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Occupational Therapy Case Study One

This case study is to demonstrate the impact that thalidomide embryopathy has on an individual beneficiary.

It also suggests how they can be supported in various areas of life to maintain their independence from an occupational therapy perspective.

Mr A - Summary of physical limitations

Mr A has bilaterally reduced movement at the wrist. He can flex his wrist forward but is unable to extend it past a neutral position.

He has no functional movement in his thumbs, so when he needs to grip something he uses his palm. His grip strength has not reduced with age, but the level of pain he feels when using his hands has increased.

He is able to do everything he needs to in everyday life, but the pain he feels in doing these activities limits how far he can go.

What life is like for Mr A

Mr A manages his pain by limiting and grading activities and finding alternatives, rather than taking medication. Here’s how he deals with everyday issues: -

Issue	Mr A's Solutions
Leisure	When reading Mr A rests the book or kindle on his knee rather than holding it
In the kitchen	He asks his partner to open bottles and jars for him, because doing it himself causes him pain Mr A uses the microwave to cook food such as vegetables to avoid carrying a hot pan of water
In the bathroom	Mr A is unable to shave because it is painful to hold a razor; He has grown a beard and now visits the barber on a weekly basis. Mr A can’t use a spray deodorant so he uses a roll-on
Dressing	He wears a shirt with poppers rather than buttons
Domestic tasks	Mr A is unable to use a vacuum cleaner, hang out washing or iron his clothes – he employs a cleaner who also does the ironing after Mr A has tumble-dried his clothes He cannot hold a dishcloth to wash the dishes so he uses a dishwasher
Shopping	He does his weekly shop online and has it delivered as he finds it hard to carry things and load/unload a trolley
Exercise	Mr A is unable to go swimming or cycling so has started running
Getting about	Driving increases Mr A’s pain so he only drives shorter distances or uses public transport

Improving Mr A's quality of life

From an occupational therapy perspective, Mr A’s tactics could work even better if he uses equipment, and turns to people who can help, to take away the burden and minimise pain. He will be able to do every-day activities, stay independent and have a better quality of life.

The following could help immensely: -

Issue	Recommendations / Equipment
General health and pain management	Occupational therapy input Compensatory strategies and equipment to reduce pain in the hands and wrists when Mr A is doing every day activities. We will ensure all equipment is assessed for suitability and meeting Mr A’s specific needs.
	Physiotherapy input Regular input to maintain tissue length around the shoulder girdle to make sure Mr A can use his upper limbs for longer and remain independent for as long as possible.
	Commercial assistance Needed with chiropody, barbering, window cleaning, cleaning, gardening, DIY and car wash and valet.
Leisure	To help Mr A read a book or his kindle more comfortably he can use aids like a multi angle lap-mounted soft tablet, or a book and e-reader stand.
In the kitchen	Useful aids like electric tin openers, grippers and openers for jars and bottles, and devices for using ring-pulls will make cooking easier for Mr A. A one-cup hot water dispenser or mixer tap that has a boil function will help with making hot drinks.
In the bathroom	Installing a wet room or level access shower will mean that Mr A will not have to grip the side of the bath whilst transferring, or hold on to the side of a shower cubicle, reducing the need to grip on to anything whilst showering. Wet room costs vary and it is always important to get a full quote from an appropriate provider, with the support of an occupational therapist. Using an electric body dryer will stop Mr A having to hold a towel after a bath or shower. Hygiene after using the toilet can be difficult but there are electric wash and dry toilets available with a hand/foot control to make them easy to use. There is also a range of dispensers (for things like shampoo, shower gel and even toothpaste) to make life easier in the bathroom.
Furniture	As Mr A is ageing, he is likely to need more support with day to day transfers from sitting to standing, or lying down as he loses strength in his legs and upper limbs. Specialist furniture will help him move on and off an armchair or in and out of bed, but items should be trialled and assessed by an Occupational Therapist to ensure they meet his needs: - Electric beds – are height adjustable to make getting in and out easier and also have adjustable backs to help with sitting up and lying down Tilting armchairs, with a riser element to help the user move from sitting to standing, could help Mr A in moving around his home
Domestic tasks	A robot vacuum cleaner will help Mr A keep his floors clean in between visits from his cleaner. He could also use electric airers and other laundry equipment to avoid him having to hang washing on a line.