Client’s Initials and Age: Ruby / 4yrs 2mos
Diagnosis and any Precautions: Right hemiplegia spastic CP
Goal/s being addressed:
1. Ruby will use a right lateral pinch to stabilize paper while cutting 3/4x across 2 consecutive sessions.
Precautions: Therapist should remain near pt when she is using the scissors, as her spasticity increases her risk of unintentional self-harm.
Prep Activity
1. Joint Compressions (2-3 minutes)
- Pt will sit in chair
- Therapist will give 10 joint
compressions to each joint on right
Intervention Activities
and left side of body
Describe the activity; be
2. Mr. Potato head (5 minutes)
specific and detailed giving
- Pt. will sit at a table in a backed
5-10 steps. Give estimated
chair
time per activity.
- Pt. will take choose outfit for Mr.
Potato head
- Pt. will dress Mr. Potato head
putting hair, eyes, mouth, ears, arms
and shoes into their respective holes
Time allotted for session: 30-40 minutes
Skill-based activity
1. Paper plate sun activity (10
minutes)
- Pt. will sit in a chair at a
table
- Pt will be asked to use
clothespins to add rays to
the paper plate sun.
- Therapist will demonstrate
- Pt will use left land to pinch
the clothespins open &
right hand to lift and
stabilize the paper plate.
- Pt will repeat until all 8 sun
rays are on the sun.
- Repeat 2x
Occupation-based activity
1. Follow the line to the target
cutting practice (6 minutes)
- Patient will be given a sheet
of paper with a line to an
ice-cream cone.
- Patient will don left handed
scissors
- Before cutting, pt will
watch therapist cut from
the start to the target.
- Therapist will instruct pt to
try.
- Using right hand lateral
pinch patient will stabilize
the paper.
- Using left handed scissors,
patient will cut down the
line to the ice-cream cone
- Repeat 4x with minimal
rest.
2. Rainbow cloud art activity (10
minutes)
- Patient will don left handed
scissors
- Patient will pick up one
sheet of colored paper with
right hand

1. 1.Patient will have increased
proprioceptive awareness of right side
of body, enabling her to bilaterally
engage in skill-based interventions.
Specific Objectives for
2.Patient will tolerate full body joint
this activity
compressions with 0 rest breaks.
List 2-3 specific objectives
per activity that you plan to
2. 1. Patient will use both right and left
measure during client
upper extremity when dressing Mr.
performance.
Potato head.
2. Patient will stabilize Mr. Potato head
with right hand and use left hand to
manipulate the other pieces of the toy.
Activity Demands
1. – 1 chair set up in a quiet environment.
(setting, materials, and
Therapist will be sitting in front of the
equipment)
patient.
List the materials that you
Graded up: Ask patient to sit on the floor
will need and how you will
without any support from a chair, requiring
set up the environment and
her to engage her core
activity.
- Pt will grasp colored paper
sheet with right lateral
pinch
- patient will cut 1 strip of
each of the 5 colors
- Patient will doff scissors
- Therapist will ask patient to
open glue bottle, using
hand over hand assistance
if help is needed.
- Patient will pick up glue
bottle using two hands
- Patient will use two hands
to squeeze Q-tip sized glue
blob onto the back of the
paper cloud.
- Repeat until 5 glue dots are
present.
- Patient will set down glue
- Patient will stick one color
strip to each glue dot.
1. 1. Patient will independently don left
handed scissors
2. Patient will use right lateral pinch with
moderate verbal cuing
3. Patient will complete 4 consecutive
1. Patient will use right lateral pinch when
lines before taking a rest break
stabilizing the paper plate 5/8 tries
2. Patient will put clothespins on all sides
2. 1. Patient will cut paper strips without
of the sun
having visual prompt of a line to follow.
3. Patient will put 4 clothes pins on the
2. Patient will cut ¾ of strips in a
sun before taking a rest break
adducted position.
3. Patient will maintain contact with the
paper in a right lateral pinch until the full
strip is cut.
