Running head: OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile and Intervention Plan

Hayley J. Meredith
Touro University Nevada

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile
The patient, Mr. Miyagi, was seen at a HealthSouth Desert Canyon Rehabilitation
Hospital on August 14th, 2014 for a 90 minute occupational therapy treatment session. He was
recommended by the fieldwork educator because of his positive attitude toward therapy and
willingness to participate in treatment activities. He was a wonderful candidate, and agreed to
partake in the interview and observation.
Who is the Client?
Mr. Miyagi is a 93 year old male who lives with his wife in a two-story home in Las
Vegas, Nevada. He worked as a buyer for Xerox for many years and still has an interest in the
business world. He has no children or grandchildren. He does not have any religious affiliation,
and does he consider himself spiritual. Mr. Miyagi has a past medical history of glaucoma in his
right eye, blindness in his left eye, and he is hard of hearing. The patient wears bilateral hearing
aids and uses a wheelchair or forward-wheeled walker for mobility in his home and in the
community.
Why is he Seeking Services?
Mr. Miyagi was modified independent in all of his activities of daily living (ADLs) and
instrumental activities of daily living (IADLs) prior to his stay at HealthSouth. Two weeks prior,
he was taken to the emergency room after experiencing chest pains. Tests and imaging showed
no sign of a heart condition or other pathologies. However, he was found to be slightly
dehydrated. Mr. Miyagi was kept in the hospital for a few days and became deconditioned due to
being bed-bound. He was then admitted to HealthSouth Desert Canyon where he has stayed for
the past week. His age, frailty, and energy level have inhibited his ability to complete his ADLs
and IADLs. Mr. Miyagi stated that he is motivated to get stronger and go home to his wife. The

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

patient also mentioned that he is apprehensive about his ability to access the upper level of his
home because the 17 steps are a struggle for him. He also stated that he would like to be
independent as possible so that his wife will not have to worry about him. Mr. Miyagi is seeking
occupational therapy services to work on the aforementioned activities and rehabilitate him to an
increased level of functioning.
Occupations
Mr. Miyagi has a lovely personality and is a self-proclaimed analyzer, negotiator, and
deal-maker which can be attributed to his vocation as a buyer for Xerox. He explained that in his
job he researched, evaluated, and bought products for Xerox to either resell to customers or use
in their everyday operations. Staying sharp, he said, is very important to him regardless of age,
and being the bread winner has given him strong sense of pride. The occupations specific to Mr.
Miyagi are ADLs, IADLs, leisure, and social participation.
ADLs and IADLs are important for Mr. Miyagi to complete independently so that his
wife will not have to assist him. After observation, it is apparent he has the most difficultly with
dressing, functional transfers, toileting, and grooming. He is responsible to complete specific
IADLs at home such as financial management and home establishment and maintenance. He is
currently concerned about maintaining his financial management responsibilities. His two-story
home inhibits his mobility and he is looking forward to getting stronger and exploring ways to
accommodate his functional needs.
Mr. Miyagi has few problems with his ability to participate in leisure activities. For the
most part, his desired activities are sedentary and he is able to perform them within his home. He
enjoys reading, watching television, and spending time with his wife.

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Social participation with his wife is very important because he wants to maintain his
familial roles as a husband. He stated concern that he has become more of a burden to his wife,
and he is uncomfortable having her assist with private matters like transferring in and out of the
shower and getting dressed.
Contexts and Environments
All aspects of occupational therapy transact together rather than being organized as a
hierarchy. Context and environment represent anywhere the patient performs their occupations.
The Occupational Therapy Practice Framework - Third Edition (American Occupational Therapy
Association [AOTA], 2014) refers to context as a variety of interconnected conditions that are
within and surrounding the patient. Contexts may be cultural, personal, temporal, and virtual.
Environment refers to the external physical and social conditions that surround the patient and
where the patients daily life occupations transpire (AOTA, 2014).
Mr. Miyagi can be categorized into cultural, personal, and temporal contexts. His cultural
context would be common activity patterns followed by seniors and those retired living in
Southern Nevada. His personal context includes individual features such as being a 93 year old
man retired from working from the business world. His temporal context would be a man retired
from work for over 30 years. Mr. Miyagis contexts do not necessarily inhibit his engagement in
occupations, however being in a later stage in life has created a shift in his occupations and what
he is physically capable of doing. The physical and social environments are where Mr. Miyagis
occupations occur. Physical environment is represented by the patients two-story home. His
social environment includes his wife with whom he interacts. Mr. Miyagis physical and social
environments inhibit his engagement in occupations because his two-story home provides
barriers to optimal mobility and access, and his social environment is small and limits his social

