Running head: PATIENT SYNTHESIS PAPER

Salt Lake Community College

Occupational Therapy Assistant Program
OTA 1170
Phys Dys Fieldwork I
Annette Bergesen
Fall Semester 2014
Patient Synthesis Paper

PATIENT SYNTHESIS PAPER

My fieldwork I experience was at Jordan Valley Hospital in the inpatient and outpatient
rehab unit, as well as at the Jordan Valley Hospital West Campus, formerly known as Pioneer
Valley Hospital. The facilities I volunteered at were rehabilitation units where patients come for
treatments in the outpatient clinic, or the inpatients rehab unit for the more acute patients that are
in the hospital. My supervisor was Cheryl Woodard, and I was able to observe her for 34 hours
between September 9th and October 22nd. (9/19, 9/26, 10/2, 10/10, 10/15, 10/22.) I spent most of
my time at Jordan Valley Hospital in the inpatient and outpatient rehab. The acute wing of the
hospital has 62 beds, and in the inpatient rehab there are 10 beds. There are 2 occupational
therapists and 1occupational therapy assistance, and my fieldwork supervisor treats around 6
patients per day depending on what the census is between the 3 facilities. The patients range in
age from mid-teens to late eighties, and the majority of the time the biomechanical frame of
reference and the cognitive model is used.
The client Im focusing on for this report is a 72 year old male who is being treated in the
Jordan Valley Hospital outpatient rehab. He has been diagnosed with a right CVA with left
hemiparesis. He also has a preexisting condition of diabetes, hypertension, increased cholesterol,
and he recently strained his back.
The clients functional deficits due to his stroke are poor balance, decreased strength,
impaired functional mobility, and he has kinesthesia and proprioception impairments. He has
moderate impairment in memory, cognitive reasoning skills, and decreased left visual scanning.
He has decreased fine motor skills, for example, he has difficulty picking up flat small objects,
and he has increased difficulty with large gross motor skills. The client has decreased upper
extremity coordination, and his non-dominant upper extremity is affected. He does not use his
affected extremity spontaneously but has to think about it and be reminded.

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The client is an average height, slim, 72 year old male of Latino heritage. He has steel
gray hair, brown eyes, and wears glasses. He also uses a single point cane to help him ambulate
and for balance. He is very friendly with a warm happy personality and he is very eager and
motivated to complete all his treatment sessions. He is retired from working at Kennecott copper
mine for many years, and he is a married and has grown children that live nearby.
The clients many deficits put him at risk for injury and falls, especially during higher
level tasks such as IADLs, so his long term goal is to remain in the community without injury or
incident and to return to his prior level of functioning. He was active prior to the stroke and he
was independent in ADLs and IADLs so his short term goals are to improve upper coordination
by 25%, improve upper extremity strength and endurance to allow for 10 minutes of activity
without getting tired. He also set goals to improve his left vision scanning without assistance of
verbal cues 75% of the time, and to complete simple problem solving tasks without assistance of
verbal cues.
The treatment plan for the client is to work on cognitive skills, visual skills, IADL
training, therapeutic activities, and neuromuscular re-education. The treatment sessions I
observed consisted of preparatory exercises, using the biomechanical frame of reference, on the
arm bike to increase his strength and endurance. He did co-contractions to his shoulder girdle up
against the wall to increase stabilization and proprioceptive input so he could complete more
difficult bilateral and cross midline activities right after that preparatory activity. The client
enjoys playing cards and often would do so with his friends before the CVA, so we played cards
in a more dynamic way. The therapist had him sitting with his legs crossed on a mattress with an
additional square foam block to sit on to make it more dynamic. The stack of cards were placed
on the left side of his body so he had to visually left scan to pick them up, then he had to reach

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across midline with his right hand to put them down on the right side into my outstretched raised
hand.
This remedial activity addressed many of the clients deficits by using many different
sensory inputs. By sitting on the foam block, it became more dynamic and helped with his
balance, kinesthesia, and ROM.
He also used bilateral integration as he had to use both hands, and he had to cross midline
to both pick up and place the cards, and it also addressed the left visual scanning problems by
having the cards on the left side so he had to look that way. Playing cards focused on his
cognitive impairments because he had to remember and use reasoning skills so he could
strategically put down the right cards. He was also using fine motor skills because he had to use
a small pinch to pick up the flat cards.
In another game the client participated in cognitive remediation activities doing simple
abstract math. This was more challenging for him and he required many more verbal cues and he
became a bit more frustrated with his inability to solve the problems. The client has expressed a
wish to be able to drive again, but his judgment and cognitive skills are not sufficient to be able
to do that yet, and he might never be able to drive due to the effects of the stroke.
The client is very eager to his best in all the treatment sessions and he follows through on
his home exercise program. He is very grateful for the help he is receiving because he recognizes
the improvements he has made. He has a very supporting wife and a large circle of friends whom
he spends a lot of time with paying cards and socializing. Before the stroke he was going to the
gym to work out on a regular basis and he enjoyed working in his yard.
When the client was discharged from the hospital, he went home with a shower chair,
which he says he is not using, and a single point cane for ambulation. He indicates that things are

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going really well at home, but at times his balance is not as good. His home has a few stairs in
the entryway as well as stairs going into the basement.
In conclusion, this was a good experience for me. I had a very skilled fieldwork
supervisor that taught me many things. I do realize that I know so very little about the
occupational therapy field and I have a lot to learn. I did become frustrated with my lack of
knowledge and confidence in the area of physical disabilities, and that made me more nervous
than I should have been. I have not spent any time really in a hospital setting, and Im not so sure
that I would like to work in that setting in the future. However I thoroughly enjoyed working
with the clients that I had the chance to see, and it was great to be able to see the progress that
they made from week to week.

PATIENT SYNTHESIS PAPER