Running head: OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile and Intervention Plan: A Cerebrovascular Accident Case

Cynthia Sanchez, OTS
Touro University Nevada

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Occupational Profile
The client, John Smith, was seen for a sixty-minute occupational therapy (OT) treatment
session in an outpatient rehabilitation setting in Las Vegas, Nevada. He was referred to
occupational therapy after having experienced a cerebrovascular accident (CVA) which resulted
in right hemiparesis. During the treatment session, John displayed decreased strength and limited
range of motion (ROM) in his right upper extremity. John is right-hand dominant; thus these
impairments have significantly impacted his occupational performance. In addition, John had
difficulty completing long activities due to limited activity tolerance. John exhibited an upbeat
and motivated attitude towards treatment despite experiencing these impairments.
Client
John is a 68-year-old male who recently experienced a CVA three months ago. His prior
medical history includes a diagnosis of hypertension. John was born and raised in Lansing,
Michigan but moved to Las Vegas, Nevada one year ago after retiring from his real estate job. He
currently lives in a single story house with his wife, Tara. John has one son and three
grandchildren, all whom still reside in Lansing, Michigan.
Prior to experiencing the CVA, John was independent in all of his activities of daily
living (ADLs) and instrumental activities of daily living (IADLs). John was previously
responsible for many household chores, including the maintenance of their landscape.
Furthermore, John and Tara shared the cooking tasks as they both enjoy cooking. However, Tara
now completes most household chores by herself and they have hired a neighbors son to mow
their lawn. John has ceased his share of the cooking tasks due to the limited ROM and decreased
strength in his right upper extremity. John has always considered himself to be an active person.
Upon moving to Las Vegas, he joined a hiking group in which he went on hikes with every two

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weeks. He stated this group helped him create a social network here in Las Vegas. John also
enjoys playing golf and had recently begun playing with friends from the hiking group. In
addition, John previously attended the gym at least five times a week for one hour to stay in
shape. John displays a positive attitude and is willing to cooperate with therapy in order to return
to his prior levels of function.
Reason for Seeking Services
After initial evaluations, it was determined that John would benefit from receiving
outpatient rehabilitation services. It was determined that he would benefit from both OT and
physical therapy. He would specifically benefit from OT skilled services to help him increase his
independence in ADLs and IADLS, activity tolerance, right upper extremity ROM, and right
upper extremity strength. John is seeking OT services because he wishes to be independent in his
occupations once again.
His goals are to return to his prior level of function and resume participation in his leisure
activities. John does not want to rely on Tara as much and wants to be able to help her as much
as he can. He has expressed concern over his right upper extremity limited ROM and over how
quickly he becomes fatigued. He expressed feeling frustrated over how his current impairments
are inhibiting his ability to participate in meaningful occupations.
Areas of Occupation
As mentioned previously, John was independent in the completion of all his ADLs and
IADLs prior to suffering the CVA. He now requires moderate assistance with showering tasks
due to decreased activity tolerance and right hemiparesis. Another ADL that John has been
experiencing difficulty with is dressing. He currently requires minimal assistance for upper body
dressing tasks and moderate assistance for lower body dressing tasks. He believes the limited

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ROM in his right side inhibits his ability to complete dressing tasks the most. Tara currently
helps him with aspects of both showering and dressing when necessary, but John has expressed
concern about not wanting so much help from Tara.
Furthermore, John also began experiencing difficulties with IADLs after experiencing the
CVA. For example, prior to the CVA John did all of the driving because he enjoyed it; however,
he is currently not driving and must rely on Tara to drive him to doctors appointments and
therapy sessions. Another IADL that he has ceased from engaging in is meal preparation. John
and Tara have always shared the cooking tasks; this is something that became a routine for them
early in their marriage. John has been unable to contribute to this activity due decreased strength,
ROM, and endurance. He has also had difficulty with common household management tasks,
such as vacuuming and yard work. However, there are certain IADLs that he is still independent
in and feels successful completing. For example, he manages all of the budgeting and financial
aspects of his and Taras accounts independently. John is responsible for paying their bills on
time; he does this either through the phone or his computer.
John finds his leisure activities to be very meaningful to him. He expressed concern over
how he has always been an active person, and he does not want to stop now. He enjoys golfing,
hiking, going on walks, and working out. These are all activities that John previously felt
successful in but no longer participates in. Even though his physical impairments have inhibited
his participation in these activities, his desire to return to them appears to be a great motivator for
him in therapy.
Contexts and Environments
Johns cultural context is supportive of his engagement in meaningful occupations. He
and his wife have made enough money from their youth to now live comfortably. He prides

