occupational analysis intervention plan 1

Running Head: OCCUPATIONAL ANALYSIS

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Occupational Analysis and Intervention Plan Lauren Hoppe Touro University Nevada

Running head: OCCUPATIONAL ANALYSIS

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Occupational Profile

1.

Client name: Sandra Hoppe

2. Age: 52 3. Sex: Female Briefly discuss each of the following: 4. Who is the client? The client is a 52 year old female who has been married to her husband for 26 years, and has two grown children who are currently out of the house and in graduate school. She works as an Occupational Therapist in an outpatient clinic. clinic. Sandra enjoys staying active by playing tennis, hiking, jogging, walking her dog, and lifting weights. She attends church every Sunday and is a part of a small bible study every Wednesday night. She also helps care for her 83 year old dad with Alzheimer’s by helping to care for him and taking care of his finances. 5. Why is the client seeking services and/or what are the client’s concerns relative to engaging in occupations and in daily life activities? The client can no longer enjoy playing tennis due to lateral epicondylitis of her right arm, when walking and jogging she would have symptoms such as stiffness and achiness that would cause discomfort. This discomfort would limit certain IADLs such as plugging cords into outlets or putting dishes away. She began to use compensatory methods while while lifting weight so she could still workout by adapting how she held the weight so it would not bother her elbow. 6. What areas of occupation are successful and what areas are causing problems or risks? Her leisure activities are affected because the lateral epicond ylitis bothers her when she is playing tennis, walking the dog, and lifting weights. Holding weights palm down caused great


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discomfort so she adapted by holding the weights in a neutral position of the wrist or completely skip exercises if it it was really hurting her. The tension caused by holding the leash leash while walking the dog also causes pain and a nd discomfort. Due to the discomfort, she is una ble to perform certain IADL’s such as, as, putting dishes away in higher cupboards. cu pboards. She is also limited at work when she needs to plug cords into an outlet, this particular action causes increased pain in her elbow. She is not limited in social participation, rest, sleep or play. 7. What contexts and environments support or inhibit participation and engagement in desired occupations? The client lives in a two story house in Casper, Wyoming with her husband and dog. Her two children are grown and away at college. She has two sisters sisters and a brother that live close by. She considers herself as a middle class class citizen and has a bachelor’s degree degree in occupational therapy. She works in an outpatient rehabilitation rehabilitation clinic that is located 5 minutes from her home. Living in a small town allows easy access to grocery stores, work and other family members. This helps to support her IADL’s by making community outings relativel y simple. The client’ client’s cultural beliefs include raising her family in a Christian atmosphere, participating in Christian holidays and attending church every Sunday. She also values education, and a truthful, honest ho nest way of life. This supports her social participation occupations by surrounding herself with many friends and activities involved at her church. Her value in education supports her work occupation by getting a good education has allowed her to have a good job which in turn helps h elps to support her leisure and play pla y occupations as well as support her family. Cultural aspect promotes participation in the activity because in o ur society staying active is considered good and a part p art of a healthy lifestyle. Tennis itself is seen as widely accepted and


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popular sport in the United States. The social aspect also supports participation because the client values interaction with her friends and family and tenn is gives her the opportunity to spend quality time with them. The physical environment in which the client plays tennis can either support or inhibit depending on location of the tennis court (if the court is indoors or outdoors) and the quality of the courts. If the courts are outside, weather ma y make play difficult (too hot, too cold, wind, rain, snow, bright sun). If the courts are inside it may b e easier to play due to the availability to control the environment (temperature and lighting). 8. What is the client’s occupational client’s occupational history? The client’s occupational history includes performing includes performing tasks and activities associated with her job as an Occupational Therapist. The roles that go along with being a mother and a wife such as caring for others, preparing meals, grocery shopping, driving, cleaning and maintaining the household. In her past occupations she also enjoyed playing softball, volleyball, tennis, hiking and walking the dog. She S he chose to give up softball after a hamstring injury she inquired while playing. She also attended church every week and volunteered for a basketball program. 9. What are the client’s priorities and desired outcomes? The client would like to maintain her independence and continue to stay active as she ages. More specifically, she would like to be able to get back to playing tennis, walking the dog, and performing IADL’s without feeling pain or discomfort. discomfort. She can still perform all of these activities now but is limited to the amount of time she can participate and has had h ad to make adjustments in order to continue performing the activities.


