Occupational Therapy
Content
Available online at www.sciencedirect.com
Procedia - Social and Behavioral Sciences 46 (2012) 3865 – 3869
WCES 2012
A case study of occupational therapy for poststroke depression in elderly
Constantin Ciucurel a *, Elena Ioana Iconaru a
a
University of Pitesti, Str. Targu din Vale, Nr. 1, Pitesti, 110040, Romania
Abstract The aim of this case-study was to draw on appropriate client-centred model of practice framework, in order to demonstrate its application in occupation-based practice with elderly with poststroke depression. We studied the case of a 64 years old woman with a poststroke depression. The assessment of our client was carried out using the Canadian Occupational Performance Measure and the Hamilton depression scale. After 6 weeks of participation in the rehabilitation program, the client had made remarkable progress. The results demonstrate that the approach is useful to improve the quality of life in clients with strok e, especially in reaching their daily occupational goals.
© 2012 Published by Elsevier Ltd. Selection and/or peer review under responsibility of Prof. Dr. Hüseyin Uzunboylu
Keywords: case study, depression, stroke, occupational therapy, elderly;
1. Introduction Occupational therapy (OT) is based on the idea that health and well-being are affected by and affect the nature and pattern of occupations in which persons engage and rich life satisfaction. Client-centred OT is a partnership The key principle of client-centred practice in occupational therapy in cerebral vascular diseases is to empower the client to actively participate in partnership and negotiate goals in the intervention process. The aim of this casestudy was to draw on appropriate client-centred model of practice framework, in order to demonstrate its application in occupation-based practice with elderly with poststroke depression, OT being an important aspect of stroke rehabilitation. OT in stroke aims at facilitating task performance by improving relevant performing skills or developing and teaching compensatory strategies to overcome lost performance skills (Steultjens et al., 2003). 2. Material and methods We studied the case of a 64 years old woman with transient ischaemic stroke in antecedents and a poststroke depression. For the case presentation we used the Canadian Process Practice Framework (CPPF). The CPPF was
*
. Tel.: +4-074-429-0917; fax: +4-034-845-3123. E-mail address: [email protected].
1877-0428 © 2012 Published by Elsevier Ltd. Selection and/or peer review under responsibility of Prof. Dr. Hüseyin Uzunboylu doi:10.1016/j.sbspro.2012.06.162
3866
Constantin Ciucurel and Elena Ioana Iconaru / Procedia - Social and Behavioral Sciences 46 (2012) 3865 – 3869
designed to enable occupational therapists to facilitate client-centred, evidence-based practice, as well as participate in reflective practice (Craik et al., 2007). The CPPF enable therapists to engage in reflective practice and enact an evidence-based, client-centred and occupation-based practice (Townsend, 2007). CPPF is about a reference framework for the occupation enabling process, based on scientific evidence and client centred (Schell, 2009). This model includes a structure of the processes that illustrates, in 8 key decision points, the client strategic approach in OT services, highlighting the importance of the societal and practice contexts and how do they impact the process (Polatajko et al., 2007). Gathering information about this model published in the international literature allow us to identify some of the CPPF contributions. It has been underlined that CPPF is suitable to a broader range of clients (including clients with stroke) and it is characterized by flexibility embracing notion that what each stage looks like depends on client, goals, therapist skills, context, and more (David et al., 2007). The assessment of our client was carried out using the Canadian Occupational Performance Measure (COPM), which focuses on occupational performance and takes the form of a semi-structured interview in order to identify occupational performance problems. Supplementary, the progress in engaging all the activities was monitored by using the Hamilton depression scale, a very useful instrument for depression after stroke (Kneebone et al., 2010). 