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.