OCTH 6140

Case Study # 1, Part II - Jeremy

100 Points
Student Name: Kaitlin Brown
Date: 10/30/20

PART I – Treatment Planning – building the steps toward your client’s functional goals

Instructions: To complete this assignment, you will need to copy and paste 2 of your goals from your Integrative Case
Study #2 Assignment in OCTH 6120 and paste them into the grids below. Then complete each subsequent section for
each of the goals.

Goal #1: In 6 months, Jeremy will dress independently 5/7 days during the week per parent report.

3 MAIN 1) Higher-level 2) Muscle Power 3) Control of Voluntary

client/performance
factors impacting this
goal. Give a brief
description of how this
impacts this goal.
cognitive/praxis
Motor planning is impacting
Jeremy’s ability to dress
independently as he
struggles to cognitively
come up with motor steps
required and struggles to
execute them in tying his
shoes.
- Jeremy is unable to tie his
shoes due to problems
maintaining grip and doing
fasteners. Lack of muscle
strength in his fingers
impacts his ability to
manipulate fasteners and
maintain a grip on the
shoelaces.
Movement – Jeremy
struggles with bilateral
coordination, fine motor
control and eye-hand
coordination. All of these
areas make it difficult for
Jeremy to manipulate his
fasteners on clothes and tie
his shoelaces as he has to
use dexterous finger
movements and coordinate
movements between his
eyes and his hands.

3 MAIN Performance 1). Manipulation – 2) Coordination – 3) Sequence –

Skills Impacting this goal.
Give a brief description
of how this impacts this
goal.
Find and list (APA) one
(1) article that you could
use to help you figure
out how to treat this
client in regards to this
goal.
(Article must be full text
and attached to this
assignment)
Explain HOW/WHY this
article could be used to
Difficulties in manipulation Difficulties in coordination, Difficulties in sequencing
impacts Jeremy’s ability to specifically bilateral impact Jeremy’s ability to tie
do fasteners on his clothing, coordination, impacts shoes. Jeremy is unable to
as well as manipulate the Jeremy’s ability to do complete the entire
laces required for tying fasteners and tie his shoes, sequence, stopping after the
shoes. as it requires both hands to first step and struggling to
work together. Laces figure out how to complete
require both hands to the rest of the task.
cross, pull through and
make loops.
Case-Smith, J. (1996). Fine Motor Outcomes in Preschool Children Who Receive
Occupational Therapy Services. American Journal of Occupational Therapy, 50(1),
52–61.https://doi.org/10.5014/ajot.50.1.52
This article addresses my goal as the purpose of the study was to identify if improvements
in fine motor skills correlate with functional performance in both self-care and mobility.
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 OCTH 6140
Case Study # 1, Part II - Jeremy
100 Points
Student Name: Kaitlin Brown
Date: 10/30/20
address or support this The intervention activities focused on manipulation, isolated finger use and eye-hand
goal and/or assist your coordination. The study found, in relation to Jeremy’s goals, that the participants
clinical decision making. improved in motor skills including in-hand manipulation and motor accuracy. There was
Is there anything you no significant improvement in grasping strength. The study also found that there was an
need to consider in improvement in functional performance, although it was not considered statistically
applying this article to significant in self-care. The study discusses that there is a moderate correlation between
this client? fine motor skills and self-care and that the development of these skills influences the
functional performance. This article supports my goal as it found that interventions
focused on in-hand manipulation and eye-hand coordination showed significant
improvement. Both of these areas impact Jeremy’s ability to do fasteners and tie his
shoes. Using this information to create interventions that target the same skills will
support his goal of dressing by improving his motor skills and accuracy. It also identified
that the development of these skills influences self-care, although it did not find a
significant improvement in self-care function. When considering this article it is important
to note that the data was for preschool age children. As Jeremy is older, his motor skills
may not be developing like they are in preschool, which could impact the rate at which his
motor skills improve. The article also talked about how fine motor skills influence self-care
tasks, as does family culture and the child’s opportunity to practice those skills. This will
be important in thinking about the support of his goal as it will be imperative that the
skills that are targeted in intervention are able to be carried over for his parents to
continue to work on.
Based off of the article Treatment Activity: Connect Four
above, design 1
treatment activity you This treatment activity addresses both manipulation and eye-hand coordination. For
could use to address this Jeremy, I would have him pick up one checker and move it into his palm to hold. After the
goal. Describe it briefly therapist’s turn, I would have him move the checker from his palm back to this fingertips
and explain HOW this (using one hand) to place it in his slot. I would have them pick up another checker to hold
would address the goal, in his palm until the next turn. Picking up and moving the checker into his hand requires
performance skills manipulation that is necessary for Jeremy’s ability to do fasteners and to manipulate his
and/or laces, which is required for tying shoes. It also addresses eye-hand coordination by having
client/performance Jeremy identify and then drop his checker into the correct slot. This addresses his goal of
factors. shoe tying as he has to be able to coordinate between his eyes and his hands. This activity
also works on praxis, as Jeremy will have to think about how to move the checkers from
his palm to fingers and then complete the motor movements.