3. Findings Ana is a 64 years old pensioner, who lives in a Romanian small town, in her private owned house, but with all modern facilities (current water, electricity, inside toilet, advanced equipment, eg washer, microwave). Ana had a stroke two years ago and she lives now with its residual effects. We interviewed Ana and her family in order to establish previously held life roles and the tasks and activities that were completed within these roles. Thus, together with her husband she used to share many domestic tasks: cooking and meal preparation, shopping and cleaning. They are really proud about their son who is a happily married engineer, thing easy to recognize from their enthusiastic way of taking about his professional and personal achievements. Infor occupational performance difficulties (Westhorpe, 2003), based on an understanding of the consequences of stroke. We started form the idea that for intervention to be meaningful, the occupational therapist needs to know the Ana had a transient ischaemic stroke in antecedents. This condition occurred after retired, for 35 years she had worked as a secretary at City Hall and now she is facing overwhelming emotional burdens. She considers herself a lucky person as she is still independent in all personal care occupations (toileting, showering, dressing, eating, she often faces mood changes, has difficulty concentrating, remembering, and making decisions. She reports feeling confused about her interest in events around her, even the lack of desire for spoiling her two grandchildren, who she used to regularly see each Sunday. oles (eg self-carer, housekeeper) as well as social roles (wife, mother, grandmother, and neighbor), but also some information about her current limitations in performing things she liked (symptoms of reactive post stroke depression). Prior to her stroke, Ana felt that she enjoyed good health. She is right handed without impairments regarding abilities and strength, which influence the range of occupations she adopts and the way in which these occupations are performed. We were interested in finding out how She used to like reading romance novels, watching TV soap operas and the cooking channel, activities that she still does but rarely as she lost her patience. Ana reported feeling ho
Constantin Ciucurel and Elena Ioana Iconaru / Procedia - Social and Behavioral Sciences 46 (2012) 3865 – 3869
3867
nt life when she likes to be alone with her thoughts. Now she describes herself as a solitary, frustrated person, due to her medical condition. She is aware of her diminished responsibilities and decreased desire for doing things she used to do, relating to this situation with a feeling of loss. In addition, Ana discussed that she had lost her confidence in regaining her social role arguing that she read a lot of articles which demonstrated that the chances for a new stroke to happen are high and that most stroke deaths occur in women. Ana still goes walking in the park around a local monastery, but only together with her husband as sometimes she looses her temporo-spatial orientation. Ana talked so passionately that she has always liked flowers, especially roses, nature, the work in open spaces and her strongest desire has been to live in a house with a large court and access to the main road like this one they have after selling their apartment five years ago. The initial assessment was carried out using the Canadian Occupational Performance Measure (COPM) which focuses on occupational performance and takes the form of a semi-structured interview in order to identify occupational performance problems. COPM enable clients to rate importance, performance and satisfaction with selfwas also highlighted that the COPM, as an outcome measure, provides opportunities to detect changes over time, and as A total of two problems were identified in leisure activities regarding getting back in activities that were enjoyable for her before stroke: having friends and family over (performance score 3, satisfaction score 4) and gardening (performance score 3, satisfaction score 4). Deciding that planting a rose garden in front of her house is the most important occupation for her in present, we proceed to explore, using the Person Environment social environments, physical abilities, interest roles, personality and the occupations she chooses and needs to perform all interact to influence her occupational performance. The PEO model of practice considers the person and
Table 1
Analysis of the PEO transaction for planting a rose garden in front of the house O-E owns gardening space; procure gardening equipment: boots, coveralls, gloves, hat; buy gardening tools: scissors, sprinkler, rake, shovel; manuals, gardening reviews; acquire fertilizer; get special insecticide; buy rose cuttings; visit floral exhibitions and greenhouses. P-E continuous family facilitation; develop social relationships; achieve personal expectations; respect safety issues regarding tools manipulation; obtain resources for gardening activities.
P-O improve skills/abilities for gardening; maintain motivation for gardening; develop dexterity; get specialized knowledge; has time to spend in gardening.
