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Hi Alyssa-Energy conservation is very important. I agree that the interventions must be client-centered, as not everyone has the same roles, routines, and occupations and it is good to focus on their volition and what their goals are. Having clothes laid out works well as it eliminates the rush and running around, as you said. Outfits can placed together by hanging shirts and pants on the same hanger. I am interested to know what kind of adaptive equipment was discussed in your article.             Jesse Herring-Sylvestre

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Hi Allison!
A loved that you used an assessment tool in order to determine what was meaningful to the patient before coming up with an intervention. This is in line with keeping our care client-centered and letting them drive their rehab in order to get the best results!

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An easy to implement intervention for a patient with a cardiac diagnosis would be to educate them on energy conservation techniques. According to a study in the Journal of Modern Rehabilitation, ADLs are affected particularily strongly by a cardiac diagnosis because of the the danger of injury from a fall post diagnosis. By educating a patient on techniques that one can use to keep fatigue low, such as taking frequent breaks and performing ADLs at a slower pace, the risk of falls can be greatly reduced.  Z., M., B., & N. (2016). Evaluation of Activities of Daily Living Instruments in Cardiac Patients: Narrative Review. Journal of Modern Rehabilitation,10(3), 139-143. Retrieved June 11, 2019, from http://jmr.tums.ac.ir/index.php/jmr/article/view/43

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Christina-
I think educating clients on adaptive equipment is a great way to help a client with energy conservation techniques. There are so many accessories out there that we have access too and we should always educate and suggest devices to our clients. It is important to assess our patients to see what devices would be best for them and to help them. I personally always put my clothes out before I shower because I have contacts so it is easier when I come out to have everything there.

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Laura Buckner

As I sought to choose a beneficial Intervention for clients with Cardiac Diagnosis, I became aware of the detrimental effect co-morbid symptoms of depression had clients with a Cardiac Vascular Disorder (CVD) diagnosis through my research.  Cohort data collection use and research review find that according to ESC et al., cardiac rehabilitation improves patient physical and mental health including depression however “depression is also associated with lower adherence to therapy and lower participation in cardiac rehabilitation”; and according to Zuidersma, et al ”findings ...suggest that an increase in depressive symptoms” with each added additional symptom of the ten depression symptoms listed in the ICD 10 “was significantly associated with a 15% increased risk of new cardiac events” after a Myocardial infraction.”  In other words, CVD and depression are strongly associated with each other and their presence together cause a downward spiral in the patients’ health status and each additional depressive symptom causes patients to spiral downward faster towards another Cardiac event.

I am currently unable to provide the two common effective treatments of medication(illegal) and Cognitive Behavioral Therapy (additional education needed); however, through the results of a quaziexperimental study conducted by Delui et al., I found a technique to use in an intervention to benefit clients with a CVD. According to Delui et al., “Our findings suggest that meditation techniques showed better outcomes in cardiac patients for reduction of systolic and diastolic blood pressure, heart rate and significant improvement of depression compared with relaxation techniques.” Further this study reviews the finding of 6 studies which found that according to Delui et al., “relaxation techniques significantly reduced depression in CVD patients…and improved the patient lifestyle.”

For this reason, I would like to address depression as a part of intervention for CVD patients. To do so I would like to educate the client in using both progressive muscle relaxation (PMR) and guided transcendental meditation (GTM) during their hospital stay.  I would include a caregiver or close family member to increase the chances of carryover into the patient’s lifestyle post discharge. Pre and post BP, HR and Blood O2 would be gathered for all Intervention participants.  During the intervention process I would use verbal/tactile cues as necessary in order to assist them to mindfully focus on their present experiences and use proper form in order to achieve the most benefit. This portion of intervention sessions would last 5 minutes and gradually increase to 20 minutes.  When the client demonstrates competence,  I would recommend that the client continues to complete PMR or GTM depending on their preference and tracked health results.