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Occupational Analysis

1. Occupation: Area(s) of occupation for the client: Subcategory: 1. Activities of daily living 2. Instrumental activities of daily living 3. Education 4. Work 5. Play 6. Leisure playing tennis 7. Social participation 2. Values, beliefs, spirituality associated with participation: She believes exercise is important and wants to live a healthy lifestyle. She also values the socialization she enquires with friends and family while pla ying tennis. She believes in good sportsmanship because of her Christian values.

3. Contexts: Context Physical/space demands Social Cultural

Personal

Temporal

Supports Tennis court on a flat, dry, even surface, with good lighting Following the rules of the game, playing fairly Using tennis as family time, playing with family members

Female with a bachelor’s degree in Occupational Therapy Having a set schedule to play tennis with family members ; such as every Saturday

Inhibits Playing on a court that is not lite well, playing while it is rainy or windy Not having friends or family to go play tennis with Not playing tennis because of outside pressures such as family does not support them playing tennis Is a 52 year old female, her age might inhibit her from recovering as quickly Having other obligations that interfere with tennis


Virtual

morning Face to face communication

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People are spaced so far apart it is difficult to communicate verbally. Hand signals may be used

4. Objects and their properties used: Materials: 

Water bottle

Tools:  

One tennis racket with appropriate head size and grip size for the person tennis balls (at least three tennis balls) with the appropriate types of tennis balls (high altitude or regular)



tennis shoes that are the right size



tennis shorts or tennis skirt with pockets to hold balls

Equipment: 

standardized tennis court (indoors or outside)



overhead lighting if playing after the sun goes down or indoors

5. Social demands: The social demands include; knowing the rules of tennis, the expectations of others participating in the activity, displaying good sportsmanship, understanding that tennis is a gentleman’s sport and acting appropriately. 6. Sequence and timing: 1. Grab at least two balls 2. Place one ball in pocket 3. Hold other ball in hand 4. Walk to one side of court 5. Have opponent walk to other side of court 5. Stand on appropriate side of court (opposite side of court as opponent) 6. Stand behind baseline 7. Make sure opponent is in position and ready to play 8. Serve ball over the net in opposite box 9. Ball must bounce in opposite service box 10. Watch ball bounce in service box 11. Opponent must hit ball off of one bounce 12. Watch ball as opponent hits ball back


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13. Be ready to run to where ball is hit, never take eye off the ball 14. Run to area where ball will be 15. Only allow ball to bounce one time 16. Position yourself on one side of o f the ball 17. Swing racket to hit the ball back over the net 18. Watch as your opponent hits ball back 19. Continue to hit ball over net until the point is over 20. The point is over once the ball goes into the net, hits out of bounds or bounces more than once on one side of the court 21. Repeat play 7. Body functions required: Function

Judgment

Concept formation

Metacognition

How It Is None Used Deciding where to hit the ball so that it is difficult for your opponent to hit it back Looking at where the ball is hit, your position on the court and the position of your opponent and deciding on the best way to hit the wall (backhand, forehand, overhead) and where to hit the ball to Thinking about what skill you can improve on to continue to get better as a tennis player for the next

Minimally Challenged

Greatly Challenged X

X

X


Cognitive flexibility

Insight/awareness

Sustained attention

Selective attention

Divided attention

Short-term memory

Working memory

Long-term memory

game Deciding to use a forehand or backhand when the ball is coming directly at you Knowing your limitations as a player and not trying to perform a slice shot when you have never practiced it before Concentrating on hitting the ball in the correct place Ignoring people cheering and staying focused on the game and where the ball is Talking to your opponent while playing Flipping a coin to decide who gets to serve first and remembering if they said heads or tails after the coin is flipped Trying different ways to hold the racket to improve backspin Having