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himself in having earned his money from hard work and values the belief that hard work pays
off. His wealth has allowed him to have access to resources that other less fortunate individuals
would not have had. For example, he has had great access to healthcare that has supported his
road to recovery. Furthermore, he and his wife enjoy traveling, and this leisure activity is
supported by their wealth.
On the contrary, Johns personal context has inhibited his engagement in occupations due
to his current physical impairments. For example, the hemiparesis that he is experiencing in his
right side has made it difficult for John to complete ADLs, such as dressing and bathing,
independently. His temporal context, which would be his retirement from work three years ago,
is supportive of his engagement in desired occupations. Retirement has allowed him to focus on
leisure activities that he previously did not have a lot of time for due to his busy work schedule.
His virtual context supports his ability to engage in social interaction. For instance, he keeps in
touch with his family in Michigan through phone calls and video chats with them through Skype.
The main physical environment that John participates in is his home, and this is a
supportive environment. He lives in a single story house with his wife. The home is spacious but
since it is just the two of them, it stays clean for the most part thus intense cleaning is not
required. Their home is located near golf courses and hiking trails which supports his leisure
hobbies of golfing and hiking.
Johns social environment is also supportive to his engagement in occupations. Tara is a
great source of support in helping John maintain his participation in occupations. She helps out
with whatever she can and has been a great source of motivation for him in his recovery. He
expressed how even though she does not like the outdoors too much she has been going on walks

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with him and has been helping him with his home exercise program. Another great source of
motivation for John is his hiking group as they have been very encouraging and supportive.
Occupational History
John and Tara have been married for 50 years and pride themselves in having raised a
wonderful family. John began working in the real estate field at a very young age and remained
in the same field until retirement. John did not pursue any higher education, but ascended the real
estate ladder throughout his career. He began as a real estate agent for a company in Michigan
but eventually opened his own company which he passed on to his son when he retired. John said
his favorite part of his job was interacting with different people and helping them find their
dream homes.
Values and Interests
John values his roles as a husband, a father, and a grandfather. He considers his wife to be
his best friend and biggest supporter. He talked about how they try to go on dates once a week;
they enjoy going to dinner and the movie theatre. Even though John does not get to see his son
and grandchildren as often as he wishes, he values the time he gets to spend with them. Johns
main interests besides his family include exercising, golfing, hiking, and cooking. He believes
that exercise is very important in helping him stay active and age well. He enjoys the outdoors
and relaxing. Other interests include watching sports, particularly football and baseball.
Daily Life Roles
John describes his daily routine as calm and serene. He stated that his routine varies
depending on whether he has therapy that day or not. If he does not have therapy, he wakes up
around six in the morning and completes his morning routine. This involves showering,
grooming, and dressing; he tries to do as much as he can on his own and Tara helps with the rest.

