Case Studies

CASE STUDY #1

Mrs. Smith is an 86 year old resident of a long term care facility. She has contractures of her left 4^th and 5^th digits. She reported having the contractures for “about 10 or 11 years”. Mrs. Smith does not have pain but experiences a burning sensation at times.

The cause of the contracture was not identified, although it appears to be similar to Dupuytren’s Contracture. Again, her left 4^th and 5^th digits are affected. Mrs. Smith has flexion at her MCP joints and proximal PIP joints. Her DIP joints are hyperflexed. She is right hand dominant.

The contracted fingers cause pressure on her palm. As a result she has developed small skin tears on her left hand. She has increased moisture build-up on her palm and an odor due to the moisture and lack of air circulation.

Mrs. Smith performs some of her self-care routines independently. She enjoys reading, doing word search puzzles, and she waters the plants in the home. She explained that she has learned to live with the contractures of her left hand.

The main concerns are the moisture build-up and also a history of skin tearing on her palm. Surgery was not considered an option or other forms of medical treatment. Custom splinting for the frail elderly is usually not successful. A comfortable splint or orthosis was required to meet the following goals.

Goals:
- Prevent skin breakdown on left palm
- Absorb moisture and provide a means of preventing odor build-up
- Provide comfort

Intervention
- Provision of a Ventopedic^TM left Palm Protector for a trial of one week. Mrs. Smith and the staff were advised of the wearing schedule, i.e., wear at night or when at rest in bed, but not during the day while performing activities.
- After one week, Mrs. Smith reported feeling comfortable wearing the palm protector at night. She said her hand did not “burn” as much. It protected her skin from tears and absorbs moisture.
- Two Ventopedic^TM left Palm Protectors were purchased for Mrs. Smith. The extra palm protector is used when the other is washed.

Jacqui Wilcox BScOTReg(NS)
Occupational Therapist
www.otns.ca
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CASE STUDY #2

Miss MacDonald is a sixty –two year old resident of a long term care facility. She has a number of diagnoses, among which is hyperhydrosis (severe continuous sweating) and a tendency towards recurring ulcers on her back and buttocks. She is confined to bed. O.T. received a referral to assess her for a specialty mattress to help heal stage 2 and stage 3 ulcers.

Miss MacDonald is mentally challenged, has significant weakness in her lower extremities and is unable to weight-bear and therefore cannot stand, nor walk. She has active use of her arms and hands. She has no skeletal deformities. She refuses to sit in a wheelchair or gerichair and prefers to stay in bed, lying on her back. She is unable to communicate effectively and unable to follow simple commands. When this resident was examined by the O.T., she had a number of persistent reddened areas on her back and buttocks and a stage 3 ulcer on her sacrum. It was also noted that her body was continuously moist and her fingertips puckered.

Miss MacDonald is totally dependent in all aspects of self care, transfers and mobility.

She is unable to turn herself in bed. She is able to feed herself once set up with the head of the bed elevated. She is incontinent of urine and feces and wears a brief. The main concerns voiced by nursing staff are moisture build-up on her body and pressure areas. Various mattresses were unable to be trialed. Low air –loss mattresses are usually recommended to reduce moisture/ perspiration for the person using it as well as for pressure relief. Unfortunately staff found that Miss MacDonald was frightened by sudden or loud noises, similar to sounds made in the operation of a low air loss mattress.

A V4 mattress was recommended instead. Both types of mattresses provide up to stage 4 pressure relief.

After receiving a V4 mattress and a cover for Miss MacDonald, it was noticed by O.T. and nursing staff that sweating remained an issue for Miss MacDonald. Likely the moisture proof cover on the V4 mattress added to the problem. A new product, the Ventopedic mattress cover was trialed and placed on top of the V4 mattress cover. Staff and family reported that it seemed to help. Miss MacDonald seemed more comfortable and the surface of the bed next to her skin, was dry to touch, resulting in the purchase of the first Ventopedic cover. A second cover was obtained when staff reported “heat blisters” on Miss MacDonald’s back when her Ventopedic cover had been removed from the bed for a few days for laundering.

After one years use of the V4 mattress and the Ventopedic cover, Miss MacDonald’s reddened areas and pressure sore resolved. Staff was able to use both systems easily, both for performing daily resident care as well as laundering.

Lynne Campbell, BSCOT. Reg. (N.S.)

Occupational Therapist

CASE STUDY # 3

Mr. Brown is a 55 year old resident of a long term care facility. He has suffered a stroke several years ago. As a result, he has active use of his left arm and leg and is paralyzed on his right side. He has increased tone in his affected leg, but no active movement. Mr. Brown is a tall man and is also morbidly obese and weighs over 300 pounds. As a result of his stroke he is unable to talk but can use gestures and facial expressions to communicate his needs. He is able to understand what is said to him.

Functionally, Mr. Brown is dependent for all aspects of self care. He is incontinent of bowel and bladder and wears a brief. He is able to turn himself in bed with the help of one staff and the bed side rail. He prefers to lie on his back and refuses to turn and stay on his side for pressure relief. Mr. Brown is unable to stand and is transferred with a mechanical lift. He uses a power wheelchair for mobility both within the facility and outside as well. His wheelchair also has a tilt option as well as a Roho seat cushion to provide pressure relief when he is up in his chair. Mr. Brown has a bariatric V4 mattress and cover for excellent pressure relief in bed.

