FORM 5 Client-Activity Intervention Plan

Student: Kelly Garcia ___ _________________Date: September 29, 2011_________ _____________________

Activity: Putting groceries away__________________

1. Client Occupational Profile and Referral

A. Client Occupational Profile The client is a 60 year old woman who is married and has two older children. She works at a casino full-time, cleaning the floors and bathrooms. The client is seeking services because of lower back pain complaints, which are affecting her ability to stand and walk throughout the day. As a result, she is having trouble completing her job tasks at work and frequently comes home early. She is also unable to cook any meals that require her to stand for more than 20 minutes. Not being able to cook the meals she used to has affected her mood, because it was something that she enjoyed doing. Her environment at work increases the pain she feels in her lower back and prevents her from doing much when she arrives home. She has support from her husband in her environment at home, which is a small one story house, and her children have been visiting frequently to help her around the house. The client has been suffering from lower back pain for approximately three years, but the pain has significantly increased. She has asthma and had surgery in her right foot to earlier this year to remove a heel spur. She has been diagnosed with scoliosis, osteoporosis, and arthritis of the spine. The client wishes to regain her independence and engage in her normal day to day activities without having to constantly take breaks to lie or sit

down. The client has expressed that her main interest at the moment would be to cook a meal for her family again. Weaknesses Difficulty walking for periods longer than 10 minutes Difficulty standing for periods longer than 20 minutes Limited trunk flexion ROM Lower back pain Abnormal curvature of spine (scoliosis) Osteoporosis Arthritis of the spine

Strengths Supportive home environment Help from family Able to complete ADLs without assistance All body systems and functions working properly Normal ROM and strength on joints of the upper extremity Mental functions are not impaired

B. Referral The client was referred to receive occupational therapy services by her family physician after receiving a diagnosis of scoliosis and spinal arthritis from her pain and back doctor. Referring physician, Nilofar Kurashi, M.D., owns a private family practice located at 5557 E. Doctor Dr., Las Vegas, NV 89112, (702)555-5555. The

reason for referral was to teach the client proper body mechanics and energy conservation techniques that she can use at home and at work. Improving the clients posture and standing endurance was another main concern of the referring physician.

2. Intervention Goals
A. Long-Term Goal (First Priority) F: Cook independently -In order to cook at home independently, the client will demonstrate her increased standing endurance. E: The client will be able to stand without having to take a break to sit down. A: The client will cook one of her favorite family home cooked meals. S: The client will cook a meal under therapist supervision at an out-patient rehabilitation clinic. T: The client will cook a 40 minute meal without having to sit down within 8 weeks. Goal: Within 8 weeks, the client will successfully utilize proper body mechanic techniques to improve standing endurance and her motor skills of bending, to cook a meal for her family without assistance and without having to sit/lie down within in a time frame of 40 minutes. B. Short-Term Goal (Support) F: Meal preparationIn order to prepare a meal by herself, client will demonstrate her ability to use proper body mechanics. E: The client will stand and only take one brief break to sit down. A: The client will prepare a small meal. S: The client will prepare a meal under therapist supervision at an out-patient patient rehabilitation clinic.

T: The client will prepare a small meal in 20 minutes within 2 weeks. Goal: Within 2 weeks the client will improve standing endurance and utilize proper body mechanics to prepare a small meal within a time frame of 20 minutes, consisting of a 2 minute break at an interval of 9 minutes.