References :

Delui, M. H., Yari, M., Khouyinezhad, G., Amini, M., & Bayazi, M. H. (2013). Comparison of Cardiac Rehabilitation Programs Combined with Relaxation and Meditation Techniques on Reduction of Depression and Anxiety of Cardiovascular Patients. The open cardiovascular medicine journal, 7, 99–103. doi:10.2174/1874192401307010099
https://holisticot.org/the-power-of-meditation/
J.S. Rumsfeld, E. Havranek, F.A. Masoudi, et al. Depressive Symptoms Are the Strongest Predictors of Short-Term Declines in Health Status in Patients with Heart Failure

J Am Coll Cardiol, 42 (10) (2003), pp. 1811-1817

Vaccarino, Viola, Badimon, Lina, Bremner, Douglas, J., . . . Raffaele. (2019, January 28). Depression and Coronary Heart Disease: 2018 ESC Position Paper of The Working Group of Coronary Pathophysiology and Microcirculation Developed Under the Auspices of The ESC Committee for Practice Guidelines. European Heart Journal, ehy913 Retrieved June 8, 2019, from https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehy913/5303703
Zuidersma, M., Ormel, J., Conradi, H. J., & de Jonge, P. (2012). An Increase in Depressive Symptoms After Myocardial Infarction Predicts New Cardiac Events Irrespective of Depressive Symptoms Before Myocardial Infarction. Psychological Medicine, 42(4), 683–693. https://doi-org.goodwin.idm.oclc.org/10.1017/S0033291711001784

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Katlyn helping patients get over their own fears/anxiety and educating them about how they can safely be reintroduced into the work force is a great example of what we can do to help our patients. Sometimes people just do not know what is possible and write themselves off as not being able to accomplish something. I think doing a mini triathlon is a great way to get Allison motivated as well as educating her on energy conservation techniques. Instead of just increasing or decreasing the traveling distance for each exercise maybe you could down grade them to activities that focus on proper body mechanics during each exercise to help assist with energy conservation. Doing an activity that helps her adjust her posture when she's on top of a bike, or showing her how she can position herself to decrease strain when she is on a bike would be an example. Bringing in her family to make it more meaningful would also be beneficial, especially since she has three kids. Make them a part of the training or education process so she can carry over what we are teaching her at home more effectively by having the family informed as well.

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Heather, I like how you found an article that speaks to ways for the Cardiac patients to maintain their social supports.  Cardiac diagnosis can isolate people from their support systems are very detrimental to their mental health. I like how the article you choose gathered great ideas and tips from people who have and continue to live in the same situation, there's nothing like real life experience.   Thank you for finding and posting this article.    Laura B

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Heather,

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Hi Jesse, I think that focusing on a patients mental well being is just as important as their physical disabilities when providing OT. I think that’s it’s great to have a group session including patients with the same diagnosis to talk with each other and learn differing coping strategies. I know it’s one thing for us as OTs to give the patients strategies but I find it to be extremely beneficial if they have another person who has been through or is going through the same situation to talk to.

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Hi Jesse,

That it a great intervention! As OT’s it is important that we are treating the whole person and not just the physical deficit they have. Mental health is a key component when it comes to rehabilitation and running a psychoeducational group will be very beneficial for all patients involved.  Being surrounded by people who have similar deficits may give a patient the confidence to talk about how they feel without feeling like they are being judged. I also agree that an intervention like this is a great way to increase the participation of the patients because they will be more confident about how to manage their CHF symptoms when they are by themselves. You could also make a handout that includes everyone’s input on their own relaxation techniques and what works best for them when dealing with stress so they can have a tool to put in their toolbox for when they go home!

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Jesse Herring-Sylvestre                                                                                                                                I read an article titled "Executive Dystunction and Depressive Symptoms Associated with Reduced Participation of People with Severe Congestive Heart Failure." This article looks beyond the physical dysfunction that is related to heart failure and addresses the cognitive and mental health concerns related to those with CHF. In the study of people with CHF, which used a number of different assessments, 64% showed symptoms that would be considered possible depression, 59& had impaired memory, 33% had impaired executive function. and 15% had impaired attention. Those who displayed impaired cognition or depressive symptoms were more likely to have reduced participation in meaningful activities. Based on this information, my skilled intervention is a psychoeducational group. This would incorporate relaxation techniques and discussion of stress management. Furthermore, I would facilitate discussion between members where they would share what they do to manage symptoms and relax. The goal would be to provide education while also providing socialization. Further, By reducing depressive symptoms, participation will increase.          Reference: Foster, E. R., Cunnane, K. B., Edwards, D. F., Morrison, M. T., Ewald, G. A., Geltman, E. M., & Zazulia, A. R. (2011). Executive Dysfunction and Depressive Symptoms Associated With Reduced Participation of People With Severe Congestive Heart Failure. American Journal of Occupational Therapy, 65(3), 306-313. doi:10.5014/ajot.2011.000588

