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Running head: OCCUPATIONAL PROFILE AND INTERVENTION PLAN

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Occupational Profile and Intervention Plan
Jesse Vallera
Touro University Nevada

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Occupational Profile
Patient
The patient, Kenneth D. Broom, is a 67 year-old male, Caucasian, height 5’11”, who had
previously lived in central Las Vegas. His primary language is English. He was originally born
in the Steam Springs area of Colorado. He attended Colorado State University to pursue
electrical engineering; however he left during his sophomore year because he had friends who
worked for a landscaping business in Las Vegas, and at that time it was lucrative. He has been
working landscaping for several decades, and in addition he had part-time jobs including
telemarketing and a professional horse-rider instructor. Mr. Broom does not have caregivers or
significant others and he states, “I’m usually a loner.” He had one brother and one sister but both
siblings are deceased. He enjoys pets, in particular dogs, but he never owned pets because it is
too much responsibility for him.
Need of Services
Mr. Broom had a cerebrovascular accident (CVA) on April 3, 2015. He was moving to a
new apartment on Las Vegas Boulevard and while moving furniture his left (L) lower extremity
(LE) failed to function properly. He had poor memory, but he continued with moving his
furniture and did not go to urgent care until two days later. He was in an acute rehabilitation
clinic until he was discharged to a skilled nursing facility (SNF) at Lake Mead Health and
Rehabilitation. The main factors resulting from his CVA are his left hemiparesis with affected
nondominant side, ataxia, hypertension, fine/gross motor deficits, spasticity, and contractures on
the left side. He had mild difficulty with memory loss, but now his cognition is fully intact. Mr.
Broom has good potential and is highly motivated to be discharged to a community apartment or
senior group home. He stated that he will have difficulty returning to landscaping; however, he

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would like to return and work as a telemarketer. He has a personal goal to ambulate to a sports
bar and grill to watch a Denver Broncos football game in the fall.
Areas in Occupations
Successful occupations. Mr. Broom has made tremendous progress in these few
months. Prior to his current level of functioning, he was independent in all activities of daily
living (ADLs), self-care occupations, mobility, communication, and many other domains in
occupations. Since his CVA, he has still been successful in executing movement with his right
dominant side to perform handwriting, in-hand manipulation, and feeding. He can fully
communicate with the therapists and nurses. He can ambulate with a wheelchair and he can use
a front wheel walker (FWW) for standing activities and he recently tried a quad cane (QC) to
ambulate, but requires two helpers.
Barriers in occupations. There are several barriers in his natural environment that are
impeding his occupations. Mr. Broom has ataxia that interferes with coordination and
synergistic fluid movements. After his CVA, he had L side hemiparesis that was exacerbated
with ipsilateral contractures and spasticity. Also, Mr. Broom has had two partial or near falls
and one complete fall in the bathroom. He feels that he is uncoordinated to don his underwear
and pants while at the same time using dynamic sitting and standing. Due to his ataxia, the
patient needs assistance with basic transfers, bed mobility, and toileting for static and dynamic
sitting and standing balance.
Environments and Contexts
In the personal context, Mr. Broom is a 67-year-old male and he has aches and pains that
he feels are normal for his age so he does not express concern relating to pain while engaging in
OT. He identifies as middle class, and has a high school diploma. In his temporal context he is