3. Intervention Activity Description

The client will have to put a bag of groceries away in a kitchen environment, while using proper body mechanics. This activity will concentrate on the clients standing endurance because she will have to stand and walk around the kitchen to put the items away. Her motor and praxis skills of bending will also be worked upon, since some items will have to be placed in a bottom cabinet. There will be approximately 15 items in a large tote grocery bag marked as either belonging in the fridge, counter, or a bottom cabinet. Steps: 1. Client will stand in front of a grocery bag and pick one item from the grocery bag. 2. Client will read the label on the item to determine if it belongs in the fridge, counter, or bottom cabinet. (Items will be labeled accordingly). 3. Client will either walk to the fridge to put the item away, walk to the kitchen cabinet and bend down to put the item away, or walk to the kitchen counter to put the item down. The client will use proper body mechanics while putting items away. 4. After the item is put away in its designated area, the client will then walk back or get back up from bending down, and walk to the table where the groceries are at. Client will continue to use proper body mechanics. 5. Steps 1-4 will be repeated until all 15 items are successfully put away.

4. Intervention Activity Preparation

In order for the client to complete the activity, I will need to teach the client proper body mechanics for standing, walking, and bending. The client needs to have a good foundational base of knowledge on how to properly bend down to put objects away, because it will help her conserve energy and limit any unnecessary strain on her back. I will also need to gather, set up, and label all of the 15 items that will be in the tote grocery bag before the client completes the activity. I will need to make sure the distance from the table, where the grocery bag will be, to the counter, fridge, and cabinet is a distance of 17 feet. If they are not a distance of 17 feet I will need to move the table further or closer away. This challenges the client and gives her enough space to comfortably move around. Making sure there is proper lighting and that the room is at an appropriate temperature are also things that need to happen ahead of time. Removing any potential environmental hazards, such as electric cords on the floor, is also an important consideration to take before the client can complete the activity. A. Review Goals and Describe Practitioners Role My chosen activity correlates with the goals I have written because the client will be working on her standing endurance and bending, which are all necessary skills that she needs to have in order to complete her long and short term goals of cooking and preparing a meal. I, the practitioner, will be involved with the preparation of the activity by gathering all of the necessary materials, such as the tote grocery bag and 15 items; as well as labeling the 15 items. I will also be instructing the client on proper body mechanics and the most appropriate ways to bend down and reach objects. As a part of the activity preparation, I will make sure the kitchen is ready,

there is enough distance between the table and points of interest (e.g. refrigerator, counter, and cabinet), and that the environment is safe. B. Personnel Required to Complete the Preparation For the majority part of the preparation, only one person is required. For example, gathering the tote grocery bag, the 15 items, and labeling the 15 items appropriately, can be done by one person, the practitioner. However, if there is not an adequate amount of distance between the table where the grocery bag is at and the refrigerator, then the practitioner might need the help of another practitioner to move the fridge or table a few feet closer or further away. I will also need the client to be present during a portion of the activity preparation process. That portion is when I will be giving the client instructions on how to use proper body mechanics. C. Required Preparation Time If all of the items that I plan to use are present in the kitchen, then I will need approximately 30 minutes to completely prepare for the activity. I will need 10 minutes to label all 15 items with a Sharpie marker and arrange them in the grocery tote bag. I will need 10 minutes to make sure there is enough space and that the environment is safe for the client to be in. Finally, I will need another 10 minutes to teach the client proper body mechanics for bending, reaching, standing, and walking. However, the length of the activity preparation may vary if the items are not in the kitchen of the out-patient rehabilitation center. In that case, I will have to bring the items from my house and then take them back after the activity has been completed. D. Required Place and Space

There needs to be enough space for the client to move around in safely, but also enough space for the client to be challenged and practice their standing endurance. There needs to be a distance of approximately 17 feet from the table where the tote grocery bag is to the fridge, counter, and cabinet. The activity preparation portion of teaching the client proper body mechanics can also take place in the kitchen. As long as the space detailed above is met, then the practitioner has enough space to demonstrate and teach the client the proper body mechanics necessary. E. Materials The objects used for the activity preparation include, a tote grocery bag and the following 15 items: a water bottle, a jar of mayonnaise, a jar of jelly, a carton of milk, a carton of a dozen eggs, five cans of tomato sauce, a roll of paper towels, a bag of plastic spoons, a loaf of bread, a bag of flour, and a small bag of potato chips. Five items will be marked as belonging in the fridge (a water bottle, a jar of mayonnaise, a jar of jelly, a carton of milk, a carton of a dozen eggs), another five will be marked as belonging in the cabinet (five cans of tomato sauce), and then the remaining five items will be labeled as going on the counter (a roll of paper towels, a bag of plastic spoons, a loaf of bread, a bag of flour, a small bag of chips). Properties: The tote grocery bag is light weight and made from cotton. It is smooth textured and sturdy, but bendable. It has two handles attached to it. The water bottle is a 16.9oz plastic water bottle. It is cylindrical shaped with ridges on the side. It has a small white cap with ridges and a paper label wrapped across it.

