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Running head: ARTHROGRYPOSIS A CASE STUDY

Arthrogryposis a Case Study


Galileo Basilio, Kristin Caroza, Ayessa Escandar, Danielle Palmer, Jennifer Unck, & Mallory
Viveros
Touro University of Nevada

ARTHROGRYPOSIS A CASE STUDY

Arthrogryposis is a neuromuscular disorder that is present at birth and the cause is


unknown. A primary characteristic of this disease is contractures of the body (Rogers, 2010).
Linda, the client, has contractures in both her upper and lower limbs. She is able to walk slowly,
but the intense contractures in her arms affect her occupational performance.
Occupational Performance
Linda is a high school junior who participates in many occupational areas throughout her
day. Under activities of daily living (ADLs), Linda is able to dress independently but only selects
clothing without any fasteners and that are easy to put on. Linda is able to transition from one
activity to the next but moves and walks very slowly. Under instrumental activities of daily
living (IADLs), Linda is able to transition from different tasks but her family is worried that if
she goes to a large college she will have limited mobility in her new community (AOTA, 2014).
Under rest and sleep, Linda is having no trouble preparing herself for bed and sleeps the entire
night. Her mother makes sure she goes to bed early in order to get plenty of sleep for the next
day. Under education, Linda is attending high school and she works on the newspaper staff. She
aspires to further her education and go to college (AOTA, 2014). Under the occupation of work,
Linda is exploring the career field of a journalism. She is starting to think about and apply to
colleges to pursue her career as a journalist. Under the occupation of play, Linda is thinking
about going to her schools formal dance with some of her friends. Under leisure, Linda loves to
look through teen fashion magazines. For social participation, Linda is very close with her family
and her two older brothers. She also likes spending time with her friends in and outside of school
(AOTA, 2014).

ARTHROGRYPOSIS A CASE STUDY

Movement/motor control, Postural Reactions, Reflexes and/or Tone


Linda displays limited range of motion in her upper extremities. Due to her multiple
deformities, Linda is slow to walk but is independent in her transitions. Linda shows some
postural control during ambulation. Although, walking is difficult for her and it does affect her
posture. She bears weight through her legs and can weight shift while controlling her movements
when walking. Although Linda has postural control, her lack of movements in other areas affect
her everyday activities. Linda impairments requires her to use hand splints because she has
limited fine motor control that prevents isolated finger movements. Linda is inflexible in her
hand movements, she does not have the control to type, write, or do the activities which are
important to her.
Self-Regulation
Self-regulation is a multifaceted process that involves an individual directing their
behavior to attain a self-established goal. Self-regulation is dependent on feedback from areas
such as, cognitive, motivational and behavioral systems (Clearly & Zimmerman, 2004).
Although, Linda is motivated to succeed and plans to go to college, there are many obstacles in
which she must overcome presently and in the future. Currently, she is unable to meet the
deadlines set by her school newspaper and this will eventually become frustrating for Linda. In
order to prevent behavioral issues, the OT may implement strategies such as teaching Linda to
set performance goals when engaging in a functional task. By having Linda set obtainable goals
for herself each day, she is decreasing her chances of displaying negative behavior. In addition to
setting attainable goals, the OT could implement a self-performance record log displaying
progressions with tasks throughout the day (Clearly & Zimmerman, 2004). Currently, Linda is
unable to wear the clothes she wants because of her disorder; however, by recording effective

ARTHROGRYPOSIS A CASE STUDY

and ineffective dressing strategies in a performance log will assist in establishing appropriate
strategies, as well as promote positive reinforcement. Both of these strategies will enhance
Lindas self-regulation capabilities and decrease her chances of engaging in negative behavior.
PEOP Model
The Person-Environment-Occupation-Performance (PEOP) model can be used to help
Linda participate and enhance her performance in occupations through the goodness of fit
between their intrinsic factors and external environment (Brown, 2014). According to the PEOP
model, the person component involves looking at Linda holistically by exploring all of her
psychological, physiological, cognitive, spiritual, and neurobehavioral factors. For Linda, it is
important to emphasize that her role as an adolescent involves developing a self-concept of her
values and hopes for the future as well as prioritizing relationships with their peers (Vroman,
2010). Linda is a bright and psychologically healthy teenager who is motivated to have all of the
life experiences as her typical peers. She wants to be able to go to dances with her friends, write
for the school newspaper, dress in fashionable clothing, and attend college someday. However,
Lindas intrinsic factors are heavily weighed down by her arthrogryposis which affects her ability
to participate in her desired occupations.
Although Linda is able to use her arms, her arthrogryposis impacts her ability to use her
hands for meaningful activities. This impacts her role as a student because being able to write is
essential for her education. Meeting deadlines for the school paper and completing school
assignments is problematic because she can neither write nor type in a proficient manner.
According to the PEOP model, this indicates a dissension between her environment and intrinsic
factors. Although Linda is a very intelligent teenager and has the cognitive ability similar to her
peers, the tools available for her makes school much more challenging because she is unable to

