Running head: OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile and Intervention Plan

Austin Lepper

Touro University Nevada

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Occupational Profile
The Client
The client is a 58 year old male who is diagnosed with a right index fingertip amputation.
The client is married and has two children who live out of state. The client works for Planet
Hollywood casino and is a stage manager for Cirque du Soleil. The client lives in a two story
home and does not have any problems ambulating around the house. The client has two golden
retrievers and one cat. The client enjoys working around the house, maintain his pool, and going
to dinner with friends.
Rationale for Services
The client is seeking services with workers compensation after sustaining a fingertip
amputation when he cut himself using a table saw while building stage equipment. The client
underwent reconstructive flap surgery four weeks ago in order to treat the injury. The physician
was unable to save the finger and the client has an amputation slightly distal to the distal
interphalangeal (DIP) joint of the index finger.
The client is very concerned with returning to work as soon as he can. The client
complains of severe pain in the finger anytime pressure is applied. The client has been unable to
complete routine housework and has had to hire a pool maintenance worker and a landscaper
which the client claims is a burden financially. The client has mentioned that he is able to
complete most activities of daily living (ADLs) using his non dominant left hand, but that it
takes him a lot more time to complete the activities. The client is concerned that he will not be
able to functionally use his right hand, and he does not know how he would be able to work
without the use of his right hand.

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Areas of Occupation
The client is successful in areas of occupation including most all of his ADLs and the
majority of his instrumental activities of daily living (IADLs). The client is successful with his
education, play, and social participation occupations as well. The areas of occupation that are
causing problems are his rest and sleep, leisure and work. The client is successful in all ADLs
except for grooming.
The client has a hard time shaving his face and he mentioned that his wife has to shave
for him. The client also has a hard time fixing his hair because of the incoordination and
endurance in his left hand.
The IADLs that the client struggles with is in the area of home establishment and
management. The client is unable to maintain and upkeep his pool and landscaping around the
house. The client has had to hire a pool maintenance worker and landscaper.
The client is having problems with his rest and sleep at night because of the pain in his
finger. The client stated that he takes pain medicine at night before bed, but it is still difficult for
him to sleep because his finger is throbbing. The client then mentioned that when he finally does
fall asleep that the pain will wake him up. The client said that when he is asleep he constantly
will roll over or hit his finger on the bed post causing severe pain.
The areas of occupation that include leisure activities the client is unable to engage in is
shooting guns. The client mentioned that shooting guns is very meaningful to him and he wants
to regain the ability to shoot guns.
Another area of occupation that the client is unable to do is work. The client is very eager
to get back to work, but because his job requires lifting heavy objects and using both hands so

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much, he is unable to go back to work. The major area under work that is affected due to his
injury is his job performance.
Occupational History
The client was born and raised in Las Vegas and started working for various hotels on the
strip after he graduated from high school. The client met his wife while he was working and she
was performing in the show. They have two children including one boy and one girl. The client
has had multiple jobs in the entertainment industry on the strip and has been employed with his
current employer for the past 10 years.
The primary roles of the client include being a husband and a father. The client is
interested in traveling when he retires and spending time with his family and visiting his kids and
soon to be grandchildren. The client is also interested in spending times with friends and being
able to stay independent. The client is motivated to be able to regain the functional use of his
right hand and return to his occupations.
Clients Priorities and Desired Outcomes
The clients priorities are to return to work as soon as possible and regain all the range of
motion (ROM) in his right hand. The client wants to decrease the pain in his finger so that he can
passively move it to increase ROM. Other priorities for the client include becoming independent
in all of his areas of occupation. It is important to the client to be able to get better sleep to
promote a better mood in order to increase his quality of life.
The desired outcome of the client is that he can get back to work and be able to have
functional use of his right hand as if there had never been an injury on his finger. The client is
nervous about regaining functional movement in his hand, and he wants to be able to take care of
his pool and his landscaping independently so that he does not have to hire those jobs out. Lastly,