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In the article I read “Contribution of Occupational therapy in cardiac rehabilitation” it talks about how it is the main health problem in the adult population. During the evaluation of the patients they talk about the role that occupational therapy has on the cardiac rehabilitation. The main goal of occupational therapy is to regain independence in our occupations and our roles. The interventions that they used were a holistic paradigm, focused on achieving a healthy, social, and productive life. The interventions they focused on were the principles of energy conservation, ergonomic analysis, simplification of tasks, and the use of adaptive equipment and technology. I think that with our cardiac patients it is going to be very important for us to educate them on energy conservation techniques. Not only to educate them on the techniques but also show them how they can use it in their occupations and the roles that they must fill. It is important that we make our treatments client centered to the patient and it is how OT can differ from other departments. We are helping get back into the roles that they had before and helping them get back into the occupations that are meaningful to them. In educating a client on their breathing can help them throughout all their activities in life, whether it is them playing with their kids outside or if it is them working out themselves. There are many ways to help your client with energy conservation techniques such as getting all the things they need to get dressed in the morning. Having all your clothes laid out can help in the morning when you are rushing to get to work. Having everything in once place set aside can help from the mornings searching for the missing sock.

Resources:

Alba Vila Paz, & Iván de Rosende Celeiro. (2016). Contribution of Occupational Therapy in cardiac rehabilitation: intervention, challenges and reflections. Cadernos de Terapia Ocupacional, (4), 791. https://doi-org.goodwin.idm.oclc.org/10.4322/0104-4931.ctoAR0708

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I read the article "Occupational performance and strategies for managing daily life among the elderly with heart failure".  This study was conducted by interviewing a series of patient's with a cardiac diagnosis to discover any common factors that occupational therapy could address.  The research from this study found two themes and 7 sub-themes among the cardiac patients that were interviewed.  Researchers found that the two main themes of patient concern were redefining and active life and planning activities and balancing the degree of effort.  These main concerns were addressed by occupational therapists "by providing information and promoting the client's own ability to adapt.  The participants described how physical fatigue and breathlessness affected their ability to get themselves outdoors and to travel" (Norberg 1).  Because this factor was limiting each cardiac patient so much the therapists implemented an intervention to educate each patient on ways to adapt their lifestyles such as using the internet to connect with friends and family or video chatting/Facetiming them to stay connected.  I found this to be interesting because the world we live in today is very technology focused and I feel that OT's are sometimes too focused on getting the patients activity tolerance high enough to leave the house to socialize but overlook the abundance of technology we have available to us.  If a patient is able to video chat with their loved ones and receive their support and encouragement the patient's moral and mood will increase.  This improved mood will then help the patient want to work on their activity tolerance to then see their loved ones face to face.

Norberg, E.-B., Boman, K., Löfgren, B., & Brännström, M. (2014). Occupational performance and strategies for managing daily life among the elderly with heart failure. Scandinavian Journal of Occupational Therapy, 21(5), 392–399. https://doi-org.goodwin.idm.oclc.org/10.3109/11038128.2014.911955

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The article that I read was “Use of Simulated Work Testing in Cardiac Rehabilitation: A Case Report”. This article reveals that 15- 20% of patients who have a chronic heart condition, more specifically a myocardial infraction or coronary artery bypass surgery, do not return to work. The reasons for not returning to work are not medical but rather concerns about meeting the demands of the workplace. In this case study, a simulated work environment which demonstrated appropriate work demands was used as a test to determine if the patient is safe to return to work. By stimulating the patients work environment and applying the just right challenge, OT’s can greatly enhance their overall work performance. These stimulated environments help ease the anxiety and gain the confidence needed for returning to work. It is also a great test to use when determining if a patient is capable/safe enough to work again. The skilled based intervention I would complete with Allison would address education on energy conservation techniques so that she does not feel any anxiety when returning to training and competing in triathlons.

Post cardiac status Allison’s activity tolerance had decreased drastically which made it difficult for her to continue to fulfil her role as an athlete. For her to get back to what she loves, it is important to give her a toolkit to help set her up for success. For an intervention, I would stimulate a mini triathlon that includes running, swimming, and biking. During each activity I will educate and demonstrate several different energy conservation techniques as well educating on what her heart rate should be and how to check it. The just right challenge will be incorporated as well by grading the three activities separately up or down by increasing or decreasing the traveling distance.

