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Running head: OCCUPATIONAL PROFILE, ANAYLSIS, AND PLAN

Occupational Profile, Analysis and Plan


Faith Wilkins
Touro University Nevada

OCCUPATIONAL PROFILE, ANALYSIS, AND PLAN

Occupational Profile
Personal Context
Melony is a 56 year old female patient admitted to the acute rehabilitation unit at Spring
Valley Hospital in Las Vegas, NV on Saturday April 15th, 2015. The patient explained to the
occupational therapy student that she has been living in and out of rehabilitation hospitals for the
past year as she has had four joint replacements in the past three years. When she is not staying
in a hospital, she lives in an apartment on the first floor with her boyfriend. She spends all of her
time outside the hospital with her boyfriend smoking marijuana and watching television together.
The patient has limited communication with her family with whom she has not seen in over five
years. She considers her boyfriend to be her only person supporting her. The patient told the
occupational therapy student, My boyfriend loves me. We talk on the phone for hours a day
when he is not here with me, but he has a drinking problem and gets mad really easy. She went
on to explain how she and her boyfriend have almost broken up numerous times in the past three
years. The patient reported her boyfriend is not abusive towards her, and she is not concerned
with his drinking problem.
The patients current life roles and responsibilities involve her focusing on her care and
her relationship with her boyfriend. She requires maximum or total assistance in nearly all
activities of daily living (ADLs). She has reported distress on her relationship because she
cannot independently care for herself. She mentioned she may begin preparing a meal, but
becomes too fatigue and her boyfriend must complete the cooking. When in the hospital she
relies on medical staff to clean her perineal area, and at home she relies on her boyfriend to assist
with perineal hygiene. The patient was reluctant to trust the therapist. Specifically when the
physical therapist and occupational therapist tried to help her transfer from sitting to standing,

OCCUPATIONAL PROFILE, ANALYSIS, AND PLAN

the patient refused to let the physical therapist approximate her knee to assist her with standing.
She complained of pain throughout most hours of the day and night in her lower back, knees,
shoulders and trunk. She expressed distress regarding the doctor reducing her pain medications
by half. She was adamant about speaking with the doctor as soon as possible in order to request
more pain medication. The patient reported no difference in her daily routines throughout the
week as she does not have obligations or responsibilities outside of the home.
Patients Concerns, Goals and Reason for Seeking Occupational Therapy Services
The patient is concerned regarding her health and wellness as evidenced by her statement,
I know my weight is a problem, I weigh 300 pounds now. She is also worried about her
dependence on the Hoyer lift to get out bed, as she is not currently able to stand. However, she
has no weight bearing precautions. The patient explained to the occupational therapy student
that she has grab bars in her bathroom at home, but is unsure of how to properly utilize the
equipment. The patient expressed two goals she would like to meet before she leaves the
hospital. The first being she wants to be able to use the bathroom by herself. Secondly, the
patient wants to be able to stand and pivot on her legs so she can get out of bed and not be
dependent on the Hoyer lift. The patient initially expressed she wanted occupational therapy to
bathe her and perform her ADLs for her. After the occupational therapist educated the patient
regarding occupational therapys role in the rehabilitation hospital, she was able to reframe her
expectations of occupational therapy. Now, she would like occupational therapy to help her
learn, practice, and implement strategies that will empower her to reach her goals of increased
independence in toileting and functional mobility.