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

interaction to primarily one person. However, I do not believe Mr. Miyagi views this as a
limitation because he enjoys spending time with his wife.
Priorities and Desired Outcomes
Mr. Miyagi expressed to the occupational therapist at HealthSouth that his priorities were
to be as independent as possible in his ADLs so that his wife does will not need to worry about
him. Mr. Miyagis first priority is to get stronger so that he can move around his home freely. His
weakness has also caused secondary extremity weakness which has negatively affected his
functional transfer ability. He would also like to successfully dress himself without help from his
wife. Therefore, the patients desired outcomes consist of independent self-care, safe transfer
ability, and uninhibited mobility.
Occupational Analysis
The patient was observed during a 90 minute occupational therapy session. The treatment
consisted of several components including self-care and ADL training directed by an
occupational therapist which occurred in the patients room.
Context/Setting of Occupational Therapy Services
Mr. Miyagi was seen at HealthSouth Desert Canyon an inpatient rehabilitation hospital.
The interdisciplinary rehabilitation team at this facility included private practice physicians,
nurses, occupational therapy, physical therapy, and speech and language pathology. The facility
has a large therapy gym with state-of-the-art progressive resistive and aerobic exercise
equipment. There is an occupation-based section of the gym that was built with a full kitchen.
The therapist has the option to treat the patient in their bedroom or in the therapy gym.
Activity & Performance

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

The patient completed a shower, toileting, grooming, and dressing during his 90 minute
occupational therapy treatment session. Mr. Miyagi stated he had no pain prior to beginning
treatment. Mr. Miyagi completed all functional transfers with minimal assist because of
deconditioning and balance concerns. The patient was able to complete toileting with minimal
assist because he required help to doff and don his pants and brief. The patient showered with
minimal assist and completed all grooming tasks with setup and moderate verbal cueing. Based
on the patients desired outcomes the occupational therapist introduced adaptive equipment and
dressing techniques early in the treatment plan. Mr. Miyagi was educated on how to utilize
adaptive equipment including a reacher, long-handled shoehorn, dressing stick, long-handled
shower brush, and Sock-Aid. After the shower the patient was seated in his wheelchair and the
adaptive equipment was placed beside him on the right within arms-reach. The patient was
allotted 25 minutes to complete his upper and lower extremity dressing which included donning
a pullover sweater, brief, sweat pants, and socks. These articles of clothing all belonged to the
patient. The patient completed the activity with minimal assistance due to difficulty with the
adaptive equipment and hands on assistance from the therapist. Dressing demanded several
performance skills including motor and process skills. Specific performance skills included
alignment, stabilization, positioning, reaching, gripping, manipulation, coordination, lifting,
calibration, flow, and endurance. The process skills required were pacing, attention, heed, choice,
use, initiation, sequencing, termination, location, and accommodation.
Key Observations: Dressing
The patient had previously been educated on how to utilize adaptive equipment while
dressing, but required moderate verbal cueing and minimal physical assistance. It was also noted
that dressing after a shower may be increasingly difficult because the skin was slightly damp. He

