Running head: OCCUPATIONAL PROFILE1

Occupational Profile and Intervention: A Client with Left Hemiparesis

Peter Wallace
Touro University Nevada

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Occupational Profile
In this paper, the client will be referred to as Jay in order to maintain their anonymity. Jay
is a 58-year old man who lives in Las Vegas, NV. Jay lives with his wife Janet. Jay and Janet
have lived in the Las Vegas area for nearly 30 years, and have been married for 35 years. They
have three children, a son and two daughters, but their children are all grown and live on their
own. Jay and Janet live in a two story home, but they live on the ground level floor and reserve
the upstairs living space for guests. Jay has two children who live out of town, but one of Jays
daughters lives nearby. Jay and Janet have two grandchildren, twin 11-month old boys. Jay and
Janet enjoy babysitting and spending time with their grandchildren. Their daughters family
visits every Sunday. Jay likes to prepare Sunday dinner for his family. Jay has been on a leave of
absence from his work since his stroke in December. Jay is a manger in an engineering field, and
he enjoys his job. He wants to return to work soon, but he is worried about keeping up with his
daily work routines. Jay enjoys work, watching movies, taking walks with Janet, and spending
time with his family, especially his grandbabies. Jay is fortunate to have a strong support system.
His wife is in good health, his daughter and grandsons live nearby, and he has many friends and
coworkers who offer support.
Jay is receiving outpatient rehabilitation services to address left hemiparesis and edema in
his left upper extremity (LUE). Jay is currently receiving one hour of occupational therapy and
one hour of physical therapy three times per week to address the paresis and edema. His paresis
and edema are due to a right cerebrovascular accident (CVA) he sustained. Jay had one month of
acute rehab, but is still experiencing difficulty with activities requiring fine motor skills. Jay was
still experiencing decreased LUE strength, endurance, and edema, so he was referred to
outpatient therapy. The edema in his left hand was limiting his range of motion and hand

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function, gross motor was mildly impaired, and fine motor was moderately impaired. Jay is
continuing services to increase his fine motor, bilateral coordination, LUE strength and
endurance. Currently, Jay is able to perform many ADLs and IADLs independently. However, he
is modified independent in lower extremity (LE) and upper extremity (UE) dressing, bathing,
and meal preparation because he requires additional time to complete tasks. He has some
difficulty with feeding, specifically cutting food with a knife. He has difficulty chopping and
cutting food for meal preparation, so he requires additional time to complete tasks. Jay likes to
cook, and he considers meal preparation to be a meaningful activity.
In addition to ADLs and IADLs, the occupation of work is important to Jay. Jay wants to
return to work. Jay has enjoyed his employment as a manger in the engineering field, and
although he could retire, he wants to return to work when he is able to perform his necessary job
functions. Jays work is important to him beyond monetary needs. However, Jays work requires
a moderate amount of physical endurance, keyboarding, and occasionally manipulation of small
parts that require adequate fine motor. Jay works 13 hour shifts, commutes 70 minutes to work,
and walks an average of three miles per day at work. All of these job performance tasks present
barriers for Jay because of his LUE paresis. Jay is concerned about having the endurance to
make it through a typical workday, and he is concerned about his job performance. At work, Jay
needs to type reports, respond to emails, and schedule his employees on the computer. Since he
works in the engineering field, he also needs sufficient fine motor skills to manipulate small
parts. Jay is concerned that he will not be able to keep up with the workload unless he improves
his physical endurance and fine motor skills. More specifically, be able to type 30-40 words per
minute with no errors. Jay suffered from his CVA about five months ago, and after one month of
acute rehab, he set a personal goal of returning to work within the first week of July.

