Running head: PROFILE AND INTERVENTION 1

Occupational Profile and Intervention

Sylvia Niemyjski
Touro University Nevada








PROFILE AND INTERVENTION 2

Occupational Profile
Client
The client is an 81 year old female who lives in Mesquite, Nevada named Joan. The
client has a husband and a son; who has an intellectual disability and utilizes a rollator. The
client said that whatever she is not able to do; her husband will help her complete. The clients
husband is to be her caregiver until she is able to become independent again, however he is 83,
and the client stated that he may not be able to do everything he needs to help her. The clients
son is completely capable of helping the client around the house, and always has a list of daily
chores. The client stated that if needed, her son will be able to help around the house with
certain tasks she may not be able to perform.
The client is seeking services because she has had total left hip replacement surgery, after
a fall in her home. The clients current concern is not being able to be at home. The client
expresses that she wants to get back to dressing on her own and wants to get back to cooking.
The areas of occupation that are successful include rest and sleep, education, play and
leisure. The areas of occupation that are currently impacted include many activities of daily
living (ADLs). Because of the clients recent surgery, she is not as mobile as she was a few
weeks ago. For example, an area of focus is functional transfers. The client has a very difficult
time getting out of bed to get to the toilet and the shower, bathing and showering are also
impacted since the client needs assistance with weight bearing and balancing. Dressing is
something the client would want to become independent in again. Because of the total hip
replacement surgery, the client has a difficult time with lower extremity dressing. All of the
ALDs mentioned could be potential risks; because of the clients weak balance and inability to
completely bear weight on the affected lower extremity, precautions need to be taken to avoid
PROFILE AND INTERVENTION 3

another fall. Currently, the instrumental activity of daily living (IADL) that is being impacted is
meal prep and clean up. The client is very passionate about taking care of her family and being
at the hospital, she cannot cook them meals.
Currently, the physical environment in the hospital is impacting the clients ability to
perform occupations. She is in a new place with a toilet and shower that she is not accustomed
to. The clients social environment is very supportive, and consists of her son and her husband
who visit her daily.
The clients occupational history consists of her being a mother and a wife, as well as a
caregiver to her family. This is the clients first visit to the hospital for a fall. The client spent
her life as a homemaker and was very involved in her sons school and sports activities as well as
her Methodist Church. She enjoys doing a variety of crafts which include: scrapbooking,
quilting and knitting. The clients son coaches softball and she frequently attends the games.
The clients desired outcomes and priorities include her being able to dress and being
able to cook full meals again. The client expects to become independent in these areas again.
Occupational Analysis
Context/Setting
The occupational therapy services took place with the client at Mesa View Regional
Hospital. All therapy services were done in the clients room and the bathroom. In therapy, the
bed, the floor space in the room, the 3 in 1 commode, and the shower were utilized.
Activity Observed
The particular activity observed was a functional transfer in and out of the shower. The
client seemed to have difficulty with this. The technique that the client was utilizing was side
stepping in and out of the shower while holding on to grab bars. The client displayed signs of
PROFILE AND INTERVENTION 4

weakness and her leg would begin to shake when she would life the other leg and had to bear all
weight on the single leg. Because this could be another potential fall risk, a new technique was
utilized. The client would now back step into the shower and front step out, utilizing her front
wheel walker. The client got into the bathroom and was facing the shower, with a 180 degrees
turn the client rotated so that the backs of her heels were against the shower. She then stepped
back with the non-affected leg, and while still holding on to the walker, then her affected leg
followed. In order to get out of the shower, the client first stepped with her affected leg, and then
the non-affected leg followed. The purpose of this was so that the affected leg always had the
support of the walker.
Key Observations
The key observations to take note of were that the client needed convincing and
persuading in order to try the activity. It was clear that the client was unsure of herself because
she was weak. It was also apparent that the client had a difficult time getting up and functionally
ambulating towards the desired destination. However, it was apparent that the client was pleased
with the alternative method of getting into the shower.
OTPF Domains
When an individual is in the hospital recovering from surgery there are many domains of
the OTPF that may be impacted. As stated above, certain ADLs and IADLs were impacted by
Joans surgery. However, with proper treatment, it is possible for the client to return to doing the
things she is passionate about.
Client Factors. Due to the clients recent surgery some Global mental functions are
impacted. A decrease in energy and drive was noted by both the client and her husband. This is
very expected though, the client is in a new place, she is on many medications, and she
PROFILE AND INTERVENTION 5

