Consumer Details

name, age, cultural background, gender, diagnosis/es, social situation, and other relevant
information (like a whole person)

Name: Jake Moore

DOB: 21/06/2013

Age: 10
Gender: Male
Culture: Australian
School year: Year 5

Diagnosis: Mild Traumatic Brain Injury (due to bicycle incident in 2023)

Social situation: lives with parents and 4 younger siblings (2 years old, 3 years old, 5 years
old, and 8 years old)

Pre‐existing medical/social issues

• Behavior
• Circumstances of Injury
• Socioeconomic Environment
• Support System
• Parenting/ability of parent to
be present

photo
current signs/symptoms/barriers/enablers/strengths/areas for development that are relevant to
the consumer's purpose for attending your healthcare business. This could include specific results
from OT/SP assessments e.g. scores on standardised assessments, observations, information from
the family, other stakeholders

Occupational therapy initial assessment with Jake, his family and his teachers is completed. School
and family report that Jake experiences frequent mood swings, in which he gets easily irritated and
hits his classmates twice after the incident. It affects his ability to regulate his emotions and
negatively impacts his relationship with his classmate. Moreover, teachers demonstrate that Jake
has difficulty in short-term memory, which involves remembering instructions and retrieving
information in short periods of time. It affects Jake’s ability to learn new information and follow
instructions in class at school. From information from Jake’s family, he has supportive parents and
supportive teachers at school throughout the therapy. Furthermore, Jake and his family have
Medicare to support medical expenses. Also, Jake is positive and willing to comply with treatment.
These enhance his motivation in attending healthcare and having treatment throughout the
recovery. However, Jake has three younger siblings in his family that his parents need to take care
of, which limits his parents from attending healthcare with Jake.

Observation at home and school is completed. Jake is observed to have a reduced attention span of
around 5 minutes for schoolwork in classes. It affects Jake to learn and concentrate in class
effectively, resulting in lower academic performance at school. The reduced attention also affects his
ability to concentrate on completing personal care tasks at home. Additionally, Jake experiences
apraxia of speech, having abnormal speech muscle movement, causing difficulty in pronouncing
words precisely and consistently (Leonhartsberger et al., 2022). It impacts severely Jake's
communication with his family, classmate, and teachers. In addition, Jake’s speech issues negatively
affect the social relationship between Jake and his classmates.

ENABLERS BARRIERS
Person factors
Psychological

Cognition

Sensory
 Motor

Physiological

Spirituality

Environment factors
Culture

Social
determinants

Social support
and social capital

Education and
policy

Physical and
natural

Technology

Signs and symptoms:

 Apraxia of speech (motor programming)/ dysarthria

- The speech produced by a person who has traumatic brain injury may be slow, slurred, and
difficult or impossible to understand if the areas of the brain that control the muscles of the
speech mechanism are damaged. This type of speech problem is called dysarthria. These
individuals may also experience problems swallowing. This is called dysphagia. Others may
have what is called apraxia of speech, a condition in which strength and coordination of the
speech muscles are unimpaired but the individual experiences difficulty saying words
correctly in a consistent way. For example, someone may repeatedly stumble on the word
"tomorrow" when asked to repeat it, but then be able to say it in a statement such as, "I'll try
to say it again tomorrow."
-  Speech and language problems—problems being understood because of weak speech
muscles (dysarthria) or problems controlling your speech muscles (apraxia of speech in adults
and childhood apraxia of speech); problems understanding what others say or what you
read; problems finding the words to say what you want or need.