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the client wants to be able to get through his morning routine and all of his ADLs just as
efficiently as he did before the injury.
Occupational Analysis
Context of OT Setting
The setting for the occupational therapy services is an outpatient hand therapy clinic
called Hand Surgery Specialists of Nevada. This company is owned and operated by four local
physicians that specialize in hand surgery, shoulder surgery, and pediatric hand surgery. The
majority of the clients that are seen at the clinic are either self-pay clients or workmans
compensation clients.
The certified hand therapist (CHT) is usually treating up to three clients at a time. The
client walks in the door of the clinic and is greeted by the office secretary and then the secretary
usually sets the client up with a moist heat pack (MHP) while the therapist is working with
another client. Each treatment session varies from about 45 minutes to one hour in duration. The
setting is very fast paced but the CHT does a great job in talking with each client and addressing
any concerns or questions that the clients may have.
Observed Activity
The CHT took the client through various activities to improve ROM, pain management,
and tactile sensitivity. An activity that I was able to observe was implemented by the CHT to
help increase the clients tactile sensitivity. The client was to brush his fingertip over a towel
while tolerating the pain to the best of his ability. The therapist had the client write out his name
on the towel with his fingertip in order for the finger to receive the tactile sensitization.
The CHT was able to grade the activity up and down by providing different textures for
the client. When the pain got to be too high for the client the therapist would use wax paper

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instead of a towel to grade the activity down. The client was able to perform the activity on his
own and did very well with the activity. The activity was painful for the client, but the therapist
explained the importance of retraining those nerve endings in the fingertip to promote tactile
sensitization.
Performance Observations
While the client was completing the tactile sensitivity activity the client was grimacing
with pain. It is important that the CHT document the pain for the client while he is attempting the
different textures throughout the activity.
The client is seeking occupational therapy services in order to regain the functional use of
his finger and right hand. The client must be able to touch different textures with his finger in
order to regain the functional use of his right hand. This activity is in direct relation to why the
client is seeking occupational therapy services.
The domains of the occupational therapy practice framework (OTPF) that are most
significantly impacting the clients ability to engage in the activities that I am observing include;
client factors, performance skills, and performance patterns. The client factors that are impacted
based on observations are the body functions and body structures. The client is struggling to get
used to the fact that he is missing one of his fingertips and it is affecting the functional use of his
right hand. The performance skills that are impacted while engaging in the activity are the motor
skills and process skills. The performance patterns that are impacted include the habits and
routines that the client is attempting to adjust to while performing the activity.
Problem List
1. Client is Min (A) in shaving and hair care due to right index finger amputation.
Rationale. This problem statement is prioritized at number one because it is
meaningful to the client as well as a necessity. Shaving and hair care are ADLs that the

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client needs to be able to do independently in order to get back to work and improve
quality of life. These activities are appropriate for outpatient rehab and can be addressed
in this setting.
2. Client is Mod (I) in leisure activities due to severe pain in his finger s/p reconstructive
flap surgery in his right index finger.
Rationale. This problem statement is prioritized second because if it is not
addressed the client could become depressed and unmotivated which could lead to further
complications in other occupations. It is important to keep the client engaged in therapy
treatments, and this problem statement should be addressed early in the intervention
process.
3. Client is unable to return to work due to right index finger amputation.
Rationale. This problem statement is listed at number three because the client is
very concerned about returning to work. The reason it is not number one or number two
is because those problem statements need to be addressed before the client can return to
work.
4. Client is Min (A) for bathing due to tactile sensitivity in his finger s/p reconstructive flap
surgery in his right index finger.
Rationale. This problem statement is number four because although it is
meaningful to the client it cannot be directly addressed in the outpatient setting. Bathing
is very important and is a problem area for the client, so the CHT should address bathing
and demonstrate how it can be modified and work with the client to help improve his
bathing at home.
5. Client is unable to complete landscaping activities due to inability to use his right hand
s/p reconstructive flap surgery in his right index finger.
Rationale. This problem statement is prioritized at number five because the client
has resolved the issue by hiring out a landscaper. The client does wish to landscape