Mr. Brown has recurring skin issues and occasionally has reddened areas on his buttocks and right ankle. He does not shift his weight while in bed. He may stay in bed all day on bowel care days. He approached the O.T. for comfort issues while in bed. Mr. Brown is very hot when in bed for extended periods of time and he sweats profusely in areas where his body rests on the bed.

When Mr. Brown received a Ventopedic mattress cover (placed on top of the V4 mattress and cover), he signaled that he was very pleased after the first night, and gave the O.T. a ‘thumbs up’ gesture. When examined by the writer, the area of the bed underneath his back, felt less hot and Mr. Brown’s skin surface was not sweaty. The level of inflation of the V4 mattress was checked as well, for proper inflation and was satisfactory.

It has been one month since Mr. Brown has received his ventopedic mattress cover. It is providing heat relief and has effectively reduced sweating. He has not had any adverse effects because of the extra layer added to the V4 Mattress.

Lynne Campbell, BSCOT. Reg. (N.S.)

Occupational Therapist

CASE STUDY FOR VENTOPEDIC HAND ORTHOSIS

Mrs. White is a 72-year-old woman residing in a nursing home. Her medical history includes Multiple Sclerosis for many years; multiple skeletal limb deformities including bilateral elbow, hip and knee contractures; and the fingers in her right hand have flexion contractures. Physically she is emaciated and has generalized weakness and is unable to stand or walk. She spends several hours a day in a customized tilt w/c with custom seating, the rest of the time she rests in bed. She is dependent for all aspects of self-care, feeding and mobility and is transferred with a mechanical lift.

Mrs. White was referred to O.T. to assess and make recommendations for her severely contracted right hand and its compromised skin integrity. Staff were unable to open her hand to clean it properly. As a result, her skin was reddened, sweaty, with a foul odor. On assessment, O.T. was able to open her hand only slightly, but was able to oppose her thumb a little. Her fingers were unable to be separated to allow abductor pads or finger separators.

It was determined that an extra-small Ventopedic Hand Orthosis would be trialed. One hand orthosis was ordered and used at all times except when it needed to be washed. Feedback from staff and observation from O.T. after one month’s use concluded that there were positive results. Mrs. White’s right hand was drier and odor was reduced or virtually eliminated. The device could be kept in place because of the strap and the fact that the roll was smooth and soft, accommodating variances in range of motion of the different fingers – something a rigid plastic hand positioner is unable to do. Attempts had been made in the past to insert a washcloth but this was rough and bulky and often fell out of her hand. It was also noted that staff are now able to open Mrs. White’s right hand more than was previously possible. A larger Hand Orthosis will be ordered to take advantage of the improved range of motion in the fingers.

Lynne Campbell, BSCOT. Reg. (N.S.),

Occupational Therapist

CASE STUDY FOR VENTOPEDIC MATTRESS COVER

Mrs. Patterson is a 78-year-old woman, residing in a nursing home. Her medical history includes intellectual impairment, functional decline, and generalized weakness. She has had a history of skin breakdown on her buttocks and coccyx. She is dependent for all her self-care, mobility, and transfers. She is a large woman who is incontinent of both bowel and bladder and suffers from consistent bowel problems. While she sits up in a Geri-chair for a few hours each day she spends the majority of her time in bed. Nursing staff report that she sweats profusely, that her bedding is always damp in the morning when they start her morning care: washing her, changing her brief and dressing her for the day. No matter how much the staff clean her after a bowel accident, there is always a persistent odor.

Initial O.T. intervention included recommending and obtaining a specialty mattress to help heal previous skin ulcers and maintain skin integrity.This has helped to heal her previous ulcers and her skin is now intact.

O.T. was consulted again by nursing staff with regard to the problem of persistent sweating and concern for this resident’s skin integrity. Staff have tried to turn this resident while she is in bed and position her on her side and off of her back, for both pressure relief and to dissipate body heat and the resulting perspiration on her skin. They have been unsuccessful. This resident prefers to lie on her back and resists any attempts to reposition her.

O.T. was able to obtain a Ventopedic Moisture Control Mattress Cover. This cover was placed over top of the specialized mattress with its moisture-resistant cover. After a month of use, nursing staff have reported the following:

“Mrs. Patterson is sleeping better; has less chafing on the skin on her sides, buttocks and back as her skin is dryer while in bed (less time spent on skin care by staff) and less foul odor at bedside. O.T. has checked that this cover is not impeding the pressure – relieving qualities of the specialized mattress by checking the appropriate level of inflation and receiving feedback from nursing staff that skin integrity remains intact.”

Lynne Campbell, BSCOT. Reg. (N.S.),

Occupational Therapists

A CASE STUDY FOR VENTOPEDIC MOISTURE CONTROL PILLOW COVERS

Mrs. Albright is an 84-year-old woman with advanced dementia; has functional decline and generalized weakness. She is no longer able to weight bear and is confined to a Geri-chair during the day and spends a significant amount of time in bed. She is dependent for all her self-care, mobility and transfers. She receives bed bathes daily and a bath and hair wash once a week. According to nursing staff, she sweats profusely and wakes up every morning with her hair and scalp sweaty, emitting a strong odor.

A Ventopedic pillow cover was ordered for her and after its continuous use for 2 weeks, staff report that her hair and head are both dry in the morning and she no longer has the previous foul odor. Because of this success another Ventopedic pillow cover was ordered.

Lynne Campbell, BSCOT. Reg. (N.S.),

Occupational Therapist