with Stroke (2)

Clinical Case

Jorge S. is a 45 year- old Hispanic man that owns a dog walking business with two employees. He lives with his wife in a two-bedroom apartment with an elevator in an urban area. They have no children, but they have a large social network. Jorge was transferred from the acute care floor

to the inpatient rehabilitation unit (IRU) with a diagnosis of a right middle cerebral artery infarct and a past medical history significant for hypertension.

Occupational Therapy Assessments and Findings

The occupational therapist used the Canadian Occupational Performance Measure (COPM), among other tools to generate Jorge's occupational profile. Jorge identified the following five occupations as being important to him: 1) bathing and dressing himself, 2) taking care of his bathroom needs, 3) meal preparation, 4) return to work and 5) playing cards with friends. Of a possible score of 10, Jorge scored his performance on the five identified occupations from 3 to 5 and he reported satisfaction scores that ranged from 1to 2. Guided by the occupational profile, Jorge's ability to perform self-­ care activities were assessed using the Section GG Functional Abilities and Goals and observation of a simple meal preparation task. Results included: Score of 7: Bladder and Bowel; Score of 4: Feeding, Grooming, UB dressing, and Transfer; Score of 3: Bating, LB dressing, Toileting, and Transfer. (6 independent, 5 set-up or clean up assistance,4 supervision or touching assistance, 3

moderate assistance, 2 substantial/maximal assistance, 1 dependent).

Decreased use of the left dominant upper extremity and left unilateral spatial neglect were significant limiting factors during task performance. Performance skills and client factors were evaluated using the following measures:

· The Fugl-Meyer Assessment and the Action Research Arm Test to further assess arm and neuromuscular skeletal functions, sensory functions and motor skills.

· The Catherine Bergego Scale to further evaluate the impact of unilateral spatial neglect on daily function as well as Jorge's awareness of the impairment.

· The Beck Depression Inventory II to assess Jorge's psychological status.

Assessment results revealed difficulty with combining left shoulder, elbow and forearm motions for performance of efficient forward, side and overhead reaching, decreased ability to reach, grasp and transport objects using the left upper extremity; moderate left unilateral neglect with poor awareness diminished tactile sensation of the left arm and hand; and minimal evidence of emerging depression.

Long Term Goals

1. Jorge will complete bathing with minimal assistance using a bath chair

2.Jorge will complete dressing with supervision from a sitting

position

3.Jorge will complete toileting skills with supervision

4.Jorge will be able to plan and prepare a simple meal with

supervision and verbal prompts.

5.Jorge will be able to grasp, hold and open containers to complete

grooming tasks.

6.Jorge will be able to play cards with friends using adaptive equipment and verbal prompts

7.Jorge will be able to access his business information on the

computer.

Adult with Multiple Sclerosis (3)

Clinical Case

Susan, age 49 was diagnosed with Multiple Sclerosis (MS) 9 years ago with no other noteworthy medical history. She was recently admitted to an inpatient rehabilitation unit after a 3-day acute hospitalization because of an exacerbation of her MS. The occupational therapist reviewed Susan's electronic medical record, which indicated that a few days before hospitalization, Susan had noticed that her left leg dragged a little. Susan woke up the next morning and was off balance that she was unable to walk Her husband took her to the emergency room, where

she was diagnosed with an MS exacerbation and was admitted to the hospital. Susan stayed on an acute neurology unit for 3 days where she received medical intervention and occupational and physical therapy evaluations. Both therapists recommended inpatient rehabilitation.

Occupational Therapy Assessments and Findings

The occupational therapist started the initial session with an informal interview followed by the administration of the Canadian Occupational Performance Measure (COPM) to determine Susan's occupational profile. Through the interview the therapist learned that Susan lives with her husband and 19-year old daughter in a single-story home. Susan is home alone during the day while her husband works and her daughter attends college. Susan is currently unemployed on disability, having previously worked as a paralegal. Before the MS exacerbation, Susan was independent with self-care activities and shared household activities with her husband and daughter. However, she recently has been experiencing fatigue, which has limited her ability to engage in self-care, household activities, shopping and other community activities. Susan walked with a cane both in her home and in the community. She reported that she had been attending a yoga class, which she enjoyed for both physical benefits and social aspects but that she stopped attending about a month ago because of fatigue. She also reported a decline in memory, which affected her daily activities and some difficulty managing her emotions. Susan's most immediate concerns were her current inability to take care of herself and be home alone during the day.

When the therapist administered the COPM, Susan identified the following five occupations as the most important: toilet transfers, dressing, meal preparation, bathing and returning to her yoga class. The therapist used the results from the occupational profile to administer the self-care and bathroom transfer items of Section GG and scores were the following: Eating: minimal assistance; grooming: minimal assistance; bathing: moderate assistance; UB dressing: touch assistance; LB dressing: maximal assistance; toileting: moderate assistance; toilet transfers: maximal assistance; tub transfers: maximal assistance. The therapist also administered the Assessment of Motor and Process Skills (AMPS) to assess performance skills. Susan chose two tasks that were meaningful and relevant to her: making a grilled cheese sandwich and washing dishes. The results of the AMPS indicated that Susan was unsafe performing these tasks and required frequent physical assistance. She had difficulty stabilizing her body, reaching for, grasping, lifting, and transporting task objects and maintaining endurance during both tasks. Because fatigue was a major client factor that limited Susan's occupational performance, the therapist administrated the Fatigue Severity Scale, a nine-item questionnaire. Susan received a score of 6.8, which indicated that she experienced substantial fatigue. Using Susan's interest and goals, the assessment results and the discharge plan for returning home and being alone during the day, the therapist focused on maximizing her independence and safety for self-­ care skills, bathroom transfers, and simple meal preparation and supporting Susan desire to return to yoga class. The therapist reviewed the evidence from the January/February 2014 issue of the AJOT Occupational Therapy Practice Guidelines for Adults with Neurodegenerative Disease and incorporated it into the occupational therapy intervention.

Long Term Goals

1. Susan will complete bathing with supervision using a bath chair and handheld shower.

2.Susan will complete dressing with supervision from a sitting position using dressing equipment.

3.Susan will complete toileting skills with supervision

4.Susan will be able to plan and prepare a simple meal with supervision and verbal prompts.

5.Susan independently understands and demonstrates energy conservation techniques during self-care activities.

6.Susan will be able to perform 1pose of yoga from a sitting position

7. Susan will be able to identify one of her stressful events and a solution.