Jane was involved in a motor vehicle accident (MVA) approximately eight months ago. This accident resulted in cervical strain. From this she has experienced constant frontal headaches which are aggravated with everyday activities, such as driving and reading. Jane has limitations in neck flexion, side flexion, neck rotation, and has generalized weakness in the left upper extremity median nerve distribution. These are the physical problems which resulted from the motor vehicle accident. Socially, there are also primary concerns. Since the MVA, Jane has been unable to be involved in leisure activities with her children and by herself. She has also been unable to work and perform her homemaking activities. These problems have caused Jane to become extremely frustrated and we, as therapists, have decided to use painting therapeutically to help her vent her "pent-up" energy.
The assumptions that have been made with regards to Jane are as follows:
Jane will begin painting on an easel that has been set up so that her head (for the most part) will remain in anatomical position. Initially, we will try to eliminate any need for neck flexion, side flexion, and rotation. To do this Jane will start with a smaller sized canvas so that it will not be necessary for a lot of movement to occur at her neck. Jane will also use a palette for her paint colors which will be held in her non- dominant hand. There is generalized weakness in her left upper extremity, but the palette is light weight and will not cause fatigue. The palette can be placed down or in a resting position between the use of colors. By using the palette Jane will be able to bring the colors into her area of vision rather than unnecessarily having to move her head and neck to find the colors. This will discourage her fatigue and prevent the onset of pain. There will be the option for Jane to either sit or stand, depending on what she feels more comfortable doing. The easel will be adjustable, so it easily can be moved up or down with respect to Jane's comfort level and stage of therapy. This is very important because the mobility of the easel is directly related to the grading of the activity which will be discussed shortly.
Prior to the initiation of therapy, the therapetic goals and the methods of grading will be discussed with Jane. This will allow the therapists to grade the activity without Jane actually knowing exactly when it is being done. To grade this activity there are a few alternatives. The size of the canvas can be increased. This will encourage Jane to move her neck in order to fill the canvas more readily. The height of the easel will be able to be adapted. Moving the easel down in small increments will encourage Jane to increase the amount of flexion and extension taking place at her neck because it will be required she look down to the bottom of the easel. The supplies (ie: paintbrushes and paint) will be placed at a lower level and off to alternating sides, aiding Jane in neck flexion and rotation. These will be brief movements, therefore minimizing fatigue and pain in her neck.
Socially, this activity will be very important to Jane. She has felt frustrated with her inability to perform certain tasks due to her injury (ie: unable to do her husbands books, homemaking tasks). Jane will be able to set up an easel in her home which would allow her to include painting as a leisure activity that she would be able to participate in with her children. This activity could also be used by Jane alone to help her to eleviate stress at home. This activity will allow Jane to feel useful and competent as she has completed a task. Jane will have a tangible result of what she has accomplished. There is also the option of Jane joining an art group after the completion of her therapy that will allow her to have a leisure activity which she enjoys and will encourage social networking.