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Patient with Ataxia and Diabetes Mellitus Essay

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Updated: Jun 11th, 2022

4-2-2016 a home visit was made to the client who had Ataxia and diabetes mellitus. This patient was deeply depressed due to numerous contributing factors. The therapist used different reasoning strategies in her session. The main purpose of this session was to introduce the new cushion for the client and provide all detailed information, in addition, to reporting any change of the patients need.

At the beginning of the sessions, interactive reasoning was used. The therapist was clearly using the interpersonal skills and strategies to support and motivate the patient to engage in the therapy. For example, the therapist listened carefully to the patient, using non-verbal agreement. It was used to convey a sense of acceptance, trust and hope to the patient and to engage the client in looking at the cushioning product. Furthermore, a sense of humor was used to help a client to interact with the student and to relieve tension

Moreover, the usage of the knowledge about the clients disability and diabetes could be described as adherence to scientific reasoning. The therapist uses the knowledge of the nature of the illness in developing health complications to guide the intervention choices. In this case, such factors as static posture and prolonged position from the immobility due to ataxic paralysis, along with the poor circulation and potential impairment of sensation that is often associated with diabetes will increase the risk of developing severe pressure ulcers and infection. Therefore, the therapist prioritizes using the cushion to the client and persuades the patient to accept the product by discussing the merits of the infinity cushion with a low profile in enabling the customer to transfer easily from and to the wheelchair

Also, the intuitive reasoning was confirmed during the discussion with the therapist at the therapeutic session. It was related to the continual refusal for many therapeutic recommendations. For instance, refusing to tilt in space would help the patient to raise her lower limbs and improve circulation as well as prevent or delay complications. Also, refusing the use of the electric wheelchair instead of the manual one would conserve energy and effort and would help the patient to do shopping without fatigue and being exhausted. The therapist felt that the patient may want to make her condition regress and that it was due to her profound depression. This fact impacted the therapist to make a decision to inform the case manager about the health deteriorations. It is important to emphasise that it was compatible with the client-centred approach, and the competent patient had the complete right to accept or to refuse the treatment. Therefore, the main role of the practitioner was to advocate and educate the patient to make a decision.

The narrative reasoning was another approach used in the case. The therapist talked about some essential activities in the client’s daily life, such as sleeping, toileting, and cooking. It helped to identify some occupational performance hinders appeared due to some technical problems and to make the plan to find the needed solution. For instance, the client mentioned the difficulty related to the transferring to bed because the remote control of the electric device needed to be replaced. It made the therapist create the plan to provide the client with the contact details of the bed manufacturer to organize the repair of some additional service. It is also vital to check the W/C quote if solid layers were added.

Eventually, these different types of reasoning helped to solve the problems and to design and conduct the therapeutic process.

On the 2nd March, while we were going to trail a wheelchair for one of the clients, the question who should prescribe and assess the wheelchair were raised. Should it be a physical or occupational therapist? Although both of them had the right to do it and this fact initiated the interesting discussion. As my background is physical therapy, I also felt curious to get to know who might be better. This fact made me reconsider the knowledge and skills of PT and OT that could be used. I think both PT and OT have the knowledge in the medical conditions and skills to teach a user how to manage and how to transfer in/out of it. OT has skills to report on a person’s physical and mental state and on the ability to handle chair whereas a physical therapist is more focused on the physical body and biomechanics. OT has skills to report on areas where the chair will be used and adaptations needed for this usage to be successful. OT knows which chairs are available and suggests most suitable one related to given environment and the kinds of activity which clients want to perform with this chair. Moreover, OT has the knowledge of the environmental factors (physical, institutional and social environment) client factors, carer, personal choice, finance and safety issues. Therefore, a wheelchair that is prescribed by an occupational therapist would be more investigated, justified and potentially more suitable (Coolen, A., & Kirby, R. 2002) This discussion provided me with a great insight about the skills in both fields and highlighted the fact that an occupational therapist should take into his/her account the knowledge of the multiple levels and factors for the better evaluation of the case.

Topic -2 – Conducting a semi-structured interview 500

The Canadian occupational performance measure format has been used for a client with a mobile bike accident. The information was gathered by asking questions related to self-care activities, productivity, and leisure. The main occupational performance issues were identified as the difficulty in putting socks on, domestic activities, getting out the house, access the community, and travel safely in the retirement village. Then I asked the client to give a number from 1 to 10. 10 stood for extremely important and satisfactory whereas one meant less important and satisfactory.

Clinical reasoning is a common skill that all clinicians are expected to possess and utilize, and all students are expected to develop. The initiative session started when we entered the clients house I had the opportunity to ask the client about his/her mood and feelings, and he answered: “Well but not good”. Then I asked him about the reason for it ( the strap on his cheek ). He told me the story about cancer and it helped to initiate the chatting. It was really good for me, helped to build rapport, and I felt more comfortable as it went naturally and spontaneous. When I started to interview him, I felt uncomfortable for many reasons. First, I felt that asking questions as an interviewer was not natural at the first contact. It made me think that the interviewee might feel the same. I also thought that the presentation of the questions in the narrative form could be more appropriate. I felt that such skills as the attendant behavior in terms of the eye contact and active listening could also help. Additionally, because of my soft voice, I had to speak louder for a client to be able to hear me better. Also, I asked some open and closed questions. Sometimes I also asked the client for more clarification and paraphrasing. I focused on his strength which was his writing as editor. However, it would be better to summarise what the client said after each section. I believe this skill can be learned and will be improved in time and due to the practice. The occupational issues were chosen resting on the patients identification.

The main difficulty is connected with my question about the rating scale and the importance of the performance and satisfaction. The English grammar was another challenging issue as it is my second langue, but I believe that the concept is not easy. I felt that the client got the meaning of the first two issues, but then I realized that he start to confuse the performance and satisfaction. It might happen because normal people do not think in this way, and I felt I needed to repeat what these numbers meant. However, I felt I could not do it because the constant reminding of the things he did not understand was not compatible with the concept of respect for older people. It this regards, I think that the preparation with the supervisor was really helpful, and her guidance was really effective. Especially useful were her tips to simplify the language with a client and avoid all technical and academic language which was the main concern for me. I have already mentioned that English is my second language, and I use it mainly for various academic purposes, not in the everyday life. I think it should be suggested in the manual to make some concepts easier..

The client is 81 years old lady who lives with her son. She had hypertension, osteoarthritis of the right and left knee in 2001, lumbar radiculopathy in 2004, left hip osteoarthritis in 2005, left hip dislocation in 2008, total left hip replacement in 2008, and left hip prosthesis dislocation in 2012. The son is the primary carer. She discharges from Mornington centre at 14/1/16 following right hip replacement. She had the previous history of falling before hip replacement due to the problems with balance. She had difficulty getting out of screen door with 4WF. Also, difficulty in lower herself into the toilet at night. She has to use the bed pan at night to ease toileting and to empty the contents into the bucket. These issues have improved since surgery, and she is linked to physiotherapy and occupational therapy for ongoing therapy. Now, she is independent in self-care activities and receives home help for domestic activities and shopping. Eventually, wheelchair has been recommended to enable her to access community without risk of falls or having fatigue.

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