meredith hayley - occupational profile intervention plan

Running head: OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile and Intervention Plan Hayley J. Meredith Touro University Nevada

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OCCUPATIONAL PROFILE AND INTERVENTION PLAN

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Occupational Profile

The client, Mr. M, was seen at a skilled nursing facility (SNF) in Mesquite, Nevada on th

May 9 , 2014 for a 50 minute occupational therapy (OT) treatment session. He was recommended by the fieldwork coordinator because of his positive attitude toward therapy and willingness to participate in treatment activities. He was a wonderful candid ate, and agreed to partake in the interview and observation. Who is the Client?

Mr. M is an 81 year old male who lives by himself in a single-wide trailer in Mesquite, Nevada. He worked as a mechanical engineer for many years in Salt Lake City, Utah. He has never been married and has no children. He does have good friends in the Mesquite area, including his neighbors. He does not have any religious affiliation nor does he h e consider himself spiritual. Although, he is curious about how other people live their lives and enjoys watching documentaries and reading books about other cultures. Why are They Seeking Services?

Mr. M was previously very proactive in accommodating his h ome environment to his physical needs. His neighbor installed grab bars in various places throughout the trailer. One morning Mr. M was attempting to get out of bed when he reached reach ed for a grab bar and strained his back. His physician determined he had suffered a minor compression fracture in his thoracic spine. The client was referred by his physician to a n orthotist for a fitted corset brace for comfort, and was directed to wear it anytime he was not in supine. The physician and treating acute rehabilitation team then recommended that Mr. M co ntinue services at the SNF in Mesquite to promote healing in his spine and practice daily activities needed for him to function independently at home. His age and injury have since affected his energy level. Mr. M stated that


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he is less motivated to do housework because it is fatiguing, and now he is concerned about the cleanliness of his home. The client also mentioned me ntioned to the occupational therapist in the SNF that he is apprehensive about his ability to act quickly in an emergency situation at home alone and feels unprepared to take care of himself. Mr. M is seeking occupational therapy therap y services to work on the aforementioned activities and rehabilitate him to and increased level of functioning. Occupations

Mr. M enjoys hands on activities and is very innovative, which may be attributed to his vocation as a mechanical engineer. en gineer. The occupations specific to Mr. M are activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure, and social participation. ADLs and IADLs are very important for Mr. M to complete bec ause he lives alone and is unable to rely immediately on someone else to assist him. He states that he has the most difficultly with dressing and functional transfers, while all other areas of ADLs are successful. He is responsible to complete all IADLs at home as well, and is currently concerned about home management and safety/emergency management. Home management tasks he must fulfill are light housework, clothing care, and dishes. The size of his single-wide trailer limits his mobility and he is looking forward to remodeling his home to accommodate his functional needs. Mr. M 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 the view from his porch. He especially enjoys building model cars and planes which he has been doing since he was a child. Social participation with friends and neighbors is very important to Mr. M because he does not have any immediate family. Although his neighbors are helpful, he stated a concern


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was that he has become more of a burden to them, and he is uncomfortable inviting them into his home when it is unkempt. Contexts and Environments

All aspects of OT transact together rather than being organ ized as a hierarchy. Context Con text and environment represent anywhere the client performs their occupations. The Occupational Therapy Practice Framework (OTPF) - Third Edition (2014) refers to context as a variety v ariety of interconnected conditions that are within and surrounding the client. Contexts may be cultural, personal, temporal, and virtual. Environment refers to the external physical and social conditions that surround the client and where the client’s daily life occupations transpire (OTPF, 2014). Mr. M 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 his individual features such as being an 81 year old man with a college degree in mechanical engineering. His temporal context would be a man retired from work for 15 years. The physical ph ysical and social environments are where Mr. M’s occupations occur. Physical environment is represented by the client’s home, a single-wide trailer. His social environment would be the friends and neighbors with whom he interacts. Priorities and Desired Outcomes

