Final Portfolio CBR

Community Occupational Therapy practice placement
Occupational therapy Diploma training – Batch XXXV, March 2019
School of Physiotherapy and Occupational therapy
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(01) Introduction
Community is an important context that influences individuals’ ability

to engage in occupations. Community can facilitate or inhibit
occupational engagement of those with and without disabilities. It
provides a unique setting for occupational therapy practice. The
Community Occupational Therapy supports individuals assisting them
to live as safely and independently as possible within their own home
environment or within residential homes. Occupational Therapist may
provide advice in issuing equipment or make recommendations for
minor or major adaptations to the home environment.
It is important for occupational therapy students to have a basic

understanding of the role of occupational therapist in the community
setting. These roles include advocacy, assessment skills, capacity
building skills and ability to apply the principles of occupational
therapy in a community context. Even though we do not have a
strongly developed community OT service in Sri Lanka the purpose of
this placement is to provide opportunities for the diploma OT students
to observe the current community based services and explore the
future avenues in establishment of such service.
(02) Duration
2 weeks (05th March 2019 to 16th March 2019)
(03) Student groups

Group No of students Placement
A 08 National Institute of Mental Health
B 08 Central Province – Matale, Digana and
Peradeniya
C 09 Lady Ridgeway Hospital, Chilaw, Puttlam

D 09 Karapitiya, Matara, Panadura
CONTENTS
1. Community Based Rehabilitation at Panadura area.
I. Report on Panadura home visits

II. Reflective writing on Panadura home visits
2. Community Based Rehabilitation at Matara area.
I. 1st home visit

II. 2nd home visit
III. 3rd home visit
IV. Visit of “Sarwodaya Suwasetha Ananda Grero Memorial
Centre for Disabled Women”, Thalpawila.
V. 4th home visit
VI. 5th home visit
3. Community Based Rehabilitation at Galle area.
I. 1st home visit

II. 2nd home visit
III. 3rd home visit
IV. 4th home visit
V. Visit of “Sambodhi” special education school
VI. Visit to “Senehasa” Children’s Resource Centre
VII. Visit of preschool of Rainbow foundation
VIII. 5th home visit
1st day
Community Based Rehabilitation at Panadura area
After we gathered to base hospital Panadura , one of the psychiatric

nursing officer gave us a brief description about home visits of
psychiatric patients.
It includes,
Why they are doing home visits?
Patients not participate for clinics regularly.
Because;
- Poor economic level

- Poor family support
- Having some physical difficulties rather than mental illness.
- Severity of the psychiatric condition & aggressive behaviors.
Therefore hospital has planned to inject “Modecate” according to the

severity of the condition & observe the functional levels within their
home environments.
Hospital staff is not wearing uniforms when dong home visits.
According to him uniform creates a gap between patient & health

team. Because of that patients are hiding their true experiences & try
to behave to suit for the professional dresses.
By wearing normal dresses, the medical team expecting to make feel

the patient as we are also the people like them.
He said that if patient is sitting on the ground, we also should have
ability to sit on the ground in the same level.
Not showing any distracting behaviors when talking with the client.
In the conversation with the client, we should behave as the patient is

the most important character.
We have to talk as he/she feels that we are the most trustful people.
How to find the location?
When they are asking the location of the patient’s home , they did not
use the condition of the client at any time. On behalf of that they are
asking the details or name of someone else in the family or directly
asking the place of the address.
Report on Panadura home visits.
Date :- 05. 03. 2019
We did 12 home visits from 9.30 am to 2.30 pm on 05. 03. 2019.
Below are the rough overview about some of them.
1st home visit
Background information of Mr. A
Mr. A is 40 years old unmarried person who lives with his younger
brother’s home in Thanthirimulla area.
Medical background of the client
Diagnosed as schizophrenia since 1992. Currently taking treatments

from base hospital, Panadura.
Social background
- He lives with his brother , elder sister and sister-in-law.
- No social association identified & according to his sister he is
not going out from home.
- They are having a family business of iron works. Mr. A is not
willing to participate with that.
Observations
 Poor personal hygiene.

 No support for the family .
 Spent whole day sleeping & not in active mood.
 Poverty of speech.
 He has addicted to smoking.
 Poor family support
 Poor insight.
Suggestions
• Educate family members about his psychiatric condition.
• introduce a meaningful leisure activity for the client.
• Introduce a purposeful daily routine for the client.
• Increase the social interaction of the client.
Related pictures
His living place Injecting Modecate
His bed room
2nd home visit
Background information of Ms. B
Ms. B is 64 years old married lady who lives with her husband in
ground floor & her son & his family is in upstairs.
Diagnosed as schizophrenia.
And she is suffering with osteoarthritis.
Currently taking treatments from base hospital, panadura.
Social background
- She lives with her husband
- Poor social association , according to her daughter in law.
Client’s complaints
- Inability to do any of the house hold activity due to joint pain.

- Complains of having delusions & hallucinations.
Observations
 Doing house hold activities (cooking , sweeping ,laundry..)

independently. But not regularly.
 sad mood.
 Poor insight about psychiatric illness.
 House is still building (having a ramp for wheel chair
accessibility).
Suggestions
• introduce methods of joint protection & energy conservation for
her physical condition.
• Doing some home modifications (for OA).
Related pictures
Entrance to the house while listening to her complaints

Her sleeping area
3rd home visit
Background information of Mr. C
Mr. C is 43 years old unmarried person who lives with his mother &
father in Kuruppumulla area in a rented house.
- Diagnosed as schizophrenia.
- Currently taking treatments from base hospital, panadura.
Social background
- He lives with his mother & father
- Poor social association & no friends, according to him.
- He is going to work in a concrete workplace in day time
Observations
 Poor ADL & IADL (hair & nails are grown, not washing
plates & cups after using, not washing cloths)
 Living in a rented house & no vehicle accessibility.
 Making “vesak” lanterns & sailing.
 Using all money for smoking.
 No care about poor ,old parents.
Suggestions
• Planning the day according to a productive daily routine.
• Doing some therapy sessions on money management.
• Improving his ADL & IADL activities.
Related pictures
Client’s house Client after injecting

Making vesak lanterns.
4th home visit
Background information of Ms. D
Ms. B is 40 years old married lady who lives with her mother , father
& his 2 son (22 & 13 years old).her husband has separated.
- Diagnosed as schizophrenia since 1992.

- Contracture in index & middle fingers in right hand followed by
a burn.
- Currently taking treatments from base hospital, panadura.
Social background
- Poor social association & lazy to go out from the home,
according to her sister.
Client’s complaints
- Lazy to do house hold works.

- Having a feeling of giddiness if not taken the medicines.
Observations
 Poor participation in house hold activities.

 Slurred speech.
 Poor family support.
 Poor personal hygiene , ADL & IADL.
 Less care of others.
 poor cognition.
Suggestions
• introduce massage techniques to reduce contracture in fingers.
• Improve ADL & IADL .
Related pictures
Injecting Modecate to the client Burn injury in her hand

5th home visit
Background information of Mr. E
Mr. A is 44 years old unmarried person who lives with his mother &
brothers family.
Diagnosed as schizophrenia for 20 years. Currently taking treatments

from base hospital, panadura.
Social background
- There are number of family members
- No social association identified . but he is going out of the
house & coming again.
Observations

 Having aggressive behaviors.
 Poverty of speech.
 Good family support
 Poor insight.
 Behaves as he is an army person.
 Independent in ADL. But poor in IADL.
Suggestions
Related pictures
Injecting Modecate to the client His bed
Unclear floor of his room Unclean arrangement in his

cupboard.
6th home visit
Background information of Mr. F
Mr. A is 40 years old married person who lives with his wife.
Diagnosed as schizophrenia. Currently taking treatments from base

hospital, panadura.
Social background
No social association identified he is not going out from home.
Observations

 Poor insight.
 Not like to take Modecate as he is complaining , his sperms
become liquefied more for that.
 Reducing his long term memory & due to that he was unable
to do his previous job (carpentry)
Suggestions
Related pictures
Client’s house Client

7th home visit
Background information of Ms. G
Ms. B is 64 years old married lady who lives with her husband in
Kolamediriya area.
Diagnosed as schizophrenia for 10 years.
Currently taking treatments from base hospital, panadura.
Social background
Poor social association not going out from the home & spending the
day on bed.
Observations
 Poor participation in house hold activities.

 Poor family support.
 Poor personal hygiene, ADL & IADL.
 Poor cognition.
 Aggressive behaviors. & due to that her husband used to
lock her inside a room.
Suggestions
• Improve ADL & IADL.
Related pictures
Client’s room & the door used to Client is lying on a bed in whole
lock her inside. day.
We did more other 5 home visits. The observations we did are more
similar to above cases.
Among them some were alone at

homes. For them we gave only
the medicines, but not injected
Modecate.
Some were met in the road,
we carry them near their
houses & according to their
consent, the medical team
injected modecate.
Most of them are diagnosed

as schizophrenia.
Then we did a visit to a rehabilitation centre in Alubomulla area.
Alubomulla rehabilitation center
• We did a visit to a nearest rehabilitation centre which

conducted by a psychiatric nursing officer Mr. Sunil
Gunawardhana.
• It was at the “Alubomulla purana viharaya” temple
• There were 6 patients who engage in rug weaving for 2 days
• per week as Tuesday & Saturday
• There is a visit of occupational therapist to the centre.
Suggestions
 Introducing new activities such as joystick making, soft toys,

paper pulp jewellery making , paper quilling wall decorations
etc.
 Increase the neatness of rug weaving activity & introduce new
techniques.
 Better to have a regular visit of an occupational therapist to the
Centre.
 Increase the number of days that held the Centre.
Related pictures
Reflective writing on Panadura home visits
Date of journal entry : 05th of March 2019
Introduction:
We did 12 home visits in Panadura area which related to the
Psychiatric field.Main aim was to inject Modecate injection for the
patients who are not participating for their clinics.
The occupational therapist of base hospital, Panadura, Mrs.

Thilini Vithanage, Dr. Gayan Jeewantha, Psychiatric nursing
officer, Mr. Sunil gunawardhana,9 trainee occupational therapists
were participated for that.
What was my learning experience?
We did all 12 home visits within the day & for that we hired van.
We went to patient’s homes & roughly observed them while

medical team is injecting. It spent only about 5 - 10 minutes in one
place.
We identified the client’s functional level, physical, social and

psychological environment & barriers & took an overall idea.
Time factor was the barrier for each home visit.
While travelling nursing officer & occupational therapist were

explained how a home visit should be & what are the practical
issues that they face.
After going to client’s settings, we talked with client & his/ her
family members.it was a difficult task to build up a good rapport
with some of them.
But most of them tried to hide their real situation in front of us.
Some were bed ridden, & some are trying to do their day today
activities with different issues of the illness.
We, especially medical officer took the consent of the client or a

family member to inject Modecate.
If there is no one in the home, they were not used to inject.
What did I learnt?
 How to build up the rapport with psychiatric patients?

 What was the role of multidisciplinary team in a home visit?
 Time is not enough to do an occupational therapy home visit &
it may need to spend a whole day with the client to have correct
details.
 What are the strengths & limitations of the client in their home
environment?
 What are the things that we can do as occupational therapists,
by doing a home visit?
 They are using 2 needles when injecting for a one person.
Likewise how far that we have to consider about client’s
comfortability.
What more I have to learn?

