Summary
Occupational therapy interventions can help in making patients independent in ADL's, providing care for one's psychosocial well-being for holistic treatment and help an individual to achieve his pre-injury status.
Abstract
Introduction
Distal humerus fracture can lead to severe functional limitations. Communited fractures especially in elderly which cannot be managed by fixation can be well managed by total elbow arthroplasty. Functional outcomes in such cases mainly depends on post surgical rehabilitation. Occupational therapy intervention can help to achieve good outcomes.
Case report:
A case of 65 year male, Right hand dominant, retired service man, who had a history of RTA in February 2022. The clinical and radiological examination showed a communited intra-aticular distal humerus fracture, AO type 13-C3 with ulnar nerve palsy. Patient was subsequently planned for total elbow replacement, and a semiconstrained type of linked implant was used.
Occupational therapy intervention was started immediately after surgery. Patient was examined and assessed on the basis of Occupational Therapy Performance Framework 4 (OTPF 4) & Patient rated elbow evaluation (PREE), Modified Barthel Index, Mayo Elbow Performance Score and Visual Analogue Scale (VAS).
Since patient was 65 year old, a custom tailored program was specifically designed for patient with taking consideration of geriatric problems. Along with this patient education regarding do's and don'ts after TEA, elbow exercises, functional activities, ADL retraining, lifestyle modification, family education, stress management was provided. Patient was assessed every month for 6 months on above mention outcomes.
There was significant improvement in elbow ranges [Elbow flexion 0°-135°, supination & pronation 0°-80°]. Also there was remarkable reduction in pain on VAS Score. Modified Barthel Index showed score of 100/100 by the end of 6th month. MAYO score showed significant improvement [85/100] by 3rd month which was persistent by the end of 6th month. PREE scores reduced from 61.6 to 32.8 by the end of 6th month [lower scores are associated with better functional outcome].
After 6 months of occupational therapy intervention, the patient is now independent in all his basic ADL's like self care, leisure activity as well as most of his instrumental ADL's like taking care of grandchildren, riding non geared bike for shorter distances in non crowded areas etc.
Conclusion-
Occupational therapy interventions can help in making patients independent in ADL's with help of exercise, splinting, functional activities, physical agent modalities , providing modifications & adaptations wherever needed and providing care for one's psychosocial well-being. All these areas are very important in holistic treatment and help an individual to achieve his pre-injury status.