1. however, it depends on the velcro that is used
2. Funding: family is on a limited income, try to find the most economical solution
3. Therapeutic goals
3.1. allow client more independence
3.1.1. parents will have to help less in that aspect
3.1.2. client will be able to don and doff pants more easily
3.1.3. will be able to toilet more independently
3.2. device must be easy to use the first time and every time after that
3.2.1. parents can also be taught how device works
3.3. reduce stress/anxiety client may be feeling
3.3.1. may help increase confidence
4. Person : Sam
4.1. Goals: to be able to zip/unzip pants independently••Funding •Environments
4.2. Funding
4.3. Daily Roles and Activities
4.3.1. riding bus to school
4.3.2. eating
4.3.3. physical play on playground
4.3.4. playing
4.3.5. reading
4.3.6. school activities
4.4. MMT:WFL
4.5. ROM:WFL
4.6. 18 years old Sam with autism, whose cognitive level is similar to a 3y/o...unable to manipulate zipper on his own.
4.6.1. requires help at school and at home for toileting and dressing
4.7. Sam was provided a cheap wire ring and button hook from school, but was always losing it. And refused to manipulate it due to sensitivity of his fingers tip.
4.7.1. Hence, the wire ring hook and button hook was inconvenience.
4.7.2. Support
4.7.2.1. needs an adult to help him
4.8. Due to tactile sensitivity
4.8.1. A magnetic device will help improves his confidence and self esteem and boost his independent of being relying on his mother and assistance aid.
4.8.2. It will also increase his occupational performance
5. Environment
5.1. Physical
5.1.1. In community
5.1.1.1. Public toilet/restroom
5.1.2. School
5.1.2.1. School restroom
5.1.3. Home
5.1.3.1. Dressing in bedroom
5.1.3.2. Bathroom
5.2. Social
5.2.1. friends
5.2.2. lives with parents
5.2.2.1. parents are "helicopter" parents
5.2.3. Teachers
6. Performance Skill
6.1. zipping pants
6.1.1. must pinch zipper on pants with a pincer grasp, proprioception to use the correct amount of force, supinate forearm and hand to pull up zipper.
6.1.2. must pronate forearm and hand to unzip pants
7. Occupation
7.1. ADLs
7.1.1. Dressing
7.1.1.1. Must manage dressing
7.1.1.1.1. needs to be able to zip up pants when donning in the morning
7.1.1.1.2. needs to be able to unzip pants when doffing in the evening
7.1.2. Toileting
7.1.2.1. manage clothing when toileting
7.1.2.1.1. needs assistance when unzipping and zipping pants to use the toilet
7.2. since Sam is always under adult supervision, he doesn't have to wear the device. His caregiver can give it to him when needed.
7.3. At school, he can take the device, just like a hall pass, and return it when he is done. His teacher or teacher's aide can remind him.
8. Barriers to performance
8.1. psychological
8.1.1. lacks attention
8.2. autism
8.2.1. tactile sensativity
8.2.2. pain
8.2.3. attention span
8.2.4. ability
8.3. family
8.4. anxiety
8.5. fine motor control/manipulation
9. Interests
9.1. Enjoy watching animals documentaries and weather
9.2. Loves the scientific fact of opposite poles of a magnets attract, while like poles repel.
9.2.1. Magnetic zipper pull will be interesting to Sam
9.2.2. Increased chance of him utilizing it independently and increasing his occupational performance
9.2.3. New node
9.3. love tearing paper into tiny pieces
9.4. Enjoy going to zoos, and listen to music
10. Clinical question
10.1. We decided to approach this question as a PICO question
10.1.1. P: Problem, Patient, or Population
10.1.1.1. 18 year old male
10.1.1.2. Autism Spectrum Disorder
10.1.1.3. Intellectual disability
10.1.2. I: Intervention
10.1.3. C: Comparison:
10.1.3.1. No Magna Zip
10.1.4. O: Outcome
10.1.4.1. Increase independence in donning and doffing pants
10.2. Magna Zip
10.3. In young adults who are on the spectrum, does using the "Magna Zip" increase independence in donning and doffing pants?
