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Occupational Profile and Intervention Plan

Faith Wilkins
Touro University Nevada


Occupational Profile
Personal Context
Ann is a 60 year old woman who moved to Las Vegas, NV two years ago. On August 8th,
2015 she was admitted to Summerlin Heights-Genesis, a skilled nursing facility, to address her
concerns related to her rapidly declining independence as a result of having been bed ridden for
46 consecutive days due to a life threatening case of pneumonia. While her pursuit as an
occupational being is currently stunted, Ann speaks of motivation and demonstrates the will to
overcome medically painful and challenging adversities. She spoke about her passions of writing
and sharing poetry, taking care of her cat, and spending time with her roommate. Ann refuses to
let her status as a patient identify who she is. She told the occupational therapy student her roles
and identity revolve around her responsibilities as a roommate, pet caretaker, a poet, and
advocate for individuals with Osteogenesis Imperfecta (OI).
Ann has a roommate of whom she considers to be her significant other. Unfortunately,
Ann has no living family members. She had one sister, who died at the age of 22 due to
complications with OI. Her father died at the age of 56 as a result of similar OI complications,
and her mother past away ten years ago from pulmonary complications as a result of COPD.
Ann lives with her roommate in an apartment on the first floor. The home has two
bedrooms, a kitchen, a living room and one bathroom. The bathroom is small with a tub shower
combination. Ann describes her home as in a rough neighborhood, but that it is, a fine place
to call home.
Patients Reasons, Concerns, and Goals for Occupational Therapy
Anns engagement in meaningful occupations has significantly declined in the past two
months. Her health was further exacerbated by the genetic condition known as osteogenesis


imperfecta (OI). Along with OI and pneumonia, Ann has been diagnosed with the following:
ascites, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), anemia,
edema in bilateral lower extremities, and diabetes mellitus. An accumulation of fluid in the
abdomen, known as ascites, has significantly impaired Anns trunk stability, and therefore, her
ability to perform daily functions such as sitting with a neutral-to-anterior pelvic tilt, transferring
out of bed, and performing activities of daily living (ADLs). One day prior to admission Ann
underwent a paracentesis procedure to drain the excess fluid from her abdomen. Her blood
pressure is being monitored closely as the effects of such drastic fluid draining can cause her
blood pressure to drop to a critical level (Phillip et. al, 2014). While she can now sit edge of bed
with a predominant posterior pelvic tilt and moderate assistance, she reports significant trunk
weakness impeding her from engaging in ADLs at a functional level.
Ann explained her concerns revolve around her declining health status, specifically in
relation to the ascites, as well as her inability to spend time with her roommate. Ann identified
two goals that would improve her quality of life. She would like to become more independent.
She expressed she would feel more independent if she could rely less on the medical staff to turn
her at night and if she could perform her morning routine of grooming on her own. Ultimately,
Ann wants to return home to socialize with her roommate and community of friends online.
Occupational Successes
Due to Anns drastic decline in ability over the past two months, she has had to face the
idea that it will take a lot of work for her to return to her previous level of functioning. She
explained that she understands this reality, and is ready for the challenge. She listed two areas in
which she feels successful. First, she has the ability to text her roommate throughout the entire


day; secondly, she has the ability to write inspiring poetry. Both of these occupational pursuits
bring satisfaction and meaning to Anns life.
Barriers to Successful Occupations
It is not difficult to identify barriers to successful occupation when assessing Anns status
as an occupational being. From a personal level to a societal level, Ann is faced with numerous
obstacles challenging her engagement in meaningful occupations. Her fragile medical condition
that often causes poor health is the most significant intrinsic factor impeding her pursuit of
meaningful occupations. She also spoke of not letting other peoples opinions of her outward
appearance bother her, but admits judging looks and whispers can provoke moments of low-selfesteem. Ann is of low socioeconomic status as she is no longer able to work due to her
condition. In order to pay bills, Ann was forced to pawn her power wheelchair.
Anns challenges and barriers continue on to the family and community level. She does
not have any living family members, and is forced to cope with the concept that her father and
sister died because of the same condition she has. She is new to the community of southern
Nevada, and has limited financial means to help her establish a community here.
On a societal level, Ann faces many challenges of which are not within her control. Ann
provides a testimony (of which will not be fully addressed but is worthy of noting) to the cruel
world of for-profit health care system. For example, her insurance company is reluctant to pay
for her paracentesis procedure. Doctors have begun to routinely refuse the procedure as the
condition is chronic and the ability to make profit from the procedure is limited as the need for
follow-up procedures will not subside. She is forced to wait longer between each procedure.
This most recent procedure was not approved until her abdomen was so distended it prevented