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

was motivated to complete the dressing activity and was enthusiastic about using the adaptive
equipment, but became fatigued during the activity and required physical assistance from the
therapist.
Pants and Brief. Mr. Miyagi was successful in threading both legs through his brief but
needed assistance to stand up from his wheelchair and to adjust it around his waist. He then
required a one minute rest break before donning his pants. He was able to manipulate the
reacher semi-effectively, but his upper extremity strength and low endurance made it difficult.
Utilizing the reacher and dressing simultaneously was extremely difficult because it challenged
his dynamic sitting balance and strength. Ultimately, inability to transfer up from his wheelchair
and poor dressing strategies prohibited him from completing this activity independently.
Socks. Mr. Miyagi needed moderate verbal cueing to prepare the Sock-Aid, but was able
to independently put each sock on the device. He required supervision to prepare the Sock-Aid
and minimal cueing to doff his socks using the dressing stick and. The patients weak grip on the
strings made use of the Sock-Aid more it difficult as well, but he was successful in donning his
socks with extra time. In doffing and donning his socks, weakness appeared to be the main
problem prohibiting his independence.
Pullover Sweater. Mr. Miyagi had the some difficulty donning his pullover sweater. He
was successful in treading both arms through the sleeves, but then could not lift his arms high
enough to drop the sweater over his head. The occupational therapist provided the patient with an
alternative method to don his sweater, by threading in one arm and the head through first. The
patient agreed this method may be more effective and stated he would try it next time. The
occupational therapist made a note that the patients problem solving skills were lacking and it
would be a potential problem to his discharge.

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Endurance. The patient had intermittent moments of breathlessness and required a

several resting breaks. Still, He was pleased with his ability to use the adaptive equipment and
his ability to dress himself.
Impactful Domains
Mr. Miyagi was seeking services so that he could return to a higher level of function and
live safely at home with his wife. The occupational domains which most significantly impacted
the patients ability to meet his desired outcomes were context, environment, client factors, and
motor performance skills. The context restraints are that the 93 year old the patient was at a
much later stage in his life where there is a natural decline in cognitive processing and muscle
tone. The patient also lives in a two-story home which is not an ideal physical environment for
his mobility. The stair steps challenge his ability to move freely in his home and limit his access
to the second level bathroom and shower.
The limiting client factors complicating Mr. Miyagis ability to engage in occupations
included body functions such as mental functions, sensory functions, and muscle functions. The
specific mental functions inhibiting Mr. Miyagi are higher level cognitive functions such as
executive functioning, praxis, and cognitive flexibility. An example of this was seen when Mr.
Miyagi was not able plan the most effective way to don his pullover sweater, causing him to get
stuck half-way through the process. Sensory functions impairing the patient were visual and
hearing functions. Mr. Miyagi has glaucoma in his right eye and is blind in his left eye which
really limits his visual functioning. He also requires bilateral hearing aids to hear, so while taking
a shower his hearing is very impaired because he cannot wear them in the water. Muscle
functions were the most inhibiting body function for Mr. Miyagi. The lack of muscle power and
muscle endurance was seen throughout the treatment and caused the patient to fatigue easily and

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

require physical assistance. There were also motor performance skills that the patient struggled
with which increased the difficulty of his daily activities. These motor performance skills include
moving, endurance, and gripping.
Problem List
1. Patient requires minimal assistance with functional transfers due to decreased strength,
dynamic standing balance, and endurance.
2. Patient is requires minimal assistance to dress upper and lower extremities due to
decreased strength and poor executive functioning.
3. Patient requires minimal assistance with showering to wash 10/10 body parts due to
decreased strength and endurance.
4. Patient requires minimal assistance for toileting due to decreased static standing balance
and strength.
5. Patient requires setup assistance and verbal curing to complete grooming tasks due to
declined executive functioning.
Problem statement one is listed as a top priority because the patient will be required to
perform multiple functional transfers daily without assistance in his home. Mr. Miyagi currently
requires another person to be present to perform functional transfers. He is unsteady when inmotion and has a limited about of energy to move around. This will be important to address
before the patient returns home so that he can have access to complete his ADLs safely and
efficiently.
Problem statement two is also high on the list of priorities because dressing activities remain
problematic for this patient. This is an activity the patient will need to complete daily and should
continue to be acknowledged in therapy. The patient has already been trained on how to use the
adaptive equipment, but the patients problem solving ability and praxis needs to be addressed. A

