Running head: OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile and Intervention Plan

Jessica A. Scott
Touro University Nevada

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile
The client, Emma, is a 34- year old female, who lives in a one story home with her
fianc, Mark, and her dog, Peanut. The client resides in Henderson, Nevada, where she has lived
since birth. Before the accident, she worked as a Brand Ambassador for ten years. She was self employed and contracted in multiple companies as a model. Emma was admitted to Sunrise
Hospital on February 15th, 2014 secondary to a traumatic brain injury (TBI) and other secondary
complications. The injury occurred when the client was walking her dog in the park. A driver
lost control of his vehicle and struck both her and Peanut. Her fianc reported that she was
thrown into the parking lot, approximately 50 feet from the grassy park area. A month after
Emma was admitted to Sunrise Hospital, she was discharged to Craig Hospital in Denver,
Colorado. Craig Hospital specializes in neuro-rehabilitation for clients who suffer from spinal
cord injuries (SCI) and TBIs. Emma spent two months at Craig Hospital before being discharged
to the Nevada Community Enrichment Project (NCEP) Facility. NCEP is a community day
program for those who are recovering from brain injuries. Emma has been attending NCEP since
June 9th, 2014. She receives occupational therapy services at NCEP and is estimated to continue
occupational therapy until September of 2014. Emma is seeking skilled occupational therapy
services to increase her independence in activities of daily living (ADLs), instrumental activities
of daily living (IADLs), bilateral upper extremity strength, gross and fine motor coordination,
visual and oculomotor skills, handwriting, and physical and cognitive endurance. Emmas
primary concern is having the ability to drive to and from work.
Emma feels successful in completing the majority of her basic self-care tasks
independently. Some of her barriers include; requiring assistance with her IADLs and developing
heterotopic ossification (HO) in her right elbow, limiting her active range of motion (AROM) in

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flexion and extension. Additionally, she has decreased bilateral upper extremity strength, visual
acuity, oculomotor movements, and physical and cognitive endurance. These factors all limit her
from becoming successful in her occupations. Mark has been an active support system for
Emma. He participates in therapy once a week, and attempts to make life easier for her. For
example, he has modified their home shower with grab bars to assist Emma with showering and
bathing.
When Emma is discharged from the NCEP, she plans on returning to work after taking a
driving rehabilitation test with a certified driving rehabilitation specialist (CDRS). Emma enjoys
yoga, cycling, playing cards, making puzzles, and walking Peanut at the park once a day.
Additionally, Emma is a vegetarian and enjoys cooking vegetarian dishes. She enjoys her job as
a Brand Ambassador and hopes to be promoted in the future. Emma and Mark have been
engaged for eight months and plan to marry by the end of this year. Emma is excited to progress
in her treatment sessions.
Occupational Analysis
Emma is currently receiving occupational therapy services at the Nevada Community
Enrichment project (NCEP) in Las Vegas, Nevada. At this facility, I had the opportunity to
observe the client perform an initial evaluation, as well as participating in community outing to
the West Charleston Library. During the initial evaluation, my fieldwork educator (FE) tested
Emmas communication and cognitive skills and interviewed Emma about her satisfaction in
desired occupations. My FE also tested Emmas upper extremity muscle strength as well as her
active and passive range of motion (ROM), fine and gross motor skills, and her visual processing
skills.

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For the occupations domain, Emma is independent in eating, oral care, tub and shower
transfers, fastening buttons, toilet transfers, toilet hygiene, and car transfers. Emma requires
modified independence for upper body and lower body bathing in the tub shower, and utilizes
grab bars in her shower. She also requires modified independent assistance in upper body
dressing, lower body dressing and completing laundry tasks. Emma requires minimal assistance
in grooming. Due to a difficulty brushing her hair, her fianc assists her with this task. Emma
requires minimal assistance in meal preparation. She utilizes lists when cooking; however she
states she mainly prepares smoothies. Emma requires minimal assistance when completing
household cleaning tasks. She reports that she is not vacuuming as she once did, however she
reports no difficulties completing other household chores. Emma requires minimal assistance
with money management. Although, she can complete six out of seven basic math problems
during the initial evaluation, she required minimal cueing for double digit division and setting up
those math problems correctly. Emma uses minimal assistance while completing community
tasks and shopping. Therefore, she completes those tasks with the assistance of her fianc. She
requires moderate assistance with pet care. She states that Mark completes most of the pet care
tasks, while she only helps by taking Peanuts meals out of the freezer to thaw. She requires
maximum assistance with yard maintenance. Before the accident, she and Marked worked on
landscaping, gardening, and planting together. Emma requires total assistance for driving
secondary to her physicians restrictions. She reports no seizures; however, Mark currently
drives her to her destinations.
For specific mental functions under the category of the client factors domain, Emma is
experiencing mild word finding deficits and short- term memory complications. She requires
verbal cues for error recognition during conversations. Her attention is easily distracted. Emma is