participates in both occupational therapy and physical therapy. Because of the business of her
day, it is natural that the client will have a lower energy drive and motivation. However, as the
therapist, it is important to keep the client motivated and remind her that all the work she is
doing is for her own benefit.
The neuromusculoskeletal and movement related functions are also impacted. The joint
mobility and joint stability is something that the client needs to be cautious about. Because of
the clients procedure, she cannot perform the full range of motion of her hip.
The gait patterns under the category of Movement functions are also impacted due to pain
and the limited range of motion in the hip. This, along with the neuromusculoskeletal and
movement related functions impact the clients ability to successfully perform her ALDs.
Because of the limited or impaired movement, the client has difficulties with occupations such as
dressing, functional transfers and bathing.
Performance Patterns. Due to the clients hospital stay and not being able to be at
home, the clients routines and roles are greatly impacted. The main concern of the client is that
she just wants to go home. The client wants to go home so that she can fulfil her role as a wife
and as a mother. This includes certain routines such as following her morning sequences, which
include getting up before everyone, making breakfast and running errands (AOTA, 2014)
Problem List
Based on the occupational profile and analysis, a series of problem statements have been
formulated for the client. The most important challenge for the client include her functional
transfers, the client requires minimum assistance in tub/shower transfers due to limited range of
motion in hip and decreased balance. This is at the top of the priority list because being able to
bathe is a very important ADL. This requires the most attention because the bathroom can
PROFILE AND INTERVENTION 6

quickly turn into a dangerous environment when wet. This should be the most important area to
address because this poses the largest risk factor for the client.
The second major issue the client is facing is that the client requires moderate assistance
in lower extremity dressing due to decreased balance and limited range of motion. This is
another important issue to address for the client. Before leaving the hospital, one of the top
priorities for the client is being able to get dressed. This is a skill that needs to be mastered so
that when the client does go home, she will be capable of doing this on her own.
The third issue that would need to be addressed is that the client is at a minimum
assistance level when performing grooming activities at the sink due to decreased standing
balance. This is an important area to address because the client needs to be both safe and able to
perform grooming activities when at home.
The fourth issue to address is that the client requires minimum assistance when
functionally ambulating due to pain in left hip. This issue is lower on the priority list because the
client has just had surgery and it is expected that there will be pain. Nevertheless, this is still an
important area for the occupational therapist to look at because she does need assistance.
However, with time and the use of the client front wheel walker, this issue will diminish from the
priority list.
Lastly, the fifth issue to address is that the client requires supervision and verbal cues
when sitting edge of bed due to weakness and pain. As with the functional ambulation, it is
expected that the client improve in this area.
Although all problematic areas are important to consider when engaging in therapy,
priorities are important and realistic to set so that therapy can be guided. By narrowing down
what needs the most attention, the biggest factors can be addressed.
PROFILE AND INTERVENTION 7

Intervention Plan & Outcomes
Long Term Goal 1 Approach
The two priority problems identified in the client addressed functional tub shower
transfers and lower extremity dressing. The first long term goal for the client is: The client will
perform a tub/shower transfer at modified independence in the room setting in 3 weeks. In order
to support this goal, the client will have two short term goals to focus on. The patient will bathe
at minimum assistance with the use of a shower chair by two weeks. Also, the patient will
transfer with modified independence from edge of bed to shower chair with the use of her front
wheel walker by two weeks.
Intervention 1. To address the short term goal of: The client will bathe at minimum
assistance with the use of a shower chair by two weeks. An intervention that includes her family
will be used. The therapist will first educate the client on energy conservation techniques and
strategies for bathing. In collaboration with the clients husband, the therapist will educate and
help the client with safe transfer techniques as well.
The therapist will hand out pamphlets to the client and her husband that clearly state the
importance of energy conservation. The therapist will then stand by the client as she bathes at
the edge of the bed, providing assistance as needed, all while involving the husband and guiding
him in how to help his wife.
OTPF Approach. The most appropriate therapeutic approach for the client would be
establish/restore. The client is after surgery and is now attempting to excel in her edge of bed
bathing. This is something new for the client after her surgery. In addition to the
establish/restore approach, the prevent approach is also used. This approach is indirectly utilized
on behalf of the husband. Because the husband was involved in therapy and educated himself, if
PROFILE AND INTERVENTION 8