 What are the occupational therapy treatments in psychiatric
field?
 What are the roles of other members of multidisciplinary team &
what is their contribution.
 When doing a home visit with multidisciplinary team , we should
keep attention that what are the questions that they ask & we
should not repeat the same question again & again .
How can I learn it? What was my plan for further improvement?
 We have to organize home visits just for only related for
our community base practice program.
 We have to give more time to observe functional level of

the client.
 We can talk with the client’s family members what are the
barriers and limitations.
Conclusion
It is more successful if we give enough time for the each
home visits.
2nd day
Community Based Rehabilitation at Matara area
1st home visit
OCCUPATIONAL THERAPY HOME VISIT REPORT
Date of doing home visit
06th of March 2019, with the supervision of occupational therapist of

New District General Hospital, kamburugamuwa, Mr Ruwan Aruna
Shantha, & 09 trainee occupational therapists were participated for
this home visit.
For that Mr.X , his wife & his mother were supported.
Background information of the client
Mr. X is 65 years old person who is living in Thalpawila area with his
wife, daughter and mother.
He was a cook before the incident & currently not engages in any
productive activity.
His family support & economical support is not in a satisfactory level.
Diagnosed as Quadriplegia, due to C3 C4 central disc protrusion,

C4/C5 compression, C5/C6, C6/C7 bilateral disc protrusion after
fallen from building on 12.04.2017.
C6 decompressive laminectomy surgery done on 03.05.2017.
Then he was admitted to New District General Hospital,

Kamburugamuwa, for rehabilitation.
Social and family history
He has poor family support. Because his wife is the only person who
can help him as his mother it too old & his daughter is working in a
garment factory in Galle ,during day time. Financial background is not
in a satisfactory level.
Reasons for home visit
As a part of community rehabilitation programme ,for our studying

purpose.
Rough structure of the house

OCCUPATIONAL THERAPY ASSESSMENT
Physical background of house
Segment Description
Distance from main road – About 300m

Main road to gate
Vehicle accessibility – Not accessible (narrow, clay
road & hilly area)
Surface – Hilly and uneven
Gate to house
Vehicle Accessibility – Not accessible
8 inches step in entrance

Entrance Door width is sufficient.
Inside the home Space – Not enough due to furniture arrangement
Steps – no steps inside the home. But in the exit

door to the kitchen there is a step about 6” height.
Kitchen and dining area – Separately situated from

house & accessibility is poor due to the step
Bed room – size & the arrangement is good. But its

situation is in front part of the house & it is far away
from the toilet.
Toilet and bathroom –there is a squatting type toilet

& by keeping a plastic chair which removed apart
from middle in side the toilet, he is doing toileting. A
new toilet, bathrooms are still building.
Switch height - Accessible

Way of lightning- electricity
Water resource- tap line
Type of floor- concrete
Type of roof- tiled
Activities of daily living (ADL)
ACTIVITY COMMENT
Feeding Fully Dependent on his wife
Self care Fully Dependent on his wife
Washing Fully Dependent on his wife
Dressing Fully Dependent on his wife
Mobility Partially independent & difficult to
manage steps
Toileting Partially independent with a home
made commode chair
Instrumental activities of daily living
Fully dependent in IADL activities.
Leisure :- watching television
Communication and interaction skills: Good
Motor skills:
 Mobility- fair in walking in a flat ground . & difficult to
manage steps
 sensory issues - little reduction of sensation
 Strength- Poor & muscle atrophy can be seen in both
upper limbs
 co-ordination – poor in both upper limb
SUMMARY OF VISIT
Present on visit and benefiters
- Mr. W.R.A.Shantha (Occupational therapist, New District

General Hospital, Matara)
- 09 trainee occupational therapists
- Mr.X’s wife and his mother
Problems identified
- Less motivation in therapy.

- Lack of range of motion in upper limbs for dressing upper half
garments.
- Lack of ROM & strength in fingers for gross & finer grasping .
- Lack of balance when walking & difficult to access steps.
- Furniture arrangement in house was identified as a safety
issue.
- Height of the step in main door is not accessible.
- Safety issue when walking to toilet in uneven ground.
- Poor economical level.
- Dependency in all ADL & IDAL activities.
- Poor psychological level in patient & his family members.
- Not having vehicle accessibility to the house.
suggestions
- Educate the client & his family member about the value of doing
therapeutic activities .
- Introduce an adaptation for self-feeding.
- Introduce a safety and comfortable commode chair.
- Suggesting a plan for newly building bathroom.
- Suggested to use 2 steps of less height to the main entrance.
- Suggested to change the furniture arrangement of the house for
safe accessibility.
Related pictures
Narrow, hilly, clay road to his His house

home.
Bathing area Temporary plastic commode chair.
his upper limbs Educating his wife for mobilize

upper limb joints.
Brushing teeth with an Eating with an adaptive spoon.
adaptation we made.
Client’s old splints fabricated to Taking measurements to fabricate

release the contractures in his a splint to prevent wrist drop.
elbows.
Reflective writing on 1st home visit in Matara
Date of journal entry :- 06.03.2019

Time :- 9.30 a.m.
Introduction
We went to Mr.X’s (62 years old) home with Mr.W.R.A.Shantha.
His home was situated 7 km away from the Matara town, in

Thalpawila area. Busses are travelling in that road as 2 busses
per hour.
His home is situated in a cross road from main road about 300
m away.that was a hilly, narrow (about 2 feet) & muddy road.
Mr.X is diagnosed as quadriplegic since 2017. He lives with his

wife, mother & daughter.
We screened the home & home environment first. Then we

talked with client & his family members about the history of the
illness & level of functioning at his home environment.
Then we got an idea about the strengths & weaknesses of the

client & what are the opportunities of him.
Then we discussed among our group members & with

Mr.Shantha about what we can do to improve his functional
level & minimize the safety issues.
Explained the importance of occupational therapy & worked to

increase the motivation of client & family members.
His upper limb (mainly shoulder & elbow) range of motion has
reduced due to disuse.
For that we planned to do therapeutic well activity daily. Then
sir got measurements to make a splint to reduce the
contracture of the elbow joint.
For the inability of eat independently, we planned to make an

adaptation & we did it by using a plastic spoon & cloth straps.
Next suggestion was to make an adaptation to brush the teeth.

But it was rejected, because we did not consider about the
mouth hygiene.
We addressed on the safety issues in house. suggesting to

change the furniture arrangement in living room, reduce the
height of the step in main entrance , suggested a plan to make
the bathroom like selecting tiles, door widths, height of the
shower & taps etc.
What did I learnt?
 When analyzing an activity we have to consider about the

quality of that activity.
Eg :-have to consider about the mouth hygiene when going to
independent the brushing activity. for that it needs ROM & also
the enough muscle strength.
 What are the things that we have to consider when we

are recommending a plan for a bath room.
Eg :- type & the texture & color of tiles, door widths , height of
the commode ,height of the tap & shower ,level of the situation
of bath room , usage of assistive devices.
 When the motivation of the client is gradually reducing

with the time client is not used to wear a splint even.
Therefore it is very important to do follow-ups’.
Eg :- it has reduced the ROM of the upper limbs due to not
doing exercises & developed contractures
 The special incident was Mr. Shantha asked Mr.X to
participate for the next home visit. They were friends
when they are admitted in the hospital & Mr.X was waiting
to see his friend.
 From that I learnt that, what are the things can do to
improve the psychological level of the client.
- How to motivate a client

- What are the things that we have to carry when doing a home
visit.(tool box, splint materials, same adaptive devices etc.
- Pathology about spinal cord injuries & its treatments regard to
occupational therapy.
- What are the things that we have to consider when providing an
adaptation? (eg:- mouth hygiene in brushing activity)
How can I learn it? What is my plan for further improvement?

- Referring the related articles about spinal cord injuries.
- Using the internet & related books to upgrade my knowledge.
- Increase the practical exposure & take more & more
experiences.
- Making a tool box with more important things related to therapy,
which we can’t find in home environment.
Conclusion
This was the 1st home visit I did under physical field. It was not much
successful. Because we were not more familiar with this experience &
we had no any idea about what to do in a home visit.
But with the help of Mr. Shantha we gave advises, increase

motivation, suggested some home modifications & suggested a [plan
for wash room.
2nd home visit

this home visit.
For that Mr.Y , his wife & his daughter were supported.
Mr. Y is 53 years old person who is living in Thalpawila area with his
wife & daughter.
He was a labor before the incident & currently not engages in any
productive activity.
His family support is good & economical support is not in a

satisfactory level.
Diagnosed as Quadriplegia following a road traffic accident since

2nd of January 2017
Admitted to Matara district hospital, Due to c4c5/c5c6/c6c7 cord

compression And 5th metacarpal fracture.
Then he was admitted to New District General Hospital,

Kamburugamuwa, for further rehabilitation.
He has good family support.
Financial background is not in a satisfactory level.

As a part of community based rehabilitation program & for studying

purpose.

Segment Description
Distance from main road – About 1km

Main road to gate
Vehicle accessibility –accessible
Surface – sloppy area

Gate to house
Vehicle Accessibility –accessible
6 inches step in entrance . but there is a wooden

Entrance ramp for easy accessibility.
Door width is sufficient.
Inside the home Space –enough space & good furniture

arrangement
Steps – no steps inside the home.
Kitchen and dining area – inside the house & not

separated by steps & wheelchair accessible.
Bed room – size & the arrangement is good
Toilet and bathroom – he is using a commode chair

which kept inside his room.
Bath area is 20 m away from the house& it is an
open area with a shower & a tap.

Water resource- Tap line
Type of roof- tiled
ACTIVITY COMMENT
Feeding Fully Dependent on his wife.
Self-care Fully Dependent on his wife
Washing Fully Dependent on his wife
Dressing Fully Dependent on his wife
Mobility Need more support
Toileting Partially independent with a
commode chair
Fully dependent in IADL activities
Leisure:- watching television
Motor skills:
 Mobility - need more & more support to walk & not
propelling the wheel chair also.
 sensory issues - little reduction of sensation in lower
limbs
 Strength- Poor & muscle atrophy can be seen in both
upper limbs & lower limbs.
 co-ordination – moderate in both upper limb
SUMMARY OF VISIT

- Mr.Y’s wife and his daughter.
- Mr. X & his wife
Problems identified
 Less motivation in therapy & worse than before.

 Lack of range of motion in upper limbs muscle spasm can be
identified.
 Lack of strength in fingers for gross & finer grasping.
 Inability to walk independently. But when he was discharged
from rehabilitation hospital he was able to walk with a support.
 Poor economical level.
 Dependency in all ADL & IDAL activities.
 Poor psychological level in patient.
Suggestions
 Educate the client & his family member about the value of doing
therapeutic activities.
 Suggested to use the adaptations given for feeding & brushing.
 Suggested to engage in therapeutic activities which already
facilitated
Related pictures
Client is walking with the Our discussion with the client.

support of his wife & daughter.
walking aid Previous splints.
Walking bar made in his home Commode chair

Brushing teeth with an adaptive Doing hip abduction & lateral
brush. rotation actively by the client.
Reflective writing on 2nd home visit in Matara area
Date of journal entry:-06.03.2019
Time :-10.45 a.m.
Introduction
We went to Mr.Y’s (58 years old) home with Mr.W.R.A.Shantha.

His home was situated 8 km away from the Matara town, in
Thalpawila area. Busses are travelling in that road as 2 busses
per hour.
His home is situated in a cross road from main road about 1km
away. That was a hilly, narrow (about 6-7 feet) & tarred road.
Mr.Y is diagnosed as quadriplegic since 2017. He lives with his

wife, & daughter.
We screened the home & home environment first. Then we

talked with client & his family members about the history of the
illness & level of functioning at his home environment.Then we
got an idea about the strengths & weaknesses of the client &
what are the opportunities of him.
Then we discussed among our group members & with

Mr.shantha about what we can do to improve his functional
level & minimize the safety issues.
Explained the importance of occupational therapy & worked to

increase the motivation of client & family members.
He was a patient who was able to walk with a support when he

was coming to home after taking treatments in Labeema
rehabilitation hospital. Therefore we planned to do a
readmission. But they were unable to do that because there is
no one to be with him as bystander.
Currently he is depending on his wife for his ADL & IADL
activities.
ADL activity Suggestion

Eating Gave the adaptation which already with him &
observed.
He can be partially independent with it.
Brushing Gave the adaptation which already with him &
observed.
He can be partially independent with it.
Walking He is having a walking frame. But he is not
using.Now he hasn’t the necessary strength in
lower limb mussels.
For that we asked his wife to do the passive
mobilization & strengthening exercises.
Other activities are difficult to independent in current situation in
the home environment.
What did I learnt?
- Importance of doing follow-up assessments.

- Some patients are obtaining their needs by using their
illness without trying become independent. So we have to
set different goals to maintain their motivation.
- We have to practice the client about how to use adaptive
devices correctly.
- This home visit was the 1st instance that we see how to
improve the motivation of a client with the help of Peer
groups. (Mr. X was participated with us to do the 2nd
home visit. Mr.X & Y are the friends with the same
condition. They came home after discharging with the
ability of walking with a support. But now Mr.Y can’t walk.
He was motivated by observing his friend & told that he
want to admit in the hospital to walk again like Mr.X)
- How to motivate a client. What is the range that OT can

work with the client & OT’s role will not ended up after
discharging.
- To carry a tool box, when doing a home visit.(tool box,
splint materials, same adaptive devices etc.
- Pathology about spinal cord injuries & it’s treatments
regard to occupational therapy.
- What are the things that we have to consider when
providing an adaptation? (how to use the adaptation in
proper manner)
- Referring the related articles about spinal cord injuries.

