Inside the O'Briens

Reading this book that gives all the insight to what life with Huntington's Disease (HD) is like was a real eye opener for the struggle that a family goes through with this disease in their lineage. Lisa Genova does a great job giving the reader every perspective, but also keeps things very educational and states the facts about how this disease is passed down from generation to generation. I thought the book was interesting to read because I had never thought about someone not knowing that they had the chance of getting it, like with Joe O'Brien who had no idea that his mother had died of HD so thus had no idea that he and each of his offspring had a 50/50 chance of having the same gene. I also liked how Genova made it so real between the siblings and the tension that could be there with some that had the gene and some that didn't have it. Before reading this book, I had never really thought about what it might be like to know how and when you are going to die. Would I want to know? The 4 children of Joe face the same dilemma, do they find out if they carry the gene and then start to believe that every little tick is the onset? Or do they go without knowing and live their life as a waiting game to see if they carry the gene? The only thing I didn't like about the book is the way it ends not letting the readers know if the youngest O'Brien kid carries the gene or not. Otherwise, it was a very educational and intriguing read.

Client: Joe O’Brien (44 years old)

OP performed by: Claire Mallicoat on 4/21/18

Occupational Profile

	Reason the client is seeking OT services and concerns related to engagement in occupations (may include the client’s general health status)	Client is seeking OT for a diagnosis of Huntington’s Disease (HD). Client is experiencing chorea (sudden, jerky movements) and can be more forceful than intended. Concern about movement on the police force and whether it is safe with his outbursts of anger.
	Occupations in which the client is successful and barriers or potential barriers to his/her success in those occupations (p. S5)	Client is successful in walking, sitting, eating, drinking, and sitting. Client was able to work up until the chorea became too much and was accused of being drunk on the job. Barriers include the jerky movements and not knowing when the impulse movements will interfere with daily activities.
	Personal interests and values (p. S7)	Client likes baseball games, spending time with family, getting drinks with the boys, being a policeman.
	The client’s occupational history/life experiences	Policeman for 20 years, father of 4, grandfather to be, husband
	Performance patterns (routines, habits, & rituals) – what are the client’s patterns of engagement in occupations and how have they changed over time? What are the client’s daily life roles? Note patterns that support and hinder occupational performance. (p. S8)	Roles- Husband, father, friend, policeman Routines- goes to work every day, gets off at 4 to be home in time for dinner. Sunday family dinner at 4pm every week. Rituals- Sunday family dinners, grew up watching baseball games with family but has to work them as a police officer. Habits- now that HD is a diagnosis, the constant movement burns calories so weight loss happens, job as a police officer becomes unsafe and he has to leave. Sudden outbursts also become a habit.
	Aspects of the client’s environments or contexts, as viewed by the client (p. S28)	Supports to Occupational Engagement:	Barriers to Occupational Engagement:
	Physical	Lives in a 3 story house on the bottom floor	Sometimes has to park far away from house and walking can be difficult with jerky movements
	Social	Has a loving wife and family to support him through the decline of the disease	Since HD is a genetic disorder, there could be tension in the family due to only some members carrying the gene
	Cultural
	Personal	Middle aged male, educated, supportive family, good job	Job requires quick movements and thoughts and standing on feet for long periods of time
	Temporal	Disease takes 10-15 years to progress	Knowing that it takes 10 years to progress and thinking every little sign is a symptom
	Virtual	Ability to get tested for gene and online genetic counseling is available along with support groups	Too much research and knowing about what HD looks like in the end could lead to suicidal thoughts
	Client’s priorities and desired target outcomes (consider occupational performance – improvement and enhancement, prevention, participation, role competence, health & wellness, quality of life, well-being, and/or occupational justice) (p. S34)	Client wants to work as long as possible at the police force without being a harm to others. Once client is no longer able to work, client wants to enjoy time spent with family as well as attend baseball games. Client also wants to maintain strength and weight and ability to walk as long as possible.