For Ana we tried to set rehabilitation goals related to activity and participation that are specific, measurable, attainable, realistic, and relevant to individual person. Using the SMART method for writing goals, we agreed that: working at least one hour each day (T2). In three weeks she will have the ground prepared (M1) and in the next two buying the necessary tools (A2), fertilize and prepare the soil (A3), select and buy the roses (A4) and plant it (A5). The progress in engaging all the activities was monitored by using again the depression scale, satisfaction measurement tools or specific steps achievement (R1) and also by her family within daily involvement (R2). One great advantage of the SMART goals method is that it also offers the key elements for the intervention plan which was structured around the activity strategies, as follows:
3868
Constantin Ciucurel and Elena Ioana Iconaru / Procedia - Social and Behavioral Sciences 46 (2012) 3865 – 3869
Week 1: Ana documented about gardening and talked with her husband and son about plants, garden decorating, gardening tools and equipment. Week 2: Ana made the list of equipment and gardening tools; go shopping and buying them. Week 3: Ana worked the ground and fertilize it. Week 4: Ana visited greenhouses, floral expositions, discussed with specialist or friends to select the roses. Week 5: Ana bought the roses and plant them. Week 6: Ana cared for the garden, invited friends to share experience and made plans for different arrangements. We considered very important that our client should be encouraged to increase the level of autonomy (regarding the temporo-spatial orientation), to state and to exceed the social isolation condition. For this reason, we worked with the client in order to maximize the ability to undertake her own personal selfcare tasks and domestic tasks and to help her to learn strategies to manage the cognitive, perceptual, and behavioural changes associated with stroke (Rowland et al., 2008). In stroke, occupational therapists assess the impact of changes in motor function, sensation, coordination, visual perception, and cognition on a person's capacity to manage daily life tasks (Rowland et. al., 2008). Because of the variety of implied factors, we considered the use of a qualitative best-evidence synthesis to analyze the results of OT in stroke highly appropriate. After six weeks, Ana was re-assessed using the COPM and depression scale which showed improvements in: occupations involvement, motivation, enjoyment, decreased anxiety and social interactions. 4. Conclusion From a global perspective, the positives aspects of the case is that Ana was a good rehabilitation candidate (moderately severe stroke), and the negatives one refers to the delay in getting to rehabilitation and accessing therapy (Teasell et al., 2009). After 6 weeks of participation in the OT rehabilitation program, Ana had made remarkable progress. She is currently able to have a normal life after stroke, becoming integrated back into the community. We decided with Ana that our therapeutic relation can end but with further referrals for psychological services if the symptoms of depression will reappear. The results demonstrate that the approach is useful to improve the quality of life in clients with stroke, especially in reaching their daily occupational goals. Best practice in stroke rehabilitation involves specialized inter-disciplinary teams working (Edmans, 2010) in a highly coordinated manner to obtain best outcomes, stroke rehabilitation being most effective for moderately severe stroke patients. OT is part of the multidisciplinary rehabilitation after stroke and functions in collaboration with the other involved healthcare professions (Steultjens et al., 2003). The purposes of intervention in elderly with stroke focus on: amelioration of participation in meaningful everyday roles, tasks, reducing of deficits impact, avoiding secondary complications and providing professional education and support to the patient and therapeutic team (Rowland et al., 2008). The use of the COPM as an occupational performance measurement tool increased client participation, which resulted in a distinct and meaningful goal to the client for each occupational problem. Together with Ana, we found the right combination of tools and techniques so that the client could handle her personal life and we can affirm that the rehabilitation took a positive turn when she began to receive OT. We proved that a good understanding of the theoretical notions, emphasizing communication and collaboration skills and a regularly feed-back from the client in all the process stages are vital in OT interventions for elderly with poststroke depression. References
Craik, J., Davis, J. & Polatajko, H. J. (2007). Introducing the Canadian Process Practice Framework: Amplifying the context. In E. A. Townsend,
Constantin Ciucurel and Elena Ioana Iconaru / Procedia - Social and Behavioral Sciences 46 (2012) 3865 – 3869