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able to make her needs known with clear speech. Emma does not have any swallowing deficits
reported or indicated. She has a regular, vegetarian diet.
Additional client factors include upper extremity strength and the ROM. Emma is within
functional limits (WFL) for her left upper extremity. For her right upper extremity, she is WFL
for all but elbow flexion and extension. For elbow flexion, Emmas passive ROM and active
ROM are at 85 degrees out of 150 degrees. This is mainly due to her HO. Her muscle strength
for elbow flexion is a grade three out of five. Emmas elbow extension is also impaired. She
ranged 125 degrees out of 150 degrees. Her muscle strength for elbow extension is also a grade
three out of five.
Emmas fine motor and gross motor skills for her bilateral upper extremity are both good.
During her initial evaluation, Emma completed the nine-hole peg test. Her results for this task
scored below the 10th percentile because she required extra time to complete the task. However,
her bilateral light touch, deep pressure, sharp and dull sensations, and proprioception were all
normal. Emma has good dynamic and static sitting balance.
During the initial evaluation, the client was tested on vision perception and processing
functions. Emma reported that she received glasses three weeks ago. Her visual acuity is 20/40
with glasses. During eye movements, her pursuits and eye movements were intact. She has
difficulty with convergence, specifically in her left eye. Emmas visual fields are intact but she
reports that her right eye feels stronger. There were no visual awareness deficits observed during
the initial evaluation. The clients visual perceptual skills were assessed by the motor-free visual
perceptual test (MVPT). Emma received a score of 34 out of 36, which indicated that she had
intact visual perceptual skills. Lastly, the client completed a letter cancellation test. She received

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100 percent accuracy on the test, which meant that she had an organized visual scanning.
Emmas eyes scanned from the top to the bottom and from the direction of left to the right.
For motor skills under the category of performance skills, Emma is ambulating without
an assistive device independently. However, she shows some balance deficits during ambulation,
which is a safety concern. Emmas right elbow was dislocated in the accident; therefore, she still
has residual limited ROM and use, making it difficult for her to swing her arm during gait.
Functional Problem List
Problem statements offer the occupational therapist with measurable information needed
to analyze the contributing factors of decreased occupational performance in clients. This
information is helpful in documenting the clients progress during occupational therapy
treatment (Gateley & Borcherding, 2012).
Problem Statement One
The client requires minimum assistance in ADLs such as grooming due to limited elbow
ROM in R UE.
Problem Statement Two
The client is unable to perform the IADL of driving and community mobility secondary
to visual processing deficits.
Problem Statement Three
The clients visual processing impairments result in a decrease of participation in IADLs
such as care of pets and home establishment and management.
Problem Statement Four
The client requires supervision during functional ambulation due to balance deficits.

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Problem Statement Five

The client requires minimum assistance during social interaction due to attention deficits
and a decrease in word finding skills.
Justification
The clients problem statements are prioritized based on her concerns stated during the
initial evaluation. By developing these functional problem statements, the occupational therapist
can create measurable long-term and short-term goals to improve the clients overall
occupational performance.
Intervention Plan & Outcomes
With the collaboration of the client and her fianc, the therapist is able to create longterm and short-term goals for the client. These goals are beneficial to measure progress of the
client throughout occupational therapy treatment. After the goals are created, the therapist is able
to formulate an intervention plan focusing on the clients occupational performance. These goals
and the intervention plans are articulated from the clients concerns, her chart review, her initial
evaluation, the interview with her fianc, and from the therapists observations.
Long-term Goal One
The client will utilize compensatory strategies during ADLs independently and with
modified independence through the use of adaptive techniques by 8/9/14.
Short-term goal one. Client will utilize compensatory strategies of bilateral upper
extremity use during table top gardening with modified independence by 7/9/14.
Intervention. The intervention approach used for this intervention is establish and
restore. By teaching Emma strategies to use both upper extremities, she will be able to establish
compensatory skills and enhance her performance of gardening. Emma has a decline in