her from being able to sit unassisted. Despite these personal, familial and societal challenges,
Ann seems to be highly resilient and optimistic.
Occupational History
In reflection of her childhood, Ann shared snaps shots of her life with the occupational
therapy student. Growing up Ann lived in the Pacific Northwest. Her childhood consisted of
stunted physical development with numerous fractures. At the age of 15 Ann injured her back
resulting in a spinal fusion of the T12 and LI vertebral bodies. When Ann was in her thirties and
forties, she held a few different positions at local software design companies. She reports having
enjoyed her time as a software designer, but was saddened when she was forced to retire early
due to her physical ailments. At the age of 50, her now ex-husband became abusive. She moved
to Las Vegas as a means to establish her own life, and a new beginning void of abusive
Values and Interests
Ann reports her new life if Las Vegas has been more positive. While, she identifies her
roommate as her only means of support, she says it is better because she no longer fears for her
safety. Ann values her relationship with her roommate, and the time they spend together
watching television. She also enjoys networking with other individuals who have OI through
online support groups. Through the support groups, Ann was able to find her love for writing
poetry. She expressed a strong desire to return to her usual routine which includes writing and
sharing poetry.
Ann explained a typical day before this recent onset of illness. She wakes between the
hours of ten and eleven. She then prepares her breakfast by heating a frozen breakfast sandwich
in the microwave. After breakfast, Ann uses the bathroom to shower and prepare for the day. She


spends her time before lunch on a computer where she is involved in numerous OI support
groups, some of which she started. Lunch is delivered by a local charity. She and her roommate
gather around the television, watch their favorite programming and have lunch. Once, the show
is over Ann returns to her computer. She typically takes a nap each afternoon. Before dinner
each night, she makes a point to sit down with paper and pencil, and write poetry.
Ann explained dinner is not a consistent matter, as they frequently do not have food in the
home as a complication of financial matters. Ann reported she has gone to bed numerous nights
hungry. Ann spends her evenings sitting on her front porch watching the sunset with her
roommate. They also have nightly TV shows in which they enjoy watching together. Ann turns
in for bed between the hours of eleven and twelve. Ann reported reminiscing of her old routines,
encourages her to restore her life as it was previous to the onset of pneumonia.
Occupational Analysis
Summerlin Heights-Genesis is a skilled nursing facility (SNF) located in Southern
Nevada. There are approximately 200 beds forming a residential unit and a rehabilitation unit.
The medical staff is comprised of physicians, physician assistants, registered nurses, nursing
assistants, and rehabilitation specialists. The rehabilitation staff consists of occupational
therapists, occupational therapy assistants, physical therapist, physical therapy assistants and
speech language pathologists.
Due to financial motives the facility is transitioning to admitting predominately persons
with private insurance. Patients, like Ann, with private insurance stay approximately twenty
days. Private insurances often allots 120 minutes five times weekly split between occupational,
physical and speech-language therapy.


Activity Observed
Upon entering Anns room, for the initial evaluation, the occupational therapy student
observed Ann lying supine in bed. Ann was alert and oriented, making eye contact and speaking
with the occupational therapist. Ann rated her pain an eight on a scale of one to ten. She
explained the pain to be generalized throughout her body with an emphasis of pain in her
abdomen. She also noted that pain is a complication of OI in which she has always had to face.
The occupational therapist reported her high level of pain to the nursing staff, which resulted in
Ann receiving pain medication. The occupational therapist began interviewing the patient to
establish an occupational profile.
Once the occupational therapist was able to gain a verbal understanding of the patients
concerns and goals, the occupational therapist established a baseline for the patients current
physical abilities. The occupational therapist conducted a full body observational screen to
assess musculature, body composition and skin integrity. The occupational therapy student
identified a distended abdomen, low trunk tone, edema in bilateral lower extremities, and
decreased strength in bilateral upper extremities. Ann stated her abdomen has significantly
impaired her ability to sit upright.
The occupational therapist then assessed Anns bed mobility. From supine to sidelying
Ann required maximum assistance as she was able to use her right arm to reach for the bed rail
on the left side of the bed, and provide just under half of the effort to assist with pulling herself
to sidelying. From sidelying to edge of bed patient required maximum assistance as she was able
to assist the occupational therapist by slightly rocking sideways to gain momentum for the
transfer. Before transferring out of bed, the occupational therapist assessed Anns static and
dynamic sitting balance. Ann scored poor for static sitting balance as she required moderate