-  Social communication issues—difficulty following conversational rules, like taking turns and
not interrupting; difficulty understanding nonverbal cues, like when someone shrugs their
shoulders

- Word repetition, inaccurate movement resulting in sound distortions, groping for sound
position and off-target movements that distort sounds, inconsistent over repeated at the
same word (having difficulty to pronounce specific sounds/make the same errors in a
sentence/during the conversation)

- Sound distortions, slower and more deliberate speech

 - Childhood apraxia of speech (CAS) is defined by the American Speech-Language-Hearing
Association (2007) as ‘a neurological childhood speech sound disorder characterized by
deficits of precision and consistency of movements underlying speech in the absence of
neuromuscular deficits (e.g. abnormal reflexes, abnormal tone)’. (Leonhartsberger et al.,
2022)

Occupational therapy initial assessment with Jake, his family and his teachers are completed.
School and family report that Jake is experiencing frequent mood swings, in which he gets easily
irritated and hits his classmates twice after the incident. It affects his ability to regulate his
emotions and negatively impacts the relationship between Jake and his classmate. Moreover,
school and family demonstrate that Jake is having difficulty in short-term memory, in which he is
unable to remember instructions and retrieve information in a short period of time. It affects
Jake’s ability to learn new information and follow instructions in class at school. From
information from Jake’s family, he has supportive parents and supportive teachers at school
throughout the therapy. Furthermore, Jake and his family have Medicare to support medical
expenses. Also, Jake is positive and willing to comply with health professionals and treatment.
These enhance his motivation in attending healthcare and having treatment, as well as feeling
emotionally supported throughout the recovery. However, Jake has three younger siblings in his
family that his parents need to take care of, which limits his parents in spending time with Jake. /
lowers his parents’ motivation to attend healthcare with Jake.

Occupational therapy observation at home and school is completed. Jake is observed to have a
reduced attention span of around 5 minutes for schoolwork in classes. It affects Jake to learn and
concentrate in class effectively, resulting in lower academic performance engagement at school.
The reduced attention also affects his ability to concentrate on completing personal care tasks at
home. Additionally, Jake is experiencing apraxia of speech, which means a person has abnormal
speech muscle movement, causing difficulty in pronouncing words precisely and consistently
(Leonhartsberger et al., 2022). It impacts severely the communication between Jake and his
family, his classmate, and his teacher at home or at school. In addition, Jake’s speech issues
negatively affect the social relationship between Jake and his classmates.

 Attention
- Impaired sustained attention for task completion or conversational engagement
- Reduced attention span
- Attention or concentration problems
• Only able to focus on school work for short amounts of time
 Emotion
- Irritability
- Irritability or easily angered • Trouble dealing with stress
- Mood changes or mood swings
-  Behavior changes—being more emotional or feeling anxious or angry; feeling depressed or
having mood swings.

 Short-term memory
- Deficits in short-term memory that negatively affect new learning
 - Short-term memory problems • Trouble remembering instructions or keeping
information and ideas in mind during tasks
-  Problems with thinking skills—difficulty paying attention, remembering, and learning new
information; difficulty planning, setting goals, and problem solving.

Occupational performance issues:

compared to peers poor hand-eye coordination
and visual processing
Behavioural dysregulation - ‘quick to temper’
and lashes out at strangers
Difficulties detecting and expressing emotion
1-2 minute concentration span
easily distracted by peers, noises, movement in
classroom
multiple instructions needed to complete
morning self-care routines

IDEAs from references:

As many as 40% to 50% of children experience a range of postconcussive symptoms immediately

following MTBI.20 The sequelae from these various symptoms range from minor inconveniences to
debilitating situations, causing alarm to parents/caregivers as was encountered with JT. In most
cases, symptoms resolve within 3 months of injury; however, a small subset of children may continue
to experience symptoms beyond 3 months.21 Children with MTBI and a prior history of head injury or
premorbid learning/behavioral difficulties may display adverse outcomes, including hyperactivity,
inattention, and behavior problems.21,

 Sensory problems—sensitivity to lights, sound, and touch; hearing loss or ringing in the ears;
changes in vision or double vision.

o Loss of awareness of joint position and movement in her right upper limb
o Increased tone and loss of voluntary motor control in R UL
o Reduced trunk control, impaired sitting balance
o Impaired expressive language
o Difficulties with motor planning
o Loss of right visual fields in both eyes
o Significant mood swings and impulsivity

