Occupational Therapy Discontinuation Report

Date of report: 4/22/14

Name: David Scott
M F
Age: 55
Date of Initial referral: 2/10/14
Primary intervention diagnosis: L CVA
Secondary diagnosis: expressive aphasia, R hemiplegia, cognitive deficits
Precautions/contraindications: Cognitive deficits (safety and awareness)
Reason for referral: Referred through U of U community client program to address
conditions 2 to L CVA.
Reason for OT discontinuation: LOS of 6 visits met
Therapist: Ali Bullard, OTS
Description of OT intervention:
Client was seen at home and community for 6/60 min sessions between February
and May of 2014. Intervention focused on ADL/IADLs including cooking, laundry,
public transportation, and community mobility. These focus areas were established
with client and wife. Intervention types: occupation-based and education/training.
No preparatory methods were used because client reported doing these types of
tasks on his own (splints and stretches). Education on energy conservation
techniques and training of one handed and compensatory strategies were provided.
PEO, biomechanical, and motor learning models guided the intervention by helping
client find optimal congruency between his home, community, and occupations.
Intervention also focused on building activity tolerance, endurance, and utilizing
preferred motor patterns for occupational performance.
Brief summary of progress towards goals:
LTG 1: By session 6, client will independently prepare a 3-step stovetop meal with
set-up assistance.
Client and wife reported that client met this goal by making spaghetti with
set-up assist the week prior.
LTG 2: By D/C, client will independently complete one load of laundry a week for
four consecutive weeks.

Goal met according to client and wife report.

LTG 3: Client will ride up and down escalator with SBA by DC.
Goal met during session .
Occupational therapy outcomes:

Initial performance in areas of occupation: Client was dependent in

stovetop cooking and public transportation, required mod verbal cues to
complete laundry tasks, and did not use escalators.

Current level of performance in areas of occupation: Client can cook

stovetop meals and do laundry with setup, ride escalator with SBA, and ride
public transportation to and from therapy independently.

COPM:
COPM was attempted on initial visit but due to expressive aphasia client became
frustrated and COPM was discontinued. Regardless, information regarding clients
priorities was gathered (donning shoes, public transport, doing dishes, cooking, and
laundry). Through informal discussion during discharge, client communicated that
he felt more satisfied with is performance and felt all his goals were met.
Client satisfaction evaluation:
Client communicated that he was very satisfied with his results from therapy. He
remembered and met all of his goals and feels less dependent on others. He was
particularly proud of his accomplishment of riding the escalator; he had a lot of fear
surrounding that event and mentioned several times how happy he was that he was
able to do that.

Contextual aspects related to discontinuation:

Cultural: Clients wife is vegan, throughout the intervention we found that

her requests for meals for Dave to make were out of the ordinary and
sometimes more challenging than traditional meals. Dave struggled with
some of the requirements of vegan cooking (i.e. using an egg substitute that
required following a list of instructions to add water and mix into separate
bowl). It would be within the clients zone of proximal development if he
prepared meals that did not require special adaptations to be vegan.

Physical: Clients home environment was well adapted for his needs and he
had all the adaptive equipment necessary for him. The sole adaptation that
was recommended was rearranging kitchen to locate items in a more
convenient place for client.

Social: Clients wife often gives too much support and assistance, hence why
client was dependent in many areas initially. It is difficult for her to allow her
husband to struggle; at times it was clear that when he struggled he would
reflect his frustration on her. It would benefit the client if she forced him to
do more for himself.

Personal: Client and wifes socioeconomic status allows for wife to stay home
and help him, as well as financially provide anything he requires.

Temporal: Client often takes long naps during day, which actually increases
his fatigue afterward. Therapist recommended pacing day with more
frequent short breaks. Client recently had seizure, which also impacts his
fatigue and occupational performance.

Discontinuation recommendations:
Client and wife stated their satisfaction with intervention and communicated
interest in continuing to be involved with community client program next year.
Therapist presented energy conservation handout due to clients wife complaining
about clients lack of energy and consistent fatigue. Therapist led discussion about
ideas they could implement into their lives to help client have more energy.
Specifically, therapist suggested moving kitchen supplies to more convenient
locations for client and client taking frequent resting breaks rather than one long
nap. Client and wife were very receptive and showed enthusiasm about
implementing techniques. Therapist recommended client continue to implement
adaptive strategies to cook stovetop dinner and perform laundry once per week.
Therapist advised wife to be present if client wants to cook anything involving the
oven for safety reasons. Client should continue to ride public transport to and from
therapy, but wife should assist if client take new route due to safety awareness
concerns. Therapist reminded client that he proved he is capable of more than he
thinks, and to continue engaging in the occupations we worked on so he could
advance to different occupations with the next students. Therapists left client
contact information and encouraged them to contact with any concerns or questions
in the future.

____________________________________
Signature

_____________________________________
Date