assistance to sustain sitting upright at edge of bed. Ann scored poor minus for dynamic sitting as
she required moderate assistance when the occupational therapist prompted her to reach outside
her base of support for a glass of water.
When transferring out of bed to a wheelchair, Ann required mechanical lift equipment
and two additional staff; however, due to her posterior pelvic tilt and poor trunk stability she was
not able to sit properly in the wheelchair and was at risk for sliding out of the wheelchair. When
Ann was not able to sit in the wheelchair, she was lifted back to the bed with the lift equipment.
After assessing transfers and bed mobility the occupational therapist assessed Anns
ability to perform ADLs specifically grooming and personal hygiene. Ann required moderate
assistance when combing her hair and brushing her teeth as she fatigued easily and was not able
to sustain holding her arm at or above head level for an extended amount of time. The
occupational therapy student asked Ann to explain her routine for dressing. Ann then explained
she only wears large dresses, because it is too painful to don lower body clothing. As the
evaluation concluded, the occupational therapist reassessed Anns perceived level of pain. The
occupational therapist verified Ann was comfortably resting in bed with the call light easily
accessible before exiting the room.
Key Observations
The occupational therapy student identified key observations impacting Anns
engagement in occupations upon the initial evaluation. First and foremost, Anns positive attitude
and motivation to engage in the therapeutic process is a noteworthy sign denoting good potential
in her pursuit of rehabilitation and reengagements in meaningful occupations. Physical
observations which have impeded her ability to engage in meaningful occupations include: low
trunk control, generalized weakness, decreased independence in ADLs, and significantly


decreased functional mobility. Her low trunk tone led to poor trunk control, poor balance and
poor trunk stability. With poor trunk stability, it was no surprise that Ann had limited upper
extremity endurance. With limited endurance and strength, Ann is forced to rely upon others to
assist in nearly all ADLs. Her generalized weakness resulted in limited movement which further
exacerbated her bilateral lower extremity edema. Ann suffers from chronic and acute pain,
which has significantly limited her functional mobility. Anns level of mobility is stunted so
severely, she must rely on others to assist her in all forms of functional mobility, even bed
mobility. These complications are specifically related to her physical condition after the severe
case of pneumonia, the paracentesis procedure to have her abdomen drained of excess fluid, and
her congenital condition of OI.
Relevant Occupational Domains
Ann has experienced a significant decline in occupational engagement as her health status
has declined in the recent months. Prior to her decline in health status, Ann was independent in
all ADLs and instrumental activities of daily living (IADLs). Throughout her trials and
tribulations, Ann continues have a positive attitude and a since of gratitude for the care she
Ann is experiencing challenges preventing from achieving functional independence
within a multitude of domains. The American Occupational Therapy Association published
guiding framework for the occupational therapy profession which identifies the areas in which
occupational therapy practioners are qualified and skilled to address (2014). The most significant
occupational domain impairing Anns engagement in occupations falls under client factors,
specifically body functions and body structures. Due to the nature of OI, her body has always
been challenged structurally and functionally; however, her current level of physical debilitation



is significantly higher than her standard norm. Because of the client factor deficits, Ann has
experienced a decline in her ability to perform meaningful occupations such as ADLs, IADLs,
leisure and social participation. Anns decreased ability to perform motor skills is yet another
secondary complication of poor bodily functioning. Reaching, positioning, bending, stabilizing,
and enduring are examples of motor skills in which Ann struggles to perform.
From a holistic perspective it is also worthy to note, the impact Anns condition has had
on her performance patterns and access to various contexts. Because of her poor health requiring
her to stay under 24-hour medical supervision, she has been forced to redefine her habits,
routines and roles so that they revolve around her care rather than her desires. Her critical
condition has practically confined her to the physical context within the walls of the hospital.
With the confounding effects ofpoor bodily functioning, limited occupational engagement,
decreased motor skills, negatively impacted performance patterns, and restricted access to her
natural contextthere is no doubt that Ann is an individual in need of skilled occupational
therapy services.
Problem Statements
One must consider the foundational concepts preventing Ann from achieving functional
independence. This foundation of hardship begins at a static, sedentary bed level and
significantly impairs all higher level occupations such as functional mobility and ADLs. The
following five problem statements were identified by the occupational therapy student.
1. Pt. requires Max when completing bed mobility 2 generalized weakness.
o Ann must rely upon medical staff to assist her in bed mobility. This is of great
concern to Ann, as well as the occupational therapy student. Bed mobility is the
basis of functional mobility and must be established before other forms of
functional mobility can be addressed.



