The Patient
Mrs. Adams is a 62-year-old retired woman who has rheumatoid arthritis (RA) and lives alone. Her daughter is a single parent with a 12-month-old child named Alison. The daughter relies heavily on Mrs. Adams to provide daily child care for Alison when she is working. Mrs. Adams’ physician has referred her to occupational therapy (OT) because she is having difficulties taking care of her granddaughter after a recent flare of her RA. Mrs. Adams presents with stiffness and weakness in her wrists and hands and a significant level of fatigue. She tells Amy, her occupational therapist, that she is concerned about her symptoms and joint problems but does not have the time to attend OT appointments.
Scenario 1
Amy: Based on your evaluation and what you’ve told me, I recommend that you come in two times a week. As you said, it’s hard for you to do some things for yourself and your granddaughter. My recommendation is that we work on your hand and wrist range of motion, strength, and dexterity so that you can take care of yourself and your granddaughter. From what you’ve told me, you’ve been quite inactive for an extended period of time and have lost a lot of strength. We need to get you stronger to improve your overall endurance so that you can take care of your house and complete your errands. I’d also like to make a splint for you to wear at night when you’re having problems and show you some adaptive equipment that you can use every day to make things easier for you at home. Being in therapy will address all of this. How does that sound?
Mrs. Adams: Some of your advice makes sense to me, but I really don’t have the time to come here. I’ve always managed to get better on my own in the past. I only came today because I told my doctor I would come, but I think he’s worrying too much.
Amy: It is extremely important for you to do your therapy so that you don’t have even more trouble in the future, especially taking care of yourself. It sounds like it’s important to you to be independent.
Mrs. Adams: It is. I would like to come to therapy if it would really help, but I’m torn because my daughter depends on me right now, and I don’t see how wearing a splint or learning about adaptive equipment will help me to take care of Alison. No, I think I’ll be able to use my hands and get my strength back over time like I always do.