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occupational performance due to having heterotopic ossification on the posterior side of her right
elbow. There are currently no treatments to prevent this process; however, treatments of HO
should include frequent ROM exercises within a pain free range. Currently, Emmas ROM in her
right upper extremity, specifically her elbow, is limited in flexion and extension. Teaching the
client to use compensatory strategies can help increase Emmas independence in occupations.
In this intervention, Emma will perform the activity of gardening on the table top. With
this activity, Emma will demonstrate skills of bilateral arm movement as well as compensatory
skills. Emmas right elbow may never see gains; however, it is important for her to continue to
utilize the right arm in meaningful occupations. For this intervention, the therapist will educate
the client on the use of bilateral arms in order to limit the impaired arms ROM. The therapist will
then demonstrate reaching for farther items with the unimpaired arm and bringing to the
impaired arm.
Schell, Gillen, and Scaffa (2014) indicated that occupation- centered practice is at the
core of occupational therapy practice. Encouraging the clients to perform in meaningful,
satisfying, and health-promoting occupations is important. From the beginning of treatments, the
occupational therapist must focus on what the clients needs and wants in order to create goals
and use them as interventions. Each intervention should provide opportunities for the client to reengage in occupations. Doing so, the clients skills and potential are developed and transformed
(Schell, Gillen, & Scaffa, 2014).
Outcome. The outcome achieved in this intervention is enhancement through
occupational performance. Because of the prognosis, this intervention focuses on enhancing the
clients performance with the clients current ability in her right upper extremity. By having the
client participate in an occupation that she found meaningful prior to her injury, she is able to

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develop new performance skills and performance patterns that will enhance her gardening
occupation (AOTA, 2014).
Short-term goal two. The client will complete upper extremity dressing tasks with
modified independence by 7/9/14.
Intervention. The intervention approach utilized is the modify approach. The
occupational therapist will determine alternate ways to increase the clients level of
independence, such as simplifying a task.
For this intervention, the client will practice compensatory strategies using her
unimpaired arm to don her shirt. The therapist will instruct the client to first string her impaired
arm through the shirt, followed by her unimpaired arm through the shirt. Then, the client will be
instructed to put her head through the shirt and pull the shirt down her back with her unimpaired
arm. The client will then be instructed to practice this skill with different shirts, jackets, and
sweaters. Practicing donning her shirt during treatment is necessary for skill acquisition and
retention in order to increase the clients independence in upper extremity dressing. The therapist
will verbalize the steps to don her shirt and then allow the client to practice the skill repetitively.
The therapist will also encourage the client to take breaks as needed to reduce frustration. This
intervention will be appropriate to complete in NCEP womans bathroom because it will provide
privacy and there is low contextual interference, which will help to improve her occupational
performance (AOTA, 2014).
Giuffrida, Demery, Reyes, Lebowitz, & Hanlon (2009) conducted a study analyzing the
functional skill of learning in men with traumatic brain injury. The purpose of this study was to
analyze how retention, acquisition, and transfer of skills differ among the participants with TBI
who either learned by using a randomly ordered practice schedule (i.e., high contextual