 The jars of mayonnaise and jelly are glass, smooth, and shiny. The jar of jelly has a net weight of 15.5oz and the jar of mayonnaise contains 16 fluid oz. They are approximately the same height. The carton of milk is white and cold when you touch it. It is one liter and comes in a square shaped carton. It has two pointy edges at the top for the opening. The carton of dozen eggs is gray, rectangular shaped, and has 12 oval-shaped bumps at the bottom for the eggs. It is also cold when you touch it. The five cans of tomato sauce are small, round, cylindrical aluminum cans. They have a red nutritional label with the picture of tomatoes. They have a net weight of 8 oz. The 60-sheet roll of paper towels is long, cylindrical shaped, and covered in a thin layer of plastic. It is soft and easily bendable when you grasp it. The bag of plastic spoons is small and holds 20 spoons. It is light weight and can be easily torn. The plastic is see through and has a smooth texture. The loaf of bread is rectangular shaped and has a net weight of 20oz. It is covered in a thin white plastic bag. It is light weight and squishy. The bag of flour is white and sturdy. It has a net weight of 5lbs. It has a smooth, slippery texture due to flour particles that seep through the opening. The bag of potato chips is plastic, black and brown. It has a net weight of 2.125oz. It has a rough, bumpy texture due to the potato chips inside. F. Equipment The equipment required for the activity preparation includes a black sharpie or marker, to clearly label the 15 items, and a table. A black Sharpie or marker is a thin black and gray colored object. It has a cone shaped cap that has to be removed in

order for someone to write with it. After the cap is removed it emits an alcohol odor. The table is a small, round, brown, and smooth wooden table. It has four wooden legs and is strong enough to hold the tote grocery bag with all 15 items. Another piece of equipment that I will use is a measuring tape to measure the distance from the table to the counter, fridge, and cabinet. Measuring tape comes encased in a hard, rough, and black plastic. It has a yellow aluminum tape that is used to measure objects. The yellow tape is shiny, bendable, and has sharp, thin borders. There are also small printed numbers on the tape. At the end of the tape there is a metal folding that allows the tape to be pulled out from its casing. The tape is also retractable. That is basically all of the equipment necessary to prepare the activity since the preparation only consists of gathering the materials necessary, labeling them, and making sure there is enough space for the activity to be carried out in. The part of the activity preparation that involves teaching the client the proper body mechanics of bending, walking, and standing, does not require any additional equipment, because the therapist will only be demonstrating how to carry out the movements. G. Safety Precautions for Personnel The safety precautions for the personnel during the activity preparation of the activity are minimal. The practitioner needs to make sure to use proper body mechanics when gathering the materials necessary, in order to avoid any injury to their back. If the refrigerator needs to be moved to meet the space requirements of the activity, then the personnel involved in moving the fridge need to be careful not to strain or damage their back during the process. Proper body mechanics should be used or a large moving dolly if necessary. If the practitioner is sensitive to the odor that Sharpies

emit, then a different marker needs to be used to label the items. A portion of the activity preparation process is to teach and demonstrate the client how to use proper body mechanics when walking, standing, and bending down. Potential safety precautions during this portion for the client include the environment. Depending on the texture of the floor and the shoes worn by the client, this could create a potential fall hazard.

