Inside the O'Briens

Joseph O’Brien

DOB: 07/15/1973

Date of Visit: 04/15/2018

Occupational Profile

	Reason the client is seeking OT services and concerns related to engagement in occupations (may include the client’s general health status)	The client was diagnosed with Huntington’s Disease. He has been having trouble walking, finding the motivation to participate in everyday activities, has chorea and agnosia, and had to retire and misses being a police officer
	Occupations in which the client is successful and barriers or potential barriers to his/her success in those occupations (p. S5)	Roles: former police officer, father, husband, son, Red Sox fan Occupations: walking, going to yoga with daughter, spending time with family and friends, eating sleeping, going to church Barriers: chorea and agnosia limits ability to walk by himself without falling and ability to use a gun and work on the police force, muscle weakness has limited ability to support himself
	Personal interests and values (p. S7)	Walking, spending time with family, watching Boston sports, yoga, Christian
	The client’s occupational history/life experiences	Roles/responsibilities: teaching family how to live with HD, grooming, bathing, yoga classes, spending time with friends and family Environmental/contextual: lives with four kids, wife, daughter-in-law, and grandson in a 3-story house, PT and speech clinics are on first floor, walking around house, and along walking paths outside of therapists offices History: was diagnosed with HD a year ago due to falls and outbursts, since client has had PT and speech therapy, had to retire from police force due to uncontrollable chorea, now spends most of his time at home or at yoga with daughter
	Performance patterns (routines, habits, & rituals) – what are the client’s patterns of engagement in occupations and how have they changed over time? What are the client’s daily life roles? Note patterns that support and hinder occupational performance. (p. S8)	DAY TIMELINE 9:30 am- wake up 10 years ago, emotional stability started to change and became irregular 10:00 am- get out of bed A little over a year ago, Joe was diagnosed with HD due to falls, dropped objects, and outbursts 10-10:30- shower Since then, client has developed chorea which continues to worsen, agnosia so he does not even recognize his chorea, instability has worsened, and outbursts have become more severe and violent 10:30-11:00- get dressed 11-12:00- watch TV 12:00-12:30- eat lunch 12:30- drive to PT 1-2:00- Physical therapy 2-3:00- Speech therapy 3-3:30- drive to yoga studio 3:30-4:30- yoga 4:30-5:00- walk with daughter 5-5:30- drive home 5:30-6:00- eat dinner with family 6-9:00- watch Red Sox 9:00- go to bed
	Aspects of the client’s environments or contexts, as viewed by the client (p. S28)	Supports to Occupational Engagement:	Barriers to Occupational Engagement:
	Physical	Room and living room is on first floor of house, therapists’ offices are on first floor of building, safe neighborhood for walking, yoga studio is one-story	Uneven walkways may induce more falling, house is 3-stories, any object in house may lead to a fall, any free standing objects may end up falling and breaking due to chorea
	Social	Family and friends are very supportive and helpful. They make sure to keep client from feeling too embarrassed in public	N/a
	Cultural	Goes to church typically every day after mass to pray for 5-10 minutes	Being a HD patient requires having to go to multiple appointments (medical, physical therapy, speech therapy, etc.) requiring a lot of physical exertion and can be exhausting mentally and physically
	Personal	44-year-old man, father, feels blessed to spend time with his children, wife, and family all together	Father who has lost motivation to do anything other than sit and watch TV
	Temporal	Does not work, so has plenty of time during the day to participate in activities	Inconsistent sleeping pattern due to constant paranoid thoughts and body will not rest
	Virtual	Uses telephone to double check that wife and kids are safe when paranoia sets in	Checks on his wife hundreds of times a day because paranoia is constant
	Client’s priorities and desired target outcomes (consider occupational performance – improvement and enhancement, prevention, participation, role competence, health & wellness, quality of life, well-being, and/or occupational justice) (p. S34)	Determine strategies to promote motivation to do more than sit and watch TV during the day, minimize the acceleration of HD, keep the independence he has to perform ADLs, learning coping with HD, paranoia, and mood swings

In the book “Inside the O’Briens”, readers get an insight on what goes in to the diagnosis of Huntington’s Disease. It shows the symptoms before a diagnosis and what happens physically and mentally after a diagnosis. It also shows the toll a diagnosis can take on a family.

While reading this book, I started to be afraid that I had HD. It shows how scary it can be and how it can sneak up on these individuals if they don’t realize they have the gene or may have the gene. I can understand how the paranoia can really be debilitating on these individuals. If someone does not know if they have the gene, but their parent does, any little common mess-up would make you feel like you have HD. From tripping on an uneven parking lot to accidentally dropping a cup or having a muscle spasm, the thought would paralyze you that you have the gene. I also did a case study on HD, and it is really upsetting to see the toll that a family member’s diagnosis can take on the family members. Even if they know that they will not get HD, seeing someone you love die in such an unflattering way is devastating.

After reading this book, I think I have a much better understanding and respect for what the family members are dealing with when someone they love is diagnosed with HD. I think that if I ever come in contact with a client who has HD, I will be sure to check on the physical and mental health of not only the client but the client’s family. I think I will be ready to tackle the symptoms of HD and understand how the client is feeling about it all. Chorea can be embarrassing and as a therapist, I will remember to affirm to my clients that there is no need to be embarrassed about their symptoms and make sure they feel like they are respected and not looked down upon.