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X

X

X

X

X

X

X

X


Discrimination of senses: Auditory Discrimination of senses: Tactile

Discrimination of senses: Visual

Discrimination of senses: Olfactory

Discrimination of senses: Vestibular-proprioception

Multisensory processing

played the game before, remembering the rules of the game Hearing your opponent call out the score Feeling the vibration in your hand when you hit the ball off center versus when you hit the ball off of rim of racket Discriminatin g between the shape of the ball and the shape of the racket The smell of a freshly opened pack of tennis balls vs Positioning yourself around the ball in order to have proper technique when hitting it back Seeing where the ball is on the court (visual) positioning your body to hit the ball (vestibular proprioceptio n) and feeling the vibration of the ball off

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X

X

X

X

X

X


Sensory Memory

Spatial relationships

Temporal relationships

Recognition

Categorization

Generalization

your racket (tactile) Feeling a ball and deciding if it is worn or new by the feeling of how much fuzz is on it Knowing the size of the court and where the net is to know how hard to hit the ball in order to get over the net but stay inside the court Knowing how long a normal tennis game should take and how long your game is taking Recognize the difference between the service court line and the baseline Categorizing the different types of rackets (small head, large head, round head) and using the one you like most to play tennis with Playing on an outdoor tennis court and being able to

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X

X

X

X

X

X


Awareness of reality

Logical/coherent thought

Appropriate thought content

Execution of learned movements

Coping

Behavioral regulation

play indoors. Also playing on a grass tennis court and being able to play on a clay tennis court Understandin g that if she plays at night she will need artificial light in order to see the ball Knowing the proper clothes to wear to play tennis Thinking about your strategy to the game while playing it and not being focused on what you are going to do after the game Having the ability to serve the ball over the net by using motor planning Having proper emotional regulation if your opponent scores a point on you or wins the game Smiling after scoring a point or frowning after hitting the ball

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X

X

X

X

X

X


Body image

Self-concept

Self-esteem

Arousal

Consciousness

Orientation to self

Orientation to place

Orientation to time

into the net Poor body image may affect participation in the activity and they may not participate due to the cloths you have to wear or because of embarrassmen t of not being in shape Perceived ability to play tennis Having the confidence to play and participate in tennis Moving out of the way of a ball flying at you Being awake and alert to play tennis Understandin g you are playing tennis Playing tennis at a tennis court instead of in the backyard Deciding when is the best time to play tennis. In the morning when it is cooler outside vs. in the afternoon when it is

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X

X

X

X

X

X

X

X


Orientation to others

Emotional stability

Motivation

Impulse control

Appetite Sleep

Function

Detection/registration

Visual modulation

hotter Being able to identify her opponent and know her name and being able to identify the other people on the next court as strangers The ability to stay calm and eventempered while playing tennis, even if frustrated Playing tennis is fun and enjoyable but will also keep you in good shape Resisting the urge to throw your racket when you are frustrated with the game n/a n/a

How It Is Used Being able to identify the shape of the tennis ball as it flies through the air Being able to focus on the flight of the ball and

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X

None

Minimally Challenged

Greatly Challenged X

X


Integration of senses

Awareness at distances

Tolerance of ambient sounds

Location and distance of sounds

Moving against gravity

Taste Smell Body in space

filtering out other visual stimuli such as the kids playing in the pool located next to the tennis court Hearing and seeing the ball bounce Knowing how far away the ball is to run for the ball or how far to reach the racket out in order to hit the ball To be able to play tennis with the sound of kids playing in the pool next to the tennis court After accidently hitting the ball outside of the tennis court, being able to listen to where it hit to judge how far it went and where it landed Running around the tennis court n/a n/a Movement of upper and lower

