Machiko R. Tomita, Kathryn Buckner, Sumandeep Saharan, Kimberley Persons, Sheng Hui Liao; Extended Occupational Therapy Reintegration Strategies for a Woman With Guillain-Barré Syndrome: Case Report. Am J Occup Ther 2016;70(4):7004210010. https://doi.org/10.5014/ajot.2016.017871
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© 2021 American Occupational Therapy Association
This case report describes a unique long-term functional recovery process to promote successful community reintegration for a woman with Guillain-Barré syndrome (GBS), a rare autoimmune disease. Her main symptoms were very limited mobility and depressive symptoms due to the unknown cause of and cure for the illness. Holistic occupational strategies helped the client stabilize her emotional state, create a safe home environment, improve a communication method, increase physical activity, and promote social participation. Participation in a fall prevention clinical trial lowered her risk of falling; at 9 mo, she reached 75% of the maximum Social Integration score; at 13 mo, she reached near-normal level for activities of daily living (ADLs) and her fastest time for the Timed Up and Go test; and at 2 yr, she achieved a 100% score in instrumental ADLs. For community integration of clients with GBS, a comprehensive strategic self-management approach should be prescribed for long-term recovery.
Occupational profile, including short- and long-term goals
Emotional state using the Center for Epidemiology Studies Depression Scale (CES–D; Radloff, 1977)
Functional status, including IADLs using the Older Americans Resources and Services (OARS) Multidimensional Functional Assessment of Older Adults (Fillenbaum, 1988), ADLs using the FIM™ (Granger, Hamilton, Keith, Zielezny, & Sherwin, 1986), and functional mobility using the Timed Up and Go test(TUG; Podsiadlo & Richardson, 1991)
Home hazards that may cause falls using the Home Safety Self-Assessment Tool (HSSAT; Tomita, Saharan, Rajendran, Nochajski, & Schweitzer, 2014)
Communication technology usability
Community integration using the Social Integration subscale of the Community Integration Questionnaire (CIQ; Willer, Rosenthal, Kreutzer, Gordon, & Rempel, 1993).
At 8 mo after the onset of GBS, when Winnie’s risk of falling reached a low level (TUG time of 12 s)
At 9 mo, when she reached the score of 9 of 12 on Social Integration
At 10 mo, when she regained sensation in her foot
At 13 mo, when she reached her second highest FIM score, 122, and best TUG time, 8.3 s.
The holistic nature of the PEO Model provides occupational therapy practitioners with a framework for guiding interventions to find the best fit among a client’s needs, roles, and abilities (person); chosen purposeful activities (occupation); and the contexts in which these occupations take place (environment).
Using a consultative model of practice beyond the initial acute phase of rehabilitation can lead to successful community reintegration.
Occupational therapists can empower clients to take responsibility for their own rehabilitation process, providing a sense of control over their own outcomes. This may result in greater client participation in the intervention process and lead to better outcomes.
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