Chapter 18 Case Study

Chapter 18
Case Study

Introductory Scenario

Kajuan is a 26-year-old male who sustained a closed head injury 4 months ago. He is currently receiving home health care OT, PT, and SLP services. You are the OTA that has been working with him on UE strengthening, coordination, self-care skills, cognition, and higher level IADLs. He has been progressing since beginning home health care 1 month ago. He is currently at a Rancho Los Amigos level of 7 – Automatic-Appropriate level of responses, with minimal assistance needed for higher level executive functioning such as budgeting, anticipating safety issues, etc.

Kajuan has progressed well and is becoming more verbal regarding his future goals. He wishes to return to work as warehouse supervisor as soon as possible, where he drives the commercial vehicles and the forklifts, among many other duties.

Multiple Choice

Referral to a driving specialist may be appropriate for Kajuan at this time; however, the OTA must collaborate with the supervising OT on a multitude of factors – all of which attempt to ensure safety for Kajuan and the public. Which of the following factors have been identified as client factors needed for safe driving?

• Physical/Sensory, cognitive. emotional regulation, insight

• Fine motor skills, endurance, strength, and cognition

• Sensory Regulation, gross motor skills, cognition, vision

• Sensation, fine motor skills, cognition, visual perception

Multiple Choice

The supervising occupational therapist thinks that Kajuan is unsafe to drive. What is the next best option for Kajuan at this time?

• Discontinue working on visual-perceptual skills

• Have Kajuan play an online driving game to see how he does

• Refer Kajuan to a driving specialist for an assessment when appropriate

• Refer Kajuan to the local DMV to take his driving test again

Functional History

Kajuan is a pleasant and cooperative male who is currently living with his father after his CHI from MVA over 4 months ago. He is doing well and progressing; however, he continues to have some cognitive dysfunction, which is preventing him from returning to his own apartment. Kajuan has some RUE weakness and diminished FM skills and uses his LUE as dominant at this time. Prior to his injury, he enjoyed fishing, fixing up his car, and watching football.

Multiple Choice

As Kajuan continues his home health OT while awaiting his evaluation for driving, which of the following activities has the same underlying components of the skills needed for driving and the BEST option for assessment?

• Donning a shirt and fastening buttons

• Making a hot meal in the kitchen

• Walking and following an obstacle course map around the neighborhood

• Folding Laundry

Evaluation and Goals

Evaluation and Goals

Goals: 

1. Client will make a hot meal consisting of 4 or more steps with supervision in 6 weeks.

2. Client will demonstrate improved cognitive function by planning and executing a budgeting activity for 1 month independently in 6 weeks.

Multiple Choice

What issues below, which Kajuan currently faces, will be the most impactful on his ability to drive?

• Functional AROM of RUE

• Sitting and standing balance issues

• Activity and frustration tolerance

• Problem solving, attention, and judgement

Multiple Choice

Which of the following activities is safe for Kajuan to participate in to improve his reaction time and responses to environmental stimuli in preparation for returning to driving?

• Playing solitaire on the computer

• Playing video games and the Wii

• Playing football in the park

• Playing a word game in his quiet room