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X

X

X

X

X

X X X


Comfort with touch

Localizing pain

Thermal awareness

Joint range of motion

extremity in order to position body to hit the ball Comfort with clothes touching the body, with the feel of the racket, and with the feel of the racket in your hand Feeling a pain in your thumb, upon inspection you can see a blister forming Touching the water bottle to see determine if it is hot from sitting in the sun Normal range of motion (ROM) needed in the shoulder to reach overhead when serving and during net play, spine ROM needed in order to perform a proper forehand/back hand and normal ROM in lower extremities in order to move around the court

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X

X

X

X


Joint stability/alignment

Strength

Muscle tone

Muscle endurance

Stretch reflex ATNR STNR Righting and supporting reflex

Eye-hand coordination

Bilateral coordination

Crossing midline

Fine motor control

Ability to hold and hold racket and perform a backhand swing Strength to hit the ball over the net to your opponent Normal muscle tone to play tennis Enough endurance to play through an entire game of tennis n/a n/a n/a Ability to stabilize yourself when thrown off balance after quickly reaching for a ball Ability to hit ball with tennis racket Using both hands to perform a backhand swing Performing a forehand swing (start to same side of body and finish across the body) Grabbing a ball from your pocket

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X

X

X

X

X X X X

X

X

X

X


Oculomotor control

Gait patterns

Blood pressure

Heart rate

Respiratory rate

Respiratory rhythm

Respiratory depth

Physical endurance, aerobic capacity

Eyes tracing the movement of the ball as it passes back and forth across the net Normal gait pattern running around the court Normal response in blood pressure during exercise in order to continue to play tennis Normal response to heart rate during exercise, should increase as intensity of exercise increases Increase in order to meet oxygen demands Slightly faster to meet oxygen demands Increased to meet oxygen demands during exercise Being able to stand and move around at a moderate to high

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X

X

X

X

X

X

X

X


Voice functions Voice rhythm and fluency Alternative vocalization Digestive system

Metabolic system

Endocrine system

Urinary functions Genital and reproductive function Protective functions of the skin Repair functions of the skin

intensity level for the duration of the game n/a n/a n/a Good working digestive system Converting food to energy to sustain activity Release of hormones to sustain energy needs n/a n/a n/a n/a

8. Muscular analysis of movements required: Muscle Shoulder flexion

Shoulder extension Shoulder abduction Shoulder adduction Shoulder internal rotation Shoulder external rotation Elbow flexion Elbow extension Wrist supination Wrist pronation

Required? Greatly Challenged Greatly Challenged Greatly Challenged Greatly Challenged Greatly Challenged Greatly Challenged Greatly Challenged Greatly Challenged Greatly Challenged Greatly Challenged

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X X X X

X

X

X X X X


Wrist flexion

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Greatly Challenged Greatly Challenged Greatly Challenged Minimally Challenged Greatly Challenged Minimally Challenged Greatly Challenged Greatly Challenged Greatly Challenged Greatly Challenged

Wrist extension Thumb flexion Thumb abduction Finger flexion Finger extension Trunk flexion Trunk extension Trunk rotation Lower extremities

9. Body structures required:

Category

Body Structure

Nervous system

Frontal lobe Temporal lobe Parietal lobe Occipital lobe Midbrain Diencephalon Basal ganglia Cerebellum Brain stem Cranial nerves Spinal cord Spinal nerves Meninges Sympathetic nervous system Parasympathetic nervous system Eyeball: Conjunctiva, cornea, iris, retina, lens, vitreous body Structures around eye: Lachrimal gland, eyelid, eyebrow, external ocular muscles Structure of external ear

