Clinical Case Study Analysis Answer

Client

John is a 72-year-old male with a confirmed diagnosis of Parkinson’s disease. He has been scored 3 on the basis of the Unified Parkinson’s Disease Rating Scale (UPDRS). He has severe physical impairments which is making it difficult to perform activities of daily living (Hamzehei et al., 2023). The patient has been moved to the residential care facility, as his family was not able to manage care for him. He is having poor social contact and requires to be managed for care in a seated position, for activities of daily living.

Concerns related to occupational performance

1. The patient’s ability for independent ambulation has been compromised.
2. The clinical deterioration of the condition is compromising with the fine motor skills.
3. The patient is struggling with self-care management. He tends to slide down in his chair when he moves during any posture change. The patient is not able to maintain an upright position comfortably.

Assessment

1. Assessment will be done for the patient with the help of a COPM examination. This method is mainly used by occupational therapists to identify the performance issues that might compromise with the activities of daily living (Bianchini et al., 2022).
2. The patient can be assessed for the centre of gravity (CoG), the centre of pressure (CoP), and fear of fall (FoF), which can help in assessing the postural instability of the patient (Palakurthi et al., 2019).
3. Assessment of gait pattern and posture control for the patient and compare the same with the normal findings.
4. The patient will also be examined with the help of Goals Attainment Scoring. This scale rating will help in defining the importance and difficulty of performing a task for the patient.
5. The patient can also be assessed with the help of the VAS scale reading for joint pain, caused secondarily by poor posture control and balance.

Goals

Short term goals

Within the next two-three weeks, John will be able to perform his activities of daily living to a partial extent, along with the help of a professional healthcare worker, who will assist John in reducing his pain and discomfort and promoting positive clinical outcomes with continuous follow-ups.

Long term goals

Within the next eight to ten weeks, John will be able to easily get in and out of his wheelchair, with minimalistic support from his family members, to ensure positive clinical outcomes and stabilize the posture for required correction and prevent any potential mechanical injury during poor postural shift.

Intervention

1. Session A

This will be done with the help of occupational therapist support. The therapy session will be carried out in an occupational therapy department where all necessary equipment will be available. The focus will be based on enhancing fine motor skills of gripping and holding objects. This will also focus on ensuring a strong grip while eating food independently and managing other precise activities. The assessment will be conducted with the help of the COPM assessment (Wagner et al., 2020). This will include assessment for self-care which is compromised for the patient due to the physical health condition. The productivity of the patient will also be assessed concerning the patient’s competence and efficacy in completing any minimal task independently. The patient wants to participate in various leisure activities, which he is not able to perform currently (Tofani et al., 2020). The leisure component of the COPM assessment will be useful in analysing the same. The planned therapy session within the close space of the occupational therapy room will allow the client to perform activities of daily living. This will also assist the therapist to educate the patient correctly regarding posture control and key considerations for maintaining a stable position (Kobayashi et al., 2022). One-on-one sessions will also help the patient in learning by doing and overcoming potential fears regarding self-care management. It will also assist in enhancing clinical outcomes with the active engagement of the patient and building his trust and confidence in himself, for enabling a state of independent functioning.

1. Session B

This will be done in a form of a group session. Group sessions will allow the patient to reflect upon his own strengths, fears and limitations, as compared to other patients struggling with the same diagnosis (Foster et al., 2021). It will also allow the patient to gain perspective regarding his clinical condition and how to overcome his limitations, hindering with the possibility of an independent state of living. It will also help in instilling confidence in the patient to try upright positing seating for basic activities of daily living.

1. Session C

This will be focused on the perspective of promoting a home care plan for the patient. The review will focus on the patient’s current status and ability to perform his activities of daily living in an upright position (Cavalcanti et al., 2020). This will mainly focus on his ability to bath, eat and dress himself without requiring must assistance. To reflect on the extent of support required, the patient’s home-based setting will also be assessed for the possible aids and equipment required for ensuring smooth facilitation of services for the patient within his home-based setting. 

Evaluation

The patient will be evaluated on a weekly basis for any updates and changes in his progress. This will be done with the help of the telephonic communication and follow-up with a point source. The patient will also be reassessed and evaluated with the help of COPM, which is mainly used by occupational therapists (Nakamura et al., 2019). The patient will also be assessed for his therapy outcomes with the help of GAS calculation. This calculation will mainly focus on the patient’s ability to attain the defined goals of treatment. This will also assist in predicting possible clinical outcomes and redefining the care plan as per the patient’s specifications (Chang et al., 2022). Verbal feedback will also be taken from the client and the relatives regarding the sessions and thus, any possible changes will be made to suit the demands and needs of the patient.