Beruflich Dokumente
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S:
Client was friendly and seemed to look forward to the sessions. He referred to his condition as
“stupid aneurysm” multiple times, and said “I’m sorry” often for not remembering things. He
O:
Client was seen January 25th and February 1st for comprehensive occupational therapy
Results:
that examines aspects of verbal, visual, spatial and perspective memory, orientation/date, and
new learning.
Overall results from the RBMT-3 indicate that Client falls well below average on the
assessment indicating a significant memory deficit. He did achieve high scores in picture
recognition (63rd percentile) and delayed recall of his belongs (25th percentile). All other subset
scores fell at 9% or lower. Client scored the lowest in the area of perspective memory, scoring
Occupational Profile:
History:
Client is a 49-year-old male who is seeking services due deficits in short term memory
secondary to an acquired brain injury from brain aneurysm, which occurred over 12 years ago.
Prior to this incident, Client worked full time in construction management and enjoyed
mountain biking, jet skiing, and other outdoor activities. He lived alone, was able to drive with
no problems, and was independent in all of his ADLs and IADLs. He previously enjoyed going to
the gym near his apartment, but it recently closed. After his brain aneurysm, Client was moved
to a care center, which he did not enjoy, and now resides in an apartment with his mother.
Current Occupational Performance:
Client reports that his days are fairly unstructured due to his lack of responsibility. He
explained that since his accident, his concept of time has been disoriented which effects his
ability to grasp what day/month/year it is. He wakes up in the morning and spends much of his
day watching television, or will ride the bus to go to different restaurants in the Sugarhouse
neighborhood of Salt Lake City. Client reports that he prepares simple meals, does dishes, and
laundry around his house. He has no problems with getting ready in the morning. Client is no
longer able to drive himself anywhere due to safety concerns following his aneurysm. He rides
one bus route on a regular basis to get to his favorite restaurants, and walks across the street to
grocery shop at a nearby Walmart. He states that although he has a large network of friends, he
often times does things by himself. His interests include going to rock concerts, eating out at
restaurants, playing solitaire, and hiking when he can. His roles include being a son, brother,
friend, and music lover. His priorities for therapy include engaging in preferred hobbies, getting
around on the bus outside of his one typical bus route, and getting back to work or
volunteering. Client was able to remember important future dates such as his 50 th Birthday and
Context:
Client lives with his older mother in an apartment in Murray, UT. He is able to navigate
in and to familiar environments such as his home, neighborhood, and Dee’s Restaurant. He
claims that he has a codependent relationship with his Mom and a large network of friends in
the Salt Lake area. Client has a sister who lives in Florida, and a niece that lives in Portland, OR.
A:
Interpretation:
Client’s strengths include being very outgoing, taking one familiar bus route, having a
vast network of friends, intact physical mobility, using social media, and taking notes on
also demonstrated that he was able to remember things that were extremely important
to him such as where his watch and phone were hidden. In addition, Client is compliant
when asked to perform tasks during treatment and actively engages with the therapists
during the sessions. He has a great sense of humor and is open and willing to talk about
his experiences.
Areas in need of intervention include his poor memory, poor balance, inability to
the bus, and taking vague notes on his phone. Client often times misplaces his phone
and iPad around his house. He seemed discouraged when taking the memory
assessment and apologized often for not remember things, which may be a sign of
psychosocial concerns. Although Client reports that he uses his iPad calendar to record
appointments, he does not know how to set a reminder alarm that would be useful in
Client is supported by his mother, friends, access to a simple bus route, and ability to
connect with people via his phone and social media. He is also supported in the fact that
fact that he can remember very valuable objects, and has average visual memory. Client
is able to remember meaningful future dates and important belongs, which may mean
that the value of the information which he needs to retain plays an important role in his
small details, and what he is supposed to be doing. During the assessment it was made
evident that Client struggles immensely with orientation and knowing what
day/week/month/year it is. It was also made clear that he cannot remember verbal
information and spatial routes that were more than 3 or more steps that were taken
around the room. These could greatly affect his ability to engage in occupations such as
exceedingly low in the area of perspective memory, which is his ability to remember to
perform an action or recall a planned activity in the future. This could be a major
contributing factor in his lack of engagement in many activities such as outings with
prospective, verbal and spatial memory and his deficits in new learning. These characteristics
are evident by extremely low scores in these areas on the RBMT-3. As Client received much
higher scores in visual memory and was able to remember very valuable objects during the
RBMT-3, we will attempt to incorporate these supports into his treatment and provide
As obtained through the COPM, client’s priorities for therapy include engaging in preferred
hobbies (going to the gym), getting around on public transportation outside of his one typical
bus route, and returning to work or volunteering. Due to the client’s short length of stay, we
will focus his priorities on increasing public transportation usage and ability to engage in
preferred hobbies. These two areas necessitate many foundational skills and can be transferred
P:
2. Within 6 sessions, client will independently participate in one previously enjoyed activity
1a. Within 2 sessions, client will independently identify a bus route to a non-familiar
1b. Within 4 sessions, client will independently take an unfamiliar single-bus route to an
2a. Within 4 sessions, client will independently demonstrate the use of one external
2b. Within 4 sessions, client will independently utilize phone applications to complete two
daily activities.
Client would greatly benefit from skilled occupational therapy (OT) services in order to
address his memory deficits and enhance his occupational performance. Therapy services will
attention to doing, to address his memory skills and increase his ability to engage in meaningful
occupations. Approaches to therapy will include establishing new skills and modifying tasks to
overcome his memory deficits. We will also provide Client with strategies to employ external
memory strategies such as timer applications on his cell phone, shopping lists, and daily
checklists. We would also like to prevent Client from any further occupational decline such as
Scientific Evidence
cognitive strategies to address memory deficits include rehearsal, mnemonics, rote scripts,
association, imagery, elaboration, translation. In this same article, the authors also discuss the
effectiveness of list making and attention to doing. The strategies we will be using to address
Client’s memory include mnemonics, imagery, translation, list making, and attention to doing.
We chose to focus our interventions around teaching Client memory strategies based on
recommendations from this article, his results from the RBMT-3, and his personality and
interests.
We will formulate our interventions with Client based on the foundational model of
Person, Environment, and Occupation (PEO). The overarching outcome of this model is to
increase the congruence between these three areas in order to enhance the client’s
breaking down (P), the required components of the occupations that he is required to perform
every day (O), and how his environment either helps or hinders his performance (E), we can
increase his ability to engage in his desired activities. As we already have a better
understanding of Client’s current memory strengths and deficits, we can now engage in task
This theory states that change occurs through making environmental modifications to enhance
and by understanding the transaction between each of the components with one another
(CO-OP) into our treatment sessions. We felt that this was a good choice for treatment based
on the fact that this model is helpful in teaching Client how to accomplish tasks by utilizing the
GOAL-PLAN-DO-CHECK approach. This will help him develop problem solving skills, utilize
guided discovery and independence, and promote learning and generalization by providing
positive reinforcement to acquire new skills. This model states that change occurs through the
dynamic interaction between client chosen goals, performance analysis, cognitive strategy use,
The interaction between these components lead to skill acquisition, strategy use,