Occupational Therapy in Community-Based Practice Settings 2nd Edition by Marjorie Scaffa, Maggie Reitz

Exercise 1

Marianne
Marianne is a 37-year-old female diagnosed with early onset multiple sclerosis (MS). She lives with her husband and two children in a two-story home. She has had a very difficult time coping since the onset of her initial symptoms and dealing emotionally with the news of her diagnosis. Many of her friends are not sure what her needs are and do not visit with her as frequently as they used to. Marianne feels lonely and isolated. She can still perform most of her ADLs and IADLs with little assistance when she is not experiencing exacerbations of the disease. Nevertheless, she and her husband realize that her functional decline could happen quickly, so they would like to begin to make some preparations to their home and their lifestyle.
During a recent visit with her occupational therapist at an outpatient rehabilitation center, Marianne discussed the emotional burden and worry that her diagnosis had brought on. Marianne's husband, who also was present during the visit, openly discussed the worry and concern he had about Marianne being able to continue to care for herself and the children with the progression of her disease.
Marianne tearfully acknowledged that she had stopped driving the children to their extracurricular activities because one of her earliest symptoms was blurred vision and at times even double vision. She also mentioned that one of the most difficult tasks she faces involves helping her children understand what is happening to her.
Marianne had worked for much of her adult life as a paralegal assistant. She also delivered a variety of legal documents around town when needed, as a temporary courier for the same law firm that employed her for paralegal functions. She feared not only that her progressive eyesight problems would soon prevent her from driving safely but also that her ability to see the legal documents on her computer screen would become so impaired that she would no longer be able to perform her work tasks.
Marianne's occupational therapist recommended that Marianne and her husband contact the ILC in their town. The occupational therapist suggested that the ILC might be a source of information on resources available in the community for assisting with changes that needed to be made as her MS progressed. Marianne decided after several weeks of contemplation to contact the ILC. An independent living specialist made an appointment for the following day to meet Marianne and her husband.
The initial meeting felt somewhat awkward to Marianne because, as she later told her IL case manager, at first she wasn't ready to acknowledge that her condition was disabling. The sincerity, friendship, trust, and rapport that she soon built with her case manager changed those initial feelings. The services that followed for Marianne and her family included referrals to support groups for her and her husband. Meeting other families who were dealing with MS was a comfort as well as an opportunity to socialize with others, alleviating the feelings of social isolation she had experienced.
Marianne also began attending computer classes at the ILC, where she learned a variety of programs that would allow her to do her paralegal work from home and maintain her job. Marianne became a skilled user of community transportation, which enhanced her feelings of independence and eased her husband's caregiver burden. Finally, and perhaps most importantly, one of the friends that she made at the support group told her about a counselor who specialized in grief counseling. Marianne began weekly visits with the counselor to help alleviate the depression and grief that she felt over her loss of independence. Her counselor also helped guide her and her husband through the process of counseling their children through the progression of her disease. Marianne was grateful for the regained sense of independence she felt that began with the support she received through her occupational therapist and the ILC.
Based on the information provided in the case study, what are some additional recommendations that Marianne's occupational therapist could have provided?