Running head: OCCUPATIONAL PROFILE & INTERVENTION PLAN

Occupational Profile and Intervention Plan

Orah Kabaei
Touro University Nevada

OCCUPATIONAL PROFILE & INTERVENTION PLAN

Occupational Profile
The Client
Loraine is a 58 year old female who moved to Las Vegas eleven years ago, to live with
her companion in a one story home in the heart of Las Vegas. Originally from Mexico, Loraine
and her family moved down to a farm in Colorado during her adolescent years. There, Loraine
would work in the fields, something she described as hard work, but fun. Loraine has been in
school until the eleventh grade. She had dreams of getting her General Education Diploma,
however her lack of motivation did not allow her to achieve that dream. Loraine has four grown,
independent children who reside in Colorado and would visit her on a daily basis when she lived
in the area. Although Loraines children are all grown up, Loraine identifies as a stay at home
mom. At home, her main occupations consists of home management tasks such as laundering the
clothes, towels and sheets, taking care of the garden, and preparing meals. Her companion works
at a local Ninety-Nine Cent store and is the bread winner in the relationship.
Reason Seeking Services and Concerns
Loraine has been admitted to HealthSouth Rehabilitation of Las Vegas following her
discharge from Valley Hospital, where she was admitted after suffering from a stroke. Loraine
has a history of heart disease, and mentioned that she had her stroke on the same day that she
suffered from her fifth myocardial infarction. As a result of her heart attack, Loraine had to have
a stem placed in her heart. While the surgeon was completing this procedure, she suffered from
a stroke that resulted in subacute infarct in her right parietal lobe, and some cortical laminar
necrosis. Damage to her heart was indicated through a lab test that showed elevated levels of
troponin.

OCCUPATIONAL PROFILE & INTERVENTION PLAN

Loraines medical history is quite extensive and includes normocytic anemia, coronary
artery disease caused by hypertension, chronic heart failure, hyperlipidemia, anxiety and
depression. She suffers from lower extremity neuropathic pain, left sciatic pain, and Chiari
malformation, which contribute to deficits in her balance. Her cerebral vascular accident (CVA)
resulted in left side hemiparesis, making it a challenge for her to engage in the occupations that
she finds necessary and meaningful.
Loraines level of function prior to her stroke indicates that she was independent.
Loraine was able to walk with the assistance of a walker, and lived comfortably at home with her
companion, doing all the things she needed to do, was expected to do and wanted to do. Loraine
hopes that her stay at the rehab will help her gain lower extremity strength and endurance to
allow her to ambulate once again with her walker and not have to rely on others. Overall, her
balance, coordination and activity tolerance have all decreased immensely and this has been very
upsetting to Loraine.
In addition to her lower extremity limitations, Loraine has significant concerns regarding
her upper extremity function. She wishes to improve her fine and gross motor skills in her
involved extremity to allow her to complete self-care tasks, dressing, particularly donning her
brassiere, and housework tasks such as folding laundry, making meals and gardening. She
placed emphasis on being able to use her upper extremities bilaterally so as not to depend on
others. Loraine also hopes to manage pain that she has been experiencing in her involved side.
Successful Areas and Barriers to Occupational Engagement
In terms of occupational engagement, areas that Loraine has been successful in include
going to the restroom (which involves having full bowel control, transferring from the
wheelchair to the toilet, and wiping herself). Loraine does all of this using her unaffected side,

