Name: Nicole Brunne Date: November 30 2016

Assignment # 4: Case Study on Rehabilitative Services (20 marks, 10%)

Mr. Smith is a 60-year-old with prostate cancer that had metastasized to his spine. He recently
underwent spinal decompression in the lumbar region. He has been in the hospital for 2 weeks following
the surgery and has very little movement and strength in his legs. His goal is to return home to live with
his wife. He is currently unable to dress, toilet, transfer or walk independently. He would like to be as
independent as possible with these, but according to the doctors, will not likely be able to return to
independent unassisted walking.

1) Identify the steps of the rehabilitation process in this case (6 points).

There are six steps in the rehabilitation process: Prevention, Referral, Assessment, Plan, Intervention
and Evaluation. According to this case study all of the steps are involved. Cancer prevention is hard to
do but in the case of Mr. Smith he may have gone for his regular check-ups with his general practitioner
to try and prevent sickness. Mr. Smith’s GP first examined and then referred him to a specialist that
most likely deals with the spine. The surgeon and specialist would then examine and assess the cancer
that has metastasized to his spine. Next a plan by both the surgeon and the PT/OT will be developed.
They will make a plan for how they will perform the spinal decompression of the lumbar region. The
PT and OT will create their own intervention plan by creating short term and long term goals for Mr.
Smith, for example his main goal of being able to go home to his wife. After the 2 weeks’ post-surgery,
Mr. Smith’s PT and OT will carry out the intervention step which involves the start of therapy
treatment. His intervention would be practicing all transfers, dressing walking and toileting
independently. Finally, the step of evaluation is when the Mr. Smith will be evaluated if he is ready to
be discharged and has met his short term and now term goals. In Mr. Smith’s case he may reach his
most of his goals but the doctors believe he probably will not walk independently again. In this case
his situation and goals can be readjusted and gait aids and assistive devices can be added in. Mr. Smith
will be discharged when his progress reaches a plateau, no longer making gains in function/mobility
and goals have been reached.

2) Describe the specific role of the OTA/PTA within this case (1 point).

The role of the OTA/PTA within this case would be to work through the treatment plans that the OT
and PT have laid out for Mr. Smith. Specifically, working on trying to increase his leg strength, range of
motion and balance as much as we can. They would also work on general strengthening of his other
extremities especially while he is in the hospital to limit muscle atrophy. They will work through
strengthening programs, stretching programs, modalities for pain relief, patient education, education
on equipment, and ambulating programs. OTA would also look into adapting the hospital environment
and home environment to try and increase Mr. Smith’s independence.

3) Develop a specific short term goal for Mr. Smith (1 point).

A specific short term goal for Mr. Smith would be that he is able to independently put sweat
pants/sweater on for comfort in 3 weeks with the use of assistive devices like a reacher.
4) Develop a specific long term goal for Mr. Smith (1 point).

A specific long term goal for Mr. Smith would be that he is able to independently move around his
home within 2 months with the use of gait aids like a wheelchair or walker and assistive devices like a
reacher.

5) List the three types of consent that Mr. Smith can provide (3 points).

The three types of consent are written consent (required for all major medical interventions and have
to be signed by the client, dated and witnessed), oral consent (is given by spoken word over the phone
or in person and is equally binding), and implied consent (occurs by virtue of the fact that an individual
seeks the care of a physician or other health care professionals). In this case Mr. Smith most likely
provides oral consent during most of his treatments.

6) Identify three health care services which will be utilized in this case (i.e. spinal decompression
surgery in the hospital). Explain how each service will be funded (i.e. OHIP pays surgeon for the
procedure). (6 points)

The first type of health service that would be utilized would be Mr. Smith’s GP office which could either
be a private clinic or walk in clinic. Private and walk in clinics are funded by OHIP which covers the cost
of the doctor seeing their patient which is a 35-dollar cap per visit. The second health care service that
Mr. Smith used would be the hospital where he had his spinal decompression surgery. The surgery
expenses will be billed to OHIP and OHIP pays the bill. Also during his stay at the hospital he would
have an x-ray of his lumbar spine and this would be covered by OHIP. Also while in the hospital Mr.
Smith will receive physiotherapy and occupational therapy which will be covered by OHIP during his
stay. Finally, Mr. Smith will most likely require further therapy through an outpatient clinic to help
improve and strengthen his legs to try and get Mr. Smith as independent as possible. In the case of a
private physiotherapy clinic, OHIP only covers the cost of therapy if the patient is over 65 or under 19
years of age. Those who are between 19 and 65 are not covered unless they are on welfare, private
insurance, WSIB or disability. In Mr. Smith’s case he would have to pay out of his own pocket for the
rest of his physical therapy.

7) Describe a challenge in the health care system which might affect Mr. Smith (2 points).

One challenge in the health care system that may affect Mr. Smith would be the shortage of physicians
in the hospital. Mr. Smith is 2 weeks’ post-surgery and still has significant muscle weakness in his legs.
If there were more PT/PTA and OT/OTA available at the hospital providing treatment sessions every
day, possibly even multiple times a day, Mr. Smith’s healing and strength may have been better at this
2-week point.

Reference

Suppiah, R. (2016, November 9). HSYS 1301 Governments Role in Health Care.

Suppiah, R. (2016, November 16). HSYS 1301 Legislation.

Suppiah, R. (2016, November 16). HSYS 1301 Money Money Money.

Suppiah, R. (2016, November 23). HSYS 1301 Challenges.

Suppiah, R. (2016, November 23). HSYS 1301 The Rehabilitation Process.