The client who is being analyzed is Frank, a 68-year old Caucasian male with a right cerebral vascular accident (CVA) of the internal carotid artery and left neglect. Frank also has coronary artery disease and diabetes. Frank lives with his wife, and has an out-of-town son, with whom he has a strained relationship. Frank lives in a ranch-style home in a suburban neighborhood, which has five steps to the front door and a non-connected garage. His wife brought him into the emergency room two weeks ago, when he was “complaining of an unbearable headache, with slurred speech, and loss of control on his left side” (Halloran & Lowenstein, 2000). He was admitted to an acute-care hospital where an endarterectomy was performed and he became stable. Frank then was transferred to a rehabilitation hospital for longer care.
Frank has an extensive occupational history. Throughout life, he has had a job as a postal worker, from which he recently retired. He has always been a very active man. He enjoys gardening and woodworking, both of which he cannot wait to resume. He has always been very friendly and social, especially with his neighbors. Since he has been retired, he enjoys his weekly bowling night with old friends from the post office. Frank also has done all of the home-maintenance tasks in his home. He is very eager to get back to performing his favorite hobbies at his home and traveling with his wife.
The occupations that Frank is successful at are in his social participation, especially with the staff at the rehabilitation hospital. Frank has a good sense of humor and loves to interact with others. He has no deficits in hearing or vision which allow leisure occupations, such a watching tv, traveling, and listening to music, to continue without any difficulty. The occupations that are causing problems are dressing and bathing. Frank needs the maximum assistance with dressing. He cannot “figure out the front from the back or the sleeve hole from the neck hole” (Halloran & Lowenstein, 2000). In addition, Frank neglected his whole left side while bathing and needed a lot of physical guidance and verbal cueing in order to complete the task. The areas of occupation that are at risk are his walking due to his poor balance. He only needs minimum assistance, but he has poor coordination and poor safety awareness. He will definitely need to be monitored to make sure that he does not harm himself.
One occupational-performance issue that is of concern to the client is dressing. Frank is unable to do this task due to his dressing apraxia, and his poor range of motion. Frank’s apraxia is due to his brain damage which causes the inability to complete dressing actions. Frank also “presents a weakness in his left upper extremities and lower extremities, he has poor dynamic sitting and standing balance, and his static standing balance is fair with good static sitting balance” (Halloran & Lowenstein, 2000). This compromised balance presents a challenge to getting dressed due to poor coordination and needing to sit while dressing. Regarding his range of motion, he has no active range of motion (AROM) or sensory deficits in his right upper extremities. His “coordination on his left side is also impaired for both fine and gross motor” (Halloran & Lowenstein, 2000). In addition, Frank has “moderate tone throughout the upper extremities, neck, and trunk, and mild tone in his lower extremities” (Halloran & Lowenstein, 2000). His passive range of motion (PROM) in his left upper extremity is “shoulder flexion 85°; abduction to 70°; and elbow flexion to 100°” (Halloran & Lowenstein, 2000). His AROM in his left upper extremity is “shoulder flexion/extension: 0°-50°; add/abduction: 0°-45°; internal rotation: 0°-5°; external rotation: 0°-15°; elbow flexion/extension: 0°-60°; supination: 0°-15°; pronation: Within Normal Limits (WNL); wrist extension: 0°-10°; wrist flexion 0°-45°; finger flexion: ¼ range. His finger extension is weak” (Halloran & Lowenstein, 2000). Normal ranges for the same actions are as follows: shoulder flexion: 0°-180°; shoulder extension: 0°-60°; add/abduction: 0°-180°; internal rotation: 0°-70°; external rotation: 0°-90°; elbow flexion/extension: 0°-135°; supination: 0°-90°; pronation: 0°-90°; wrist extension: 0°-70°; wrist flexion: 0°-80°; finger flexion: 0°-90°. From comparing Frank’s ranges to the normal ranges, one is able to see that Frank has very limited range of motion. This, along with his other impairments, also hinder his ability to dress.
Regarding dressing, Frank’s applicable contexts and environments are cultural, personal, temporal, physical, and social for whether they support or inhibit his performance in this occupation. Frank does not take part in any virtual contexts or environments. His cultural context and environment support him because in American culture, through rehabilitation facilities, there is a lot of care for older adults and people with disabilities. Frank has trouble dressing due to a CVA and he will be supported by the rehab staff through this struggle and not inhibited. His personal context supports his performance because he is a middle aged male who still has function of his right upper extremities. He also is a male of high socioeconomic status and is able to afford therapeutic caregivers that can help him with dressing. His temporal context and environment supports his participation and engagement in dressing due to the fact that Frank is retired. Upon his return to his home, he will not have to rush to go to work in the morning, so he can take his time with his wife getting dressed in the morning. His physical environment is supportive because he lives in a spacious ranch-home where he has enough room to dress.
A meaningful leisure occupation to Frank is gardening. Gardening involves the use of his fingers, wrists, elbows, shoulders, etc. Once Frank is able to continue this hobby, it will be an excellent activity to help regain strength, while doing something he loves. Frank cannot wait to start gardening again since he values hard work and home-grown food. He also enjoys how calming it is to be with nature and views it as a form of meditation. Overall, Frank is excited to start living life again as he did before the CVA and gardening will be one step in the right direction.