Reference: Wilke, N. A., & Sheldahl, L. M. (1985, May). Use of simulated work testing in cardiac rehabilitation: A case report. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/3874553

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Hi Sarah, I think that is a great intervention, You really focused on the MOHO model with incorporating her kids into an athletic type game/intervention. This will help with her motivation and volition, and then habituation because like you said it is a game she can play with her family, which then helps her performance capacity by taking into account her physical and mental characteristics. This in the result will help with increasing optimal occupational performance which is what is what we as therapists are striving for. Would you consider using a self efficacy scale as well when treating her, because she may be experiencing some emotions about going from the role as a competitive athlete to now experiencing fatigue and decreased activity performance?

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Norberg, E.-B., Löfgren, B., Boman, K., Wennberg, P., & Brännström, M. (2017). A client-centred programme focusing energy conservation for people with heart failure. Scandinavian Journal of Occupational Therapy, 24(6), 455–467. https://doi-org.goodwin.idm.oclc.org/10.1080/11038128.2016.1272631

I forgot to post my source with my post above!

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Alison is very young and is used to participating in an active life style. Before her cardiac previous to her cardiac condition she had the roles of being a mother and an athlete. She strives to have her old life back pre the condition, and wants to continue those roles, but some adjustments need to be made in order to allow this to happen. Post cardiac patients often experience fatigue, and have a higher chance of undergoing another cardiac episode. If I were to see Allison for a session, I would educate her about energy conservation techniques that she can implement at home and in her daily lives so she can hopefully return back to the roles she had before pre condition. A study was conducted where occupational therapists created a client centered program for energy conservation for patients with CHF who experience fatigue daily. The program was based off of the Occupational Therapy Intervention Process Model, which looks at the person, the environment, and the occupation of the client under the current condition and circumstances. So the program was used to create an energy conservation plan that was individualized to the client. Everyone is different, so it would make sense to educate and create different techniques that are client specific, based off of the occupational profile. This program then highlighted eight points on educating and implementing the energy conservation techniques. These consisted of educating on energy conservation and what it means to be fatigued. Knowing your daily routine, not only activities but being able to recognize patterns in your body that alert you that you are becoming fatigued. Figuring out a good balance or routine for taking breaks, and determining what is effective for the client, planning and prioritizing activities throughout the day, working ergonomically, using technology and environmental adaptations, strengthening the body and working at a slower pace. These are all individual components that look at Allison's life, roles, and occupations and incorporate energy conservation techniques in order to help her perform. For example, since she is a mother and is used to caring for the family, she can look and prioritize her routine and activities by listening to her body and knowing when and how she becomes tired. If she normally feels fatigued more in the morning than the afternoon, then she can plan for a light morning and maybe plan more energy consuming tasks for the afternoon. Educating Allison about energy conservation techniques in this way would relate to the PEOP Model. It is looking at who she is as a person and her occupational profile, what environment she inhabits and adjusts and modifies the task to help prevent fatigue and enhance occupational performance.

Alyce Gill

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See all the wonderful things Parth Desai has made

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@Jennifer White I agree with your intervention approach of education.  I chose to address anxiety and fear in my post as well.  Something like an MI can have a residual affect on a person and leave them not knowing how to handle certain emotions.  Educating them on how to safely push themselves is very important to getting them to where they were before the MI

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I read the article “Use of Simulated Work Testing in Cardiac Rehabilitation: A Case Report” and the skill based intervention I wanted to apply was education of coping techniques to reduce anxiety, as well as use of the ‘Just Right’ challenge.  In the article I read, it said that, “Currently about 15% to 20% of myocardial infarction patients do not return to work. (Wilke, N., Sheldahl, L.)” Interestingly enough, a good amount of these people aren’t returning for non-medical reasons, one of which is, “patient anxiety regarding ability to perform job demands. (Wilke, N., Sheldahl, L.)” So if a patient is too anxious and scared to work, you need to educate them on how to cope with their anxiety so they can get back to where they were; and coupling this with the just right challenge can help decrease anxiety and let them know that they still do have what it takes to complete tasks that their job requires of them, even if it’s in small steps.

Wilke, N. A., & Sheldahl, L. M. (1985). Use of Stimulated work testing in cardiac Rehbaliitation: A case report. Retrieved June 5, 2019.

