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Running head: OCCUPATIONAL PROFILE

Occupational Profile, Analysis, and Intervention Plan


Melody Klatt
Touro University Nevada

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Occupational Profile

The Client
The client is a 78-year-old woman named Dorothy, who is currently receiving hospice
care services from Gerinet Healthcare Hospice in Las Vegas. Dorothy has been living with a
diagnosis of Type II Diabetes and chronic kidney disease, and Dorothy currently receives
hospice services in her single-story home, where she has been living in retirement with her
husband, John. Dorothy and John receive regular visits from friends and neighbors who live in
their neighborhood or elsewhere in town, and they have one adult daughter who is married and
living with her husband and three children in California.
Occupational History, Values, and Interests
Dorothy was living in retirement with John prior to her admission to hospice care. She
retired at the age of 65 after working as a high school English teacher for most of her adult life.
She expressed that she had greatly enjoyed her job, but was glad to retire after working so hard
for so many years. John had also retired at the age of 65 after working as a professor of
literature at a local university for many years. Dorothy and John have been married for 55
years, and Dorothy expressed that her role as a wife, a mother, and a grandmother were the most
important aspects of her life. When asked about her life after retirement, Dorothy expressed
with a smile that being able to indulge in leisure activities and quiet time at home had been
wonderful. She stated that her preferred leisure activities had involved playing word games
with her husband, as both of them enjoyed games that challenged their vocabulary and wit with
words; cooking and eating gourmet meals, doing some light gardening in the yard, and writing
or telling both fictional stories and stories about her life. She stated that back when she had
been able to visit her grandchildren, her favorite thing to do was sit down with them and tell
them stories about her childhood, or weave elaborate fantasy stories for them to listen to. Her

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storytelling ability was something she was immensely proud of, and she expressed that she
missed doing that very much.
Roles
As stated previously, Dorothy identified the fact that her roles as a wife, mother, and
grandmother were extremely important to her. Dorothy described the fact that fulfilling aspects
of her roles had become difficult since her condition began to decline as a result of her
diagnosis, and though she knew that it was natural for her to have to let go of some of these
roles as a result of her declining condition, she stated that there were still some things that she
wished she could do. When asked to provide some examples of specific activities that she
missed in regards to her roles, Dorothy said that she misses being able to participate in certain
simple activities with her husband such as being able to eat together and play word games
and stated that she also misses being able to tell her grandchildren stories. She expressed that
she felt that these activities were an important part of filling her roles as a wife and
grandmother.
Patterns of Engagement in Occupations
When discussing her patterns of engagement in occupations, Dorothy stated that before
she began receiving hospice care, her daily routines were more structured, even in retirement.
She and John used to get up at a similar time each day, eat at the same time, go on outings at the
same time, and go to bed at the same time. Now, however, she reported that much of her daily
schedule is impacted by visitors that she receives, including friends and neighbors that visit and
the hospice staff members that come by to care for her. She reported that she has been receiving
hospice care for four months, and said that she doesnt have a regular daily schedule because
depending on who is visiting and when they are visiting, each day will be different. She says
that nurses and certified nursing assistants (CNAs) will come by at different times, depending

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on the day, and sometimes she will also receive visits from the spiritual counselor that works at
the hospice site. Friends and neighbors comprise other visits, and the times and lengths of their
visits will usually vary. She mentioned, however, that she normally likes to have evenings free
so that she can have dinner and spend some quiet time with her husband before they go to sleep.
Reason for Seeking Services
Dorothy is not currently receiving occupational therapy (OT) services, but upon
receiving an explanation of what OT is and what types of services are offered by the profession,
Dorothy expressed interest in receiving that type of care. If Dorothy were to receive OT
services, the focus of the interventions would be to improve her quality of life by enabling her
to participate in leisure activities that are important to her, to optimize her participation in selfcare tasks such as feeding, and to fulfill elements of her roles as a wife and grandmother.
Dorothy is living with a diagnosis of Type II diabetes and kidney disease, and these conditions
primarily the kidney disease in its advanced stages have been causing her to experience
excessive fatigue, weakness, and shortness of breath while performing even simple movements.
However, her condition has unexpectedly become more stable and has even improved over the
past two weeks, and she feels as though she has regained a small amount of strength and
alertness that she expressed interest in taking advantage of for as long as this improvement
lasts (Dorothy D, personal communication, August 4th, 2015).
After receiving information about OT and the services that are provided by occupational
therapists, Dorothy verbally expressed interest in the treatment, stating that this was due to the
fact that OT sounded ideal for what she would like to accomplish in relation to occupations
that are important to her. She stated, I know I might not get back to doing much, but if I could
get even a little better at some of the things I like to do while Im still around, I would sure be
happy (Dorothy D., personal communication, August 4th, 2015).