- Using the internet & related books to upgrade my
knowledge.
- Increase the practical exposure & take more & more
experiences.
- Making a tool box with more important things related to
therapy, which we can’t find in home environment.
Conclusion
This was the 2nd home visit of the day. Mainly we got an idea
about the dedication of the family members to take their family
member in to the previous position. They have made the similar
therapy Equipment in the OT & PT departments to engage the
client in same activities. But the client was not supportive to do.
But with the help of Mr.Shantha we gave advises, increase

motivation, suggested some home modifications & asked the
client to readmit to the hospital.
3rd home visit

this home visit.
For that Mr.Z , his wife & his younger son were supported.
Mr. Z is 58 years old person who is living in Dewinuwara area with

his wife & younger son. he is having other 2 sons & one of them is
doing a job & other one is studying.
His family support & economical support is in a satisfactory level.
Diagnosed as paraplegia following a road traffic accident since 27th

of November 2017. He was Admitted to Matara District hospital .Due
to accident , wedge compression of L1 vertebra body ,and femur
neck fracture occured. After 2 days he has Sent to Karapitiya
teaching hospital for further treatment then after 6 weeks client was
sent to rehabilitation hospital ,Labeema to occupational therapy and
physiotherapy treatments for 10 months .
Currently he is walking with a walker with moderate support.
He has good family support.
Financial background is in a satisfactory level.

For studying purpose.

Segment Description
Distance from main road – About 1.5km

Main road to gate
Vehicle accessibility –accessible
Surface – highly sloppy area

Gate to house
Vehicle Accessibility – not accessible
6 inches step in entrance. Door width is sufficient.

Entrance
Inside the home Space –enough space & good furniture

arrangement
Steps – there are steps inside the home with more

height (couldn’t observe)
Kitchen and dining area – inside the house &

separated by steps & wheelchair or walker is not
accessible.
Bed room – not observed
Toilet and bathroom – he is using a commode chair

Bath area is arranged in a side of veranda for the
client. He is bathing by sitting on commode chair.
In that place also there is a step about 10“ height.
Water resource- taps line
Type of roof- sheet

ACTIVITY COMMENT
Feeding Independent with a minimum
support as he is difficult to go to
kitchen.
Self-care Need moderate support
Washing Need moderate support
Dressing Independent
Mobility Need moderate support with
working aid.
Toileting Partially independent with a
commode chair
Fully dependent in IADL activities
Leisure:- watching television (he is difficult to come out
From room to operate television when there is no one at home.)

Motor skills:
 Mobility - need moderate support to walk with a walking
aid.
SUMMARY OF VISIT

- Mr.Z’s wife and his daughter.
Problems identified
- Less motivation in therapy.

- Inability to walk independently
- Dependency in some ADL & all IDAL activities.
- Developing Foot deformities.
- Barriers in home arrangement (steps in many paces of home).
Suggestions
- Educate the client & his family member about the value of doing
- Suggested to use walking aids with proper heights.
- Suggested to engage in therapeutic activities which already
facilitated in home.
- Suggested to reduce the heights of the steps.
- Suggested to reduce the slope of the road to home.
Related pictures
Slope to his home. Client with his walking aids.
Client is walking by holding walking Sensory stimulation in his foots.

bars in his home.
Commode chair. A walking aid.

Reflective writing on 3rd home visit in Matara area
Date of journal entry:-06.03.2019
Time :-02.00 p.m.
Introduction
we went to Mr.Z’s (58 years old) home with Mr.W.R.A.Shantha.
His home was situated 8 km away from the mathara town,in

Dewinuwara area. His home is situated in a cross road from
main road about 1.5km away. That was a hilly, narrow (about 6-
7 feet) & tarred road.
Mr.Z is diagnosed as paraplegic since 2017. He lives with his

wife, & his younger son.
- We screened the home & home environment first. Then

we talked with client & his family members about the
history of the illness & level of functioning at his home
environment.
- Then we got an idea about the strengths & weaknesses
of the client & what are the opportunities of him.
- Then we discussed among our group members & with
Mr.shantha about what we can do to improve his
functional level & minimize the safety issues.
- Explained the importance of occupational therapy &
worked to increase the motivation of client & family
members.
- There is no space to walk in their compound. They have
very limited space. Client is not like to walk in veranda &
he want to walk in a long distance. We explained the
client what will happen if he discontinues walking.
- Client & his family members speak a lot. They described
the same thing again & again.it was a difficult task to
extract important point & time became a barrier.
What did I learnt?
- How to select the walking aids according to the abilities of the

client
- How to overcome safety issues in the home & home
environment.
- When we are advising the client, how to do it without hurting
them.
- What is the importance of appreciation for a client to motivate
him?
- Getting a thorough knowledge about spinal cord lesions and

treatments
- We should plan a transport method to use rather than walking
for a long distance. Then we can save our time for an effective
home visit.
- Before we give suggestions for client .we should think client
financial background & their family support. It is applicable or
not according to client’s situation.
- How to extract necessary information from the story of the
client.
How can I learn it? What was my plan for further improvements?
- I will improve my knowledge about spinal cord injury by using

internet, related articles & by referring books.
- Before doing a home visit we have to plan what we have to
carry. What we are going to do, how we are going or what is the
transport method that we are going to use.
Conclusion
This was the last home visit of the day. It was not much successful as
we had no enough time to observe his performance of ADLs.
We were unable to extract the necessary information from the client &
we missed to ask or observe inside the home.
Visit of Sarwodaya Suwasetha Ananda Grero Memorial Centre for
Disabled Women, Thalpawila.
Reflective writinng on Sarwodaya Suwasetha Ananda Grero

Memorial Centre for Disabled Women, Thalpawila.
Date of journal entry:
7th of March 2019
Introduction:
On that day we visited to Sarwodaya Suwasetha Ananda Grero

Memorial Centre for Disabled Women, Thalpawila.
Mr. W.R.A.Shantha (Occupational therapist, New District General

Hospital, Matara) and 9 students from of occupational therapy were
participated for it.
Sarvodaya Suwasetha is one of the main social service organizations
in the country.
(It was registered as an independent society in 1986. It was also
registered under the Voluntary Services and re-registered under
Parliamentary of 1998 and registered as a charitable organization
under the Ministry of Social Services.)
Vision
Towards a nation that respects the rights of children, adolescents,
youth, elders and disabled persons to live a life with dignity
Mission
Promotes and protects the rights of children, adolescents, youth,
elders and disabled persons affirming their entitlement to love,
compassion and protection within a caring environment.
Suwasetha home for the differently abled woman is located in
th
Thalpawila, Matara district .It was started on 27 of October in 2004
by Sarwodaya Suwasetha Sewa Society.
Currently there are 6 women receiving residential care and protection

in this home. Most of them are wheel chair bounded. But they attend
to all their personal needs by themselves while assisting household
work as well. They also add meaning to their lives by engaging
themselves in handicrafts, sewing, crochet etc. The staff in this home
consists of 2 members.
Activities conducted in this home include going on religious tours,
observing sil, New Year and Christmas celebrations, meditation
programs, dhamma sermons as well as health clinics.
Sarvodaya Netherlands provides part of the funding for the
maintenance of this Home.
Cooperation received from the people of the area for the continued
success of this project is commendable.
We were divided in to 5 groups & discussed with 5 women and with

staff members in the home.
We observed them & identified their difficulties practically such as

how they are propelling the wheel chair, how they are transferring to
bed, commode, chair from wheel chair, how they are sweeping, how
they are reaching to kitchen to cook, & the accessibility of above
places.
We gathered details about the home layout and the physical

background of the home. We identified architectural barriers of
building which are cause to limit their performance.
And we observed how they are successful in performing their day to

day activities and how they add a meaning to their lives by doing
various kinds of leisure activities.
Previous day we planned to do a presentation on joint protection &

energy conservation methods as the morning session. But time was
not enough for that & we suddenly planned to do it in their lunch time.
Finally we did our presentation because one of them have diagnosed
as Rheumatoid arthritis and other two women have symptoms of
Arthritis.
And we did upper limb strengthening exercise program because most

of them are wheelchair bounded & they all having issues with their
upper limbs due to over use. Especially the staff was very happy
about this program.
What did I learn?
As Occupational therapists we have a major role in these kinds of

places. But most of the times there is no reference for the service. &
what can we do with a late reference.
Eg:-
 wrong postural problems

 ADL problems
 Psychological issues.
When we work with an institute, it is harder to work with their rules &
regulations.
What more I have to learn:
- How arranging a treatment in an order to have a maximum

benefit.
- Realistic suggestions to adapt the environment to independent

the client in all areas in daily life.
- How to be prepared before the visit.

- How to work under the rules & regulations of an institute.
How can I learn it? What is my plan for further improvements?
- By discussing with our senior Occupational therapists.

- Through the Internet, related articles & by referring books.
- By increasing the practical exposure & taking more
experiences.
- By following the rules & regulations of different organizations.
Conclusion
If an occupational therapist visits at least once a month, it is very

valuable for women in this Centre.
In most of the institutions, there is no any well planned arrangement

for the benefit of the differently abled people.
Strengths in the home
- All the members are functionally independent in many of the

activities.
- There is wheel chair accessibility to the kitchen, wash room, out
(garden) & each & every place in the home.
- Kitchen arrangement is comfortable for wheel chair bounded
patients (the height is achievable by the wheel chair).
- Maintaining a monthly clinic to identify their needs & issues & to
maintain their health.
Related pictures
Their washroom Accessibility to hearth.
Accessibility to the zinc (tap) Presentation done on joint

protection & energy
conservation
Group activity
In Sarwodaya Suwasetha Ananda Grero Memorial Centre for

Disabled Women, Thalpawila, according to our plan I & Arosha talked
with Miss.Podi Manike who is 65 years old.
She is unable to walk due to a congenital disorder. And also her both
hip joints were dislocated, shortened & wasted lower limbs &
observable & due to above reasons she is wheel chair bounded from
her childhood.
According to our observations & assessments, we found some areas

that she is not independent.
Problem 01
She needs help of someone when she is coming back from

bathroom.
Analysis
Bathroom is situated below the level of the home. Therefore there is a

slope towards the bathroom. So she needs more muscle energy of
upper limbs to take it up.
She is having pain in both shoulder & elbow joints in both upper
limbs.
Door width is just 2” larger than the width of the wheel chair. This
space is not enough to propel the wheel chair.
Suggestions
Planned to increase the door width of the bathroom as this problem,

is common for all 6 members in home.
Discussed with the matron about their plan to build a new bath room
with more facilities. For that we gave a report about the modifications
should be done to the current wash room.
4/6th of the members are using wheel chairs. To reduce the pain of
upper limbs, we suggested new, modified wheel chairs with a handle
& can use easily with minimum energy use.
Problem 02
she wants support of someone to hang cloths in out to dry after

washing.
Analysis
Height of the wheel chair is not enough to the wire to hang cloths by
her hands & if the wire placed near to the ground , animals will take
their cloths away.
Suggestions
Introduce an assistive device to hang cloths.
For now,
We asked to take the wire down by using a stick & then put the cloths
in the wire & keep the stick as a jack to the wire for support.
Problem 03
She is difficult to rub her back of the trunk without help of anyone.
Analysis
She lost her trunk balance when bending forward to take her hand
back.
She is having a pain of shoulder joints & reduction of range of motion

due to that.
Suggestions
Introduce an assistive device to rub posterior trunk.
Eg :- brush with a lengthened & curved handle.

Special education centre
Introduction
There were 12 special needed children & 2 special education

teachers.
There was only one class & school time was 8.00 am to 12.00 pm.
According to our observations there were children with down’s

syndrome, autism, & learning disability.
Positive factors I observed.
- Children are obeying to teacher’s words.

- There is a three wheel to transport students to the school &
again to their homes.
- Special care for each child & teacher tries to take the attention
of each child towards her. For that she has a good voice.
- There is a visit of a speech therapist to the school once a
month & in the same day there is a program to the parents.
- Teacher is taking help of the other children to take the active
participation of other children.
Negative factors I observed.
- Poor parental support to the school.

- Poor motivation of the students & there are less number of
activities to improve the motivation of children.
- Less attention & concentration of the children. If teacher is not
at the class, those children are not having self-discipline.
- Poor cognitive level of children.
- Having a mixture of different conditions & it is difficult to set
common goals to them.
Students in this school are differ from each other by age , diagnosis ,
cognitive level , skills & abilities. This becomes an advantage as well
as a disadvantage for the children.
Common suggestions to teacher……….
- Give a star or a smile face in their books at the end of each task
to increase motivation.
- Maintaining a chart in the wall to give a star in each day for the
good performances of child & not giving it, if he/she done a
wrong thing.(pasting a photo of them to recognize themselves)
& at the end of the week giving a gift for the best performance.
- Practice mouth massaging techniques to reduce drooling.
- Asked to take them for a trip after completing a given task.
- Suggested to take the help of an occupational therapist at least
once a month.
Related pictures
4th home visit
09th of march 2019, with the supervision of occupational therapist of

this home visit.
For that Miss.P, her sister was supported.

