Occupational Therapy Case Studies: Patient Assessment & Techniques

This document presents three occupational therapy case scenarios, detailing patient assessment, intervention techniques, and interview strategies. The first case involves an elderly patient in an acute medical ward, focusing on safe transfer techniques using slide sheets and initial patient interviews. The second scenario addresses an Asian woman recovering from a stroke, exploring techniques for sitting up in bed, moving to a chair, and lateral transfers, along with culturally sensitive interview questions. The third case involves a young Maori man with a spinal injury, outlining techniques for transferring from bed to a wheelchair, emphasizing the importance of preventing musculoskeletal injuries, and discussing the patient's rehabilitation and self-care. The document emphasizes patient dignity, cultural awareness, and the application of appropriate techniques to enhance patient mobility and well-being. The document includes references to relevant literature to support the techniques.

Running head: OCCUPATIONAL THERAPY
OCCUPATIONAL THERAPY
Name of the Student
Name of the university
Author’s note

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Case scenario 1
Introduction of self- After positioning the patient up the bed, the interview should be initiated
with the introduction of the occupational therapist to the patient with warm greetings. After
establishing a rapport with the patient, the occupational therapist might enquire about any type of
physical difficulties that the patient is facing.
L- An elderly patient
I- The occupational therapist.
T- Pulling the patient up from the edge of the bed.
E- An acute medical ward
The techniques and the reason
Sliding sheets are useful in turning the patient or moving up the bed or providing bed
bath to the client. The slide sheets work by reducing the friction and hence less force is required
for moving the clients.
The techniques initiates with placing of the slide sheet, grabbing the end of the slide sheet
for pulling the patient.
Moving and handling techniques
The body of a patient may slide when the person is in bed for a long time. While pulling
up the patient to the bed, an occupational theorist should assess the patient medically before

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trying an attempt to lift him/ her. Verbal prompts should be carried out with the person before
assisting the person to get up or before lifting the person. It should be remembered that the goal
is to pull up the patient and not lift (Kennedy et al., 2012).
Placing of the slide sheet
It is necessary to place a bed sheet between the slide sheet and the skin to reduce the
friction between the skin and the slide sheet and thus maintain the skin integrity.
It is necessary to keep the edges of the slide sheet to the edge of the bed as a guide.
In case the bed is large then larger slide sheets are recommended.
The clients should be rolled to their sides pulling and straightening the sheet on the other side. It
is recommended to keep a pillow or a soft support to prevent the patient from banging their head.
Removing the slide sheet
The slide sheet has to be removed after the patient has been moved up. While removing it the
slide sheets should be tucked to from one side and then the bottom sheet is removed first from
the other side. The slide sheets have to be applied beneath with the buttocks up as the thighs will
not be in contact with the loose mattress. It should be ensured that the client foot are not in the
bed linin. The patient’s ankle should be held firmly for anchoring the feet to the mattress. The
client should be asked to push upwards by using their feet, ensuring that their buttocks are not
lifted from the bed.
The slide sheets should be grabbed at the upper back and hips of the patient on the side of
the bed. Putting one leg forward the weight should be given on the back leg and on the count of

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three the occupational therapist should full the sheets towards the head of the bed. The whole
thing should be repeated unless the person gets the right position.
Initial interview with Mr. White
Mr. White is 83 year old New Zealand European elderly patient. Care should be taken while
interacting, to maintain the dignity of the patient. It has to be understood that Mr. White’s
hearing disability and physical burden is withdrawing him from social interaction with his
friends. Due to which the patient might feel depressed hence it is necessary to provide a
conducing environment before the interview.
The following questions can be asked in the interview-
 How are you feeling currently Mr. White?
 How much are you having difficulty in hearing me?
 Do you face difficulties to do your daily chores?
 Are you having difficulties in walking?
 Are you bale to maintain your personal hygiene?
 Do you face difficulties while bending?
After the conduction of the interview the therapist can educate the patient or the patient’s
family with some physiotherapies that can be practiced at home.


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Case scenario 2
Introduction of self
The therapist should exchange some greetings with the Asian women. The therapist should be
culturally aware before interacting the patient and verbal consent should be taken while handling
the women.
L- An Asian woman
I- The occupational therapist.
T- Helping the patient to sit up and then lifting her in to the nearby chair.
E- Community rehabilitation or stroke.
The technique and the reason
The said technique can be useful as it would avoid any unwanted muscular strain to pull the
patient up in the bed. Patient surviving from stroke often have weakness on one side of the body
or have difficulty in movement. The below mentioned techniques are some of the novel
approaches to move the patient.
Techniques to sitting up in bed
Initially the client will be helped to raise her head that would help the therapist of raising
her upper body such that they are resting on the elbows and the lower arm. Their hands should be

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place flat bedside their hips on the bed. Their rams can be used to push themselves up in a sitting
position (Kennedy et al., 2012).
Apart from this several kinds of aids can be used to help out Mrs. Wong to sit up in bed
like the bed levers, bed blocks or the overhead poles (Kennedy et al., 2012).
In case Mrs. Wong does not have enough upper limb support or balance in the upper portion of
the body, then she can be immobilized by hip itching, where the clients are assisted to walk up
the bed on their buttocks.
At first the patient has to be asked to sit up in bed. Then Mrs. Wong should be asked to
close her hands to fists behind their hips. She will be helped to push herself up in the bed with
the help of her heels. In this technique hand blocks can be used (Kennedy et al., 2012).
Techniques to move the patient at the edge of the bed
While helping out the client to sit at the edge of the bed the client should be assisted in
bending her knees. Following that she should be assisted in rolling on to her sides by turning the
head in the direction of the roll, rotating the bend knees in the direction of the roll by placing the
arms across the chest.
The client should be helped to use her hand and the elbow for pushing up and lowering
the legs on the floor. A slide sheet can be used for patients for bringing their feet at the edge of
the bed. In case Mrs. Wong faces severe difficulties while mobilization, a bed lever can be used
to pull them up in the sitting position (Corbetta et al., 2012). In case of an electric bed the head
of the bed can be raised automatically without causing any pain to the client.