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interference) or a blocked ordered practice schedule (i.e., low contextual interference). The
results showed that the participants in the blocked practice group demonstrated higher skill
acquisition than the random performance group due to cognitive processing. Cognitive
processing is significantly impaired following TBI (Giuffrida, Demery, Reyes, Lebowitz, &
Hanlon, 2009). For this intervention, the client will benefit from completing block practice; the
client will practice donning her shirt multiple times to gain skill acquisition.
Outcome. The outcome the therapist hopes to achieve in this intervention is an
improvement of occupational performance. Gaining skills in dressing will improve Emmas
performance in this meaningful occupation. This will also increase her participation in other
occupations because she will be dressed and prepared for the day.
Long- term Goal Two
The client will increase visual processing skills during ADLs and IADLs with minimal
assistance by 8/9/14.
Short- term goal one. The client will complete at least ten minutes of visual processing
activities with Spot It cards while seated with minimal assistance by 7/9/14.
Intervention. The intervention approach utilized in this intervention is establish and
restore. Slowed processing speed is a prominent factor of those who suffer from traumatic brain
injuries. Battistone, Woltz, and Clark (2008) stated that one of the reasons these individuals have
a slower processing speed is due to fear of failure. These individuals choose to perform more
cautiously and take more time to complete tasks to reduce failure.
In the intervention, the therapist will sit the client in between two walls and velcro
different game cards on each side. The game cards consist of multiple pictures with various
shapes and sizes. Each card has a picture on it that has a match on a different card. The therapist

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will sit in front of the client and time her processing speed during the task. The therapist first
asks the client to look for a certain picture on one wall. Then find the same picture on the other
side of the wall. This will help to improve her processing speed, as well as her visual tracking.
Battistone et al. (2008) conducted a study that observed processing speed deficits due to
traumatic brain injury. The study provides performance accuracy scores at various stimulus
exposure durations and associated response deadlines. In this task, the participants were asked to
view a circular array of numbers and decide if a highlighted number in the center of the circle
had a match anywhere in the array. The results concluded that the participants who had TBIs
were significantly slower on information processing (Battistone, Woltz, and Clark, 2008).
Outcome. The outcome achieved during this intervention is an improvement of
occupational performance. This intervention will help the client increase her visual processing
skills. The occupational therapist will set a baseline and continue to track the clients progress
throughout the treatment course. The intention of this intervention is to improve and increase the
clients occupational performance (AOTA, 2014).
Grading up. To grade this activity up, the therapist can create more distance between the
cards across the wall from the top to the bottom. By spreading the cards out, the client is required
to utilize more visual scanning techniques and visual processing skills to find the pair of
matches. This will increase the skills mentioned above and help her to progress throughout
treatment.
Grading down. To grade the activity down, the therapist can use fewer cards and only
choose the bigger pictures on the cards. Having fewer cards will make it easier for the client to
scan all the cards. Choosing the bigger pictures on the cards will make it easier to determine the
pictures. Making the task easier will decrease the processing time.

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Short-term goal two. Client will demonstrate improved visual processing skills and
reaction time by 7/9/14.
Intervention. The intervention approach is establish and restore. The driving simulator
is a tool that can determine whether a client has impairments that will decrease his or her on-theroad driving performance. The driving simulator will be utilized in this intervention to determine
Emmas impairments, specifically her visual processing skills. After determination, the driving
simulator will include driving activities that will focus on those specific impairments. During the
treatment sessions, the therapist will keep a record and track Emmas progress. Keeping record
of Emmas progress will help the therapist determine the future treatments during Emmas stay
at the NCEP.
Roenker, Crissell, Ball, Wadley, & Edwards (2003) conducted a study analyzing the
speed of processing and driving simulator training, which resulted in improved driving
performance and reduced reaction time of the participants. The researchers specifically analyzed
processing speed prior to training, immediately after training, and 18 months after training. In the
procedure, the participants were tested on simple reaction time and choice reaction time
(Roenker, Crissell, Ball, Wadley, & Edwards, 2003).
The results indicated that processing speed for the driving simulator was high throughout
the study, including the 18 months post-trial. In conclusion, processing speed during the driving
simulator can enhance driving performance by reducing the processing time (Roenker, Crissell,
Ball, Wadley, & Edwards, 2003).
Outcome. The outcome achieved in this intervention is improvement in occupational
performance. Based on the findings by Roenker et al. (2003), Emma will benefit from practicing

