OCCUPATIONAL

THERAPY
Treatment Session Plan

Clients Name: M Supervising Therapist: Carrie L. Saks, OTR/L

Student Therapist: Samantha Adams
Date of session: 11/28/2016 Time: 4:30 PM
Clients Goals:
1. M will use an age appropriate tripod grasp to independently copy all lower case letters with
80% legibility, on 4/5 opportunities.
2. M will use age appropriate grasp to cut a circle within 1/2" of the line, on 4/5 opportunities,
with good bilateral coordination
3. M will attend to a non-preferred tabletop activity for a minimum of 10 minutes, with sensory
strategies as needed, on 4/5 opportunities without excessive fidgeting.
4. M will independently complete 5 jumping jacks with good coordination, on 4/5
opportunities.
5. M will independently complete a 3-step motor sequence without loss of balance and with
good coordination as observed by therapist, on 4/5 opportunities.
6. M's family will learn and utilize 8-10 novel strategies to utilize throughout the day to
improve regulation needed for successful participation in age appropriate daily activities.

Clients Occupations to be treated include: (check all that apply)

ADLs/Self Care: (bathing, showering, toileting & hygiene, swallowing/eating, feeding, Personal device care & managing personal belongings,
personal organization ,functional mobility, personal hygiene and grooming)
Instrumental ADLS & Graphic Communication: (Care of others, Care of pets, child rearing, Communication management, driving & community
mobility, financial management, health management & maintenance, home establishment & management, meal prep & cleanup, religious/spiritual
activities & expression, safety & emergency maintenance/awareness, & shopping & Handwriting, Keyboarding, Drawing, Coloring, Art, etc).
Rest & Sleep: (Rest, sleep preparation, sleep participation)
Work: (Employment interests & pursuits, Employment seeking & acquisition, job performance, retirement preparation and adjustment, volunteer
exploration & participation).
Play & Social Participation: (Social Awareness, Building/Maintaining Relationships, Turn-taking, imaginative play, sharing materials, exploring
new play ideas/opportunities, play exploration, social participation in community, family and with peers)
Leisure: (Leisure exploration & participation)
Client Factors & Performance Skills/Patterns addressed: (check all that apply)
Motor/Muscle/Movement Skills Sensory Skills Social Skills
Core Stability Manipulation Temperature Pressure Engages/Approaches Others
Endurance Coordination Hearing Taste Concludes/Transitions/Takes turns
Position/Aligns Motor Planning Vestibular Smell Communicates (verbal/non-verbal)
Joint Mobility Reaching/grasp Tactile Pain Looks/Turns (Makes eye-contact)
Joint Stability Reflexes Proprioceptive Visual Emotional Expression
Tone & Strength Controlled Discrimination Modulation Physical behavior (regulates movement, position,
Movement touch)
Other: Other: Other:
Processing/Cognitive/Mental functions: Visual Perceptual/Visual Motor Skills
Attends Experience of self & time Oculomotor Skills Object Perception
Memory Emotional regulation Visual Attention Eye-hand Coordination
Sequences Tasks Energy & drive Visual Discrimination Copying Shapes
Executive Functions Notices/responds to cues Visual Motor Speed Spatial Relations
Chooses/Uses materials Pacing of activities Visual Memory Form Constancy
Locates/Gathers materials Organizes Materials Depth Perception Visual Acuity
Adjusts/Accommodates Navigates Environment Visual Closure Sequential Memory
Initiates/Continues/Terminates Orientation to self, other, Figure Ground Visual Closure
Tasks/Activities time & place
Other: Other:
Materials:
Table, chair, paper, yarn, tape, buttons, glue, hole puncher, scissors, weighted ball, music player (iphone), body
awareness cards, Legos, pudding, chalkboard, chalk, paper towels.
Space Intervention Description & Approach: Type: Practice Goal(s)
Time Create/Promote Occupations/ Model: addressed:
Division of Occupational Therapys LIFE SKILLS CLINIC
540 Arapeen Drive Suite 200
Main Clinic Number 801-585-6837FAX 801-585-6813www.LifeSkillsClinic@utah.edu
 OCCUPATIONAL THERAPY
Treatment Session Plan

Establish, Activities Sensory 4,6

Restore Preparatory/ Processing,
(remediation) methods & tasks
Maintain Education/ Motor learning
Modify training
(adaptation, Group
compensation) Intervention
Prevent
Warm up (5-10 Minutes): Activity Demands: Anticipated Outcome(s):
Superman ball game: M will lie prone (OTPF table 7) (OTPF Table 9: check the box and
and extend his arms and legs while Relevance: Calming, engaging describe clients individual expected
outcome)
catching and pushing a weighted ball play
between the OTS and COTAs. M will Objects: Weighted ball Occupational Performance
move to a sitting position back to back, Space demands: Rehab gym or
and will have to use both arms to pass enough room to move around Prevention
the ball to the person behind him Social demands: listening and
without dropping the ball. He will then following directions. Health and Wellness
repeat and go back to the prone Sequencing/Timing: Wait to
position. catch the ball and push it towards Quality of Life
someone else.
Skills: paces, attends, heeds, Participation
moves, endurance, aligns,
stabilizing, positions, lifts, attends, Role Competence
continues, edures, .
Body Function/Structures: Well-Being
Proprioception, attention, mental
functions, coordination, muscle Occupational Justice
tone/endurance, visual, skin and
related structures
Activity 1 (15 minutes): Approach: Type: Practice Goal(s)
Dance party body awareness: Create/Promote Occupations/ Model: addressed:
M will pick a body awareness card Establish, Activities
Sensory 4, 5, 6
and will then do a dance move Restore Preparatory/
(remediation) methods & tasks Processing,
involving that position. The therapist Maintain Education/ Motor
will then pick a card and make up a Modify training Learning, PEO
dance move that M will have to copy. (adaptation, Group
compensation) Intervention
Prevent
Activity Demands: Anticipated Outcome(s):
(OTPF table 7) (OTPF Table 9: check the box and
Relevance: engaging, fun while describe clients individual expected
learning outcome)
Objects: music player, body Occupational Performance
awareness cards
Space demands: Rehab gym Prevention
and enough room to dance.
Social demands: following Health and Wellness
directions, listen.
Sequencing/Timing: Waiting his Quality of Life
turn and dancing to the beat.
Skills: stabilizes, positions, Participation
paces, manipulates, endures,
attends, uses, handles, continues, Role Competence
sequences, regulates.
Body Function/Structures: joint Well-Being
mobility, muscle tone/endurance,
visual, skin and related structures Occupational Justice