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Transfer from the edge of the bed to a chair
In this case there has been a lateral transfers where the patient has to be moved from one
sitting position to the other. Before using any techniques risk assessment should be done before
moving out the patient. Wheel chairs or general chairs with movable armrests can be used for
positioning the patient (Hung et al., 2014).
At first the surface to which the client has to be moved should be at right angle to the
position of the client.
The client should get hold of armrest of the chair and position her arms on the bed and
the hand flat on the floor. The patient should lean forward, placing their leading foot in the
direction in which they are moving (Hung et al., 2014). The client should push up through their
arms and their legs and then moved across to sit in the chair. Mrs. Wong may also find it easier
to stand erect and then transfer to a walker.
Interview with Mrs. Wong
Mr. Wong is an Asian woman and hence the therapist might face problems in communicating
with the patient. The therapist should assure the patient in a culturally safe way.
Interview questions:-
 How are you feeling Mrs. Wong?
 Can you understand my language?
 Do you ace difficulties while moving your left arm and legs?
 Do you have pain while moving them? How much can you rate your pain?
 Do you face difficulty in maintaining your personal hygiene?
 What kind of difficulty do you face?

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 Do you feel pain on bending?
 Do you maintain your medications regularly?
In this case the patient can be taught to divide the complex task in to simple task and then
encourage the patient to perform the entire task. Therapists can help out the patients in
identifying the functional change such as the installation of the grab bars in the bathroom such
that it becomes easier for the patients to mobilize.


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Case Scenario 3
Introduction of self
The therapist should enter the room with consent of the patient, would greet him before
transferring him to the wheelchair. The OT would be able to engage in communication in a
language that is comprehensible to the patient.
L- A 19 year old Maori man
I- The occupational therapist.
T- Helping the patient to sit up and then moving him in to a wheelchair.
E- A spinal unit
Rationale for choosing the movement techniques
The below mentioned technique would provide less strain on the already existing
musculoskeletal injury. Awkward positions may further deteriorate the condition and may case
unwanted pain.
Techniques of transferring from bed to wheel chair
Transferring a patient from the bed to wheelchair requires specific techniques to prevent falls or
musculoskeletal injury in patients. Furthermore the carer can also be at risk of musculoskeletal
injuries, sprains or strains to the back, shoulder, necks, legs, knees and arms due to high weight
lifting or awkward postures, fast movement or uneven loading (Nas et al., 2012).

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This case scenario helps the transfer of the Manaaki, in the wheel chair from the edge of
the bed. In such a case a walker can be useful for Manaaki to get transferred to the wheelchair.
The walking frame has to be kept directly in front of the patient. It should be made sure that the
chair is raised to level of 90 degree with the bed (Nas et al., 2012). The patient should be asked
to position themselves with her arms on the armrest of the walker and her feet spread flat on the
floor. The patient should be asked to lean forward towards the walker. The patient stands with
the help of the walking frame supported by the caregiver. The patient then moves to the chair
while holding to the walking frame. The patient is positioned before the chair. The client sits
down placing the hands on the arm rest. The client is then assisted to sit down in the chair with
the help of the care giver and the walker.
There are few things that has to be considered, such as positioning of the seat or the
furniture or the wheelchair such that there is enough space for both the patient and the caregiver
and such that the carer can be at the side of the client all the time.
Furthermore, care should be taken about the clothing as clothing can get arrested and may
cause fall. While transferring Manaaki, care should be taken such that the brakes are on and the
footplates are removed.
Interview with Manaaki
 How are you feeling Manaaki?
 Are you facing difficulty in maintaining your balance?
 Can you grade your pain?
Manaaki can be taught by the OT to do self-care, dressing, hygiene, grooming, toileting,
learning the wheel chair postures, strengthening, stretching, tenodesis training, fine motor

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activities, desensitization and training about visual perception (Waters & Rockefeller, 2010).
The OT can educate the patients regarding the setting up of a wheel chair accessible
bedroom. The patient can be taught about the arm circles and the neck roles, wrist roles and
the door stretch. Manaaki should be addressed in a culturally safe way.

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References
Corbetta, D., Sirtori, V., Moja, P. L., & Gatti, R. (2010). Constraint-induced movement therapy
in stroke patients: systematic review and meta-analysis. European journal of physical
and rehabilitation medicine, 46(4), 537-544.
Hung, J. W., Chou, C. X., Hsieh, Y. W., Wu, W. C., Yu, M. Y., Chen, P. C., ... & Ding, S. E.
(2014). Randomized comparison trial of balance training by using exergaming and
conventional weight-shift therapy in patients with chronic stroke. Archives of physical
medicine and rehabilitation, 95(9), 1629-1637.
Kennedy, C. A., Amick III, B. C., Dennerlein, J. T., Brewer, S., Catli, S., Williams, R., ... &
Franzblau, A. (2010). Systematic review of the role of occupational health and safety
interventions in the prevention of upper extremity musculoskeletal symptoms, signs,
disorders, injuries, claims and lost time. Journal of occupational rehabilitation, 20(2),
127-162.
Nas, K., Yazmalar, L., Şah, V., Aydın, A., & Öneş, K. (2015). Rehabilitation of spinal cord
injuries. World journal of orthopedics, 6(1), 8.
Waters, T. R., & Rockefeller, K. (2010). Safe patient handling for rehabilitation professionals.
Rehabilitation Nursing, 35(5), 216-222.