11. Problems
11.1. Made a tag along wire hooked but client dislike manipulating it.
11.1.1. Client will lose it on purpose, therefore not effective.
11.2. Made Velcro strap instead of the zipper but client resents the feel of the material.
11.2.1. Client states that Velcro strap struck too tight and its too hard for him to pull it apart.
11.3. Client enjoyed wearing watches therefore a tiny mini hook was fixed unto the watch so that client wont loose it.
11.3.1. Client says the mini hook tends to pierce his skin .
11.4. Client's mom insisted that the device should be easy for Sam to use or wear.
11.5. Made an elastic cloth wristband with a magnet inside. Due to tactile sensitivity, Sam refused to don it.
11.6. Solutions:
11.6.1. Final Product: idea #1
11.6.1.1. Bathroom Pass magnet: Magna Zip
11.6.1.1.1. in the shape of Sam's favorite animals and superheroes
11.6.1.1.2. attach a magnet to the bottom, requiring only a fisted grip to zip and unzip pants
11.6.1.1.3. attach a magnet on a ring to clip onto his zippered pants that will attach to his bathroom pass
11.6.2. Final Product: idea #2
11.6.2.1. Magnets sewn into zipper area to magnetically close pants.
11.6.2.1.1. Was not functional: the magnets were not strong enough to work through the jean material
11.6.3. Final Product: Idea #3
11.6.3.1. Hook and Loop Fastener
11.6.3.1.1. Allows client more independence
11.6.3.1.2. easily able to open and close hook & loop with verbal cues
11.6.3.1.3. inexpensive
11.6.3.1.4. easy to sew on
11.6.3.1.5. lightweight
11.6.3.1.6. minimal user error
12. We need to create a device that helps Sam be able to dress himself as independently as possible by fastening his pants
12.1. Scientific
12.1.1. autism
12.1.1.1. tactile sensitivity
12.1.2. body mechanics
12.1.2.1. pronate forearm/hand
12.1.2.2. different grasp types
12.1.3. Cognitive Level
12.1.3.1. 3 year old
12.1.3.2. the device must be developmentally appropriate.
12.2. Diagnostic
12.2.1. autism
12.2.2. intellectual disability
12.2.3. FIM Level 4-toileting and dressing
12.3. Ethical
12.3.1. will this harm the client?
12.3.1.1. This device will not harm him, it is helping support his toileting independence
12.3.2. is this device improving access to care?
12.3.3. is this sustainable?
12.4. Pragmatic
12.4.1. Is it affordable?
12.4.1.1. yes, it can be purchased for under $5 and sewn into his pants.
12.4.2. How long does it last?
12.4.2.1. if he can incorporate this device into his routine, he will improve his self-care ability
12.4.3. Is it easy to fix/replace?
12.4.3.1. yes, magna zip parts can be purchased at many stores
12.5. Generalization
12.6. Interactive
12.6.1. ask the client how he feels about using device
12.6.2. His Mother's opinion is vital because she will be supporting him during the learning process of using device as well as establishing the new routine
12.6.3. Collaborate to find best possible solution together
12.6.4. Ask about benefits/difficulties with using the device
12.7. Conditional
12.8. Narrative
12.8.1. Learn about their "story"
12.8.2. Sam has a really hard time at school when it is time to use the restroom. He had previously had a zipper hook but he continually lost it. He has an aide at school to help him but his goal is for him to be more independent and only require verbal cuing to use the restroom.
12.9. Procedural
12.9.1. MOHO
12.9.2. now that Sam is using the magna zip to close his pants, he is a lot more independent. He reached his goal of a FIM 5. He is able to pat his pants and they stay closed. When he needs to open them, he just rips them open.
12.9.2.1. With daily use, this should last the life of the pants. May need to periodically clean out lint from the hook part of the material.
12.9.3. Client has the role of a student and son. His routine involves dressing in the morning, undressing at night, and toileting throughout the day. He is motivated to try to open and close his pants but his tactile sensitivity is preventing him from moving forward. The zipper on his jeans is too small and he doesn't want to touch it and his fingers are contracted and he is unable to grasp the zipper. He is in a Special Day Class at school and lives with his supportive parents. His environment is very supportive.
12.9.4. Treatment Plan
12.9.5. Sequencing of "zipping up"
12.9.6. PEO