Occupational Analysis and Intervention Plan

Megan Lawrence
9-30-13













Occupational Profile
1. Client name: J.M
2. Age: 23
3. Sex: M
Briefly discuss each of the following:
4. Who is the client?
The client is a 23 year old male who lives in a one bedroom second story apartment in Vancouver,
WA with his 60lb 3 year old dog. He is moderately physically active and within the appropriate
weight range for his height. He has family that lives within the area that he visits most weekends.
Monday through Thursday he attends the local college and is on track to graduate in May 2015.
Friday through Sunday the client works at an Interstate Battery store from open to close, which on
average is 9 hours a day. The client enjoys working on his old motorhome, snowboarding, riding his
Harley, and relaxing at home. The client has no previous medical problems, reports no pain, and is
taking no medication.
5. Why is the client seeking services and/or what are the clients concerns relative to engaging in
occupations and in daily life activities?

The client is seeking services to maintain current occupational performance and prevent future
occupational performance problems while walking his dog 3-4 times a week.
6. What areas of occupation are successful and what areas are causing problems or risks?
The occupation the client engaged in for this analysis was walking his dog Maggie on the rural
private road that they live on 3-4 times a week. The client is successful in the IADL care of pets and
health management and maintenance. Within this occupation the client is able to perform the
preparatory activities of getting all required tools such as a leash and collar for Maggie, and the
actual occupation of walking down the road. The client wants to reduce and manage the risks
involved in performing the occupation, such as wrist strain from holding the leash and increase
muscle endurance.
7. What contexts and environments support or inhibit participation and engagement in desired
occupations?
The clients personal context of being a 23 year old educated male supports participation in the
desired occupation. The physical context of the environment both supports and inhibits
participation. The supporting factors include that the terrain is level and paved to decrease
accidental falls, there is minimal traffic, the area has a very low crime rate, and along the road there
are open fields that Maggie can be let loose in to increase her workout without overexerting the
client. Some potentially inhibiting factors include that to safely walk Maggie there needs to be
daylight so the times to go on a walk are limited from 7am-7pm, and the weather in Washington is
often rainy in the fall which may increase tools needed for the walk like an umbrella or rain coat to
stay warm and dry. The cultural context supports participation in the occupation of walking a dog.
Within the area there are many residents who walk their dogs, as it is somewhat of a cultural
expectation that if you have a dog to take care of it by taking it on walks. The temporal context, as
with the physical environment, is potentially limiting due to the need for daylight when walking on
the road.

8. What is the clients occupational history?
The clients occupational history includes that he is a full time electrical engineering student in his
senior at WSUV. Taking 13 credits he is also able to work 26-30 hours a week as a manager at an
Interstate All Battery store in Portland, Or. When not working or in school, the client enjoys working
on cars and is currently fixing up his 1990 Toyota Dolphin motorhome by gutting the inside and
making mechanical adjustments. The client is also an experienced snowboarder and goes as often as
he can afford to Mt. Hood Meadows in the winter. In the summer and fall the client enjoys taking his
dirt bike and riding on local trails with friends, taking his dog on hikes, and boating.
9. What are the clients priorities and desired outcomes?
The clients priorities and desired outcomes include maintaining safety, and potentially increasing
muscle endurance while walking his dog. The client greatly enjoys taking Maggie on walks and is
aware of the benefits of walking not only for himself but for his dog as well; having such a positive
outlook on taking walks, the client hopes to ensure his ability to continue to go on walks with
Maggie.












Occupational Analysis

1. Occupation: Walking a dog
Area(s) of occupation for the client: Subcategory:
1. Activities of daily living
2. Instrumental activities of daily living Health management and maintenance, care of pets
3. Education
4. Work
5. Play Play exploration and play participation
6. Leisure
7. Social participation

2. Values, beliefs, spirituality associated with participation:
Values: Time spent with Maggie is worthwhile and a positive commitment.
Beliefs: Walking Maggie will increase the clients health and wellness.
Spirituality: Time spent walking is often a time to think about life and whats important in
it.
3. Contexts:
Context Supports Inhibits
Physical/space demands Paved and level ground, low
traffic, nearby fields for off leash
running, low crime rate area
Limited time due to light levels,
potential rainy/cold weather
Social It is encouraged to be active
with your dog, often see other
neighbors walking by with their
animals
N/A
Cultural It shows pet owner
responsibility when taking your
dog out to get exercise.
Maggie does not always get along
with other dogs
Personal Young male, able to complete a
slow pace walk
N/A
Temporal There are many hours of
daylight within a day
Walking time is limited to time of
daylight
Virtual N/A N/A

