Golf Tees for OT

 Recently in my Neuro Aspects class, we were given the daunting task of designing an intervention using random material for a case study. My case study involved a 51-year-old woman named Alice, diagnosed with secondary progressive multiple sclerosis 18 years ago. 

My item was..... *drum roll please* a golf tee. 

As someone who has never dabbled in golf outside of put-put, I would be lying if I said I didn't have to google what a golf tee looked like. After a few pictures, the panic began to set in.

What in the world can I make out of a golf tee?

In the true spirit of client-centered practice, I started by focusing on Alice. Alice is an independent woman, despite her diagnosis. She spends most days alone because her husband works 6-7 days weekly. She retired from teaching two years ago and misses interacting with the children and her gardening hobby. Alice also enjoys caring for the house while her husband is at work by doing the laundry and preparing dinner for them daily. She takes pride in her appearance and enjoys dressing up.

While she claims she is managing to do all of these things independently, her husband often finds these tasks uncompleted in varying stages. This is due to her increasing fatigue, the most common symptom of multiple sclerosis. Her fatigue significantly impacts her ability to perform her daily occupations, preventing her from the leisure activities she loves. Her exhaustion is also causing gross and fine motor coordination issues and leading to cognitive deficits in planning, organization, task monitoring, task initiation, and working memory. Since her fatigue significantly impacts her ability to maintain independence and enjoy what she loves, I decided that this would be my main focus of intervention. 

Now.... what to do about those golf tees? 

My first idea was to create a modified gardening tool, something that could help her reengage with an activity that was meaningful to her. The goal was to design a modified gardening hoe using the golf tee as the spikes. Instead of a standard handle, the handle would be more oversized and upright, so she could use a cylindrical grasp, reducing the need for fine motor manipulation. After reflecting, I decided this design only addressed the decreased fine motor coordination caused by fatigue. Changing the handle while making the item easier to grasp does not really address the level of fatigue she would experience. 

The second idea had similar issues. Since cooking was a primary occupation for her, I thought I would design a modified cutting board, using the golf tees to stabilize ingredients so she could chop more easily. Alice usually gets fatigued by chopping but can still chop, so stabilization was not the issue; energy expenditure was, and I was not confident in my ability to make a chair out of golf tees. 

Over the past two weeks, I played with countless more ideas and was met with the same concern: am I designing something that will help Alice? 

The thing about multiple sclerosis is that every day is different. Somedays, Alice might wake up with enough energy to participate in a dozen meaningful activities. Other days she might wake up, only able to complete one. I needed to think of something to help her prioritize these activities so she could adjust her schedule based on how she felt that day. That is how I landed on a task board. Using a peg board, a foam board, a cardboard box, index cards, and golf tees, I designed a board that allows Alice to plan her day, prioritize activities, and gauge her energy levels by rating which activities use the most energy. I color-coded the golf tee pegs in red, yellow, and green to signal the energy required for each task. Three sections on the board indicate the priority level of the functions so she knows which tasks she should focus on and which ones can wait if she gets too fatigued. I also broke down the task cards into parts of a task so she could give herself breaks as she completed them. A shopping list is included to cue her to note items she needs to replace as she completes a task and allow her to have a premade list when she goes grocery shopping. 

Now I know a to-do chart doesn't seem all that innovative, and to be honest, it isn't, but I believe it will significantly impact Alice's life. It will help her plan, stay organized, reduce fatigue, and most importantly, help her become more mindful about her energy levels and reduce her tendency to push herself too hard. Because the board can be hung on the wall while she plans for the day, she will also be working on the ROM in her shoulder and gross and fine motor coordination as she maneuvers the cards and uses the golf tees to attach them to the board, as well as working on her working memory as she plans the day's tasks. As her disease progresses and her symptoms worsen, she can remove the board from the wall and plan the activities sitting to conserve more energy. 

In addition to showing Alice and her husband how to use the board, I would also introduce ways of adapting the tasks to allow her to use even less energy. For example, finding a way for Alice to sit as she prepares ingredients for dinner or folds laundry would significantly lessen the energy required to complete those activities. I would also introduce her to ways she can prepare for future high fatigue days by implementing strategies like meal planning and ensuring she has some frozen meals prepared for days when her fatigue is higher. 

Overall, this assignment was a difficult one. It required a lot of knowledge about Alice and her experience with multiple sclerosis and constantly questioning whether my intervention idea would be impactful. It was hard accepting that maybe the best idea for Alice wasn't necessarily the most innovative option. Reassessing the client's goals is vital when designing an intervention; it keeps you on track and prioritizes the client's needs. After a stressful couple of weeks, I am confident in my intervention and feel like I learned a lot about the complexity of designing an intervention.