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He then drinks a cup of coffee as he reads the newspaper. Tara cooks breakfast as he reads the
newspaper, and they eat together in their dining room. After breakfast, they run errands and then
go back home. Once they are home, they then have lunch together. While Tara completes several
household chores, John exercises on his own. He completes ROM exercises, hand manipulation
exercises, and light weights. Tara then goes for a walk with him and then they spend the rest of
the afternoon watching television until dinner time. The days when he has therapy are similar to
these days except that instead of running errands he goes to therapy for two hours.
Patterns of Engagement
Johns patterns of engagement have changed over the past couple of years and again since
the CVA. Before his retirement, he had a very busy work schedule but now he has significant
free time to occupy with leisure activities. In the months prior to the CVA, he was occupying his
free time with meaningful occupations. He was traveling with Tara, playing golf, going on hikes,
and keeping as active as possible. However, since the CVA, he has not engaged in any of these
activities. Even though he attempts to remain active, his decreased activity tolerance makes this
difficult.
Priorities and Targeted Outcomes
Johns main priority is to return to his prior level of function. He wishes to once again be
able to complete his ADLs and IADLs independently. He also wants to return to participating in
leisure activities. He wants to plan a trip to Michigan to visit his son and grandchildren.
Furthermore, he wants to return to playing golf and going on hikes. John also wishes to return to
his weekly gym routine. He hopes to recover fully and return to fulfilling all of his roles. Overall,
John wants to feel physically healthy again and improve his quality of life. He is very determined
to work hard to reach his goals.

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Occupational Analysis
Context and Setting
John was seen for an OT treatment session in the outpatient therapy gym at Summerlin
Hospital Medical Center in Las Vegas, Nevada. The outpatient therapy team consists of
occupational therapists, physical therapists, and speech therapists. The therapy gym contains
exercise equipment, such as arm bikes, treadmills, and weight machines. Specialized
rehabilitation equipment such as electrical stimulation and resistance bands are also available in
the therapy gym. Clients are typically seen one to three times a week and between one to three
hours per session depending on what services they are receiving.
John is currently receiving OT and physical therapy twice a week for one hour each. The
OT treatment sessions are held in the therapy gym section dedicated to OT. This side of the room
includes an adjustable therapy table, cabinets with shelves, open counter space, and a sink. All
the materials and tools used for therapy sessions are found in the cabinets. Sessions are also
sometimes held in a separate room with a therapy mat and a shoulder finger ladder for ROM
exercises.
Activity Observed and Client Performance
John showed up to his therapy session with a motivated attitude and ready to work. The
occupational therapist began the session by passively stretching Johns right upper extremity on
the therapy mat. John was instructed to lay prone with his right upper extremity hanging off the
mat. The occupational therapist passively stretched his upper extremity in full range for shoulder
flexion, extension, and abduction. The stretches were held at end range for about 60 seconds. She
then instructed John to actively complete 10 repetitions of each stretch without holding at the end
range. John experienced difficulty with each stretch due to the limited ROM in his right upper

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extremity. He had difficulty fully extending his elbow when performing the repetitions and
instead held it in slight flexion. The occupational therapist provided him with an air splint for his
elbow which assisted him with elbow extension and allowed him to gain a few more degrees in
each direction when stretching. John also expressed experiencing pain in his shoulder and rated it
a three out of 10, but stated that he could tolerate it.
After the stretches, the occupational therapist had John complete the Nine Hole Peg Test
in order to observe any changes in his fine motor control. John completed the activity with his
right hand and experienced difficulty with reaching and when grabbing the pegs with a tip to tip
pinch. He also had difficulty moving his hand quickly from the pegboard to the side of the table
to drop the pegs. He expressed concern over his slowed reaction times and how he could not
release the pegs as fast as he intended to.
Lastly, John participated in a catching activity with a tennis ball and using his right upper
extremity. For this activity, the occupational therapist would bounce the tennis ball toward Johns
right side, and he was instructed to reach out with his right upper extremity and catch the ball.
While John was able to approximate where the ball would land, he had difficulty closing his
hand fast enough to grasp the ball and catch it. After John had the ball in his hand, he was
instructed to throw the ball back to the occupational therapist with his right hand. Overall, John
was able to catch 70 percent of the bounces throughout three trials.
Key Observations
Johns main impairments include limited ROM and decreased strength in his right upper
extremity. John displayed expressions of pain when moving his upper extremity past his current
threshold for active ROM. However, he kept insisting that it was tolerable pain and wanted to
continue with the activities. Besides decreased ROM and strength, John also displayed difficulty

