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 

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? 

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. 

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

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.

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 

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. 

Alyce Gill 

 I forgot to post my source with my post above! 

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 

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

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

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! 

     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