School Aged:
Physical:
•More complex gross and fine motor skills
•Athletic development
•Steady growth: 3 ‐4 inches per year
•Motor & perceptual motor skills better integrated
•10‐12 yrs: puberty begins for some children
Cognitive:
•Progression from ego‐centric, illogical, magical thinking to more
concrete thinking
•Explosion of vocabulary
•Poor understanding of time, value, sequence of events
•Vivid imaginations
•Receptive language better than expressive till age 4
Social:
•Wants to please adults
•Development of conscience

Emotional:
•Self‐esteem based on what others tell him or her
•Increasing ability to control emotions, less emotional outbursts
•Curious
•Self‐directed in many activities
•Self esteem based on ability to perform and produce
•Alternative strategies for dealing with frustration and expressing
emotions

Initial Symptoms:
 Vomiting
 Headache
 Crying and inability to be consoled
• Restlessness or irritability
Persistent Symptoms:
 Excessive crying
 Persistent headache
 Poor attention
 Changes in sleep patter

Assessments completed (after hospital):

initial interview with parents and teacher and
observation during school/self-care occupations
Goal-Oriented Assessment of Lifeskills
Vineland Adaptive Behaviour Scales
Lowenstein Occupational Therapy Cognitive
Assessment
School Function Assessment

Questions answered in Discussion Board:

In the patient details section you need to create a client that would use your service. As you're describing a
fictional case that you're creating yourself you do not need to cite it. You do not need to cite for signs and
symptoms or diagnoses if you are describing the client. If you are describing a diagnosis and are including signs
and symptoms that you would expect to see, then a reference would be needed as you would then be referring
to a source for that information. You do not have to cite a source when talking about the outcome of
assessment scores/analysis, however you may wish to cite the assessment when you introduce it.

 Barrier vs enabler
o Enabler - something external to the client that exists in their envionment that contributes to
their successful functioning/participation.
o Barrier  - something external to the client that exists in their envionment that limits or
restricts their successful functioning/participation.
 Strength vs area for improvement
 o Strength - a positive application of a skill or behaviour that   supports successful participation.
o Area for improvement - a skill or behaviour that   could be further supported or developed to
improve successful participation.
 Sign vs Symptom
o Sign - something observed within the presentation of a consumer that is indicative or linked
with their health condition (ie. percieved by someone else).
o Symptom - something observed by the consumer within their experience of health condition,
which may be linked to a dianosis (ie. experienced by the person themselves).

Not only is the child’s role of being a student compromised, but also the role of a
parent/caregiver (Liu & Li, 2013). Parents/caregivers can require more significant
support in managing their child’s behavioral and psychological challenges after a TBI
(Liu & Li, 2013). As behavioral problems become increasingly difficult to control,
parents/caregivers may become more permissive in their parenting approaches (Liu & Li,
2013). The role of the parent shifts during this period in time where the parent now needs
to plan for current and future treatment/rehabilitation plans, learn how to help their child
manage behaviors, and access services for their own support throughout the process

Occupational therapy practitioners can prepare the family for changes in roles and
routines, educate the family and school staff on the diverse needs of the student,
evaluate
ways to support the child, facilitate skills required for school participation, help
children
and families develop advocacy skills, enhance social skills for school and community
environments, and collaborate with the transition team (Orentlicher et al., 2017).
Examples of interventions that occupational therapy practitioners can provide
include: (a)
education about the transition, (b) problem solving solutions for child and family

19
concerns, (c) providing coaching, (d) managing clothing for toileting, (e) increasing
independence in school-related activities, (f) eating (snacks in the classroom), (g)
dressing (putting on a jacket), (h) school routines, (i) participating in circle time/group
activities, (j) using/adapting technology, (k) and drinking from the water fountain
(Orentlicher et al., 2017) (https://commons.und.edu/cgi/viewcontent.cgi?
article=1485&context=ot-grad) (Boldt & Rick, 2020)

