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Embed code for: Crispo.OT Progress Report.Final
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PROGRESS REPORT ©
October 5, 2016
DATE OF DISABILITY:
January 7, 2016
DATE OF REFERRAL:
July 12, 2016
DATE OF VISITS:
August 15, 2016; August 22, 2016; September 12, 2016; September 19, 2016; October 3, 2016
Trudy Perrow, Rehabilitation Consultant
Lynn Rutledge, B.Sc. (Psych), B.Sc. (OT), M.Sc (OT),
Ph.D. (Candidate), OT Reg.(Ont.)
Mr. Crispo was referred to Lifemark by Trudy Perrow Consultant with Great West Life. The request was for an Occupational Therapy Consultation to identify any psychosocial and/or cognitive barriers and appropriate course of intervention in order to facilitate the client’s safe return to work.
Throughout treatment, Mr. Crispo was a willing participant in all sessions and appeared quite engaged and focused on therapeutic sessions. The results of various tests will be reviewed below, in addition to psychological interventions and behavioral observations by this therapist.
Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) The RBANS is a brief neurocognitive battery with four alternate forms, measuring immediate and delayed memory, attention, language, and visuospatial skills. The RBANS was developed for two primary applications: 1) As a stand-alone “core” battery for the detection and neurocognitive characterization of dementia. 2) As a brief neurocognitive battery for the detection and tracking of neurocognitive deficits in a variety of disorders.
August 15, 2016
The client obtained a total scale score of 100. His percentile ranking was in the 50th percentile, which is considered in the average range. The following were the index scores and rankings for the 5 subtests: (1) immediate memory index score 100, 50th percentile, average range, (2) Visuospatial - Constructional – index score 102, 55th percentile, average range, (3) Language – Index score 113, 81st percentile, high average range, (4) attention – Index score 115, 84th percentile, high average range, and (5) delayed memory – index score – 91, 27th percentile, average range.
The client scored well in the language and attention subtests and in the average range for the immediate and delayed memory and visuospatial subtests.
The Comprehensive Trail Making Test (CTMT)
Assesses cognitive deficits in terms of problems with psychomotor speed, visual search, sequencing, and attention; and impairments in set shifting. The CTMT is a set of five visual search and sequencing tasks that focus on attention, concentration, resistance to distraction, and cognitive flexibility (or set-shifting).
These trials access a very similar construct and the trials increase in her complexity as the test progresses.
The overall T score was 311, which is considered a high average ranking with a percentile score of 91. His percentile rankings varied between 73 and 99 on the 5 trials. This was a very competitive score on this test as it is very sensitive and most individuals do not score nearly as well.
The client presented with relatively consistent scores across the 5 trials of this test. He showed a competitive testing taking style while completing this test.
The Montreal Cognitive Assessment (MoCA)
Assesses various cognitive domains including: attention and concentration, executive functions, memory, language, visuospatial skills, conceptual thinking, calculations, and orientation. A score of 26 or above on the MoCA is considered to be normal.
Just within the mildly impaired range according to the scoring criteria of this test.
The client scored 1/5 on short term verbal recall and 5/6 on orientation. He reported that he could not recall the work list after having heard the word list on the RBANs.
The client has noted that he develops panic symptoms in stressful situations at work, which has been affecting his ability to see himself in returning to work. He identifies having nightmares regarding returning to work, such as being pursued or being in conflict at work. He voices anxiety about any punitive measures that could arise after return to work. He has indicated that he experiences dizziness and vertigo.
This therapist has drawn the direct link between these symptoms and a sense of panic that he develops in perceived stressful situations. He has indicated that he has not been using any strategies to address these panic symptoms. He does appear to understand that these symptoms could arrive in other situations, employment or otherwise and he has been agreeable to learn to address these symptoms.
This therapist and the client has started to review the fundamental approaches in addressing panic symptoms, including mainly cognitive re-structuring, grounding and relaxation/breathing techniques. Initial mindfulness strategies have been completed including breathing techniques but more advanced techniques have not yet been employed. These mindfulness techniques will be used in later sessions and combined with compassion focused techniques.
In terms of cognitive re-structuring, the client has participated in various CBT activities such as thought records, case formulations, evidence for/against, thinking in shades of gray and cost/benefit analyses. This client and this therapist have reviewed various activities, such as thought distortions during sessions and the client has been encouraged to recognize how his own thought patterns and behaviors are persistent and can be problematic in certain situations. He has identified certain obsessive tendencies that can circumvent his ability to complete some tasks in a fast and efficient manner. He may complete a task very well and in a thorough manner but can have difficulty with meeting timelines. He notes that he can feel very overwhelmed with large volumes of work.
The client has identified a placement for volunteering with Velodrome in Milton where he may start volunteering with mechanical work. He has also identified several lifestyle strategies such as engaging in more physical activity and group activities such as cycling in a group and speed skating. He indicated that he cycles on occasion. He was provided with the information to join a speed skating group. He has identified that he would like to resume going with a cycling group on a regular basis but has not yet achieved this goal. He reported that he walks on a regular basis.
Occupational Therapy Clinical Impression:
The client has completed several cognitive assessments with this therapist in recent sessions, and scored within the average range on the RBANS, the high average range of the CTMT and the mildly impaired range on the MOCA. He was noted to present with a competitive test taking style. The client generally showed high average skills in attention and language and skills in the average range in visuospatial function, and immediate and delayed memory.
The client has been participating very well in terms of exploring useful strategies and in developing an increased understanding of his anxiety and how he will manage this anxiety in the future in his workplace.
Other familial stressors
various anxiety and panic symptoms at the time that he went off work
Stressful nature of his workplace
In terms of occupational therapy, it is the opinion of this therapist that the client has also been actively engaged in cognitive assessment and psychosocial intervention approaches.
Occupational Therapy Recommendations:
It is recommended that the client continue with his current occupational therapy program with the same frequency of once per week. Activities will involve cognitive behavioral strategies to address his anxiety. It is recommended that the client receive 5 more sessions of occupational therapy.
Progress will be reviewed following 4 weeks of occupational therapy to ensure Mr. Crispo is progressing as anticipated and to determine a plan moving forward to continue to assist as required with his future return to work plan.
The issues leading to disability were reviewed with Mr. Crispo in detail and I would refer the reader to his working file for further details.
I trust that this information will be of benefit to you in the management of the file. Please contact me at 877-765-5523 ext. 7025 should you have any questions or concerns regarding this report.
Lynn Rutledge, B.Sc. (Psych), B.Sc. (OT), M.Sc (OT), Ph.D. (Candidate), OT Reg.(Ont.)
C.O.T.O. Reg.#: G0205181
Client: Crispo, Sam
Employee ID #: E000104131nt or otherwise and he has been agreeable to learn to address these symptoms.
Progress will be reviewed following 4 weeks of occupational therapy to ensure Mr. Crispo is progressing as anticipated and to determine a plan moving forward to continue to a