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Functional Intervention: Dog-Care Kit

Heather Kravitz, S/OT


Neuro-musculoskeletal and Sensory Function OT 6210
Patient Chart Review

Patient Name: D.R. Evaluation Date: 3/27/17

Height: 57 Weight: 249 lbs. DOB: 1/9/17 Age: 48

Insurance Aetna Pain None Reported Allergies: Penicillin

Diagnosis: L. below the knee amputation PMH: PVD, HTN, HLD, DVT, DM Type II, Renal
transplant in 2010, LLE ischemia, glaucoma,
legally blind, R. macular degeneration,
peripheral angioplasty in 2013

Precautions: Fall risk Diet Fluids


ADA Thin
Cardiac Nectar thick
Renal Honey thick
Regular Pudding thick
Pureed NPO
Mechanical Soft
NPO
Prior Level of Function: disabled; pt needed help Psychosocial/ Family Situation: pt is
with ADLs and some mobility; pt could ambulate in divorced, lives with parents, and is retired for
house but had limited community mobility; pt had disability
assistance from mother and home health RN

Home set up: DME Owned:


House/ apartment Ambulatory Device: WC, wheeled
1 story/ 2 story walker, rollator
Steps to enter: 0 (ramp access into house) AE:
Bathroom equipment: shower chair,
1st floor bed and bath w/ tub shower bedside commode, shower grab bar
Leisure/ Hobbies/ Interests: ADL and IADL Performance: Patients stated goals:
Reading, playing w/ dog Pt needs help w/ self-care & To go home
indoor mobility; pt is
dependent when going
up/down stairs; LE dressing is
mod I.

Transfers Ambulation Wheelchair Wheelchair cushion


Min A./ contact guard Min A./contact guard Standard WC Standard cushion
assist assist

Postural assessment N/A Sitting Balance Standing Balance


Pelvis: Static= good Static= poor
Spine: Dynamic= good Dynamic= poor
Scapula:
Vision N/A Cognition
Pursuits: A&O x2
Saccades: Follows: multiple step directions
Visual Fields: STM: independent
Left Right LTM: independent
Routine Problem Solving: independent
Complex Problem Solving: independent
Functional Intervention Occupational Therapy Kit Description

Impairment Kit Addresses Community mobility, UE ROM, fine motor control, problem
solving, working memory
Itemized list of contents in kit - 1 bowl
- 3 dog collars
- 1 zip lock bag of blue marbles
- 1 plastic container of blue marbles
- 1 zip lock bag of beads
- 10 plastic cups
- 1 dog leash
- 2 dry erase markers
- 8 piece measuring set
- 1 picture of a clock
- 1 daily/weekly planner (front & back)

Pictures of all components of kit

Instructions for use of kit


The therapist can choose which tasks to delegate depending on
the impairment he/she is addressing (cognitive or physical).
The therapist can read the description of the scenario to the
patient, and the patient will have to complete the scenario. It
will be based on the therapists judgement how to grade the
activities (suggestions given below) in order to find the just
right challenge for the patient. When you are finished using
the kit, wipe all of the supplies clean.

Examples of intervention 1. Scenario # 1- It is time to feed your dog. Retrieve


activities all of the necessary supplies in order to do so.
Supplies can be dispersed around room (high and
low locations). Scoop the appropriate amount of
food into the bowl. The patient can continue to
practice scooping and pouring food into bowl.

2. Scenario # 2- Your dog eats 2 cups of hard food at


breakfast and 2 cups at dinner. Given different
sized measuring cups, fill the food bowl with 2
cups of food. Therapist can decide which
measuring utensil they want to give the patient i.e. a
c spoon.

3. Scenario # 3- You feed your dog twice a day, once


for breakfast and once for dinner. You just fed your
dog breakfast at 8:00 a.m., and need to feed them
dinner 10 hours later. Draw on this clock the time
when you would feed them dinner. (Different
times can be used)

4. Have the patient schedule out a typical day for


them, hour by hour, including when they need to
feed their dog, bathe the dog, walk the dog, etc.

5. Practice fastener management by opening and


closing the collars and attaching a leash to it. If
possible, patient can practice putting the collar on
one of the therapy dogs at Dodd and practice
community mobility while walking the dog outside
(with therapists supervision).
How kit can be graded for low 1. (Scenario #1) In order to grade the activity down,
and high level patients can place all supplies in one area, within reach of
the patient. If the patient cannot grasp the small
handle of the cup, use a bigger cup to change the
grasp. If the marbles are too heavy, can be replaced
with lighter beads. In order to grade the activity
up, supplies can be dispersed in challenging
locations all over the therapy gym (really
challenging their balance). The activity can also be
graded up by having the patient wear wrist
weights while scooping and pouring the food.
The container that the food is stored in can also be
adjusted depending on the patients fine motor
skills (for example, if patient has good fine motor
control, use a zip lock baggie or Tupperware).

2. (Scenario #2) In order to grade the activity down,


you can use bigger cups (i.e. 1 cup, cup), or just
tell the patient to put 2 scoops of food in the
bowl. In order to grade the activity up, smaller
cups can be used (i.e. 1/4cup) requiring the patient
to add more scoops. In addition, this activity can be
graded up by being in a noisy environment, or
made easier by taking away any distraction.

3. (Scenario #3) In order to grade the activity down,


perform in a quiet room away from distractions.
The patient can also be given the specific time to
write, telling them you have to feed the dog at
6:00 p.m., draw that time on the clock. If the
patient cannot write, they can say the answer out
loud and the therapist can write it down. In order
to grade the activity up, perform the activity in a
busy, loud environment or ask the patient to
answer the question while performing another
task. You can also give complex problems such as
You feed your dog twice a day, once for breakfast
and once for dinner. You just fed your dog
breakfast at 8:00 a.m., and need to feed them
dinner 10 hours later. After work, you need to go
to the post office and pick up 3 items from the
grocery store. What time should you be home to
feed your dog dinner? This will cause the patient
to use higher-level thinking and pick out the
important information needed to solve the
problem. This can also be a nice prompt to begin
working on time management and scheduling.

4. (Scheduling/time management) This activity can


be graded up or down depending on how many
verbal cues are given to the patient to fill out their
schedule in its entirety. In addition, if the patient is
unable to write, the therapist can write their
answers down for them.

5. (Fastener management) A larger collar can be used


to grade the activity down, because it is easier to
manipulate. Using a smaller collar will grade the
activity up, challenging the patients fine motor
skills. If the patient is able to take the dog for a
walk, you can set up challenges for the patient to
navigate around with the dog instead of just
following a straight path. (For example, take the
patient on uneven terrain, through doors, up an
elevator, etc.)

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