Mr. M expressed to the occupational therapist at the SNF that his priorities were being able to live safely and independentl y without stimulating pain in his back. Mr. M’s first priority is his pain management because it has h as been fairly debilitating thus far. The pain and injury also caused secondary extremity weakness which has h as negatively affected his functional transfer ability and fine motor skills. He would like to be successful moving throughout his trailer and


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not be limited by his ability to transfer functionally. Therefore, the client’s desired outcomes consist of independent living, safety preparedness, and uninhibited mobility. Occupational Analysis

The client was observed during a 50 minute OT session. The treatment consisted of several components including an ADL training intervention. The intervention was directed by an occupational therapist and occurred within the therapy gym. Context/Setting of Occupational Therapy Services

Mr. M was seen in Highland Manor of Mesquite which is a nonprofit SNF. The interdisciplinary rehabilitation team at this facility includes OT, physical therapy, and speech and language pathology. The facility has two rooms devoted to therapy. One was a therapy gym and contained state-of-the-art progressive resistive and aerobic exercise equipment. The other room was more occupation-based and was built with a bathroom, kitchen, and therapy mats. The second room stored many tools, materials, and supplies used by the occupational therapist. The therapists had the option to treat the patient in their bedroom or in the therapy therap y rooms. There was also common living areas and outdoor outdoo r patios for residents to socialize. Activity & Performance

Based on the client’s desired outcomes the occup ational therapist introduced adaptive equipment (AE) and dressing techniques early in th e treatment plan. Mr. M was educated on o n how to utilize AE from a hip kit to compliment his back precautions. The hip kit included a reacher, long-handled shoehorn, dressing stick, long-handled shower brush, and Sock-Aid. The client was requested to dress his lower extremities using the hip kit and proper body mechanics. The client was seated on a therapy mat and the AE was placed beside him on a side table within armsreach. The client was allotted 20 minutes to complete lower extremity dressing which included


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donning and doffing pajama pants, socks, and cowboy boots. These articles of clothing all belonged to the patient. In addition to AE the client used a motorized scooter and front wheeled walker for durable medical equipment (DME). The client used the DME for mobility, and while standing held on to the scooter scoo ter or walker for secondary support while donning and doffing his pants. The client completed the activity with minimal assistance due to time constraints constraints and inconsistency with back precautions. An in-depth discussion of observations from the client’s performance is included within the key observations section. The dressing activity demanded several performance skills including motor and process skills. Specific performance skills included alignment, stabilization, positioning, reaching, gripping, manipulation, c oordination, lifting, calibration, flow, and endurance. The p rocess skills required were pacing, attention, heed, choice, use, initiation, sequencing, termination, location, and accommodation. Mr. M also demonstrated a specific performance pattern of routine. This was revealed when he repeatedly repeat edly followed a distal to proximal sequence in his p referred doffing method, and a proximal prox imal to distal method for donning his clothing. Key Observations

The client had previously been educated on back precautions to avoid painful movements, but required verbal cueing multiple times to remember. The corset brace was designed to fit the client in an upright postural position. Despite this intention, Mr. M has a tendency to hunch forward in a kyphotic position that limited the purpose of the brace. He demonstrated that he was able to don and doff his back brace at edge-of-mat. He was motivated to complete the dressing activity and was enthusiastic abo ut using the AE, but became fatigued during the activity.


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Pants. Mr. M was right hand dominant and depended solely on that hand to manipulate

and coordinate each device. However, his coordination was lacking which made it difficult to control the device with one hand. He used his left hand to stabilize himself on the therapy mat, and was not able to control another device simultaneously because his poor static balance and low endurance made that difficult. Mr. M remembered to dress his weaker right side first and was very successful donning and doffing his pajama pants using the reacher. It was observed however, that Mr. M would have ha ve potential for difficulty buttoning or zipping pants or b lue jeans because he required one hand for steadying assistance. He was successful in dressing his pants but needed a three minute rest break before beginning the next task. Socks. Mr. M needed moderate verbal cueing to prepare the Sock-Aid, but was able to