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still active in his stage of life and was still working as a landscaper and telemarketer when he had
his CVA. In the cultural context he is Catholic, and he frequently visits the Shrine of the Most
Holy Redeemer on Las Vegas Boulevard. He still has rituals and routines for his Catholic
tradition (such as praying, kneeling, singing, etc.). He is familiar with the virtual context but he
rarely utilizes technology because he would rather experience community and real-life events.
Mr. Broom lived in a two-story apartment and was independent with all ADLs and
IADLs such as meal preparation, laundry, driving, grocery shopping, etc. Now that he has been
in Lake Mead Health and Rehabilitation he wants to look for a senior group home because he
will no longer live in his previous apartment. He has difficulty in the physical environment
mainly due to his left side hemiparesis and poor static and dynamic sitting and standing. He
would like to resume all his ADLs and IADLs in the physical environment so he can continue his
ambulation, meal preparation, laundry, and home management to be more independent. His
communication is fully intact so he can participate in his social environment. However, he has
difficulty with community mobility so he can only engage in social participation around the
SNF.
Patient’s Occupational History
Mr. Broom was pursuing electrical engineering but decided to move to Las Vegas, NV in
the mid-1980s to work as a landscaper because he always enjoyed outdoor activities rather than
working as an engineer. He worked as a telemarketer when the landscaping was stagnant in the
slow seasons. As previously mentioned, Mr. Broom completed all ADLs and IADLs
independently. Besides his personal self-care activities, he enjoys hiking in national parks,
skiing in Colorado, fishing, and football games rooting for the Denver Broncos. He also enjoys

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horses and dogs, but states that it is too much responsibility to walk, feed, groom, and play with
these pets.
Values and Interests
Mr. Broom was brought up in a Christian rural area near Steam Springs, Colorado and his
denomination is Catholic. He attends a Catholic church but he has not been going since his CVA
due to the barrier of community mobility. He had an active life style until recently, as
demonstrated with his various activities including hiking, going on trips, going outdoors, and
skiing. The activities that he will continue when he is discharged are watching football games,
fishing, and using public transport to attend his church.
Roles
The daily life roles are different from before and after his CVA. Before he was a tenant
in his two-story apartment and he always maintained a clean household. When something broke,
he always fixed the items around the house because he stated, “I’m handy about tools and
construction.” At the SNF, he still maintains his room and offers help when other patients or
nurses have household problems. He is friends with two co-workers at the landscaping business.
Both of his friends have families so he can join these friends in hiking, babysitting, and attending
events.
Previously Patterns of Occupational Engagement
Mr. Broom had many negative impacts on aspects of his occupations for ADLs, IADLs,
work, leisure, and social participation since his CVA. He now cannot complete proper bed
mobility, static and dynamic sitting balance, toileting, and UE/LE dressing for his ADLs. He
also has trouble with cooking, laundry, home management, and grocery shopping for his IADLs.
In addition, he cannot work for his landscaping business due to his left side hemiparesis,

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ambulation, and ataxia to coordinate complex movements. He enjoys gathering for football
games and going to church, but now cannot ambulate or drive to these types of events.
Patient’s Priorities and Outcomes
Mr. Broom has had a negative impact on his occupational performance. There are certain
interventions that could improve his well-being and quality of life so that he could be as
independent as possible and take an active role in resuming meaningful and purposeful
occupations in his life. The primary focus is to remediate his toileting, functional transfers,
bilateral UE/LE and trunk strength, and decrease fall risk. If these outcomes are achieved then
he will increase function in his ADLs and IADLs such as meal preparation, etc. Other outcomes
to promote self-efficacy are participating in mobility and taking an active role to be more
independent in the household.
Occupational Analysis
Context in OT Services
Mr. Broom has received occupational therapy (OT) and physical therapy (PT) in both the
rehab gym and his SNF patient room. His medical insurance is Medicare-B and the maximum
amount of therapy he can be awarded is 720 minutes per week. Mr. Broom is highly motivated
to take advantage of the maximum amount of therapy. He has difficulty with his physical
environment due to his ataxia and L side hemiparesis. Mr. Broom utilizes a standard wheelchair
for his DME; however, if it is warranted, a helper can assist him with a FWW or QC depending
on what activity he wants to accomplish. In addition, he had a negative impact on his social
environment due to his limited ambulation and community mobility, and he can only live inside
the SNF.