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with fine motor skills. Another observation was Johns slowed reaction times. As mentioned
earlier, even though John could place his upper extremity in the right position to catch the tennis
ball he was unable to form a spherical grasp quickly enough to catch the ball. As a result of this,
the tennis ball would bounce off his palm and fall onto the floor. John appeared frustrated over
not being able to close his hand around the tennis ball fast enough.
Throughout the treatment session, John also displayed signs of fatigue due to his
decreased activity tolerance and required various breaks. Swinging his arm in a downward
circular motion appeared to help him relax his arm and pain when taking a break. John was alert
and oriented to all aspects of his rehabilitation program. He was eager to participate in all
activities and pushed himself to perform better with each task.
Significant Impacts
While observing Johns performance, various client factors were noted to have a
significant impact on his ability to successfully participate in the activities. The client factors
noted impacted Johns occupational performance both in positive and negative ways. For
example, his values and beliefs had a positive impact on his performance as he strongly believes
in hard work and commitment. These beliefs led him to push himself to perform better
throughout the session. On the other hand, neuromusculoskeletal and movement-related
functions had a negative impact on his occupational performance. More specifically, joint
mobility, muscle power, and muscle endurance made it difficult for John to complete tasks that
required the use of this right upper extremity. Johns gait patterns also impacted his occupation
performance as his right foot slightly dragged on the floor when ambulating.
Various performance skills also impacted Johns occupational performance. Deficits in
his motor skills appeared to negatively impact his ability to engage in meaningful occupations.

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For example, specific skills such as reaching, gripping, and coordinating inhibit his ability to
incorporate bilateral use of his upper extremities in the performance of ADLs and IADLs.
Problem List
Problem Statements
1.
2.
3.
4.
5.

Client requires Mod (A) for showering 2 activity tolerance.

Client unable to perform dressing tasks (I) 2 AROM in R UE & fine motor skills.
Client unable to complete outdoor leisure activities 2 activity tolerance.
Clients fine motor skills inhibit ability to (I) complete simple meal preparation.
Clients reaction time results in safety concerns for driving (I).

Justification
Problem statement 1: Client requires Mod (A) for showering 2 activity tolerance. I
chose this as the top priority because it appears to be the area where John is experiencing the
most difficulty. Furthermore, showering is an activity that John completes on a daily basis. Even
though Tara currently helps him when necessary, John does not want to rely on her and wants to
perform this activity independently. This is understandable because showering is a private
activity, and he would prefer to complete it independently. By working on the contributing factor
of activity tolerance, we can also improve his occupational performance in other tasks. For
example, working on increasing his activity tolerance can act as a foundation for helping him
reach his other goals such as returning to his outdoor leisure activities.
Problem statement 2: Client unable to perform dressing tasks (I) 2 AROM in R UE &
fine motor skills. I chose this problem statement as one of the tops ones because dressing is an
activity that John must also complete on a daily basis. John experiences difficulty completing the
upper extremity movements required for dressing such as shoulder flexion, extension, and
abduction. Furthermore, he experiences difficulty with tasks that require the use of fine motor
skills such as buttoning and pulling zippers. These problems can all be successfully addressed in