independently put each sock on the device. He required minimal cueing to don and doff his socks using the dressing stick and Sock-Aid, and was aware that the activity would be easier with short socks rather than a longer style. The client’s weak grip grip on the AE device made use of the SockAid more difficult as well. h is cowboy boots. This of course was not Shoes. Mr. M had the most difficulty donning his optimal footwear for the client, but he was a damant that these were the only onl y pair of shoes he would consider wearing at home. He had a great deal of difficulty trying to squeeze his swollen feet and ankles into the narrow n arrow boots. With moderate assistance from the occupational therapist, the client was able to don his cowboy boots using a long-handled shoe horn. The occupational therapist was reluctant to compensate for the client, but time constraints of the therapy session necessitated his assistance. The occupational therapist made a note to continue the discussion for alternative footwear in the future.


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Endurance. The client had intermittent moments of breathlessness and requ ired a

moderate amount of resting breaks. Mr. M tried to avoid bending forward too far. This consequently strained his neck and an overflow of laboriousness was seen in his face. Still, He was pleased with his ability to use the AE and the ability to dress himself. Impactful Domains

Mr. M was seeking services to promote healing in his spine and practice daily activities so that he could return to a higher level of function and live safely at home. The occupational domains which most significantly impacted the client’s ability to meet his desired outcomes were context, environment, client factors, and motor p erformance skills. The context restraints were that the 81 year old the client was at a much later stage in his life where healing is more difficult. The client also lived alone in a single-wide trailer which was not an ideal ide al physical environment for his recovery. The trailer did not meet his needs functionally because it was too small of a space for his mobility to be optimal. The corset brace should also be included in the client’s limiting physical environmental factors as it inhibited his movement and wa s not ideally functional because of his kyphotic posture. The limiting client factors complicating Mr. M’s ability to engage in occupations included body functions such as neuromuscular, movementrelated, and muscle functions. There were also performance skills that the client struggled with which increased the difficulty of his daily activities. These motor performance skills include stabilization, coordination, and endurance. Problem List

1. Client is unsafe in emergency management tasks due to declining cognitive processing. 2. Client requires moderate assistance with home management tasks due to decreased energy and drive.


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3. Client requires contact guard assist for functional transfers due to decreased dynamic standing balance and endurance. 4. Client requires moderate assistance with lower extremity dressing due to de creased seated balance and back precautions. 5. Client is unable to build model cars for leisure du e to limited grip strength and coordination of dominant right hand. Problem statement 1 is listed as a top priority because the client divulged his concern for safety in emergency situations. Safety is always a to p priority for any client, and safety should be addressed with Mr. M specifically because he is u nsure of how to react appropriately to an emergency situation in his trailer. The client needs to feel confident that he can take care of himself at home and feelings of helplessness should be eliminated. When Mr. M feels assured and prepared to respond aptly to an emergency he will be encouraged to engage in other occupations within his home. Problem statement 2 is also high on the list of priorities because the client lives alone and will be responsible for all IADLs upon his discharge. The client is easily fatigued which has decreased his desire and motivation to do housework. Mr. M stated he desires d esires a clean trailer which is necessary for his health and mobility. Although, household maintenance has become a larger burden for him, Functional transfers were addressed in problem statement 3 because Mr. M currently requires another person to be present to perform functional transfers. He is unsteady when in-motion and has a limited about of energy energ y to move around. This will be important impo rtant to address before the client returns home, but will require him to improve his p hysiological status increase self-confidence.