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Successful Occupations and Barriers


When asked about what occupations she feels successful in, Dorothy stated that she does
not currently feel successful in many occupations. However, with prompting she added that she
does feel like she can speak a bit better and comfortably move a bit more on her own now that
she has regained some strength. Dorothy then went on to identify the main barriers that she
believes are hindering her ability to participate in the occupations she would like to participate
in, including the amount of weakness that she still feels, and the shortness of breath that she
experiences whenever she attempts to speak for long periods of time. She says that the
weakness she feels keeps her from performing even simple movements without experiencing
excessive fatigue, including self-feeding and writing motions, and indicated that easily
becoming short of breath has hindered her ability to participate in verbal word games or tell
stories like she used to.
Environmental Supports and Barriers
Dorothy reported that her greatest source of support at home is her husband, John. She
said that because of his dedication and patience, she doesnt have to worry about anything
(Dorothy D., personal communication, August 4th, 2015). She also acknowledged that she feels
a great deal of support from the hospice staff that visit her at home. Dorothy also expressed
gratitude for the fact that she was able to have a hospital bed at home, indicating that the
hospital bed is much more comfortable and offers her a much better feeling of support,
especially when she wants to sit up (Dorothy D., personal communication, August 4th, 2015).
In regards to barriers that Dorothy perceives in her environment, Dorothy expressed that
she mainly sees her own physical limitations as being the barriers to her ability to engage in
occupations. She said that because she isnt able to get out of bed, she doesnt really have to
worry about barriers in the environment. She said that the only barrier in the house that she has

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ever thought about is the fact that some rooms are not large or open enough to easily
accommodate her hospital bed, so there are some rooms that she could not be comfortably
placed in even if she wanted to be there for a while.
Priorities and Desired Outcomes
Regarding her priorities and desired outcomes, Dorothy once again emphasized the fact
that there are certain activities she missed doing that she felt were an important part of her role
as a wife and a grandmother. She expressed that because she has recently gained a bit more
strength and alertness, she would like to try and be more functional in certain activities that she
prefers. When asked about specific activities that she would like to prioritize, Dorothy stated
that she would like to eat a meal with her husband. Because of the extreme weakness that she
was experiencing because of her diagnosis, Dorothys meals recently consisted of pureed food
in a cup that would be placed directly in front of her on a lap tray while she was sitting up in her
hospital bed, so that she could drink from the straw without having to go through the motions of
chewing or bringing the cup to her mouth. She expressed that because she is regaining some
strength now, however, she would like to try eating more solid foods and would like to eat with
utensils so that she can feel like she is having a real meal in the company of her husband.
Dorothy stated that her second priority was to find a way to continue telling her
grandchildren stories. She said that it gave her such joy to be able to pass on some of her
memories and experiences to them, especially now that she is nearing the end of her life. She
said that she currently cannot write or type stories for them because of the weakness she feels in
her arms and hands. She also expressed interest in resuming her ability to play word games
with her husband and being able to give him verbal instructions for meals to prepare now that
she has been regaining some appetite, though she acknowledged that all of these activities