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

10

dressing intervention will act as a means to improve Mr. Miyagis executive functioning, task
performance, and ability to generalize problem solving strategies to other activities.
In problem statement three, decreased strength and endurance are once again affecting the
patients ability to complete an ADL. The patient completed showering eight body parts on his
own so is rational to assume that improving his overall strength and endurance will result in a
higher level of functioning in other activities such as showering. Addressing the underlying
factors in functional transfer training will correlate to an improvement in ability to shower
without assistance.
The same justification is true for problem statement four. Completing toileting is challenged
by Mr. Miyagis decreased strength and poor static standing balance. However, these underlying
factors are also affecting functional transfers and will be addressed by problem statement one
because intervening in functional transfers will be generalized to improving toileting task
performance.
Grooming has been prioritized last because this activity was completed at a higher level of
functioning. Although the patients executive functioning is an important underlying factor
affecting his performance, executive functioning will be addressed with the dressing
intervention. Rather than approaching each problem individually, the patient will have more
success at home if he acquires skills that can be generalized and practiced within different
activities. His wife may also be able to assist in setup or grooming itself at home.
Intervention Plan & Outcomes
Occupational therapy is unique because the interventions include the use of occupations
as a means or an end to facilitate engagement in meaningful activities. Occupational therapists
can utilize preparatory methods and tasks, education and training, advocacy, and group

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

11

interventions in the treatment process to promote health and participation (AOTA, 2014). The
intervention plan consists of plan development, which involves selecting client-centered goals
that are objective, measurable, and occupation focused (AOTA, 2014). The intervention plan also
establishes an intervention approach and methods for service delivery. The occupational therapist
should always consider the patients potential discharge needs and plans, as well as
recommendations or referrals to other professionals the patient may benefit from (AOTA, 2014).
Long Term Goal 1
Patient will perform all functional transfers with supervision within 3 weeks.
Short term goal a. Patient will complete edge of bed to wheelchair and wheelchair to
edge of bed transfers in his room with supervision within one week.
Intervention. The patient will complete progressive resistance strength training on upper
extremities to improve overall strength and the ability to push himself up from a surface or pull
himself up using a grab bar. Progressive resistance training (PRT) is a type of exercise where Mr.
Miyagi will exercise his muscles against some type of resistance that will be progressively
increased as his strength improves. The exercise will be conducted three times a week at
moderate to high intensity by using exercise machines, free weights, cuff weights, or elastic
bands. After completing these preparatory strengthening activities, the patient will practice more
purposeful strengthening activities including sit-to-stands and wheelchair pushups. The transfer
itself can be included in the intervention and used as a means to an end. The patient will also
perform the edge of bed to wheelchair and wheelchair to edge of bed transfer with the therapy
staff and nursing staff whenever possible. This intervention will include educating Mr. Miyagi on
proper positioning and techniques to promote a successful transfer. These techniques include (a)
having both feet flat on the floor; (b) heels angled toward the surface to which the patient is

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

12

transferring; (c) placing feet shoulder width apart to have a wider base of support; (d) placing
feet slightly behind knees; (e) ensuring a position of anterior pelvic tilt; (f) using bilateral upper
extremities to assist in the transfer.
Approach. This therapist should use an establish / restore approach method to direct this
intervention. These functional transfers are familiar to Mr. Miyagi, but his abilities have been
impaired by a natural decline in his strength due to aging and his hospital stay from which he
was further deconditioned. His functional transferring skills have been recently compromised;
therefore collaborating with the patient to restore these skills will increase his knowledge and
performance of procedures to ensure access and mobility within his home.
Evidence-Based Article. Liu and Latham (2009) completed a Cochrane Review
examined if PRT could help to improve physical function and muscle strength in older adults.
They found evidence from 121 randomized controlled trials, with a total of 6,700 participants,
which showed that older adults who exercise their muscles against a force or resistance become
stronger (Liu and Latham, 2009). Twenty of the trials included older adults older than 80 years
old. PRT also improved their performance of simple activities such as walking, climbing steps, or
standing up from a chair more quickly (Liu and Latham, 2009). Overall, this review suggests that
PRT has a small but significant effect on improving physical function, a moderate effect on
decreasing some impairments and functional limitations, and a large effect on increasing
strength. Therefore, this intervention is evidence-based and safe for Mr. Miyagi.
Outcome. The desired outcome for the PRT based intervention is improvement in
occupational performance. PRT would aid in improving and enabling skills and patterns in
functional transferring. This outcome is applicable to Mr. Miyagi because his performance is