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therapy. The occupational therapist can help John work on the skills required for dressing, teach
him compensatory strategies, and introduce him to adaptive equipment. John can also receive
education on energy conservation strategies which will help him save energy when completing
dressing tasks, particularly lower body dressing.
Problem statement 3: Client unable to complete outdoor leisure activities 2 activity
tolerance. I chose this problem statement because it appears to be in alignment with the clients
goals. John wants to return to being able to play golf, go on hikes, and exercise again. This is one
of his greatest motivators, so I believe that working on it is necessary. By addressing this goal,
we can help John feel like he is regaining his life and improve his perceived quality of life.
Furthermore, by helping him reach this goal, we will also impact his social context because he
will be able to participate in his hiking group once again.
Problem statement 4: Clients fine motor skills inhibit ability to (I) complete simple
meal preparation tasks. I chose this problem statement because John has not been able to
participate in meal preparation with Tara, and this is something that he wants to work on. By
helping him reach this goal, we can help him return to his role of supporting husband.
Furthermore, by working on fine motor skills we can also help him gain the skills required to
improve his performance in other areas. For example, by improving his fine motor skills it would
also allow him to dress with less difficulty and drive safely.
Problem statement 5: Clients reaction time results in safety concerns for driving (I). I
chose to place this problem statement last because even though it is very important, it might not
be feasible to address driving in this context since there is no occupational therapist driving
rehabilitation specialist on staff to perform driving evaluations and training. Furthermore, he still
has access to community mobility. Tara is willing to drive him to places for now, and if she is not

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available, he has intact cognition and knows how to use public transportation. John would be
referred to an occupational therapist driving rehabilitation specialist. However, the skills required
for driving safely may still be addressed in therapy in order to help him return to this occupation.
These skills include reaction time, bilateral upper extremity use, coordination, full ROM, and
visual perception. Thus, even though driving itself might not be addressed directly in the
treatment sessions, the occupational therapist may still help John improve these skills.
Intervention Plan and Outcomes
Problem 1
Client requires Mod (A) for showering 2 activity tolerance.
Long term goal 1. Client will bathe 10/10 body parts c CGA using SC within 6 wks.
Short term goal 1a. Client will bathe 7/10 body parts c Mod (A) using SC within 2 wks.
Intervention. In order to help John reach this short term goal, he requires an intervention
that will help increase his activity tolerance. This can be achieved by using a simple meal
preparation activity as an occupation-as-a-means. As mentioned throughout the occupational
profile, cooking is an activity that John finds meaningful and one in which he has ceased
participation in since the CVA. Research has shown that occupation-based interventions can lead
to post-stroke neuroplastic change, increased functional use of the affected upper extremity, and
improved occupational performance (Skubik-Peplaski, Carrico, Nichols, Chelette, & Sawaki,
2012). For this intervention, John will perform the entire meal preparation activity while
standing in order to help increase his activity tolerance. Besides increasing activity tolerance,
research has shown that extra standing practice can lead to increased motor recovery after a
stroke (Allison & Dennett, 2007). The occupational therapist will instruct John to prepare a
peanut butter and jelly sandwich and a cup of coffee. All ingredients will be placed on the

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highest shelves in the cabinets to promote shoulder flexion and work on increasing his upper
extremity ROM.
John will be instructed to use both his affected and non-affected upper extremities when
completing the tasks. Research has demonstrated that bilateral training has shown a reduction in
movement time of an affected upper extremity and increased upper extremity functional ability
when compared to unilateral training (Summers et al., 2007). While preparing the sandwich and
coffee, John will be required to work on the skills necessary for showering. These skills include
reaching, stabilizing, manipulating, and enduring. The approach used with this intervention is to
restore the clients prior level of function in showering. The outcomes expected are improvement
of occupational performance and role competence.
Short term goal 1b. Client will bathe 9/10 body parts c Min (A) using SC within 4wks.
Intervention. To begin this intervention, the occupational therapist will lead John through
various passive ROM stretches. These will include elbow flexion and extension, shoulder
flexion, shoulder external rotation, and wrist and finger flexion and extension. These stretches
will help John move through the motions that are required for showering. John will then be
instructed on Theraband exercises to strengthen his shoulder. These exercises will include
shoulder flexion, extension, abduction, and external rotation. Next, the occupational therapist
will set up an activity to help John work on increasing his activity tolerance. This activity will
involve John cleaning two of the windows in the therapy gym. He will be provided with a clean
cloth and a tub of soap water. John will be encouraged to use his right upper extremity to clean
the windows in horizontal, vertical, and circular motions. By having John clean windows rather
than countertops, it puts his upper extremity in an against gravity position thus working more