ARTHROGRYPOSIS A CASE STUDY

physically document her thoughts and knowledge. Lindas inability to dress in fashionable
clothes or use fasteners hinders her occupation of self-care as well, causing occupational
performance dysfunction.
Fortunately, Lindas social environment includes a very supportive family and school
staff that want to see her become successful in her education and accomplish personal goals of
writing for the school paper and attending college. The PEOP model emphasizes that
occupational performance will increase when a persons environment is adapted to their
abilities. Physical environmental modifications include using voice recognition text will allow a
faster method of documentation and allow her to make deadlines for the school newspaper.
Therefore, she can turn in assignments without the need of an extension from her
teachers. Through the PEOP model, Linda may use environmental modifications and
compensatory strategies to develop a sense of independence and self-efficacy through mastery of
her occupations (Vroman, 2010). By using the PEOP model in self-care, writing, and mobility
she will have a better goodness of fit in her occupational performance.
Frames of Reference
Linda would benefit best from occupational therapy by using compensatory, cognitive
theory, and biomechanical frames of references (FOR). Each of these FOR assess a different
aspect of Lindas disorder, and each are important for function. Linda will get her greatest
functional performance possible when used these FOR cohesively.
The compensatory FOR is best suitable for addressing Lindas use of adaptive equipment,
as well as completing ADLs or IADLs at school and home. Implementation of this FOR allows
the occupational therapist to modify an activity by replacing or alternating different movement
patterns, using adaptive equipment, or adjusting the task and environment to match the childs

ARTHROGRYPOSIS A CASE STUDY

current ability levels (Shepherd, 2010). For instance, using adaptive equipment or manipulating
the physical environment will make it easier for an individual to perform everyday occupations.
Linda is currently pursuing a journalism career and finds it difficult to engage in this meaningful
activity because of her limited range of motion (ROM) while typing. From a compensatory point
of view, the occupational therapist may introduce novel movement patterns to Linda so that she
can engage in journalism via use of an iPad and stylus. (Shepherd, 2010). In addition, the
physical environment itself could be modified by creating a workstation that allows for easy
accessibility and better utilization of computer access. If Lindas team (i.e. teacher, occupational
therapist, counselor) continues to introduce information simplistically, build upon past
information via grading, and encompasses all of her senses then the compensatory FOR will be
used at an optimal level (Schneck, 2010).
In conjunction with the compensatory FOR, Linda would benefit from biomechanical
FOR. The biomechanical FOR is implemented to evaluate and or increase an individuals
strength, endurance and ROM (Exner, 2010). Arthrogryposis is presented in many forms and is
described as congenital contractures affecting multiple areas of the body. No matter the form, the
goal of treatment is to mobilize the joints, increase coordination of movements and address any
musculoskeletal issues (Bamshad, Van Heest, & Pleasure, 2009). In relation to Linda, she has the
ability to use both arms but has difficulty using isolated finger movements due to her
arthrogryposis. The reason the biomechanical FOR is suited for Linda and her impairments
within hand skill development is it allows occupational therapist to address grasping pattern
deficits, as well as examine the relationship between the intrinsic and extrinsic muscles involved
in the hand. Implementation of the biomechanical FOR will addresses the issue of limited
movement patterns by implementing ROM, either active or passive. With arthrogryposis, joint