2. Pt. requires Mod to maintain static sitting balance 2 poor trunk control & posterior
pelvic tilt.
o This problem is of high importance as it ultimately impacts Anns ability to engage in
all occupations that occur outside of the supine position. Ann has goals to restore her
independence and being able to sit in a neutral-to-anterior pelvic tilt is a pivotal
musculoskeletal function in her pursuit of independence.
3. Pt. requires Total t/f out of bed 2 posterior pelvic tilt & trunk strength.
o Anns posterior pelvic tilt and poor trunk stability make transferring from one surface to
another nearly impossible. The posterior pelvic tilt causes her line of gravity to be
behind her base of support, and her poor trunk strength inhibits her from gaining
forward momentum to initiate a transfer.
4. Pt. unable to perform LB dressing 2 pain exacerbation.
o While pain is certainly a factor to be aware of, Ann has spent her life coping with high
levels of pain and therefore this challenge ranks fourth on the list of problems inhibiting
engagement in meaningful occupations.
5. Pt. requires Mod when completing personal hygiene 2 endurance.
o Ann is able to perform just over 50% of personal hygiene while in bed. She is not able
to complete tasks such as brushing her teeth or combing her hair, as she becomes too
fatigued. The occupational therapy student will work with Ann to establish
compensatory techniques to allow her to participate in these meaningful occupations,
while she builds a baseline of strength and postural stability.
Intervention Plan and Outcomes
Long Term Goal #1. Pt. will move supinesitting EOB c

Mod (I) requiring time &

bed rails by D/C.

Short Term Goal #1a. Pt. will roll supinesidelying c

Mod in bed within 1 wk.



Few research studies have been published regarding effective occupational therapy
interventions for individuals with OI. Of the published literature for rehabilitative interventions
for individuals with OI, focus is predominantly on the pediatric population. However, one article
was found to specifically address adults with OI receiving rehabilitation services. This article
states, Prolonged immobilization is detrimental, because it can weaken muscles further and
demineralize bones. (Brusin, 2008, p. 542). In Anns case, it is apparent that 46 days on bed
rest has had a significantly negative impact on her physical condition. It is imperative the
occupational therapy student cease this pattern of immobilization and promote a healthy routine
of mobilization now that she is no longer on bed rest per physician orders.
This mobilization must begin at the most basic level of mobility. Mobility can be viewed
in a hierarchal pyramid with the higher levels not being accomplished until the foundation skills
are established. Within the hierarchy of mobility skills, Susan Pierce, identifies bed mobility as
the foundational level of mobility (2008). Thus, implying that Anns intervention must begin
with bed mobility and then progress to higher levels of mobility such as bed transfers and
bathroom transfers.
Relevant guidelines for mobility intervention for occupational therapist are identified in
Pierces chapter, Restoring Mobility, within the textbook, Occupational Therapy for Physical
Dysfunction. These guidelines include: plan according to patients occupational functioning,
address ADLs before higher levels of occupation, consider contextual factors, and understand
adaption and compensatory strategy that may improve mobility skills (Pierce, 2008).
The intervention planned for Ann to meet her goal of rolling supine to sidelying will
entail her repetitively practicing bed mobility with the occupational therapist as her current level



of occupational functioning is extremely low. Ann must rely on medical staff to move her, thus
her physical context is quite confining and reliant upon others. In order to improve Anns
mobility, strength and endurance, this intervention will consist of Ann practicing bridging her
hips, using her upper extremities to reach for the bed rails and engaging her core to role side to
side. Throughout this practice the occupational therapy student will educate Ann on effective
techniques to move about her bed while ensuring her fragile bones are protected. These
techniques will help her to establish appropriate places to bear weight, ways in which she can
rotate and elongate her trunk and ways in which she can use her abilities to her advantage. The
occupational therapy student expects Ann to fatigue easily and require numerous breaks
throughout the session. Overall, this intervention aims to restore Anns ability to maneuver
within her bed; thereby, expecting an outcome which will improve her overall abilities to perform
meaningful occupations.
Short Term Goal #1b. Pt. will transfer supinesitting EOB c

Min after inclining

the bed ~ 70 within 2 wks.

