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Occupational Therapy Case Study Two

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 C - Summary of physical limitations

Mr C has shortened legs, thighs, knees and feet. Until a few years ago, he always depended on lower limb prostheses and crutches to keep him mobile; but a left sided knee replacement in 2014 rendered him unable to wear prosthetic limbs, or to crawl on his knees to get around at home. The knee replacement has helped Mr C manage his pain successfully but he is now totally reliant on a wheelchair.

He reported that he uses his upper limbs to transfer himself from wheelchair to bed, toilet and stair lift. He does not use any equipment to support the transfer.

What life is like for Mr C

The main issue for Mr C is the unsuitable nature of his home environment. He has a number of strategies in place to help him carry out every-day tasks but life is not easy: -

Issue	Mr C's Solutions
The home - Mr C's home is not suitable for a wheelchair user
It does not have level access and there is limited space which makes it harder to manoeuvre a wheelchair	He has a stair lift to access the first floor but he will be unable to use this if he requires hoisting to in future years
Neither the kitchen nor the bathroom is wheelchair accessible	Mr C is independent in his personal care and with toileting. He has a wash and dry toilet and grab rails in the bathroom and a ‘Bath Knight’ bath lift to enable him to bathe independently. Although the bath lift currently supports this activity, it will not be as helpful as Mr C physically changes as he ages.
Mr C is unable to identify who is at his door before he opens it increasing his vulnerability
He needs support to reach items such as books from higher shelves and has previously fallen when trying to reach them. He also needs help with other fetching and carrying in the home.
Getting about	Mr C is unable to put his wheelchair in and out of the car independently so has to be accompanied on trips out of the house. His vehicle is adapted with hand controls so he is able to drive himself.

Improving Mr C's quality of life

From an occupational therapy perspective, Mr C will need much more help as he grows older.

Solutions are as follows: -

Issue	Recommendations / Equipment
General health and pain management	Occupational therapy input Mr C needs occupational therapy help with getting equipment and support with testing it to make sure it meets his needs. He will also need support when his ability to transfer changes with age and he requires the provision of a hoist and/or specialist slings to support him appropriately and safely. Mr C definitely needs more supportive accommodation that he can get around better in a wheelchair, including an adapted bathroom and kitchen.
	Physiotherapy input Mr C would benefit from regular hydrotherapy sessions aimed at improving function. These can also help to address musculoskeletal issues such as joint stiffness and weakness, as well as helping with muscle tension and pain management.
	Commercial assistance Needed with gardening, bin cleaning, DIY, decorating, window cleaning, chiropody.
In the bathroom	Mr C already has an electric wash and dry toilet in his downstairs loo, which helps him maintain his personal hygiene. As his ability to transfer deteriorates he will also need a level access shower with a wheeled shower chair to enable him to shower independently.
Furniture	Mr C will need a rise/recline armchair to help him change position whilst seated as an alternative to his wheelchair. An electrically operated armchair is virtually silent and offers various seating positions – fully reclined through to normal upright and inclined. It also features a dual motor. Different seat sizes are available but your needs should be assessed by an occupational therapist before you buy. An electric adjustable bed will also help Mr C as he relies more on slings and hoists to move from one position to another.
Wheelchairs	Mr C needs wheelchairs to help him get around at home, and out in the community. He will need both electric and manual chairs, so that he has everything he needs when his abilities change. Some electric wheelchairs give you the option to be at a raised height so that you can be the same height as the people you are with, as you would have been when wearing prosthetics. This could be invaluable for Mr C. Choose a chair with an easily accessible battery, long rear swing arms for a comfortable ride, good stability and traction and a fully adjustable seating system.
Ceiling track hoist and sling	If Mr C is unable to use his upper limbs to complete his transfers he will need a ceiling track hoist. He is likely to need a specialist sling which an occupational therapist can help source and assess.
Emergency lifting cushion	A portable, lightweight emergency lifting cushion could support Mr C if he were to fall onto the floor, both in the home and outdoors. They consist of four sections. The fallen person is manoeuvred into a sitting position on the deflated cushion which can then be inflated with another person supporting them from behind. One section is inflated at a time by a powerful battery-operated pump. When the sections are fully inflated, the cushion is very sturdy and the person will have been raised into a normal sitting position. The person can then stand or transfer with assistance to another chair.