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

13

presently limited and this outcome would reflect an increase in his occupational performance
(AOTA, 2014).
Short term goal b. Patient will increase dynamic standing balance from Poor + to Fair +
within 2 weeks.
Intervention. Patient will continue with a core strengthening program to improve core
muscle strength and endurance. Mr. Miyagi will perform a progressive program consisting of
eight exercises designed to increase the strength and endurance consisting of (a) bridging; (b)
reclining curl; (c) curl up; (d) seated oblique crunch; (e) abdominal contraction; (f) lower trunk
rotation; (g) straight leg raise; (h) seated marching. The exercises may be performed in a seated
or supine position and without specialized equipment. Incorporated isometric and dynamic
contractions of the core muscles will all be performed in a slow, controlled manner, 5-25 seconds
per repetition depending on the exercise, and the patient will rest 1-2 minutes between sets. This
strengthening program will be utilized three times a week, and may be continued at home after
discharge. Once again, the patient will rehearse the transfer itself within the intervention as a
means to an end.
Approach. The intervention approach appropriate for this activity would again be an
establish / restore approach method. This intervention is designed to establish muscle power and
endurance Mr. Miyagi has lost. Restoring his strength would reduce the risk of a fall during a
functional transfer and increase his functional independence.
Evidence-based article. Kahle and Tevald (2014) recently published an article in the
Journal of Aging and Physical Activity. The purpose of this randomized controlled trial was to
determine the effects of a core muscle strengthening home exercise program on balance in older
adults. Slow, prolonged contractions were emphasized in the intervention to improve strength

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

14

and endurance, as previous studies have shown that core muscle endurance is associated with
balance performance (Kahle and Tevald, 2014). Balance was assessed using the Functional
Reach Test (FR) and the Star Excursion Balance Test (SEBT), and trunk muscle performance
was assessed with curl-up test performance (Kahle and Tevald, 2014). The three outcome
measures were assessed at baseline and after the intervention. At the post-test, participants in the
exercise group demonstrated significantly greater improvement in performance on all outcome
measures than those in the control group. Results suggest that core strengthening should be part
of a comprehensive balance-training program for older adults. Overall, the results suggest that
core muscle performance can be improved by a comprehensive balance training program,
leading to improved balance (Kahle and Tevald, 2014).
Outcome. This intervention is planned to elicit the desired outcomes of improved
occupational performance and participation. This outcome will increase the patients engagement
in desired occupations that require a functional transfer (AOTA, 2014). The goal is for Mr.
Miyagi to be personally satisfied with his ability maintain his balance during a functional transfer
and increase his independence.
Long Term Goal 2
Patient will complete upper and lower extremity dressing of 4/4 clothing items with
supervision within three weeks.
Short term goal a. Patient will demonstrate problem solving strategies which dressing the
upper extremity with less than three verbal cues within one week.
Intervention. Reduced sensory-input in older adults who are visually impaired cause them to
have to rely more on their cognitive resources when performing ADLs. Mr. Miyagi is blind in his
left eye and has glaucoma in his right eye. Therefore, this intervention would include cognitive

