Case study:

16 October 2011

Occupational therapy: diversity of role in different settings

---

Key points

---

Tom* was a 38 year old man who had been diagnosed with renal cell cancer with lung and brain metastases. He lived with his wife, who was his main carer, and their two young children. Although he was not able to work his employer was supportive, paying his salary for the previous five months.

Tom’s condition appeared to be fluctuating, and when first seen by the occupational therapist he presented with a three-day history of right hemiplegia as a result of disease progression. Tom was on a high dose of steroids to reduce the brain inflammation and started two cycles of chemotherapy before having a week of whole brain radiotherapy. All activity proved exhausting for him.

Occupational therapy took place in an acute hospital. As well as gaining relevant information about his home and social circumstances, the occupational therapist assessed Tom’s physical difficulties, which resulted from his dense right-sided weakness. He was found to have adequate sitting balance and head control for one person to support him while he washed and dressed but no right hip or knee control, so he was unable to stand without support.

Other possible impairments which might have affected Tom, such as sensory, cognitive or perceptual difficulties, were assessed but were not found to contribute to his difficulties. Using a functional activity such as washing and dressing was useful in contributing to this assessment and it also helped to establish that he did not have any problems with communication.

Rehabilitation included encouraging Tom to be aware of, and to use, his right side. The occupational therapist worked closely with the physiotherapist to ensure the same techniques were used when carrying out personal activities of daily living and during exercise sessions.

The occupational therapist supported him on his right side as he used his left hand to wash himself. By blocking his right hip and knee he was able to stand to wash, dry and dress. These treatment techniques were documented in his notes, so that nursing staff could also follow them, ensuring a consistent approach.

Discussions were held with Tom and his wife about future plans for discharge home. This was broached sensitively to reassure them that the hospital would not hurry his discharge home but it ensured that all necessary arrangements were made in a calm and thorough fashion. This included the feasibility of Tom being based downstairs with appropriate adaptations and equipment as well as support services. His wife had already been giving this some consideration and was able to take control of these decisions with some suggestions from the occupational therapist.

Tom’s hemiplegia started to resolve within four days and he began to gain active and useful movement in his right arm and hand. After eight days he regained hip and knee control and began to walk using a rollator zimmer frame. The occupational therapist carried out a home visit with his wife present but Tom felt too tired to attend.

The occupational therapist suggested an additional banister rail on the stairs and strategically placed grab-rails by the toilet and shower cubicle and had already shown Tom and his wife the range of equipment available in the occupational therapy department at the hospital.

A joint decision was made to keep the adaptations to a minimum since his condition was fluctuating but introduce them in the future if they became necessary.

*All names have been changed to protect confidentiality

Author
Jill Cooper, head occupational therapist

---

Back to top