You attempt the activity The manipulation required to pick-up, move the checker and return it to this fingers may
above with your client be too difficult for Jeremy. To grade the activity down, I would have Jeremy just pick up
and it is too difficult. the checkers with his pincer grasp and place it within the correct slot.
Identify a skill that may
make this activity too
difficult for the client.
Grade the activity
DOWN to make it easier
based on your identified
skill.
You begin the activity To make the activity harder, I would have Jeremy pick up and hold more than one checker
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 OCTH 6140
Case Study # 1, Part II - Jeremy
100 Points
Student Name: Kaitlin Brown
Date: 10/30/20
above with your client to increase the manipulation needed between his palm and his fingers. With more in his
and it is obvious it is too hand, he would need more manipulation to bring the checkers from his palm back to the
easy for them. Use the tip of this fingers. I could also have him bring the second checker closest to the top to his
skill identified above (in fingers versus the top one in his palm.
down-grading) and
grade the activity up to
make the requirement
for this skill harder.

Goal #2: In 6 months, Jeremy will eat without spills in 5/7 provided opportunities per OT observation.

3 MAIN 1). Attention: Jeremy does 2). Muscle Power: Lack of 3) Control of Voluntary
client/performance not attend to eating. muscle strength in his Movement: Using utensils
factors impacting this Inattention can impede his fingers and hands impacts requires fine motor control
goal. coordination and his ability to grasp and and eye-hand coordination.
manipulation with his manipulate utensils Difficulties in these areas
utensils, increasing his efficiently, creating impacts Jeremy’s ability to
number of spills. uncoordinated movements use his utensils proficiently
and spills. without spills.
3 MAIN Performance 1) Manipulates – Difficulties 2) Coordinates- Jeremy has 3) Attends – Jeremy does
Skills Impacting this goal in manipulation influence difficulties in coordinating not attend to task while he
Jeremy’s uncoordinated his utensils which leads to is eating which impacts his
movements in managing spills. This includes using control when using utensils,
utensils and leading to spills. his fingers and hand in a causing spills. This impacts
This creates difficulties in coordinated manner to the calibration of utensils as
picking up and shifting manipulate his utensils as with not attending, food
utensils in the hand. well as his UE. Coordination may spill off the spoon, or
difficulties not only impact create difficulty in spearing.
his ability to coordinate
and manipulate his
utensils, it also impacts the
ability to use his helper
hand to stabilize the bowl
while he scoops.
Find and list (APA) one Neistadt, M. E. (1994). The Effects of Different Treatment Activities on Functional Fine
(1) article that you could Motor Coordination in Adults With Brain Injury. American Journal of Occupational
use to help you figure Therapy, 48(10), 877–882. https://doi.org/10.5014/ajot.48.10.877
out how to treat this
client in regards to this
goal.
(Article must be full text
and attached to this
assignment)
Explain HOW/WHY this This article discusses that tabletop and functional activities are two common intervention
article could be used to approaches when improving fine motor coordination in adults with brain injuries. This
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 OCTH 6140
Case Study # 1, Part II - Jeremy
100 Points
Student Name: Kaitlin Brown
Date: 10/30/20
address or support this study looked to see if functional activities (i.e., meal prep) improved functional
goal and/or assist your coordination more than tabletop activities (i.e., puzzles). The study found that meal prep
clinical decision making. was more significant in picking up small objects with the dominant hand, but that the
Is there anything you improvements were comparable and as effective in the other areas of the coordination
need to consider in tests. For this study, I am interested in the fact that both tabletop and meal prep activities
applying this article to improved fine motor coordination, as fine motor coordination difficulties impact Jeremy’s
this client? ability to use utensils in a coordinated manner to reduce his spilling. His assessment
indicated that he was below average in fine manual control and manual coordination and
his mother reported that he is uncoordinated with utensils. Due to this, this article
supports my goal in that tabletop activities support fine motor coordination, which would
impact his use of utensils in developing more control, coordination and dexterity. It is
important to consider that this article was focused on adults with brain injuries while
Jeremy is only seven. This is important to consider as Jeremy is still developing both gross
and fine motor skills while the individuals in this study are fully developed and are
working towards restoration. This difference in development may impact the
effectiveness of the intervention.
Based off of the article Treatment Activity: Playdough
above, design 1
treatment activity you This activity is a table top activity working on building fine motor coordination. The
could use to address this treatment would be using the playdough to manipulate and coordinate movements of the
goal. Describe it briefly fingers and hands by pushing buttons into the playdough and pulling them out. It could
and explain HOW this also be picking up toothpicks and pressing them into the playdough. Rolling and
would address the goal, manipulating the playdough into snakes, balls and various shapes. It would all work on
performance skills building fine motor skills and coordination that Jeremy requires to manipulate and use his
and/or utensils in a coordinated manner. This addresses the goal of building manipulation and
client/performance coordination required of utensil use as he struggles with fine motor control.
factors.
You attempt the activity
above with your client Manipulates: If Jeremy struggles to manipulate the playdough into different shapes,
and it is too difficult. manipulate and remove the buttons, and the toothpicks etc. Jeremy could just play with
Identify a skill that may the playdough without the activities, as moving the playdough in your hands is
make this activity too manipulation by itself.
difficult for the client.
Grade the activity
DOWN to make it easier
based on your identified
skill.
You begin the activity Have Jeremy tear little pieces of playdough and roll them into balls only using the fingers
above with your client of one hand. Instead of using buttons, use smaller beads so that it requires more
and it is obvious it is too manipulation of his fingers to put them in and pull them out. Smaller beads could also be
easy for them. Use the used to increase manipulation.
skill identified above (in
down-grading) and
grade the activity up to
make the requirement
for this skill harder.
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 OCTH 6140
Case Study # 1, Part II - Jeremy
100 Points
Student Name: Kaitlin Brown
Date: 10/30/20