Not only is the child’s role of being a student compromised, but also the role of a
parent/caregiver (Liu & Li, 2013). Parents/caregivers can require more significant
support in managing their child’s behavioral and psychological challenges after a TBI
(Liu & Li, 2013). As behavioral problems become increasingly difficult to control,
parents/caregivers may become more permissive in their parenting approaches (Liu & Li,
2013). The role of the parent shifts during this period in time where the parent now needs
to plan for current and future treatment/rehabilitation plans, learn how to help their child
manage behaviors, and access services for their own support throughout the process (Kirk
et al., 2015). (https://commons.und.edu/cgi/viewcontent.cgi?article=1485&context=ot-grad)

Occupational therapy practitioners focus on both the cognitive and physical

deficits while following a client and family-centered model, which fits well with the
transitioning stage. (https://commons.und.edu/cgi/viewcontent.cgi?article=1485&context=ot-
grad)
A caregiver's opinion and understanding of TBI affects can be a direct factor in
the child receiving services or not (Haarbauer-Krupa et al., 2018). Both caregivers and
students should be educated at the time of injury and given specific recommendations and
a list of what to monitor in regards to transitioning back to school (McAvoy &
Haarbauer-Krupa, 2019). (https://commons.und.edu/cgi/viewcontent.cgi?
article=1485&context=ot-grad)

Parents learn to provide necessary supports (i.e., positive

verbal mediation, daily planner, timer, checklists) and mod-
ifications (i.e., preparing materials in advance, reducing
clutter and distractions) for their child in the home environ-
ment to promote transfer of strategies and successful occu-
pational performance at home (Hahn-Markowitz et al, 2020)

A review of interventions for executive dysfunction in

children and adolescents recommended involving parents
in intervention, as the psychoeducation of parents is a criti-
cal element in their children’s treatment (Riccio & Gomes,
2013). Halperin et al. (2013) conducted a study that aimed
to examine whether cognitive enhancement administered
to preschoolers through play would impact the severity of
their ADHD symptoms. Children attended sessions target-
ing EF, motor control, attention/tracking and visuospatial
abilities. Parents attended separate psychoeducation and
group support sessions. Their role at home was to progres-
sively increase the cognitive and behavioral demands of
games as children mastered necessary skills. (Hahn-Markowitz et al, 2020)

Education is one of the main components of occupational therapy, it supports Jake’s parents in
learning skills and strategies to support and assist Jake in engaging self-care occupation, and allows
opportunity to coollarative with Jake and his surrounding supporters, which are his parents.
(Towsend and Polatajko (2013) to in engaging daily occupations at home, with supports and
assistance

In occupational therapy, education skills are to stimulate growth

through engagement, with active participation in the occupations of everyday life.
By teaching people , communities, and organizations to actively participate and collaborate in
shaping everyday life, occupational therapists put the ancient Chinese
proverb into a modern context (Hopkins & Smith, 1988):
Give a [person] a fish and you feed [her/him] for a day. Teach a [person] to
fish and you feed [her/him] for a lifetime.
Education skills are aligned with skills to collaborate with clients, and to design learn-
ing opportunities and resources for diverse experiential, rote, didactic, or other learning
styles. Occupational therapists are particularly skilled in the educational use of simulated
occupations in hospitals or other settings designed to offer therapy apart from the natural
environment (Townsend, 1996). Where occupational therapy facilities have
been created, client education may involve demonstrating or practising simulated occupations before
clients transfer their learning to their own home, work, or other environments. Clients, from
individuals to organizations, may learn through doing with instruction in performing or organizing
routines of occupations, or in adapting the
environment, for instance, in the home, community, or business ()

Another part of the session includes education (20 minutes):