As Ann progresses in her physical abilities for bed mobility, the occupational therapy
student will help Ann further establish autonomy and strength by helping her to restore the skill
of transferring from supine to sidelying. Once Ann is able to progress to this level it is
imperative her pulmonary condition be monitored as individuals with OI are known to have
complications with pulmonary functioning as they may have malformations of the rib cages,
weak chest muscles and kyphosis (Reed, 2014).
Anns intervention will progress slowly at a therapeutic pace. The occupational therapist
will educate Ann on the proper placement of her arms so that she may assist in pushing up from



the bed during the transfer. However, the occupational therapy student expects Ann will need to
utilize compensatory methods to be successful in reaching functional independence. Thus, Ann
will be taught to elevate the head of the bed, and then use momentum to rock herself forward.
Due to Anns upper extremity weakness the occupational therapy student is be obliged to follow
a biomechanical approach to work on strengthening the upper extremity. As Estelle Brienes
suggests, isotonic active exercises are the best method to use when applying resistance is
contraindicated for individuals (2013). Due to Anns fragility and weak musculature, activities
with resistance and high strain are contraindicated. Therefore, the occupational therapy student
will implement isotonic active exercises such as flexing and extending her shoulder, abducting
and adducting her shoulder and flexing and extending her biceps for a set number of repetitions
dependent on Anns fatigue, endurance, strength and vital signs.
If Ann can increase her upper extremity strength, she is reasonably expected to improve
her ability to push her body up with transferring from sidelying to sitting edge of bed.
Throughout this intervention the occupational therapy student will utilize a restorative and
compensatory approach. When monitoring outcomes, the occupational therapy student will track
her improvement in occupational performance.

If necessary this activity will be down-graded by utilizing gravity assisted positions
during isometric exercises. This activity may be graded-up by encouraging Ann to sustain a
contraction against gravity for three to five seconds before relaxing. Grading of the activity will
be closely monitored to ensure the challenge is just right for Ann.



Long Term Goal #2. Pt. will maintain trunk control & a neutral-to-anterior pelvic tilt
while seated EOB for 2 min c

no more than 3 VC by D/C.

Short Term Goal #2a. Pt. will maintain a neutral pelvic tilt while in the seated position
for 1 min while grooming EOB c

Min within 1 week.

The occupational therapy student will work with the patient achieve a neutral-to-anterior
pelvic tilt. An anterior pelvic tilt is most functional. However, Anns lack of trunk control (as a
result of debility and status post paracentesis) will impede her from achieving ideal positioning
in the beginning weeks of therapy. The occupational therapy student will use manual techniques
to facilitate a more forward pelvic tilt.
In a research study assessing bodily structures and functions on postural imbalance,
pelvic tilt was identified as a factor determining postural stability along with implications for
other bodily functions, such as breathing. With a posterior pelvic tilt, weight is unequally
distributed above and below the diaphragm thereby decreasing the efficiency of the diaphragm
and the bodys ability to breathe (Key, Clift, Condie & Harley, 2008). As previously stated, Ann
is at risk for pulmonary issues due to structural malformations, and therefore, it is crucial the
occupational therapy student addresses Anns bodily positioning during all foundational
Once Ann is familiar with initiating a forward pelvic tilt, the occupational therapy student
will work with Ann on building strength for a neutral pelvic tilt. The occupational therapy
student understands Ann must have incentive to engage in the strength building activity, and



therefore an intervention using occupations as a means will be integrated into the intervention.
Ann will read her poetry aloud while sitting tall and proud on the mat. The occupational therapy
student will be sitting next to her providing physical and verbal cues as needed. Ann will likely
need breaks, at which point she could lay down on the mat or prop herself up against the wall. If
Ann were to choose to lay down, this would provide yet another opportunity to work on her
previous goal of transferring sidelying to sitting. This intervention is also a restorative approach
as Ann is on a quest to regain her ability to control her posture. The outcome measures will
detect improvement in occupational performance as well as mark her return to participating in
meaningful occupations.
Short Term Goal #2b. Pt. will sit EOB while completing grooming tasks for 2 mins

CGA & set up within 2 wks.