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Activity and Patient’s Performance
Mr. Broom receives 60 minutes of skilled occupational therapy treatment at Lake Mead
Health and Rehabilitation for six days per week. He reported that he first received OT in the
middle of April soon after his CVA and at that time he was more dependent than he is now.
Upon entering the room, Mr. Broom was in a semi-reclined supine position. He performed bed
mobility utilizing raising the head of the bed and grasping the side railings to transfer from
supine to edge of bed (EOB). According to the SNF policy, he was deemed appropriate for
contact guard assistance (CGA) due to his unsteady or poor (P) dynamic sitting balance.
Objectively, he had a facial expression of pain, but he stated that it was merely frustration due to
his dynamic sitting balance. Shoulder flexion was assessed in the left UE and was measured at
70 degrees using a goniometer. A 3- MMT grade was determined using standardized manual
muscle testing (MMT). Elbow flexion and hand grip was limited in muscle strength and power
due to L side hemiparesis. Sensory input from LUE and LLE was fully intact.
Patient requested mod A stand and pivot transfer to EOB to wheelchair (w/c) to ambulate
(amb) to bathroom. He recognized that the w/c was locked during transfer. He transferred mod
A from w/c to toilet seat and used grab bars to feel secure while dynamic sitting and standing on
toilet seat. He transferred sit to stand with mod A but needed max A to don pants due to
clothing management. He ambulated back to the room using his standard w/c and engaged in
UE and LE dressing. Patient used gravity-assisted sleeve technique and used affected UE by
leaning forward and then over-the-head method. Left side had limited ROM due to contractures
so adaptive equipment (A/E) LE dressing was utilized for hip kit including reacher, dressing
stick, sock aid, and long handle shoehorn with mod A.

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Key Observations
Mr. Broom had difficulty with each functional transfer while initiating and executing
complex movement. It was evident on EOB that the patient had P dynamic sitting balance and
required proprioception and vestibular input when using the upper extremities. His core strength
and trunk endurance were only moderate and after several minutes he fatigued. As previously
mentioned, he had limited ROM due to UE and LE contractions and spasticity. When
transferring from sit to stand the patient had great difficulty due to postural sway secondary to
his ataxia and his L side hemiparesis while over compensating with the right side. The patient
needed verbal and tactile cues to self-correct his position because his center of gravity was
outside his base of support.
Domains of OTPF Impacted
Mr. Broom desires independence for all functional transfers and self-cares to have a swift
recovery and to discharge out of the SNF. He requires assistance in many ADLs and IADLs that
impede his daily functions. Client factors that have been affected by his CVA are his L side
hemiparesis and ataxia, which according to the Occupational Therapy Practice Framework
(OTPF) has impaired specific mental functions of sequencing complex movement (American
Occupational Therapy Association [AOTA], 2014). In addition, his higher-level cognition has
been impaired due to his apraxia. His neuromusculoskeletal movement has been impaired
including joint mobility, joint stability muscle power, and muscle tone that impacted his motor
performance skills including flows, grips, reaches, stabilizes and aligns (AOTA, 2014). Many of
these occupations have challenges in his physical environment and thus many of the ADLs
including bathing, toileting, dressing, and functional mobility he has to remediate or compensate.

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In addition, other occupations that have been negatively impacted are community mobility, meal
preparation, and religious and spiritual activity in his IADLs.
Problem List
The following problem statements are prioritized in the order that the patient would like
to address.
Problem Statements and Rationales
1. Patient requires mod A with functional transfers due to his ataxia.
Mr. Broom has difficulty with complex movements due to his ataxia. He requires several
contact points when activating his vestibular and proprioception sensory inputs to feel secure.
Fortunately, Mr. Broom has great confidence and does not have a fear of falling. His vision,
vestibular, and somatosensory systems are somewhat intact, but he has difficulty with
coordination and limited muscle control.
2. Patient requires max A for toileting with clothing management due to L side hemiparesis.
Mr. Broom has fallen three times due to his L side hemiparesis that contributes to his
UE/LE weakness, ataxia, and difficulty with static and dynamic standing balance while donning
his pants. The patient was assessed with 3- MMT for shoulder flexion. In addition, the L side
hemiparesis impacted his ability to have optimal ROM and he must grasp the grab bars to bend
down to grip his pants.
3. Patient requires CGA in static & dynamic sitting balance due to decreased trunk strength.
The patient has contractures and spasticity in several areas of his L side. The right UE,
right LE, and right side of the trunk overcompensate while static and dynamic sitting, which has
contributed to postural deficits. This limits his ability to have optimal trunk rotation and
dynamic sitting endurance.

