Topic: Assessment Case Study

Richard is a 56 year old man. He has a medical history of high blood pressure & type 2 diabetes. Richard is overweight and describes himself as a social drinker and smoker. A year ago Richard had a left sided stroke. Following his acute admission to hospital, he underwent 6 weeks of inpatient rehabilitation followed by 3 months of outpatient therapy.
At his 12 month review with his rehabilitation specialist, a referral to the community occupational therapy service was recommended for community access and participation. The rehabilitation specialist initiated the referral and advised that Richard has mild right hemiparesis, mild right sided neglect, moderate dysphasia & some executive functioning impairments.
Richard lives with his wife and 2 adolescent sons, aged 15 and 17. They live in their own, single storey home in Granville. His wife is very supportive and wants to do everything possible to support her husband in his recovery. In addition to supporting Richard, she is currently completing all of the domestic ADL’s (i.e. shopping, cooking & housework) and providing the majority of assistance to their two sons (i.e. schoolsupport, taking them to sport and providing transport to their eldest son who works casually). She also works 3 days per week.
Since completing his outpatient rehabilitation program he has predominantly stayed home. Richard is mostly independent with his self-care however does still receive some minimal assistance from his wife with showering and dressing in the morning. He is able to eat meals independently, which his wife has pre-prepared. Richard is able to mobilise independently with a walking stick around the house. He has mobilised short distances (500m) when he has gone to the local shopping centre with his wife on a few occasions . When fatigued, he sometimes bumps into things on his right side. He also has some residual right upper limb weakness (i.e. affecting fine motor abilities). His wife also reports that he sometimes forgets his appointments and to take his medication.
Richard feels frustrated and depressed by being so reliant on his wife and having to rely on her to drive him everywhere. He is also upset that he has not been able to be involved with his sons’ sport and leisure activities since he has had his stroke. For many years, Richard was on the committee of their sons’ soccer club. Richard would also like to resume the task of obtaining the weekly family groceries.
Richard also feels socially isolated as he and his wife have not socialised with their extended family and friends very much since he had the stroke. Initially their family and friends were concerned and sympathetic and visited him in hospital and at home a few times. In recent months, they have not visited as much. Richard and his wife used to enjoy going out to dinner, going to large sporting events, and going out to see live shows and concerts occasionally.
Prior to his stroke, Richard worked as a senior accountant for a company in the city. He used to drive to/from the local train station and catch the train to/from work. Richard is currently on extended leave however is keen to return to work. Richard is concerned about how he will financially support his family once his paid leave runs out. His employer has indicated that they are supportive of his return to work.
As the community occupational therapist, you received the referral from the rehabilitation specialist requesting occupational therapy assessment and interventions to facilitate Richard’s community access and participation.
In preparation for conducting the initial community occupational therapy assessment, prepare the following assessment portfolio (2,500 word limit):
1. Research the following terms related to stroke, provide a definition of the following terms and describe how they may impact on Richard’s community occupational performance. This may be presented in a table format.
a. Left sided stroke
b. Right neglect
c. Right hemiplegia
d. Dysphasia
e. Executive functioning
2. Develop a 2 page occupational therapy initial assessment guideline/form
intended to guide your initial meeting with Richard & ensure you collect all the relevant information. Use an occupational therapy model/framework as a basis for your assessment form and provide justification as to why you selected this model/framework and how it is appropriate for a community based occupational therapy assessment. Present this as blank initial assessment form that you would complete when you conduct the initial interview with Richard.
3. Prepare a 1-2 page handout to give to Richard at the initial assessment. The handout should provide Richard with 5 information sources or services that may assist with his self-management post stroke. Provide a brief description of each source/service, contact details/links and indicate why they may be useful to Richard.
4. Identify 3 types of environments in which Richard carries out his community occupations. From your own knowledge of these types of environments, describe the potential barriers or enablers to his community performance & participation in these 3 environments. This may be presented in table format.
Choose one of the environments (identified above). Locate a similar environment in your local area and complete a community access audit using the SPACES (Systematic Pedestrian and Cycling Environment Scan) Instrument (The University of Western Australia, n.d. Retrieved from http://www.cpah.health.usyd.edu.au/pdfs/2007_SPACES_Audit_Instrument.pdf) .
The SPACES instrument can be downloaded from:

http://www.cpah.health.usyd.edu.au/pdfs/2007_SPACES_Audit_Instrument.pdf

The SPACES observer’s manual can be downloaded from

http://www.cpah.health.usyd.edu.au/pdfs/2007_SPACES_Observers_Manual.pdf

Include the completed SPACES instrument as an appendix to your assessment (please note: this will not be included in the word count).
Identify 3 potential issues that Richard may encounter if he were to access this environment & explain why they may be an issue for Richard.

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