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Occupational Therapy Case Study Three

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.

Mrs Y - Summary of physical limitations

Mrs Y has significant problems with her vision with microphthalmos and a non-functioning left eye since birth. She has deteriorating vision in her right eye due to microphthalmos and coloboma which has gradually worsened over the last few years. She is registered blind.

Mrs Y describes her vision as ‘no vision in her left eye and very little vision in her right eye’; she can distinguish between light and dark and, occasionally, see some colour.

She experiences visual disturbances that she describes as, ‘like waves through my eyes’ and these make her feel nauseous.

She struggles with harsh lights like those in a supermarket and wears dark glasses to reduce the discomfort; and has had an awning fitted at the side and back of her home to provide shade in the summer and protect her vision from harsh sunlight.

Mrs Y has a history of falls with no warning resulting from vasovagal problems, which are exacerbated by her lack of vision and reduced hearing.

When she is walking outside she will hold onto her husband’s arm for guidance and stability. She has tripped on kerbs and walked into doors. At home she leaves all the doors open.

She also trips in the house, so it is important that things are left in the same place and not moved to support her vision and level of safety.

Mrs Y has Reynaud symptoms in her upper and lower limbs causing colour changes and swelling in her fingers.

She has a history of sciatica. The pain in her back increases towards the end of the day and impedes her ability to bend or lift items.

She experiences numbness in her feet and hands, with no motor deficit.

What life is like for Mrs Y

Mrs Y has many strategies already in place in her home to compensate for her lack of vision and lessen the impact it has on her day-to-day life.

Issue	Mrs Y's Solutions
Around the home	Mrs Y sometimes needs help with activities but keeping her independence is very important to her. Because of her sight loss she no longer does the cooking and leaves it to her husband. She takes care of her own personal care and wants to do this for as long as possible. Her level of function is impacted on by her lower back pain.
Reading	Mrs Y uses a digital magnifier to read printed material. It is a battery powered device with a built-in light, but even then it is very difficult to read printed documents. Where possible she uses an iPad or other technology to read documents, as these give a greater level of magnification. She is unable to read the boxes containing her medication, so her husband manages and prepares her medication for her. Mrs Y knows when she needs to take her medication and administers it herself.
Communication	Mrs Y has a ‘Doro’ mobile phone, a specialist phone for people who are blind or deaf. The phone ‘speaks’ the numbers or contacts and can be programmed to ring 999 at times of an emergency. Mrs Y uses telephone banking with Nationwide to manage her finances.

Improving Mrs Y's quality of life

Mrs Y and her husband are coping well with the challenges of everyday life, impacted by her disabilities. As they both age, however, life may not be so easy and the following approaches could improve their lives significantly:-

Issue	Recommendations / Equipment
General health and pain management	Occupational therapy input Mrs Y would benefit from the assistance of an occupational therapist in sourcing equipment to compensate for her visual impairment and the loss of function as a result of her sciatica.
	Physiotherapy input Mrs Y will benefit from a rolling programme of exercise rehabilitation, either of a progressive and ‘rehabilitative’ nature or aimed at maintenance of movement and function.
	Commercial assistance Needed with gardening, DIY, painting and decorating, bin cleaning, window cleaning and chiropody. A twice-weekly hairdressing appointment will help Mrs Y wash and style her hair, something her sight loss prevents her from doing.
In the bathroom	Mrs Y will find life much easier if she changes her bathroom to a wet room with a textured floor to help with orientation. Better lighting will help with her lack of vision and underfloor heating will help further with orientation. She will also benefit from hands free dispensers for shampoo, soap and toothpaste. A Radar key will help her access disabled toilets when she is out in the community, with her husband showing her where the toilet and wash basin are. She can then use the facilities independently.
Furniture	Specialist furniture will help Mrs Y in transferring from standing to sitting or lying as she continues to have back problems. A rise/recline armchair will help her sit down and get up again, without putting a strain on her back. An electric adjustable bed will also help with the transition from lying to standing, and with sitting up in bed. You can buy combination beds where one side remains static whilst the other is adjustable, which will help Mrs Y and her husband each find the sleeping position that is right for them.