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Several environmental and contextual factors have been either a support or a barrier to
Jays occupational performance. Jays physical environment was a barrier during his initial
recovery, but he is able to navigate his physical environment fairly well now. He was having
trouble weight bearing in quadruped position, which is one of his interventions. So, an
environmental modification was made, in the form of a nonslip pad, to help his hand from
slipping while weight bearing in a quadruped position. Jays computer keyboard is challenging
for him because he hasnt been able to use his left hand when typing because he hits the wrong
key, holds keys down too long, and experiences fatigue in his left hand. Jay needs to have
adequate keyboarding skills to complete his job functions. Jays workplace and workload
requires physical endurance, so this is another area of concern. Jay views his age as a supporting
context. Jay is only 58 years-old, and he contributes his rapid recovery process to his age. The
virtual context has been another supportive contextual factor. Jays coworkers and extended
family have offered him support through phone calls, text messages, and emails. Jay has
repeatedly commented on how much support he has received, and how he has stayed in contact
with his coworkers and friends.
Jays priorities are centered on his desire to return to work with the physical strength,
endurance, and function needed to fulfill his job requirements. Jay values hard work, and he
wants to complete his job functions with very limited work accommodations. One of Jays
beliefs is that hard work pays off. While Jay holds this belief, it does not hinder his
performance, as he values the advice of his therapists.
Jay also values commitment to family. He enjoys spending time with his wife, daughter,
and two grandsons, and he fulfils his roles as husband, father, and grandfather. He enjoys doing
his household chores, especially cooking. He likes going to movies and dinner with his wife, and

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he adores his grandchildren. He derives meaning and purpose in his life from these important
roles. Jay daily roles included work roles before his CVA. Jay believes that he needs to be at his
prior level of function to fulfil his work roles, so he is very motivated to restore his UE strength
and endurance and his eye-hand coordination. Jays prognosis for functional return of his left
arm and hand is suitable for his goal.
Jay has several interests. He enjoys watching movies and has a nice home theatre system.
He likes to watch cooking shows, and enjoys cooking at home. He enjoys watching sports and
occasionally goes to a UNLV game. Jay likes to read, and enjoys staying current on political
issues. He enjoys going out with Janet to fine restaurants. Recently, he started writing a book
about his stroke and the recovery process.
Jay has several daily life roles. He is a husband, father, grandfather, engineer, manager,
chef, religious man, and the handyman of his house. The roles that are most important to Jay are
husband, father, grandfather and manager. Jay values hard work, but likes to play hard too. He
likes to entertain family and friends and wants everyone to have a good time.
Before his CVA, Jay had a specific activity pattern. He worked the same schedule and
performed the same routines. However, his patterns of occupational engagement have changed
because he hasnt been working and his performance skills and client factors have changed
dramatically. He has developed a few different routines, like his sleep routine. He goes to bed
later and wakes up later than he did before. Things that were easy to him have become
challenging.
Jays priorities are centered on his desire to return to work with the physical strength,
endurance, and function needed to fulfill his job requirements. His priorities are centered on
occupational performance and role competence in his work occupation. Jay has identified goals
that he would like to work on to meet his long term goal of returning to work in July. He wants to

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type at least 38 words per minute, improve fine motor skills, increase UE range of motion
(ROM), increase UE strength, and physical endurance. After observing Jay progress, his goal of
returning to work in July seems obtainable.
Occupational Analysis
Observation of occupation-based activity in the outpatient setting was infrequent, and
most of the interventions observed were based on therapeutic exercise and biomechanical frame
of reference. However, Jay was observed performing the occupation-based activity of
keyboarding (typing). He was also assessed with several fine motor assessments once a week;
unfortunately, these assessments were used for therapy interventions as well. There appears to be
an enormous disconnect between the occupation-based interventions learned in the class-room
setting and what is actually being implemented in the field.
Context and Setting
Jay is being seen in an outpatient rehab center located in a large hospital. The majority of
clients observed in this setting were post CVA. The vast amount of CVA clients is most likely
due to the fact that the outpatient rehab is affiliated and located within a large hospital bedcuase
many referrals actually come from within that hospitals inpatient and acute rehab departments.
Jay was referred to outpatient rehab from the hospital. Jay is able to drive himself to his
outpatient appointments now, and he currently sees both occupational therapy and physical
therapy for one hour 3x/wk. Once again, this setting seems to focus more on a biomechanical
frame of reference and is centered on the establish/restore approach within the occupational
therapy practice frame work (AOTA, 2014). Unfortunately, clients in this setting perform mainly
rote exercise to help restore skills and abilities, and no real occupation-based intervention occurs.