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The lower extremity dressing activity observed during the o ccupational analysis remains problematic for this client. Problem statement 4 addresses the the level of physical assistance required to help Mr. M complete lower extremity dressing. This is an activity the client will need to complete daily and should continue to be acknowledged in therapy. However, the client has already been trained on how to use the AE, and with a few adjustments to his approach the client will ultimately be successful with practice. For example the client would benefit from using a full length mirror to watch himself as he dresses to see his feet without having to bend forward breaking his back precautions. The client can practice his dressing skills in his room at the SNF every morning and evening without it having to be addressed in every OT treatment session. The client’s injured back back has caused additional weakness weakn ess in all of his extremities. Mr . M’s dominant right hand is no exception and its’ functional usability has been compromised. The client expressed the enjoyment he has h as in building model cars and planes. pl anes. This requires precise fine motor movements and coordination, although the client demonstrated limited grip and regulation of his dominant right right hand. This should be addressed if possible possible to encourage Mr. M to continue participation in his life-long life-long hobby. However, this problem is not as great of a priority as safety, emergency management, or home management and may be addressed later. Intervention Plan & Outcomes

OT is unique because its 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 interventions in the treatment process to promote health and participation. (OTPF, 2014). The intervention plan consists of plan development, which involves selecting client-centered goals that are objective, measurable, and occupation focused (OTPF, 2014). The intervention plan also establishes an


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intervention approach and methods for service delivery. The occupational therapist should always consider the client’s potential client’s potential discharge needs and plans, as well as recommendations or referrals to other professionals the client may benefit from (OTPF, 2014). Long Term Goal 1

Client will perform efficient and appropriate procedures for emergency management tasks with modified independence within 4 weeks. Short term goal a. Client will independently complete 4/5 safety procedures within two

weeks. Intervention. The client will be educated on five safety procedures that he can use at

home to prevent or act in an emergency situation. The techniques will be demonstrated for the client, and then practiced in multiple environments throughout the SNF. The five safety procedures consist of (a) replacing batteries in smoke and carbon monoxide alarms; (b) proper use of a mfire extinguisher; (c) identify and navigate a safe route from is bedroom to the exit of SNF; (d) locate phone numbers of emergency services in telephone directory; (e) research and consider emergency response program, such as Life Alert, to begin at home. The client will exercise his critical thinking skills, and increase his confidence to initiate emergency action to reduce threats to his health and safety at home. Approach. This therapist should use a restore approach method to direct this

intervention. These safety procedures are familiar to Mr. M, but his abilities have been impaired by a natural decline in his cognitive processing because of aging. His cognitive processing skills have not recently been challenged and collaborating with the client to restore these skills will increase his knowledge and performance of preventive procedures to maintain a safe home environment.


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Evidence-Based Article. The use of contingency strategies, escape rout es, and assistive

devices to increase perceived control and willingness to engage in activity are described in an article by Taylor and Kielhofner (2003). The authors’ state authors’ state that approaches which can reduce anticipatory anxiety and increase perceived con trol, like safety procedures, will improve overall performance and the likelihood of occupational engagement (Taylor and Kielhofner, 2003). This article was focused on clients with chronic fatigue syndrome (CFS). However, the intervention strategies it discusses will benefit Mr. M because he experiences similar challenges of a p erson with CFS. Shields, et al. (2013) also reinforce the promotion of lifesaving benefits of safety based intervention so that older adults may be appropriately protected. After data from home visits was collected, knowledge results were concerning because, concerning because, “the majority of seniors were unaware of vital safety information needed to protect themselves adequately” adequately” (Shields, et al., 2013, p. 20). This evidence supports the validity of Mr. M’s M’s priority to priority to feel safe and to act sufficiently in an emergency to protect himself at home. Outcome. The desired outcome for the safety based intervention is well-being. This is

applicable to Mr. M because the intervention is directed towards improving his self-esteem, security, and opportunities for self-determination (OTPF, 2014). Having the tools to act appropriately in an emergency will positively impact multiple aspects of his human life domains and encourage him to interact freely in him home. Short term goal b. Client will perform 7/7 fall recovery techniques in sequence with

modified independence within 2 weeks.