Multiple Sclerosis

I recently watched a YouTube video entitled “Multiple Sclerosis- Breea’s Story”. I chose this video because I actually have a friend from high school who was diagnosed with MS and I unfortunately never really learned what it was. Her symptoms were not as severe at Breea’s and now she has it well maintained with medication. The video followed an 18-year-old former cheerleader’s journey of recovery after her diagnosis of MS. Within 24 hours, Breea went from a high school cheerleader ready to graduate to completely paralyzed on her left side, blind in her left eye, and unable to swallow or speak. She was then diagnosed with severe onset of Multiple Sclerosis and spent over a month in the hospital working with many different therapists. After watching this, I decided to follow Breea on social media to continue to see her progress and to keep getting educated on MS and the side effects that it can bring that someone may never think of.

I think that what I really took from this was a better understanding of what MS is. I knew it was a terrible disease, but because my only experience with it was not very severe, I just figured that most cases were like my friend’s. As a future occupational therapist, it was really cool to see Breea getting back to doing what she originally wanted to. When in the hospital, her therapists took her bowling, made Toaster Strudels, and her parents took her to the beach. By month 8, at home, Breea was beginning to start some basic gymnastics again which is something that was really important to her and she hopes to be able to cheer again one day. Breea’s story is very inspiring for anyone who has paralysis on one side. She showed a resilience and motivation to get back t what was meaningful to her and return to her high school, go to prom, and graduate. Breea said in the video that there is “no time to waste, life can change so suddenly” which is sadly so true. I think a lot of time, I get so focused on my future and what I have to do to prepare for it that I forget to enjoy the now when really, tomorrow is not guaranteed. Breea actually wrote in her college admissions essay that she cannot live her life feeling sorry for herself, because that will not heal her. This should make most people take a step back from their lives, realize how blessed they are, and stop feeling so sorry for themselves. Everyone is going through something hard, we just have to keep pushing through the hard times to get to the good. I would highly recommend watching this video to anyone who needs a little motivation or to someone who does not know a lot about the side effects of Multiple Sclerosis.

B. (2012, September 08). Multiple Sclerosis-Breea's Story.wmv. Retrieved from https://www.youtube.com/watch?v=hfD9s1_TN0s

Guillain Barre' Syndrome

This TED Talk was from a man who was diagnosed with Guillain Barre' syndrome when he was 17 years old and hospitalized for 4 months. This is an autoimmune disease that attacks the myelin sheath on your body’s nerves which make them unable to transmit nerve impulses or messages. Because of his nerves being attacked, this man was unable to move or swallow and his breathing was limited which eventually led to him being put on a ventilator along with a feeding tube. This video really made me appreciate all my little victories I have never thought about as a blessing such as being able to dress myself, walking at my high school graduation, or just sitting up and getting out of bed every morning. He talked about how he was one of the only patients on his floor (mainly for spinal cord injuries) that would ever walk again. He also said that the sensation of breathing through his nose for the first time without the ventilator was one of the best sensations of his entire life. He also mentioned his rehab team multiple times. He stated that his rehab team (he specifically mentioned OT) made him become himself again and one thing that really meant a lot for him and he took as a little victory to getting back to being himself was just being able to play the Wii in his room one day.

After watching this video, I think I am going to start appreciating what I have more often. He stated that you never truly learn gratitude for something so little until you can’t do it anymore. I think it is super important to reflect on all the blessings we have. Right now, going through grad school is HARD. Often times I think about how hard I have it, but realistically I am one of the most blessed people on this planet. I am pursuing a career I absolutely love, I am healthy, and I am surrounded by an amazing support system of faculty and peers. When I think of all that I have and then compare it so someone like this man giving the TED Talk or the hundreds of kids in the hospitals just in Memphis, all those pity thoughts for myself go away. I remember that its because of this career that I get to help those individuals going through the darkest days of their lives and make them a little brighter.

https://www.youtube.com/watch?v=pzmx6bZXRHo

OT Theory: Motor Skill Acquisition

The theory I chose was "Frame of Reference for Motor Skill Acquisition". This theory is designed for children and adolescents. The main idea behind this theory is that learning how to participate in an activity varies greatly depending on the activity. There is a continuum of tasks ranging from closed (tasks that involved environments that don't require much movement such as brushing your teeth) to open tasks (tasks that take place in an environments that require movement such as a baseball game). This theory focuses on the child's ability, characteristics of the task, skills required, environment, and regulatory conditions (aspects of the environment that determine movement specifics). A child who would be considered "functional" in this theory would be a child who is able to self-evaluate to meet the different requirements of each task based on the context and function of the task. An OT may be measuring the child's ability to perform in a certain environment, and possibly modify an environment for the child to enhance his/her performance.

Public Health

In America, there is a desperate need for an increase in public health. This can focus on an individual, group, or a community. There are are many ways an individual can be deprived of a healthy lifestyle. This can range from education to a stable ecosystem. Education can determine an individual's health based on the knowledge of how to be healthy, or it can stem from the quality or amount of education received which can lead to an increase or decrease in finances that would allow more access to health care services. Having a stable ecosystem can include things such as the quality of air that is breathed in or the amount of water available for a community.
There are many different types of interventions that can reduce the threats to health. There are three subcategories of these interventions. Primary interventions include immunizations which prevent the disease or an injury from ever taking place. Secondary interventions reduce the impact of a disease or injury that has already occurred, so that could be early onset screenings for autism or cancer. Finally there are tertiary interventions that limit the impact of an ongoing illness or injury's lasting effects. This is what a typical rehabilitation model looks like. For example a patient who had a stroke regaining muscle strength in her arm would be tertiary intervention.