he does choose to physically help his wife with certain tasks, he will do so in a proper manner,
and not injure himself.
Evidence. In the review if literature by Ulla-Maija and Marinela (2012) it was examined
if family-centered occupational therapy is truly applied in practice. The age group that was
examined was in a pediatric setting. The best way to promote occupational performance is to
have the involvement of the family. For a recovering client, the family serves as an important
support system. The results of the review showed that the idea of family centered treatment is
used; however, therapists do not always consider the client as part of a whole family system.
The therapists will involve the family in treatment, but goals are not always related back to the
family as a whole system. The researchers bring up an interesting point by saying that the needs
of family members need to be addressed as well when in therapy. The researchers concluded
that the client is composed of three major components: Family, environmental settings, and
contextual influences. All this points to Occupational competences, which in turn extends to
therapeutic success (Ulla-Maija & Marinela, 2012).
The study of Ulla-Maija and Marinela (2012) relates to the current intervention because
the therapist involves the husband in the session. As stated earlier, the client and her husband are
both older adults. It is not only important that the husband be a part of the session to support his
wife, but also to benefit himself. Although the client knows that her husband will be there for
her and help her if it is needed, looking at the situation realistically, her husband may not always
be able to help her. This is not because he would not want to, but physically he may not be able
to help her. By having the husband be involved in the therapy session, he is gaining knowledge
in how to help his wife if needed-but this help could come in the form of guidance once the
client returns home. By encouraging the husband to have an active role in therapy for his wife,
PROFILE AND INTERVENTION 9

the therapist is also promoting the husbands wellness by possibly avoiding a safety risk for
when the client returns home.
OTPF Outcomes. The most appropriate outcome for this intervention would be
occupational performance (improvement) and quality of life. The client would be improving her
skills to bathe at the edge of her bed. While the client is becoming more efficient in this, her
quality of life will also increase. The client will be able to perform this ADL as independently as
possible, and this will increase her life satisfaction. The most appropriate (indirect) outcome for
the husband would be prevent. Seeing that the husband follows through on all the instruction
and techniques that he was educated on, he will prevent injury to himself and his wife, if all is
properly carried out.
Intervention 2. In order to address the second short term goal of: the patient will
transfer with modified independence from edge of bed to shower chair with the use of her front
wheel walker by two weeks, functional transfers will be the focus of this intervention. The client
will first sit at the edge of the bed and use her reacher and sock aid in order to put on her non-slip
socks. This will promote sitting balance as well as practice in dressing. Then, with minimal
assistance from the therapist, the client will transfer from the edge of the bed to a shower chair
using her front wheel walker. Throughout this session the therapist will be educating the client
on safety techniques when completing this functional transfer. This would include making sure
the client has a cleared area to ambulate in order to avoid tripping. Once the client is in the
shower chair, she will then practice the ADL of bathing. Once again, the therapist will be by the
client in the event she needs assistance.
PROFILE AND INTERVENTION 10