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This is unfortunate because the environment and context are equally important to occupational
performance.
Activity and Client Performance
Jay initially came to outpatient rehab with very limited active range of motion (AROM)
and limited functional use of his LUE. Because of his left hand edema, he had decreased passive
range of motion (PROM) in his wrist and distal and proximal interphalangeal (IP) joints. Once
again, observation of occupation-based activity in the outpatient setting was uncommon. Most of
the interventions observed were based on therapeutic exercise, and the evaluations and functional
assessments observed appeared to be based exclusively on a biomechanical frame of reference.
However, Jay was observed performing the occupation-based activity of keyboarding (typing).
The occupational therapist wanted to assess Jays ability to type on the computer keyboard
because this is one of his necessary job functions, and he had set it has one of his top goals. This
was the first time the OT had assessed his performance skills in this occupational-based activity.
This activity would be considered a job performance skill under work occupations according to
the American Occupational Therapy Association (2014). Jay was initially evaluated with
decreased left shoulder AROM with internal rotation, shoulder flexion and extension, elbow
flexion and extension, supination and pronation, wrist extension, wrist flexion, finger flexion,
and finger extension. His manual muscle testing (MMT) was consistently 3+/5 for most of the
above motions. His hand grip strength was 95lbs with his noninvolved hand and 31 with his
involved. His pinch strength in the involved hand was about one third of his noninvolved for 2point, 3-point, and lateral pinch. However, when entering the fieldwork experience, he was
within normal limits for much of his UE, with the exception of his hand. Currently, he is
impaired in bilateral coordination and fine motor tasks. He recently scored 32 seconds on the 9-

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peghole test with his involved and 20 with his involved. His feeding and meal preparation
occupations are mildly impaired due to his impaired fine motor skills and AROM in his left
hand. He is modified independent for bathing, dressing, and meal preparation because it takes
him additional time to complete the tasks within these occupations.
Key Observations
Several key observations were noted. While observing Jay perform rote fine motor tasks,
it was noted that Jay had difficulty with in-hand manipulation and thumb opposition. The
observation was conveyed to the fieldwork educator. She hadnt directly assessed or observed
these two fine motor skills, but she was indirectly providing some treatment by having him
squeeze a strengthening ball and pick coins out of theraputty. Jay appears to be compensating for
opposing thumb deficit. These deficits could account for some of Jays hand fatigue and
decreased fine motor skills (Exner, 2010). Jays in-hand manipulation is poor to nonexistent.
According to Exner (2010) in-hand manipulation is the ability to move and position objects
within the hand without using the other hand, and it is, perhaps, the most complex fine motor
skill. Working on these fine motor skills may increase the repertoire of interventions designed to
increase Jays occupational performance. While Jay was observed typing on the keyboard, it was
clear that he had difficulty making isolated finger movements in his left hand. The therapist
asked him to type with only one hand. While observing him closer, it appears that he is focusing
on where his fingers are going with his left hand but not with his right hand. He also appears to
have difficulty with bilateral coordination. This could be caused by a spatial deficit as well as
physical deficits. Observation of Jay donning and doffing a button-up shirt revealed difficulty
with clothing buttons. In-hand manipulation skills help with positioning
of clothing buttons, zippers, snaps and laces. Tying laces is another dressing task that utilizes