OCCUPATIONAL PROFILE, ANALYSIS, AND PLAN

Occupational History
The patient grew up in a small town in Oklahoma. She moved to Las Vegas from
Louisiana five years ago to be closer to a boyfriend she met online. Patient explained to
occupational therapy student that she has a child, but has not seen him since he entered the foster
care system at the age of six. The patient was a special education teacher for five years before
becoming too disabled, as she stated, to work. The patient has not held a job in the past twenty
years explaining that she cannot work, because she would have to pay back her student loans and
she claims she cannot afford to do so. Five years ago, she was a member of a science fiction
book club. She once attended a church, and enjoyed the fellowship.
Occupational Successes
The patient feels successful when relaxing at home watching television. She also feel
successful when she is able to have a supply of marijuana in her home available for use at all
times. With total assistance, the patient feels better after showering and completing toileting on a
commode.
Barriers to Successful Occupations
This patient is exposed to numerous barriers prohibiting occupational success within the
personal, hospital, and community context due to numerous complications with her health status
and personal motivation to change her lifestyle. The patients biggest personal barrier is her
functional debility to due to her severe obesity. She has poor health, decreased endurance,
decreased strength, increased risk for falls, and poor functional mobility. She is also complacent,
and reports being satisfied with her current level of occupational engagement.

OCCUPATIONAL PROFILE, ANALYSIS, AND PLAN

Within the hospital, barriers for the patient include her dependency on the Hoyer lift, her
unwillingness to trust staff when helping her stand, and the enabling ability to hit a button and
have assistance at her door. Community barriers have significantly impacted her life style. She
must operate her power wheelchair on the busy street to access the bus stop and local convenient
store. This is due to the sidewalks in her neighborhood not being wheelchair accessible. Nor
does she have access to a vehicle, which in turn limits her community mobility. She also
chooses not to work as it would alter her financial status.
Values and Interests
Patient explained to the occupational therapy student that her values and interests revolve
her desire to smoke marijuana. She chooses to stay home and smoke marijuana over any and all
social engagements. She values her time spent at home on her couch smoking and watching
soap operas. She also stated she likes the feeling of having the munchies, and her favorite food
to snack on is cookies and ice cream. She explained, when her boyfriend makes her leave the
house, they go out to eat or they go walk around the mall. She would prefer to start doing more
things in her community such as going to the movies and visiting an art show. She is interested in
learning more recreational activities to pursue upon discharge. Patient expressed she was once a
member of a church, but she no longer attends one because she is scared of judgement.
Adaptive Equipment Utilized
Melony has had her power wheelchair for approximately five years. She uses the power
wheelchair as her main means of mobility. When cooking in the kitchen, Melony uses a manual
wheelchair so that the foot pedals are less in the way when reaching for the counter and sink.
She had a ramp installed to help her enter the home using a power wheelchair. She also has grab

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bars installed in her bathroom; however, she explained to the occupational therapy student that
she is not confident in her ability to use the equipment properly and consequently does not utilize
the grab bars at home.
Occupational Analysis
Setting of Occupational Therapy Services
The Spring Valley Hospital offers various levels of inpatient care. This particular patient
was on the acute inpatient rehabilitation unit. The rehabilitation unit specializes in serving
individuals with a range of physical needs secondary to either a stroke, orthopedic surgery,
general debility, or any other physically disabling condition. The patients on this unit receive
intensive therapy five to six times a week. Occupational therapy meets with each patient for
ninety minutes, and physical therapy meets with each patient for ninety minutestotaling three
hours of rehabilitation daily.
Patients are often referred to the rehabilitation floor from the acute care unit within the
hospital. However, Melony, was referred by her physiatrist at another local rehabilitation
hospital. This is an atypical referral process. Her healthcare provider was the main cause of the
transfer, as the insurance company would no longer approve her continued stay at the previous
facility.
The rehabilitation floor consists of 26 beds, two gyms, a nurses station, and a
recreational room. Each room is a private, single-occupant room with a bathroom, hospital bed,
chair, small closet, sink, mirror, and television. The two gyms are designed for the respective
therapy. The physical therapy gym has parallel bars, stairs and various ambulation devices. The

