1. Leisure: Facetime with family members
1.1. Performance Components
1.1.1. Attend: being able to attend to facetime conversation with other person
1.1.2. Look: being able to look at phone to work facetime conversation
1.1.3. Reply: being able to reply to person on facetime conversation
1.1.4. Position: being able to position self with phone to effectively communicate through facetime
1.1.5. Grip: being able to grip phone effectively to communicate through facetime
2. Parkinson's Disease
2.1. Shuffling gait
2.2. Rigidity
2.3. Fasciculations
2.4. Tremors in hands
2.5. Kyphotic posture due to shuffling gait
2.6. Muscle atrophy in UEs and LEs
2.7. Weakened Voice
2.8. Fatigues easily
2.9. Pain
2.10. Lived with PD for almost 10 years. Symptoms became severe within the last 2 years
3. Occupations
3.1. Sleep: prefers sleeping upright due to fear of sleeping complications
3.2. Eating: requires assistance to feed self
4. Barriers to Performance
4.1. Fearful of walking & moving without assistance
4.2. Overall body pain, especially in mornings
4.3. Grips: impaired ability to grip items due to B hand contractures and pain (especially in the mornings), no functional use of hands limiting ability to access phone independently
4.4. Lifts: impaired ability to life items, such as phone, due to rigidity in UEs and tremors
4.5. Positions: inability to properly position self due to increase rigidity throughout body, unable to access phone due to poor position of body with phone
4.6. Coordination: inability to coordinate movement to hold phone due to tremors
4.7. Produce Speech (Social): inability to clear speech due to muscle atrophy as a result of PD
4.8. Turns toward: unable to turn her head and neck while she is engaging in social interaction
5. Environment
5.1. Single story home
5.2. Lives with husband & caretaker (support system)
5.3. Pets (birds)
5.4. Hospital bed
5.5. Bedroom: limited space for mobility and transfers
5.6. Lazy Boy Furniture in living room
5.7. Wheelchair to move from room to room
5.8. Kitchen table
6. Performance Skills
6.1. Walks: able to complete some steps but only with caregiver assistance
6.2. Attends: able to attend to task at hand (ex: facetime or eating) without getting distracted
6.3. Chooses: able to choose what she wants to do when given choices
6.4. Replies: able to engage in conversations effectively and relevant to topic of discussion
6.5. Looks: able to make eye contact with anyone she is talking to
6.6. Heeds: able to use goal-directed conversation to instruct her caregivers to feed her, transfer her, or let them know that she needs to use the restroom.
7. Retired NICU Nurse & career in Federal Law
8. Lives with husband and 24 hr. live-in caregiver
9. Interests: spending quality time with her caregiver, reading, talking on the phone, watching tv, eating chocolate pudding
10. Clinical Question:How can we create a functional device that will help Judy access her phone, adapt to her environment, increase her independence to meet her needs?
10.1. Narrative:
10.1.1. Enjoys eating chocolate pudding, socializing with caregiver, talking on the phone through facetime
10.1.2. Lives with husband and 24-hr live-in caregiver
10.1.3. Diagnosed with Parkinson's Disease in 2012
10.1.4. Retired NICU Nurse and career in Federal Law
10.1.5. Deeply spiritual and enjoys reading bible verses
10.1.6. Difficulty with current Facetime set up in the morning and at night
10.2. Scientific:
10.2.1. Parkinson's Disease
10.2.1.1. Contractures in Bilateral hands and neck
10.2.1.2. Poor Posture (Kyphotic)
10.2.1.3. Labored Speech
10.2.1.4. Poor ROM in BUEs due to rigidity
10.2.1.5. Limited ROM in finger dexterity
10.2.1.6. Steady decline of gross motor skills
10.3. Diagnostic:
10.3.1. Parkinson's Disease Symptoms
10.3.1.1. Contractures in Bilateral hands
10.3.1.2. Shuffled gait
10.3.1.3. Kyphotic posturing
10.3.1.4. Labored speech
10.3.1.5. Experiences pain throughout body especially in mornings (6/10 pain level)
10.3.1.6. Increase stiffness in mornings
10.3.1.7. Limited ROM due to rigidity in BUEs
10.3.1.8. Fatigues easily towards the middle and end of the day
10.3.2. Diabetes
10.3.2.1. Special diet
10.3.2.2. Insulin as well as other medications
10.4. Ethical:
10.4.1. Low cost device (Husband and client are retired)
10.4.2. Lightweight to be able to move around as needed
10.4.3. Universal to hold different size phones if needed
10.4.4. Strong support to withstand weight of phone
10.4.5. Able to move close to client so that they can see the screen clearly
10.4.6. Increase independence in conversation with Facetime
10.5. Procedural:
10.5.1. Decrease interruption of phone set up every time phone moves position during Facetime
10.5.2. Decrease her need to adjust phone due to pain in UEs when needing to move
10.5.3. Maintaining gross motor skills in LE (plantarflexion of her foot to initiate and adjust the phone independently.)
10.6. Interactive:
10.6.1. Fearful of going out in public due to condition worsening & perceptions of others
10.6.2. Dealing with mental health issues (depression) due to lack of socialization
10.6.3. Experiencing occupational alienation due to being completely dependent in all ADLs
10.6.4. Experiencing Occupational Alienation due to being completely dependent in all ADLs
10.7. Conditional:
10.7.1. Instruct patient on device set up and break down in case they need to store it
10.7.2. Instruct husband on materials used and set up in case device breaks in future
10.7.3. Device will give client privacy and independence in conversations through Facetime which she currently lacks
10.7.4. Will allow her to socialize more through videos calls to family and friends
10.7.5. Promoting the use of her current performance skills such as engaging in social interaction, cognition (sequencing through how to set up the device), AROM of her foot
10.8. Pragmatic:
10.8.1. Device will need to be set up (moved around) to where client will be facetiming due to client's limited functional ability/mobility
10.8.2. Increase her independence and privacy in conversations
10.8.3. Low cost (~$25)
10.8.4. Strong base of phone to function in different environments
10.8.5. Adjustable phone holder to fit different size phones
10.8.6. Easy for client/caregiver to understand use and set up (Low complexity)
10.8.7. Device can be adapted to fit her future needs (ex: attaching foot pedal for client to move it manually- Clinical Reasoning)
10.9. Generalization:
10.9.1. Device allows client to engage in conversations without needing to position and set up
10.9.2. Device promotes independence and autonomy, something hard to come by for individuals with Parkinson's
10.9.3. Knowing that PD is a progressive disease, we thought of a device that she can potentially use for the remainder of her life. It is easily modifiable. (**if we decide to use the DC motor foot pedal, this can be taken away when she can no longer perform gross motor movements)
10.9.4. Current needs for Judy involves socialization to better cope with occupational alienation. Cognition is intact, therefore we are able to provide her with a device that allows her to independently instruct a caregiver to set it up
10.9.5. Head/neck ROM is very limited, most of her time spent is on the phone. Her current positioning is not optimal for preventing contractures
11. Diabetes
12. Device:
12.1. Light weight
12.1.1. PVC pipe and light but wide base
12.2. Low cost
12.2.1. Total:
12.3. Portable
12.4. Simple instructions for use
12.5. Meets clients needs
12.5.1. Increase her privacy and independence
12.5.2. Minimal positioning for client
12.5.3. Able to use in different envirnoments
12.5.4. prevents contractures in UE, head and neck