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bilateral hand use. Increasing bilateral coordination, in-hand manipulation, and thumb opposition
should be included in Jays intervention plan.
Domains of OTPF Impacted
As mentioned earlier, Jay is having difficulty with grip strength, isolated
finger movements, bilateral coordination and hand use, pinch strength, inhand manipulation, and thumb opposition. These difficult areas hinder Jays
occupational performance and pose as barriers in Jays goal of returning to
work. These specific deficits fall under performance skills in the occupational
therapy practice framework. These deficits more specifically fall under motor
skills: grips, manipulates, and coordinates in the frame work (AOTA, 2014).
Prioritized Problem List
Problem Statement 1
Client is unable to perform daily work task of typing 30-40 words per
minute due to decreased fine motor skills and paresis 2o CVA.
Rationale. Work is a meaningful occupation to Jay; an occupation that has meaning beyond
monetary value. Jay derives significant purpose and meaning from work, and he wants to return
to work as soon as he feels capable of effectively performing his job functions. According to the
therapist, Jays prognosis should allow for his goal of returning to work. However, one of Jays
concerns is keeping up with the workload demands. Jay does a lot of typing at work because he
is required to submit reports, respond to emails, create schedules, and order parts. Jays
performance in this task is below the average requirement for his role as manager. Jays
occupational therapist (OT) should consider intervention for increasing his performance skills in
this area as well as adaptive technology and other modifications that may increase his

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performance. For example, there is speech to text software that could accommodate his
occupational demands.
Problem Statement 2

Client requires mod (I) with meal preparation due to fine motor skill impairments,
decreased bilateral coordination, and decreased grip strength.

Rationale. Jay has difficulty with cutting and chopping food and opening containers due to
his decreased grip strength in his left hand. Jay is right hand dominant, so he is accustomed to
holding jars and containers in his right hand, and twisting the lids off with the left hand. Jay also
has difficulty holding his food items in place while cutting and chopping food for meal
preparation. Cooking is a meaningful occupation for Jay, so his OT should consider this problem
high on the priority list.
Problem Statement 3

Client requires mod (I) for UE & LE dressing due to decreased grip strength and fine
motor skills 2o LUE paresis.

Rationale: Jay has difficulty performing dressing activities that require manipulation of
buttons, snaps, zippers, and ties. Although dressing is and ADL of utmost importance, this was
selected 3rd on the priority list because Jay can perform the occupation; it just takes him
additional time to complete it. In addition, it was low on Jays priority list.
Problem Statement 4

Client requires mod (I) for bathing due to decreased grip strength, shoulder internal
rotation, and bilateral coordination 2o LUE paresis.

Rationale. Jay has difficulty performing the ADL of bathing/showering because of his
decreased grip strength and bilateral coordination. This occupation was not directly observed
within the inpatient setting, but Jay stated that it was a problem area for him. Since it was not

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directly observed, simulation was observed to see what performance skills or client factors were
hindering performance. Again, Jay can perform the activity, but it takes him additional time. So,
this problem was low on the priority list.
Problem Statement 5

Client is unable to perform work skills requiring manipulation of small parts due to fine
motor skill impairments 2o LUE paresis.

Rationale. Jay has difficulty with fine motor tasks. This is a job performance requirement,
but he doesnt perform these tasks frequently because he is the manager. Although this related to
his work, and his work is meaningful to him, he performs this far less than he does other job
performance areas. Also, the other problem statements address the performance skills of grips,
manipulates, and coordinates.
Intervention Plan & Outcomes
Long-term Goal 1
Client will type an average of 25 words per minute for 15 minutes with less than 4 errors
using both hands within 4 weeks.
Short-term Goal 1a
Client will tolerate 15 minutes of typing A, S, D, F and F, D, S, A with left hand
using isolated finger movements and correct hand placement on keys within 2 weeks.
Short-term Goal 1b
Client will type an average of 20 words per minute for five minutes with less than 6
errors using both hands within 2 weeks.
Intervention 1a
Use of activities that encourage in-hand manipulation and bilateral coordination. Client
will perform an occupation as means to make a necklace for his wife. This intervention was
actually performed, and the client enjoyed it. It was introduced for fieldwork 3rd objective
assignment. The intervention is performed to increase in-hand manipulation and bilateral
coordination, which are important components of any activity that involves fine motor skills. In
this intervention, the client holds a handful of beads in his involved hand and strings them onto a