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muscles. Lastly, this activity will also help John in beginning to reintegrate into his role of
completing chores and house management.
A research study by Pang, Harris, and Janice (2006) found that a combination of range of
motion, shoulder exercises, and functional training in treatment was just as effective as
constraint-induced movement therapy in upper extremity function improvement in individuals
recovering from a CVA. A separate study by Studenski et al. (2005) found that therapeutic
exercise programs focusing on strength, balance, and activity tolerance led to more rapid
improvement in physical, social, and role function in individuals post-CVA. The approach used
for this intervention is to restore the clients skills required for showering independently. The
outcomes expected include occupational performance enhancement and role competence.
Problem 2
Client unable to perform dressing tasks (I) 2 AROM in R UE & fine motor skills.
Long term goal 2. Client will complete seated LB dressing c Mod (I) within 6 wks.
Short term goal 2a. Client will don button shirt c Mod (I) in seated position within 2
wks.
Intervention. In order to help John reach this goal of donning a shirt, we will focus on
working on both his activity tolerance and his fine motor skills. For this intervention, the
occupational therapist will take John outdoors to work on an activity involving tasks related to
his hobby of golf. Research has shown that incorporating leisure activities into treatment sessions
can lead to higher perceived levels of well-being by clients (Sveen, Thommessen, Bautz-Holter,
Wyller, & Laake, 2004). The occupational therapist will take John out to the lawn in front of the
medical center. The goal of the activity is for John to place golf tees on the lawn and then
balance golf balls on top of each one. John will be handed five golf tees at a time and be

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instructed to keep all of them in his right hand as he bends down to place them on the grass.
Furthermore, he will instructed to use only his right hand to place each golf tee in a row. By
having John bend down to place the golf tees, we will also be working on increasing his
endurance. Furthermore, by having John use only his right hand to hold and place the golf tees,
we will be working on palm to finger translation which will help improve his fine motor skills.
The occupational therapist will hold a bucket of golf balls from which John will grab one at a
time to balance on top of each golf tee.
The activity will focus on having John perform as many repetitions as he can tolerate
throughout the treatment session. Waddell, Birkenmeier, Moore, Hornby, and Lang (2014)
demonstrated that incorporating high numbers of task-specific repetitions using the affected
upper extremity can lead to improved grip and pinch in individuals recovering from a stroke.
Furthermore, the results of their research showed that individuals begun using their affected
upper extremity more often after engaging in an upper extremity high-repetition intervention
(Waddell et al., 2014). This activity will also work on other skills required for dressing such as
reaching, gripping, and coordinating while incorporating his hobby of golf. John is to take breaks
when necessary and the occupational therapist will provide verbal cues when needed.
Grading the intervention. To grade this intervention up, John will wear one-pound wrist
weights as he completes the activity. This will add more resistance as he places the golf tees,
reaches for golf balls, and attempts to balance the golf balls. Another way to grade this
intervention up, is to hand John more than five golf tees at a time. By handing him a higher
number of golf tees, he will be required to use a higher level of manipulation to keep the golf
tees from falling out of his hand as he places each one. On the other hand, to grade the activity
down the occupational therapist may use ping pong balls which are lighter than golf balls. The