OTPF Approach. The most appropriate approach to this intervention is improvement in
occupational performance. The client current has a limitation and by practicing functional
transfers. This outcome will reflect increased occupational performance in this particular ADL.
Evidence. The study of Hagsten, Svensson and Gardulf (2004) examined whether or not
occupational therapy is beneficial to those with hip fractures. The patients that were included in
the study were over 65 years old; the study took place in Sweden. Using random selection, 100
patients were assigned to an OT group, or to routine postoperative care. After both groups
received the necessary postoperative care, the OT group was then given individualized training
every weekday morning which lasted 45 to 60 minutes. The interventions were based on self-
care and independence at home. Each patient practiced getting up from bed, going to the
bathroom, performing morning activities and getting dressed. The Klein-Bell scale as well as the
Disability Rating Index (DRI) was used to assess the clients ADLs and IADLs. The results
concluded that OT training sped up patient recovery in the areas of: dressing, toileting and
bathing. This means that a patient can return to independent living much sooner. The
researchers suggest that follow-up visits are needed for further re-evaluation (Hagsten, et al.,
2004).
The study of Hagsten, et al., (2004) relates to the current intervention which involves the
client performing a functional transfer and bathing. The study emphasizes the importance of
individualized care in occupational therapy for a client who has just undergone hip replacement
surgery. The specific ADL of bathing was one that was impacted positively by occupational
therapy. This study is important because it emphasizes how vital occupational therapy is for a
client. The interventions in the study were similar to the current intervention proposed for the
PROFILE AND INTERVENTION 11

client. Hagsten et al., (2004) had their participants perform occupation based activities in the
areas of ALDs, just as was done in the current intervention.
OTPF Outcomes. The outcomes for the client can be seen in the category of
occupational performance under improvement. The client currently has a limitation due to her
recent hip surgery and the client is relearning how to functionally transfer and shower with the
use of a shower chair. Another outcome that is applicable to the client is quality of life. The
client will now be able to become more independent when her goal of bathing at modified
independence is reached.
Long Term Goal 2 Approach
The second long term goal is: the client will dress with modified independence in the
room setting in 3 weeks. In order to support this goal, the client will have two short term goals
to work on. These include: The patient will don and doff socks using the hip kit with
supervision in 6 minutes by 2 weeks. Also, the patient will don and doff pants with elastic band
with verbal cues using the hip kit by 2 weeks.
Intervention 3. To address the short term goal of: The patient will don and doff socks
using the hip kit with supervision in 6 minutes by 2 weeks; a colorful poster will be made to
serve as an education guide for the hip kit. Because the client is very passionate about crafts and
scrapbooking, this particular intervention will be client centered. The occupational therapist will
educate the client and visually show the client all parts of the hip kit. The client will then choose
what adaptive equipment she feels most comfortable using in the hip kit, glue a picture of the
piece of equipment on the poster, and write a short blurb about the items intended use.
In the next part of the treatment session, the client will then utilize her poster guide to
practice putting on socks as independently as possible. The therapist will provide verbal cues
PROFILE AND INTERVENTION 12

and guidance as needed. The important part is that the client chooses what equipment to use and
feels involved in the processes.
OTPF Approach. The most appropriate intervention approach for this intervention
would be Establish/Restore. Although the client is performing a task that she was able to do
on her own in the past, the way of doing it is new. If the client is using a sock-aide, then this is
new skill that is being learned by the client. The client and the therapist must work together to
establish how to become as efficient as possible in this skill.
Evidence. The study by Thomas, Pinkelman, and Gardine (2010) investigated the
reasons for noncompliance with Adaptive Equipment in Patients returning home after a total hip
replacement. The study looked at ten participants who were obtained through a convenience
sample, and interviewed them via telephone. The ages of the participants ranged from 46-84
years old at the time of surgery, with the average hospital stay being 1-7 days, and all of the
participants had received occupational therapy services. All nine participants had purchased a
reacher or grabber, eight purchased a long handled shoe horn and many purchased a raised toilet
seat or sock aide. The results showed that the top reason for noncompliance with adaptive
equipment was the lack of client involvement in decision making. Many clients stated that they
did not know what was happening, they were just told to buy equipment. In the end, 72% of the
participants were using the adaptive equipment while 28% were not (Thomas, et al., 2010).
The study by Thomas et al., (2010) shows how important the input of the client is in
decision making when adaptive equipment is concerned. The current intervention is important
because by having the client make the poster and choose what she will use at home, she feels
more involved in the process. Occupational therapy ought to be very client centered. By having
the client involved in the actual choosing of the adaptive equipment rather than just handing the
PROFILE AND INTERVENTION 13