OCCUPATIONAL PROFILE & INTERVENTION PLAN

but finds it to be challenging when attempting to engage in occupations that require bilateral use
of her upper extremities, since the stroke has made her feel as if her left hand has a mind of its
own, is hard to control, and has a subluxation by the shoulder. Occupations that require
bilateral use of her upper extremities and have thus presented to be a challenge include grooming
tasks, preparing meals, folding laundry, gardening, and such. Fortunately, her companion has
been very supportive throughout the process and has taken the responsibility of driving to the
store to pick up groceries, clean around the house, and assist Loraine with self-grooming tasks.
Clients Occupational History
Other than working the fields of her family owned land back in Colorado, Loraine did not
share any other steady jobs she may have had. While her children were young, Loraines main
role consisted of taking care of her children. She briefly mentioned that she raised one of her
grandchildren, too. Based on her description of her current routine, it was evident that Loraines
main role consisted of home management and meal preparations. She greatly values her
companion and the care, support and romance they have in their relationship. Loraine shared that
prior to the pain she has been experiencing in her lower extremities, she used to be an avid
dancer. This was something she and her companion enjoyed doing together on their free time.
Unfortunately, her leg problems were not only stopping her from dancing, but taking long walks,
too.
Clients Values and Interests
Loraine greatly values her independence and stated that she would like to live life to the
fullest regardless of the weakness she is experiencing on the left side of her body. Throughout
conversation it was evident that Loraine greatly desired to be discharged from HealthSouth and
return back to her home to be with her companion.

OCCUPATIONAL PROFILE & INTERVENTION PLAN

Clients Daily Life Roles

Loraine described her daily life roles prior to her stroke to consist mainly of housework
and leisure activities. Her day would usually start off with engaging in self-care tasks such as
showering, brushing her teeth, and putting on makeup. She would then head to the kitchen and
make her companion and herself breakfast. When her companion would leave to work, she
would spend the remainder of the day putting the house together and preparing meals for lunch
and dinner. Once she has completed her chores, she would relax by watching television or
reading a novel.
Clients Priorities and Desired Targeted Outcomes
Upon inquiring on Loraines expected outcomes from the treatments she has been
receiving at HealthSouth, it was evident that she set priority on wanting to be able to walk again
and not have to rely on her wheelchair. Prior to her stroke Loraine was using a front wheel
walker to assist her in ambulating. She expressed that she would like to return to this level of
function. Loraine placed emphasis on how she would like to be independent again so as not to
have to depend on others. Her companion has been very supportive since her stroke, and will be
assisting her with many of the things that she used to do independently, however, she does not
feel comfortable with the idea of having to rely on him for self-care tasks such as grooming and
getting dressed.
Loraine conveyed that she has been at HealthSouth for approximately two weeks and is
ready to be discharged home. She mentioned that the therapist explained to her that the first 6
months after a cerebral vascular accident is the time period most crucial in preventing learned
nonuse of her involved extremity. While Loraine has noticed significant improvement in her
involved extremity during her stay at HealthSouth, she expressed that she would like to be

OCCUPATIONAL PROFILE & INTERVENTION PLAN

discharged home to continue occupational therapy services in an outpatient setting. Since she is
expected to stay at the rehab for another week, at this point in her treatment Loraine would like
to spend her occupational therapy sessions working on regaining motor movement in her
involved upper extremity.
Occupational Analysis
Context/Setting
Loraine was seen at HealthSouth Rehabilitation of Las Vegas, to be treated by Tony Nguyen,
a licensed and registered occupational therapist. HealthSouth is an inpatient rehabilitation that
provides therapeutic services to adults that may have experienced a stroke, traumatic brain
injury, total hip arthroplasty or other post-acute condition that may benefit from rehabilitation
services. The on call physician is a rehab specialist, otherwise known as a physiatrist. The
majority of the team consists of physical therapists, occupational therapists, nurses and speech
language pathologists. The facility has case managers on staff to help coordinate the care of the
patients.
Inpatient rehabilitation provides intensive, interdisciplinary rehabilitation services with the
aim to improve function and promote each patients highest degree of independence. The
majority of treatments take place in the rehabs large gym and are comprised of simulated
activities such as dumbbells, range of motions arcs, arm bikes and such. The rehab also has an
ADL room which is equipped with a kitchen, a laundry and dryer and a bathing/toileting area.
While this room provides an environment fit to engage in many activities of daily living (ADLs)
and instrumental activities of daily living (IADLs) such as meal preparation and home
management, it is rarely used. ADLs such as self-grooming, toileting and bathing typically take
place in the patients room to maintain the patients privacy.