Division of Occupational Therapys LIFE SKILLS CLINIC

540 Arapeen Drive Suite 200
Main Clinic Number 801-585-6837FAX 801-585-6813www.LifeSkillsClinic@utah.edu
 OCCUPATIONAL THERAPY
Treatment Session Plan

Activity 2 (15 minutes): Approach: Type: Practice Goal(s)

Lace a Paper Plate Snowman: M will Create/Promote Occupations/ Model: addressed:
use a hole punch to punch out holes Establish, Activities
Motor learning, 1, 2, 3
around two paper plates, lace yarn Restore Preparatory/
(remediation) methods & tasks PEO
through the holes, glue on eyes and Maintain Education/
buttons, cut out a carrot and hat and Modify training
glue them on, and draw on a mouth. (adaptation, Group
compensation) Intervention
Prevent
Activity Demands: Anticipated Outcome(s):
(OTPF table 7) (OTPF Table 9: check the box and
Relevance: engaging, fun play describe clients individual expected
Objects: two white plates, yarn, outcome)
hole punch, tape, buttons, glue, Occupational Performance
scissors, orange paper, and
markers. Prevention
Space demands: table and
chairs Health and Wellness
Social demands: listening,
sequencing, following directions Quality of Life
Sequencing/Timing: Correctly
follow the steps of the activity. Participation
Skills: stabilizes, uses, attends,
heeds, positions, coordinates, Role Competence
moves, flows, endures, uses,
sequences, adjusts. Well-Being
Body Function/Structures:
muscle tone, attention, visual, Occupational Justice
skin and related structures.
Activity 3 (15 minutes): Approach: Type: Practice Goal(s)
Handwriitng Without Tears: letters c, Create/Promote Occupations/ Model: addressed:
o, a, g, d, q, s, v, w, e, i, and u Establish, Activities
Motor learning, 1, 3, 6
Restore Preparatory/
(remediation) methods & tasks Handwriting,
Client will first demonstrate, Maintain Education/ Sensory
practice, and review letters on Modify training Processing
chalkboard. (adaptation, Group
compensation) Intervention
Prevent
M will then make letters with
chocolate pudding. Activity Demands: Anticipated Outcome(s):
(OTPF table 7) (OTPF Table 9: check the box and
Relevance: engaging, fun play describe clients individual expected
Objects: chalkboard, chalk, outcome)
Activity facilitate handwriting skills Occupational Performance
and target skills: tripod pinch grip, napkins, chocolate pudding.
fine motor skills, attention to task Space demands: kitchen area,
table top Prevention
Social demands: listening,
following directions Health and Wellness
Sequencing/Timing: must first
do letters on chalkboard before Quality of Life
moving to pudding.
Skills: stabilizes, aligns, Participation
coordinates, moves, endures,
Division of Occupational Therapys LIFE SKILLS CLINIC
540 Arapeen Drive Suite 200
Main Clinic Number 801-585-6837FAX 801-585-6813www.LifeSkillsClinic@utah.edu
 OCCUPATIONAL THERAPY
Treatment Session Plan

attends, sequences, adjusts, Role Competence

regulates, touches,
Body Function/Structures: Well-Being
Attention, Visual, Muscle
tone/endurance, joint mobility. Occupational Justice

Cool Down (5 minutes): Approach: Type: Practice Goal(s)

Legos Create/Promote Occupations/ Model: addressed:
Establish, Activities
Restore Preparatory/ Sensory 3,6
(remediation) methods & tasks Processing,
Maintain Education/ Behavioral-
Modify training
Acquisitional
(adaptation, Group
compensation) Intervention
Prevent
Activity Demands: Anticipated Outcome(s):
(OTPF table 7) (OTPF Table 9: check the box and
Relevance: fun, engaging play, describe clients individual expected
outcome)
reward for hard work
Objects: legos Occupational Performance
Space demands: table
Social demands: joint play Prevention
Sequencing/Timing: able to
conclude when asked Health and Wellness
Skills: grips, manipulates,
coordinates Quality of Life
Body Function/Structures:
visual, muscle tone/endurance, Participation
mental functions
Role Competence

Well-Being

Occupational Justice

Home Program/Homework:
Continue to practice magic "c" letters and s, v, w, e, i, and u, and using sensory strategies.

Student Therapist Signature: Date:

Supervising Therapist Signature: Date:

Division of Occupational Therapys LIFE SKILLS CLINIC

540 Arapeen Drive Suite 200
Main Clinic Number 801-585-6837FAX 801-585-6813www.LifeSkillsClinic@utah.edu