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Intervention. The client will be educated on a fall recovery program with a seven-step

backward-chaining method. In this method each step must be completed with ease before the next step is attempted or added. 1. The client sits in a chair or mat and turns slightly to one side, sliding one knee over the edge until it is half way to the ground. The patient then pushes back up onto the chair. 2. The patient follows the same procedure as in Step 1, assuming a half kneeling position p osition on the floor, and then returns to the starting position. 3. The client follows the sequence of Step 1 and 2, progressing from half kneeling kne eling to high kneeling with both knees on the floor. Then, the patient pushes back up to sitting. 4. The client completes steps 1 through 3 followed by placing both hands hand s on the floor to assume a prone kneeling position and then returns to sitting. 5. Lower the body from prone kneeling to side sitting/half sitting, then progress back through the chain until standing or sitting. 6. The client completes step 5, then lowers the body to a side-lying position, then progresses back through the chain until sitting. 7. The client rolls from side-lying to supine and progresses back throu gh the chain until sitting. This step will be optional because the client’s back brace does not permit supine positioning. The techniques will be demonstrated for the client, and then practiced in a controlled setting in the therapy gym.


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Grading the intervention. This intervention can be easily graded down or up. Grading

the intervention down makes the activity easier, e asier, and provides assistance at difficult times to promote success. This could be done in steps one and two by supplying a weight bearing support cushion or wedge which would wo uld allow the client to build up comfortably to raising themselves completely from ground. Grading down could also be implemented in step four by using a cushion, pillow, or foam wedge as an intermediate training stage for placement of hands. If the client was unable to successfully complete more complex steps in the sequence the therapist could assist them physical while getting up from the ground. Also, when the client has mastered the first three steps, he would not have to repeat them with each attempt to master subsequent stages. To grade up the fall recovery reco very intervention the client could begin from a standing position rather than sitting which would also require them to stand up completely from the ground. The Th e program could also be done in various environments which would complicate the activity. Examples of these environments would be in a shower or tub or outside in the t he parking lot. Approach. The intervention approach appropriate for this activity would be establish

because it is designed to change client variables to establish a skill (OTPF, 2014). The client is a potential fall risk and the intervention would develop Mr. M’s ability to recover after a fall. Establishing this skill set would reduce the risk of further injury if Mr. M is not a ble to get up from a fall or call for help. Evidence-based article. This intervention plan was adapted from a research report by

Reece and Simpson which addresses the most effective way for occupational therapists to teach fall recovery strategies to older adults (1996). The results showed that the backward-chaining method of teaching older adults how h ow to get up from the floor is much less stressful to older adults


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and to therapist than the conventional sequential method (Reece and Simpson, 1996). Fall recovery and prevention is a relevant topic being addressed by the American Occupational Therapy Association (AOTA) and is aligned with the concept of productive aging. The AOTA states that OT practitioners are uniquely suited to address fall prevention with older adults because the majority of falls are multifactorial multifactorial in nature, and are influenced by the client and their environment (AOTA Inc., 2012). The role of the occupational therapist may involve training in fall recovery programs to target improving ph ysical abilities of the client to safely perform daily tasks (AOTA Inc., 2012.) Outcome. This intervention is planned to elicit the desired outcome of well-being. This

outcome will increase the client’s perceived contentment with his sense of security and creates opportunities for self-determination (OTPF, 2014). The goal is for Mr. M to b e content with his ability to recover from a potential fall and increase his independence. Long Term Goal 2

The client will complete three household cleaning tasks with modified independence in one hour within four weeks. Short term goal a. The client will independently monitor his perceived and expended energy

levels in the SNF within two weeks. Intervention. Mr. M will be asked to log his activity levels and fatigue using the NIH

Activity Record (ACTRE), and he will review h is experiences at each treatment session to determine his available energy periods to schedule activities. Supplies needed for this intervention include the ACTRE record booklet and a pen or pencil. Time is also needed to educate the client on how to appropriately fill out the form throughout the day. The therapist