Miss.P is 65 years’ old unmarried women who live in
Wewahamanduwa, Matara, with her younger sister.
Both of them are not doing a job & income is mainly from garden.
She was diagnosed as Sero-negative Rheumatoid Arthritis since

2003.
Now she is in chronic inactive stage, therefore no pain in involved

joints.
Her hands are deformed with ulnar deviated from

metacarpophalangeal joints, Z thumb deformity and Boutonniere
deformity.
Her feet are also deformed.

She lives with her younger sister and she also having Trigger finger
deformity of thumbs and little fingers of a hand.
She has a brother and he supports to them, because they haven’t a
much income.
There is no family history regarding condition rather than her sister.
As a part of the community based restoration program & for studying

purpose.

PHYSICAL BACKGROUND OF HOUSE
Segment Description

Main road to gate
Vehicle accessibility - Accessible
Surface – Flat and even

Gate to house
Vehicle Accessibility – Accessible
3 steps at the entrance (about 3’’x 3)

Entrance Door width is normal
Inside the home Space – Good space
Kitchen and dining area – There are no steps or

barriers, equipment placed in reachable height.
Bed room – There are 2 bed rooms, Space is good.
Toilet and bathroom – Squatting type toilet
Switch height – Accessible
Way of lightning - Electricity

Water resource - Taps line from own well
Type of floor – Cement
Type of roof - Tiles
ACTIVITY COMMENT
Feeding Independent with a normal spoon
Self-care Independent
Washing cloths Need moderate support
Dressing Need minimum support in
buttoning.
Mobility Independent.
Toileting Independent.
Independent in IADL activities.
Leisure:-Independent in leisure activities. (Sewing)
Motor skills: - can walk independently. But there is a gait abnormality.
No sensory issues or pain identified.
Social situation:-moderate level
SUMMARY OF VISIT
- Ms. P (client)
- Her sister
- 9 students of occupational therapy.
Problems identified
- Her hands are fully deformed, but she is independent in many

activities except cooking (inability to hold objects, pots) ,
buttoning & putting hooks in under garments ,washing cloths &
difficult to hold soap in bathing.
- Her sister has early symptoms of the particular condition.
- They have large garden to maintain therefore, more stress on
the joints and it can cause further deformities.
- There are many safety issues due to poor finer and gross grip.
Suggestions
 Educate the client & her sister about methods of joint protection
and energy conservation.(asked to use a sharp knife ,using
palm or forearm when carrying large/heavy objects & asked to
take meals without keeping the food plate on her palm & eat
while keeping the plate on a table. )
 Advised to do day today activities with resting period during
each activity.
 Suggest them to decrease more stressful activities to joints.
Related pictures
Client’s home Client’s garden

Her deformed hands Her deformed legs
ROM in shoulders ROM in elbows
How she holds pen to write. Nodules

Her mug used to drink water. Splint’s used by the client.
Reflective writting on 4th home visit in Matara area
8th of March 2019
Introduction:
This is the 1st home visit of the day and Mr. W.R.A.Shantha
(Occupational therapist, New District General Hospital, Matara) and 9
students of occupational therapy were participated for it.
It was a very rural area & a bus is travelling once per hour. The client
was Ms.P, 65 years old unmarried women who lives in
Wewahamanduwa, Matara with her younger sister.
She was diagnosed as Sero-negative Rheumatoid Arthritis since

2003.
Then we talked with client and identified problems and done a home
and home environment assessment.
We went there at about 8.30 am with the guidance of Mr. Shantha.
Ms. P’s house was very large with a huge garden. There is no any
male person lives with them & both of the sisters have to do heavy
work load in a house & their garden by themselves.
Ms. P’s hands and feet are deformed at its worst, but she hasn’t any
pain in involved joints. This is good experience because her hands
deformed with many types of deformities but she is independent in
most aspects in her daily life.
She is dependent on her sister only for cooking & washing heavy
cloths.
Her gait pattern also changed due deformed legs & it may cause to
develop further deformities.
Maintaining the garden is also a big challenge for them. It may cause
to have the same illness for her sister too.
What did I learn?
- How to build up a rapport with a client.

- The signs and symptoms of chronic stages of Rheumatoid
arthritis.
- How deformities of hands limit the activities of a person.
- How the environment limits the functions of a person and how
to minimize it.
- What is the importance of good family support?
What more I have learn:
- Realistic suggestions to adapt the home environment to

independent the client.
- Making splints to prevent further deformities.
- Reading books to take thorough knowledge about occupational

therapy intervention.
- Take more clinical experiences regarding the condition by be
with clients.
Conclusion:
It was a big strength for us. Mr.W.R.A.Shantha, Occupational

therapist was with us, therefore our home visit program was very
successful.
It is good to educate the client regarding the methods of energy

conservation and joint protection. & there is a probability to have the
same disease for her sister, because she is having a trigger finger in
her right thumb.
5th home visit

this home visit.
For that Miss.Q, her father, mother & brother were supported.

Miss.Q is 19 years old girl who lives in Wewahamanduwa, Matara .
She studied up to ordinary level at Sujatha Girls College & got 9A
passes, Matara.
She was a badminton player in international level.

She was diagnosed as Right side hemiplegia due to MCA+ACA
ischemic infarction, complete ICA obstruction on 21.02.2017.
After that her cognitive level decreases and therefore, again she
started to study from Grade 3 level and now she is in the Grade 8
level.

She lives with her parents and brother.
Family support & financial background is good.
As a part of the community based restoration program & for studying

purpose.

PHYSICAL BACKGROUND OF HOUSE
Segment Description

Main road to gate
Vehicle accessibility - Accessible
Surface – Even and slope

Gate to house
Vehicle Accessibility – Accessible
A small step
Entrance Door width is normal
Space – Good space

Inside the home
Kitchen and dining area – There are no steps or
barriers, equipment placed in reachable height.
Bed room – Space is good & well arranged.
Toilet and bathroom – Commode type toilet.

Attached bathroom can be used by the patient easily.
Switch height – Accessible
Way of lightning - Electricity
Water resource - Taps line
Type of floor – Tiles
Type of roof - Sheets

ACTIVITIES OF DAILY LIVING
ACTIVITY COMMENT
Feeding Fully independent with an
adaptive spoon.
Washing Need minimum support.
Dressing Need minimum support.
Mobility Independent & can manage steps
Toileting Independent
Partially independent in IADL activities
 Laundry: Independent by washing machine

 Ability to use telephone: Independent
 Mode of transportation: With father by father’s car
 Responsibility of own medication: Dependent due to memory
problems
 Ability to handle finance: Dependent due to low cognitive level
 Care of others: Poor
 Care of pets: Good
 Safety procedures and emergency responses: Dependent due
to perception problems
Leisure:- independent.
Motor skills:-
 Mobility- independent in walking & can manage steps

 sensory issues - little reduction of sensation in thigh &
below thigh area in affected side (right)
 Strength- moderate strength
 co-ordination – poor
 proprioception – poor
 steriognosis - good
SUMMARY OF VISIT
- Miss.Q (client)
- Her parents and brother
- Mr. W.R.A. Shantha (Occupational therapist, New District
- 9 students from School of physiotherapy and occupational
therapy.
Problems identified
- She has problems with sensory, orientation, proprioception,

memory and slowness of work.
- Communication problems. (information processing errors)
- Poor ROM of Shoulder, Elbow, Wrist joints and fingers of
affected upper limb.
- Poor psychological level & worrying about past performances.
- Need of a vocational training.
Suggestions
 Educate family members, school teachers about her condition

and what are the problems of her.
 She has equipment for therapeutic activities at home therefore,
we can suggest her to engage with those activities and explain
therapeutic value and motivate.
 Suggested to do a vocational training & understand her
strengths & weaknesses.
 Suggested to improve the mathematical skills by participating
for private classes.
 Suggested to improve her drawing skills up to vocational level.
 Her happy factor is her dog. We suggested be with her dog to
relax her mind.
 Normally she has a fear to face challenges & become more
stress. We asked her mother to expose her to different
challenges gradually.
Related pictures
Her home Her awards won by playing

badminton.
Her therapy equipment. Her working area.
Her therapy equipment. Her ROM in upper limb

Her lower limb function. Taking an object on ground.
How she writes with an Her drawings with her non

adaptation. dominant hand.
Her previous writings. Assessing for vision.

Reflective writing on 5th home visit in Matara area
8th of March 2019
Introduction:
This is the 2nd home visit of that day and Mr. W.R.A.Shantha
(Occupational therapist, New District General Hospital, Matara) and 9
students of occupational therapy were participated for it.
The client was Miss.Q & she is 19 years old girl who lives in
wewahamanduwa, Matara.
She was diagnosed as Right sided hemiplegia.
She was a very talented badminton player and bright student in

school, then she suddenly experienced a stroke and her right side of
the body was paralyzed.
we screened the home & home environment first. Then we talked

with client & her family members about the history of the illness &
level of functioning at his home environment.
Then we got an idea about the strengths & weaknesses of the client
& what are the opportunities of her functional level.
We did sensory assessments & cognitive assessments.
She has less sensation in thigh & below the thigh in her affected side.
Then we discussed among our group members & with Mr.shantha

about what we can do to improve her functional level & discussed
with her & family members about her future & selected a suitable job.
Computer training, fashion designing, photography were some of the
suggestions presented.
Her cognitive level also decreased. But cognitive level increased up
to level of grade 8 students now.
Currently she is able to walk and upper limb functions are somewhat
poor. Coordination, gross & finer grips are the weak areas.
But currently, she adapted to do more activities using her non

dominant hand.
Ex: writing, eating, drawing
Even by the left hand she can draw well.
What did I learnt:
- How to build up a rapport with a client.

- What is the importance of good family support?
- What is the importance of therapeutic activities to the
hemiplegic patient?
- How the environment limits the functions of a person and how
to minimize it.
- For this age child, we have to work to find a job how she will
continue the job.
- According the previous performance of the child, parents are
comparing with the present situation. They want have the
previous child again. when we are suggesting anything related
to the child we should have to do it again by relating to the
family status.
What more I have learn:
- Realistic suggestions to adapt the home environment to

independent the client.
- Making of proper adaptations to independent the client.
- How to suggest a most suitable vocational training for a client.
- How to present our suggestions & explain without hurting client
& family members according to their social situation.
- Reading books to take thorough knowledge about occupational

- Take more clinical experiences regarding the condition.
- Search the internet and read articles about vocational training
programs in Sri Lanka.
- Discuss with a senior therapist.
Conclusion:
It was a big strength for us. Mr.W.R.A.Shantha, Occupational

therapist was with us; therefore our home visit programme was
successful.
We observed that it can take good improvements if the stroke

happens in early stages of life.
Community Based Rehabilitation (CBR) at Galle area
1st day
We attended to teaching hospital – Karapitiya to have an orientation

knowledge on CBR program in Galle area.
Normally occupational therapists are not doing home visits in that
area without any special reason. But they have planned 2 home visits
on that day for us. Before that we learned;
 why we (OTs) are doing home visits
 To identify an individual’s occupational capabilities and

functional difficulties in the context of illness or disability.
 What are the skills that OT should have?
 Good observational skills

 Ability to adapt the environment to suit the individual’s
need.
 To give advices on how activity can be adjusted in
specific environment to support an individual’s strengths
and minimize limitations.
 To work towards a client- Centered approach & give
meaningful recommendations.
 Empathy other than sympathy.
 How to decide if a home visit is needed?
 According to the cause of the trauma.

 To establish wheelchair access or to ensure any walking
aid
 To practice any special activity as part of your treatment,
where the hospital environment is not supportive.
 To verify, how an individual will cope at home
environment.
 To adapt the environment in an client-centered way & to
give appropriate recommendations.
 When to visit?
 A Pre discharge visit

 A Discharge visit
 A Post discharge visit
 (pre admission visit)
 Who to involve?
 The patient/ person
 Another health care professional (some members in multi-
disciplinary team (PSW) )
 Family members & carers.
 What we did?
We did 2 home visits. Both are under pediatric category and regards
to cerebral palsy (CP).
1st home visit
On 11th of march.2019 eight occupational therapy students, with the

senior occupational therapist of Teaching hospital Karapitiya Ms. DLN
Priyangika, participated for the visit. For that baby’s mother and father
were supported.
Master N is 12 years old. Lives in Dangedara area in Galle district

with his parents. Has one elder brother (16 years) who is schooling.
His father is a jewellery maker, mother is a housewife. Economical
background is fair. Parents are in satisfactory educational level.
Diagnosed as Cerebral Palsy. Had a hip dislocation one year ago.

Before that he walked with support. After the dislocation he is unable
to walk. Currently he is wheelchair bounded. Still he is having
seizures 2-3 times per day.
Due to a visual impairment he had subjected to surgeries of lens

replacement in both eyes.
Social & family history
His house is about 5kmm away from karapitiya hospital & that is not a
rural area.
There is no evidence on family history regarding cerebral palsy.
Reasons for the home visit
For studying purpose.