OCCUPATIONAL PROFILE & INTERVENTION PLAN

Activity and Clients Performance

Upon entering Loraines room for her ninety minute therapy session, Loraine was in the
midst of communicating with her roommate, all the while attempting to make a phone call. Once
Loraine was done with her call, she explained that her roommate had asked her to call her
husband to come in for a visit. Based on this observation, it was apparent that Loraine is
cognitively intact and is able to communicate appropriately. Loraine then went ahead and
transferred independently from a supine position to edge of bed (EOB) using her right hand to
push herself up the bed in a sitting position. While Loraine was transferring, her left arm, the
involved side, was in a flexor synergy position. Sitting edge of bed, Loraine attempted to put her
socks on using her functional side and right arm (dominant hand). Loraine struggled with
grasping onto her socks to pull them up, so Tony bent down to help Loraine pull them up. Once
Loraine had her socks on, she transferred from edge of bed to her wheelchair with contact guard
assist (CGA) and allowed Tony to transport her to the rehab gym.
At the rehab gym, Loraine was seated in her wheelchair, positioned in front of a table
with a stack of cones placed by her unaffected side. The therapist instructed Loraine to use her
affected arm to cross midline to reach and grab for a cone, and place it on the opposite side. The
therapist explained that this activity is beneficial in promoting extension of Loraines involved
side since the flexor muscles have predominated. Additionally, this activity help strengthen gross
motor skills and through repetitions, teaches her to control her movements. Loraines next
activity was presented with Thera-putty and plastic knives. The therapist instructed her to use
her dominant hand to mush on the putty, while bearing weight on her involved hand. Loraine
occasionally transferred the putty to her involved hand and struggled to mush on the putty. After

OCCUPATIONAL PROFILE & INTERVENTION PLAN

doing this for a few minutes, Loraine took a brief break and was then asked to complete three
sets of tens on an arm bike. Her therapy session was cut an hour short since Loraine was
scheduled to join a stroke group where further education and coping skills were to be provided
for patients who suffered from a cerebral vascular accident.
Key Observations
Key observations from the discussed activities indicate that motor movement is impaired.
Loraine is able to move her left arm in a synergistic manner, but does not have smooth,
coordinated movements. When she attempts to use her left arm as an assist for functional tasks,
her arm is dominated by flexor tone and it is difficult for her to extend her hand to grasp objects.
She does not sit or stand with a symmetric posture, and tends to lean on the left side. Her left
scapula is downwardly rotated and she has a slight lateral flexion of her trunk on the left side
with a weight shift to the right in sitting. Loraine is right hand dominant and can complete ADL
and IADL tasks with her right hand, but struggles to complete tasks, such as dressing, that
require the use of both hands.
Domains Impacting Performance
Cerebral Vascular Accidents (CVA), otherwise known as a stroke, is a complex
dysfunction caused by a lesion in the brain because of a disruption in blood supply to the brain
from blockage or bleeding in the brain (Wolf & Birkenmeier, 2011). Stroke results in upper
motor neuron dysfunction that produces hemiplegia, or paralysis of one side of the body,
including the limbs and trunk and sometimes the face and oral structures that are contralateral to
the hemisphere of the lesion (Gillen, 2013, p. 846). Thus, a lesion in the right hemisphere, such
as the case with Loraine, will result in hemiparesis of the left side of the body. Accompanying
motor paresis or paralysis, it is of the norm to experience a variety of other dysfunctions such as