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4. Patient requires mod A with LE dressing due to decreased ROM on L side.
Mr. Broom has contractures and spasticity on his L side that limit his ability to reach his
pants, socks, and shoes. He has difficulty reaching the full distance and often trunk muscle
recruitment is necessary for complete movement. When this occurs, his center of gravity shifts
out of his base of support and he is prone to fall risk.
5. Patient requires min A in bed mobility due to L side hemiparesis.
Mr. Broom has decreased trunk strength, which limits his ability to raise his hips and
bilateral LE (BLE) to properly bridge and move in bed mobility. He requires grasping the side
rails of his bed and raising the head of the bed to compensate. When he completes his movement
from the EOB, he requires side rails because his dynamic sitting balance is unsteady.
Intervention Plan and Outcomes
Long-term Goal #1
Patient will safely complete functional transfers ĉ SPV in his room and rehab gym within
8 wks.
Short-term goal #1. Patient will complete sit ↔ stand transfer from EOB → standard
w/c ĉ CGA in 3 wks.
Intervention #1. Mr. Broom will complete a stand and pivot transfer with CGA using
gait belt. This will be an establish and restore intervention to remediate his functional transfers.
The patient will use an anterior tilt and BUE to weight bear (WB) and push up with BUE and
BLE with minimal assistance. The patient has ataxia and he needs vestibular input for any kind
of functional transfer. He requires a stable grasp with an immobile object while he executes a
linear and circular movement in his own space. Before he will do this transfer, he will use
preparatory methods to raise both his knees and increase strength and endurance through his

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BLE. He then will complete his transfer while WB from EOB to a standard wheelchair because
he wants to be independent as possible. The patient will receive education on weight bearing,
weight shifting, and skin checking to prevent skin breakdown. In addition if the patient is
fatigued he will utilize diaphragm-breathing techniques. The outcomes for the intervention will
increase his occupational performance for improvement in BUE, BLE, and trunk strength and
endurance. This will benefit his coordination and complex motor movements (AOTA, 2014).
Literature review. A study entitled, Effect of specialized task training of each
hemisphere on interlimb transfer in individuals with hemiparesis, was conducted to determine
whether interlimb functional transfers have a positive impact on disrupted unilateral hemisphere
damage (Yoo, Jung, Yoo, Park, Park, Lee, & Kim, 2013). Twenty CVA patients met criteria for
a Brunnstrom recovery stage of five or higher. Specific training utilized single starting location,
reaching movements, and grip and release movements to determine left to right limb transfer and
the results showed statistically significant improvements (p<0.05) on functional transfer. This
will be useful for Mr. Broom to use BUE reach and WB to increase sensory input while
functional transferring.
Short-term goal #2. Patient will safely transfer w/c → FWW while performing
grooming activities at sink for 10 min ĉ CGA in 3 wks.
Intervention #2. The main focus of this short term goal is to functionally transfer from
sitting to standing. This intervention is an establish and restore approach because he will be
remediating normal transfer from sit to stand. The patient will have a vertical spine and slight
anterior tilt while sitting in his standard w/c. He will have a 90-degree angle in knees with feet
on the floor. He will grasp a FWW with right UE for facilitation with CGA. The FWW is used
for a stationary object to provide vestibular sensory input to compensate for his ataxia and to