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independently, but it is prioritized number five because the client would rather address
the above problems first.
Intervention Plan & Outcomes
Long-term Goal
Client will shave and comb his hair independently with his right hand by the end of 4
weeks.
Short-term goal. Client will shave with supervision with his right hand using a built up
handle by the end of 2 weeks.
Intervention. The initial step for intervention would be for the CHT to first and
foremost fabricate a splint for the client. The splint will protect the finger, and the CHT
will educate the client on wound care and donning and doffing the splint. The client will
then be educated and introduced to different adaptable handles and select the one that
provides the most comfort and ease of use while shaving. The client will then be applied
with a moist heat pack (MHP) prior to treatment for 15 minutes in order to increase ROM
in the finger. Following MHP the client is hypersensitive in his finger so the client will
then be introducing textures to his finger tip in order to enhance his ability to hold on to
the razor while shaving. The client will then be educated on pain control techniques while
practicing shaving. The CHT will then manually stretch the other fingers to ensure that
they will not become stiff in the joints.
Intervention approach. The most appropriate intervention approach for this
intervention is the establish/restore approach. This is the most appropriate approach
because the intervention is designed to restore the skill of shaving, and for the client to
learn how to become efficient with shaving even with his current impairment.

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Client/caregiver training and education. The client and caregiver training and
education for this intervention includes teaching the client proper wound care techniques
and demonstrating safe handling of the finger while donning and doffing the splint. The
client and caregiver will also be introduced to various built up handles for the clients
razor to promote independence in shaving. The CHT will also be there to guide treatment
and answer all the questions that the client or caregiver may have.
Precautions. This intervention has precautions including the MHP and making
sure to not burn the client. There are also precautions while applying the splint and
making sure the material is not too hot for the clients finger. Wound care can be painful
for the client, and it is important to have a calm voice and be gentle with the client while
addressing wound care.
Grading up/grading down. This intervention could be graded up and graded
down during the sensitivity activity and by proving smooth textures to grade it down and
more rough textures to grade it up. The CHT could also grade up the intervention by
providing the client with a home exercise program (HEP) in order to increase the use of
his right hand and begin working on strengthening the hand and finger.
Outcomes for intervention. The outcomes that are hoped to be achieved through
this intervention are improving the clients quality of life and overall well-being. The
client will be introduced to various built up handles to promote independence for the
client, which will lead to an overall better quality of life. The well being of client is being
addressed by fabricating a splint in order to protect the clients finger.
Literature review. Amini (2011) examined effective rehabilitation techniques in
individuals with work-related injuries or conditions of the forearm, wrist, and hand. This

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systematic review applies to the intervention because the client sustained a work related
injury in his hand. The review explores various preparatory activities that are commonly
used in the hand therapy setting. The study discusses the benefits of splinting and also
thermal modalities which are both being used in my intervention. The review includes a
total of 36 studies and the results support the premise that many client factors can be
positively affected through the use of several commonly used occupational therapyrelated modalities and methods.
Short-term goal. Client will comb his hair with supervision using his right hand by the
end of 2 weeks.
Intervention. The CHT will conduct the Canadian Occupational Performance
Measure (COPM) of the client to better comprehend the clients concerns and goals for
occupational therapy services. The client will then be applied with a moist heat pack
(MHP) prior to treatment for 15 minutes in order to increase ROM in the finger. The
client will then be applied with electrical stimulation for ten minutes in order to decrease
pain and edema in the hand and finger. The CHT will then instruct the client on
compensatory techniques for combing his hair in order to promote independence. The
client will then practice combing his hair with a brush using compensatory techniques
and supervision from the CHT. Lastly, the CHT will manually stretch the other fingers to
ensure that they will not become stiff in the joints.
Intervention approach. The intervention approach that is most appropriate for
this intervention is the establish/restore approach. The clients impairment in his finger is
expected to heal and the client will be able to restore the skills that he was able to

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accomplish prior to the injury. Many of the interventions are preparatory activities that
will help to restore the client to full independence.
Client/caregiver training and education. The client and caregiver will be
educated on different compensatory techniques for combing the clients hair. The client
will be educated on energy conservation techniques will combing his hair. The CHT will
also answer any questions that the client or caregiver may have regarding treatment.
Precautions. This intervention has precautions including the MHP and making
sure to not burn the client. Electrical stimulation has precautions such as making sure the
client does not have a pacemaker. Electrical stimulation could be painful to the client and
it is important for the CHT to make sure and not set the electrical impulses to high.
Grading up/grading down. The intervention could be graded up by requiring the
client to do a sensitization activity while receiving electrical stimulation. The intervention
could be graded down by the therapist providing minimum assistance during the combing
activity.
Outcomes for intervention. The outcomes that are hoped to be achieved through
this intervention are role competence and quality of life. Role competence is hoped to be
achieved by conducting the COPM and engaging the client in roles that he once assumed
before the injury. Quality of life outcomes are expected to be achieved by incorporating
pain management in the intervention, as well as compensatory techniques to promote
independence.
Literature review. Jack & Estes (2010) investigated the benefits of developing
interventions using a client centered approach, and more specifically examining the hand
therapy setting using an occupational adaption approach as opposed to the traditional

