Authors (including presenting author) :
CHOY YT(1), Lam WT(1), Yeung CTY (1)
Affiliation :
(1) Community Rehabilitation Service Support Centre (CRSSC)
Introduction :
A 50-year-old gentleman with four limbs amputation done was referred to an occupational therapist in CRSSC (Community Rehabilitation Service Support Center) by doctors for wheeled mobility, home intelligence and environmental modification. He was suffered from pancreatic cancer with Whipple operation completed. When he was on adjuvant chemotherapy, his condition was complicated with cholangitis abscesses and septic shock. In view of four limbs gangrene, he had to undergo bilateral below-elbow amputations and below-knee amputations
Objectives :
Considering patient’s young age and unaffected cognition, he has experienced critical changes in daily living related to his loss of limbs. An occupational therapist acted as a case manager, conducted a holistic assessment regarding patient’s self-care needs, mobility needs and environmental needs with patient and his significant others. After goal setting, colleagues from diverse professionals include Prosthetists & Orthotists and Rehab Engineers were consulted when formulating interventions.
Methodology :
This patient is living at home with his wife and three young children. He is dedicated to enhance his functional mobility by all means in order to reduce caregiver stress and re-construct self image. Despite the fact that patient was queuing for four limbs prosthesis and physiotherapy, two main goals were identified to tackle his present dilemma: (1) Enhance patient’s functional mobility by power wheelchair usage (2) Promote independence of feeding task by customized tableware. The first goal was achieved by occupational therapist modifying the control of conventional power wheelchair, offering power wheelchair driving skills training and home modification advices. The second goal was co-achieved by Prosthetist-Orthotist and Rehab Engineers. The former assessed the muscular strength of the amputation stump and advised proper socket design for daily activity, including the probability of myoelectric hand training program, the latter utilized their 3D modelling skills such as 3D scanning and CAD drawing to create a universal cuff that could adapt to various tableware such as knife, fork and spoon etc. During the process, multiple factors were considered, namely ergonomics, ease of use, hygiene, and durability to maximize the practicality. To ensure proper fitting and usage of aids, continuous support include on-site training and follow-up modification were provided to address user’s concerns or facilitate further customization requirements.
Result & Outcome :
Pre and post assessments were taken to measure his functional outcomes. It is noticeable that he was satisfied with aids prescribed and re-gained independence in feeding task and mobilization.