client the hip kit and instructing her to purchase it, she will feel like a person and not just another
number in the facility. Because the client would have been involved in the process of education
and choosing of the adaptive equipment, she will be more likely to participate in the other part of
the treatment session, where she is actually utilizing the equipment.
OTPF Outcomes. The type of outcome that should come out of this intervention is
Occupational Performance, more specifically, improvement. The limitation that is present is
the clients decreased ability to complete lower extremity dressing; this would reflect increased
occupational performance by the client.
Intervention 4. The current intervention addresses the short term goal of: the patient
will don and doff pants with elastic band with verbal cues using the hip kit by 2 weeks. The
purpose of this intervention would be to become accustomed to the hip kit even more,
particularly the reacher and the dressing hook. In this intervention, the client will get to choose
what materials she wants to work with when practicing to use her reacher. The materials will
most likely come from one of the activities the client is passionate about. This may include
small gardening equipment, crafting equipment or quilting materials. For example, if the client
were to choose quilting materials, then she would first practice picking up various material from
the ground and then setting it on her lap. The client would then take the material from her lap
and place it on the ground, all while using the reacher and the dressing hook. This motion will
imitate the donning and doffing of pants, but by using quilting scraps, the client will be more
interested in the process.
After the client gets accustomed to using the reacher and the dressing hook, the quilting
scraps will be replaced with the pants that the client wears on a regular basis. The client would
then practice donning and doffing the pants using the same skill set practiced when working with
PROFILE AND INTERVENTION 14

the quilting scraps. The therapist will be with the client at all times providing guidance,
reassurance and direction when needed.
Grade up and Down. The current intervention can be graded up or down in a variety of
ways. First, to grade the intervention down, when the client is practicing using the reacher, the
type of quilt fabric can be changed. To grade the intervention down, a heavy and thicker type of
material can be used. This material will not be as flimsy, so it will be much easier to pick up
with the reacher. To grade the intervention up and provide the client with a challenge, a thinner
material can be used when the client is practicing with the reacher. If a thinner quilt material is
used, the client will require much more focus and precision in order to pick the fabric up. To
challenge the client even more, the clients pants with the elastic waistband can be switched with
another pair of pants that the client has brought. If the client uses jeans, the task will require
more focus and more balance when the client is zipping and buttoning the jeans up.
OTPF Approach. The most appropriate intervention approach to this intervention can
fall under establish/restore as well as modify. The intervention shows the establish/restore
aspect by having the client learn and practice how to use the reacher. This is establishing a skill
that has not yet been developed; prior to the clients admission to the hospital, she had not had
any practice with a reacher. This intervention also contains some of the modify approach. The
activity is being modified for the client through the use of adaptive equipment.
Evidence. The study of Hoshii et al., (2013) examined the effects of subject chosen and
therapist chosen activities while in occupational therapy. The study took place in a private
psychiatric hospital in Japan. There were a total of 59 subjects who participated in the study; all
had been diagnosed with schizophrenia. The Global Assessment of Functioning Scale was
utilized in the study. The subjects were put into two groups; one half had the therapist chosen
PROFILE AND INTERVENTION 15

activities while the other group chose their own activities. The Canadian Occupational
Performance Measure (COPM) was used in the process of extraction of the chosen activities, so
that the therapists could see the thinking behind the pickings. The therapist chosen activity
group did not use the COPM, but instead therapists chose the activities based on treatment
recommendations. The subjects took part in these activities two hours a day, once a week, for
six months. The psychiatric symptoms were measured using the Japanese version of the Positive
and Negative Syndrome Scale (PANSS). In the beginning of the study, no significant
differences were found between the two groups. However, after the six months, it was found
that suspiciousness, hostility, and preoccupation items were significantly improved in the
subject-chosen activity group. The findings of the study suggested that if subjects have a choice
in occupational therapy activities their psychiatric symptoms can be improved (Hoshii et al.,
2013).
This study supports the current intervention by showing a positive impact on clients when
they are given a choice. Although the study by Hoshii et al., (2013) was based in the mental
health field, the principle of the study can be extended to many interventions. As seen in the
study, by making an intervention very client centered, the results may be more beneficial.
Although in the current intervention, the client does not choose the whole activity, she still has a
say in a part of it that she is completing. By allowing the patient to choose, the patient will be
more interested in the activities, and possibly have more motivation to perform better than if a
therapist simply dictated what the patient was to do.
OTPF Outcomes. The outcome of Occupational Performance, specifically
improvement, is the anticipated outcome. The client has a limitation in the lower extremities
when it comes to dressing. Through the use of the reacher and dressing stick, the client will
PROFILE AND INTERVENTION 16