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Hi Taylor,
My thinking behind it was that not every client will be always up to work hard every session. I was thinking more of a therapeutic use of self with the client expressing how they feel and help with words of encouragement. I remember Parth early on in 100 saying that not all clients are going to be doing everything and needs to talk to the therapist. I could totally be wrong with everything though. As far as documenting it that is a great question. Parth, if I am on the right track how would you document that?

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Allison Caruso

The article I choose is called, “Activity Performance Problems of Patients with Cardiac Diseases”. The purpose of this article is to explain the consequences of patients with cardiac diseases and analyze activity limitations and quality of life.

As the therapist, I would use Canadian Performance Measure (COPUM) to determine what activities are meaningful to the client. Also, I would use The Nottingham Extended Activities of Daily Living (NEADL); a scale that was used in this study to detect the impact of limitation in daily living activities. These two assessments can help determine meaningful treatment interventions for not only a cardiac patient, but for any diagnosis.

For the treatment intervention, I would focus on an ADL or IADL activity that was the most meaningful for client, and educate the clients on energy conservation techniques. Decreased energy is one of the most significant residual effects for cardiac patients (Duruturk,Tonga, 2015); it is important for cardiac patients to conserve their energy in order to prevent falls and further strain on the heart. For example, if my patient, Allison wanted to independently dress herself in the morning, I would have her perform the ADL, but educate her on energy conservation techniques and also safety precautions. I would teach Allison to don and doff her clothing while seated at the edge of her bed, and recommend leaving her clothing in an area near the bed in order for her to conserve her energy. Also, I would teach Allison proper breathing techniques to perform when she feels out of breath, and teach her to take timed breaks in order to conserve her energy throughout any ADL or IADL.
Duruturk, N., Tonga, E., Karatas, M., & Doganozu, E. (2015). Activity performance problems of patients with cardiac diseases and their impact on quality of life. Journal of physical therapy science, 27(7), 2023–2028. doi:10.1589/jpts.27.2023

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Louie, I accidentally choose the same article you picked! I should have checked before posting! I like how you included educating the patient on how to use a spirometer. I would also educate the client on how to take their own pulse. That can be another way to educate the client on how to notice warning signs if they are over extenuating themselves       .-Allison Caruso

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Hi Sarah- I did not know the most common problems that were described. The one thing that caught my attention the most was the outings. That wasn’t really on my radar until you said something. It does make sense though because it can be physically exhausting. Even if It was something as simple as going out for coffee in the morning. I love these types of interventions because it such a real life activity.

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Louis, I never thought of the spirometer.  That is a great idea.  I see them in a lot of the homes I work in and the patients usually ignore the spirometer.  Educating on a chair lift is good too although it could be costly for the patient.  What would you suggest for a patient that cannot afford a chair lift or just flat out refuse to have a chair lift installed in their home because of how it looks?

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Taylor, I would definitely write "energy conservation" when documenting.  That is a large portion of cardiac rehab.  The patient has to learn how to manage his illness.  Something as simple as lifting a gallon of milk after a cardiac episode is not allowed.  The patient will need to know these limits and how to conserve energy when by milk by purchasing a quart or half gallon instead of a full gallon.  Being educated on simple items like buying milk will help to conserve energy in the long term.

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Louis, I mention that the patient will be educated on monitoring his heart rate and through this education he will learn how to grade the activity according to his activity tolerance level during that activity or while performing a task at home.  Thank you for the feedback.

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Jen White, This is a very thorough, thought out intervention. I like that fact that you involved your patient in the intervention, allowing them to ask questions and for clarifications of anything that that may have been missed. The only other thing I con think if is to possibly grade the activity as the patient progresses. Great job!

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Sorry, I hit enter and it sent. my reference is...Activity Performance Problems of Patients with Cardiac Diseases and Their Impact on Quality of Life. E. Doganozu, MD. N. Duruturk, E. Tonga, M. Kartas. Retrieved from Http://www.ncbi.nlm.gov/pmc/articles.

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The article that I researched was, Activity performance problems of patients with cardiac diseases and their impact on quality of life. I chose this article because my intervention would be a combination of energy conservation techniques and education. This article states the importance of The Canadian Occupational Performance Measure (COPM) and The Nottingham Extended Activities of Daily Living (NEADL) Scale in assessing activity limitation in patients with cardiac limitations. After the assessments have been completed I would educate the client on possible environmental modifications in their home such as grab bars or even a chair lift if the client is required to go to another level in their home to minimize fatigue. Also, AD like an extended sponge for bathing, sock aid, bedside commode and a grabber to assist with functional reaching and item retrieval. All of these items will help keep the clients HR at a lower functioning level while performing ADL's/IADL's in the home as well as limiting the risk of falls. I would also educate the client on the importance of using an incentive spirometer to keep their lungs free and clear to prevent any secondary problems to the lungs, while showing them the proper techniques for deep breathing.