ARTHROGRYPOSIS A CASE STUDY

stiffness is a result of abnormal connective tissue being built around a joint and based on this
information, Linda would benefit from both active and passive ROM (Ferguson & Wainwright,
2013). Having the occupational therapist passively move Lindas hands will ultimately improve
her engagement in ADLs such as dressing. It will address fine motor activities within therapy and
increase success in using adaptive equipment (AE) with dressing. By having Linda actively
participate in ROM of her lower extremities, the therapist is facilitating activation of gross
muscles. This can help with flexibility and help her enjoy activities like going to her schools
formal dance. Linda is independent in her walking and transitions, but by implementing weight
bearing activities such as standing flat footed can improve her endurance. It can help maintain
independency within her lower extremities as well (Ferguson & Wainwright, 2013). As
mentioned earlier, Linda is able to dress independently, but she is limited to sweat clothes
because of her joint contractures. By implementing a daily exercise regimen that targets
functional activities such as dressing can improve her pre-existing independence, as well as
increase her overall endurance.
The last FOR that would be suitable for Linda and her arthrogryposis is the cognitive
orientation to daily occupational performance (CO-OP). This FOR utilizes the role of cognition,
to allow an individual to acquire new occupational skills, while improving on pre-existing skills
in order to develop occupational competency (Polatajko et al., 2001). Linda is best suited for this
FOR as she is cognitively able and motivated to complete a functional task, but needs
incorporation of additional cognitive strategies to enhance occupational performance.
Completion of school newspaper assignments has become difficult for Linda due to her physical
limitation. The implementation of assisted technology (i.e. word prediction) has been put in place
to enhance efficiency. The caveat with word prediction is it also takes time to choose from a

ARTHROGRYPOSIS A CASE STUDY

word bank. In order for Linda to receive the most functional use from adapted technology,
suggesting voice recognition would be most appropriate. Voice recognition software requires
decreased amount of motor output, while increasing cognitive functioning. With the use of voice
recognition, Linda can now complete task in a more efficient manner and can continue to pursue
an occupation she loves. Thus, assigning Linda to the fashion editorial will allow her to engage
in a meaningful occupation, while improving effectiveness within voice recognition. She will be
able to express words in which she is familiar with due to her reading of fashion magazines. In
addition, the CO-OP could be used to address Lindas community mobility as she is cognitively
able to acquire new occupational skills, while improving on pre-existing. This FOR will assist
her on mapping out her route to the bus stop so that she can further gain access to other
occupations such as grocery shopping. Furthermore, this FOR will allow her to gain the skills
needed to be mobile when she goes to college.
CAPE/PAC Assessment
One of Lindas central tasks as an adolescent is to form a sense of identity. This is a
complex process as it involves an active exploration of her interests as well as a perspective of
her values and goals. Linda may have a more difficult time developing her self-identity
compared to her typical peers because of her arthrogryposis. Teenagers with disabilities face the
extra challenge of forming a healthy self-concept without being defined by their debility
(Vroman, 2010). Occupational Therapists can facilitate a healthy adolescent development by
accentuating the unique qualities of their personality and interests.
Identifying Lindas interests and hobbies and using it throughout her intervention is a
great way for occupational therapists intrinsically motivate her during treatment. The Childrens
Assessment of Participation and Enjoyment & Preferences for Activities in Children

ARTHROGRYPOSIS A CASE STUDY

(CAPE/PAC) is a tool that practitioners can use to document the activities that Linda participates
in (King et al., 2004). It is designed for individuals ranging from 5-21 years old and assesses
their engagement in 14 formal and 35 informal activities. This assessment measures individuals
by the diverse amount of activities they participate in and the intensity of their engagement in
it. Among these activities, the CAPE/PAC also assesses their enjoyment of it and their
participation preference including where and with whom (King et al., 2004).
The CAPE/PAC is a tool that can help practitioners establish rapport with Linda because
it provides information that is client centered. Linda is a motivated teenager who is interested in
many activities just like her typical peers. Using the CAPE/PAC will help occupational therapists
develop an approach in therapy that utilizes her interests in various play and leisure activities as
well as where, how, and with whom she enjoys it the most.
COPM Assessment
Linda who is a junior in high school, is in a stage of her life where increase
independence, school participation, and community activities are of importance to her. Linda,
expresses these interests by being involved in school activities and showing her need of
independence by stating her interests in attending college. Although, due to Lindas disability, it
is more difficult for her to attain her goals in comparison to other teenagers. During Lindas
occupational therapy sessions it is important to focus on identifying and prioritizing her everyday
issues that restrict her from achieving her goals.
The Canadian Occupational Performance Measure (COPM) is an assessment tool that
serves to identify issues of personal importance of a client and detects changes of performance
and satisfaction over time (COPM, n.d.). The COPM would be another great tool to use on
Linda, because it will only focus on occupational activities that are important to her and address