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would be difficult due to her tendency to feel short of breath when speaking for long periods of
time.
Occupational Analysis
Dorothy was seen in the living room of her home for an OT evaluation of her ability to
feed herself and participate in a speaking activity. Dorothy was seated in her hospital bed upon
the OTs arrival, and she was provided with an adjustable lap tray that was situated over her lap.
Dorothys husband John went into the kitchen to prepare her a 10-ounce pureed meal, which he
poured into a 16-ounce Styrofoam cup. He then placed a straw in the cup and placed the cup on
the lap tray, adjusting the tray so that Dorothy was able to simply lean her head forward and
drink from the straw. Dorothy verbalized that this was how she normally ate her meals. During
the activity, it was also noted that Dorothys trunk and neck tended to fall a bit too far into
flexion while sitting upright in her hospital bed, particularly after she moved her head to be able
to drink from the straw in front of her.
Dorothy then participated in a discussion about what types of meals she would like to
eat, and Dorothy said that she would be willing to eat almost anything as long as it didnt
require too much chewing, and that she wanted to be able to use a fork. She said that she would
like to give some recommendations for recipes, but explained that she recently had not had the
strength to be able to write them down or type them up on their laptop computer. With
encouragement, she agreed to demonstrate an attempt to write on a notepad with a pencil, and
showed that even though she could move her hand into the correct position to grasp the pencil
securely, she still had difficulty with the actual motions of writing and could do little more than
that because she found the activity to be too tiring. She also described how tiring it was for her
to hold her arms up and continuously move her fingers while typing on a laptop, and said this
kept her from attempting to write on it. When asked if she could list a recipe while John wrote

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the steps down on the notepad for her, she agreed to try. However, while speaking, Dorothy
articulated only eight of the recipes steps before she had to pause due to becoming short of
breath. She tilted her head down and drew in long, labored breaths to try and regulate her
breathing, and later confirmed that this was how she normally coped with spells like this.
During the activities, Dorothy appeared motivated to do her best and perform well, and
verbalized her belief that her abilities would improve if she worked at them. Her husband,
John, also expressed his willingness and drive to assist Dorothy in any way that he could. John
also mentioned that he and Dorothy owned an iPad, and said that he had heard about
applications that were supposedly good for helping with certain things like this and expressed
interest in utilizing it during future activities with Dorothy (John D., personal communication,
August 4th, 2015).
Domains that appeared to most significantly impact Dorothys performance in the feeding
and speaking activities were client factors and performance skills. Dorothys ability to engage in
activities such as self-feeding, writing, and typing seemed to be most significantly affected by
motor limitations (deficits in strength, endurance, and coordination) that were caused by the
weakness she was experiencing due to her diagnosis. In addition to this, her susceptibility to
experiencing episodes of dyspnea affected her ability to speak for long periods of time. The
pattern of slight flexion that Dorothys trunk and neck seemed to repeatedly fall into while she
was sitting up in her hospital bed may also have contributed to her susceptibility to becoming
short of breath.
Problem List
A list of problems statements were composed for Dorothy in regards to her functional
performance and are stated as follows:

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1. Dorothy is unable to feed herself with a fork and spoon without assistance,
secondary to increased bilateral weakness in her upper extremities.
2. Dorothy is unable to participate in a storytelling leisure activity, secondary to
dyspnea.
3. Dorothy is unable to participate in verbal word games for longer than 20 seconds,
secondary to dyspnea.
4. Dorothy is unable to utilize a pencil to write down stories, recipes, or answers to
word games, secondary to increased bilateral weakness in her upper extremities.
5. Dorothy is unable to type on a laptop computer without assistance, secondary to
increased bilateral weakness in her upper extremities.
Problems statements regarding Dorothys ability to feed herself and participate in a
storytelling leisure activity will be prioritized, as she expressed that these were the two activities
she was most interested in focusing on at this time. Improving in the skills required for selffeeding including grasp and manual coordination will help Dorothy to improve in other
skills that require grasp and manual coordination, such as writing, and her ability to participate
in typing activities will be improved after her skills in manual coordination and overall
endurance improve. Improving her ability to participate in storytelling will also help Dorothy to
improve her ability to take part in other activities that require speech, such as the word games
that she enjoys playing with her husband.
Intervention Plan and Outcomes
After conducting the interview and analysis of occupational performance with Dorothy,
a treatment plan was developed for her. Two long-term goals with two short-term goals and

