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Occupational Therapy Case Presentation (Neurology),[object Object],Prepared by: 	Teoh Jou Yin (A 118729),[object Object],		Occupational Therapy Programme,[object Object],		Faculty of Allied Health Sciences,[object Object],		National University of Malaysia,[object Object],Occupational Therapy: Helping people live lives THEIR way.,[object Object],~ British Association of Occupational Therapy,[object Object]
The Kawa Model in Neurology
What is Occupational Therapy’s role?,[object Object],To FACILITATE / ENABLE / EMPOWER clients to engage and participate in life processes and activities that are important and of value to them, i.e. to do the things in life that they want to do and need to do.,[object Object],(Teoh et al. 2010),[object Object],How to do that?,[object Object]
CONCEPTUAL MODEL,[object Object],OF PRACTICE,[object Object],Conceptual models of practice describe phenomena of interest like “occupation” or “occupational performance”, guide treatment approaches by easily allowing therapists to focus on the right problem areas, and help to predict outcomes in clinical interventions.,[object Object],(Iwama 2010),[object Object]
The Kawa Model,[object Object],The essence of the Kawa Model (Iwama 2006) is basically to enable occupational therapists everywhere to “just ask the client how they want to live their lives so that it is more meaningful to them, and look together with them at what we can do to achieve that.”,[object Object],The Kawa Model can be used as a conceptual model of practice, frame of reference, assessment tool and modality. (Iwama 2010),[object Object],It can be used with any population since it is based on the client's own perceptions of what is important to them, and the only possible contraindication is an occupational therapist unskilled in the therapeutic use of self.,[object Object],DISCUSS THE KAWA MODEL ON FACEBOOK!,[object Object],http://facebook.com/KawaModel,[object Object]
FRAMES OF REFERENCE,[object Object],FORs can be defined as the principles behind practice specific to a client population.,[object Object],FORs include a statement of the population to be served, guidelines for determining adequate function or dysfunction, and principles for remediation. ,[object Object],(Bruce & Borg 1987),[object Object]
Neuro Developmental Frame of Reference (Pendleton & Schultz-Krohn 2006),[object Object],Neuro: brain function,[object Object],Developmental: Components of movement required to develop.,[object Object],Core principles:,[object Object],Individualize functional outcomes – provide interventions specfic to client’s context.,[object Object],Emphasise motor control – quality of movement,[object Object],Increase active use of the involved side – manual cues and progressive challenge,[object Object],Provide Practice to improve motor performance leading to motor learning.,[object Object],24 Hour management to increase retention and turnover.,[object Object],Interdisciplinary approach. ,[object Object]
OCCUPATIONAL THERAPY,[object Object],PERFORMANCE FRAMEWORK,[object Object],A summary of interrelated constructs that represent and guide occupational therapy practice and articulate occupational therapy’s contribution to promoting health and participation through engagement in occupation.,[object Object],(AOTA 2008),[object Object]
The Kawa Model in Neurology
EVALUATION,[object Object],SUBJECTIVE EVALUATION,[object Object],STEP 1: FIND OUT WHAT THE CLIENTS WANT AND NEED.,[object Object]
Kawa Interview (23/9/2010, 30/9/2010),[object Object],Blue - river - life flow and overall occupationsRed - river walls and floor - environments, social & physicalLilac - rocks - circumstances that block the river flow and cause dysfunction/disabilityYellow - driftwood - personal resources that can be assets or liabilities.,[object Object]
The Kawa Model in Neurology
The Kawa Model in Neurology
The Kawa Model in Neurology
The Kawa Model in Neurology
EVALUATION,[object Object],OBJECTIVE EVALUATION,[object Object],STEP 2: VERIFYING THE DETAILS.,[object Object]
AREAS OF OCCUPATION,[object Object],Categories articulating “the many types of occupations in which clients might engage” (AOTA 2008),[object Object],Activities of daily living (ADL), Instrumental activities of daily living (IADL), Rest and sleep, Education, Work, Play, Leisure, Social participation,[object Object]
Areas of Occupation,[object Object],1. Activities of Daily Living (MBI) – 23.9.2010,[object Object]
CLIENT FACTORS,[object Object],Specific abilities, characteristics or beliefs that reside within the client and may affect performance in occupation. (AOTA 2008),[object Object],Values, beliefs & spirituality; body functions; body structures,[object Object]