OCCUPATIONAL PROFILE, ANALYSIS, AND PLAN

occupational therapy gym has a functioning kitchen and bathroom, activity tables and arm
bicycle. The recreational room seems to be used limitedly for patient care or patient interactions.
Activity Observed
As the occupational therapy student, I was able to observe the occupational therapist
perform an initial evaluation. During this evaluation, the patient expressed she would like to
shower. The occupational therapist sought the assistance of a physical therapist and a certified
nursing aid. The physical therapist took the lead in transferring the patient to a shower chair.
Initially the two therapists attempted to help the patient transfer from sit to stand. However, the
patient was untrusting of the physical therapist and unwilling to put pressure on her knee. When
the patient was sitting edge of bed without back support, she had poor trunk stability and balance
as she would fall to her side any moment the therapists were not supporting her. The therapist
decided it was best to use a Hoyer lift. The first attempt at the Hoyer lift was unsuccessful as the
therapists used an unfamiliar sling and the patient ended up folded into a ball suspended in the
air unable to transfer to a seated position. Although the second attempt was successful it took
four people to complete the transfer to the rolling shower chair. Once on the shower chair the
occupational therapist and I wheeled the patient to the shower. In the shower the patient was
able to use her right upper extremity to complete most of the upper body cleaning tasks. The
patient has left upper extremity paresis secondary to a stroke causing her to implement
compensatory strategies to wash her right arm. The patient was unable to wash her lower
extremities and perineal area. The patient was able to dry her upper body off with her right arm,
but she required maximum assistance to dry her lower body. The patient required moderate
assistance to don the hospital gown. The patient used her right arm to brush her teeth and to
comb her hair. The patient was then transferred with a Hoyer lift back to bed.

OCCUPATIONAL PROFILE, ANALYSIS, AND PLAN

Key Observations
Throughout the initial evaluation I noticed a severe lack of basic occupational
engagement. Specifically, the patient does not currently have the confidence in her body to
stand, she requires the total assistance of two people to perform basic ADLs such as toileting and
showering. Her intrinsic motivation to commit to the rehabilitation process is wavering. When
the physical therapist, occupational therapist and certified nursing assistant worked diligently to
help her stand, the patient become entirely uncooperative when the physical therapist
approximated her knee. The patient began screaming she was in too much pain. During the
Hoyer lift the patient was also vocal in expressing her discomfort and displeasure with the
therapists. I did not witness the patient actively assisting the therapists or trying to move on her
own. Throughout the shower I noticed that patient was able to clean her upper body, flex her left
upper extremity to 70, and wash her hair with her right upper extremity. The patients lack of
intrinsic motivation was evident when she greeted the occupational therapist by commenting,
Oh good, youre here to shower me, and when she contributed little effort throughout the
transferring process. The patient worked harder to request more pain medication than to sit up on
her own. There were numerous observations made throughout this evaluation. The most
prominent observations pertain to her overall physical debility and misconstrued perception of
the rehabilitation unit.
Reason for Seeking Skilled Occupational Therapy Services
The patient, Melony, is seeking skilled occupational therapy services due to a current lack
of independence in basic ADLs secondary to a diagnosis of debility and past medical history of
four joint replacements. As previously mentioned, education was needed to correct the patients
perception of occupational therapy. She was under the impression occupational therapy was