Eyes, ears, and related structures

Required? Check If Yes X X X X X X X X X X X X X X X X

X X


Voice and speech structures

Cardiovascular system

Immune system

Respiratory system

Respiratory system (continued) Digestive, metabolic, and endocrine systems

Genitourinary and reproductive systems

Structures related to movement

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Structure of middle ear: Tympanic membrane, Eustachian canal, ossicles Structures of inner ear: Cochlea, vestibular labyrinth, semicircular canals, internal auditory meatus Structures of the nose: External nose, nasal septum, nasal fossae Structure of the mouth: Teeth, gums, hard palate, soft palate, tongue, lips Structure of pharynx: Nasal pharynx and oral pharynx Structure of larynx: Vocal folds Heart: Atria, ventricles

X

Arteries Veins Capillaries Lymphatic vessels Lymphatic nodes Thymus Spleen Bone marrow Trachea Lungs: Bronchial tree, alveoli Thoracic cage Muscles of respiration: Intercostal muscles, diaphragm

X X X X X

Salivary glands Esophagus Stomach Intestines: Small and large Pancreas Liver Gall bladder and ducts Endocrine glands: Pituitary, thyroid, parathyroid, adrenal Urinary system: Kidneys, ureters, bladder, urethra Structure of pelvic floor Structure of reproductive system Ovaries, uterus, breast and nipple, vagina and external genitalia, testes, penis, prostate Bones of cranium Bones of face Bones of neck region Joints of head and neck Bones of shoulder region Joints of shoulder region Muscles of shoulder region

X

X

X X X X

X X X X X X X X X

X X X X X X X


Structures related to movement (continued)

Skin and related structures

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Bones of upper arm Ligaments and fascia of upper arm Bones of forearm Wrist joint Muscles of forearm Ligaments and fascia of forearm Bones of hand Joints of hand and fingers Muscles of hand Ligaments and fascia of hand Bones of pelvis region Joints of pelvic region Muscles of pelvic region Ligaments and fascia of pelvic region Bones of thigh Hip joint Muscles of thigh Ligaments and fascia of thigh Bones of lower leg Knee joint Muscles of lower leg Ligaments and fascia of lower leg Bones of ankle and foot Ankle, foot, and toe joints Muscle of ankle and foot Ligaments of fascia of ankle and foot Cervical vertebral column Lumbar vertebral column

X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Sacral vertebral column Coccyx Muscles of trunk Ligaments and fascia of trunk Areas of skin: Head, neck, shoulder, upper extremity, pelvic region, lower extremities, trunk, and back Structure of skin glands: Sweat and sebaceous Structure of nails: Fingernails and toenails Structure of hair

X X X X X

10. Performance skills required:


Skill

Required?

Motor/praxis

Yes

Sensory (perceptual)

Yes

Emotion regulation

Yes

Cognitive

Yes

Communication/soci Yes al

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How the Skill Is Used

Picking up the tennis racket to play tennis Pacing movements to swing the racket Adjusting body position in response to were the ball is Visually determining how far away the net is Being able to maintain balance by vestibular input due to position changes Controlling anger or frustration during the game Continuing to play even when frustrated or not playing well Problem solving how to hit the ball Following the rules of the game Communicating with your opponent if the ball is in or out Communicating who gets to serve first

11. Performance patterns: Parts of this occupation has elements of which of the following: (check all that apply) appl y) 

X

Pattern Useful habit

Describe Bouncing the ball three times before the serve to help refocus and catch breath before the next play

X X

Dominating habit Routine

Hitting your racket on your shoe after missing a point Following the routine of the game (serve and play until point is won)

X

Ritual

Shaking hands with your opponent after the match is over

X

Role

Participating in the role of a tennis player

Intervention Plan

1. Identify 1 objective and measurable goal of the intervention: The client will find a tennis racket, with the help of a tennis professional, which has the appropriate grip size for the size of her hand and a lighter racket within the next month. a. According to OTPF what type of outcome is this?


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The goal is considered adaptation because becaus e the client will modify the objects and its properties used in tennis in order to prevent pain from her lateral epicondylitis. 2. Intervention approach: 

Approach Create/promote

Describe

Establish/restore Maintain X

Modify

Modify the size of grip on racket and decrease the overall weight of the racket to minimize the amount of strain placed on the lateral forearm flexors.