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reduce fall risk so the patient will be more secure. Mr. Broom has expressed interest in using
standing positions so he can do a variety of activities with his prior level of function (PLOF). In
addition, this intervention will improve standing tolerance to assist in developing trunk strength
with other functional transfers. Education will be provided to use proper footwear, proper
posture, and verbal and/or tactile cues as needed. As mentioned for the first intervention, the
outcomes will increase his occupational performance for improvement in BUE, BLE, and trunk
strength and remediate his ataxia (AOTA, 2014). Moreover, he will improve his standing
tolerance.
Literature review. A study titled, Inter-task transfer of meaningful, functional skills
following a cognitive-based treatment: Results of three multiple baseline design experiments in
adults with chronic stroke, was conducted using a Cognitive Orientation to daily Occupational
Performance (CO-OP) treatment approach for post-CVA patients by improving inter-task
transfer performance through untrained skills (McEwen, Polatajko, Huijbregts, & Ryan, 2010).
The goal of inter-task transfer of skills is to generalize through different environments while
using the same concepts of the activity. The CVA patients used a variety of different activities
including meal preparation, gardening, ambulation, dressing, and functional transferring (e.g.
getting in and out of a chair,) and the patients clinically improved in specific motor skills for all
twelve activities, except handwriting that was not clinically significant. Mr. Broom would
benefit from a variety of different motor skill tasks that generalize with respect to his functional
transfers. The example was given to transfer from sit to stand for a grooming activity; however,
the patient will benefit from transferring from sit to stand to complete a meal preparation activity
to reinforce his transfer motor skills.

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Long-term Goal #2
Patient will complete toileting with clothing management ĉ Mod (I) using A/E in 8 wks.
Short-term goal #3. Patient will don pants utilizing reacher after clean-up toileting
using grab bars ĉ min A in 3 wks.
Intervention #3. Mr. Broom will transfer from the toilet to standing using the grab bars
and will grasp a reacher to raise his pants. He will pay attention while donning to not overreach
while bending. This intervention is a modify approach because he will compensate for toileting
with clothing management using A/E and grab bars. The patient has L side hemiparesis and this
approach will reduce his unsteady standing balance and fall risk. Education will be provided for
A/E with reacher and DME with grab bars. Furthermore, the patient will use proper posture and
vertical spine while grasping pants. The outcomes for this intervention will improve his
occupational performance and enhance the occupation in toileting (AOTA, 2014).
Literature review. A study entitled, Toilet grab-bar preference and center of pressure
deviation during toilet transfers in healthy seniors, seniors with hip replacements, and seniors
having suffered a stroke, was conducted to determine the effect of center of pressure (COP) in
toilet transfers (Kennedy, Arcelus, Guitard, Goubran, & Sveistrup, 2015). The results showed
that grab bars were preferred to minimize COP deviation and the author discussed, “The
preference and safety of the two vertical bars should be considered in the design of accessible
toilets and in accessibility construction guidelines” (Kennedy et. al., 2015). This intervention
would be beneficial for Mr. Broom to minimize COP deviation using grab bars and to decrease
fall risk while using his reacher to don his pants.
Short-term goal #4. Patient will complete LE dressing using A/E while seated EOB ĉ
CGA in 3 wks.