To increase Jake’s attention span in completing personal care tasks at home, an occupational
therapist provides education to Jake’s parents on strategies based on activity analysis. First, an
occupational therapist explains to Jake’s parents that dividing smaller tasks for a personal care
activity for Jake is essential alongside guidance when Jake does personal care activity at home
(Dancza & Rodger, 2018). Then, the occupational therapist explains the concept of breaking down
the task with an example activity, which is showering: breaking down the task of showering into four
smaller tasks, including washing hair, washing the upper body, washing the lower body, and drying
the body. The occupational therapist then asks Jake's parents to guide him to complete each task at
divided times in a day. Also, the occupational therapist educates Jake’s parents about providing
micro-breaks in between activities for Jake.

 as if you are talking to your fieldwork supervisor e.g. l “In today’s session, I used xxxx
because …. The evidence for this approach comes from Jones (2017) who found xxx.”
A class I study9 investi-

gated the effectiveness of cognitive remediation and cognitive-

behavioral psychotherapy for participants with persisting com-

plaints after mild or moderate TBI. The cognitive remediation

consisted of direct attention training along with training in use

of a memory notebook and problem-solving strategies. Cognitive-behavioral therapy was

used to increase coping behaviors and reduce stress. Participants demonstrated improved
performance on a measure of complex attention and reduced emotional distress compared
with a wait-list control group, although there was no effect on community integration.
(https://reader.elsevier.com/reader/sd/pii/S0003999310009500?
token=5810583A89B3BE92A41525306226428CB175E747B1F0A16E786F65227E8C425D
1F08C0B1A3EBBCED7A6DF50C077379B1&originRegion=us-east-
1&originCreation=20230408155446)

Cognitive rehabilitation consists of diverse interventions; however, there is a consensus in

literature that cognitive rehabilitation has to be tailored to individual needs.[5] Studies have
divided cognitive rehabilitation therapy into two components: Restorative and compensatory
approach.[5] The restorative approach aims at reinforcing, strengthening, or restoring the
impaired skills. It includes the repeated exercise of standardized cognitive tests of increasing
difficulty, targeting specific cognitive domains (e.g., selective attention, memory for new
information). Compensatory approach teaches ways of bypassing or compensating for the
impaired function.[5] (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4904751/)

o 1-2 SMART goals for the session i.e. what do you hope the person will
achieve/learn/be able to do/know by the end of the session;
o what will occur in the session – be specific. Make sure another OT/SP could pick up
your plan and follow it without needing to talk to you. Describe what happens at the
beginning, middle, and end of the session;
o where will the session take place e.g. outside, school, home, clinic, therapy gym;
o who will be involved (OT OR SP only; family member; teacher; therapy assistant);
o length of the session;
o equipment or materials needed. You can make assumptions that you have access to
any equipment you need;
o if relevant – include pictures of equipment etc.

SMART goals that realistic session; what will happen in the

session; where will the session take place; who will be involved; length of each session; equipment or
materials needed
Additionally, interventions focusing on attention and/or executive
function in the following areas: attention regulation, attention processing, dual-task

21
training, and problem solving have strong evidentiary support (Cicerone et al., 2011;
Couillet et al., 2010

ASHA, 2019; Brown, 2019).

the goal in the plan should be a session level goal that is achievable within the session.

You need to provide adequate detail so that we know what activity you are doing, but there is no need to
describe every step, especially if it is something oibvious that could be implied. Remember in this unit that the
session plan is assessed on the IPE outcomes and your ability to plan for clients with a range of needs (beyond
a uni-professional model) however this isn't a clinical unit per se, so we're not assessing your ability to plan for
any specific intervention (such as use of a sock aid). The assessed component is more importnatly related to
how realistic and clear the activities are, rather than your ability to plan to use sock aids or interventions
specificialy. Equally with the questions you need to make it clear what information you will be asking as much
as it is relevant to the goal, but there isn't a need to script every question.