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string one-by-one. First, the client picks up beads one-by-one and puts them into his palm until
he has a handful of beads, which requires finger-to-palm translation. Then, the client holds a
handful of beads and bring the beads from palm to finger (palm-to-finger translation) to string
the beads onto the string. The string is held in the other hand, uninvolved hand, while beads are
being strung onto the string, encouraging bilateral coordination. When client finishes stringing
enough beads to complete the necklace, the client then ties the two ends together, which again
requires bilateral coordination. In addition to in-hand manipulation and bilateral coordination,
the activity also works on wrist rotation, eye-hand coordination, finger flexion, finger extension,
wrist extension, and proximal stabilization. This intervention utilizes establish/restore
intervention approach. It utilizes establish because Jay has never made a necklace out of beads
before. It utilizes the restore part of this approach because it is restoring bilateral coordination
and in-hand manipulation that he once had (AOTA, 2014).
Literature review. Implementing interventions that improve in-hand manipulation and
bilateral coordination can improve performance in other occupations that require fine motor
skills. According to Exner (2010) in-hand manipulation is the ability to move and position
objects within the hand without using the other hand. In-hand manipulation is one of the most
complex fine motor skills. The intervention works on in-hand manipulation, bilateral
coordination, wrist rotation, eye-hand coordination, finger flexion, finger extension, wrist
extension, and proximal stabilization, which are fine motor skills that can increase Jays
occupational performance in the job skill of keyboarding. Exner (2010) reviewed several studies
that tested functional dexterity among children. The studies that were reviewed utilized
intervention which focused on in-hand manipulation. The results of these studies suggest that
practicing tasks that require in-hand manipulation can increase functional dexterity, as measured
by the amount of time required to rotate and place 16-pegs. Exner (2010) also suggests that in-

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hand manipulation is significantly correlated with functional dexterity; while, grip and pinch
strength is not. This is disconcerting because many therapist center functional dexterity
intervention on a biomechanical frame of reference, using grip and pinch strengthening
exercises. The necklace intervention provides an occupation as means that works on fine motor
skills necessary for keyboarding and provides a finished product that the client can be proud of.
Occupation-based interventions, like this one, can increase motivation, self-efficacy, and selfesteem, which will ultimately increase occupational performance.
Intervention 1b
Client will type A, S, D, F and F, D, S, A with left hand for 5 minutes. This allows
the client to practice using isolated finger movements with the involved hand. Jay has difficulty
with isolated finger movements so this intervention allows him to practice those movements, but
does not place a time limit or quota on his performance so he can gain confidence and necessary
motor control. While this is repetitive, it is focused on an important job performance skill that
Jay considers important. The intervention was performed with Jay, and he was thankful that an
actual occupation was being addressed, instead of rote exercise that doesnt seem pertinent to
restoring skills. This intervention uses the establish/restore intervention approach for restoring
fine motor skills for job performance (AOTA, 2014).
Literature review. Repetitive task practice (RTP) is regularly used to
improve occupational performance after a stroke. According to Nilsen et al.
(2015), RTP is goal directed and utilizes frequent repetition of task-related
movements. Having Jay type A, S, D, F and F, D, S, A with his left hand for
5 minutes utilizes frequent repetition of task-related movements. Nilsen et al.
(2015) conducted an evidenced-based review of 17 RTP studies and found
that 13 out of the 17 studies had positive findings. These findings support

