occupational therapy

Firstly, I did not choose Case Study 4 because Ms. Hayes has a diagnosis of Alzheimer’s Disease that is in the moderate stage. She demonstrates unsafe elopement behaviors in and outside of the home in addition to cognitive deficits that would be unsafe for driving, like short-term memory loss and disorientation to time and place. Additionally, Case Study 3 is on Mr. Kunayak, who demonstrates right-sided hemiparesis, neglect, and mild cognitive impairment, especially in the areas of attention and problem-solving. These deficits would also make it unsafe for him to return to driving at this time. That left either Case Study 1 with Ms. Lopez, who had a right femoral neck fracture with PWB restrictions, and Case Study 2 with Mr. Scaffa, who had pneumonia and COPD exacerbation with physical restrictions for when leaving the home.

Based on the information we know from the initial case studies, I would say that Case Study 2 with 69-year-old Borat Scaffa would be the most appropriate to drive. Ms. Lopez has partial weight-bearing restrictions in her right leg, which is the leg used while driving to press the brakes and gas pedals. This would not be recommended as you have to apply substantial pressure on either pedal to brake or go. It would also be challenging to get in and out of the vehicle with these restrictions, especially depending on the vehicle she has. Mr. Scaffa is able to ambulate with contact guard assist and has a portable oxygen tank. This means he would be able to safely ambulate to the car and bring along his medical equipment that he needs. Additionally, he has physical activity limitations for MET levels 2-3 for the first week. Activities within these MET levels include leisurely walking, completing tasks while seated, and other light activities like making a bed or grocery shopping (Bonder & Dal Bello-Haas, 2024, p. 158). Walking to the car, getting into the car, and sitting in the driver's seat to drive would fall into these MET levels. He is also on a home exercise program by physical therapy to help with his strength and endurance. It also states that there are no current symptoms that would affect other body functions needed for driving, like vision or cognition.

CarFit recommendations could improve client safety and satisfaction in the areas of positioning, access to different controls or buttons in the vehicle, and providing additional resources (Carfit, n.d.). They would be able to provide him with information on appropriate seating within the car and demonstrate how to adjust and move components of the car to improve fit. This could include moving the seat to reach the pedals, moving the mirrors to see out of them appropriately while driving, making sure mirrors or lights are clean, or appropriate seat belt positioning. Observations are also made on how a person moves within the car, like if they are able to enter the car without difficulty or turn to look out a certain angle. Information and guidance can be given to drivers if they have difficulty in areas of strength, range of motion, or pain (CarFit, n.d.). CarFit could also provide information and recommendations on further interventions or referrals to improve safety and fit. Additionally, CarFit can provide information and resources on community mobility resources that someone could use if they are unable to safely drive or need assistance for periods of time.