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interventions supporting each one were created in collaboration with Dorothy and her husband,
and the interventions that have been chosen for Dorothy were created to be relevant to the
preferred occupations and priorities that she identified.
Long-Term Goal 1
The first long-term goal that was established for Dorothy is stated as follows: In 3 weeks,
Dorothy will complete a verbal recording of five 10-minute short stories for her grandchildren, cc
Mod (I), using a Dragon Dictation application on her iPad & implementing breathing techniques
as needed.
Short-term goal 1. The first short-term goal that was created to support the first longterm goal for Dorothy is stated as follows: In 1 week, Dorothy will complete a 2-minute game of
Categories cc her husband, cc Mod (I), while implementing breathing techniques as needed.
The intervention. The intervention would consist of introducing Dorothy to positioning
and breathing techniques that will assist her with controlling her dyspnea while completing a
speaking task. In a research article written by Booth, Moffat, Burkin, Galbraith, and Bausewein
(2002), the authors discussed a variety of nonpharmacological interventions that may be used to
relieve shortness of breath in clients who are susceptible to dyspnea. These interventions
included education on breathing techniques, positioning, and pacing strategies that were shown
to be effective in helping clients manage their dyspnea (Booth et al., 2002). Based on this
evidence, an intervention session for Dorothy was designed to center around education on
breathing techniques, positioning, and pacing strategies that she could utilize while completing
a lengthy speaking task.
The intervention would begin with Dorothy transferring from supine to sitting, utilizing
the supportive functions of her hospital bed. Dorothy would be asked to assume the sitting
position that she normally does when sitting up in her hospital bed. Dorothys position would

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then be analyzed by the occupational therapist, and recommendations would be made to


improve her sitting posture in a manner that will optimize her airflow and speaking ability.
Education in relation to the importance of positioning would be relayed to Dorothy and John,
and Dorothy would be given an opportunity to practice properly positioning herself in the bed
when transferring from supine to sitting. John would also be given an opportunity to practice
assisting Dorothy with achieving this position in the hospital bed while sitting up.
Dorothy would then be provided with education on breathing techniques and pacing
strategies that could help her when she feels that an episode of dyspnea may be coming over
her. Breathing techniques such as pursed-lip breathing and diaphragmatic breathing would be
demonstrated for her, and she would be given an opportunity to practice the techniques until she
attained a comfort level with performing them. Dorothy would then be prompted to engage in a
word game with her husband, such as a one-word-story game wherein a story is told by her and
John taking turns saying one word at a time, and Dorothy would be reminded and encouraged to
utilize the breathing techniques and pacing strategies when she felt that she may be falling short
of breath. Rest breaks would be provided as needed throughout all activities.
The intervention approach that this activity would most appropriately be supported by is
a compensatory approach. The specific goal of the activity would be to introduce Dorothy to
compensatory techniques that she may utilize to assist her with completing speaking activities
without suffering from severe fatigue that may be brought on by prolonged episodes of dyspnea.
The targeted outcome for this intervention would be for Dorothy to improve in her ability to
complete a speaking task without becoming severely short of breath.
Short-term goal 2. The second short-term goal that was created to support the first
long-term goal for Dorothy is stated as follows: In 2 weeks, Dorothy will verbally recite three