OCCUPATIONAL THETAPY ASSESSMENT
Segment Description
Main road to Distance from karapitiya hospital:- about 5km

gate
Distance from main road:- About 500m.
Vehicle accessibility
Gate to house Surface:- even & flat surface
Vehicle accessibility:- accessible
Entrance No steps. Door width is normal. Wheelchair

accessible.
Inside the Space: Enough space to propel.

home
Steps : 2 steps inside the home (6” *2)
Bed room: Enough space to propel and turn the

wheel chair. Consist of 2 beds.
Plug points are in the level of the bed & child is

entering fingers.
Toilet and Bathroom: Situated outside. Difficult to
reach by wheelchair. Squatting type toilet (baby is
not using it). Commode chair size is also too large &
therefore mother is used to wear pampers for him.
Kitchen & dining area:- the kid is sitting on a chair in

the kitchen till his mother is cooking.
To prevent dragging electrical appliances by the

child, mother has kept them far away from the child.
Way of lightning : Electricity
Water resource : Own tap lines
Type of floor : Tile in living room and cement in other places
Type of roof : Tile
Screening of baby
Methods of assessment:- by asking from parents & other family

members
Name:- master N
Developmental stages
Event Achieved / not Achieved age

Head control Yes – partially N/A (not
assessed)
Turn side to side Yes – partially N/A
Roll over Yes – partially N/A
Sit with support Yes N/A
Sit without support Yes – partially N/A
Stand with support No N/A
Stand without support No N/A
Walk with support No N/A
Walk without support No N/A
Tone:- diskinetic movements

Basic sensory abilities
Vision: fair
Hearing: good
Tactile: reacting to touch
Medication
drugs for control fits.
Child is participating for the clinics & therapy sessions with his
parents.
ACTIVITY COMMENT
Feeding Dependent (Mother is feeding
him in sitting position. Can eat
solid foods. Can take a biscuit in
to the mouth individually by hand
, but not eat. He can’t drink water
by a bottle also)
Self-care Fully dependent
Washing Fully dependent
Dressing Fully dependent
Mobility Carrying by parents or by wheel
chair. ( he is unable to propel )
Play skills
Not playing with his brother

Like to play with ball & keys. But not for a long time.
Like to tourch , rings , bangals , watches like glimmering things.
Communication
If he wants ice-cream, he is acting like eating ice-cream by mouth.

If he wants tea he is telling, “tea”.
By seeing bangles, he id=s telling “waaalu”.
If he sees a light is going to worship.
If he wants to go out he says “bruum”.
Hand skills
Can hold light weighted objects.

Present gross grasping.
Pull a ball towards him.
Poor finer grasping.
Summery of visit
Present on visit & benefiters
- 09 occupational therapy students

- Baby N & his parents & his elder brother.
- Occupational therapist of teaching hospital , karapitiya,Ms.
D.L.N. priyangika
Problems identified
- Unable to walk.
- Poor cognitive level.
- Difficult to grasp something with hands.
- Decreased ROM in hip joints (In Abduction and adduction)
- Developing scoliosis.
- Dependent in all ADL. & spending the whole day sitting on a
chair or lying on a bed.
- Poor knowledge of the occupational therapy treatments.
- Architectural barriers in the house (slopes & steps).
- Mother is having a back pain due to carrying the child by
bearing in her hand.
suggestions
- Educate the family members about easy transferring

techniques.
- Modify the wheel chair with a good & comfortable back support
& shoulder support (butterfly shape) & footrest with adjustable
heights.
- Educate his mother about the importance of preventing
pressure sores & ask them to change positions in each 20 min.
- Suggesting about using of temporary wooden ramps to the
place of steps.
- To reduce the circumference of the commode chair , ask the
client’s mother to keep a part of a three wheel tire.
Related pictures
Gate to house. Living room.
Step in the house. Slope to out of the house.
Baby on his wheel chair Baby’s commode chair.

Baby’s bed room Baby on his bed.
Bathroom Developing scoliosis

Reflective writting on 1st home visit in Galle area
Date of journal entry : 04th March 2019

Time:- 9.30am
Introduction:
We participated for the home visit in Dangedara area in

Galle district. The client is master N who is 12years old. We, 9
0ccupational Therapy students and the senior Occupational
Therapist of teaching hospital Karapitiya, Ms. D.L.N. Priyangika
participated for the visit. The client, his mother and father joined
with us to share the details with us.
Master N, is diagnosed with Cerebral Palsy following

seizures after 2 days of birth.

With the entrance we started to screen the home & environment.
Then we talked with baby’s mother. She carried the baby on her
hands to the living room.
Then we observed the child. He is fully dependent on his parents.

He is sitting on the wheel chair, or lying on the bed & spending
whole day. He was not even responding to his name.
We recognized the architectural barriers of the home background

which is a barrier to propel the wheelchair. There were 2 steps
(about 6”*2) inside the house which separating living room from
kitchen & bed rooms.
His cognitive level & his vision are poor.
Earlier his mother also was not much supportive for us for
giving information about the child. But later she gave us enough
details.
What did I learnt
Parents are tired enough by struggling with the child. They are
seeking help from anybody they met. But some of them are
cheating. Therefore the poor parents are always in a doubt about
to whom we should go. From that I understood what is the
importance of explaining what we are going to do & how it affects
the client.
We experienced how the hospital set up is not practicable for
the home set up. Suggestions for the adapting the physical
background may not be possible to make into action because of
some problems. For an example if we asked to make a
temporary ramp to keep on a step, there may be several issues.
Eg :-whether there is enough space to keep a ramp in standard
inclination , is that easy to move here & there , what is the weight
,what is the strength etc. By considering all these things a person
may select the option to portage the baby as previous.
In baby’s room there were some safety issues. One is the height
of the plug points are in the same level of the bed. Baby is
entering fingers in to it. Next thing is there are ants on the
mattress & in one time they have ate baby’s sexual areas as he
does not have sensation.

- We should have a thorough knowledge of the treatments
for the particular conditions.
- How to build up the trustworthiness in parents & other
family members.
- What are the standards that we are using in making
ramps?
- What are the types of wheelchairs & how we can modify
them according to the need of the child?
- How to reduce deformities & how we can manage a
patient on a wheel chair.
- What is the difference between special chair & wheel
chair?
- Discuss with a senior occupational therapist.
- Referring books & related articles.
- Search through the internet.
- By increasing the practical exposure & getting more
experiences.
Conclusion
Our home visit program was successful as our senior therapist
Ms. Nirosha Priyangika was with us. After going to baby’s
house she guided us very well by highlighting what we missed.
But we wasted more time by travelling by foot more than 2-3
km. If we had a good communication with baby’s mother, it
would not be that much difficult to find the place and we could
save our time and the energy.
2nd home visit
11th of march 2019, with the supervision of occupational

therapist of pediatric unit of teaching hospital of karapitiya, 08 trainee
occupational therapy students were participated for this home visit.
For that baby “B”, her mother, grandmother & her twin brother were
supported.
Baby B is a 14 years old child, living with her mother,

grandmother, & her own twin brother. Her father has separated her
mother is currently unemployed. They are living in baby’s uncle’s
house(still building) with the financial support of them. Poor
economical level, moderate family support & baby B’s mother is in
satisfactory education level. They are living in katugoda – Galle area
& all neighbors are Muslims.
Baby B is diagnosed as having mixed cerebral palsy with

global developmental delay. She suffers for 14 years due to a birth
complication. (Delayed birth when comparing with her twin brother).
She is not having seizures and currently she is having the use of
occupational therapy.
There is no any family history of cerebral palsy.

Her house is situated 500 m away from Galle- Matara main road.
Most of the people around her house are Muslims. There is no much
help from them also.
For our study purpose.

OCCUPATIONAL THRAPY ASSESSMENT
Segment Description
Main road to gate Distance from main road – 500m
Vehicle accessibility - accessible
Gate to house Distance- about 1-2 m to the varenda
Surface- uneven (there is a step, about 1
feet height)
vehicle accessibility - no
from compound to verenda again there is a
step of nearly 8” height.
Entrance There is a step of height of 5”
Door width is enough for wheel chair
accessibility.
Inside the home Space – not having enough space due to
furniture
Steps – there are no steps in ground floor.
Upper floor is not built.
Kitchen & dining area – not using the
kitchen. But to go for a wash or for the
toileting activity, she has to pass kitchen.
Bed room – situated in a far corner of the
living room. Difficult to access through
furniture.
Beds are accessible for the baby.
Toilet & bathroom – she is using a plastic

commode using by little babies.
In out , there is a squatting type toilet.
Bath area is 10 m away from home. Mother
is difficult to take her out because of having
a back pain.
Personal care – depend on mother or
grandmother.
Type of roof- slab (upper roof is not completed)
Screening of baby
Methods of assessment: By asking from the parents

Name: baby B

Head control Yes- partially N/A
Turn side to side Yes- partially N/A
Roll over Yes- partially N/A
Sit with support Yes- partially N/A
Sit without support No N/A
Stand with support Yes- partially N/A
Stand without support No N/A
Walk with support Yes- partially N/A
Walk without support No N/A
Tone : Diskinetic movements

Vision - good
Hearing- good
Tactile- good
ACTIVITY COMMENT
Feeding Depend on her mother. can eat a
biscuit individually.
Self-care Depend on her mother
Washing Depend on her mother
Dressing Need more support
Mobility Need more support to walk. She
is difficult to propel wheelchair
Play skills:
Not like to play with her brother.
She likes to play with elderly ladies.
Communication:
Not talking. But using symbols to express feelings, smiling, crying.
Hand skills:
Having a little amount of gross grasp. But with diskynetic movements.
It is difficult to use for a function.
Summary of visit
Present on visit & benefiters:
- 09 trainee occupational therapy students,

- Ms. D.L.N.priyangika (OT in teaching hospital - karapitiya)
- Baby B ,
- her mother, her grandmother, her brother
Problems identified
o No independency in ADL & spending the day by sitting on

a chair or lying on a bed.
o Having the need of re modifying the wheelchair to position
her comfortably to prevent deformities.
o Baby’s mother is having a back pain due to struggling

with the baby.
o Home arrangement is not creating chances for the child to
become independent.
 Eg: concreted floor gives more resistance to propel
wheelchair or any other walking aid.
 Placement of more furniture in the full area of living
room disturbs child to move.
Strengths & limitations of the client
Strengths:-
Her mother, grandmother, brother – are with good insight &

supportive for therapy. Specially her brother understands what other
family members can’t.
Limitations:-
 Structure of the surrounding (neighbors are not

supportive)
 House is still building.
 Mother is not having a job & having back pain.
 Poor economic support.
 Her grandmother is having a hernia & she is difficult
to support the baby for transferring.
 Baby is not like to do play activities with her brother.
 Floor is concreted & it caused for baby’s active
activity participation.
Suggestions
 Educate the family members about easy transferring

techniques.
 Suggested to arrange the living room, bed room & kitchen to
take space for wheelchair.
 Suggested to practice the baby for a commode chair in toileting
activity. For that asked to remove the middle part of a plastic
chair or make one, using wood.
 Asked to engage the child in play activities to improve gross &
finer grasp.
 Asked to practice the child in walking with the walking aid given.
 Explain the importance of using wheelchair for transferring.(it
will help to mother to reduce her back pain, & grandmother also
can support).
 Finding a job for her mother, as she can do it in home.
Related pictures
Entrance of baby’s home. Accessibility from road to

garden.
Her wheelchair. Walking frame.
The way she walks. When the baby is on wheelchair.

Kitchen Living room
Bed room Bathing area
Building bath room Commode using by the child

Reflective writting on 2nd home visit in Galle area

Time: - 2.30 pm
Introduction:
We participated for the home visit in Magalle area. The
client is baby P who is 14 years old. We, 8 Occupational
Therapy students and the senior Occupational Therapist of
teaching hospital Karapitiya, Ms. D.L.N. Priyangika participated
for the visit. It was about 1.30pm when we were reaching there.
The client, her mother, grandmother and her twin brother were
supported us by giving information.
Baby P is diagnosed with Cerebral Palsy.

