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Primary Deficits
constant frontal headache
stiff neck and pain radiates from between her neck to between her shoulder blades
pain in dorsum of forearms & altered sensation in fingertips
limitations in neck flexion, side flexion & rotation
tightness of upper cervical extensors, pecs, & scaleni & rhomboid weakness
paraspinal muscle spasm (> on L side)
generalized weakness on L upper extremity median nerve distribution
Previous Roles & Responsibilities
mother (has 2 young children)
wife (husband frequently out of town)
responsible for all of homemaking & child rearing tasks
responsible for looking after husband’s books on computer
*** presently having difficulty fulfilling all previous duties
Assumptions
client expressed an interest in cooking
being able to cook & take care of family is an important goal / routine in her life
deconditioned due to 8 months of broken routine
also poor balance of ADL incl, self care, productivity, leisure
problems with "pacing" and either too little activity or too much (suffers consequences later)
Goals
1) empower client such that she can take control of her pain (& her life), as opposed to pain controlling her life
2) body awareness (awareness of limits) & pacing
3) return to roles & routines
4) increased ROM and stamina
5) rearrange / adapt environment
6) good body mechanics
Adaptive Equipment
Swivel book holder with movable arm (to hold papers / recipes)
Arm support (designed to prevent arm, shoulder, and neck fatigue)
Procedure
Step 1
- look at kitchen ergonomics
- avoid excessive reaching & bending
Step 2
- physically analyzed recipes on computer
- client chooses recipe she feels is up to her level physically
- this gives indication of performance areas client is having problems with
Click here for a sample of a physically analyzed recipe
Step 3
- plan breaks such that she does not strain herself
- test limitations in terms of body mechanics
Step 4
- do the activity independently
Step 5
- client keeps a journal, indicating how she felt physically while doing the activity, problems, how satisfied she was, how she felt she could have been more effective, and if she felt she had overexerted herself.
Therapeutic Benefit
this is age-appropriate & culturally significant activity
in her role as a homemaker, cooking is an activity that is important for her and gives her a sense of accomplishment in re-establishing her normal routines
challenging physically and can be graded
helps increase ROM & stamina in neck through the activies of chopping, grating, and reading recipes. The height of the cutting surface and recipe holder can be adjusted as client becomes more comfortable with various degrees of flexion in her neck
manually washing the dishes after cooking will help her increase the ROM in her neck with respect to side to side flexion. She can begin with short time intervals (i.e. wash 3 dishes and place in dish rack) and increase the time intervals as she feels more comfortable
learning to adjust to her environment by ergonomically re-arranging kitchen and learning appropriate body mechanics
because recipes are on computer, she can slowly become used to using the computer which will be adapted to meet her physical deficits
with time, she an increase the period of time that she spends on the computer
learn skills for analyzing activities in her life in order to anticipate and gain control over the amount of pain she experiences
Grading
1. Stamina and ROM
can be graded with respect to difficulty, length of time for preparation, amount of neck flexion required for individual recipe
because there are physically analyzed recipes, she can begin with the less demanding ones in order to get used to the use of proper body mechanics
she can also test her limits and gain confidence in her abilities by beginning with less demanding activities
with time, she can move on to more challenging recipes that require more ROM and stamina
through the use of a journal, the client and therapist can keep track of improvements in physical function
2. Empowerment
client’s increasing feelings of control will be apparent to therapist as the client first independently chooses recipes from those previously analyzed by the therapist which she feels is appropriate to her level (with respect to physical demands, time required for preparation, and scheduling breaks)
when client feels ready, she then chooses unanalyzed recipes from other sources (cookbooks, internet) and analyzes the physical requirements with the help of the therapist
finally client is able to analyze recipes herself and gain confidence in her ability to analyze other activities in her life thereby not unnecessarily restricting her occupational performance
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