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performance issues within those activities as a means of intervention goals. The COPM uses a
unique, individualized approach in assessing a client, it is found to be intrinsically motivating in
accomplishing goals.
The COPM is a form that consists of five steps when assessing a clients occupational
performance measure. The first step of the COPM is to define the problem, such as having Linda
identify daily occupations that are important to her, however unable to accomplish. After Linda
identifies significant occupational problems, she then rates the importance of each occupation
based on a 10-point scale where 1 is the least important and 10 is the most. Next, Linda will
choose up to five of the most important problems identified in step two. The top five problems
identified by Linda will then serve as a basis of intervention goals. In step four, Linda will be
asked to rate her own level of performance and satisfaction with the occupations she has
identified using a 10 point scale. The final step is the client reassessment; where Linda is
reassessed at the completion of the intervention to self-rate her performance and satisfaction for
the problems that were addressed during therapy. Through these various steps, the therapists then
uses the following scores to calculate Lindas satisfaction and performance changes over time
(COPM, n.d.).
Functional Problem Statements
1. The client requires community mobility assistance in order to attend a large college
due to lower limb contractures and muscle weakness.
2. The client is unable to wear clothes that include fasteners due to the lack of joint
mobility in her fingers.
3. The client is unable to complete journal assignments on a timely manner due to her
poor fine motor skills.

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4. The client requires assistive devices in handwriting and typing due to limited range of
motion in her upper extremity.
5. The client requires maximal assistance to take notes in class due to her physical
impairment that prevents isolated finger movements.
Family, Caregiver, and Childs Goals
Although Linda displays functional problems, her condition does not stop her from
attaining her goals. As a teenager in high school, one of Lindas goals it to be able to attend a
large college with a football team. She is driven and motivated to accomplish this goal by doing
well in school and by participating in all school activities even though it is difficult for her to do
so. However, Lindas plan to attend college has brought some concern to her family regarding
her abilities to manage community mobility. Therefore, a goal the family would like Linda to
achieve is to attain community mobility skills such as the ability to use public transportation.
Another goal Linda would like to attain is to be able to wear clothes that require
fasteners, such as gaining the skills to be able to button and zip clothing. Linda has demonstrated
her interest in fashion by spending much of her time looking through fashion magazines.
However, Linda is unable to wear garments that require button and zippers due to her difficulties
in her fine motor skills. Therefore, Linda must resort to wearing clothing that require minimal
effort, such as wearing sweatpants.
Lastly, Linda has also expressed her goal in becoming a journalist. Linda has chosen to
participate in her schools newspaper, however has found it difficult to turn in assignments on
time due to her physical limitations. Due to her physical limitations, specifically in her fine
motor skills, Linda has agreed to work with an occupational therapist to find modifications that
will help her improve word processing skills. Therefore, the occupational therapists goal for

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Linda is to be able to have her successfully use the voice recognition software so that she may
continue participating in her schools newspaper.
1. Lindas family would like to see her gain community mobility skills once she goes to
college.
2. Linda would like to gain compensatory skills that will allow her to be able to attend a
large college.
3. Linda would like to wear clothes that are fashionable which require the use of
fasteners, such as buttons and zippers.
4. Linda wants to continue participating in her schools newspaper so that she may attain
her ultimate goal of becoming a journalist.
5. Lindas occupational therapist would like her to be able to successfully use the voice
recognition software so that she can continue to participate in her schools newspaper.
Occupational Therapy Goals
With the family and childs goals in mind, both long term goals and short term goals have
been developed. The long term goals are set to be achieved within a year, and successful
completion of the short terms goals will be achieved within six months.
Goal 1: By the last semester of the school year, Linda will independently navigate and ride the
public transportation system from school to home.
Objective 1A: Linda will research bus routes, schedules, and connections for community
mobility to and from: school, home, and the grocery store by using her adaptive keyboard
and touch screen tablet.
Activity I: Map Retrieval: This activity will use Lindas tablet, cell phone, Transit app,
and an adaptive stylus pen to actively work on Lindas knowledge of the public