Rationale

Occupational therapy practitioners can prepare the family for changes in roles and
routines, educate the family and school staff on the diverse needs of the student,
evaluate
ways to support the child, facilitate skills required for school participation, help
children
and families develop advocacy skills, enhance social skills for school and community
environments, and collaborate with the transition team (Orentlicher et al., 2017).
Examples of interventions that occupational therapy practitioners can provide
include: (a)
education about the transition, (b) problem solving solutions for child and family

19
concerns, (c) providing coaching, (d) managing clothing for toileting, (e) increasing
independence in school-related activities, (f) eating (snacks in the classroom), (g)
dressing (putting on a jacket), (h) school routines, (i) participating in circle time/group
activities, (j) using/adapting technology, (k) and drinking from the water fountain
(Orentlicher et al., 2017) (https://commons.und.edu/cgi/viewcontent.cgi?
article=1485&context=ot-grad)
Not only is the child’s role of being a student compromised, but also the role of a
parent/caregiver (Liu & Li, 2013). Parents/caregivers can require more significant
support in managing their child’s behavioral and psychological challenges after a TBI
(Liu & Li, 2013). As behavioral problems become increasingly difficult to control,
parents/caregivers may become more permissive in their parenting approaches (Liu & Li,
2013). The role of the parent shifts during this period in time where the parent now needs
to plan for current and future treatment/rehabilitation plans, learn how to help their child
manage behaviors, and access services for their own support throughout the process (Kirk
et al., 2015). (https://commons.und.edu/cgi/viewcontent.cgi?article=1485&context=ot-grad)

Occupational therapy practitioners focus on both the cognitive and physical

deficits while following a client and family-centered model, which fits well with the
transitioning stage. (https://commons.und.edu/cgi/viewcontent.cgi?article=1485&context=ot-
grad)

A caregiver's opinion and understanding of TBI affects can be a direct factor in

the child receiving services or not (Haarbauer-Krupa et al., 2018). Both caregivers and
students should be educated at the time of injury and given specific recommendations and
a list of what to monitor in regards to transitioning back to school (McAvoy &
Haarbauer-Krupa, 2019). (https://commons.und.edu/cgi/viewcontent.cgi?
article=1485&context=ot-grad)

Radomski and colleagues (2016) completed a systematic review to study

interventions that address cognitive impairments and improve occupational performance
after a TBI. The following listing of interventions appropriate for OT practice was
reported: “interventions to address problems with executive function, attention, or self-
awareness, interventions to address problems with memory, interventions to address
multiple cognitive domains using general compensatory approaches, interventions to
address multiple cognitive domains using computer-based brain training” (Radomski et
al., 2016, p.1). Occupational performance in social participation and life satisfaction is
likely to improve when awareness of deficits and the need for remediation of
performance skills is determined (Radomski et al., 2016).
(https://commons.und.edu/cgi/viewcontent.cgi?article=1508&context=ot-grad)

Based on a cognitive task analysis, jigsaw puzzling may demand multiple cognitive abilities including
visual perception (e.g., recognizing objects, patterns, and orientation of lines), constructional praxis
(e.g., integrating visual and motor information to assemble pieces), mental rotation (e.g., mentally
rotating piece’s orientation to fit them to other pieces), cognitive speed and visual scanning (e.g.,
sorting puzzle pieces), cognitive flexibility (e.g., switching attention between different strategies,
between different puzzle pieces, and between puzzle shape, image, and color), perceptual reasoning
(e.g., integrating different perceptual information to develop strategies and plans how to solve the
puzzle), and working and episodic memory (e.g., keeping the association between spatial location
and visual patterns/images of puzzle pieces in working memory and long-term memory). (Arnim &
Kolassa, 2018)

You can have multiple goals/intervnetions/activities in the session plan, but you only need to provide a
rationale for one of them.

In your rationale you need to explain why you have selected and are indending to use one of the specific
intervnetions with your client. There may be multiple interventions/approaches/goals/techniches in your
session plan, but you only need to provide a rationale for one specific intervnetion.