We walked for a long distance as we had no idea about the
place. Then we entered to a Muslim village. Baby’s house was
in a corner of that village.
With the entrance we started to screen the home &

environment. Then we talked with baby’s mother &
grandmother.
We observed the child; she is fully dependent on her mother.
We recognized the architectural barriers of the home

background which is a barrier to propel the wheelchair. The
house is not completed & ground is concreted & not smooth.
Their kitchen is made with clay &no enough space.
Baby is moving here & there with more support of her mother.
Grandmother also can’t help as she is suffering with a hernia.
His brother is healthy & he likes to help her sister. But she is
not like to be with him.
Baby is always in smiley face & she is having more diskinetic
movements when she is going to a work.
She is difficult to express her ideas in words. But she has her
own way of responding that can be interpreted by her mother
and grandmother.
What did I learnt?
- We experienced how the hospital set up is not practicable for

the home set up.
- Suggestions for the adapting the physical background may not
be possible to make into action because of some problems.
They are living in the baby’s uncles’ home so they cannot make
changes in that house as they don’t have a house.
- They have no way of income to hire three wheelers to bring the
baby to the hospital. They have no enough transport facilities.
So carrying the baby to a hospital is very difficult. So if an
Occupational Therapist can visit regularly, that would be very
effective.
- I understood how the support of the neighboring houses is
affecting for the child. There is no help for them from
surrounding people.
- People are selecting quick solutions for their problems rather
than selecting long term effective methods. In one day it may
be a disadvantage for them if they did not have correct guiding
& regular follow ups.

- Take a thorough knowledge of the treatments for the
particular conditions.
- We can have a good understanding about the physical
structure and physical barriers of the clients’ home and
what are the possibilities for that.
- Taking a good knowledge about wheel chairs & making
walking aids & how to take measurements.
- How to contact other professionals to give a social
support for clients & their families.
 Reading books to take thorough knowledge about occupational
therapy intervention & articles.
 by using internet
 Taking more clinical experience.
 Asking from experienced senior therapists.
Conclusion
Our home visit program was successful as our senior

therapist Ms. Nirosha Priyangika was with us.
But if we had a proper map for the client’s home it would not be
that much difficult to find the place and we could save our time
and the energy.
2nd day
We did 2 home visits in Yakkalamulla Magedara area & Wandurabha

area. Both are spinal cord injuries at T10 & C7 levels. (Both of them
are three wheel drivers).
3rd home visit
OCCUPATIONAL THERAPY REPORT
12th of march 2019, without the supervision of any occupational

therapist, but with clear guidelines of Mr. Thenu Guruge –
occupational therapist of Maliban hospital - Galle
09 occupational therapy students were participated for this home
visit.For that Mr.A , his wife & father were supported.
Mr.A is 43 years old three wheel driver who is living in Magedara

area. He is a father of 2 children (15 years old daughter & 9 years old
son ) & living with them ,his wife & his parents.
She is not doing a job & their income level is not in satisfactory level.
But Mr. A is having a good family support & motivation to perform his
daily needs.
He had suffered with back pain before 1 & ½ years ago the
injury. On 09th of february2013, suddenly he felt numbness in lower
limbs & unable to walk.
After the 1st admission to karapitiya hospital he has transmitted to

NHSL & treated there in 1 week & he was diagnosed as having
paraplegia due to intramedullary abscess in T10 level.
Then he has taken rehabilitation treatments from ragama
rehabilitation hospital (had a wheel chair) & Maliban hospital - Galle.
Currently he is having urinary tract infection & poor functioning of
liver.
Good family support. But poor economic level.

Supportive villagers & friends & Mr. A is closely associating the
temple & religious person.
There is no family history of such disease.

For studying purpose

Segment Description
Main road to From yakkalamulla-magedara main road= 1.5km
gate Vehicle accessibility:- can access by a three wheel.
Narrow & un even road
Gate to house Distance :- about 10m
Vehicle accessibility :-accessible
Entrance There is a step about 6”.but to overcome it he has
used a wooden ramp.
Door width is sufficient for wheelchair.
Inside the Space:-having enough space.
home Steps:- there are no steps inside the house .the 3”
step to kitchen is also replaced by a concrete ramp.
Kitchen & dining area:- limited space in kitchen. But
client can propel wheelchair through it.
Bed room:- a small room with a bed. Client needs
more effort to turn the wheelchair towards the bed.
Toilet & bathroom :- he is having a wheel chair with
a commode & he can propel the wheel chair to the
squatting type toilet & transfer in to the commode
chair & propel it inside the toilet can manage
toileting activity independently.
Bath also independent same as the toileting activity.
Switch height :- accessible

Type of floor- tiled
Type of roof- tile
ACTIVITY COMMENT
Feeding Independent
Washing Independent
Mobility Independent
Toileting Independent
Independent in IADL activities according to his needs.
 He is scraping coconuts to help his wife.

 He is the person who is doing shopping for the family.
 Taking his children to the school is one of his main duty of the
day. Other than that he is doing school hiring also.
 He is having poor sleep at night due to parenthetic sensations.
Therefore he is doing hires in any night time without any
problem.
 That has become a great service for the villagers.
 Leisure:- he is a busy person most of the times. But he is going
to the temple & doing medication in his leisure times.
He is voluntarily explaining his life experience to other disabled

people to motivate them.
Motor skills:
o Mobility- independent with wheel chair.
o Sensory issues - no sensation in both lower limbs. Having
burning like sensation in whole day.
o Strength- muscle atrophy can be seen in both lower limbs

SUMMARY OF VISIT
- Mr. Thenu Guruge (Occupational therapist, Maliban

Hospital,Galle)
- Mr.A’ , his wife and his father.
Problems identified
- Ossification in both hip joints & due to that he can’t bend

forward.
- Safety issues when transferring from wheel chair.
- Not having vehicle accessibility to the house other than a three
wheel.
- He needs a new wheel chair, because it has broken now.
suggestions
 Introduce a safety and comfortable commode chair & wheel
chair.
 Suggested to take the help of his wife or any other family
member to transfer from three wheel to wheelchair.
 He is having a pain in his upper limbs when propelling the
wheel chair through the ramp. For that to reduce the energy
expenditure, asked to reduce the inclination of the ramp.
Related pictures
Ramp in the main entrance. Slope made in the exit of the

kitchen.
Slope made from dining area to Client’s ability of bending side to

kitchen. side & ramp from living room to
dining room.
Way to bathing area & toilet from Way that client keeps his lower
home. limbs & his upper limb
functioning.
Modified three wheel. Place he scrapes coconut.
Worshipping place. Transferring from wheelchair to

commode chair.
His bed room. Transferring from bed to

wheelchair.
Reflective writing on 3rd home visit in Galle area

Time: - 9.30 AM
Introduction:
We participated for the home visit in Yakkalamulla-
Magedara area in Galle district. The client is Mr.A who is 43
years old. We, 9 0ccupational Therapy students were
participated with the guide line of senior Occupational Therapist
of Maliban hospital, Galle, Mr. Thenu Guruge. The client, his
father & his wife were joined with us to share details with us.
Mr.A, is diagnosed with paraplegia.
We found the place by a telephone conversation with the client.

we knew only the condition of the client & we imagine a patient
who is sitting on a wheel chair. There was a three wheel to take
us to patient’s home & when we are travelling by three wheel
we don’t know the patient is the three wheel driver. We were
wondering about him as he is in a higher level than we thought.
From that time we started our observations. We talked with the

patient about his history of the illness. He told the way he feels
the development of his back pain & suddenly he was unable to
walk.
Then we observed how he is moving inside the home & his
needs. for an example , how he is going to kitchen, dining area,
bed room, out from the house & in to the house.
Then we observed how he is going to toilet, & for bathing &

washing activities.
We observed a nice arrangement that he has made to propel
the wheelchair easily to the wash area. It was 6-7 m away from
the house. The pathway was concreted as a having a
semicircular curvature. Through that he can move without using
his hands.
For every place of steps he has made wooden ramps. Through
that he is easily propelling wheel chair in & out.
He was a well-motivated person & he is doing his best for his
family.
What did I learnt?

- I learned how to arrange a home environment to independent a
paraplegic patient.
Eg :- using of ramps, making a semicircular curvature to propel
the wheelchair easily.
- I understand how the follow up of an occupational therapist,

help to independent the client.
- Even the patient is paraplegic, if we are not mobilize lower limb

joints, it may cause to joint stiffness & muscle atrophy.
- From the very 1st day we should work to increase the

psychological level of the client.

- We should have a thorough knowledge of the treatments for
the particular conditions.
- How to build up the trustworthiness in parents & other family

members.
- What are the standards that we are using in making ramps.
- What are the types of wheelchairs & how we can modify

them according to the need of the client?
- How to reduce deformities & how we can manage a patient
on a wheel chair.
- How to minimize the safety issues of the client
- As we observed we understood that a paraplegic patient

can independent in driving. Like-wise we wanted to know
what the other opportunities that they have are.
 Discuss with a senior occupational therapist.
 Referring books & related articles.
 Search through the internet.
 By increasing the practical exposure & getting more
experiences.
Conclusion
Mr. Thenu Guruge guided us very well.
By this home visit we got an idea about how we can contribute for
the independency of the client.
4th home visit
12th March 2019, 09 OT Students with senior therapist Mr. Thenu

Guruge did the home visit with the participation of Mr. Sujeewa and
his family members.
Mr. S is 38 years old person who is living in Waduramba area in

Galle. He lived with his wife and two daughters (6 & 14 years old). He
is a three-wheeler driver & his wife plucking tea leaves in morning
time.
His economic level is not in a satisfactory level. But he is having a

strong family support to satisfy his ADL & IADL activities.
And he is a person with good motivation.
Branch of tree fallen on his back of the neck on 07.03.2013 & injured
on C7, T1 & become complete paraplegia. After doing ACDF with
peek cages he has referred to occupational therapy & physiotherapy
for rehabilitation.
Due to a pressure sore in his left buttock area & colostomy was
done.
Social and Family history
Good family support. Poor financial support.

Reasons for home visits
As a part of the CBR program, for the studying purpose.

Physical background of Mr. S’s home
Segment Description
Main road to gate From Wadhurabha main road to his house =
2.5km
Vehicle accessibility :- accessible
Narrow & un even road
Gate to house Distance :- about 20m

Vehicle accessibility:-accessible by a three
wheeler very difficultly.
Entrance There is a step about 1 feet.

Door width is sufficient for wheelchair.
Inside the home Space:- very little space & it is also limited
by furniture .
Steps:- there are no steps inside the house .
Kitchen & dining area:- limited space in
kitchen. Client can’t propel W/C in to it &
door width also not enough. Kitchen is
covered with wood.
Bed room:- a small room with a bed.
Living room:-client’s bed is there.
Toilet & bathroom:- he is using colostrum

bag .
Switch height :- accessible

Water resource- tap
Type of floor- cement
Type of roof- tile
ACTIVITY COMMENT
Feeding Partially Independent (because
client can’t reach to the kitchen)
Washing Independent .but he is difficult to
reach to the tap without help of
any one.
Mobility Partially dependent (because
there is no even & enough space
in compound or inside the home)
Toileting Depending on his wife to fix &
remove the colostrum bag.
Partially independent in IADL activities according to his needs. He

can do shopping, driving the three wheel etc…
Leisure :- No special leisure activities are doing. But he like to listen

Buddhist chanting during his free times.
Motor skills:
o Mobility- independent with wheel chair. But with the
barriers of the home & home environment he is difficult to
propel the wheelchair.
o Sensory issues - no sensation in both lower limbs.
Having burning like sensation in whole day.
o Strength- muscle atrophy can be seen in both lower limbs

SUMMARY OF VISIT
- Mr. Thenu Guruge (Occupational therapist, Maliban Hospital)

- Mr.S’, his wife and his daughters.
Problems identified
- Uneven compound with large number of rocks.

- He is unable to reach to the bathing area without help. Because
it is situates 3” above the ground level.
- There is no shower to bath. If there is a shower he can easily
bath & conserve his energy.
- Safety issues when transferring from wheel chair.
- Not having vehicle accessibility to the house other than a three
wheel. Taking the three wheel also a safety issue for him.
- He needs a new wheel chair, because it has broken now.
- There is a slope near the washing area & it is a safety issue for
him.
Suggestions
 Introduce a safety and comfortable wheel chair.
 Suggested to take the help of his wife or any other family
member to transfer from three wheel to wheelchair.
 If we can make even his compound, then he can propel the
wheelchair independently. For that it is better to concrete the
area as he can reach to the door & bathing place.
 There is no enough space inside the house. for that we can ask
to remove all the furniture without his bed & fan. But it is not
practical as there is no space to in his whole house.
 Poor economical level is the main issue in this family. For that
we can arrange a job for his wife.
 There is a slope near the washing area & for that suggested to
make a fence to avoid slipping to down.
Related pictures
Road to home. Road to home.
Client on his bed. Modified three wheel.
AFO Washing area.

Reflective writing on 4th home visit in Galle area

Time :- 9.30am
Introduction:
We participated for the home visit in Wandhurabha area in
Galle district. The client is Mr.S who is 38 years old. We, 9
0ccupational Therapy students were participated with the guide
line of senior Occupational Therapist of Maliban hospital, Galle,
Mr. Thenu Guruge. The client, his wife & 2 daughters were joined
with us to share details with us.
Mr.A, is diagnosed with paraplegia.
We found the place by a telephone conversation with the client.

