Posts filed under ‘dementia’

Would a splint be contraindicated in this case?

We all know that one of the purposes of splinting by occupational therapists is for joint protection and to preserve function and range of motion.  I have blogged before about my experience with fabricating below knee amputation (BKA) splints, used to preserve knee extension for being able to fit orthoses at a later date.

Sometimes, however, I wonder if a patient really needs the splint.  For example, I once had a 85 year old patient who had severe Alzheimer’s dementia, was completely bedbound at a nursing home at baseline and had a BKA due to gangrene.  While normally I would make a splint, I wasn’t sure that it was indicated in this case.

First, the patient was bedbound at baseline, and therefore an unlikely canditate for a prosthetic.  Second, a patient is very likely to develop skin breakdown and sores from a splint if the splint schedule isn’t adhered to, or frequently monitored.  Third, splints aren’t generally the most comfortable things.

Providing a splint would not increase or improve quality of life, and so it would seem to me that a splint would not be indicated in this case for the reasons listed above.  What are your thoughts?


November 17, 2008 at 8:09 pm 22 comments

Identifying Yourself

It is important to always properly identify to your patients who you are, what your role is in the therapeutic process, and what you plan on doing during that treatment session. Sometimes, however, that just isn’t enough.

I am taking a graduate elective that allows me to have 60 hours of extra clinical time so that I can further gain experience in the setting of my choosing before graduating. I have liked acute care for a while now, and I therefore decided to do another clinical in acute care.

My last day was earlier this week. We went in to see an 80+ year old lady who had been admitted for CHF and also had a diagnosis of dementia. While the patient agreed to let me treat her by walking from her bed to the bathroom to do a toilet transfer, she kept asking me over and over again why I was doing this “procedure.” I explained each time that the doctors wanted to know how safe she was so that she could go home. However, no matter how many times I explained it, she kept asking me about the procedure. Before leaving, she asked that we come back so that we could speak to her daughters.

A few hours later, we went back to her room as requested, and her daughters were now there. Turns out that since I wasn’t wearing a formal identification from the hospital (because I was only there for 60 hours), she thought I was someone from some random nursing home. She was afraid that I was assessing her for a nursing home. No matter how many times I told her that we were occupational therapists, she was still worried.

So even if you identify yourself as an occupational therapist, that isn’t always enough. I think it was great that the patient was cognizant of the fact that all hospital employees should have identification, and that she realized that I wasn’t wearing a hospital ID.

April 1, 2007 at 1:50 am 3 comments

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