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transportation system and ability to use these electronic devices to locate bus routes and
be able to navigate in the community.
Activity II: Locating the Bus Stop: This activity will be done outside the clinic and will
work on safety awareness by walking to the bus stop, being aware of the walking meter
signals, and identifying the location of crosswalks in order to cross the street in a safe
manner.
Objective 1B: Linda will ride the bus from school to home with parent supervision and
minimal assistance from her parent.
Activity I: Getting on the Bus: Linda will step onto the bus and locate a seat on the bus.
This activity will improve Lindas ability to navigate around narrow spaces, and help her
identify when it is safe to enter the bus. Identifying when the bus is at a complete stop,
when the entrance is safe to enter, and locating an appropriate seat will allow Linda to be
familiar with the logistic of public transportation.
Activity II: Planning out what is necessary to ride the bus including: bus fare,
identifying stops, and knowledge of departure times. This activity will teach Linda to
manage her money and bus account, work on notifying the bus driver when her stop is
approaching, and help with time management so she arrives at the bus stop on time.
Goal 2: By the end of Lindas junior year of high school Linda will independently take notes for
each class using an audio transcriber and independently typing additional notes on her adaptive
keyboard.
Objective 2A: Linda will turn in a school newspaper column by the due date completed
independently with help of an adaptive keyboard and audio transcriber.

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Activity I: Interview: Linda will conduct a mock interview asking ten questions while
recording the audio on her iPhone and tape recorder. Linda will practice using the audio
transcriber (Dragon Speech app) and sending the transcription via email. Linda will then
download the transcription, and type in her personal notes. This activity will improve
Lindas time management, note taking, and typing skills.
Activity II: Typing Exercise: The therapist will dictate the newspaper article, while
Linda writes and transcribes what it said. Linda will also activate the audio recorder to
help support her note taking. This activity will improve Lindas typing skills to meet her
needs for school. Linda will also gain confidence knowing she is actively part of the
writing process.
Objective 2B: Linda will have a personal fashion blog up and running and will update it
bimonthly.
Activity I: Research Activity: Navigating through different websites to know what to put
on the blog. This will help Linda research current fashion trends, favorite designers, and
clothing brands. Searching the internet will help increase her proficiency of conducting
research.
Activity II: Social Media Activity: Set up a fashion social media account (Twitter,
Facebook, Instagram, or Pinterest). Blogging will allow her to formulate her own identity,
thus giving her a voice at all times and creating availability to her audiences at every
moment of the day
Goal 3: In a year, Linda will independently dress herself in a professional outfit (e.g. skirt, dress,
pants, and buttoned blouse) with the assistance of AE.

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Objective 3A: Linda will independently plan and prepare a complete outfit including pants, tshirt, and a jacket from her closet within 15 minutes.
Activity I: Retrieving the Outfit: Linda will open the clothing drawer and pull out pants,
then grab and pull off a blouse from the closet rod. This activity will work on Lindas
grasp and ability to hold on to clothing.
Activity II: Linda will put on the clothes independently without zipping and buttoning.
This activity will allow Linda to dress herself with complete independence, and be able
to get ready for the rest of the day.
Objective 3B: Linda will put on a blouse and pants with moderate assistance by using button
hooks and zipper pulls.
Activity I: Putting on Jeans: Linda will practice using the zipper pull to aid in zipping up
the jeans after they are pulled to her waist. Linda will be able to wear more fashionable
clothing as she prefers, increasing her confidence at school.
Activity II: Putting on a Blouse: Linda will practice putting on a blouse with use of a
button hook. This activity will work on Lindas ability to independently pull her upper
extremities through the sleeves, and button up the entire blouse with aid from the button
hook.
Environmental Setting
The treatment session will take place at an outpatient center. Linda will come into the
outpatient center once a week to receive her occupational therapy. The goals will be focused on
dressing, community mobility, and the use of voice recognition software. The therapist will work
on the goals with Linda during her session but will also ask her to practice her skills throughout
her daily life.

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Collaboration with the Client and Significant Others


To collaborate with the client and significant others in order to continue and modify the
intervention, the therapist would need to build a strong relationship with Linda and her family.
Linda and her family are very close and it is important that the therapist build a therapeutic
relationship with them. Specifically, the therapist needs to talk with Linda and her family, and
build a trusting relationship. The therapist needs to communicate with the family throughout the
process and really listen to what Linda and her family want from therapy in order for the
intervention to be meaningful to them. The therapist should set up meetings with Linda and
family and also be open to communication through notebooks and email. The therapist should
also encourage Linda to practice her developing skills throughout her daily routine.
SOAP Note
S: Client was ready and eager to start the session. She stated that she was excited for OT today.
She kept a positive attitude throughout the session and was pleasant to work with. Client had
frustrating moments when making errors with audio transcriber.
O: Client participated in a 45 minute session at Pineview Outpatient Clinic. The treatment
focused on self-dressing, and independently audio transcribing to complete a deadline for the
schools newspaper. Client put on a button up shirt and buttoned the shirt using an adaptive
button hook with Mod A. Client required verbal cues and minimal HOH assistance to facilitate
the button hook. Client exhibited decreased isolated finger movements but used problem solving
skills to manipulate clothing to complete the activity. During the word processing activity, client
was able to voice record one page of an article with Mod errors and 5 breaks. Client was able to
transcribe a paragraph without making an error, but had difficulty fixing mistakes when errors
were made. Client had difficulty going back when she made errors with the voice recorder.