OCCUPATIONAL PROFILE & INTERVENTION PLAN

sensory disturbances, cognitive and perceptual dysfunctions, visual disturbances, personality and
intellectual changes and a complex range of speech and associated language disorders (Gillen,
2013).
Fortunately, Loraine has not been experiencing any cognitive, perceptual or visual
dysfunctions. Her speech and language comprehension has remained intact. Her primary
concerns revolve around motor and sensory disturbances of the (left) involved side.
Occupation is described as the daily activities in which people engage in and are
influenced by the interplay among client factors, performance skills, and performance patterns.
Domains of the Occupational Therapy Practice Framework (OTPF) that are most significantly
impacting Loraines ability to successfully engage in occupations are mostly involving body
structures of the involved side, which in turn impact motor skills (American Occupational
Therapy Association [AOTA], 2013). Body functions which are inhibiting Loraines successful
return to full function include her limitations in strength and active range of motion (AROM) of
her left upper extremity (LUE), her impaired balance and coordination and her generally
decreased activity tolerance. Loraines ability to extend her arm smoothly is predominated by
the flexor synergy tone in her involved side. Griping, manipulating and coordinating objects with
her affected hand also present to be a challenge. Loraine easily fatigues when engaging her weak
side in activities.
Although some of the movements lost due to Loraines cerebral vascular accident have
been partially remediated in the two weeks she has been at HealthSouth, her strength and AROM
still limit her functional performance greatly. Loraine greatly values her independence and hopes
to return to her prior level of function. While she admires her companions care and readiness to
help her engage in self-care occupations such as dressing and grooming, these are areas that she

OCCUPATIONAL PROFILE & INTERVENTION PLAN

10

hopes she can once again be independent in. Loraine is extremely motivated and cooperative in
therapy sessions, increasing her potential for recovery.
Problem List
The following problem statements, goals and interventions are based on information
obtained from Loraines occupational profile, observations made through an analysis of
occupations, and her most recent functional independence measures (FIM). Since Loraine was
not evaluated using manual muscle testing protocol, outcome measures for desired goals will be
monitored in accordance to her ability to be functional through a re-evaluation of the FIM
assessment.
Problem Statement
1.

Patient is unable to participate in many preferred ADL, IADL, and leisure tasks

secondary to decreased LUE strength and AROM.

2. Patient requires MOD A. for UE dressing secondary to her inability to use bilateral upper
extremity.
3. Patient requires MAX A. for LE dressing secondary to decreased balance.
4. Patient requires CGA when transferring from EOB to W/C due to decreased dynamic
standing balance.
5. Patient is unable to participate independently and safely in many preferred ADL, IADL
and leisure tasks due to her limited balance and LLE coordination.
Although Loraine placed emphasis on her priority to be at her prior level of modified
independence in ambulation, at this stage in Loraines treatment, it would not be appropriate for
the occupational therapist to address this concern. Loraine is currently receiving physical therapy
treatments to address ambulation goals. She has only recently began standing for very brief
periods of time, indicating that she is not yet at a level to engage in dynamic standing balance.
Thus, it would be fitting to work on upper extremity strength and AROM which will in turn be

OCCUPATIONAL PROFILE & INTERVENTION PLAN

11

working on sitting dynamic balance, before addressing standing dynamic balance. This lies on
the premise that sitting dynamic balance is always addressed before dynamic standing balance.
Upper extremity dressing is to be addressed separately from other ADLS. This is justified
based on an article that states on average, occupational therapist spend nearly a third of their
time providing UE control activities, yet this training was not associated with success in UE
dressing (Richard, Lathman, Jette, Rosenberg, Smouth, & DeJong, 2005, p.S57). While having
Loraine engage in repetitive task training will promote neuroplasticity of the affected limb, upper
extremity and lower extremity dressing will be addressed separately based on the client factors
that are impeding success in this activity of daily living. Upper extremity dressing will take
precedence over lower extremity dressing because Loraine specifically expressed that she would
like to don her brassiere without assistance. By addressing concerns of dressing, Loraine will
gain a sense of autonomy, all the while eliminate factors that may potentially contribute to
caregiver burden.
Intervention Plan & Outcomes
Before addressing any of the goals listed below, it would be appropriate to address
Loraines inability to maintain alignment in postures required for the occupations she chooses to
engage in. It has been observed that Loraine tends to compensate because of changes in muscle
strength, muscle tone and muscle activation, and changes in sensory processing of her affected
side. That being said, it would be of significance for the therapist to prepare the patient for
functional skill by ensuring that the patient is sitting in an upright and symmetric posture prior to
engaging in ADL tasks. This can be done using the Neurodevelopmental Treatment (NDT)
approach which is aimed at restoration of function through identifying and correcting
underlying impairments that interfere with movement and participation in everyday activities
(Schultz-Krohn, Pope-Davis, Jourdan & Mclaugh-Gray, 2013, p. 823). The therapist will