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ping pong balls will be easier for John to manipulate and place on the golf tees. The approach
used for this intervention is to restore the clients skills required for dressing independently. The
outcomes expected include occupational performance enhancement and improved quality of life.
Short term goal 2b. Client will don pants & socks c Min (A) in seated position within 4
wks.
Intervention. John will be educated on various topics which will help him reach the goal
of donning pants and socks. First the occupational therapist will educate John on techniques used
to to don pants and socks from a seated position. The seated technique for donning pants that will
be use is as follows: 1) cross affected leg over unaffected leg; 2) place correct pant leg over
affect foot and pull into leg; 3) dress unaffected leg; 4) pull pants up as far as possible and shift
weight over each buttock; 5) stand up to pull pants around waist (Ryan & Sullivan, 2011). Seated
dressing techniques will allow John to save energy when performing dressing tasks. After being
educated on this technique, John will be given the opportunity to practice. The occupational
therapist will set up the items to Johns far right side in order to promote use of his affected upper
extremity. Furthermore, the occupational therapist will give John verbal reminders to use his
right upper extremity as much as possible. Research has shown that bilateral training can lead to
better motor control, greater functional gains, and greater efficiency in reaching during both
unilateral and bilateral tasks (Lin, Chen, Chen, Wu, & Chang, 2010).
Lastly, John will receive education on other energy conservation techniques as well as
adaptive equipment that he may use to save energy when dressing. Energy conservation
techniques to be taught include pacing self, taking breaks, and breaking down tasks into smaller
pieces. John will be provided with handouts on these techniques to take home and implement on
a daily basis. Furthermore, the occupational therapist will educate Tara on the dressing

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techniques, adaptive equipment, and energy conservation techniques used during the session so
that she can help John implement them at home. Wolf and Birkenmeier (2011) stated that
caregiver training is essential when a client is unable to perform ADLs on their own; the
caregiver spends the most time with the client, thus they can have a huge impact on their
occupational performance. The approach used for this intervention is to restore the clients skills
required for dressing independently. The outcomes expected include occupational performance
enhancement and quality of life.
Precautions and Contraindications
Throughout treatment sessions it is important to monitor the clients shoulder pain levels
and note any changes. The client is very motivated and pushes himself past his limitations;
however, it is essential for the occupational therapist to monitor how much the client can really
handle in order to prevent any further damage. It is also important to be aware of his decreased
activity tolerance and know when to provide him with breaks. With this in mind, the
occupational therapist should also be mindful of keeping an appropriate pace and not rushing the
client. Furthermore, the clients blood pressure should be monitored throughout the session due
to his history of hypertension.
Frequency and Duration
The client will continue OT treatment sessions twice a week for sixty minutes until time
of discharge. All short term goals are expected to be me within two to four weeks, while all long
term goals are expected to be met within six weeks. After six weeks, the client will be reevaluated and goals will be adjusted as necessary. The client will also be provided with a home
exercise program and energy conservation handouts to continue to implement at home.
Theory

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The frame of reference primarily used for this intervention plan was the biomechanical
frame of reference. This approach is based on the understanding that the impairment may be
remediated and it focuses on improving ROM, strength, and endurance (Gillen, 2014). All of the
interventions focus on at least one of these aspects as well as on restoring the client factors to
enhance the clients occupational performance. When using this approach, the outcome of the OT
session is focused on activity participation while the approach is focused on the biomechanical
client factors required to complete the task (Breines, 2013).
Client and Caregiver Education
The client will receive education and training during each session. He will be educated on
adaptive equipment, energy conservation techniques, and compensatory strategies. A home
exercise program will be developed to continue to strengthen his right upper extremity, increase
his ROM, and improve his endurance. The program will be explained to his wife as she is the
primary caregiver and can help enforce it. The client will be referred to an occupational therapist
driving rehabilitation specialist to address the factors that cannot be addressed in the current
context.
Clients Response
The occupational therapist will monitor the clients response at each therapy session.
Completion of short term and long term goals will demonstrate client improvement. In addition,
ROM and manual muscle testing will be used to document upper extremity progress. The
occupational therapist may note improvements in endurance and activity tolerance based on
observations. The clients pain levels will be documented after each treatment session.

References

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Allison, R., & Dennett, R. (2007). Pilot randomized controlled trial to assess the impact of
additional supported standing practice on functional ability post stroke. Clinical
Rehabilitation, 21(7), 614-619. doi:10.1177/0269215507077364
Breines, E. B. (2013). Therapeutic occupations and modalities. In H. M. Pendleton & W.
Schultz-Krohn (Eds.), Pedrettis occupational therapy: Practice skills for physical
dysfunction (7th ed., pp.729-754). St. Louis: Mosby, Inc.
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