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10-item recipes & record them utilizing a Dragon Dictation application on her iPad, cc Mod (I),
within 20 minutes & implementing breathing techniques as needed.
The intervention. The intervention would focus on continued client education about
breathing techniques and posture to prevent severe episodes of dyspnea, and would also
introduce Dorothy to the use of speech-to-text applications on her iPad. Due to the fact that
Dorothy has difficulty with manipulating writing utensils or typing on a laptop, but still wishes
to be able to record recipes and pass on stories to her grandchildren, it will be recommended
that she utilize a speech-to-text iPad application specifically an application called Dragon
Dictation to record lists and stories. In an article written by Bontje, Kinbanian, Josephsson,
and Tamura (2004), the subject of occupational adaption with older adults was discussed, and
the authors identified that their research study showed that older adults reported increased
satisfaction with being able to maintain their daily routines and engage in fulfilling occupations
while utilizing assets in their natural environment to overcome constraints in occupational
performance. This supports the use of the iPad that Dorothy and John own to assist Dorothy
with successfully engaging in occupations that are important to her.
The intervention would begin with Dorothy sitting up in her hospital bed, and she would
be given a review of the posturing and breathing techniques that would assist her with managing
her dyspnea, and Dorothy would be given a chance to practice the techniques as needed.
Dorothy would then be given her iPad, and she would receive a demonstration on how to
download and access the Dragon Dictation application on her iPad. Dorothy would then be
given an opportunity to practice the steps of accessing the application, and John would also be
provided with this education so that he would be able to assist Dorothy with setting it up in the
future, if needed. Dorothy would then receive education on how to utilize the application, and

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specifically how to utilize the recording functions of the Dragon Dictation application in a
manner that would accommodate her need to take rest breaks while recording lists or stories on
it. Finally, Dorothy would be prompted to practice recording a list such as the steps required
to pot a new plant in the garden - on the iPad utilizing the Dragon Dictation application. She
would be prompted to take rest breaks and implement breathing techniques as needed to help
her complete the list that she started.
This intervention would be considered an activity that focuses on implementing a
compensatory approach. Utilizing the iPad to record lists would enable Dorothy to record items
such as recipes for John, and would also later translate to helping her record stories for her
grandchildren. The targeted outcome for this intervention would be for Dorothy to improve in
her occupational performance of recording lists and stories by utilizing a modified technique for
completing the activity.
Long-Term Goal 2
The second long-term goal that was established for Dorothy is stated as follows: In 3
weeks, Dorothy will feed herself one meal of solid food cc medium consistency, cc S/U & using a
fork cc a built-up handle, within 20 minutes.
Short-term goal 1. The first short-term goal that was created to support the second longterm goal for Dorothy is stated as follows: In 1 week, Dorothy will consume 10 oz of pureed
food from a cup & straw on an elevated lap tray cc arm supported on pillows, utilizing an elbow
flexion/extension pattern to slide cup to & from mouth for each sip, cc S/U & within 30 minutes.
The intervention. This intervention would focus on helping Dorothy to improve in the
strength, endurance, and motor coordination that will be required for her to engage in a selffeeding activity with eating utensils. A research article written by Guidetti and Tham (2002)
described the value of improving a clients functional status and quality of life by enabling them

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to improve in their ability to perform self-care activities, and the article also specifically
described the value of allowing clients to have opportunities to repeatedly practice self-care
skills and adapt their environment to facilitate success for them in completing occupations. The
elements of this article support the focus of this intervention activity for Dorothy.
The intervention would begin with Dorothy sitting upright in her hospital bed, and her
adjustable lap tray would be situated over her lap. Dorothys dominant arm would be propped
up on pillows beside her, and her lap tray would be elevated until it stood at a height that would
allow Dorothy to slide items across the lap tray toward her mouth while utilizing only elbow
flexion and extension. Dorothy would then be given a Styrofoam cup with a straw and two
ounces of liquid or pureed food inside of it, and would be asked to consume the liquid or food
while practicing sliding the cup from one end of the lap tray to the other with each sip. Rest
breaks would be given as needed, and Dorothys posture would be adjusted as needed to
facilitate her movements and ensure her comfort. The gross motor skills required to complete
this activity would translate to Dorothys ability to bring an eating utensil from her lap tray to
her mouth an activity that would normally be too fatiguing for her to complete for any length
of time. Dorothys arm being supported by pillows would help to minimize the shoulder gross
motor movement that would normally be required to complete a self-feeding task. Education
would be provided to Dorothy and John about other activities that Dorothy could complete
while practicing these motions, and if time allowed Dorothy would be prompted to practice one
of these activities, such as playing a card game in such a way where she would be required to
move cards from one end of her elevated lap tray to another. Activities like the card game
would also encourage Dorothy to practice grasp and fine motor movement, which would
potentially help her to improve in other activities that require these skills, such as grasping
utensils and writing.