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should allow for five minutes of reflection time at the beginning of every treatment session to educate the client on their results. Approach. For this client-centered activity the most appropriate intervention approach

would be create / promote because it is designed to provide an activity experience that will enhance the client’s performance client’s performance in his natural contexts (OTPF, 2014). The client’s activity levels will not be changed. Rather, Ra ther, this approach will allow him to develop a realistic appraisal of his performance capacity, and of the effects of engagement in patterns of activity. Evidence-based article. In their article, Taylor and Kielhofner (2003) also state that self-

assessment can facilitate cognitive organization, activity planning, and problem solving. Thereby increasing the client’s feelings of control over his life. It is equally important to provide opportunities for clients to review and receive feedback on their own capacities and limitations (Taylor and Kielhofner, 2003). Mr. M has a lowered sense of capacity and reduced feeling of effectiveness. This self-assessment is an empowerment-oriented strateg y that will facilitate positive feeling towards his ability to to expend his energy in a productive manner. Mr. M has environmental challenges and barriers as well; his fatigue is c omorbid with other conditions and causes his daily life and leisure tasks to be d emanding. Finally, his fatigue attenuates his motivation to engage in occupations as it would with a person with CFS. This intervention would benefit Mr. M on multiple levels and will ultimately motivate motivate him to initiate other occupations. The ACTRE was validated as a quantifiable q uantifiable measure of daily activity by Jason, et.al (2009). This study was also based on clients with CFS and the data collected on the ACTRE was totaled to identify specific abilities that could be rated in terms of associated symptoms (Jason, et al., 2009). Their findings indicated that the percent of time client’s spent feeling tired was positively associated with more time in pain and doing activities that were fatiguing (Jason, et


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al., 2009). This suggests that it is important to incorporate energ y conservation techniques to decrease laboriousness of certain activities. The authors concluded that their findings suggest that activity logs can provide clinicians with v aluable sources of data for understanding patterns of behavior and activity among this population (Jason, et al., 2009). Mr. M would benefit from an activity log like the ACTRE because b ecause his fatigue is restricting his access and motivation to complete household occupations. Outcome. The desired result for Mr. M in this intervention will be an experienced

outcome. Experienced outcomes are acknowledged by the client when they have realized the disruptions of engagement in occupation and are able to return to their desired d esired habits, routines, roles, and rituals (OTPF, 2014). Quality of life will be impacted by this intervention. The client will perceive his progress and improve his self-concept (OTPF, 2014 ). This will create more active participation and beliefs that he can move forward towards his goals. Short term goal b. The client will independently demonstrate the use of 4/5 energy

conservation techniques during OT treatment session within 2 weeks. Intervention. The client will be educated on five energy conservation techniques that he

can use at home to accomplish light housework activities. The techniques will be d emonstrated for the client, and then practiced in multiple environments throughout the SNF. The five energy conservation techniques consist of (a) decrease prolonged standing by choosing to sit on his scooter or in a chair; (b) use AE devices to compensate for weakness and decrease his energy expenditure; (c) eliminate tasks that are non-essential; (d) combine tasks when unable to eliminate extra work; and (e) take rest breaks before fatigue sets in. They are broad bro ad enough for the client to utilize his critical thinking skills and develop his own individualized strategies that would have practical application in his trailer.


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Approach. This intervention approach would be considered modify because it is directed

at reviewing activity demands to support performance in the client’s natural client’s natural setting (OTPF, 2014). Introducing compensatory techniques and energy saving strategies will enhance the client’s performance and reduce his levels of fatigue. Evidence-based article. In 2006, authors Gitlin, et al. completed a randomized trial of a

multicomponent home intervention program to reduce functional difficulties in older adults. Their goal was to, “reduce functional difficulties, fear of falling, and home haz ards and enhance self-efficacy and adaptive coping in older adults with chronic conditions” conditions” (Gitlin, et al., 2006, p. p. 809). The multicomponent home intervention program was extensive and included OT and physical therapy sessions involving home modification, energy conservation, and fall recovery techniques (Gitlin, et al., 2006). The results showed that intervention participants had less difficulty with IADLs than the control group, and reported greater use of control-oriented strategies learned from energy conservation techniques (Gitlin, et al., 2006). Most importantly, the intervention enhanced engagement in occupations using the energy conservation techniques, and other intervention components, which “previous research showed to be associated with beneficial health outcomes” (Gitlin, et al., 2006, p. 813). Outcome. There are two desired outcomes for Mr. M in this intervention. Occupational

performance improvement and participation will be targeted. Fatigue is the limitation that is present and prevents Mr. M from partaking in various occupations. Once this client is able to efficiently use the energy conservation techniques his his engagement will be personally satisfying and congruent with his desired outcomes. Precautions

Back precautions will be considered, and the corset brace should not be worn in supine.