Prevent

3. Activity selection a. Activity selection: Identify 1 example of each for the intervention plan Activity Occupation-based intervention

Describe Playing a short game of tennis with the appropriate tennis racket that had been fit to them. Also, playing tennis with a lighter ball such as a foam ball or racket ball in order o rder to decrease the amount of o f stress placed on the lateral forearm flexors, while still allowing the client to engage in tennis.

Purposeful activity Preparatory method

Dusting her blinds Performing pain management techniques such as ice, massage and heat.

b. Discuss how activity selection relates back to occupational profile and occupational analysis The activity selection is a crucial step in the intervention process, it should be an activity that is meaningful to the client. The information gained in the occupational profile can help h elp to determine what activities interest interest the client and are most most meaningful to them. As a therapist, we should pick activities that are gradable, adaptable, have a definite end point and require several


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body systems. The occupational analysis aides in determining all factors involved in the activity so the therapist can determine if the activity will e ncourage mastery of the skill and give the client a sense of accomplishment once completed. c. Discuss how activity selection will support achievement of client identified goals and goal of the intervention plan Activity selection will help to support achievement of client identified goals and goals of the intervention plan through participation in meaningful activities, and by working toward established goals set by the therapist and client in the the occupational profile. The occupation based intervention was playing tennis using using a lighter racket and lighter lighter tennis ball. This activity is meaningful to the client and allows the client to continue to p articipate in tennis while recovering from her lateral epicondilitis. The purposeful activity chosen for this client was dusting. This allows similar movements to the ones used in tennis. Dusting is also still meaningful to the client because it is part of her IADLs and fits into her role as a mother and wife. wife. The preparatory methods used were ice packs and heat packs to implement a pain management program. 4. Describe how intervention can be graded or adapted and why An intervention is graded to provide the client with a “just right challenge.” Therapeutic interventions should challenge the client but still allow them to successfully complete the activity. If therapy becomes too challenging for the client they may become frustrated and give up. In order to provide the “ just right challenge,” challenge,” grading grading up and grading down are used to adjust the activity as needed to stimulate stimulate success. Grading up is done to give the client a greater challenge, while grading down is used when the activity is too difficult for the client. To grade an activity the therapist should look at the activity demands, the context and a nd environment in which the activity takes place, the sequence and timing and the social demands of the activity, and then examine each one to determine where the activity can be made more challenging and


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where it can be made easier. For example, if the activity takes place in a loud environment with many distractions, try eliminating any distractions to grade the activity down. Adapting an activity is changing, modifying, or alternating the whole activity or parts of the activity so the client can successfully complete the occupation. The goal of adapting is to increase client participation and overall independence. This can be done by finding alternative methods of completing the activity or by using adaptive equipment. 5. Safety concerns and/or precautions The client has pain of the right lateral epicondyle with certain certain movements. Caution should be taken when performing movements that extend the wrist because, this could cause strain on the muscles and increase inflammation. 6. Discuss the role of the occupational therapy practitioner during the intervention The role of the Occupational Therapist (OT) in intervention is to guide an evidence b ased intervention that is goal directed and client cent ered. The OT should be there every step of the intervention process to insure progress is being made and to adapt or grade an activity as needed. The therapist should reevaluate and adjust ad just intervention to ensure short and long term goals are met and most importantly, the therapist should be there to encourage the client so that they can succeed in meaningful occupations and live life as independently as possible. 7. Discuss what is expected of the client during the intervention The client is expected to be a part of therapy and be compliment with the intervention plan. They are encouraged to ask questions and openly discuss any hesitations they may have with therapy. It is important for the client to be ho nest with the therapist about pain levels or hesitations so that therapy can be most beneficial. bene ficial.


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References American Occupational Therapy Association (2008). Occupational therapy practice framework: Domain and process (2nd process (2nd ed.) American Journal of Occupational Therapy.

occupational analysis intervention plan 1

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