4. Objects and their properties used:
Tools: Dog collar, dog leash, tennis shoes, jacket, umbrella, and comfortable clothing that
allows movement
Materials: Dog treats
Equipment: N/A



5. Social demands:
Client is expected to keep Maggie on a leash while walking on the road.
When walking past other people walking their dogs it is expected to give them plenty of
room and say hello.
If dog wants to play with another dog, ask the other dogs owner if it is ok before
approaching them.
When dog uses the restroom clean it up and throw it away.
If hot day, have water available for you and your dog.

6. Sequence and timing:
1. Once outside call Maggie
2.When Maggie arrives say sit
3. Once sitting, get leash out of pocket with right hand
4.Grab Maggies collar with left hand
5. Grasping collar in left hand and leash in right, latch the two together
6. Allow Maggie to stand up by saying ok
7. Firmly grasp leash in right hand (be prepared for resistance due to pulling)
8. Initiate walking toward road
9. Give slight tug on leash to Maggie knows to follow.
10. Walk at slow and steady pace
11. During walking stay alert to cars on road, other people
12. while walking keep Maggie within 5ft on leash
13. halfway through walk take leash from right hand into left
14. Once leash is in left hand grasp firmly with left fingers.
15. Walk for desired amount of time.

7. Body functions required:
Function How It Is Used None Minimally
Challenged
Greatly
Challenged
Judgment Determine
what clothing
to wear
according to
weather. Make
decisions
during walking
to keep
client/dog safe.
X
Concept formation Knowing to put
leash on dog to
go on walk
X
Metacognition Think about
ones abilities
X
to know how
quickly to walk.
Use self-talk to
adjust motor
process when
changing
speeds due to
dog.
Cognitive flexibility Being able to
grab a coat or
walk faster to
return home if
it starts raining
during the
walk.
X
Insight/awareness Awareness of
surrounding
people and
objects.
X
Sustained attention Pay attention
to task
throughout the
whole walk.
X
Selective attention Mind fellow
walkers around
while focusing
on road in
front.
X
Divided attention Paying
attention to
cars going by
while watching
road to avoid
pot-holes and
gravel areas.
X
Short-term memory Remembering
that there is a
loose dog
within a certain
area to avoid.
X
Working memory Used to
remember to
put dog on
leash when
going on a
walk.
X
Long-term memory Recall
previously
learned
information,
X
such as when
going on walks
around 6pm
there will be
the heaviest
traffic flow.
Discrimination of senses: Auditory Distinguish
between a car
coming from
behind from
nature sounds.
X
Discrimination of senses: Tactile Feeling the
difference
between grass
and concrete
while walking.
X
Discrimination of senses: Visual See other
people/animals
while walking
in order to
avoid them.
X
Discrimination of senses: Olfactory Recognizing
the smell of
dead animal to
know not to let
dog off leash
because they
will want to roll
in it.
X
Discrimination of senses: Vestibular-
proprioception
Knowing
which
direction to be
facing in
space to
follow road
and be able to
orient ones
self through
different body
positions.