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Frequency and Duration

The client should continue to be seen for OT treatment 5 days a week 50 minute sessions. The client’s short term goals will be met within two weeks, and the long term goals will be met within four weeks. This service delivery is realistic to meet the needs of the client. Primary Framework

The model of human occupation occ upation is the primary framework supporting this intervention plan. This model offers an integrative means of understanding the synergistic and evolving relationships between motivation, values, roles, habits, functional capabilities, and the environment as they influence Mr. M. MOHO provides a framework for the types of changes ch anges required in these different domains during the rehabilitation process. Client Training and Education

Training and education will begin every ev ery session and will include demonstrations, handouts, verbal cueing, and physical assistance with activities. Client comprehension is crucial to the success of these interventions and will be reassessed continuously. The client’s comprehension is also critical to his success upon discharge. Client’s Response to Intervention

The client’s response on his daily activity log book will be one way to monitor and assess his progress. Another formal way to measure the the client’s response would be by reevaluating using the Independent Living Scales (ILS). The ILS will address problem solving and task performance in areas of health and safety and managing the home which are both areas the client wishes to address. The therapist should continuously monitor and modif y the intervention based on client response to intervention as well. This informal assessment process will consider the client’s satisfaction with his progress p rogress and feelings towards discharge.


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References

American Occupational Therapy Association, Inc. (2012). Occupational Therapy and Prevention of Falls [Fact Falls [Fact sheet]. Retrieved from http://www.aota.org/About-OccupationalTherapy/Professionals/PA/Facts/Fall-Prevention.aspx 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 Gitlin, L. N., Winter, L., Dennis, M. P., Corcoran, M., Schinfeld, S., & Hauck, W. W. (2006). A Randomized Trial Of A Multicomponent Home Intervention To Reduce Functional Difficulties In Older Adults. Journal of the American Geriatrics Society, 54(5), 809-816. Retrieved from: http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=5&sid=cb1e Jason, L. A., Timpo, P., Porter, N., Herrington, J., Brown, M., Torres-Harding, S., et al. (2009). Activity logs as a measure of daily activity among patients with chronic fatigue syndrome. Journal syndrome. Journal of Mental Health, 18(6), 18(6), 549-556. doi: 10.3109/09638230903191249. Kielhofner, G. (2008). Assessment: Choosing and Using Structured and Un structured Means of Gathering Information. Model Information. Model of human occupation: theory and application (4th application (4th ed., p. 165). Retrieved from http://books.google.com/books?id=1LlhR_DSKTcC&pg=PA165 Reece, A., & Simpson, J. (1996). Preparing Older People to Cope Cop e After A Fall. Physiotherapy, 82(4), 227-235. Retrieved Retrieved from http://dx.doi.org/10.1016/S0031-9406(05)66877-0. Shields, W. C., Perry, E. C., Szanton, S. L., Andrews, M. R., Stepnitz, R. L., Mcdonald, E. M., et al. (2013). Knowledge and injury prevention practices in homes of older adults. Geriatric Nursing, 34(1), 19-24. doi: http://dx.doi.org/10.1016/j.gerinurse.2012.06.010 Taylor, R., & Kielhofner, G. (2003). An Occupational Therapy Approach to Persons P ersons with

OCCUPATIONAL PROFILE AND INTERVENTION PLAN Chronic Fatigue Syndrome: Part Two, Assessment and Intervention. Occupational Therapy in Health Care, 17 (2), (2), 63-87. doi: 10.1300/J003v17n02_05

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meredith hayley - occupational profile intervention plan

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