OCCUPATIONAL PROFILE & INTERVENTION PLAN

12

discourage compensation, and place emphasis on regaining normal movement and postural
control. Not only will an improved sitting posture allow for greater freedom of movement, but it
will prevent and minimize abnormal patterns of movements from the beginning. (Schultz-Krohn,
Pope-Davis, Jourdan & Mclaugh-Gray, 2013). That being said, it will be beneficial to incorporate
the NDT approach as a preparatory activity prior to engaging Loraine in occupation- based
interventions.
Long-Term Goals, Short-Term Goals and Interventions
Long-Term Goal One Patient will complete seated ADLs, IADLs, and leisure activities
independently, using her LUE, with rest breaks within 2 weeks.
Short Term Goal One In order to increase strength and AROM of LUE, patient will
engage LUE in brushing teeth > 2 min. with rest breaks, within one week.
Intervention. Task specific training involves the active, repetitive practice of functional
activities in an effort to learn or relearn a motor skill. Practicing a skill can result in improved
performance of that skill (Hubbard, Parsons, Neilson, & Cary, 2009). The neuroscience and
rehabilitation literatures are converging to strongly support the idea that extended task-specific
training is critical for producing lasting changes in motor systems networks, motor learning and
motor function (Lang & Birkenmeier, 2014, p. 2). During this intervention the client will be
instructed to open the toothpaste with her affected hand. She will then grasp the toothbrush with
the affected hand, while she squeezes toothpaste onto the bristles of the toothbrush with her nonaffected hand. She will place the toothbrush on her teeth and brush her teeth back and forth, side
to side, up and down, four times.

OCCUPATIONAL PROFILE & INTERVENTION PLAN

13

Approach. This intervention approach lies in the premise of establish and restore
(remediation, restoration). Loraine will be instructed in repetitions to promote neuroplasticity,
and restore motor skills that have been impaired.
Outcome. Improvement of occupational performance is identified as the mechanism of
outcome measurement with this intervention. Having Loraine repeatedly engage in a functional
task that is of importance to her will restore Loraines left upper extremity movement, and
subsequently allow her bilateral active engagement. Participation in her desired occupations such
as grooming will lead to personal satisfaction and a sense of autonomy.
Short-Term Goal Two In order to increase strength and AROM of LUE, patient will
engage LUE in watering plants > 3 minutes with rest breaks and SBA, within one week.
Intervention with grading options. This occupation as a means intervention is aimed at
repeated training of challenging movements while engaging the patient in a task that she finds
meaningful. Repetitive task practice is an overarching term used to describe training approaches
that include performance of goal-directed, individualized tasks with frequent repetitions of task
related or task specific movements (French et al., 2008). In their evidence-based article, Nilsen
et. al (2015) report on the effectiveness of various types of repetitive task practice (ie. Taskspecific training, repetitive motor training etc.) in improving aspects of occupational
performance after stroke, thus supporting the use of task specific training in post stroke
rehabilitation.
During this intervention, Loraine will be taken into the rehabilitations garden to water
plants with the intention of practicing motor control while seated in her wheelchair. Loraine will
grasp the water can with her affected upper extremity and pour water onto the plants while seated