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

15

training to accompany ADL training. The cognitive training would include memory training
involved in teaching mnemonic strategies such as organization, visualization, and association for
remembering material. Also, reasoning training involved in teaching strategies for finding the
pattern in a letter or word series and identifying the next item in the series would be included. As
well as speed of processing training involved in visual search and divided attention. Sessions
would focus on applying these strategies to solving everyday problems such as mnemonic
strategies to remember a grocery list, or reasoning strategies to understand the pattern for
successful dressing. This training could then be correlated to dressing activities where the
patient could identify efficient dressing strategies.
Approach. For this client-centered activity the most appropriate intervention approach
would be establish / restore because it is designed to change patient variables to restore his
cognitive abilities which have impaired (AOTA, 2014). The patients activity levels will be
changed and this approach will allow him to improve his performance capacity which will
positively influence his activity patterns.
Evidence-based article. In 2010, Heyl and Wahl investigated the role of cognitive resources
in the everyday functioning of older adults who were visually impaired. Vision loss clearly
threatens the functional autonomy of older adults. Resources that are relevant to everyday
functioning, like cognitive functioning, may be of greater importance for those who are visually
impaired than for those who are sighted. The main focus was on measures of age-sensitive
cognitive abilities that tend to decline with increasing age (Heyl and Wahl, 2010). Speed of
processing, working memory, and semantic fluency were all tested as outcome measures and
indicators of central executive function. To assess objective everyday functioning, researchers
used a selection of 10 items from classic ADL-IADL scales (Heyl and Wahl, 2010). Results

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

16

showed that the older adults who were visually impaired scored significantly lower than did
those who were sighted. According to the findings, classic everyday competence training for
older persons who are visually impaired should be enhanced by systematic cognitive training to
enhance independent living skills (Heyl and Wahl, 2010).
Outcome. Quality of life will be impacted by this intervention. The patient stated that it
was important for him to stay sharp so this intervention will nicely complement the patients
goals. This intervention will also influence improvement in occupational performance and
participation. The result will be an increase in occupational performance and this patient will
engage more in his desired occupations in ways that are personally satisfying and congruent with
his expectations.
Short term goal b. Patient will demonstrate effective use of two adaptive equipment
tools with supervision to complete lower body dressing within two weeks.
Intervention. Mr. Miyagi will continue to be trained to dress his lower extremity using
adaptive equipment. A combination of approaches will be used including minimal physical
assistance, demonstration, and instructional cues. Information will consist of device care, safety
precautions, and what to do if the device needed repair or replacement. The patient will have
opportunities to dress his lower extremity using a reacher, long handled shoe horn, Sock-Aid,
and dressing stick. The patients own clothing will be used and the activity may occur in the
patients room or in the bathroom.
Grading the Intervention. The intervention on dressing devices use can be easily
graded up or down. Grading the intervention down makes the activity easier, and provides
assistance at difficult times to promote success. This could be done by using full hand-over-hand
assist and frequent instructional cueing. Grading down could also be using only one adaptive

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

17

device at a time, rather than attempting to use the reacher and dressing stick simultaneously for
example. The patient may also require scaffolding which is a method of grading activity down
when the therapist provides assistance to patient. Scaffolding may occur at times when he may
struggle, or when he is unsuccessful in completing a step.
Unnecessary or excessive assistance will only create more dependency on the therapist or
caregiver. Therefore, increasing patient independence is important and can be achieved with
grading up. Grading up the intervention on dressing device use may include increased latency
before and after prompting the patient to initiate an activity step without help (Christiansen,
2011). This would allow the patient time to initiate the prompted performance. Fading prompting
procedures can be done effectively two ways for this patient. Allowing the patient an opportunity
for observation learning or modeling before attempting dressing may reinforce the steps. Using
graduated guidance will also be effective to move towards fading out physical prompts
(Christiansen, 2011).
Approach. This intervention approach would be considered modify because it is directed
at reviewing activity demands to support performance in the patients natural setting (AOTA,
2014). Introducing compensatory techniques to dressing tasks will enhance the patients
functional performance and reduce his levels of fatigue.
Evidence-based article. Schemm and Gitlin (1998) examined methods occupational
therapists use to teach bathing and dressing device use to older patients in rehabilitation
programs. They found that teaching occurred frequently through oral instruction and
demonstration (Schemm and Gitlin, 1998). Effective therapeutic teaching required preparation,
interaction, cues, repetition, support, rewards, and included more than a brief demonstration.
Results from this study confirm previous findings, namely mat older patients were positive about