We knew only the condition of the client & we imagine a patient
who is sitting on a wheel chair same as Mr.A. There was a
three wheel to take us to patient’s home same as the previous
case. But suddenly we understood the driver is the patient with
the experience of the previous case.
The way to his house is very difficult & hilly with rocks. But he
drives the three wheel to his house. His house is situated in a
top of a mountain in a very limited space.
From that time we started our observations. We talked with the

patient & his wife about his history of the illness.
Then we observed how he is moving inside the home & his
needs. For an example, how he is going to kitchen, dining area,
bed room, out from the house & in to the house.
Most of the time to perform his ADLs, he need his wife’s

support. That is because of the space problem & safety issues.
What did I learnt?
- I learned how to arrange a home environment to independent a
paraplegic patient.
- I understand how the follow up of an occupational therapist,
help to independent the client.
- I learnt how the environmental barriers cause to the
dependency of a client.
- From the very 1st day we should work to increase the
psychological level of the client.
- We have to think about the how the client can increase the
number of hires. For that the pleasant look of the client is very
much important. There should not bad smells coming from the
vehicle, & patient should be clean & be with a pleasant & happy
mood. I learnt the lightning of the joystick is also very much
important to this kind of a patient.
 We should have a thorough knowledge of the treatments for

the particular conditions.
 How to build up the trustworthiness in parents & other family

members.
 What are the standards that we are using in making ramps.
 What are the types of wheelchairs & how we can modify

them according to the need of the client?
 How we can ask help from government or private sector to

help this kind of patient.
 How to minimize the safety issues of the client

- Discuss with a senior occupational therapist.
- Referring books & related articles.
- Search through the internet.
- By increasing the practical exposure & getting more
experiences.
Conclusion
Mr. Thenu Guruge guided us very well.
By this home visit we got an idea about how we can contribute for the
independency of the client.
3rd day
Reflective writing on Sambodhi special education school
Date :- 13th of March 2019

Time :- 07.00 AM
Introduction
We did a visit to “Sambodhi” special education school at Galle. This

school was a concept of Sambodhi project. Mr. & Mrs. Dissanayake
are the founders of this institute.
Children are referring to this school no NGOs, children homes &

schools mainly.
We went there with the guide of Mr. Thenu Guruge. He gave us a

plan to conduct within the school time.
Our plan was to divide in to 3 groups & do observations near the bus
halt, near the school gate & inside the class room at 7.00 to 7.30 am.
Then discuss with the principal of the school & have an idea about
the structure and the plan of the school towards the children with
special needs.
Then to select 4 students and observe them within the class room &
to plan what we can do for them?
According to the plan we divided in to groups & forced on our tasks.

What we observed?
How students are coming to the school?
Most of them are coming with their parents by their private vehicles
(by motor bicycle, three wheel mainly). Less number of them is using
public transport. And one boy came by his bicycle alone.
What were parent’s ideas?
According to them, their behaviors in school and the home are

extremely differ. Parents are unbelievable how they are behave in the
school. They are taking responsibilities, leaderships, participate in
practice sports, cleaning activities etc. But at home they are
neglecting to do.
Taking them to school is also a help for the parents, to spend their
daily activities normally.
How students are separate in to classes?
It is only by their IQ Level. But for aged children, they are separating
in to classes according to the gender also.
End of the year teachers are gathered together to discuss about the
strengths and weaknesses of students. Then they are choosing
students for up grade classes.
What is the school arrangement?
It is same as a normal school. There is only one building with

upstairs. There is a ramp from ground to the classroom & having
wheelchair accessibility.
There are prefects to control other students. School time is 7.30 am

to 1.30 pm. Assembly, sports practice, competitions and all as same
as other schools.
There is a large washing area to practice students about BADL

activities (brushing, washing, toileting, combing ...)
What are their strengths?
 They have a well trained staff. Some of the teachers are also
disabled. It has become a positive factor for the students to
understand them & be close to them easily.
 Dedications of the teachers are excellent. They all think
separately about each student & they always try to take all of
them up from their current situation.
 Parent’s support is the other factor.
 They are always being with the school to help them. They are
following what the teachers are telling. According to parents we
felt that they are with a positive idea about the school.
 Each day is structured according to a time table.
 There is a visit of speech therapist to the school once a month.
What are their limitations?

 There is no enough buildings to conduct classes effectively.
 There is wheel chair accessibility to the school.
 Lack of facilities.
 No visit of occupational therapist regularly.
Related pictures
Playground & school. Late comers are waiting for the

time.
Morning exercise programme. Cricket practice.
Learning in classes. Learning in classes.
Out class activities with parents. ADL training.

Group work
In our case me & my friend, Nadeesha specially considered about a

boy (15 years old) who is hyperactive according to his class teacher.
He is a baby of hydrocephalus & now his shunt is too short for him.
He is living with his father & mother has separated. Father is a bean
seller in front of a bar from 5.00 pm to 10.00pm. This baby also going
with him as there is no one at home.
This boy has practiced to tell bad words & act like a drunkard man in
the school.
Therefore his class teacher asked us to suggest something to settle
him.
Then Nadeesha & I talked deeply about him with his class teacher &
his father. The thing we understood is, the reason for his behavior is
his living society. Both of us can’t say his father, not to carry him to
his business place. But we gave him a plan to keep the boy near him.
The plan was to,
1. Giving a little task to do by the boy.
Eg:- filling grams to the bag, handover the bay to the customer.
2. Giving him a same coin or paper money daily by telling the
value of it.
Eg:- this is Rs.20.00.
3. Then change the value of paper money & do as previous.
4. After 1 month he will know to identify the value of some money.
Then father can get it in to practice by asking to take some
money by mixing his memory.
Eg;- give me Rs. 50 & 20.
5. With the time the boy may practice for money management.
6. By increasing his task gradually, we can feel him as an
important person for father’s business.
We explained our plan to his class teacher & asked him to find what
he did with his father daily. When teacher is asking the same
question daily, his father also can’t neglect the task.
What did I learnt?
Special need children need more care & attention than other children.
They are learning things by practicing. For that we have to do more
with the active participation of the child. They are keeping fewer
amounts in their memory.
How the stigma causes to change the mind of special need children
as well as their parents & other family members.
Visit to “Senehasa” Children’s Resource Centre
Reflective writing on “Senehasa” Children’s Resource Centre
Date of Journal entry: 14.03.2019

Introduction:-
We visited “Senehasa” children’s Resource center (SCRC) as
a part of our community Based Rehabilitation (CBR) programme
.Ms.Nirosha Priyangika (Senior Occupational therapist) and our group
members of CBR programme (09) participated for that.
It was placed at Ananda Mawatha, Kithulampitiya, Galle .
It was started in August 2003 by nonprofit making Organization and it

has been registered with department of social service in the southern
province and governed & administered by “Senehasa” foundation .It
was formed by committed group of professionals & parents with
stated aim of offering therapeutic, educational & social support to
children with special needs in physically, sensory & intellectually
disabilities and their families.
Aim – To contribute overall goal of enable children’s with special

needs aged between 0 and 18 years living in southern province to
reach their potential and reduce the burden on their families and
society.
Mission – To provide therapy too mentally and physically

challenged children to achieve their greatest potential of
independence in life and society. To provide leadership,
information & technical assistance to individual & other
organization.
Vision – To help children with disabilities and special needs

achieve quality in society and enjoy every human and
civil right as any other child.
Until 2003, few centers in Southern province provided care for
children. Children who need intervention program have to travel
long journey. It caused to from this center .This institution mainly
focus children in Galle and Matara districts.
1022 children have been registered to “Senehasa
Children Resource center” with variety of physical, sensory &
intellectual disabilities, But in now a days 70 children participate
actively.
2 buildings with toilets were there .That has wheelchair

accessibility. Those buildings consist with large and small work
areas. And single room bungalow for therapist accommodation.
There was multisensory room with equipment.
Human resources:
 Medical specialist in pediatrics, child psychiatrist
and Medical officers.
 Occupational therapist
 Physiotherapist
 Speech & language therapist
 02 Music teachers
 A dancing teacher
 4 special education teachers
 Specialist center officers(president, vice president,
secretary, treasurer assister and committee
members)
 parents
 volunteers
Services
 Pediatrics medical assessment and Clinics

 Play group & child stimulation unit
 Social club
 Dancing , music ,art & craft sessions
 Sports / outdoor play areas
 Special seating & equipment
 The Multisensorial room
 Counseling & parental awareness program.
 Bakery class, paper bag making as vocational
training
Income
 Interests
 Donation
 Ordinary & life membership fees
 Daily attendance fees
 Sales of bags & greeting cards
Expenditures
 Staff allowances
 Stationaries
 Electricity
 Water
 Telephone bill
 Unit expenses
 Security charges

 We got chance to participate for therapy session that
was conducted by Ms.Nirosha Priyangika (Senior
Occupational therapist) .We presented our suggestions
for each child.
 We got chances to participate for a music class,
gardening activities and paper bag making activity. With
those activities we got chance to observe them.
 We got chance to talk with founder of this institution

(SCRC) . She is also a mother of a child with cerebral
palsy. According to her the most important 7 specific
factor of this institute is the “love”. This was the reason to
keep the name for the institute as Senehasa.
 We could talk with children and their parents also to

know about their idea about this institute & it’s
functioning.
What did I learn?

 What are the advantages that gained by children & their
parents from these type of institutions.
 What is the importance of love for special need children &

how it may influence for the development of the child?
 How can occupational therapist join with this type of

institutions & what is their contribution?
 I have to learn more about how to work in community
setting effectively.
 I have to learn more about pediatric field (pathology, its Rx
and management)
 Engage more in pediatric field and get more clinical

experience.
 Can talk with our senior Occupational therapists who
expert for pediatric field.
 Through the Internet, & referring related articles.
 Update the knowledge of occupational therapy
intervention day by day.
Conclusion
The day was successful , because Ms.Nirosha
Priyangika was with us. She guided us very well & explained what
Occupational therapist can do to improve the functional & cognitive
levels of the differently abled children , while she is observing the out
patients came to the institution. It was a great opportunity for us.
Related pictures
Founder & her own son. Occupational therapy clinic.

Music practice. Dancing practice.
Music practice. Singing a group song for us.

Visit to preschool of Rainbow foundation
Reflective writing on preschool of Rainbow foundation
Date of journal entry:- 15.03.2019
Introduction
We went to a preschool in Hammeliya area started at 2006 ,

which is giving learning experiences to 04 special need children
as well as normal children.
It is conducted by a German foundation called "Rainbow". To

work as a successful team there were human & non-human
resources. Human resources are , speech therapist , special
education teacher , preschool teachers , volunteer workers
(local and foreign ) , supportive parents .
Non-human resources are, 2 buildings , special seats, activity

room for special need children and free environment.
We identified some strengths & weaknesses of them.
• Strengths
 Having a young, supportive staff & supportive
parents.
 Financial support of German foundation.
 Belief of the need of love & affection for a child.
 Calm & quit environment.
• Weaknesses
 Poor theoretical & practical knowledge about
management of children with special needs.
 Property problems & because of that they can’t do
any changes in buildings or in environment.
But they are going to build a new building due to a property problem
that they faced.
Observe the preschool ,their office area, and surrounding

environment .
Then we had a discussion session with members of sri Lankan

rainbow foundation.
Done a rough observation of the children with disabilities.

discuss with their family members, speech therapist & teachers
about their behaviors , interests , needs , medical issues,
services from the foundation individually towards them .
Observed the learning patterns of normal preschool children &
discussed what are the techniques that teachers are using to
encourage the children.
What did I learn?
How we as occupational therapists, giving suggestions in the field

of construction?
 Ramps ( height – 1 foot height to 12 feet distance)
 Door widths (minimum width for wheelchair accessibility)
How to build up a rapport with little children?
 Their understanding is not enough to understand the value
of therapy.
 They have their own way of accepting . easy to work with
them through play activities.
 Need more and more motivation to maintain within an
activity.
 Story telling
 Giving gifts
 Preparing interesting environment for therapy.
 Taking the help of the family members, mainly who
is more closer to the baby.
 Not using play activities of same pattern.
 Need more appreciation
 It is good to work individually with the children or make small
groups with less than 5 members as they need more care &
attention.
What more i have to learn?
 About the treatments of paediatric conditions (what we can
do for a hyperactive child?)
 What are the organizations or institutes that we can request
help to have different wheel chairs, orthosis, special seats?
 Less experience on clinical practice & arranging a
treatments in an order to have a maximum benefit.
 Realistic suggestions to adapt the home environment to
independent the child up to maximum level
How can I learn it ?
 through related books

 by using internet
 studing well in the class room
 asking from experienced senior therapists
What is my plan for further improvements?
 Take more clinical experience actively rather than doing

observations so far.
 Reading books to take thorough knowledge about
occupational therapy intervention.
 To learn about occupational therapy treatments on pediatric
conditions.
Conclusion
It is good to have a visit of occupational therapist to the

preschool as there are about 15 patients are coming to take
speech therapy & most of them are with the need of
occupational therapy according to speech therapist.
Difference is the caring of the children than other places with

kind & lovely manner. They are acting as a day care center for
2 – 3 children.
But the medical care is poor & they do not have much
knowledge or experience on treatment techniques using.
The president of Sri Lankan foundation is using some

massaging therapy using in Canada, which is not scientific as
we felt.
They do not have correct idea about the planning of a building

for the benefit of special need children.
Therefore as trainee occupational therapists we did

suggestions for modifications of new building, treatment
techniques used for different pediatric conditions, how to use
play activities as a therapy etc……..
Mrs. Thakshila senavirathne (OT tutor of school of OT & PT)
was helped us to present our suggestions in realistic way.
Related pictures
Non appropriateness of table & Special room for special need
chair. children.
Special chairs in preschool. A Sensory stimulation tool.
Preschool for normal children. Children are learning in

preschool.
5th home visit
15th of march 2019, with the guidelines of occupational therapist of