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visual processing skills utilizing a driving simulator. This intervention will increase Emmas
long-term driving performance and success in many other occupations as well.
Precautions and Contraindications
Heterotrophic ossification (HO) is the formation of bone where bone does not normally
grow. There are no specific treatments to HO, and the clients are typically on range of motion
restrictions by their physicians. By completing range of motion on the clients elbow, the bone
may cause breakage to the skin. To minimize this effect, the occupational therapist must follow
the physicians restrictions and not force the elbow through passive range of motion.
Another precaution for this intervention is to be aware of motion sickness during the
driving simulator intervention. Some of the driving situations may cause the client to feel dizzy
and experience nausea. If the client is experiencing these feelings, it is important to stop the
activity and provide the client with food or drink items to coat the stomach. Every client may
have a different reaction on the driving simulator; therefore, it is very important for the
occupational therapist to ask how the client is feeling throughout the task.
Frequency and Duration
The client will receive occupational therapy services for three months, five times a week,
for 90 minutes a day. The clients short-term goals will be met within the next month, and the
clients long-term goals will be met within the next two months.
Primary Framework
The primary framework used to guide this intervention is the Person-Environment and
Occupational Performance Model (PEOP). For this client, utilizing the PEOP model will be
beneficial for analyzing factors that either enhance or limit her occupational performance. The
model is offered as a tool for an occupational therapist with the intention of enabling clients to

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engage successfully in meaningful occupations in their chosen environments. The model

analyzes the components that make up the individual, the environment, and the interactions that
influence the clients participation in their occupations (OBrien and Hussey, 2012). This model
is used to guide the intervention and goal setting process for Emma. The clients goals are
created with the collaboration of the client and her fianc. Having a client-centered approach and
focusing on Emmas intrinsic factors will allow her to be confident in her treatment sessions. By
modifying the clients environmental support or extrinsic factors, the client will be able to
benefit from the intervention plan. With these focuses in these elements, Emmas functional
occupational performance will improve.
Client/Caregiver Training
The interventions for the client discussed above are occupation-based and client-centered.
They focus on the clients diagnosis of TBI and secondary complications due to her TBI. The
fianc has a crucial part in the clients recovery process, and it is important to have him present
during treatment sessions. Educating both the client and her fianc will be beneficial during the
intervention process because it will allow the client to increase her environmental support. With
the increase in environmental support, Emma can increase her occupational performance. When
the client is home, the fianc will be able to assist her sufficiently because he was adequately
educated by the occupational therapist.
Response to Interventions
The clients progression and response to intervention will be monitored daily. This will
be achieved by the occupational therapist completing daily progress notes and by performing a
reassessment midway through the clients treatment plan. By reassessing the client, the therapist
will be able to analyze if the client is progressing or regressing. The client will also be reassessed

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the week before the client is set for discharge to analyze if the goals have been met. If the goals
are not met, the length of stay may be altered. The occupational therapist may also refer the
client to other additional services, such as home health.

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References
American Occupational Therapy Association. (2014). Occupational therapy practice
framework: Domain and process (3rd ed.). American Journal of Occupational Therapy,
68(Suppl.1), S1-S48. http://dx.doi.org/10.5014/ajot.2014.682006
Battistone, B., Woltz, D., & Clark, E. (2008). Processing speed deficits associated with
traumatic brain injury: processing inefficiency or cautiousness? Applied
Neuropsychology, 15, 69-78. Doi:10.1080/09084280801917863
Gateley, C.A., & Borcherding, S. (2012). Documentation Manual for Occupational Therapy (3rd
ed.). Thorofare, NJ.: Slack Incorporated.
Giuffrida, C.G., Demery, J.A., Reyes, L.R., Lebowitz, B.K., & Hanlon, R.R. (2009) Functional
skill learning in men with traumatic brain injury. American Journal of Occupational
Therapy, 63, 398-407. doi: 10.5014/ajot.63.4.398
OBrien, J.C. & Hussey, S.M. (2012). Models of practice and frames of reference. In J.C.
OBrien, S.M. & S.M. (Eds.). Intro to occupational therapy (4th ed., pp 137-138).
Missouri: Elsevier
Roenker, D.L., Crissell, G.M., Ball, K.L., Wadley, V.G., & Edwards, J.R. (2003). Speed of
processing and driving simulator training resulting in improved driving performance.
Human Factors and Ergonomic Society, 45(2), 218-255.
Schell, B.A., Gillen, G., & Scaffa, M.E. (2014). Philosophy of occupational therapy. In B. A.
Schell, G. Gillen, & M.E. Scaffa (Eds.).Willard and Spackmans occupational therapy
(12th ed., pp. 42-43). Philadelphia: Lippincott William & Wilkins.