INTERVENTION PLAN FOR COMMUNITY CLIENT WITH REFLECTION

Copy/paste one LTG and the matching STG from your evaluation SOAP note. This will be the goal set around which you design
your treatment session.
For this and all subsequent weeks, please answer the following questions before designing your treatment plan for the next week. If
you were unable to see your client the past week, you do not need to answer these questions. Answer the questions based on the
treatment that you implemented:

What went well with your treatment?

The client continued to use the mug and demonstrated progress in learning the strategies to position and open his hand on the mug.
He also learned how to use his R hand to stabilize the mug so that his L arm moves in an efficient way, allowing him to drink from the
mug. He was also able to increase the amount of water in the mug.

Did things go as you planned or not? Explain.

For the most part, things went as planned as far as him improving in using the mug. One thing that did not go as planned is taping.
He was taped for supination but due to his high tone, I am unsure if the tape was not stretched enough to benefit him or if because of
his high tone, that taping is just ineffective. One other thing that did not go as planned is that the treatment was focused on
positioning and the task only required him to bring his arm up to the counter one time. The client also did not like the cueing strategy
to remember to bring his L arm to the table or in using sweatbands as a reminder.

What will you do differently with this next treatment plan?

After multiple sessions of cueing the client to position his L arm and providing different strategies, it is clear that our client is
beginning to tire of those conversations and working on the mug. His activity tolerance has decreased and he has started letting us
know through various comments that these no longer appeal to him and his wife has mentioned that they do not carry over to home.
As our client has low motivation, we decided that the next few sessions we should switch gears, and focus more on standing
tolerance as that would greatly benefit him and use positioning briefly in our treatments without focusing the entire treatment purely
on positioning and the mug.

Long-Term Goal: By discharge, the client will position his L UE during feeding to decrease pain and instability with no more than 3 indirect verbal cues

Short-Term Goal: In 3 sessions, the client will increase his standing tolerance from baseline by 4 minutes
 Describe client factors
relevant to occupational
performance problem in the
goals you selected
High muscle tone L UE
PROM shoulder flexion 70
degrees. Scapula manually
elevated, shoulder flexion
PROM is 90 degrees. Has
10 degrees shoulder
abduction, external rotation
and forearm supination in
PROM. Elbow flexion is 80
degrees PROM.
Has 70 degrees of volitional
movement in shoulder
flexion and 5 degrees
shoulder abduction against
gravity. Occurs within flexor
synergy with trunk rotation to
R side and scapular
elevation.
Able to flex bicep and extend
elbow in gravity eliminated.
No active elbow flexion or
extension against gravity.
No volitional movement to
List and provide rationale for
the OPM and CPM you will be
using in this treatment
relevant to this client’s goals
PEO
This client has a lack of
congruence between the
person, the environment, and
his occupation. The client’s L
hemiplegia, inattention, slow
processing, and pain is
impacting his participation in
feeding. In the client’s
environment, his wife often
does things for him, limiting
his opportunity to use his L
arm in occupations, leaving
his L arm hanging at his side,
increasing his pain.
Rehabilitation
This client is considered
chronic post-stroke. He would
like to use his L UE more in
his daily occupations. Since
he is two years post-stroke,
treatment will focus on using
compensatory strategies to
Describe the skilled OT session you Describe one (and only one)
will use to address the client factors way you can grade the
in the first column.
activity in your treatment
session up and down on one
client factor
Client factor: Endurance
The client will be standing at a Grade up: Have the client
counter waist-high. His w/c will complete two puzzles or one
be directly behind his legs, 10 minute puzzle before
locked in case he needs to sit sitting down for a break.
down.
Grade down: Have the client
The client will stand at the complete most of the puzzle
counter and build 3-4 electric while seated at the table.
snap circuit puzzles depending Have the client stand to insert
on time. Each puzzle will take the last three pieces (around
around five to ten minutes. To 2-3 minutes before sitting
start, the client will be asked to again).
stand at the counter to begin
the puzzle. The goal is for the
client, after multiple sessions
of positioning, to bring his L
arm, lifting with his R hand, to
the table. If the client does not,
I will provide indirect cues
through the hierarchy until he
brings his arm to the table.
Each puzzle will have no more
than 10 pieces, and the pieces
will already be out and on the
counter for the client to find.
The client will read from the
booklet and put the puzzles
supinate and pronate
forearm, flex and extend the
wrist, and flex and extend
fingers actively or in gravity
eliminated.
No light touch sensation in
palm of hand.
No proprioception in thumb.
Pain in L shoulder, L bicep,
back and neck.
Thoracic kyphosis
Slow processing
Inattention to L side
L visual field cut
use his L UE in occupation to together using his R hand,
assist in positioning for while his L hand rests on the
shoulder stability and pain. counter. The client will stand
while completing the puzzles,
Biomechanical sitting down as often as
needed for a break (Baseline
The client’s current pain level standing about 5 minutes).
is a barrier to his occupations. During the break, the client will
As he leaves his L arm passively stretch his L hand
hanging at his side, he lacks with his R. When he has
shoulders stability, creating recovered, the client will stand
more pain. Due to his limited and continue putting the
PROM and pain along with electric snap puzzles together.
his limited volitional The client will then reposition
movement in his shoulder, the his L arm, using his R arm to
client does not use his LUE in lift, on the counter each time
occupation. He also has poor he returns to standing at the
posture that contributes to his counter from a break.
overall pain level. This model
will be used to address his
pain through positioning of his
L UE and posture. The
client’s poor standing
tolerance also impacts his
ability to position his L UE
when standing and this model
will be used to increase his
standing endurance.