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The focus of this intervention approach would be restoring a skill, as the activities would
be intended to promote strength, endurance, and motor coordination for Dorothy, specifically in
relation to the occupation of self-feeding. Elements of the intervention also include a
compensatory approach, but the ultimate goal would be for Dorothys self-feeding skills to be
restored. The desired outcome of this intervention would be for Dorothy to improve in her
ability to complete the gross and fine motor movements required for her to be able to feed
herself with eating utensils during a meal.
Short-term goal 2. The second short-term goal that was created to support the second
long-term goal for Dorothy is stated as follows: In 2 weeks, Dorothy will use a spoon cc a built-up
handle to transfer 10 scoops of food cc a thickened consistency from one plate to another on a lap
tray, cc S/U & minimal spillage, within 20 minutes.
The intervention. The intervention activity would focus on introducing Dorothy to
eating utensils with built-up handles and allowing her to practice feeding motions with them, to
promote her ability to use them later while eating a meal. In a research article written by
Burkhardt, Ivy, Kannenberg, Low, Marc-Aurele, and Youngstrom (2011), the authors
specifically discussed the role of occupational therapists in working with clients who are
receiving end-of-life care, and emphasis was placed on the importance of improving clients
quality of life by helping them to fulfill roles and participate in occupations that are important to
them. Dorothy stated that she believes sharing a meal with her husband is part of her role as a
wife, and identified that this occupation is important to her. Therefore, an intervention that
focuses on helping Dorothy to participate in this occupation supports her values and goals, and
is also supported by the findings of this research article.
The intervention would begin with educating Dorothy about the purpose of utensils with
built-up handles, and allowing her to explore the feeling of a built-up fork and spoon. Dorothy

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and John would also be provided with education about preparing solid foods for Dorothy; they
would be encouraged to prepare foods of medium-to-soft consistency, such as boiled vegetables
and noodle dishes (or other foods of similar consistency that are deemed appropriate for her
diet), and John would also be encouraged to ensure that the food is prepared or cut up into small
pieces so that Dorothy may easily chew the food and prevent becoming fatigued.
Dorothy would then be given an opportunity to practice utilizing the utensils with builtup handles. Her arm would be supported by pillows and her lap tray would be elevated in a
fashion similar to that of the previous intervention activity that was described, and two plates
would be set in front of her, one on the far end of the lap tray and one on the side closest to her.
The plate on the far end of the lap tray would have 10 spoonfuls of a soft food such as yogurt or
porridge on it, and Dorothy would be encouraged to use the spoon with the built-up handle to
transfer the food from that plate to the plate that is closest to her. Rest breaks would be
provided as needed, as well as opportunities to practice breathing techniques to help prevent
fatigue or episodes of dyspnea. If appropriate, and if Dorothy was not too fatigued, the activity
would be repeated to allow Dorothy to continue practicing the motions and grasp required to
manipulate the spoon.
The focus of this intervention activity would be to restore a skill for Dorothy, as the
ultimate goal would be for her to improve in the strength, endurance, and motor coordination
that is required for her to be able to utilize eating utensils to feed herself. Elements of a
compensatory approach would also be utilized to help optimize her performance in the activity,
but ideally the activity would assist Dorothy in regaining her ability to independently perform
the motions of self-feeding. The targeted outcome of the intervention would be for Dorothy to
improve in gross and fine motor skills that are required for the occupation of feeding herself
with a spoon or fork.