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biomechanical frame of reference. This study is applicable to the intervention because it

utilized the COPM in order to promote an occupational adaption approach. The study
used the COPM to provide a baseline to gain input from clients and determine which
occupational tasks were of most concern. The findings indicate clinically important
improvements in all functional tasks that were addressed using the occupational adaption
approach.
Long-term Goal
Client will participate in new or old leisure activities independently with decreased pain
in his right hand by the end of 4 weeks.
Short-term goal. Client will participate in one new preferred leisure activity with Mod
(I) with his right hand by the end of 2 weeks.
Intervention. The client will be applied with a moist heat pack (MHP) prior to
treatment for 15 minutes in order to increase ROM in the finger. Following the MHP the
client will be given ultrasound on the finger to decrease inflammation and pain. The CHT
will then educate the client and caregiver on different leisure activities that the client can
participate in and figure out which leisure activities that interest the client. The CHT will
play a preferred card game with the client and instruct the client on techniques to
decrease pain in his finger. The card game will promote tactile sensations in the finger
when the client has to pick up the cards, and it is an activity that is meaningful and
enjoyable for the client. Following the card game, the CHT will manually stretch the
other fingers on the right hand to ensure that they will not become stiff in the joints.
Intervention approach. The intervention approach that is most appropriate for
this intervention is the establish/restore approach. The compensation and adaption

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approach can be incorporated into this intervention as well, but establish and restore is
more appropriate because the client is expected to restore all the skills that he once had in
his right hand and index finger.
Client/caregiver training and education. The client and caregiver education in
this intervention is introducing different leisure activities to the client that he will be able
to successfully engage in. The goal of this intervention is to keep the client engaged in
therapy and provide meaningful activities for the client to ensure that the client does not
become depressed following his amputation. The CHT can train the client and caregiver
on different compensatory strategies for the different preferred leisure activities that the
client engages in.
Precautions. This intervention has precautions involving the MHP and checking
the clients skin to ensure that the client will not get burned or have skin irritations. The
tactile sensations for the card game could be painful for the client and should be closely
monitored by the therapist.
Grading up/grading down. The intervention could be graded up by having the
client reaching for the cards instead of not having them directly in front of the client. The
intervention could also be graded up, by having the client touch different rough textures
before picking up the cards. The intervention could be graded down by allowing the
client to use his left non-involved hand when his right hand and finger become fatigued.
Outcomes for intervention. The outcomes that are hoped to be achieved through
this intervention are participation and occupational justice. The intervention is engaging
the client is desired occupations and satisfying activities in order to promote

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participation. Occupational justice will be achieved by providing the client with

meaningful occupations such as the card game throughout the intervention.
Literature review. Lohman & Royeen (2002) conducted a study to assess the
clinical phenomenon of post traumatic stress disorder in relation to traumatic hand
injuries. This is related to the intervention because in the treatment session the client will
participate in a card game in order to decrease stress and engage the client in a
meaningful activity. The purpose of the article was to add neuroscience dimensions to
clinical reasoning in which an occupational therapist may engage in relation to a client
with posttraumatic stress disorder secondary to traumatic hand injury. The study
concluded that knowing a persons life narrative allows perspective regarding changed
occupational patterns that can result from a traumatic episode and contributes to a
broader picture that takes into account the person as a neuro-occupational being.
Short-term goal. Client will engage in previously enjoyed leisure activity using A/E with
his right hand by the end of 2 weeks.
Intervention. The client will be applied with a moist heat pack (MHP) prior to
treatment for 15 minutes in order to increase ROM in the finger. The CHT will educate
the client on different A/E such as splints and gloves that can be worn to protect the
finger during leisure activities. The CHT will interview the client to decide what leisure
activities the client likes to engage in and which activities that have been affected
secondary to the injury. The CHT will massage the clients hand and finger and work on
scar mobilization. Following the massage, the therapist will conduct passive range of
motion (PROM) on the right index finger with pain as tolerated by the client. The client
will bring in a preferred leisure activity in the clinic and the CHT will supervise the client