- 1 paper plate
1. 4 line cutting practice sheets, 1
- 8 clothespins
child sized chair and table, left
- 2 child-sized backed chair
handed scissors. Therapist will
- Age appropriate table with
sit on the right side of the patient
space for therapist to sit
to encourage right sided use in
next to pt
the activity.
- Private treatment room
 Graded down: Perform joint compressions
State 2 ways to grade/adapt with the patient laying on a mat.
the activity or environment. 2. Child sized chair, table, Mr. Potato head
toy. Therapist will be sitting next to the
patient at the table.
Graded up: Once potato is dressed, pt will
be asked to undress the potato requiring
increased strength and UE coordinated
efforts.
Graded down: Patient will lay on a wedge
in prone to complete the potato head
activity. This will give her additional
proximal support.
By using the biomechanical FOR in the first
Clinical Reasoning prep-activity, Ruby’s functional performance was
Why did you choose this enhanced throughout the remainder to the
activity? (what approach are treatment session. CP can cause a decrease in
you using and/or frame of processing of vestibular, visual and
reference; how does this proprioceptive information. After observing that
activity match the child’s Ruby disregarded her right hand during the eval
needs?) session, I thought it was important to
incorporate an activity that would “wake-up” her
right side of her body, and re-establish where
that arm was in relation to her body. Joint
alignment was established, encouraging optimal
function for the next activities. Using the motor
learning theory for the second prep activity
increased Ruby’s intrinsic motivation, as she saw
that she was able to complete an activity that
required both her right and left side to work
together. Ruby was challenged to problem solve
without the additional stress of maintaining a
lateral pinch. The engagement of her right hand
to help complete a task was transferrable to the
next activity that was bit more demanding.
Graded up: Patient will be asked to put
the clothespins on specifically marked
X’s on the paper plate sun.
Graded Down: Patient will be asked to
use right lateral pinch and left lateral
pinch to stabilize the sun while the
therapist adds the clothespins sun rays.
I choose to apply the motor learning
theory when creating this skill-based
activity. Ruby’s intervention is focused
on improving her bilateral coordination,
specifically using her right hand to
stabilize the medium with a right lateral
pinch and her left had to manipulate the
tool. After identifying a movement
pattern that needed practice, the right
lateral pinch, a whole-task action was
created. Ruby is seated in a supportive
chair at a child sized table to give her
stability while working on the task.
Along the way Ruby will receive
knowledge of results and performance
from the therapist, reinforcing her
progress and hard work. Additionally
this task is short and repetitive, and
allows her to take frequent rest breaks.
This task focuses more on ruby’s ability
to maintain a sustained right lateral
pinch, before adding in the complexity
of cutting. She is able to establish this
foundational skill before moving onto a
Grade up: Increase the space between
the dots for the patient to follow /
change the shape of line the patient must
follow while cutting.
Grade down: Decrease the distance
between the start and end of the cutting
target.
2. Pre-cut paper cloud, 5 color of
colored paper, glue bottle, left
handed scissors, 1 child sized
table, 2 child sized chairs.
Therapist will be seated on the
right side of the patient.
Grade up: Patient will be asked to
complete the same activity but using
colored card stock, rather than colored
paper.
Grade down: Add dotted lines for the
patient to follow while cutting.
This intervention is also rooted in the
motor learning theory. The first activity
helps Ruby establish two foundational
skills, cutting and stabilizing. The first
task is relatively simple and only takes a
brief time to complete, so minimal rest
breaks were given. The therapist
demonstrated the skill before Ruby’s
first attempt, as she is still in the skill
acquisition stage. The first task is
graded to help Ruby succeed by having
distinct lines for her to follow while
cutting. The second task was designed
to be more challenging, but also more
meaningful. At the end of the activity
she had something to take home with
her. Again, the therapist demonstrated
the task before asking Ruby to try.
These two activities focus on helping
Ruby achieve a goal-directed functional
activity – cutting while adequately
stabilizing. As she practices both skills
will become more refined
 more complex movement pattern, such
as stabilizing while cutting.
S/OT name: Mackenzie Ackerman