OCCUPATIONAL PROFILE, ANALYSIS, AND PLAN

going to perform her ADLs for her. However, after receiving education the patient was able to
change her mindset and have a better understanding of the skilled services offered by the
occupational therapy department. The patient wishes to be able to stand and pivot to her
wheelchair, learn how to uses the grab bars in her bathroom and to ultimately be able to use the
bathroom independently.
Relevant Occupational Domains
The American Occupational Therapy Association published, The Occupational Therapy
Practice Framework: Domain and Process 3rd edition (OTPF), a domain and practice framework
intended to guide the practice of occupational therapy (2014). In the OTPF relevant domains are
identified that underscores occupational therapist areas expertise. A few of these domains that
pertain to the patient are as follows: the activity of daily living, instrumental activities of daily
living (IADLs), client factors, performance skills, client habits and routines, and the environment
where the patient performs her life occupations. The patient significantly lacks independence in
basic ADLs specifically within the areas of personal hygiene and functional mobility. The patient
has also expressed a deprivation in her ability to perform IADLs as she relies heavily on her
boyfriend to cook and clean their home. Client factors that pertain to this patient involve her
bodys structure and functional abilities. Her level of obesity decreases her ability to perform
basic life occupations. The patients habits and routines have significantly impacted her identity
as an occupational being. This is evident as she currently spends every day at home watching
television, smoking marijuana and eating. This unhealthy lifestyle inhibits her from engaging in
occupations that could improve her quality of life. The patients environment has proven to be a
barrier in her occupational pursuits as she is unable to adequately navigate her community as the
sidewalks are not wheelchair accessible and she does not have access to personal transportation.

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The immediate hospital environment has proven to be, at times, enabling as she relies on the fact
that she has help at the push of a button. All of the aforementioned domains will be addressed
throughout her stay at this rehabilitation hospital in hopes of increasing her autonomy and selfefficacy.
Problem Statements
1. The patient requires total assistance of two people when performing functional transfers
due to no standing tolerance and significant lower extremity weakness.
This is the biggest concern as the patient is not able to get out of bed on her own
to engage in numerous occupations such as activities of daily living, purposeful
work, or recreation due to a lack of confidence in herself and therapy team and
generalized lower extremity weakness.
2. The patient requires total assistance of two people when toileting due to decreased ability
to weight shift and maintain balance.
Because of the patients current inability to get out of bed on her own, she now
prefers to use a bed pan opposed to a commode. The patient identified one of her
goals as being able to use the bathroom on her own by the time of discharge.
3. The patient requires moderate assistance when showering due to decreased range of
motion and strength in left upper extremity.
The patients ability to shower her upper body is within functional limits;
however, this is not the case for her lower body. In order to increase her
independence in showering it is vital the occupational therapy student and patient
address showering within the intervention.
4. The patient performs limited meal preparation and cooking due to decreased endurance
and increased fatigue.
The patient relies on her boyfriend to carry out cooking responsibilities because
she is easily fatigued. By improving the patients activity tolerance she may be

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better equipped to live a more nutritious lifestyle which will enable her to engage
in more occupations.
5. The patient engages in limited leisure activities due to decreased activity tolerance,
decreased strength and decreased functional mobility.
The patient identifies her primary occupations to be watching television and
smoking marijuana. She expressed limited ability to engage in other activities
because it is too exhausting to find and then go to community activities. The
occupational therapy student recommends addressing activity tolerance and
community education to increase her community involvement and in turn help her
to establish a larger support network.
Intervention Plan & Outcomes
Goals
Long term goal #1. The patient will complete functional transfers using adaptive
equipment with modified independence by discharge.
Short Term Goal #1a. Patient will stand and pivot when transferring out of bed to the
wheelchair each morning to complete ADLs with minimal assistance in one week.
Intervention
In order to meet the short term goal of increasing functional transferring tolerance, the
occupational therapy student and patient will work deliberately to establish a functional and
purposeful morning routine. There is evidence proving occupational therapy interventions are
effective when associated with a routine and with intention because the patients are more likely
to continue the treatment when the occupational therapist is not present (Priscilla Stoffel &
Nickel, 2013). The intervention will take place before she has completed her ADLs each
morning. This intervention will entail the patient performing sit to stand from her wheelchair to

