Download - OT Case Study
The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
OT Case Study Rachel Walton OTR/L April 6, 2016
The role of occupational therapy in oncology is “to
facilitate and enable an individual patient to achieve maximum functional performance, both physically and psychologically, in everyday living skills regardless of his or her life expectancy” (p. 75).
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OT Roles in Cancer Rehabilitation
• ADL/IADL training • Cancer-Related Fatigue • Caner-Related Cognitive
Dysfunction • Chemo-Induced Peripheral
Neuropathy • Cancer-Related Pain
National Comprehensive Cancer Network (NCCN): “Cancer-related fatigue is a distressing, persistent
subjective sense of tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.”
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Cancer-Related Fatigue
Cancer-Related Cognitive Dysfunction Cancer-related cognitive dysfunction or CRCD,
describes memory or thinking problems that occur as a side effect from chemotherapy treatments. It can affect a person’s ability to carry out daily tasks
70 year old female Medical History Diagnosed with breast cancer in 2006 Underwent right mastectomy and right axillary
sentinel lymph node biopsy Received post-op systemic chemotherapy Patient developed lymphedema in her right arm in
2012 History of mild cerebral palsy affecting her right arm
and seizure disorder Social History: Living in an assisted living apartment Involved in church Supportive family in a different state
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Case Study: Jillian
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Increased Fatigue with daily activities Mental Fatigue with social
interactions Difficulty remembering to perform
important tasks and attend appointments/events
Difficulty multi-tasking and staying
focused on a task Increased anxiety and stress
Global Complaints
Activities of Daily Living (ADL) and Instrumental Activities of Daily
Living (IADL)
Difficulty with upper body dressing and morning routine due to increased fatigue and limited use of RUE
Increased fatigue after cleaning apartment
Increased fatigue with cooking due to only using LUE
Forgetting to pay bills on time
Difficulty with carrying out grocery shopping
Leisure
Forgetting to attend volunteering events at church and increased fatigue with attending Sunday morning church service
Increased mental fatigue with social gatherings at assisted
living apartment
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Impact of Jillian's Functional Ability
Canadian Occupational Performance Model (COPM): looks at self-reported occupational performance problems
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OT Assessments
Performance Problems
Satisfaction Performance
Morning Routine 5 5
Cleaning house 2 3
Grocery Shopping 5 4
Money Management
4 6
Performance: 1= not able to do at all ----------------- 10 = able to it extremely well Satisfaction: 1= not satisfied at all ----------------- 10 = extremely satisfied
Multidimensional Assessment of Fatigue Scale: 40.1 (50 = severe fatigue) Highest self-rated fatigue scores were with household chores,
bathing/dressing, shopping/errands
FACT-COG (2008): assesses perceived cognitive dysfunction quality of life measure Perceived Cognitive Impairments Perceived Cognitive Abilities Comments from Others Impact on Quality of Life
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OT Assessments
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OT Intervention Patient will verbalize at least 5 different fatigue management and energy conservation strategies utilized with morning routine. • One handed dressing
techniques for UB/LB dressing • Adaptive equipment
education • Adapt patient’s home and
bathroom environment in order to ensure optimal performance with morning routine.
• Organization • Energy conservation
strategies
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OT Intervention Patient will be able to complete weekly routine chores, without experiencing an increase in symptoms, utilizing compensatory strategies.
• Activity modification • Developed a weekly
schedule • Schedule in rest breaks • Energy conservation
strategies
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Activity Modification Examples
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• Education on external memory aides (calendar's, making a list, task reminders on smart phone, written instructions on refrigerator, memory book)
• Organize a routine schedule for
paying bills each month • Develop a checklist of bills that
need to be paid and review it last week of the month
Patient will be educated on and demonstrate independent use of 2-3 compensatory strategies to improve functional memory skills in order to increase independence with money-management tasks.
OT Intervention
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Develop an action plan
• Break down task and decide what makes the
task difficult • Develop strategies/alternative ways of
performing task • Trail new strategies • Modify as needed based on patient success
Patient will independently utilize cognitive strategies to initiate, plan, and organize functional tasks in therapy to promote independence with grocery shopping.
OT Intervention
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Develop An Action Plan • Break down task and decide what makes the task difficult
• Scheduling transportation • collecting all needed items • making sure your within budget • getting back to bus on time
• Develop strategies/alternative ways of performing task • Write bus schedule in calendar/memory book/post on refrigerator • Choose the same time to catch bus each week • Make a grocery list, start at one end of store and work your way
down • Decide budget before leaving, plan meals for the week • Set phone alarm 15 minutes before bus arrives, as well as when bus
arrives
• Trail new strategies
• Modify as needed based on patient success Problem solving steps repeated for maintaining budget.
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OT Problem Solving Worksheet Example
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Conclusion
Global Fatigue Score went from 40 to 27. Patient demonstrated a 8 point increase on FACT-Cog – demonstrating minimal detectable change Patient reported feelings of being more equipped to take on the challenges of fatigue and cognitive dysfunction.
COPM Initial Assessment Re-Assessment
Performance Problems
Satisfaction Performance Satisfaction Performance
Morning Routine 5 5 7 7
Cleaning house 2 3 5 5
Grocery Shopping 5 4 7 6
Money Management
4 6 7 7
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Questions
Thank You
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For more information on OT’s role in cancer rehabilitation please contact: Rachel Walton OTR/L Stephanie Spielman Oncology Rehabilitation [email protected]