hopefully improve in the area of lower extremity dressing. The outcome of Quality of life is
also applicable and an expected outcome for the client. The clients quality of life will be
increased if she can independently dress, since this was one of her desires.
Precautions/Contraindications
When working with a client who has just undergone a total hip replacement, there are
important factors to take into consideration when doing therapy with a client. First, the client
should not invert her feet when lying in bed; an abductor pillow can be useful to prevent this
from occurring. Second, the client should not flex at the hips past 90 degrees. When in bed, the
client should not have her legs raised or the client should not bend down. Third, the client
should not adduct the legs. An abductor pillow may also be useful in the prevention of this.
Both the therapist and the client need to be mindful of these precautions when working together.
Frequency and Duration
In order for treatment to be most effective, the client should participate in occupational
therapy sessions that are 60 minutes a day, four times a day for two weeks.
Primary Framework
The primary framework utilized for this intervention plan was the Model of Human
Occupation. The MOHO sees clients composed of three elements, these include: volition,
habituation and performance capacity. Volition refers to motivation, or the process by which
people are motivated by what activities they do. Along with volition there is personal causation,
which refers to the thoughts and feelings about ones abilities. This could be seen with the
client, although the client presented with limitations, she knew that she could accomplish her
goals, and therefore was very determined. Values were also addressed in the intervention plans
PROFILE AND INTERVENTION 17

with the client; the client truly valued her family. Because of this, the clients independence was
also valued so that she could return to her normal lifestyle, which included taking care of her
family. Interests were addressed in the interventions as well; the client is interested in doing
crafts. For one of the interventions, the client was to make a poster that allowed her to remember
the purpose of each item in the hip kit. Another way that interests were addressed was that the
client was able to use different types of fabric when practicing using the reacher. Habituation
refers to the clients habits and roles. This was indirectly addressed in the intervention; by
having the client be independent in her ADLs, she will be able to once again fulfill her roles as
mother and wife. Performance capacity refers to how a persons mental and physical abilities
impact performance. By providing the just right challenge and the options of grading up and
down for the client, the mental and physical capacity of the client were properly met. Providing
the client with interventions that include her hobbies and interests will motivate clients to
perform even better during treatment (Forsyth, et al., 2014).
Client/Caregiver Training
In order to address proper techniques that the client will need to carry out once at home, it
is necessary to communicate with both the client and her husband. It will be important to remind
the client and the caregiver about the hip precautions (stated previously). In order to ensure
more safety, the therapist should review proper transfer techniques with the client and encourage
the use of the hip kit.
Clients Response to Intervention
The client will continually be reassessed throughout treatment in a way to monitor the
clients progress. If needed, the interventions and goals may be altered to better fit the clients
PROFILE AND INTERVENTION 18

needs. It is vital to therapy that the client makes progress and is able to go home. If the
interventions or approaches are not matching up with what the client needs, then changes need to
be made. The therapist should be aware of how the client is responding and be able to determine
if the client simply needs more motivation or if too much was expected from the client.














PROFILE AND INTERVENTION 19

References
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Hagsten, B., Svensson, O., & Gardulf, A. (2004). Early individualized postoperative
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Ipswich, MA. Accessed June 1, 2014.
Ulla-Maija, S., & Marinela, R. (2012). Family-centered occupational therapy; is it really
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