Title: Role of Occupational Therapy Before and After Heart Transplant: A Case Study

Author:
Jaime Garrett, MOT, OTR/L
Mallory Wiles, OTD, OTR/L
Cristiane Meirelles, PT, PhD

JACOT Volume 6, Issue 1

Abstract

Background
Mechanical circulatory support devices have been increasingly used as a bridge to sustain organ function and stabilize hemodynamics while patients remain on the heart transplant waiting list. The medical intervention, intra-aortic balloon pumps (IABPs), may be placed via transfemoral artery, which may limit out of bed daily occupational engagement and participation.
Methodology
This case study is of a 68-year-old female, who was admitted to the intensive care unit with decompensated heart failure. Due to progressive hemodynamic instability, an IABP was placed while the patient was awaiting heart transplant. Occupational therapy was continued post-heart transplant until time of patient’s discharge.
Results
Prior to heart transplant, occupational therapy provided skilled interventions to address activities of daily living (ADLs) performance, cognitive function, coordination and strength, activity tolerance, while the patient was unable to mobilize due to institutional restrictions and medical precautions with an IABP implanted pre-transplant. Rehabilitation services were re-initiated post heart transplantation, with the aim of returning the patient to their prior level of function. A variety of assessments were used pre-transplant and post-transplant to measure change in function. The patient’s total length of hospital stay was 18 days. Post heart transplant, the patient was discharged home with home health services and support from their spouse.
Discussion
This case study provides an example of an evaluative and intervention approach for delivering occupational therapy services with a patient awaiting heart transplant with medical intervention specific to a transfemoral IABP. There were no adverse medical events pre and post heart transplant with occupational therapy services.