OCCUPATIONAL PROFILE & INTERVENTION PLAN

14

in her wheelchair. In addition to addressing upper extremity active range of motion, strength, and
dynamic sitting balance, this intervention will promote neuroplasticity and cortical
reorganization through engagement of repetitive practice. Related tasks that may benefit from
motor strength and control through repetitions of this task include pouring juice from a pitcher
and pouring cereal into a bowl (Lang & Birkenmeier, 2014).
In the case where Loraine finds that this task does not challenge her, difficulty of the task
will be increased by giving her a water can that is filled to the top with water, and is more heavy.
Additionally, she will be instructed in watering plants that are hanging in baskets, requiring her
to use more proximal strength and motor control. On the contrary, if Loraine finds this task to be
too challenging, the activity can be graded down by simulating pouring with an empty water can.
This would require less proximal strength, grip strength and motor control, and overall difficulty
of the task.
Approach. This intervention approach is designed to change variables in the patients
client factors and motor skills, thus taking the approach of establish, restore (remediation,
restoration).
Outcome. Remediation through repetitive task movements will serve to meet the outcome
criteria of improvement in occupational performance, which will in turn allow for participation
in desired occupations.
Long Term Goal Two Patient complete upper extremity dressing with modified
independence using adaptive dressing techniques, within two weeks.

OCCUPATIONAL PROFILE & INTERVENTION PLAN

15

Short Term Goal One Patient will don brassiere without physical assistance, 90% of the
time, within 5 tx sessions.
Intervention. In their article, Richard et. al (2005) state that BADL training in stroke
rehabilitation consists largely of teaching compensatory techniques for completing activities such
as 1-handed dressing techniques and prescribing adapted equipment to make 1-handed dressing
activities easier (p. S57). During this intervention, the therapist will educate Loraine on
different dressing techniques she can incorporate when donning her brassiere. The therapist will
verbally guide Loraine on the procedure to donning her bra successfully, as well as provide
Loraine with recommendations on adapted bras that may allow her to don her brassiere
independently. Loraine will be given a couple options and will select the technique(s) that she
finds to be most successful in. The first method is as follows: Loraine will be instructed to place
her affected arm in her brassiere, and don the other side with her non-affected arm as she usually
does. Back closure can be managed by aligning the brassiere around the waist so that the cups
are faced backwards (Ryan & Sullivan, 2011). The strap can be held in place by hugging it with
the affected arm. The hook should be fastened in the front, and the bra should be swiveled
around so that the cups are in the front (Ryan & Sullivan, 2011). The straps should be pulled over
the affected shoulder first, and pulled over the non-affected shoulder using the thumb of the
unaffected hand.
Another method is to fasten the bra first and then put the bra on by donning it over the
head (Ryan & Sullivan, 2011). Since Loraines fine motor control has been compromised, larger
hooks can be substituted for smaller hooks or a Velcro strap and D ring may be sewn in as
substitutions for the fastener. A bra extender will also be recommended to increase the girth
accommodation, which may potentially ease the donning process (Ryan & Sullivan, 2011).

OCCUPATIONAL PROFILE & INTERVENTION PLAN

16

Approach. Patient education and instruction on adaptive dressing techniques is classified

under the intervention approach of modification (compensation, adaptation).
Outcome. The outcome hoped to be achieved through this intervention is improvement in
occupational performance of upper extremity dressing, specifically donning a brassiere. After
selecting and practicing the dressing technique that Loraine feels most successful and
comfortable in incorporating in her daily routine of dressing, it is expected that Loraine will
achieve modified independence in this area of occupation.
Short Term Goal Two Within 3 tx sessions, patient will don pullover shirt without
physical assistance 90% of the time in order to be independent in UE dressing.
Intervention. During this intervention, Loraine will be trained on donning a pullover shirt
using adaptive dressing techniques. The therapist will verbally guide Loraine throughout this
intervention, and physical guidance will be provided if additional cueing is necessary. Loraine
will be instructed on using shirt tags or labels to identify the front and back side of the garment.
She will pull the correct sleeve onto the affected arm, and pull the garment onto the affected
shoulder (Ryan & Sullivan, 2011). She will be guided to bend her head forward through the neck
opening, and place the unaffected arm into the other sleeve. The sleeve can be straightened out
by rubbing the arm against the leg, and the garment should be pulled over the torso (Ryan &
Sullivan, 2011). Loraine will be provided with opportunities to practice this technique to
promote autonomy in donning pullover shirts.
Approach. Once again, modification is the approach utilized in guiding the intervention.