X
Multisensory processing Hear, see, and
feel while
walking dog.
X
Sensory Memory Remembering
how the road
looks and what
material you
are walking on
X
to stay on road
and find way
back home.
Spatial relationships How much
space is
needed
between
walker and dog
in order to not
trip over one
another.
X
Temporal relationships Knowing when
to turn around
to walk home
due to daylight
left and to not
walk a distance
that is too long.
X
Recognition Recognize
roads and
houses to
guide walk.
X
Categorization Categorize the
start, middle,
and end of the
walk to know
how far
progressing.
X
Generalization Transfer
walking skills
learned from
first dog owned
with parents to
current dog.
X
Awareness of reality Awareness that
what one
is doing is real
life and not a
dream
X
Logical/coherent thought Thinking
logically when
walking down
road to keep
dog away from
traffic.
X
Appropriate thought content Maintaining
thought on
safety and dog
while walking.
X
Execution of learned movements Repeat learned
movements
such as pulling
back on leash
when dog pulls
too much to
get her to slow
down.
X
Coping Handling it
appropriately if
it starts to rain
while walking.
X
Behavioral regulation Knowing to use
proper dog
walking
etiquette
throughout the
whole walk.
X
Body image Comfortable
with other
walkers
watching you
walk by,
knowing what
own body looks
like for
capabilities like
stepping over
tall bush.
X
Self-concept Understanding
that owning a
dog means that
walks will be
needed as part
of role.
X
Self-esteem Confidence in
dog walking
skills.
X
Arousal Avoid walking
into trees,
bushes.
X
Consciousness State of being
awake.
X
Orientation to self Knowing who
one is and that
they own a
dog.
X
Orientation to place Being aware of
location on the
X
road.
Orientation to time Being aware of
the day and
time to ensure
it is
appropriate for
taking a walk.
X
Orientation to others Being aware of
neighbors also
walking down
the road.
X
Emotional stability Not getting too
upset if dog
doesnt behave
as wanted
during walk.
X
Motivation Encouraging
self to get out
on walk for the
benefit of dog.
X
Impulse control Controlling the
urge to turn
around and
shorten walk.
X
Appetite Natural desire
to see fall
colors on trees
during walk.
X
Sleep Client needs to
be awake
during activity.
X



Function How It Is Used None Minimally
Challenged
Greatly
Challenged
Detection/registration Detecting basic
shapes of
objects around.
X
Visual modulation Regulating
where eyes are
oriented.
X
Integration of senses Hearing objects
around you,
detecting
surface walking
on, while
locating road
to walk on.
X
Awareness at distances Looking ahead
to know what
X
to avoid, and
watching feet
to avoid
tripping.
Tolerance of ambient sounds Being ok with
birds chirping
in background.
X
Location and distance of sounds Knowing where
a car is in
relation to you
when walking.
X
Moving against gravity Standing up
and posture
while walking.
X
Taste X
Smell Smelling for
dead animals in
order to avoid.
X
Body in space Proprioceptive
control
important to
not bump into
dog by
knowing
movement of
arms and legs
during walking.
X
Comfort with touch Being tolerant
with dog
occasionally
bumping into
you.
X
Localizing pain Knowing if you
have a blister
on foot from
walking.
X
Thermal awareness Knowing if too
hot/cold in
order to
don/doff a
jacket.
X
Joint range of motion To move hips,
legs in needed
directions.
X
Joint stability/alignment Stability
needed to
reduce
possibility of
shoulder/hip
X
dislocation.
Strength Lower body
strength
needed for
walking, upper
body strength
needed for
holding onto
leash.
X
Muscle tone Appropriate
muscle tone
needed for
normal posture
and readiness
in case dog
lunges away.
X
Muscle endurance Needed to
maintain
constant
walking pace
for distance of
1-2 miles.
X
Stretch reflex N/A, but
impairments
may be present
if not found at
appropriate life
milestone
X
ATNR N/A, but
impairments
may be present
if not found at
appropriate life
milestone
X
STNR N/A, but
impairments
may be present
if not found at
appropriate life
milestone
X
Righting and supporting reflex Used when
being pulled to
one direction
by dog.
X
Eye-hand coordination Used to hold
the leash in
proper
position, clean
up dog poop.
X
Bilateral coordination Having both
legs walk in
straight line.
X
Crossing midline Using right
hand holding
leash when dog
pulls to left.
X
Fine motor control Grasping the
leash with
hand/fingers.
X
Oculomotor control Detection of
visual
information.
X
Gait patterns Using both legs
interchangeabl
y when
walking.
X
Blood pressure Participant
must be aware
of blood
pressure so
that they do
not overexert
themselves

X
Heart rate participant
must be aware
of heart rate
so that they
do not
overexert
themselves

X
Respiratory rate Breathing
normally and
adjusting
during aerobic
exercise.
X
Respiratory rhythm Maintaining
normal rhythm
while walking
at a steady
pace.
X
Respiratory depth Taking breaths
that are
appropriate
depths for
walking pace.
X
Physical endurance, aerobic capacity Client walking X
at steady pace
for 1-2 miles.
Voice functions Required to
command dog.
X
Voice rhythm and fluency Used to not
scare dog with
steady voice.
X
Alternative vocalization Whistling X
Digestive system N/A X
Metabolic system N/A X
Endocrine system N/A X
Urinary functions N/A X
Genital and reproductive function N/A X
Protective functions of the skin Blisters from
walking shoes.
X
Repair functions of the skin Heal the
blistering from
walking.
X