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Intervention #4. Mr. Broom will sit on EOB and utilize his left UE using A/E to don
underwear, pants, socks, and shoes through learned non-use. Although this is an occupation-asan-end of the short-term goal, the intervention will include an occupation-as-a-means that
involves using a fishing pole to hook his clothing. A magnet will be placed inside his
underwear, pants, and socks and he will use trunk flexion and extension to cast in a rowing
motion. The patient enjoys fishing and so he will use A/E that is a fishing pole to activate trunk
flexion and extension while increasing ROM in BUEs while sitting at the center of the bed in a
semi-reclined position. This intervention is a modify approach because he will compensate in
order to complete his LE dressing using A/E. Education will be given on the proper use of A/E
techniques. The outcomes for this intervention will improve his occupational performance with
his limitation and enhance this occupation in LE dressing (AOTA, 2014). The client factors that
will improve are his coordination, increased ROM in BUEs, trunk flexion/extension, and reduced
contractures and spasticity on the left side.
Literature review. A study entitled, How occupational therapists teach older patients to
use bathing and dressing devices in rehabilitation, was conducted on 86 participants with
orthopedic deficits, CVAs, or lower limb amputations, to teach use of A/E with LE dressing
(Schemm & Gitlen, 1998). The methods used involved oral instruction and demonstration and
were an average of two and a half sessions that were ten minutes in duration. The results showed
that there was a positive effect by “having greater knowledge of device use,” and an increase in
utilizing A/E that was statistically significant (p<0.05).
Precautions and Contraindications
Mr. Broom will have precautions while he is conducting complex movement with his
functional transfers and dynamic sitting/standing balance. Due to his left side hemiparesis, he

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will reach at optimal ROM and not overreach that causes any pain or unsteady balancing issues.
Objective observation will be conducted to perceive if Mr. Broom has the required sensory
inputs (vestibular, visual, etc.) for completing his transfer. With each transfer, the patient will
utilize full WB in BUE and BLE, and will be provided assistance with a gait belt and CGA for
precautions. The patient will grasp side rails while reaching for dynamic sitting balance to have
better security. Mr. Broom has contraindications that may occur during activities such as
changes in high blood pressure, shortening of breath and/or fatigue. If these contraindications
occur, then the activity should either be discontinued or rest given while utilizing breathing
techniques (e.g. purse-lip breathing or diaphragm breathing) that will help decrease heart rate
and blood pressure. In addition, an abdominal binder or compression stockings will be beneficial
if the patient has orthostatic hypotension.
Frequency and Duration
The patient is currently receiving PT and OT treatment in a skilled nursing facility in the
patient’s room and the rehab gym. The frequency and duration for the intervention plan will be
60-minute sessions, 12 times a week (720 minutes per week) for eight weeks. Mr. Broom has
good rehabilitative potential to increase meaningful and purposeful activities for his occupations
in ADLs, IADLs, work, and social participation. The patient’s main concern is the left side
hemiparesis and left contractures influencing his engagement in meaningful occupations. The
current course of treatment for the SNF will be to continue with the plan of care and plan
interventions based on the patient’s functional transfers, self-cares, and ADLs.
Grading Up and Grading Down
In the intervention of donning pants after toileting with A/E, one grading up activity is for
reaching and acquiring clothing with a longer distance (e.g. placing the clothes on a stool outside

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the patient’s base of support) to increase trunk elongation and muscular stretching and to prevent
contractures or spasticity. However, if the patient has increasing difficulty for this occupation,
he would benefit from back support and limiting trunk rotation due to dynamic standing balance.
To down grade this activity the patient would thread his underwear and his pants sitting down
and utilize the raised toilet seat with drop arm feature (e.g. armrests) so he will have more sitting
balance support.
Primary Framework
The Person-Environment-Occupation model is an appropriate model because it is based
on many holistic components for Mr. Broom and his environment. To assess these aspects it is
imperative to use “therapeutic use of self” to gather as much information as possible. This
client-centered model demonstrates an interaction between the person, the environment, and the
occupation. Ongoing development occurs throughout the patient’s dynamic experiences as the
person engages in specific situations and contexts. It is an occupational therapy practitioner
responsibility to find the patient’s goodness of fit in regards to the person, environment, and the
occupation to optimize occupational performance. The occupational performance and
participation is the most effective way to engage all aspects of the patient to promote the
patient’s self-efficacy. Mr. Broom had severe debility and could not perform many occupations
with the onset of his CVA; however, he has had tremendous recovery each week and has
increasing ROM, muscle endurance, and coordination for his client factors throughout his
development. Law states, “The person is defined as a unique being who assumes a variety of
roles simultaneously. These roles are dynamic, varying across time and context in their
importance, duration, and significance” (Law et al., 1996, p.15). This interaction has been
remarkable has Mr. Broom has been remediating, restoring, and compensating for many of his