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Latoya cooper
Jennifer  you and have the same idea
Patient education give the therapists to opportunity to combine all the patient problem as well as set plan to work on the area individually. And patient education the patient is fully aware of the capabilities

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Hi Emily, I really like your article but I guess I am wondering how it would be documented? would it be geared to helping with ADL or IADLS? In my opinion it seems more of a personal reflection journal but I could be understanding it wrong. - Taylor M

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Hi Jennifer, I  think that education is a great idea for this client. When I researched I couldn't find any evidence based articles on it so I am happy that you included this. I wonder if during documentation we could write " energy conservation" because they could use these techniques to help in that way as well. Were you thinking of incorporating those strategies within the education? - Taylor M

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Hi Parth, @parthdesai,  I think what sets this intervention apart from PT and makes it more OT is the fact that we are thinking of the clients home when giving them exercises. These are all movements that can be done at their house and they are individualized to fit the needs of each person, whereas in PT they would give the standard exercises without asking them about their home base. Also, I think it could be documented and taxed as energy conservation techniques, becoming independent in IADLS, and becoming independent in ADLS because these movements help to improve overall strength, balance, coordination. - Taylor M

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Latoya cooper
The intervention I chose is therapeutic education. I  read a case study about a 54 years old cardiac arrest patient and in this case study they use therapeutic education to help the patient with rehabilitate.  I found out that therapeutic education helps the patient to work on self-management such as dietary habits, safely regaining functional recovery, reconditioning the heart by self-monitoring his heart rate, exercises and motivation. After each session of exercise, the therapists provide the patients with video, discussions and material to help with self-management.  The goal was set to accomplish in six weeks of outpatient treatment and they accomplish their goals within that time.  Therapeutic education allows the patient to be self-aware. It gives the patient guide for prevention measures they need to take to stay health. In another article research done by scientist shows therapeutic education is the key component in patient’s health improvement. They show the result for modification of diet exercise and smoking.  Therefore, I think if I use this intervention along with other interventions it will help Allison feel better both physically and mentally.   Because cardiac arrest affect the person both physical and mentally. And therapy should work on the person as whole.

Mampuya W. M. (2012). Cardiac rehabilitation past, present and future: an overview. Cardiovascular diagnosis and therapy, 2(1), 38–49. doi:10.3978/j.issn.2223-3652.2012.01.02

Tudor, Mariana & Iconaru, Elena Ioana & Ciucurel, Manuela & Ciucurel, Constantin. (2017). A Case Study of Occupational Therapy in Acute Myocardial Infarction Patient. 1686-1693. 10.15405/epsbs.2017.05.02.206.

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In the article Activity Performance Problems of Patients withCardiac Diseases and Their Impact on Quality of Life the COPM was utilized for interviews with patients. “The most commonly described problems were walking [tolerance] (45.7%), climbing up the stairs (41.4%), bathing (30%), dressing (28.6%) and outings (27.1%).” The intervention I would do with the client would be to start off with a pitch and catch game, utilizing a tennis ball with velcro catch pads and incorporate her kids in the activity. It could be graded up or down by increasing/decreasing the speed thrown, distance thrown, or how the ball is thrown. This is an easy and inexpensive game that thefamilycould even utilize at home. This intervention can help to improve and work on activity tolerance, which would be my focus since all the most common problems seem to center around this issue. Having the patient take breaks, or even do the activity seated are other ways to modify this intervention. Talking with the client about posture and breathing techniques during the activity can also help her to work on energy conservation. “Patient-reported outcomes can provide an additional measure complementary to objective biomedical measures.” Keeping communication open with the client and making sure to check in and see how they are performing/feeling is important, as well as to make sure we as practitioners are providing the just right challenge. The better we are able to motivate them, the better potential outcome they will have.

