Professional Seminar IV

FIELDWORK I ASSIGNMENT
Client Evaluation from site

Occupational Profile
Who is the client? What is his or her occupational history, life experiences, or
previous patterns of engagement that influence who they are today? (2 points)

The client is a 70 y.o. male. He grew up in Georgia and moved to Montana 20 years ago.
He spent his 20s and 30s as a mason/bricklayer before becoming involved in the cattle
and horse industry. He spent a number of years buying government wild mustangs and
breaking them. He brought them back to Georgia for sale and owned 20 horses at one
point. His daughters rode horses and were successful in competitions. He is married to a
woman who lives in Georgia while he lives in Montana. She has been sleeping in the
hospital for 2 months and will act as his caregiver for a week upon d/c to home. In
Montana, he had a cattle ranch and did this until 10 years ago when he was trampled by a
cow while trying to brand her (and sustained a TBI).

What is the reason for referral for this client? Why are they seeking services? (1
point)

MI two months before. Comorbid CHF, diabetes, CKD.

What are the client’s and/or family member’s current concerns and goals for the
intervention? (2 points)

The client just wanted to go home and sleep. He wasn't always motivated to engage in
therapy.
His wife wanted him to be safe and independent at home.

What occupations does the client currently identify as important or meaningful? (2

points)

Being at home and sleeping. Fishing.

What occupations is the client currently successful in. Why? What difficulties is
the client currently having with his/her daily occupations? (2 points)

Success: Grooming while seated.

Difficulty: Showering. Grooming in standing. Bed mobility. Toileting. Home
management.

What contexts support engagement in the desired occupations? What contexts

inhibit participation? (ie cultural, personal, physical, social, temporal and/or
virtual) (1 point)
Social: When I treated the patient for a 1.5hr session, I noticed that he opened up quite a
bit when we talked about the West and Western movies. He was more amenable to
engaging in therapy with me after that. My supervisor did not always engage with
patients very much and I believe this affected his motivation during therapy. So, certain
social contexts could promote or inhibit participation. In addition, his wife acted as a
caregiver and promoted his occupational participation.
Physical: Contexts supportive of occupational success include using a shower bench, w/c
use, walker use, and use of the reacher. Environments that required navigation and
manipulation w/ walker were difficult for him.
Personal: Personal characteristics mostly inhibited his occupational participation i.e.
negative mood, low self-efficacy.
Cultural:, He was a rancher and enjoyed living in rural areas where he could be
independent and away from crowded areas. He looked forward to getting back to
Montana (had a “Montana or Bust” sign on the back of his w/c) so I think this was his
primary motivation.

Analysis of Occupational Performance

Select one occupation from the treatment plan the client is having difficulty with to
analyze: ________________ (1 points)

Home management

From the Practice Framework, choose 3 specific performance skills and/or client
factors that are most impaired in this client’s performance of the occupation.
Describe how the impairment affects performance (3 points)

Muscle Endurance - The patient had poor activity tolerance and inability to stand or
participate in activities for long periods of time.
Energy and drive (motivation) - The patient engaged as minimally as possible in therapy
and was resistant to receiving client education in order to improve rehab outcomes and
safety.
Positions - The patient may improve his performance by positioning himself effectively
with respect to his environment and the occupation, in order to reduce safety issues.

What would it take for the client to overcome these difficulties? (1 points for
realistic assessment from the client’s perspective)

The client would benefit from increased participation in therapeutic, functional activities
and therapeutic exercise that emphasized functional movements and “whole-body”
movements. The patient would benefit from increased safety training on walker
management and transfers.

Specifically describe one way you, as an occupational therapist, would evaluate or

quantify the client’s current performance of the identified occupation. (2 points)

I would evaluate the patient’s performance physically and cognitively by having the
patient engage in a brief, multi-step activity in his room, providing cueing and assist as
required. I would ask him to pIace dirty socks in the hamper, ambulate to EOB and brush
teeth, and organize/wipe down his bedside table. would examine functional mobility,
safety awareness, use of AE, trunk control and posture, static and dynamic balance, FM,
GM, ROM, and any other trouble areas that arise.

Design and describe at least two interventions that can be used by an occupational
therapist during treatment to improve performance in this occupation. (4 points, do
not describe a treatment your supervisor did, this needs to be your own design)

1. Improve walker management, safety awareness, and functional activity tolerance

by having the patient practice a laundry task. Place laundry in dirty bins on
counter top and instruct patient to sort into light and dark piles before transporting
clothing in bag attached to walker over to laundry machine. Have client sit in
chair to practice taking breaks and place clothing in washer. Instruct patient to
take clothing out of dryer (placed in their by the therapist) to fold clothing.

2. Have patient sit and pull 5 clean dishes from dishwasher and place on counter. Have
patient reach for dirty dishes placed on the countertop and place them in the dishwasher.
Then Instruct patient to stand and put away clean dishes in cupboard before weight-
bearing through arms and using microfiber cloth and spray bottle to wipe down
countertop.

Write a Long Term Goal that is appropriate for this person that addresses the
identified occupation. Goals should be measurable, related to the
occupation, and have a stated deadline for completion. (3 points)

In 2 weeks, patient will complete laundry management activity with modI, demonstrating
reduced fall risk.

Write two Short Term Goals that lead to the above Long Term Goal. Short terms
goals should build directly toward the achievement of the long term goal. (6
points for two SMART goals)

In one week, patient will independently clean bathroom sink and organize toiletries,
demonstrating proper 2WW management for safety.

In one week, patient will make his bed with modI, demonstrating increased functional
activity tolerance.