3869
& H. J. Polatajko, Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation (pp. 229-246). Ottawa, ON: CAOT Publications ACE. Davis, J., Craik, J. & Polatajko, H. J. (2007). Using the Canadian Process Practice Framework: Amplifying the process. In E. A. Townsend, & H. J. Polatajko, Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation (pp. 247-272). Ottawa, ON: CAOT Publications ACE. Edmans, J. (2010). Occupational Therapy and Stroke . (2nd ed.). Wiley-Blackwell, (Chapter 3). Henry, A. D. (2003). The interview process in occupational therapy. In E. B. Crepeau, E. S. Cohn, & B. A. Schell (Eds.), Willard and , (pp. 285 297). Lippincott Williams and Wilkins, Philadelphia. Kneebone, I., Baker, J., & O'Malley, H. (2010). Screening for depression after stroke: developing protocols for the occupational therapists. British Journal of Occupational Therapy , 73(2), 71-76. McColl, M. A., Law, M., Stuart, D., Doubt, L., Pollack, N. & Krupa, T. (2003). Theoretical Basis of Occupational Therapy . (2nd ed.). Thorofare, NJ: Slack, (Chapter 4). Metzler, M. J. & Metz, G. A. (2010). Analyzing the barriers and supports of knowledge translation using the PEO model. Canadian Journal of Occupational Therapy, 77(3), 151-158. Polatajko, H. J., Craik, J., Davis, J. & Townsend, E. A. (2007). Canadian Process Practice Framework. In E. A. Townsend, & H. J. Polatajko (Eds.), Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation (pp. 233). Ottawa, ON: CAOT Publications ACE. Rowland, T. J., Cooke, D. M., & Gustafsson, L. A. (2008). Role of occupational therapy after stroke. Annals of Indian Academy of Neurology , 11(5), 99-107. Schell, B. A. (2009). Professional reasoning in practice. In E. B. Crepapue, E. S. Cohn, & B. A. Schell (Eds.), Occupational Therapy (pp. 314-327). Lippincott Williams and Wilkins, Philadelphia. Steultjens, E., Dekker, J., Bouter, L. M.., van de Nes, J. C., Cup, E., & van den Ende, C. (2003). Occupational therapy for stroke patients - a systematic review, Stroke, 34, 676. Sumsion, T., & Smyth, G. (2000). Barriers to client-centredness and their resolution. Canadian Journal of Occupational Therapy , 67, 15-21. Teasell, R., Meyer, M., Foley, N., Salter, K. (2009). Stroke Rehabilitation in Canada. Topics in Stroke Rehabilitation , 16(1), 11-19. Townsend, E., & Polatajko, H. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation. Ottawa, ON: CAOT Publications ACE, (Chapter 3). Westhorpe, P. (2003). Exploring balance as a concept in occupational science. Journal of Occupational Science , 10(2), 99-106.
Procedia - Social and Behavioral Sciences 46 (2012) 3865 – 3869
WCES 2012
A case study of occupational therapy for poststroke depression in elderly
Constantin Ciucurel a *, Elena Ioana Iconaru a
a
University of Pitesti, Str. Targu din Vale, Nr. 1, Pitesti, 110040, Romania
Abstract The aim of this case-study was to draw on appropriate client-centred model of practice framework, in order to demonstrate its application in occupation-based practice with elderly with poststroke depression. We studied the case of a 64 years old woman with a poststroke depression. The assessment of our client was carried out using the Canadian Occupational Performance Measure and the Hamilton depression scale. After 6 weeks of participation in the rehabilitation program, the client had made remarkable progress. The results demonstrate that the approach is useful to improve the quality of life in clients with strok e, especially in reaching their daily occupational goals.
© 2012 Published by Elsevier Ltd. Selection and/or peer review under responsibility of Prof. Dr. Hüseyin Uzunboylu
Keywords: case study, depression, stroke, occupational therapy, elderly;
1. Introduction Occupational therapy (OT) is based on the idea that health and well-being are affected by and affect the nature and pattern of occupations in which persons engage and rich life satisfaction. Client-centred OT is a partnership The key principle of client-centred practice in occupational therapy in cerebral vascular diseases is to empower the client to actively participate in partnership and negotiate goals in the intervention process. The aim of this casestudy was to draw on appropriate client-centred model of practice framework, in order to demonstrate its application in occupation-based practice with elderly with poststroke depression, OT being an important aspect of stroke rehabilitation. OT in stroke aims at facilitating task performance by improving relevant performing skills or developing and teaching compensatory strategies to overcome lost performance skills (Steultjens et al., 2003). 2. Material and methods We studied the case of a 64 years old woman with transient ischaemic stroke in antecedents and a poststroke depression. For the case presentation we used the Canadian Process Practice Framework (CPPF). The CPPF was
*
. Tel.: +4-074-429-0917; fax: +4-034-845-3123. E-mail address: [email protected].
