Date: 05/10/2024

Referral:

• OT referral was received to assess the client for a mobile hoist due to a recent deterioration in function and mobility.

Introduction:

·       Mandy is a 48-year-old woman living with her supportive partner in a rented unit.

·       Mandy lives with muscular dystrophy where she has seen rapid deterioration of her condition over the previous 12 months. As a symptom of her primary diagnosis, Mandy experiences recurrent falls and is healing from multiple lower limb fractures. Mandy also experiences depression and anxiety due to the occupational deprivation and reduced independence she faces.

Goals relevant to case study:

o   I would like to have the right supports and resources in place so I can be less of a burden on my partner

o   I would like to be more independent in self-care tasks through obtaining necessary equipment

Challenge:

Mandy up until 3 months earlier has walked with supervision small distances inside her home. Now she was required to be transported by manual wheelchair to each location in the home when required. Mandy was also no longer able to pivot transfer due to healing ankle fracture and required maximal manual handling support from her partner to sit to stand from her recliner. Mandy’s partner was becoming increasingly burdened due to his own orthopaedic issues.

OT completed a functional assessment in the home to determine level of independent capacity, main issues with access, mobility and function around the home as well as determine the gap in current support.

On observation, many issues were identified with access to the bathroom including the toilet being located too close to the wall for a commode to be positioned over it safely. This required Mandy to transfer onto the toilet from an inadequate distance, whilst risking a fall each time. Furthermore, access to the shower was not level meaning a commode could not access this space and a transfer from wheelchair to shower chair, over a shower lip, was required.

Strategy:

Based on this assessment, Mandy would seem eligible for SDA which she and her partner consented to applying for. It was decided at this time the mobile hoist application would wait until entry into the SDA was gained. This also gave OT and Mandy an opportunity to trial various options in the current home to determine what features she benefited from within the different models.  

A number of other assistive technology items were also deemed as necessary during the assessment however it was decided that the process to obtain would commence once moved into the new property.  

Once moved into the new SDA and the hoist decided upon, the electric bed and hybrid pressure mattress, as well as the shower commode trial was arranged. It was important that the equipment was compatible with the new SDA environment, which is why we waited to complete the trials until this time.

Following NDIS approval, and the items being delivered by the supplier, OT provided training on correct operation, manual handling, and positional techniques to formal supports, to ensure Mandy and support staff maintained optimal safety at all times. With a focus on pressure care, regular communication was also had between client, support staff, and OT during this time to reduce risk of pressure injury development or onset of pain due to introduction of this new piece of equipment.

As the dust settled following transition to the new SDA, OT conducted a follow-up review where Mandy reported she felt anxiety due to the number of rapid changes in her environment. Mandy also indicated low mood over the loss of independence in being able to engage freely in meaningful activities of choice. OT commenced ongoing therapy sessions with Mandy to support these mental health challenges. Examples of OT strategies included:

• Acceptance and Commitment Therapy (ACT)

• Thought management

• Grounding and relaxation

Furthermore, through exploration of meaningful activities and activity analysis, to determine how barriers to engagement could be removed, OT was able to support Mandy to return to attending live music events, pottery class, and shopping for small items in her community once again. This supported a greater quality of life for Mandy.  Other strategies such as timed voiding, as well as fatigue and pain management strategies, were also implemented to ensure community engagement was sustainable.

Outcome:

Due to relocating to the SDA and having the necessary equipment in place, Mandy was able to enjoy her relationship with her partner in the context of a loving partnership, as opposed to being that of a carer and patient. This enriched their time spent together and improved quality of life for Mandy significantly.

Mandy was able to have increased independence relating to showering and self-care following being hoisted onto her self-propelled commode. This provided a sense of control and confidence back in Mandy’s life.

Mandy demonstrated increased quality of life through the opportunity to attend meaningful activities in her community as she once was able to do. Having the person-to-person supports enabled her to have in-the-moment assistance to ensure barriers to function were eliminated as they arose. This reduced anxiety for Mandy in this community context.

Conclusion:

Follow-up consisted of:

• Development of routine to promote a sense of control over daily life.

• Regular review of task engagement to grade level of participation, with view to be whole task independent where possible.

• Ongoing goal-setting

• Ongoing regular reviews and troubleshooting issues as they arise in the interest of pressure injury prevention and pain management. This is a necessary process with the introduction of new equipment.

• Ongoing mental health assessment and ongoing use of strategies. OT also continued task analysis for upcoming community attendances as Mandy regained interest and motivation to engage in other community areas.