OCCUPATIONAL PROFILE & INTERVENTION PLAN

17

Outcome. Education and instruction on adaptive dressing techniques will not only lead to
improvement of occupational performance, but grant Loraine a sense of autonomy in upper
extremity dressing (regardless of her hemiperetic arm) which will in turn lead to an overall
quality of life
Precautions and Contraindications
Precautions and contraindications following stroke vary for each individual. Due to
Loraines limited left lower extremity coordination and function, as well as her limited left upper
extremity protective extension, Loraine is at risk for falling. Loraines left upper extremity
shoulder subluxation should also be considered during intervention planning, but this should not
limit her involvement significantly. Care should be taken not to pull on Loraines affected
extremity, or let in hang around, unsupported.
Loraines past medical history of related conditions of heart disease such as coronary
artery disease, chronic heart failure and her most recent myocardial infarction needs to be taken
into consideration in intervention planning as well. Since Loraine recently suffered from a heart
attack that left parts of her myocardium damaged, it is of importance for the therapist to guide
Loraine in recognizing signs of fatigue while engaging in activities, and determine rest breaks as
needed (Mathews, 2013).
Frequency and Duration of Treatment
Based on HealthSouth standards, Loraine has been seeking occupational therapy services
ninety minutes a day, five to six times a week. She is scheduled to be discharged in a week, and
will continue to receive treatments until her discharge date. Further treatment in an outpatient

OCCUPATIONAL PROFILE & INTERVENTION PLAN

18

setting is indicated to ensure continued use of her affected upper extremity in conjunction to
physical therapy treatments to address ambulation goals.
Theoretical Framework
The task oriented approach and rehabilitation frame of reference are the two frameworks
used to guide intervention planning. When a client suffers from impaired motor function and
motor control due to neurological damage, such as the case with Loraine, the task oriented
approach is often suggested as a preferred neuro rehabilitative intervention to improve
occupational performance (Kovic & Schultz-Krohn, 2013). The task oriented approach is based
on a systematic model of motor control and theories of motor learning. The main goal of this
approach is to find optimal movement patterns for task performance, using the actual activities
and tools for therapy that one would use in daily life (Kovic & Schultz-Krohn, 2013). This is
mainly because functional tasks (such as brushing teeth and watering plants) helps to organize
motor behavior. Application of this model will address performance skill deficits while
simultaneously incorporating neuroplasticity to direct cortical changes that facilitate
neuromuscular recovery (Kovic & Schultz-Krohn, 2013).
The rehabilitation frame of reference takes a top down approach, and focuses on training
with the use of equipment or techniques (compensatory strategies) to facilitate independence
rather than remediation or correction of the underlying deficit (Rybski, 2011). Remediation often
takes time, and since Loraine would like to be able to dress herself on her own, it is appropriate
to educate her on adaptive dressing techniques to give her a sense of autonomy in this area of
occupation. Through the application of these two frameworks, it is expected that there will be an
improvement in Loraines overall occupational performance.

