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Case Study: Functional rehabilitation

by Rachael Hargreaves

Wendy, a 46 year old mother of two, was walking along a pavement when she was struck by a motor vehicle. She sustained multiple fractures including; a fractured right tibia and fibula, a complex right glenoid fracture and bilateral rib fractures. She underwent surgery to insert an intra-medullary nail into her right fibula and to insert three pins into her fractured glenoid. Wendy was discharged home non weight bearing through her right leg and was therefore set up to live on the ground floor of her three storey property. She was reliant on her husband to assist her with strip washing and she was unable to access her bathing and toileting facilities which were situated on the second and third floor of the family home. Wendy had been provided with a commode however did not receive any follow up, once at home, from an occupational therapist. Her case manager referred her to The OT Practice for an assessment and she was seen within 4 days of receiving the referral.

During the OT assessment it was ascertained that Wendy had progressed to fully weight bearing and was mobilising with a walking stick. She had also just began to use the stairs and was managing this with one hand rail and a walking stick. Wendy expressed that her main concern was not being able to get into her bath to shower. She explained that she found stepping into the bath painful and was too frightened to attempt this without support. She had reduced range of movement in her right shoulder meaning that she was unable to use this arm to reach out and support herself when transferring into the bath, thus adding to her anxiety. Wendy’s friend had suggested that she may require major works to take the bath out and put a level access shower in, although Wendy was not keen on this idea. Furthermore, Wendy had begun to cook meals again for her family however reported that she was finding it very painful to stand for long periods in the kitchen and had to ask her husband for support, something she resented as he already worked long hours.

A functional assessment was completed and Wendy’s mobility and transfers within her home environment were explored. It was observed that Wendy was able to lift her legs into bed when in a seated position, mirroring the use of a bath board. Consequently, it was recommended that Wendy could access her bath in a seated position using a bath board. A grab rail and bath seat were also recommended to allow Wendy to either sit within the bath enclosure to shower, and/or stand in the bath using a left hand side rail. In addition, a long handled sponge was suggested to compensate for the loss of movement in her right arm and to allow Wendy to wash the parts of her body that she was unable to reach with her right hand. Furthermore, a perching stool was recommended for use in the kitchen to allow Wendy to sit and rest when preparing meals.

The OT arranged delivery of the equipment with the supplier and the fitting of the grab rail with a local contractor. As a result, Wendy was able to access her bath safely and confidently to shower independently. A follow up visit was completed by the OT to ensure that Wendy was using the bathing equipment safely. Both Wendy and the OT were very pleased with the outcome which was both cost effective and aiding Wendy to return to her previous level of independence with personal care. With regards to meal preparation, Wendy was able to reserve energy and relieve pain by using the perching stool to sit in a functional position at the work surface whilst preparing vegetables and washing up.

A difference in Wendy’s mood was observed during the follow up visit and she reported that her ability to engage in these simple activities independently had made such a huge impact on her self-esteem. In addition, she reported feeling more in control and better equipped to look after herself and her children without depending on her husband for assistance. Wendy was to continue with regular physio therapy aimed at increasing her strength and range of movement in both affected limbs and she was expected to progress back to her near baseline. It was recommended that an occupational therapy review was initiated if there were any future concerns.

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