8. Muscular analysis of movements required:
Muscle Required?
Shoulder flexion X
Shoulder extension X
Shoulder abduction X
Shoulder adduction X
Shoulder internal rotation X
Shoulder external rotation X
Elbow flexion X
Elbow extension X
Wrist supination X
Wrist pronation X
Wrist flexion X
Wrist extension X
Thumb flexion X
Thumb abduction X
Finger flexion X
Finger extension X
Trunk flexion X
Trunk extension X
Trunk rotation X
Lower extremities X

9. Body structures required:


Required?
Check If
Category Body Structure
Yes
Nervous system Frontal lobe X
Temporal lobe X
Parietal lobe X
Occipital lobe X
Midbrain X
Diencephalon X
Basal ganglia X
Cerebellum X
Brain stem X
Cranial nerves X
Spinal cord X
Spinal nerves X
Meninges X
Sympathetic nervous system X
Parasympathetic nervous system X
Eyes, ears, and related Eyeball: Conjunctiva, cornea, iris, retina, lens, vitreous body X
structures Structures around eye: Lachrimal gland, eyelid, eyebrow,
external ocular muscles
X
Structure of external ear X
Structure of middle ear: Tympanic membrane, Eustachian
canal, ossicles
X
Structures of inner ear: Cochlea, vestibular labyrinth,
semicircular canals, internal auditory meatus
X
Voice and speech
structures
Structures of the nose: External nose, nasal septum, nasal
fossae
X
Structure of the mouth: Teeth, gums, hard palate, soft
palate, tongue, lips
X
Structure of pharynx: Nasal pharynx and oral pharynx X
Structure of larynx: Vocal folds X
Cardiovascular system Heart: Atria, ventricles X
Arteries X
Veins X
Capillaries X
Immune system Lymphatic vessels X
Lymphatic nodes X
Thymus X
Spleen
Bone marrow X
Respiratory system Trachea X
Lungs: Bronchial tree, alveoli X
Thoracic cage X
Respiratory system
(continued)
Muscles of respiration: Intercostal muscles, diaphragm
Digestive, metabolic, Salivary glands
and endocrine systems Esophagus
Stomach
Intestines: Small and large
Pancreas
Liver
Gall bladder and ducts
Endocrine glands: Pituitary, thyroid, parathyroid, adrenal
Genitourinary and Urinary system: Kidneys, ureters, bladder, urethra
reproductive systems Structure of pelvic floor
Structure of reproductive system Ovaries, uterus, breast and
nipple, vagina and external genitalia, testes, penis, prostate

Structures related to Bones of cranium
movement Bones of face
Bones of neck region
Joints of head and neck X
Bones of shoulder region X
Joints of shoulder region X
Muscles of shoulder region X
Bones of upper arm X
Ligaments and fascia of upper arm X
Bones of forearm X
Wrist joint X
Muscles of forearm X
Ligaments and fascia of forearm X
Bones of hand X
Joints of hand and fingers X
Muscles of hand X
Ligaments and fascia of hand X
Bones of pelvis region X
Joints of pelvic region X
Muscles of pelvic region X
Ligaments and fascia of pelvic region X
Bones of thigh X
Hip joint X
Muscles of thigh X
Ligaments and fascia of thigh X
Bones of lower leg X
Knee joint X
Muscles of lower leg X
Ligaments and fascia of lower leg X
Bones of ankle and foot X
Ankle, foot, and toe joints X
Muscle of ankle and foot X
Ligaments of fascia of ankle and foot
Structures related to Cervical vertebral column X
movement (continued) Lumbar vertebral column X
Sacral vertebral column X
Coccyx X
Muscles of trunk X
Ligaments and fascia of trunk X
Skin and related Areas of skin: Head, neck, shoulder, upper extremity, pelvic X
structures region, lower extremities, trunk, and back
Structure of skin glands: Sweat and sebaceous X
Structure of nails: Fingernails and toenails
Structure of hair





10. Performance skills required:

Skill Required? How the Skill Is Used

Motor/praxis

X

Recalling and completing walking motion while holding into
dog.
Sensory (perceptual)
X


Be able to see, hear and feel all that is around ones self and
adjust motions as needed.
Emotion regulation
X


Maintaining composure when dog misbehaves, persisting
through frustration when dog doesnt follow directions.
Cognitive

X

Being able to remember how to return home and use skills
to control dog.
Communication/social
X



Communicating with dog on commands, neighbors when
walking by.