5. Intervention Activity Implementation

A. Personnel The practitioner and the client will be the only ones involved with the completion of the activity. The client will carry out the tasks involved in the activity, such as putting the items away using proper body mechanics and the practitioner will supervise the client and make sure they are completing the activity correctly. B. Setting and Location This activity will take place in the out-patient rehabilitation clinic that the client was referred to. The out-patient rehabilitation clinic has a kitchen for practitioners to work on their clients ADLs and IADLs with. There is appropriate lighting, temperature, and space available. The floors are linoleum and there is a grip mat next to the kitchens sink. C. Space Required The space required for the activity to take place is the same as the space requirements checked during the activity preparation portion. In other words, there needs to be an adequate amount of room between the client and the points of interest. There needs to

be approximately 17 feet of distance between the table where the groceries are placed to the refrigerator, the counter, and the cabinet. D. Environment The environment that the activity will take place needs to be at room temperature for the client to be comfortable. There will also need to be proper lighting to ensure client safety. Due to the fact that the activity will be carried out at the kitchen of an outpatient rehabilitation clinic, the environment will consist of background noise and other clients and therapists walking around. E. Materials The materials necessary for the actual activity are a tote grocery bag, a water bottle, a jar of mayonnaise, a jar of jelly, a carton of milk, a carton of dozen eggs, five cans of tomato sauce, a roll of paper towels, a bag of plastic spoons, a loaf of bread, a bag of flour, and a small bag of potato chips. Properties: The tote grocery bag is light weight and made from cotton. It is smooth textured and sturdy, but bendable. It has two handles attached to it. The water bottle is a 16.9oz plastic water bottle. It is cylindrical shaped with ridges on the side. It has a small white cap with ridges and a paper label wrapped across it. The jars of mayonnaise and jelly are glass, smooth, and shiny. The jar of jelly has a net weight of 15.5oz and the jar of mayonnaise contains 16 fluid oz. They are approximately the same height. The carton of milk is white and cold when you touch it. It is one liter and comes in a square shaped carton. It has two pointy edges at the top for the opening.

 The carton of dozen eggs is gray, rectangular shaped, and has 12 oval-shaped bumps at the bottom for the eggs. It is also cold when you touch it. The five cans of tomato sauce are small, round, cylindrical aluminum cans. They have a red nutritional label with the picture of tomatoes. They have a net weight of 8 oz. The 60-sheet roll of paper towels is long, cylindrical shaped, and covered in a thin layer of plastic. It is soft and easily bendable when you grasp it. The bag of plastic spoons is small and holds 20 spoons. It is light weight and can be easily torn. The plastic is see through and has a smooth texture. The loaf of bread is rectangular shaped and has a net weight of 20oz. It is covered in a thin white plastic bag. It is light weight and squishy. The bag of flour is white and sturdy. It has a net weight of 5lbs. It has a smooth, slippery texture due to flour particles that seep through the opening. The bag of potato chips is plastic, black and brown. It has a net weight of 2.125oz. It has a rough, bumpy texture due to the potato chips inside. F. Equipment: Assistive Devices and Adaptations Included The equipment required for the completion of the activity includes a table, a kitchen counter, kitchen cabinets, and a refrigerator. The table is a small, round, and smooth brown wooden table. It has four wooden legs and is strong enough to hold the tote grocery bag with all 15 items. However, any sized shaped, color, or size of table can be used as long as it can hold the tote grocery bag and items. The kitchen counter is connected to the wall, wooden, sturdy, and has a smooth counter surface. It is large enough to hold the five items in the grocery bag. The refrigerator is tall and heavy. It has at least two handles and doors. The inside of it is cold, has light, and shelves to

store food on. The kitchen cabinets are below the kitchen counter. They are wooden and have a small round handle. G. Required Intervention Time The amount of time required for the activity ultimately depends on the client and her ability to stand throughout the activity. Steps 1-5, which includes the client picking an item from the bag, reading the where the item should go (e.g. cabinet, counter, or fridge), walking and putting the item away, and walking back to the table to get another item, should take one minute or less. In total, the activity should take approximately of 15 minutes. H. Safety Precautions for Client A potential hazard that could cause harm to the client is the kitchens floor, because it is linoleum and the client might slip and fall if they do not have appropriate footwear. Also, the activity requires carrying some objects that might be heavy to the client, such as a bag of flour, and this could possibly injure the clients back if they do not use proper body mechanics. Putting the items away can also be a potential hazard if the client does not use proper body mechanics when standing, walking, and bending down.

