Contraindications / Precautions for Treatment: Activity orders should always be clarified with MD if not documented in OT order or activity section of MD orders Refer to the Neuroscience Precautions and Considerations for Rehabilitation Services handout. (See Appendix I) Examination: Medical History: previous medical/surgical history especially previous neurological events and treatment, baseline physical and cognitive status History of Present Illness: series of events leading to hospitalization, date of onset, date of admission (to OSH, BWH), neurologic diagnostic procedures, patient complaints/symptoms, neurology/neurosurgery exam and assessment, and current or planned treatment Medications: various pharmacological agents may include anticonvulsants, diuretics, antihypertensives, thrombolytics, anticoagulants, and pain controlling agents. Side effects are associated with above medications and may resemble neurological symptoms including confusion, sedation, movement disorders, weakness, dizziness, headache, and neuropathy. It is important to determine medical status and relationship to functional presentation to determine if behavior or altered status is medicated related.
Motor skills (physical): Posture Mobility Coordination Strength and effort Energy Process skills (cognitive): Energy Knowledge Temporal organization Organizing space and objects Adaptation Interaction skills (communication): Physicality Information exchange Relations Evaluation / Assessment: Establish Diagnosis and Need for Skilled Services A patient with neurological symptoms associated with a brain lesion resulting in impairments or dysfunction altering his or her baseline functional status will benefit from a skilled occupational therapy assessment and intervention.
Prognosis Predicted level of improvement post OT intervention is for the patient to return to maximal level of performance in areas of occupation and to resume performance patterns in appropriate environmental context within 1-12 months. Prognosis is highly dependent on the anatomical location and size of the lesion, neuro-recovery, co-morbidities, complications, secondary impairments, occupational context and activity demands. Goals Individual, specific, measurable, patient-directed goals with parameters and time frames are established to guide and reflect the effectiveness of intervention planning, as well as document patient progress. Goals reflect 1-6 week time frame and are designed to/may include: Maximize performance, participation in areas of occupation Maximize performance skills and patient factors to remedy/modify/prevent impairment Re-establish or modify performance patterns as result of disability Modify or promote context to maximize occupational performance
Treatment Planning / Interventions Established Pathway Established Protocol _X_ Yes, see attached. ___ Yes, see attached ___ No _X_ No
Remediation/restoration of performance skills, performance patterns and patient factors (body functions, body structures) when impairment results in declined functional performance. Modify/compensate/adapt context, activity demands and performance patterns for maximal occupational performance when the lesion results in patient factors that are not likely to change or performance skills that are not likely to improve. Prevent decline in performance skills, performance patterns, patient factors in a case of a small or uncomplicated lesion with good predicted outcome.
Frequency & Duration Frequency of treatment is dependent on the assessment and intensity required to achieve reasonable goals and activity level, minimize impairments and occupational dysfunction, and prevent further impairment and/or dysfunction. Duration of treatment is dependent on patient factors, participation level, and demands to produce the desired outcome for intervention.