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bathroom sink, standing at the sink to complete ADLs, sitting back down into the wheelchair,
navigating herself to the closet and then standing up at her closet to put on clean clothing. By
having the patient performing occupations in the bathroom and at the closet, the occupational
therapy student will be able to assess the patients ability to move about her environment in the
most natural context available. When therapists are able observe the patient navigate a natural
environment they are better able to assess the patients level of ability and potential safety
concerns (Sladyk & Jacobs, 2010). It is also within thought that by teaching the patient how to
formulate a morning routine of getting up and out bed, she will begin to become more
intrinsically motivated to engage in more meaningful occupations throughout the day.
According to the Occupational Therapy Practice Framework: Domain and Practice
(OTPF), the restoration category of intervention is most appropriate for this intervention (2014).
This is due to the fact that the patient was once able to perform typical morning ADL routines.
The occupational therapy student expects outcomes of this intervention to impact the following
categories role competence, participation and improvement in occupational performance.
Establishing a morning routine with increasing independence will allow the patient to more
adequately perform roles of partner, allow her more opportunities to participate in occupations
and improve her overall engagement in occupation.
Short term goal #1b. The patient will transfer to and from the wheelchair to the toilet
using grab bars with modified independence in two weeks.
Intervention
Researchers within the occupational therapy profession, Kathryn Karp, Jessica Taylor and
David Nelson identified the three risk factors for falls: lower extremity dysfunction, fear of
falling and self-reported falls history (2012). Therefore, it is vital that the occupational therapy

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student address the patients lower extremity dysfunction and fear of falling. In order to improve
lower extremity functioning, the patient will repetitively practice transferring from the
wheelchair to the toilet utilizing the grab bars and the education taught by the occupational
therapy student. This article also reported the importance of grab bars and adequate non-slip
flooring to decrease fall risks (Karp, Taylor, & Nelson, 2012). Since the patient has grab bars in
her home but is unaware of how to use them, the occupational therapy student will educate the
patient on the proper utilization of the adaptive equipment to decrease her fear of falling. The
education will be spoken, demonstrated and performed by both the occupational therapy student
and patient. According the OTPF this method of intervention is classified as promotion and
modification as the goal is to education and implement adaptive equipment throughout bathroom
mobility, and the intended outcomes focuses on the patient returning to participating in self-care
occupations (2014).
Goals
Long term goal #2. The patient will complete all toileting tasks using adaptive
equipment with modified independence by time of discharge.
Short term goal #2a. The patient will be able to weight shift from one lower extremity
to another in order to perform self-care tasks in the bathroom within two weeks.
Intervention
Studies have shown addressing weight shifting to lower extremities with physical debility
can increase the patients awareness, use and strength of the weakened limb (Stock & Mork,
2009). Due to the fact that the patient has relatively equal and substantial weakness in both
lower extremities, it is crucial she begins to use and strengthen her lower extremities in order to

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restore function and prevent further debility. To address this issue, the occupational therapist will
implement a restorative and remediating intervention with intended outcomes of improving the
patients occupational performance (OTPF, 2014). The intervention will specifically entail the
patient sitting edge of bed, with a reacher in her hand, and a laundry basket approximately a foot
away from her feet. The occupational therapy student will instruct and encourage the patient to
collect clothing garments from the floor around her and place them into the laundry basket.
Throughout this activity, the patient must focus on weight shifting through the lower extremities,
reaching outside her base of support, and balancing to maintain an upright and functional
position. As the patient begins to build upon her weight shifting ability this activity may be
generalized to activities in the bathroom such as weight shifting for hygiene tasks and weight
shifting to flush the toilet.
Grading Up
If the patient is excelling and needs more of a challenge, the occupational therapy student
will have the patient either sit closer to the edge of the bed or stand while reaching for garments
with the reacher. The occupational therapy student could also increase the rigor of the activity by
having the patient utilize the reacher when grabbing for things in a wet environment, such as her
towel when getting out of the shower.
Grading Down
If the patient becomes too discouraged or the risk of safety becomes too great, the
occupational therapy student can lessen the demand of the activity to ensure a therapeutic
session. Down grading the activity would take place if the basket and garments were moved
closer to the patient, causing her to stay closer to midline and her base of support.