1877-0428 © 2012 Published by Elsevier Ltd. Selection and/or peer review under responsibility of Prof. Dr. Hüseyin Uzunboylu doi:10.1016/j.sbspro.2012.06.162
3866
Constantin Ciucurel and Elena Ioana Iconaru / Procedia - Social and Behavioral Sciences 46 (2012) 3865 – 3869
designed to enable occupational therapists to facilitate client-centred, evidence-based practice, as well as participate in reflective practice (Craik et al., 2007). The CPPF enable therapists to engage in reflective practice and enact an evidence-based, client-centred and occupation-based practice (Townsend, 2007). CPPF is about a reference framework for the occupation enabling process, based on scientific evidence and client centred (Schell, 2009). This model includes a structure of the processes that illustrates, in 8 key decision points, the client strategic approach in OT services, highlighting the importance of the societal and practice contexts and how do they impact the process (Polatajko et al., 2007). Gathering information about this model published in the international literature allow us to identify some of the CPPF contributions. It has been underlined that CPPF is suitable to a broader range of clients (including clients with stroke) and it is characterized by flexibility embracing notion that what each stage looks like depends on client, goals, therapist skills, context, and more (David et al., 2007). The assessment of our client was carried out using the Canadian Occupational Performance Measure (COPM), which focuses on occupational performance and takes the form of a semi-structured interview in order to identify occupational performance problems. Supplementary, the progress in engaging all the activities was monitored by using the Hamilton depression scale, a very useful instrument for depression after stroke (Kneebone et al., 2010). 3. Findings Ana is a 64 years old pensioner, who lives in a Romanian small town, in her private owned house, but with all modern facilities (current water, electricity, inside toilet, advanced equipment, eg washer, microwave). Ana had a stroke two years ago and she lives now with its residual effects. We interviewed Ana and her family in order to establish previously held life roles and the tasks and activities that were completed within these roles. Thus, together with her husband she used to share many domestic tasks: cooking and meal preparation, shopping and cleaning. They are really proud about their son who is a happily married engineer, thing easy to recognize from their enthusiastic way of taking about his professional and personal achievements. Infor occupational performance difficulties (Westhorpe, 2003), based on an understanding of the consequences of stroke. We started form the idea that for intervention to be meaningful, the occupational therapist needs to know the Ana had a transient ischaemic stroke in antecedents. This condition occurred after retired, for 35 years she had worked as a secretary at City Hall and now she is facing overwhelming emotional burdens. She considers herself a lucky person as she is still independent in all personal care occupations (toileting, showering, dressing, eating, she often faces mood changes, has difficulty concentrating, remembering, and making decisions. She reports feeling confused about her interest in events around her, even the lack of desire for spoiling her two grandchildren, who she used to regularly see each Sunday. oles (eg self-carer, housekeeper) as well as social roles (wife, mother, grandmother, and neighbor), but also some information about her current limitations in performing things she liked (symptoms of reactive post stroke depression). Prior to her stroke, Ana felt that she enjoyed good health. She is right handed without impairments regarding abilities and strength, which influence the range of occupations she adopts and the way in which these occupations are performed. We were interested in finding out how She used to like reading romance novels, watching TV soap operas and the cooking channel, activities that she still does but rarely as she lost her patience. Ana reported feeling ho
Constantin Ciucurel and Elena Ioana Iconaru / Procedia - Social and Behavioral Sciences 46 (2012) 3865 – 3869
3867