Part II – Billing for Therapy Services

1) Based upon what you know about Jeremy, Provide two ICD-10 Codes that you might use for your billing.
Remember, ICD-10 Codes are Diagnostic Codes. Explain your reasoning.
a. . R41.840 – Jeremy struggles to attend to homework and eating due to deficits in attention per his
mother’s report and observations in the evaluation.
b. . R27.9 – Jeremy has a coordination deficit that impacts his ability to shower, dress, use utensils
proficiently, and play. This coordination deficit is not a specific coordination disorder or diagnosis.

2) Based upon your treatment plan activities, theory, frame of reference, and goals, which CPT codes might you
use when billing for your first therapy session? Explain your reasoning.

a. . 97530. Both of my treatments are activities that are working on skills to improve functional
performance, but they are not the actual occupation.
b. . 97112. My treatments focus on coordination as Jeremy has coordination deficits post TBI.

Part III – General Plan of Care Questions

1) Based on what you know about Jeremy, write your Plan of Care Recommendation for Jeremy.
(Ex. OT services recommended 2x/week for minutes/week for ___ Months, for a total of __ visits.)

OT services are recommended twice a week for 45 minute sessions, for 6 months, for a total of 48 visits. Services
are recommended to address difficulties in dressing, feeding, brushing teeth, completing homework, and
participation in PE and recess.

2) After you have completed your interventions with Jeremy, identify 3 activities you could recommend for
Jeremy and his parents to complete at home in order to promote carry-over of therapy at home:
a. . Stringing beads
b. . Arts and Crafts: Rip tissue paper, crumble it into little balls and glue it on the picture (i.e., Christmas
tree, coloring page)
c. . Legos
All of these activities require manipulation and eye-hand coordination, which is important for Jeremy to
reach his goals.

3) Are there any other professionals, based upon your evaluation and knowledge of Jeremy that you think he
should be referred to (assume he is not receiving any other services at this time)”
a. Based on his evaluation, I think Jeremy could be referred to physical therapy. From the evaluation, he
does have some balance, coordination and strength deficits that could be targeted in PT.