Reference: Duruturk, N., Tonga, E., Karatas, M., & Doganozu, E. (2015). Activity performance Problems of Patients with Cardiac Diseases and Their Impact on Quality of Life. Journal of Physical Therapy Science,27(7), 2023-2028. doi:10.1589/jpts.27.2023

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Emily                                                                                                                                                    The article I read was very focused on the client's needs and how to achieve the goal. The article had interviewed a number of participates and asked them various questions. They took each question/concern the client had and answered it in a way occupational therapy can help them. Most of the interventions was more education based but there was other types of interventions as well. One of the concerns the client stated was "“I think I
must bake a sponge cake or something. But I don’t do it because I can’t finish it. Then I get very tired ...in my back.” The article went on the state this is mental fatigue, which means not having the energy to start the activity. When we watched the video of Alison, she started to open up a little bit about how she was worried what people were saying about her. " Was I being irresponsible?" This was showing some mental fatigue. She was showing she wasn't having energy to complete her activities. I would use therapeutic use of self to help find words of encouragement to help complete the activity.                                                                                                                         Norberg, E., Boman, K., Löfgren, B., & Brännström, M. (2014). Occupational performance and strategies for managing daily life among the elderly with heart failure. Scandinavian Journal of Occupational Therapy,21(5), 392-399. doi:10.3109/11038128.2014.911955

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Jennifer White          Christina,  I believe that re-training on ADLs is vitally important to the client.  As a CNA, I see lots of patients use their disability as a reason they are unable to do an activity such as bathing.  When, in actuality, if they are trained properly on safe ADLs, especially bathing, then the client would be more independent.  The OTA can also recommend installing grab bars.  A lot of people try to use the suction cup ones and do not realize that these fall off easily.  Educating on the importance of grab bars is critical as well.

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Jennifer White           Julie and Chistina, I think that some coping techniques besides breathing could be listening to music as well. I find depending on my mood and stress level, if I listen to music I calm down.  Relaxing music is a great way to slow the heart rate and relieve stress.  Also, I am a big supporter of animal therapy.  If the patient has a pet we could recommend some snuggle time with the pet.

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Jennifer White

I read the article “A Case Study of Occupational Therapy in Acute Myocardial Infarction Patient”.  The intervention I would use is education.  Since the patient will be having anxiety, fear, and possibly depression after their MI episode I feel that educating the patient on how to handle his feelings while performing his occupations as a father, husband, and employee are critical to his rehabilitation.  The article talks about educating the patient on identifying and solving occupational problems he may be facing.  The intervention was a “program focused on daily engaging the patient in functional activities (walking, dressing, cleaning the house)”.  The sessions are focused on self-management and are performed during phase II of the patient’s cardiac rehabilitation.  The intervention starts in small sessions of 15 minutes each and gradually increases to 30 minutes.  The patient is to start each session with a 5-minute warm up and end with a 5-minute cool down.  At the end of each session the therapist uses therapeutic education for the patient where the patient can ask questions, receive information, and watch videos with the therapist.  As the therapist, I would educate the patient on cardiac precautions while he is performing his ADLs and IADLs.   Since the patient becomes fatigued while performing his daily tasks, I will educate him on pacing himself and using a slow relaxed speed.  He will have to remember to take frequent breaks.  The education will involve how he should schedule rest breaks into his daily routine.  He will learn how to relax because relaxing will help to reduce his stress and anxiety.  The therapeutic education is helpful in reducing the patient’s anxiety, fear and depression about his cardiac diagnosis.  Educating the patient helps increase his self-efficacy and helps him to make good decisions and solve problems he may face regarding his condition.  Also, the patient is educated on how to monitor his heart rate before and after each session and record the outcomes.  By monitoring his heart rate, the patient and therapist are able to grade and monitor all demanding activities making each activity just right for that session.  Therefore, my intervention is not only working on the physical deficit the patient is experiencing due to his MI, but also working on his mental status through education.  Reference:  Tudor, Mariana & Iconaru, Elena Ioana & Ciucurel, Manuela & Ciucurel, Constantin. (2017). A Case Study of Occupational Therapy in Acute Myocardial Infarction Patient. 1686-1693. 10.15405/epsbs.2017.05.02.206.

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@ Taylor - good EBA.  My thought provoking question would be is this intervention unique to OT? How can we stand out and be distinct to suggest its an OT based tx?

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Christina -
Good work on addressing environment. Item retrieval is a great purposeful activity as we have discussed. This purp - leads to the OBI of bathing.