OCCUPATIONAL PROFILE & INTERVENTION PLAN

19

Client/Caregiver Education
Loraine will be educated on her diagnosis, prognosis and plan of care. Since Loraine
recently suffered a myocardial infarction, it is vital for her to be knowledgeable of precautions
and contraindications while receiving skilled services to ensure that she does not overly exert
herself. Loraine will be taught proper handling of her affected shoulder, proper bed positioning,
and transfers. Lastly, Loraine will be provided with a written home exercise program to
encourage use of her affected limb once she is discharged home.
Family education is extremely important throughout the treatment process. The
psychologic consequences of stroke are substantial, and the incidence of depression in this
population is 35% (Gillen, 2013). Since Loraine has a history of depression and anxiety, it is
likely that the onset of her disability will exacerbate these psychosocial factors. It would be
beneficial to educate Loraines companion, whom she has a wonderful relationship with, about
the disability and its complications to allow her companion to assist her in adjusting to disability.
Monitoring of Response
Throughout intervention, Loraine will be re-evaluated by skilled observation, self-reports and
a final administration of the functional independence measure (FIM). Observations will provide
the therapist with information on Loraines ability to comply with intervention plans such as
utilization of modified dressing techniques demonstrated during treatment session, and repetitive
task training. Loraine will be encouraged to voice when she is experiencing fatigue and needs a
rest break, to ensure that she does not overly exert herself. Lastly, the therapist will re-evaluate
Loraines functional status through a formal administration of the FIM.

OCCUPATIONAL PROFILE & INTERVENTION PLAN

20

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
Gillen, G. (2013). Cerebrovascular accident/stroke. In H. M. Pendleton, & W. Schultz-Krohn
(Eds.), Pedrettis occupational therapy: Practice skills for physical dysfunction (7th ed.,
pp. 844-880). St. Louis: Mosby, Inc.
Hubbard, I. J., Parsons, M. W., Neilson, C., & Carey, L. M. (2009). Taskspecific training:
Evidence for and translation to clinical practice. Occupational Therapy
International, 16(34), 175-189. doi:10.1002/oti.275
Kovic, M., & Schultz-Krohn, W. (2013). Performance skills: Definition and evaluation in the
context of the occupational therapy framework. In H. M. Pendleton, & W. Schult-Krohn
(Eds.), Pedrettis occupational therapy practice skills for dysfunction (7th ed., pp. 450460). St. Louis, MO: Elsevier.
Lang, C. E., & R. L. Birkenmeier. Upper-extremity task-specific training after stroke or
disability. Bethesda, MD: AOTA, 2014. Print.
Mathews, M. M. (2013). Cardiac and pulmonary disease. In H. M. Pendleton, & W. SchultKrohn (Eds.), Pedrettis occupational therapy practice skills for dysfunction (7th ed., pp.
1194-1214). St. Louis, MO: Elsevier.
Nilsen, D. M., Gillen, G., Geller, D., Hreha, K., Osei, E., & Saleem, G. T. (2015). Effectiveness
of interventions to improve occupational performance of people with motor impairments
after stroke: An evidence-based review. American Journal of Occupational
Therapy, 69(1), doi:6901180030p1.
Richards, L. G., Latham, N. K., Jette, D. U., Rosenberg, L., Smout, R. J., & DeJong, G. (2005).
Characterizing occupational therapy practice in stroke rehabilitation. Archives of Physical
Medicine and Rehabilitation, 86(12), 51-60.

OCCUPATIONAL PROFILE & INTERVENTION PLAN

21

Ryan A. R., & Sullivan J. W. (2011). Activities of daily living adaptations: Managing the
environment with one-handed techniques. In G. Gillen (Eds.), Stroke rehabilitation. A
function-based approach (3rd ed., pp. 718-728). St. Louis, MS: Elsevier Mosby.
Rybski, M. (2011). Kinesiology for occupational performance. Thorofare, NJ: Slack
Schultz-Krohn, W., Pope-Davis, S.A., Jourdan, J.M., & McLaughlin-Gray, J. (2013). Traditional
sensorimotor approaches to intervention. In H.M. Pendleton & W. Schultz-Krohn (Eds.),
Pedrettis occupational therapy. Practice skills for physical dysfunction (7th ed., pp.
796-830). St. Louis, MO: Elsevier Mosby.
Wolf, T. J. & Birkenmeier R. (2011). Intervention to increase performance and participation
following stroke. In C.H, Christiansen & K. M. Matuska (Eds.), Intervention strategies
to enable participation. Ways of living (4th ed., pp. 281-298). Bethesda, MD. AOTA
Press.