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the use of RTP to improve occupational performance after a stroke. Using RTP
for this intervention promotes motor relearning.
Long-term Goal 2
Client will cook homemade chicken tortilla soup (I) using basic ingredients within 4
weeks.
Short-term Goal 2a
Client will demonstrate the ability to open three twist open jars using A/E within 2 weeks.
Short-term Goal 2b
Client will cut three separate ingredients using both UE (I) within three weeks.
Intervention 2a
Client will participate in a game of toss and catch using a four inch weighted therapy ball
to improve hand function. This intervention uses the establish/restore intervention approach for
restoring his fine motor skills for the job performance of typing. The intervention also utilizes
create and promote approach for increasing self-efficacy (AOTA, 2014). The client will be asked
to through the ball at pitch-back tramp and then catch the ball. The client will use the involved
UE. The intervention will strengthen muscles in the hand and UE while allowing for some thumb
opposition movement. A cylindrical grasp is used to catch and throw the ball, and a cylindrical
grasp and disc grasp is often used to open lids and jars around the kitchen.
Literature review. Jay likes to cook, but cooking often requires opening and
closing lids, jars, and containers. Strengthening grasp will increase performance in these tasks as
well as increase fine motor skill. According to Schepens (2009), repetitive intervention working
on grasp can increase functional tasks requiring fine motor skills. The study used 60minute
interventions three times per week for six weeks to improve hand function in adults suffering
from a CVA. They used several of the assessments introduce in the 635 course, like the
Minnesota manual dexterity test and nine-hole peg test. The subjects had significant
improvement with increased grasp force, gross coordination, and functional tasks, These findings

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suggest that the chosen intervention would be appropriate for Jay because it would increase his
overall fine motor skills and grasp strength, and grasp strength is needed for him to open and
close jars, lids, and containers in the kitchen when preparing meals.
Intervention 2b
Client will play a hungry man game with tennis ball and beads. Client will hold a tennis
ball with a slit in it and squeeze the ball in his involved hand place beads in one at a time with
other hand. After beads are placed he will squeeze ball to remove beads. The tennis ball is made
to look like a man and the slit in the ball is his mouth. This intervention was actually performed
with the client. Although this game is really for children, Jay actually enjoyed it. You can make it
more fun for the client and more challenging by placing a countdown timer in front of them and
giving them an amount of beads that is somewhat challenging to put in in that timeframe. This
activity works on bilateral coordination, grip strength, and thumb opposition. The intervention
also utilizes create and promote approach for increasing self-efficacy (AOTA, 2014).
Literature Review. According to Wolf and Birkenmeier (2011), Motor skills practice is
used to remediate motor skills with clients who have had a stroke. A repetitive motion helps with
motor relearning and cortical restructuring. Picking up small items, squeezing the ball and
working with both hands helps with remediation of motor skills, which increases the clients
occupational performance in many tasks requiring fine motor skills. Remediation involves
several factors, such as repetitive practice of motor tasks, improving strength, relearning of
sensorimotor relationships, and improving functional performance with whole tasks (Wolf &
Birkenmeier, 2011). Although the intervention does not include whole tasks, it does focus on
improving strength, relearning sensorimotor relationships, and repetitive practice. The
intervention will improve Jays ability to hold items in one hand and cut or chop with the other,
as well as increase his overall fine motor skills and increase cortical restructuring. The

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intervention game will improve Jays fine motor skills and grasp strength, which will increase
Jays occupational performance in his IADL of meal preparation and leisure occupation of
cooking.
Precautions and Contraindications
One of the most important precautions with Jay is his edema. Preparatory methods, like
retrograde message, can be used before interventions if his hand has additional swelling. Jay still
has problems with hypertension, and although he is on medication, his blood pressure has been
high occasionally. Jays blood pressure should be taken before every intervention session.
Hypertension is a contraindication for therapy, especially if any gross motor activities and
muscle strengthening is to be included in therapy. Precaution when implementing interventions
requiring cutting of food are necessary too. Insuring a safe environment and safe hand
positioning during cutting is important. One should also be aware of subluxation of the shoulder
for clients who are post stroke.
Frequency and Duration
Interventions will be implemented within a 60-minute session. It is recommended that
Jay attend three 60-minute session per week. Jays treatment sessions will occur on Mondays,
Wednesdays, and Fridays. This affords him a day to rest in between each session day. This is
important because Jay sees both physical therapy and occupational therapy back-to-back each
visit. Jay shows good potential for restoration of previous occupational performance and good
benefit from therapy three time per week.
Grading Up and Grading Down
Grading up and down can be done for the necklace making intervention by having him
hold more or fewer beads in his hand, increasing or decreasing the size of the beads, increasing
or decreasing the gauge of necklace lace/string, and putting more or fewer beads onto string. One
could also stabilize more proximal extremities or allow propping of proximal extremities to