Anns desire to become more independent is a challenging, yet realistic goal for someone
with her condition. Research was conducted assessing quality of life and likelihood for
independence in ADLs and IADLs in adults with OI. This study concluded that individuals with
OI typically report high levels of perceived quality of life, are often employed, have good
educations and live their lives independently (Balkefors, Mattson, Pernow, & Sf, 2013). To
assist Ann in becoming more independent in self-care, the occupational therapy student will help
Ann to establish enough trunk control to complete grooming tasks. The occupational therapy
student will provide skilled services by teaching Ann compensatory techniques while
remediating her physical abilities.
The occupational therapy student will offer compensatory techniques such as, propping
her distal humerus on the table while brushing her hair. This compensatory intervention will



help her to suspend less weight against gravity thereby conserving energy, allowing her to brush
her hair longer. She will also be taught how to use compensatory techniques when opening
bottles with tight lids (e.g. toothpaste, mouthwash, etc.). Ann will also be taught how to
distribute ADL tasks throughout the day so that she does not exhaust her strength first thing in
the morning. After being taught these techniques, the occupational therapy student will have
Ann verbalize and demonstrate to prove her understanding of the techniques. The occupational
therapy student will continue to assess her grooming performance and offer compensatory
strategies as needed. This modified approach will be measured by her participation and
improvement in occupational performance.
Precautions to Consider
Numerous precautions will be taken into consideration when working with Ann. These
precautions and potential contraindications include: bone fragility, edema, skin fragility, vision
impairment, scoliosis, vascular irritation, high levels of pain and shortness of breath. Her
condition of ascites also increases her risk for orthostatic hypotension as the change in fluid
build-up in her body may alter her blood pressure. When addressing bed mobility and transfers,
the occupational therapy student will be mindful of her skin integrity and reduce skin shearing as
much as possible. As well as her lower extremities ability to weight bear, due to being bed
ridden for a prolonged amount of time, her lower extremities will be weak and fragile.
Frequency and Duration of Intervention Plan
Due to the nature of the facility and Anns insurance provider, she will receive
occupational therapy services five times weekly for 60 minutes. Her insurance will like cease
payment on the 20th day of her stay at the skilled nursing facility. At which time the occupational
therapy student expects she will be discharged to rehabilitation facility closer to her home.



Guiding Frames of Reference/Model

In order for Ann to reach her goal of becoming more independent, the occupational
therapy student will utilize two guiding frames of reference (FOR), known as the biomechanical
FOR and the rehabilitation FOR. As Ann has lost a significant amount of strength and
endurance, the biomechanical FOR is the best model to use as it focuses on restoring range of
motion, strength and endurance (Rybski, 2012). It will take time for Ann to regain this strength
and endurance which is why the occupational therapy student chose to also apply the
rehabilitation FOR when planning Anns intervention. The rehabilitation FOR has a
compensatory and adaption approach that can be integrated into Anns routines and occupations
instantaneously (Cole & Tufano, 2008). Teaching Ann compensatory techniques while she
works to restore physical functioning, will promote resumption in her occupations and life roles
sooner rather than later. For example, portions of the intervention aimed to establish trunk
strength and postural control will draw from the biomechanical FOR. While the portion of the
intervention where Ann learns compensatory techniques for ADLs, will follow the rehabilitation

Patient and Caregiver Education

As previously mentioned, Ann will be educated throughout the intervention on
compensatory techniques and proper body mechanics. Anns roommate is the closest person she
has to a caregiver. However, due to the roommates own medical complications she is not able to
visit the facility; therefore, the occupational therapy student may phone the roommate to provide
her a summary of techniques and tips to help Ann be more successful in meaningful occupations.



The occupational therapy student will recommend home health services for Ann when she
returns home.
Monitoring Response to Intervention
Anns goal is to become more independent. Considering her current level of dependence, her
progress will be monitored in terms of her increased, or decreased, bed mobility, postural control,
sitting balance and overall reengagement in meaningful occupations. The occupational therapy
students has created interventions that are reasonably expected to empower Ann to rely less on
As per policy at this facility, Ann will receive an occupational therapy reevaluation every
seven days. This reevaluation will allow the occupational therapy student to track her progress,
or regression, of functional levels based on scores from the Functional Independence Measure.
The occupational therapy student will also maintain an open line of communication with the
patients level of satisfaction in terms of the occupational therapy services offered.

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