North Mountain Medical and Rehab Center in Phoenix, AZ has continually had an increase in respiratory patients over the years, making it well known to the community as a premier respiratory facility. The goal of almost every resident coming through our doors is to return to the community, and the Therapy Team chose to implement a Pulmonary Rehab Program designed with specific interventions for these residents, which often means taking a different approach to rehab due to their lower level of activity tolerance. A patient must first meet the criteria to participate in the Pulmonary Rehab Program, and once admitted into the program, we have select guidelines for assessments, treatment plans, educational material, and involving community resources to continue to help our respiratory patients thrive while in our facility and then discharged home.

After a successful 1^st quarter kick-off, the team continues to grow the program with new goals. Shannon Dougherty, PT, is working towards a specialized PT Certification in Pulmonary Rehab. Kelly Schwarz, DOR, is getting involved in community education programs through Breathe Easy Arizona. The team has researched the use of different standardized tests to add to their assessments, and will implement the use of manometers and inspiratory muscle trainers to their treatment sessions.

At North Mountain, we are truly taking an interdisciplinary approach to helping our residents “Breathe Easy” on the road to success!!

By Kelly Schwarz. DOR, North Mountain Medical and Rehab Center, Phoenix, AZ

Prior research has indicated that older adults treated with four weeks of reminiscence-structured activities to target specific personal memories showed fewer depressive symptoms, less hopelessness, improved life satisfaction and retrieval of more specific life events (Allen, 2009). Toward that end, we wanted to provide rehab patients and/or their caregivers with a value-added service — one that emphasizes a celebration of life and identifies the patient’s volition, rituals and habits through the use of a client-centered legacy-building intervention.

Through legacy-building activities, such as engaging with family members, creating slideshows, creating scrapbooks and creating videos, the patient and family improve existential awareness of their past, present and future. The goal is to improve activity tolerance, facilitate out-of-bed activities and address underlying deficits that influence ADL performance skills.

Partnerships and Collaborations

Our partnership with the Loma Linda University Occupational Therapy department, as well as other higher education institutions, allows us to recruit graduate-level fieldwork students to participate in our legacy-building project. By the end of week 12 (the end of fieldwork rotation), the FW II student presents a facility in-service regarding implementation and outcomes of the legacy-building program.

A Case Study in Legacy-Building

One patient, an 87-year-old woman, was admitted to Sea Cliff Health Care after a hospitalization secondary to generalized weakness, decreased functionality and decreased oral intake that revealed UTI, dementia, dehydration, coronary artery disease, anemia and urosepsis. The patient was evaluated by physical and occupational therapists for intervention once a day, five days per week, from March 24 to May 18, 2015.

Plan-of-care goals had to be modified throughout the process to address the patient’s increased aversive behaviors, outbursts and anxiety with therapy requests. We introduced behavioral modification techniques and legacy-building interventions, such as scrapbook making, a quote book and an interview for personal needs.

Thereafter, the patient met several functional goals and showed increases in other areas of ADL function, including BUE strength, seated balance, UB/LB dressing tasks and hygiene/grooming tasks. With the help of behavioral modification techniques and legacy-building interventions, the patient was able to demonstrate decreased aversive behaviors, confabulations, outbursts and anxiety and increased socialization (she sang more) without the use of psychotropic drugs.

Conclusion: a FW II Student’s View

Is the legacy-building project a valuable interpersonal teaching exercise? Why?

The experience during my level 2 fieldwork with the legacy-building project has allowed me to be a part of making a difference in the life of a patient that otherwise may have not had the means to advocate for their own care or means of participating in meaningful occupations at a vulnerable time in life.

What characteristics should future FW II students possess to be successful in this program?

It was important to be able to use therapeutic use-of-self in order to shape therapy sessions based on the patient’s needs and desires. Patience and empathy were also important characteristics for building rapport necessary to facilitate patient honesty, thoroughness and willingness to reveal personal anecdotes and experiences.

Did the program meet its objectives? The program reached its objectives to create mementos and informative aids for facilitating increased communication between patient and family/caregivers, while creating a product that is meaningful and can be used to maintain the patient’s legacy.

By Kristine Lewis MOT, OTR/L, Sea Cliff Health Care, Hungtington Beach, CA, In partnership with Loma Linda University OT Department

At Southland Rehabilitation & Healthcare Center in Lufkin, TX, we have found success in using a “Therapeutic Use of Self” method of treatment. Defined as “the use of oneself in such a way that one becomes an effective tool in the evaluation and intervention process” (Mosey, 1986), Therapeutic Use of Self consists of a planned interaction between a patient and another person in order to:

• Alleviate fear
• Provide reassurance
• Obtain and provide information
• Give advice
• Assist the other individual to gain more functional use of inner resources

We implemented the Therapeutic Use of Self method with Mr. K, using various techniques to engage the patient, including patience, rapport, trust, humor and honesty.

Since the use of Therapeutic Use of Self, Mr. K. is a changed man! Today he actively participates in occupational and speech therapy, inquires about other ideas to improve his health, smiles more often and enjoys his therapy. We look forward to using Therapeutic Use of Self with many more patients in the future and seeing the benefits firsthand.

Fall prevention is a primary concern at Willow Bend Nursing & Rehabilitation, and we work diligently to evaluate patients for fall risks as well as implement preventative measures. With Therapy working closely with our Activities Department, we have helped many patients to avoid falls as well as gain greater independence.

Our Balance Program consists of a screening, an evaluation with a standardized test upon admission, therapeutic intervention, quarterly balance assessments and various balance-related activities. The goal is to progress patients from a medium fall risk to a low fall risk, with modified independence in activities such as ambulating, standing balance in grooming tasks and toileting.

In our program, we had a patient move from a Berg score of 27 and a medium fall risk at evaluation to a score of 47 and a low fall risk at discharge. The patient was able to return to assisted living at PLOF and continue being independent with all basic ADLs, simple meal prep, light housekeeping, leisure activities, walking to the dining room and community outings.

Through a close collaboration between Therapy and Activities, we are able to develop and implement balance-related activities for our patients, such as tai chi, core stability and our walking program. The combination of therapy and balance-focused activities enables us to progress patients safely through the program and reduce their fall risk significantly.