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Short term goal #2b. Patient will perform perineal hygiene utilizing adaptive equipment
requiring modified independence within three weeks.
Intervention
Research has shown older adults with chronic conditions report a higher level of selfefficacy when they can independently perform basic self-care activities such as toileting hygiene
(Gitlin et al., 2006). With this in mind, the occupational therapy student will utilize an
intervention using occupations as an ends. The occupational therapy student will facilitate while
the patient practices standing, while simultaneously holding on to the grab bar with one hand and
with the other hand using an assistive hygiene device to clean her perineal area. The assistive
hygiene device is a long handled toilet aid that grasps toilet paper and is used for wiping the
perineal area. The patient will need to implement weight shifting strategies learned in the
previous intervention to ensure standing balance and access to the perineal area. This
intervention will take place during daily occupational therapy intervention.
According to the OTPF, this intervention is considered a mixture of restoration and
modification (2014). Restoration is applicable as the patient was once able to independently
complete bathroom hygiene; whereas, modification is also relevant as the patient will utilize an
adaptive device as a means to compensate for her decreased range of motion and decreased
standing balance. The intended outcome model falls within the improvement to occupational
performance category as the ultimate goal is to increase the patients participation in occupation
despite the presence of performance limitations (OTPF, 2014).
Precautions to Consider
The patient has had a total of four joint replacements in the past three years. She is not
currently under any post-surgery precautions. The doctor has specified she is allowed to weight

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bear as tolerated. With this in mind, all staff should be cautious of the patients fragility and past
medical history pertaining to weakened joints. When transferring this patient, she has shown
significant fear, distrust and hesitation; and therefore, it is best to speak calmly and frequently
with the patient when transferring her to ensure more comfort and control over the situation.
Due to her level of obesity, the equipment used to assist the patient must be graded for bariatric
patients (Reed, 2014). The patients skin should also be monitored as skin break down may
occur as she currently struggles to shift her weight to relieve pressure.
Frequency and Duration of Intervention Plan
Typical stay for individuals on this unit ranges from five days to two weeks. However,
this patients situation is complicated as she has reported living in and out of rehabilitation
hospitals for the past year. Her status with the insurance company is not known, but the patient
did report that if the insurance company ceases payment she will not be able to stay in the
hospital. Insurance, aside, the occupational therapist explained to the occupational therapy
student that she suspects the patient will need one month to reach her ultimate goal of
significantly increased independence. Throughout the patients stay, she will receive
occupational therapy services for 90 minutes daily, five to six times weekly.
Guiding Frames of Reference
The occupational therapy student has determined the rehabilitation frame of reference
(FOR) accompanied by the biomechanical FOR as the two most appropriate frames of reference
to guide the course of intervention. The rehabilitation FOR considers the patient from a topdown approach, meaning that the patient as a holistic being is considered first and foremost.
Because of the patients physical debility and increased weakness, she needs compensatory

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techniques with adaptive equipment to increase her engagement in occupations. The


implementation of compensatory techniques and adaptive equipment is a critical marker for the
rehabilitation FOR (Shultz-Krohn & Pendelton, 2013).
As the patient begins to engage in more occupations such as basic self-care and hygiene
with the use of adaptive equipment, the occupational therapy student will work collaboratively
with the interdisciplinary team to focus on the patients current limitations of significant
weakness in her lower extremities, overall decreased functional mobility, and decreased
functional range of motion. The guiding FOR will shift to the biomechanical FOR due to the
fact that the attention will shift to the patients limitations and the therapeutic emphasis will be a
bottom-up approach (Shultz-Krohn & Pendelton, 2013).
Patient and Caregiver Education
One of the first matters addressed, in terms of educating the patient, occurred during the
initial evaluation regarding the services offered by occupational therapy. The occupational
therapy student suspects the patient will need to be reminded of how occupational therapy is
offered to assist her in achieving her goals, not simply completing her occupations for her. The
patient also expressed an interests in learning how to use the grab bars in her bathroom.
Teaching the patient how to safely use her grab bars, will be a pivotal aspect to increasing her
independence. As the occupational therapy student builds rapport with the patient, the
occupational therapy student will begin to educate and emphasize the importance of engaging in
healthier and active occupations throughout the day. If the occupational therapy student is able
to meet the patients boyfriend, she will explain to him ways in which he could support his
girlfriends engagement in healthier occupations and avoid enabling her. The occupational