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

18

assistive device use. The study concluded that effective device use instruction can minimize
nonuse, increase frequency of use, and avoid and safety problems. Overall, this study supported
the teaching practices of dressing devices for older adults and that interventions should include a
variety of teaching methods.
Outcome. There are two desired outcomes for Mr. Miyagi in this intervention.
Occupational performance improvement and participation will be targeted. Once this patient is
able to efficiently use the dressing device techniques his engagement will be personally
satisfying and congruent with his desired outcomes.
Precautions
Mr. Miyagi is a fall risk due to his poor balance.
Frequency and Duration
The patient should continue to be seen for occupational therapy treatment five to seven
days a week for 90 minute sessions. The patients short term goals will be met within two weeks,
and the long term goals will be met within three weeks. This service delivery is realistic to meet
the needs of the patient.
Primary Framework
The person-environment-occupation-performance (PEOP) model was the primary
framework which guided this intervention plan. The PEOP model is suited for a variety of
individual needs across the life span and identifies the most important occupational performance
issues. The PEOP model uses the interactions of a persons intrinsic factors and extrinsic or
environmental factors as constructs that explain possible contributing factors for function and
dysfunction. Intrinsic, extrinsic, and environmental factors were all considerations of this
intervention. Examples of these were client factors such as strength and executive function, his

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

19

wife as social support, and his two-story house which could limit access to his home. Although
elements of the intervention plan were influenced by the biomechanical frame of reference
occupational adaptation model, and developmental frame of reference an emphasis on functional
skills and occupational performance was always present. Therefore, the focus on occupations
supports the use the PEOP model and its top-down approach to guide this intervention.
Client Training and Education
Training and education will begin every session and may include demonstrations,
handouts, instructional cueing, and physical assistance with activities. The patients
comprehension is critical to using adaptive equipment successfully upon discharge and will be
reassessed continuously. The patients wife will also act as a caregiver for Mr. Miyagi and should
be instructed on how to assist her husband in a way that can maximize his independence. She
should be encouraged to attend treatment sessions before discharge to be aware of her husbands
functional abilities.
Clients Response to Intervention
The patients response to intervention will be continuously monitored and assessed daily
by the therapist before and after interventions to track his progress. This informal assessment
process will consider the patients satisfaction with his progress and feelings towards discharge.
A formal way to measure the patients response would be by reevaluating using the Functional
Independence Measure (FIM). The FIM will measure all areas of daily living and performance
including functional transfers and dressing which are areas the patient and therapist wish to
address in the intervention plan.

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

20

References
AOTA. (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
Christiansen, C. (2011). Ways of living: intervention strategies to enable participation (4th ed.).
Bethesda, MD: AOTA Press.
Heyl, V., & Wahl, H. (2010). Cognitive ability as a resource for everyday functioning among
older adults who are visually impaired. Journal of Visual Impairment & Blindness,
104(7), 391-403. Retrieved from http://web.a.ebscohost.com/ehost/detail/detail?vid=3
Kahle, N., & Tevald, M. A. (2014). Core Muscle Strengthening's Improvement of Balance
Performance in Community-Dwelling Older Adults: A Pilot Study. Journal of Aging &
Physical Activity, 22(1), 65-73. doi: 10.1123/japa:2012-0132
Liu, C.J., Latham, N.K. (2009). Progressive resistance strength training for improving physical
function in older adults. Cochrane Database of Systematic Reviews 2009, Issue 3. doi:
10.1002/14651858.CD002759.pub2.
Schemm, R. L., & Gitlin, L. N. (1998). How Occupational Therapists Teach Older Patients To
Use Bathing and Dressing Devices in Rehabilitation. American Journal of Occupational
Therapy, 52(4), 276-282.