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Precautions
Precautions for all intervention activities include the fact that Dorothys diet must be
closely monitored due to her diagnosis of Type II diabetes, and that her current state of
weakness could potentially present as a choking hazard if foods of appropriate consistency are
not selected for her. Dorothys medication must also be taken into consideration when
performing intervention activities, as certain side effects or dietary restrictions that the
medication may impose may impact her endurance or what she is able to safely eat.
Frequency and Duration of Intervention Plan
In a hospice context, the frequency and duration of OT services provided to Dorothy
would be impacted largely by her current plan of care within hospice services. After speaking
with nurses and staff members who were involved in Dorothys care at Gerinet Healthcare, it
was determined that Dorothy could potentially receive 45 minutes of occupational therapy
services three times a week during the day, and that the duration of the intervention plan could
be three to four weeks. Long-term goals for Dorothy have been initially set for three weeks, as
it was deemed possible for her to potentially meet these goals by that time.
Grading Activities
For the intervention that involved Dorothy utilizing the utensils with built-up handles to
transfer food items from one plate to another, an example of a graded-up activity would be to
lower or remove the pillow support provided for Dorothys arm, so that she would be required
to employ a greater degree of shoulder movement in order to complete the motions over her lap
tray. This would require Dorothy to use more gross motor movement in her dominant arm
overall, and would more greatly challenge her strength, endurance, and motor coordination.
An example of a way to grade-down this activity would be to place the plates closer to
Dorothy on the lap tray and situate them so that they are closer together; she would then be

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required to perform less movement in order to scoop the food from one plate to another. The
amount of food that Dorothy is required to transfer with the spoon could also be lessened in
order to decrease the demands of the activity, while still requiring Dorothy to complete and
practice the motions of self-feeding.
Primary Framework for the Intervention Plan
For this intervention plan, the Model of Human Occupation (MOHO) was used as the
primary framework to guide its invention. MOHO is built on fundamental concepts that take
into a count a clients motivation for participating in occupation, their routines and patterns
when completing their occupations, the nature of their performance in a skill, and also the
influence of their environment on their occupations (Kielhofner, 2008). For Dorothy, all of
these concepts were put into practice while creating the intervention plan. Dorothys motivation
for participating in occupations was addressed by taking into account the values, interests, and
beliefs she had in relation to her abilities while creating goals and planning intervention
activities. This information was gathered in the occupational profile, and specific goals and
activities were created in relation to roles and values that she identified. Dorothys routines and
habits within her occupations were also taken into consideration, and all intervention activities
were created to correlate as closely as possible with the routines and occupational habits that
Dorothy was most used to and comfortable with such as ensuring that she was able to eat
sitting up with her food situated on a surface in front of her, as that was a habit she had had
throughout her life while eating with her husband.
Dorothys ability to perform in her occupations was also taken into account in the
occupational analysis that was conducted, as well as her potential to perform in the intervention
activities that were planned. Dorothys diagnosis and her current physical condition were taken
into account when thinking about activities that she could successfully engage in, as well as

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while formulating goals that she could feasibly meet. Lastly, Dorothys environment was taken
into consideration while creating the intervention plan by identifying ways that her environment
could support her (such as the fact that she had a hospital bed that could help her sit up), as well
as identifying ways that her environment could be altered so that she could more successfully
engage in her occupations (such as adjusting the pillows on her bed to help her with the motions
of self-feeding). By implementing these concepts, MOHOs guidance helped to ensure that the
intervention plan would be client-centered, occupation-based, and relevant to Dorothys needs.
Client Education
Client education would be an ongoing process throughout the implementation of the
intervention plan. Education in regards to such things as positioning, compensatory strategies,
use of applications on the iPad, breathing techniques, and food portioning and preparation
would all be provided to Dorothy and John during the intervention activities. Considerations
would be given to Dorothy and Johns preferred learning styles; verbal explanations,
demonstrations, visual aids, and practice opportunities would be provided as needed to ensure
an optimal learning experience for them.
Monitoring and Assessment of Client Response
Throughout each activity in the intervention plan, Dorothys progress and response to
the activities would be monitored continuously. This would be accomplished through
observation of Dorothys physical responses to the activities including her facial expressions
and body language as well as utilizing clinical observation skills in regards to her performance
and progress. Verbal discussions would also take place with Dorothy as a means of monitoring
her response to activities. Data such as the amount of cues, repetitions, and time required for
Dorothy to complete tasks would also be gathered for a more objective assessment of Dorothys
progress.

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References

Bontje, P., Kinbanian, A., Josephsson, S., & Tamura, Y. (2004). Occupational adaption: The
experiences of older adults with physical disabilities. American Journal of Occupational
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