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participating in the activity while using his right hand with A/E. Following the preferred
leisure activity, the CHT will manually stretch the other fingers on the right hand to
ensure that they will not become stiff in the joints.
Intervention approach. The intervention approach that is most appropriate for
this intervention is the establish/restore approach. The intervention is attempting to
restore the client in participating in a preferred leisure activity that the client was able to
do prior to the injury.
Client/caregiver training and education. The CHT will educate the client and
caregiver on different A/E that can be utilized for various leisure activities. The CHT will
train the client on pain management techniques with the leisure activity that the client
brings to the clinic.
Precautions. This intervention has precautions involving the MHP and the CHT
needs to make sure that the hot pack is not burning the clients skin. The CHT also needs
to be careful while passively stretching the client and make sure to not cause too much
pain by moving the finger too far.
Grading up/grading down. This intervention could be graded up and down in
many different ways while the client is participating in the preferred leisure activity. The
CHT could grade the activity up by providing the client with different textures throughout
the activity. The activity could be graded down by allowing the use of A/E and involving
the left hand more throughout the activity.
Outcomes for intervention. Outcomes that are hoped to be achieved through this
intervention are role competence and participation. Role competence is hoped to be
achieved by assisting the client in a preferred leisure activity, and helping the client to

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effectively meet the demands of the activity. Participation is a hopeful outcome to be

achieved because the intervention involves engaging the client in desired occupations.
Literature review. Chan & Spencer (2004) examined similarities and differences
in physical recovery and psychosocial adaptation, engagement in occupations and
relationships, perceived outcomes and expectations, and adaptive issues and strategies of
five participants from an ongoing study of adaptation to hand injury. This is related to the
intervention because the study analyzes psychosocial adaptation and during the treatment
the client will be using adaptive techniques during a preferred leisure activity. The results
of the study include the importance of motivating occupations and relationships, changes
over time in expectations for the future, and differences between independent and
interdependent adaptive strategies following hand injury.
Frequency and Duration
The frequency and duration of the intervention plan would be one hour sessions, three
times a week for four weeks.
Framework
The primary model utilized for this intervention plan is the occupational adaptation (OA)
model. The traditional framework for the hand therapy setting is the biomechanical frame of
reference, however the OA model was utilized because it makes the intervention much more
client centered. The OA model has three elements including the person, environment, and the
interaction between the two. The OA model encompasses all areas of the OTPF making it a great
model for occupational therapists to utilize in practice. The framework guided intervention
planning by incorporating the client in goals and selection of leisure activities in order to
promote occupational engagement in meaningful activities. The goals for the intervention were

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guided by the OA model because they were client centered goals that took into account the
environment as well as the interests of the client.
Clients Response
The clients interventions will be monitored and assessed towards the progress of goals
every time the client comes to the clinic for treatment. The CHT will be constantly monitoring
the client and assessing and determining any progress that the client has made towards their
goals. The CHT will conduct a formal reevaluation two weeks after the initial evaluation.

References
American Occupational Therapy Association. (2014). Occupational therapy practice framework:
Domain & process. (3rd ed.).American Journal of Occupational Therapy. 68(Suppl. 1),
S1-S48. http://dx.doi.org/10.5014/ajot.2014.682006

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Amini, D. (2011). Occupational therapy interventions for work-related injuries and conditions of
the forearm, wrist, and hand: A systematic review. American Journal of Occupational
Therapy, 65, 2936. doi: 10.5014/ajot.2011.09186
Chan, J., & Spencer, J. (2004). Adaptation to hand injury: An evolving experience. American
Journal of Occupational Therapy, 58, 128139.
Jack, J., & Estes, R. I. (2010). Documenting progress: Hand therapy treatment shift from
biomechanical to occupational adaptation. American Journal of Occupational Therapy,
64, 8287.
Lohman, H., & Royeen, C. (2002). Posttraumatic stress disorder and traumatic hand injuries: A
neuro-occupational view. American Journal of Occupational Therapy, 56, 527537.