6. Intervention Activity Sequence (10 action steps or less)

1. Client will stand in front of a grocery bag and pick one item from the grocery bag. i. This step falls into the Areas of Occupation domain because standing in front of a grocery bag and picking an item from it, is a component of an Instrumental Activities of Daily Living (IADL) activity. Shopping falls

under IADLs and a part of shopping is putting the items away, which is what the client is beginning to do in this activity. ii. This step falls under the Client Factors domain because it requires the client to use her body functions and structures (e.g. her upper and lower extremity structures) to stand and move her arm to pick an item from the grocery bag. iii. This step falls under Performance skills because the client will be using her motor and praxis skills of standing and keeping her balance as she reaches to grab an item from the tote grocery bag. Depending on the item she reaches for, she will have to use her fine motor skills and hand strength to grasp the item. The client is also using her proprioceptive skills as her arm reaches to grab an item and her cognitive skills to follow the directions of the step. The clients sensory and perceptual skill of touch is also being used when she reaches into the bag to feel for an item. iv. This step falls under performance patterns, because standing is a part of the clients routines and roles throughout her day. For example, she has to constantly stand at work to do her job. Standing in front of a grocery bag and reaching in to pick an item can also be something that she engages in routinely, about twice a month, when she goes grocery shopping. v. This step falls under the Context and Environment domain because it is taking place in the physical environment of a kitchen, which is where the client enjoys being at her house. The personal context and environment of

this step is a 60 year old woman with a job standing in front of a grocery bag as a part of therapy. vi. This step falls under activity demands because the client is standing in front of the materials that will be used in the overall activity: a grocery tote bag and 15 grocery items. It also prompts the client to use the required body functions and body structures of the activity, because the client is using her lower and upper extremity structures to complete the step. 2. Client will read the label on the item to determine if it belongs in the fridge, counter, or bottom cabinet. (Items will be labeled accordingly). i. This step falls under the Areas of Occupation domain, because looking at an item from a grocery bag and deciding where to put it away in a kitchen is a component of the IADL activity of grocery shopping and cleaning of home management. For instance, when cleaning or putting groceries away an individual needs to look at the item and determine where it belongs. ii. This step falls under the domain of Client Factors because it requires the client to use her mental, sensory, and neuromusculoskeletal body functions to stand, read the label on the grocery item, and decide if it goes in the fridge, counter, or bottom cabinet of the kitchen. iii. This step falls under the Performance Skills domain because the client is using her sensory perceptual skills of visually reading the label and identifying where the item belongs. The client also uses her cognitive skills in this step to sequence the steps she will have to take now that she

knows where the item belongs, such as whether she has to walk to the fridge, counter, or cabinet. iv. This step falls under the domain of Performance Patterns because identifying where a grocery item needs to be put away in a kitchen is a routine that the client engages in every time she goes shopping. It can also relate to her role as the primary household care taker. v. This step falls under the Context and Environment domain because it is taking place in the physical environment of a kitchen, which can influence her performance in the activity because she enjoys cooking. This step can also be broken down into the personal context of a 60 year old woman who has a job, enjoys cooking, and is receiving occupational therapy services. vi. This step falls under the Activity Demands domain because the client is looking at a grocery item (an object of the activity) and determining where it will have to be placed. The client is also using some of the required body functions and structures need to carry out the activity by completing this step, such as her mental functions and eyes. 3. Client will either walk to the fridge to put the item away, walk to the kitchen cabinet and bend down to put the item away, or walk to the kitchen counter to put the item down. The client will use proper body mechanics while putting items away. i. This step falls under the Areas of occupation domain because the client is essentially putting away a grocery item away in a kitchen. This is a