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A: Client exhibited problems with self-dressing which limits her ability to function
independently with harder level of clothing. Client demonstrated errors while audio transcribing
which limits her ability to perform school responsibilities. Client transcribed a paragraph without
errors which shows progress from prior sessions. Client showed potential when demonstrated
problem solving skills to correct the errors that were made during voice recording. Client will
benefit from skilled OT services to perform ADLs independently with AE, and to make Min
errors during voice transcribing.
P: Continuation of OT services once a week for 45 minutes. Plan to decrease amount of errors
with voice recording. Client will continue to participate in dressing activities to improve
independence with AE. Plan to implement a zipper pull into the next session. Plan to
communicate with parent to encourage client to use AE at home.
Post-discharge Environment/Specific Recommendations
Post discharge Linda will remain in school and continue to work on recommendations
given to her by the occupational therapist. An alarm system is recommended for Linda, to help
her keep a schedule and to stay on top of the due dates. This is will allow Linda to continue on
track with newspaper deadlines, blog updates, and school assignments. We recommend that she
puts her schedule into a calendar on her iPad. By doing this she can receives reminders that are
emailed and also alarms that will pop up on the screen. She can determine how far in advance
she wants to be notified and the calendar will automatically remind her. This will help Linda be
more efficient and will increase her ability to time manage her responsibilities and occupations.
A yoga class would also be a recommendation that could be beneficial for Linda. Yoga is
a great activity that would allow Linda to stretch out her muscles and help keep them loose for
her everyday activity. It is also a good source of exercise. Yoga classes can be found throughout

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the community, offering different levels of difficulty. This would allow Linda to go at her own
speed and do only what she is able to do. Yoga is an activity she can perform on her own or with
friends. Incorporating yoga into Lindas schedule to help stretch out her tight muscles would be
very beneficial to her health.
Articles
Part of our intervention for Linda is to be able to teach her how to dress in clothes with
fasteners independently using dressing devices. In a related study, older adults were given
assistive technology in dressing and bathing to increase their independence and determine
whether or not they were satisfied using them (Schemm & Gitlin, 1998). The study consisted of
86 patients and 19 occupational therapist who provided training on assistive devices.
Specifically, the participants received an average of 3 dressing devices for home use, such as
dressing sticks, reachers, and adaptive shoe laces (Schemm & Gitlin, 1998). The results of the
study demonstrated that the use of dressing devices increased their satisfaction during dressing
routine and they would most likely implement the use every day at home (Schemm & Gitlin,
1998). Therefore, we would like to implement the use of assistive technology in dressing for
Linda, to increase her satisfaction during her dressing routine while empowering her to wear
clothes that she likes instead of clothes that are convenient.
Linda aspires to attend college after graduating, therefore she will need to participate in
community mobility. A study related to community mobility looks at the importance of getting a
client to be optimally mobile beyond the hallways of their home or school. The study included
100 participants who actively use assistive technology to help facilitate mobility in their home
and community (Layton, 2012). The research indicates accessible public transportation networks
are a big factor for influencing ones likelihood to engage in community mobility (Layton, 2012).

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Therefore, we chose to teach Linda how to participate in community mobility activities such as:
accessing the bus stop, getting on and off the bus safely, and navigating throughout the
community.
As Linda progresses in her education, she would benefit from using a voice recognition
software for word processing because it is necessary for her to document her work efficiently in
order to keep up with a heavier curriculum. Related researched found that students with
disabilities were able to greatly increase their fluency and length of their writing with the use of
voice recognition software (Garret et al., 2011). However, the words transcribed was on average
72.6% accurate using voice recognition compared to 93.9% for regular typing methods. Garret et
al. (2011) emphasized the importance of the students ability to produce more of their thoughts
and the need for more research as technology advances.

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