Client Factors: Body Functions,[object Object],Neuromuscular skeletal and movement related functions,[object Object],Dominant hand: Rt Affected hand: Rt ,[object Object],Joint Range of Motion: (23 / 9 / 10),[object Object],Lt UL AROM: full,[object Object],Rt UL ROM:,[object Object],1. Shoulder external rotation: AAROM 90, AROM 502. Shoulder abd/add: AAROM 80, AROM 603. Shoulder Extension: AROM 20,4. Shoulder Flexion: AAROM 120, AROM 20 (will produce compensatory movements)5. Elbow: AAROM 70-160, AROM 70-1106. Forearm: No movement, remains in supine postition7. Wrist: No movement.,[object Object],Muscle Tone (Modified Ashworth Scale),[object Object],Right arm and forearm: 0 / 5,[object Object],Right wrist and fingers: 3 / 5,[object Object],Left upper limb: 0 / 5,[object Object]
Activity Demands,[object Object],Specific features of an activity that influence the type and amount of effort required to perform the activity. (AOTA 2008),[object Object]
Activity Demands (Activity Analysis) – 30 / 9 / 10,[object Object],#1 Ambulation- pt walks with abnormal gait- rt knee straightened- rt hip in abduction- rt ankle shows eversion when lowering foot#2 Toileting- pt's toilet and bathroom layout was evaluated and drawn out- pt's tap and hose is on rt side of toilet bowl, towards the back end close to the wall.- pt has difficulty reaching for hose with left hand.- pt does not use toilet paper at home- pt can wash self using hose only, but not clean enough as unable to douche with other hand- pt is able to wipe self and put on garments including panties.,[object Object]
Contexts & Environments,[object Object],The variety of interrelated conditions surrounding the client in which the client’s daily life activities occur. (AOTA 2008),[object Object]
Home (Bathroom Assessment) – 30 / 9 / 10,[object Object],Problems:,[object Object],[object Object]
 Client might have safety concerns getting up from toilet bowl
 Client at risk of falls (instable gait + potentially slippery floor due to shower area being right in front of toilet bowl).,[object Object]
Long Term Goals,[object Object], To regain participation and engagement and participate in life processes and activities that are important and of value to client.,[object Object]
INTERVENTION,[object Object],STEP 4: OCCUPATIONAL THERAPY TREATMENT PLANNING,[object Object]
Problem: Client has safety concerns: fear of falls. (30/9/10),[object Object],Aim: To address safety concerns during functional ambulation.,[object Object],Intervention: Gait training (Pendleton & Schultz-Krohn 2006),[object Object],Method:,[object Object],[object Object]
 Pt was also given prompts to invert ankles when lowering foot.
 Duration for practice was also provided: 10 mins.
 Therapist uses modelling, walking alongside patient at a diagonal angle in order for patient to mimic movements.
 Carer was also educated to observe patient movements during ambulation in order to provide cues when appropriate.,[object Object]
 Pt was then educated on why she has to take responsibility and initiative to perform home programme
 i.e. that once a week therapy was insufficient, that she cannot depend on therapist entirely to take responsibility for her recovery.

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The Kawa Model in Neurology

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  • 25. Client might have safety concerns getting up from toilet bowl
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  • 30. Pt was also given prompts to invert ankles when lowering foot.
  • 31. Duration for practice was also provided: 10 mins.
  • 32. Therapist uses modelling, walking alongside patient at a diagonal angle in order for patient to mimic movements.
  • 33.
  • 34. Pt was then educated on why she has to take responsibility and initiative to perform home programme
  • 35. i.e. that once a week therapy was insufficient, that she cannot depend on therapist entirely to take responsibility for her recovery.
  • 36. Pt was encouraged to set timeline for herself to evaluate progress with goals
  • 37.
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  • 39. Pt is also taught to close eyes and take deep breaths when aware that she is beginning to feel anxious.
  • 40. While closing eyes, client is taught to think of calming soothing images i.e. beachside scenery, etc.
  • 41.
  • 42.
  • 43. Pt was asked to relax, close eyes, and visualise both hands opening and closing in slow, controlled movements. (Fine motor movements.)
  • 44. Gross motor movements were addressed by means of shoulder extension exercises (both hands clasped together.)
  • 45. Pt was also educated about purpose of activity and how to perform it at home.
  • 46.
  • 47. Pt is taught to make use of television viewing times as home programme exercise times.
  • 48. Pt watches tv at 11am, 6pm and 10pm.
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