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( ps I did not know that hitting enter wouldn't make a new paragraph shoot!). Anyways, this study patients were taught new exercises that they can perform independently and that would be safe for them following their cardiac injuries. It was found that patients who learned these new exercises and documented themselves performing them independently ( without their CR doctor) had higher rates of exercise adherence in the 6 months following discharge compared to cardiac patients who received normal treatment ( non SCI). The intervention group as a whole reported an increase of 74.13 minutes of independent exercise each week. The purpose of this was to increase the activity of CR patients outside of the structured cardiac rehab setting so that they can begin to engage in an everyday lifestyle independently and free of worry that the exercises they are doing may be harmful to them! I thought this intervention was great because it taught cardiac patients safe exercises and made sure they were performing them correctly before sending them home to complete them on their own time. I think it can definitely be documented through OT as well. here is a link to it : https://eds-a-ebscohost-com.goodwin.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=18&sid=8d2be4c0-45ea-4f41-abe7-3ccb19eca798%40sessionmgr4008

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I read a study titled, "Evaluation of an Intervention to Increase Self-Efficacy for Independent Exercise in Cardiac Rehabilitation" conducted by Sherry Barkley and Nancy Fahrenwald. This study focused in on a self efficacy intervention (SCI) to promote independent exercise and independent exercise behavior in cardiac rehabilitation (CR). This study explored whether SCI as an intervention showed improvements in exercise self efficacy in cardiac patients. The study occurred at a hospital in MidWestern US and only patients that were referred to phase II of CR were invited to join- a total of 65 completed the study.

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Christina,
Absolutely, I honestly don’t know anyone who doesn’t need ways to cope with stress. Personally, I deal with mine by extreme cleaning or running/working out until I have no energy left. What makes us so special as OTA’s is our relationship with the client will allow us to have more insight to them so we can use the just right challenges and come us with a way to cope with stress in a way that fits them. I like to cope with stress by being active but my roommate is the sleep it off type. That’s what gives our job the fun challenge because no two people are the same.
Great point! Do you have any ideas for coping activities that would seem to fit this case?

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Hi Julianne,

I like how you talk about stress hormone and how they can affect a person’s heartrate, especially in cardiac disorders. Stress can be debilitating in people without these limitations, so I can only image how it impacts the life of a person with one! Do you think there are ways an OTA can provide skilled treatment for a person dealing with stress that doesn’t have cardiac issues?

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In caring for clients with cardiac-related disorders, energy conservation techniques are commonly incorporated into ADL re-training interventions This can especially effective in bathing ADLs where there is a higher risk of injury due to falls. First, the OTA can educate the client on the installation and use of a tub bench and long-handled shower head for seated showers and how to use proper body mechanics to minimize fatigue and shortness of breath. The OTA can also suggest altering the environment around them to reduce unnecessary effort. This can include educating the client to gather everything they need (towel, clothes, etc..) before beginning the ADL and placing it nearby. Finally, the OTA can demonstrate slow, deep breathing techniques to the client, so it can be utilized when the client is feeling over exerted.

American Occupational Therapy Association. (n.d.). Occupational therapy’s role in chronic disease management [Fact sheet]. Bethesda, MD: Author. Retrieved from http://www. aota.org/-/media/Corporate/Files/AboutOT/ Professionals/WhatIsOT/HW/Facts/FactSheet_ ChronicDiseaseManagement.pdf

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I read the article, "Use of Leisure time by Cardiac Patients" becuase my skilled intervention is coping with stress through use of education of relaxation techniques. According to (Fitts, H., Howe, M. (1987), the way an individual copes with stress will determine their health.The article explains that behavior is paired with a chronic stress respose that results in the increased release in the hormones epinephrine, norepinephrine, and other various stress hormones. This obviously will raise heart rate and make it hard for Allison to participate in athletic events that she deperately wishes to. In education of the relaxation breathing or walking to calm down instead of running will giver her the balence they are talking about in this article between Leisure and other occupations. They also discissed that moderate levels of social activity was MOST beneficial to health ,so adding in the two sons could make this intervention that much more "skilled." Resource: Fitts, H., Howe, M. (1987) Use of Leisure Time by Cardiac Patients. American Journal of Occupational Therapy. Pg 583-588

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As we know Allison is a patient status post a cardiac condition who underwent rehab to restore participation in her meaningful occupation. Based on your evidenced based research - please post one skilled based intervention that you can facilitate in the future for a patient status post a cardiac diagnosis.  Please comment on ONE other post ensuring you address your classmate by name.