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grade down the occupation-based intervention. The reason for grading up or down is to provide
the client with the just-right challenge.
Primary Framework
The Person-Environment-Occupation-Performance (PEOP) model is a good fit for
occupation-based interventions because it is client-centered. The biomechanical frame of
reference has its place in the establish/restore approach too. The PEOP model provides a great
philosophical base to guide intervention. The PEOP model describes the interaction between
intrinsic factors (client factors), and extrinsic factors (environmental factors). Intrinsic factors
and extrinsic factors can either support or restrict occupational performance, so the goal is to
modify these factors to support performance in desired activities and tasks (Baum &
Christiansen, 2005). Jays muscle weakness and fatigue impede his occupational performance.
Jay has trouble grasping items with enough force to be successful in some of his meal
preparation tasks. Jay is unable to perform many of the tasks needed at work too. Many of Jays
motor skills have been impacted from his CVA, which can impact psychosocial areas as well. Jay
has a strong social support system in place, which is a positive extrinsic factor that supports
occupational performance.
Client/Caregiver Training and Education
Education can be provided for physical modification suggestion, use of durable medical
equipment (DME), and home therapy and exercise programs. Its possible for Jay to use adaptive
technology to aid in his keyboarding needs, this may require training. Jay also can be given
homework in the form of specific home exercises. It is also important to educate the client and
caregiver about the specific deficits and diagnoses, what to expect from therapy, and how to get
the most pout of therapy. The client should be continually educated throughout therapy sessions

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too. The therapist should always educate the client on what they are working on and why the
intervention was selected.
Response to Intervention
Assessments are often taken to gage the outcome of therapy. While increased
occupational performance and quality of life are the ideal outcomes, it is much easier to measure
daily, weekly and monthly progress with physical measurements, like MMT, AROM, PROM,
grip strength, and pinch strength. Since paresis and edema in the LUE is Jays problem areas, the
majority of assessments will be measures of physical strength. The circumference of digits and
hand can be taken for edema. The Functional Independence Measure (FIM) scores can be used to
monitor ADLs; however, Jay is already at the independent or modified independent level for
ADLs. Tests, such as the Minnesota, 9 peg-hole test, and grooved peg-board test, can be used to
assess fine motor skills. A baseline should be established to effectively measure progress.
Clinical observation should be used in conjunction with assessments so the clients performance
abilities can be further explored. This allows the therapist to adjust intervention plans to the
needs of the client. Outcome measures are performed twice a week for Jay. Measurements for
Jay have included MMT, ROM, Grip strength, pinch strength, Minnesota manual dexterity test,
groove peg-board test, and measurements for his edema. Intervention planning, monitoring of
progress, and discharge planning will be considered from outcome measures.

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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
Baum, C.M., & Christiansen, C. (2005). Person-environment-occupation: An occupation-based
framework for practice. In C. Christiansen, C. Baum, & J. Bass-Haugen (Eds.),
Occupational therapy: Performance, participation, and well-being (3rd ed., pp. 243266). Thorofare, NJ: Slack Incorporated.
Conti, G. E., & Schepens, S. L. (2009). Changes in hemiplegic grasp following distributed
repetitive intervention: a case series. Occupational Therapy International, 16(3-4), 204217. doi: 10.1002/oti.276
Exner, C. (2010). Evaluation and interventions to develop hand skills. Case-Smith, J., &
OBrien, J. C. (Eds.), Occupational Therapy for Children (6th ed.) (pp.275-324).
Maryland Heights, MO: Mosby.
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), 6901180030p1-6901180030p9.
Wolf, T. & Birkenmeier, R. (2011). Intervention to increase performance and participation
following stroke. Christiansen, C. & Matuska K. (Eds.),Ways of living: Intervention
strategies to enable participation (4th ed.). Bethesda, MD: AOTA Press.

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