component of an IADL, because it can be considered a part of cleaning or home management. It is also the end result of when an individual goes grocery shopping. ii. This step falls under the Client Factors domain because the client is using the body functions and structures that reside within her to complete the step. She is using her neuromusculoskeletal functions to move, walk, bend, and stand. Her cardiovascular and respiratory body systems must be working to allow her do this. This step also requires her to use most of her body structures that allow movement and promote healthy functioning (e.g. legs, arms, and heart). This step also requires her to use her memory to remember the proper body mechanic techniques taught to her (mental function). iii. This step falls under the Performance Skills domain because the client has to use her motor and praxis skills of walking, bending, and using her balance to put the item away. Depending on the item she grabbed, the client will have to use her fine motor skills to hold on to the object or to open the fridge or cabinet doors. The client also has to use her cognitive skills to judge how she is going to walk and/or bend down to put the item away, while using the proper body mechanics that were instructed to her earlier. iv. This step falls under the Performance Patterns domain because walking to the refrigerator, kitchen counter, or cabinet can be something that the client engages in daily. For example, as a part of her daily routine in the

morning or going to work. Putting a grocery item away in the kitchen can also be a routine that she engages in every time she goes grocery shopping. v. This step falls under the Context and Environment domain because it takes place in the physical environment of a kitchen. It is taking place during the day and a person is completing the step as a part of a therapy session. The person is a 60 year old woman, who works full-time. vi. This step falls under the Activity Demands domain because the client is not only engaging in the required actions of the activity and using the required body structures and functions, but they are also carrying an object of the activity with them. 4. After the item is put away in its designated area, the client will then walk back or get back up from bending down, to the table where the groceries are at. Client will continue to use proper body mechanics. i. This step falls under the Areas of Occupation domain because walking back to the kitchen table where the groceries are at is a part of functional mobility, which is an activity of daily living (ADL). Functional mobility means moving from one place to another during every day activities, which is what the client is doing. Walking back and forth to get grocery items and putting them away can also be considered a part of IADLs of home management (keeping the house clean) and grocery shopping. ii. This step falls under the Client Factors domain because the client is using her body structures and functions to walk back to the table

successfully. These structures and functions include her feet, legs, and all of her body systems. iii. This step falls under the Performance Skills domain because the client is using her motor and praxis skills of getting up from bending down and she is coordinating her body movements to complete the step. She also has to maintain her balance while walking back. iv. This step falls under the Performance Patterns domain because walking back to a kitchen table after putting a grocery item away can be a part of the clients grocery shopping routine. The task of simply walking to a kitchen table from one point of a kitchen to another can be a daily routine that the client engages in at home. v. This step falls under the Context and Environment domain because it is taking place in a physical environment. The environment is the kitchen of an out-patient rehabilitation clinic. It is taking place during the day and the person is a 60 year old woman, who works full-time and is receiving occupational therapy. vi. This step falls under the Activity Demands domain because the client is using the underlying body structures and functions needed to carry out the whole activity. During this step the client is not holding a physical object of the activity, but the client is using her legs and joints to walk back to the table. The client is also doing this step in the space demands of the activity, which include a 17 ft. distance between the table and counter, cabinet, and fridge.

5. Client will repeat steps 1-4 until all 15 items are successfully put away. This step is a repetition of all of the previous steps in the activity and therefore how it fits into the 6 domains of occupational therapy has already been explained. Overall, step five is a combination of how steps one through four fit into each of the domains of occupational therapy.