11. Performance patterns:
Parts of this occupation has elements of which of the following: (check all that apply)
Pattern Describe
X Useful habit Grabbing doggie bags when walking out the door to go on a walk.

X Dominating habit Not re-tying shoes when they become undone during walk.

X Routine Walking to the end of the road 2 times during a walk.

X Ritual Letting Maggie play in the field after being good on a walk.

X Role Dog owner



Intervention Plan
1. Identify 1 objective and measurable goal of the intervention:
a. According to OTPF what type of outcome is this?
The client wishes to prevent future occupational performance problems and increase his physical
endurance while walking his dog 3-4 times a week. This could be measured by taking a baseline
measurements of distance walked within a time limit and then re-measured after the intervention
to see if a greater distance could be walked within the same timeline. According to OTPF this could
be categorized under the occupational performance, health and wellness, and prevention outcomes.

2. Intervention approach:

Approach Describe
Create/promote

Establish/restore

X Maintain Maintain current level of health.

Modify

X Prevent Prevent future occupational performance injuries while walking a dog.


3. Activity selection
a. Activity selection: Identify 1 example of each for the intervention plan

Activity Describe
Occupation-based
intervention
Going on walks with dog to build up necessary endurance to complete walk
and increase hand strength by holding leash.

Purposeful activity Practices how to put on and take off leash on dog to increase hand strength
with that movement.

Preparatory method Provides hand strengthening activities using a theraband to increase hand
strength needed to hold firmly onto the leash.





b. Discuss how activity selection relates back to occupational profile and occupational
analysis
When choosing an activity for the client to participate in, reviewing their occupational
profile and occupational analysis is crucial. Within their occupational profile and analysis
the therapist can see what the client is interested in so that they can choose an activity
that is meaningful to the client. The therapist also will gain additional insight into what
areas of occupation that the client needs the most help with in order to most efficiently
structure the activity.

c. Discuss how activity selection will support achievement of client identified goals and
goal of the intervention plan

By choosing an appropriate activity that is meaningful to the client and part of the just-
right-challenge, the client will be motivated to complete the activity and will feel
accomplished after completing it. This in turn supports the achievement of client
identified goals, as well as the goal of the intervention plan.

4. Describe how intervention can be graded or adapted and why
Intervention can be graded up or down according to what level the client is at. For example,
during the occupation of walking a dog, if the client feels it is too easy and is not getting much
out of it, it could be graded up by decreasing the time allowed to complete the walk. In contrast,
if the client feels it is too hard, it could be graded down by decreasing the distance walked.
Adaptations are made when the client is unable to perform the occupation, so parts of the
occupation are modified. For example, if being outside is too stimulating for the client, the client
could find a quite gym or large room to walk to dog in.

5. Safety concerns and/or precautions
During the occupation of walking a dog, one of the main safety concerns would be the actions of
the dog. If not well trained the dog may try to run after other animals while still attached to the
leash, which quickly places tension on the owners upper extremity. This in turn could injure the
clients upper extremity or result in the loss of balance. A precaution for this would be to
instruct the client to hold loosely onto the leash so if pulled rapidly it will simply fall out of the
clients hands and not cause them harm. To prevent an auto related accident the client should
wear brightly colored clothes. In addition, the proper footwear is needed to maintain traction
and stability.

6. Discuss the role of the occupational therapy practitioner during the intervention
The role of the occupational therapy practitioner during intervention is to give assistance to the
client when needed. This includes; setting up appropriate goals that the client can achieve and is
meaningful to the client, potentially using therapeutic use of self during the intervention,
monitoring clients response to intervention and making grading and adaption modifications
when needed, and taking the time to listen to the client and be there when needed.

7. Discuss what is expected of the client during the intervention
During the intervention the client is expected to put their top effort towards to goals that have
been outlined by the practitioner and themself. It is also their responsibility to communicate
with the practitioner their concerns and wants that they envision for themselves during therapy.
Being that client safety is one of the top concerns, the client is also expected to inform the
practitioner if they are in any pain throughout the intervention.