nt life when she likes to be alone with her thoughts. Now she describes herself as a solitary, frustrated person, due to her medical condition. She is aware of her diminished responsibilities and decreased desire for doing things she used to do, relating to this situation with a feeling of loss. In addition, Ana discussed that she had lost her confidence in regaining her social role arguing that she read a lot of articles which demonstrated that the chances for a new stroke to happen are high and that most stroke deaths occur in women. Ana still goes walking in the park around a local monastery, but only together with her husband as sometimes she looses her temporo-spatial orientation. Ana talked so passionately that she has always liked flowers, especially roses, nature, the work in open spaces and her strongest desire has been to live in a house with a large court and access to the main road like this one they have after selling their apartment five years ago. The initial assessment was carried out using the Canadian Occupational Performance Measure (COPM) which focuses on occupational performance and takes the form of a semi-structured interview in order to identify occupational performance problems. COPM enable clients to rate importance, performance and satisfaction with selfwas also highlighted that the COPM, as an outcome measure, provides opportunities to detect changes over time, and as A total of two problems were identified in leisure activities regarding getting back in activities that were enjoyable for her before stroke: having friends and family over (performance score 3, satisfaction score 4) and gardening (performance score 3, satisfaction score 4). Deciding that planting a rose garden in front of her house is the most important occupation for her in present, we proceed to explore, using the Person Environment social environments, physical abilities, interest roles, personality and the occupations she chooses and needs to perform all interact to influence her occupational performance. The PEO model of practice considers the person and
Table 1
Analysis of the PEO transaction for planting a rose garden in front of the house O-E owns gardening space; procure gardening equipment: boots, coveralls, gloves, hat; buy gardening tools: scissors, sprinkler, rake, shovel; manuals, gardening reviews; acquire fertilizer; get special insecticide; buy rose cuttings; visit floral exhibitions and greenhouses. P-E continuous family facilitation; develop social relationships; achieve personal expectations; respect safety issues regarding tools manipulation; obtain resources for gardening activities.
P-O improve skills/abilities for gardening; maintain motivation for gardening; develop dexterity; get specialized knowledge; has time to spend in gardening.
For Ana we tried to set rehabilitation goals related to activity and participation that are specific, measurable, attainable, realistic, and relevant to individual person. Using the SMART method for writing goals, we agreed that: working at least one hour each day (T2). In three weeks she will have the ground prepared (M1) and in the next two buying the necessary tools (A2), fertilize and prepare the soil (A3), select and buy the roses (A4) and plant it (A5). The progress in engaging all the activities was monitored by using again the depression scale, satisfaction measurement tools or specific steps achievement (R1) and also by her family within daily involvement (R2). One great advantage of the SMART goals method is that it also offers the key elements for the intervention plan which was structured around the activity strategies, as follows:
3868
Constantin Ciucurel and Elena Ioana Iconaru / Procedia - Social and Behavioral Sciences 46 (2012) 3865 – 3869
Week 1: Ana documented about gardening and talked with her husband and son about plants, garden decorating, gardening tools and equipment. Week 2: Ana made the list of equipment and gardening tools; go shopping and buying them. Week 3: Ana worked the ground and fertilize it. Week 4: Ana visited greenhouses, floral expositions, discussed with specialist or friends to select the roses. Week 5: Ana bought the roses and plant them. Week 6: Ana cared for the garden, invited friends to share experience and made plans for different arrangements. We considered very important that our client should be encouraged to increase the level of autonomy (regarding the temporo-spatial orientation), to state and to exceed the social isolation condition. For this reason, we worked with the client in order to maximize the ability to undertake her own personal selfcare tasks and domestic tasks and to help her to learn strategies to manage the cognitive, perceptual, and behavioural changes associated with stroke (Rowland et al., 2008). In stroke, occupational therapists assess the impact of changes in motor function, sensation, coordination, visual perception, and cognition on a person's capacity to manage daily life tasks (Rowland et. al., 2008). Because of the variety of implied factors, we considered the use of a qualitative best-evidence synthesis to analyze the results of OT in stroke highly appropriate. After six weeks, Ana was re-assessed using the COPM and depression scale which showed improvements in: occupations involvement, motivation, enjoyment, decreased anxiety and social interactions. 