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ADLs and IADLs. He will continue to increase his client factors and performance skills each
time he feels confident in his abilities.
Patient Training and Education
Education will be provided to instruct Mr. Broom with environmental awareness with
each of these interventions. As previously mentioned, the patient should wear proper footwear
and use stationary objects to feel more secure for transfers and reaching activities. Before any
functional transfer, the patient will utilize anterior pelvic tilt, vertical spine, and 90 degrees in
knees with feet on the floor. The patient may require verbal and/or tactile cues to properly align
his position. DME will be used to grasp side rails, armrests, FWW, and other types of stationary
objects to reinforce balance sensory inputs. In addition, instruction will be given on proper A/E
with LE dressing techniques including reacher, dressing stick, sock aid, and long handle shoe
horn. Education will be provided to properly weight shift to check for skin breakdown or
decubitus ulcers. Likewise, instruction will be provided for stretching techniques to increase
optimal ROM to prevent further contractures and reduce spasticity.
Response Monitored and Assessed
Mr. Broom will receive skilled OT services and will have documentation with each
intervention. Clinical observation and informal verbal interviews will be assessed to determine
any changes with his performance abilities. After three weeks of OT treatment, reevaluation will
be performed to determine if the short-term goals are met. If these goals are too strenuous or the
patient has completed his goals too soon, the long-term goals should be altered and tailored to
the patient’s needs. In addition, standardize manual muscle testing (MMT) will be used to
detect progression in intervention. Standardize MMT measures against gravity positions and

OCCUPATIONAL PROFILE AND INTERVENTION PLAN
gravity-minimized positions, so it is suitable to assess Mr. Broom’s deficits. MMT should be
assessed at the beginning of the treatment and after three weeks to monitor his progress.

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References
American Occupational Therapy Association. (2014). Occupational therapy practice framework:
Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1),
S1-S48. http://dx.doi.org/10.5014/ajot.2014.682006
Kennedy, M. J., Arcelus, A., Guitard, P., Goubran, R. A., & Sveistrup, H. (2015). Toildet grabbar preference and center of pressure deviation during toilet transfers in healthy seniors,
seniors with hip replacements, and seniors having suffered a stroke. Assistive Technology,
27(2), 78-87. doi: 10.1080/10400435.2014.976799
Law, M., Cooper, B., Strong, S., Stewart D., Rigby, P., & Letts, L. (1996). The person
environment occupation model: A transactive approach to occupational performance.
Canadian Journal of Occupational Therapy, 63. Retrieved from:
http://www.caot.ca/cjot_pdfs/cjot63/63.1%20Law.pdf
McEwen, S. E., Polatajko, H. J., Huijbregts, M. P., & Ryan, J. D. (2010). Inter-task transfer of
meaningful, functional skills following a cognitive-based treatment: Results of three
multiple baseline design experiments in adults with chronic stroke. Neuropsychological
Rehabilitation, 20(4), 541-561. doi: 10.1080/09602011003638194
Schemm, R. L., & Gitlin, L. N. (1998). How occupational therapists teach older patients to use
bathing and dressing devices in rehabilitation. American Journal of Occupational
Therapy, 52(4), 276-282. doi: 10.5014/ajot.52.4.276
Yoo, I., Jung, M., Yoo, E., Park, S., Park, J., Lee, J., & Kim, H. (2013). Effect of specialized task
training of each hemisphere on interlimb transfer in individuals with hemiparesis.
NeuroRehabilitation, 32(3), 609-615. doi: 10.3233/NRE-130883