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therapy student will provide the patient with resources specifying various ways in which she
could engage in her community, such as a book club, local church or charity.
Monitoring Response to Intervention
In this rehabilitation hospital, it is policy that all patients be reevaluated every seven days.
The reevaluation will consists of the occupational therapy student observing and assessing the
patients ability to perform all tasks and activities needed to complete a shower. With each
reevaluation the occupational therapy student will assess the patients level of support needed
throughout specific tasks (functional bed mobility, functional transfers, dressing, bathing, etc.)
and compare the level of assistance needed to the previous levels. These levels of assistance will
help the occupational therapy student to modify the patients goals if necessary. For example, if
the patient only required moderate assistance one week to transfer from bed to wheelchair but the
next week the patient required maximum assistance completing the same transfer, the
occupational therapy student would know to investigate as to why the patients ability had
regressed. In order to monitor the patients response to intervention the occupational therapy
student will ensure the patient understands the reasoning behind her intervention and the
importance of practicing techniques learned in occupational therapy throughout her daily
routines particularly when occupational therapy is not present.
As long as the patient is motivated, willing and engaged in throughout the therapeutic
intervention, she should be able to increase her independence, her ability to functionally navigate
her environment and increase her quality of life. If the patient begins to shows increased
weakness, regression in motivation, and decreased willingness to practice learned techniques, the
occupational therapy student will have to consider that the patient may not be fit for occupational
therapy services. However, the occupational therapy student will consider the patient making

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progress, if she begins to take initiative in her therapy sessions, completes routines to build lower
extremity and core strength, plans her changes, and executes the changes and most importantly if
she demonstrates practice of skills learned in occupational therapy outside of the occupational
therapy session.

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
Gitlin, L., Winter, L., Dennis, M., Corcoran, M., Schinfeld, S., & Hauck, W. (2006). A
randomized trial of a multicomponent home intervention to reduce functional difficulties
in older adults. Journal of the American Geriatrics Society, 54(5), 809-816.
doi:10.1111/j.1532-5415.2006.00703

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Gustafsson, L., Nugent, N., & Biros, L. (2012). Occupational Therapy Practice in Hospital-based
Stroke Rehabilitation? Scandinavian Journal of Occupational Therapy, 19(2), 132-139.
doi: 10.3109/11038128.2011.562915
Karp, K. E., Taylor, J. M., & Nelson, D. L. (2012). Bathing area safety and lower extremity
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Priscila Stoffel, D., & Nickel, R. (2013). The use of activity as a tool in the process of
occupational therapy intervention in neurological rehabilitation [Portuguese]. Cadernos
de Terapia Ocupacional da Ufscar, 21(3), 617-622. doi:10.4322/cto.2013.064
Reed, K. (2014). Quick reference to occupational therapy (3rd ed.). Austin, TX: Pro-Ed.
Stock, R., & Mork, P. (2009). The effect of an intensive exercise programme on leg function in
chronic stroke patients: a pilot study with one-year follow-up. Clinical
Rehabilitation, 23(9), 790-799. doi: 10.1177/0269215509335291

Shultz-Krohn, W. & Pendleton, H. (2013). Application of the occupational therapy practice


framework to physical dysfunction. In A. Falk & B. Gower (Eds.), Occupational
therapy:

Practice skills for physical dysfunction. (pp. 28-53). St. Louis: Mosby, Inc.

Sladyk, K. & Jacobs, K. (2010). Occupational therapy essentials for clinical competence.
Thorofare, NJ: Slack, Inc.

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