A Closomat Case Study
This case study is written using the Person, Environment, Occupation (PEO) occupational therapy model (1996). Law et al developed the person, environment, occupation model as a response to an identified need of occupational therapy, which describes the theory and application of the interaction between the person (P), their environment (E) and the occupation (O) . The model gives a defined framework to enable Occupational Therapists to concisely clinically reason their intervention.
The following case study will therefore be presented using PEO (Person, environment and Occupation) model to support reflection and clinical reasoning processes.
Chris is an 82 year old gentleman who recently suffered a left Partial Anterior Circulatory Stroke (PACS) leaving him with unilateral left sided upper and lower limb weakness and a homonymous hemianopia (a visual field loss of the same side of each eye, in this case the right side).
During his recovery Chris has progressed from being mechanically hoisted and is now able to transfer using a non-mechanised stand aid that allows him to remain in a perched position during the transfer.
Chris is right hand dominant and is therefore having to learn new ways of completing tasks with his left hand using educational, compensatory and adaptive approaches.
Chris lives with his 78 year old wife who has Parkinson’s disease and carers in her own right. They own their bungalow which has no internal steps and despite a narrow hallway provides sufficient turning circle for transport on a mobile aid.
Their bathroom is large enough to accommodate the stand-aid and a wheelchair with space for carers to support completion of tasks as required.
Chris accepts that he requires support with some tasks but has set goals that reflect his wish to remain as independent as possible within critical daily tasks whilst maintaining his dignity.
Once the task has been set up Chris can wash his top half from the perched position and is learning to shave using an electric razor with his left hand. This position and ability has been transferred to simple kitchen tasks where he is demonstrating an ability to make his own hot drink with only minor changes to kitchen layout. Although this still requires someone to transport him and the drink from A to B Chris hopes that in the near future, with motorised seating and further kitchen adaptations, he will be less reliant on care and able to manage at least in between calls.
One of the tasks Chris is having difficulty with despite attempts to adopt new techniques is personal hygiene post-bowel movement. His slightly reduced dynamic core sitting balance, particularly with lateral movements due to right sided weakness, combined with loss of dominant hand had made the task very difficult leaving Chris either unclean or requiring assistance which he found undignified.
Chris’ Occupational Therapist, who was involved to support functional re-ablement, moving and handling and equipment provision, accepted that the goal to support independent post-toilet hygiene may only be met with an adaptive approach. If the effort was reduced in completing the task the Occupational Therapist also felt that this would support independence in other elements of the daily routine.It was therefore suggested that Chris would benefit from a wash/dry toilet system such as the Closomat Palma Vita. This product was recommended specifically due to its unique one touch control option, operated by the left elbow in this instance, but ultimately ensuring that sitting balance was not compromised.
The Occupational Therapist also considered that if Chris’ condition were to deteriorate in the future, accessories such as the lateral body supports and the touch sensitive switch could be added to maintain use and independence making it effective and efficient in the long-term.
To ensure that the installation was appropriate and to support the DFG application the Occupational Therapist requested a site survey and demo which was carried out within 5 days and subsequent quote was received within 48 hours of this visit.
The Occupational Therapist felt that the Palma Vita was necessary and appropriate with the DFG grants officer agreeing that it was reasonable and practical.
The total cost came in well under the £5000 threshold;
• Palma Vita is £2,660
• Installation of £510
• Annual service plan £195
This allowed the proposed adaptation to be fast-tracked by the local authority with no required means testing. Approval therefore was granted within 6 weeks and once Closomat were informed the installation was carried out within 5 days.
Chris was delighted with the result, feeling that he was starting to gain some control over the most personal elements of his care with dignity. The energy Chris saved allowed him to engage in other elements of functional rehabilitation, maximising his independence without compromise.
The OT Service