7. Documentation:
A. Domain In general, the activity fits into the domains of occupational therapy because it involves certain aspects of each domain. The activity of putting groceries away can be considered an area of occupation, particularly an instrumental activity of daily living, and it takes into consideration the client factors, performance skills, performance patterns, context and environment, and activity demands. For example, it is not going against any of the clients beliefs or spirituality and it can be associated with her values, because she enjoys cooking. It also uses the clients body structures and functions, which are a part of the client factors domain. This activity requires the client to use her sensory perceptual, motor, and cognitive skills as she physically puts the groceries away (performance skills). The fact that she is doing an activity that involves putting groceries away falls under the performance patterns domain, because putting groceries away can be part of her monthly routine at home. Completing this activity can even help her at home when she does it as part of her shopping routine. Where the activity takes place, who the client is, and the tools and materials required for the activity, are all things that can fit under the context and environment and activity demands domains of occupational therapy. The activity

focuses on certain aspects of the domains, which helps improve the clients help and engagement during treatment. B. Process I used the occupational profile to create an intervention that will focus on what the client needs help with and fits in with what the client enjoys doing. Implementing this intervention will ultimately help the client achieve the occupational therapy outcomes because it is purposeful activity. The activity of putting groceries away allows me to see what the client can do and needs help on to achieve the established occupational therapy outcomes. I also used the occupational profile to create interventions that relate to her goal of wanting to prepare a meal for her family, without having to take a break to sit down. In other words, I created goals and interventions based on her desire to increase her standing endurance. I took the intervention planning and implementation a step further by also having it work on her motor skills of bending and teaching her proper body mechanics, so that she may be able to conserve her energy as she completes activities. By taking into account who the client is, what the client hopes to achieve, and creating interventions that work on her performance skills, is how I have utilized the occupational profile, intervention planning, and intervention implementation to achieve the occupational therapy outcomes of quality of life and role competency. Furthermore, by creating an intervention that teaches the client proper body mechanics I have achieved the occupational therapy outcome of prevention. By the end of the intervention, her occupational performance should improve. C. SOAP Note

Subjective: The client Mrs. C. was ready to participate in the therapy session after practicing some stretching/strengthening exercises at home that her doctor had given her earlier in the week. She was complaining of a pain in her lower back and mentioned that she did not take any pain medication today because it made her nauseous and light headed yesterday. Objective: The client engaged in 6 minutes of a motor and praxis skills activity that worked on her standing endurance and bending, before having to sit down. After taking a three minute sitting break, the client continued with the activity and successfully put the remaining 8 grocery items away in 9 minutes. Client has limited trunk flexion and has bad sitting/standing posture. Despite demonstration and cuing, the client continues to engage in erroneous proper body mechanics. Client has upper and lower extremity function and active range of motion. However, the client has limited endurance in her lower extremities. Her proprioceptive and vestibular functions are not affected by her lower back pain. Assessment: Mrs. C. was engaged and motivated throughout the session. She demonstrated an improvement in utilizing proper body mechanics toward the end of the activity; however she needs constant cuing to prevent her from forgetting the proper body mechanic techniques for walking, standing, and bending. The client has low standing endurance and an abnormal spine curvature, which affects her pace when she walks and the amount of time that she can stand/walk. The client would benefit from compensatory strategies and energy conservation procedures that can be provided with occupational therapy. Additionally, with continued skilled occupational

therapy intervention, Mrs. C. has the potential to improve her standing endurance, bending, and manage her pain. Plan: Address the clients poor posture by continuing to teach her proper body mechanics. Address forgetfulness on proper body mechanic techniques by giving client a worksheet to practice at home and as a reminder. Educate family members, particularly the husband, on her condition and what can be done in her home environment to help her. Address standing endurance with therapeutic standing and strengthening exercises. Address limited trunk flexion with ROM exercises.
(Hersch, Lamport & Coffey, 2005)

Reference American Occupational Therapy Association (2008). Occupational therapy practice framework: Domain and Process (2nd ed.). Baltimore, MD: AOTA Press