Maliban hospital of Galle, Mr. Thenu Guruge , & supervision of Ms.
Thakshila Senavirathne, 09 trainee occupational therapy students
were participated for this home visit.
For that baby “B”, his mother, his father, his aunty was supported.
Baby B is a 3 years & 9 months old child, living with his mother ,
father, his 2 elder sisters & his aunty. His father is having a grinding
mill. His mother is a primary school teacher & she is in satisfactory
education level. They are living in Hammeliya – Galle area & all
neighbors are very supportive. Even baby’s parents are doing jobs ,
they are in poor economic level.
Baby has diagnosed as having basal ganglia infarction when he was

4 months old.
 It has happened due to medical malpractice when injecting .
• Taken habilitation treatments from Maliban hospital – Galle for
continuous 6 months (with hospital admission.)
• With the help of occupational therapy , now the baby is in a
hopeful level.

There is no any family history of such a disease. Socially they are
well functioning & they are having enough support from neighbors.
As trainee occupational therapy students we did this home visit

mainly for our study purpose.
But for the benefit of the child, we did relevant suggestions &
recommendations to gain the maximum functional level.

Segment Description
Main road to gate Distance from main road – 500m
Vehicle accessibility - accessible
Gate to house Distance- about 5-6 m to the veranda
Surface- even
vehicle accessibility - yes
from compound to veranda there is a step of
nearly 4” height.
Entrance There is a step of height of 5”
Door width is enough for wheel chair accessibility.
Inside the home Space –having enough space & no more furniture
Steps – there are no steps in.
Kitchen & dining area – not using the kitchen.
Bed room –easily accessible
Beds are too height & not accessible for the baby.
Toilet & bathroom –he is using a plastic

commode.
In out, there is a squatting type toilet.
Bath area is 10 m away from home. Parents can
still carry him to toilet or bath as still he is small.
Personal care – depend on family members
Way of lightning: electricity

Water resource: tap (private well)
Type of floor: tiled
Type of roof: tiled
Screening of baby
Methods of assessment: by parent’s information

Name : baby “B”

Head control Yes- partially
Turn side to side Yes- partially
Roll over Yes- partially
Sit with support Yes- partially
Sit without support No
Stand with support No
Stand without support No
Walk with support No
Walk without support No
Tone : diskinetic movements

Vision - good
Hearing- good
Tactile- good
ACTIVITY COMMENT
Feeding Depending on his family member. can eat rice .
but the hygiene is poor.
Self-care Depending on his family member
Washing Depending on his family member
Dressing Depending on his family member
Mobility Rolling or dragging on the floor
Play skills:
Very interesting in play activities. Like to play with water more time.
Communication:
Having a vocabulary of about 30 words. But difficult to pronounce &
only telling 1st letter. Mother has to understand by practicing. He is
having an unique way of speaking.
Hand skills :
Having gross grasping ability. Poor finer grasping in both hands. Left
hand is little better than right hand
Summery of visit
Present on visit & benefiters :
o 09 trainee occupational therapy students,

o Ms. Thakshila Senavirathne ( tutor of OT)
o Baby B , his parents & other family members
Problems identified
- No independency in ADL & IADL activities.

- Not having proper balance to sit without back support
- Inability to stand & walk independently
- Poverty of speech.
- Lack of engagement of baby, in activities.
- parent’s lack of knowledge in positioning & mobility of the
baby
Strengths & limitations of the client
Strengths
 His family members , mainly his mother is with good insight &
good education level to understand the child
 Baby is having 2 elder sisters who can engage with him in play
activities
 Enough space in living room for babies play activities
 Better occupational therapist who is very supportive &
knowledgeable
 Baby’s pre school
Limitations
 Parents lack of knowledge on therapy

 Poor financial support
 Lack of chances for the child , because of the parental love
 Steps in the main entrance & exit In the back of the home
 Parents are busy with their own works & difficult to find time to
work with the baby.
 Taking oilments as treatments (Sinhala Ayurwedic Rx)
Suggestions
 Educate the family members about positioning & easy

transferring techniques.
 Educate the family members on further issues that they may
have to face.
Eg :- Advantages & disadvantages of using a
special chair
 Asked to engage the child in play activities to improve gross &

finer grasp.
 Asked to practice the child in standing & walking with the
walking aids given.
 Suggested to create opportunities for the child to be
independent.
Related pictures
When baby is in the preschool. His special chair at home.
Previous way of drinking water. Engaged him to drink by

holding a cup at both sides.
Throwing a toy while sitting on Throwing a toy while sitting on

special chair. 90-90 position.
Baby wearing AFO. Eating.
The way baby moving here & Educating mother about

there. positioning techniques.
Educating mother.
Reflective writing on 5th home visit in Galle area
Date of journal entry - 15.03.2019
Time : 11.45 am
Introduction
We did a home visit in Hammeliya area with Mrs. Thakshila

senavirathne & all our group members.
The child is diagnosed as a basal ganglia infarction who is 3

years & 9 months old. He has faced the illness when he was 4
months old due to medical malpractice.
They have done rehabilitation & habilitation treatments as much

as possible.
Baby’s mother is a primary school teacher & his father is having
a grinding mill. He is living with his parents & 2 elder sisters &
his aunty.
Their house is well built & most of the things (family ,
environment , OT treatments , pre school) are supportive for
the child.
Currently they are doing Sinhala medication also.
The baby was a one of the special need children in the

preschool of rainbow foundation.
After ending the preschool we did the home visit of baby B. For
that speech therapist also participated as a villager.
First we discussed with baby B’s mother about the history,
prognosis, passed milestones, current strengths & limitations of
the baby.
According to her, baby’s cognitive level is approximately
normal, but his functional level is below the level of 4 years old
child.
Mrs. Thakshila explained baby’s mother about correct
positioning & importance of that.
Then she engaged the child with play activities while keeping in
the 90 90 sitting position with the support to the hips.
Next we observed the way of feeding. He is dependent on a
family member for that activity.
He drinks water with a soother.
Then we gave the opportunity to eat & drink independently
while sitting on a special chair.
He was able to hold the cup with both hands & drink water.
He ate with his left hand. But difficult to eat neatly due to having
poor grips & finger opposition.
Then we observed the way of his mobility. He is rolling or

dragging on the floor to move here & there inside the home.
When he was sleeping he always used to be in prone lying .
What did I learnt?
How to build up the rapport with parents & specially with a child
Age appropriate activity selections
What are the needs that should be with the baby to do CIMT
(good cognitive level, one hand should be well working)

 About the treatments of pediatric conditions (what we can do for
a hyperactive child?)
 What are the organizations or institutes that we can request
help to have different wheel chairs, orthotics, special seats?
 Less experience on clinical practice & arranging a treatments in
an order to have a maximum benefit.
 Realistic suggestions to adapt the home environment to
independent the child up to maximum level
 through related books

 by using internet
 studying well in the class room
 asking from experienced senior therapists
 Take more clinical experience actively rather than doing

observations so far.
 Reading books to take thorough knowledge about occupational
 To learn about occupational therapy treatments on pediatric
conditions.
Conclusion
On the above home visit , our active participation as a group

was reduced & it became a day of learning by our madam,
Mrs.Thakshila Senavirathne.
We learnt a lot from her on different topics. Practically what we

can do with a baby is experienced on that day very critically.
Finally the home visit was very successful & baby & his family
members were also satisfied very much due to the participation
of Mrs.Thakshila Senavirathne.
SPECIAL THANKS ,
 Ministry of health
 Mr. Rohana Perera (Principle of School of Physiotherapy &
Occupational Therapy)
 Mrs.Thakshila Senavirathne (Tutor of Occupational Therapy,
Coordinator of Down South Group)
 Mrs.Wasana Dahanayake (Tutor of Occupational Therapy)
 Mr. Ashoka Sanjeewa (Tutor of Occupational Therapy)
 Mrs.Thilini Vithanage (Occupational Therapist, Base Hospital -
Panadura) , & Dr. Gayan Jeewantha, Psychiatric nursing
officer, Mr. Sunil gunawardhana of Base Hospital - Panadura
 Mr.W.R.A.Shantha (Occupational Therapist, New District
Hospital - Matara)
 Mr. Senaka Satharasinghe (Occupational Therapist, New
District Hospital - Matara)
 Mr.Thenu Guruge (Occupational Therapist, Maliban Hospital -
Karapitiya)
 Miss. Nirosha Priyangika (Occupational Therapist, Teaching
Hospital- Karapitiya)
And
All the other Tutors of School of physiotherapy & Occupational

Therapy. (Mr.Nandana Welage , Mr. Iranga , Mr. Bhanaka Fernando)
All the Occupational Therapist Of District Hospital Matara & Teaching

Hospital- Karapitiya.
All the Clients & all their family members.
Members of Down South Group (Group D) (R. Mathushan, J.L.P.T.

Dineshika, T.G.Shashini Nimasha, G.Y.M.Madhumadhavie
Rathnayake, M.G.Nadeesha Pritangani, M.A.I.Nalaka,
K.A.A.Samadhi, H.Arosha kumuduni, & me,K.R.Jeewa Jayanagani) &
All my colleagues of 35th batch.
THANK YOU … !

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Community Occupational Therapy practice placement

Occupational therapy Diploma training – Batch XXXV, March 2019

School of Physiotherapy and Occupational therapy

Community is an important context that influences individuals’ ability

It is important for occupational therapy students to have a basic

2 weeks (05th March 2019 to 16th March 2019)

(03) Student groups

C 09 Lady Ridgeway Hospital, Chilaw, Puttlam

1. Community Based Rehabilitation at Panadura area.

I. Report on Panadura home visits

2. Community Based Rehabilitation at Matara area.

I. 1st home visit

3. Community Based Rehabilitation at Galle area.

I. 1st home visit

Community Based Rehabilitation at Panadura area

After we gathered to base hospital Panadura , one of the psychiatric

Why they are doing home visits?

Patients not participate for clinics regularly.

- Poor economic level

Therefore hospital has planned to inject “Modecate” according to the

Hospital staff is not wearing uniforms when dong home visits.

According to him uniform creates a gap between patient & health

By wearing normal dresses, the medical team expecting to make feel

In the conversation with the client, we should behave as the patient is

How to find the location?

Report on Panadura home visits.

Date :- 05. 03. 2019

We did 12 home visits from 9.30 am to 2.30 pm on 05. 03. 2019.

Below are the rough overview about some of them.

1st home visit

Background information of Mr. A

Medical background of the client

Diagnosed as schizophrenia since 1992. Currently taking treatments

 Poor personal hygiene.

2nd home visit

Background information of Ms. B

Medical background of the client

And she is suffering with osteoarthritis.

Currently taking treatments from base hospital, panadura.

- Inability to do any of the house hold activity due to joint pain.

 Doing house hold activities (cooking , sweeping ,laundry..)

Entrance to the house while listening to her complaints

3rd home visit

Background information of Mr. C

Medical background of the client

Client’s house Client after injecting

4th home visit

Background information of Ms. D

Medical background of the client

- Diagnosed as schizophrenia since 1992.

- Lazy to do house hold works.

 Poor participation in house hold activities.

Injecting Modecate to the client Burn injury in her hand

Background information of Mr. E

Medical background of the client

Diagnosed as schizophrenia for 20 years. Currently taking treatments

 Poor personal hygiene.

Injecting Modecate to the client His bed

Unclear floor of his room Unclean arrangement in his

6th home visit

Background information of Mr. F

Medical background of the client

Diagnosed as schizophrenia. Currently taking treatments from base

 Poor personal hygiene.