4. Conclusion From a global perspective, the positives aspects of the case is that Ana was a good rehabilitation candidate (moderately severe stroke), and the negatives one refers to the delay in getting to rehabilitation and accessing therapy (Teasell et al., 2009). After 6 weeks of participation in the OT rehabilitation program, Ana had made remarkable progress. She is currently able to have a normal life after stroke, becoming integrated back into the community. We decided with Ana that our therapeutic relation can end but with further referrals for psychological services if the symptoms of depression will reappear. The results demonstrate that the approach is useful to improve the quality of life in clients with stroke, especially in reaching their daily occupational goals. Best practice in stroke rehabilitation involves specialized inter-disciplinary teams working (Edmans, 2010) in a highly coordinated manner to obtain best outcomes, stroke rehabilitation being most effective for moderately severe stroke patients. OT is part of the multidisciplinary rehabilitation after stroke and functions in collaboration with the other involved healthcare professions (Steultjens et al., 2003). The purposes of intervention in elderly with stroke focus on: amelioration of participation in meaningful everyday roles, tasks, reducing of deficits impact, avoiding secondary complications and providing professional education and support to the patient and therapeutic team (Rowland et al., 2008). The use of the COPM as an occupational performance measurement tool increased client participation, which resulted in a distinct and meaningful goal to the client for each occupational problem. Together with Ana, we found the right combination of tools and techniques so that the client could handle her personal life and we can affirm that the rehabilitation took a positive turn when she began to receive OT. We proved that a good understanding of the theoretical notions, emphasizing communication and collaboration skills and a regularly feed-back from the client in all the process stages are vital in OT interventions for elderly with poststroke depression. References
Craik, J., Davis, J. & Polatajko, H. J. (2007). Introducing the Canadian Process Practice Framework: Amplifying the context. In E. A. Townsend,
Constantin Ciucurel and Elena Ioana Iconaru / Procedia - Social and Behavioral Sciences 46 (2012) 3865 – 3869
3869
& H. J. Polatajko, Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation (pp. 229-246). Ottawa, ON: CAOT Publications ACE. Davis, J., Craik, J. & Polatajko, H. J. (2007). Using the Canadian Process Practice Framework: Amplifying the process. In E. A. Townsend, & H. J. Polatajko, Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation (pp. 247-272). Ottawa, ON: CAOT Publications ACE. Edmans, J. (2010). Occupational Therapy and Stroke . (2nd ed.). Wiley-Blackwell, (Chapter 3). Henry, A. D. (2003). The interview process in occupational therapy. In E. B. Crepeau, E. S. Cohn, & B. A. Schell (Eds.), Willard and , (pp. 285 297). Lippincott Williams and Wilkins, Philadelphia. Kneebone, I., Baker, J., & O'Malley, H. (2010). Screening for depression after stroke: developing protocols for the occupational therapists. British Journal of Occupational Therapy , 73(2), 71-76. McColl, M. A., Law, M., Stuart, D., Doubt, L., Pollack, N. & Krupa, T. (2003). Theoretical Basis of Occupational Therapy . (2nd ed.). Thorofare, NJ: Slack, (Chapter 4). Metzler, M. J. & Metz, G. A. (2010). Analyzing the barriers and supports of knowledge translation using the PEO model. Canadian Journal of Occupational Therapy, 77(3), 151-158. Polatajko, H. J., Craik, J., Davis, J. & Townsend, E. A. (2007). Canadian Process Practice Framework. In E. A. Townsend, & H. J. Polatajko (Eds.), Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation (pp. 233). Ottawa, ON: CAOT Publications ACE. Rowland, T. J., Cooke, D. M., & Gustafsson, L. A. (2008). Role of occupational therapy after stroke. Annals of Indian Academy of Neurology , 11(5), 99-107. Schell, B. A. (2009). Professional reasoning in practice. In E. B. Crepapue, E. S. Cohn, & B. A. Schell (Eds.), Occupational Therapy (pp. 314-327). Lippincott Williams and Wilkins, Philadelphia. Steultjens, E., Dekker, J., Bouter, L. M.., van de Nes, J. C., Cup, E., & van den Ende, C. (2003). Occupational therapy for stroke patients - a systematic review, Stroke, 34, 676. Sumsion, T., & Smyth, G. (2000). Barriers to client-centredness and their resolution. Canadian Journal of Occupational Therapy , 67, 15-21. Teasell, R., Meyer, M., Foley, N., Salter, K. (2009). Stroke Rehabilitation in Canada. Topics in Stroke Rehabilitation , 16(1), 11-19. Townsend, E., & Polatajko, H. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation. Ottawa, ON: CAOT Publications ACE, (Chapter 3). Westhorpe, P. (2003). Exploring balance as a concept in occupational science. Journal of Occupational Science , 10(2), 99-106.
