Running head: OCCUPATIONAL PROFILE1
Occupational Profile and Intervention: A Client ith Left !e"ipare#i# Peter $allace Touro Touro Univer#it% Nevada Nevad a
OCCUPATIONAL PROFILE Occupational Profile
In thi# paper& the client ill 'e referred to a# (a% in order to "aintain their anon%"it%) (a% i# a *+,%ear old "an ho live# in La# -ega#& -ega#& N-) (a% live# ith hi# ife (anet) (a% and (anet have lived in the La# -ega# -ega# area for nearl% ./ %ear#& and have 'een "arried for .* . * %ear#) The% have three children& a #on and to daughter#& 'ut their children are all gron and live on their on) (a% and (anet live in a to #tor% ho"e& 'ut the% live on the ground level floor and re#erve the up#tair# living #pace for gue#t#) (a% ha# to children ho live out of ton& 'ut one on e of (a%0# daughter#0 live# live# near'%) (a% and (anet have ha ve to grandchildren& tin 11,"onth old 'o%#) (a% and (anet eno% 'a'%#itting and #pending ti"e ith their grandchildren) Their daughter0# fa"il% vi#it# ever% 2unda%) (a% li3e# to prepare 2unda% dinner for hi# fa"il%) (a% ha# 'een on a leave of a'#ence fro" hi# or3 #ince hi# #tro3e in 4ece "'er) (a% (a% i# a "anger in an engineering field& and he eno%# hi# o') !e ant# to return to or3 #oon& 'ut he i# orried a'out 3eeping up ith hi# dail% or3 routine#) (a% eno%# or3& atching "ovie#& ta3ing al3# ith (anet& and #pending ti"e ith hi# fa"il%& e#peciall% e#peciall% hi# grand'a'ie#) (a% i# fortunate to have a #trong #upport #%#te") !i# ife i# in good health& hi# daughter and grand#on# live near'%& and he ha# "an% friend# and coor3er# ho offer #upport) (a% i# receiving outpatient reha'ilitation #ervice# to addre## left he"ipare#i# and ede"a in hi# left upper e5tre"it% 6LUE7) (a% i# currentl% receiving one hour of occupational therap% and one hour of ph%#ical therap% three ti"e# per ee3 to addre## the pare#i# and ede"a) !i# pare#i# and ede"a are due to a right cere'rova#cular accident 6C-A7 6C-A7 he #u#tained) (a% had one "onth of acute reha'& 'ut i# #till e5periencing difficult% ith activitie# re8uiring fine "otor #3ill#) (a% a# #till e5periencing decrea#ed LUE #trength& endurance& and ede"a& #o he a# referred to outpatient therap%) The The ede"a in hi# left hand a# li"iting hi# range of "otion and hand
OCCUPATIONAL PROFILE function& gro## "otor a# "ildl% i"paired& and fine "otor a# "oderatel% i"paired) (a % i# continuing #ervice# to increa#e hi# fine "otor& 'ilateral coordination& LUE #trength and endurance) Currentl%& (a% i# a'le to perfor" "an% A4L# and IA4L# independentl%) !oever& he i# "odified independent in loer e5tre"it% 6LE7 and upp er e5tre"it% 6UE7 dre##ing& 'athing& and "eal preparation 'ecau#e he re8uire# additional ti"e to co"plete ta#3#) !e ha# #o"e difficult% ith feeding& #pecificall% cutting food ith a 3nife) !e ha# difficult% chopping and cutting food for "eal preparation& #o he re8uire# additional ti"e to co"plete ta#3#) (a% li3e# to coo3& and he con#ider# "eal preparation to 'e a "eaningful activit%) In addition to A4L# and IA4L#& the occupation of or3 i# i"portant to (a%) (a% ant# to return to or3) (a% ha# eno%ed hi# e"plo%"ent a# a "anger in the engineering field& and although he could retire& he ant# to return to or3 hen he i# a'le to perfor" hi# nece##ar% o' function#) (a%0# or3 i# i"portant to hi" 'e%ond "onetar% need#) !oever& (a%0# or3 re8uire# a "oderate a"ount of ph%#ical endurance& 3e%'oarding& and occa#ionall% "anipulation of #"all part# that re8uire ade8uate fine "otor) (a% or3# 1. hour #hift#& co""ute# 9/ "inute# to or3& and al3# an average of three "ile# per da% at or3) All of the#e o' perfor"ance ta#3# pre#ent 'arrier# for (a% 'ecau#e of hi# LUE pare#i#) (a% i# concerned a'out having the endurance to "a3e it through a t%pical or3da%& or3da %& and he i# concerned a'out hi# o' perfor"ance) At or3& (a% need# to t%pe report#& re#pond to e"ail#& and #chedule hi# e"plo%ee# on the co"puter) 2ince he or3# in the engineering field& he al#o need# n eed# #ufficient fine "otor #3ill# to "anipulate #"all part#) (a% i# concerned that he ill not 'e a'le to 3eep up ith the or3load unle## he i"prove# hi# ph%#ical endurance and fine "otor #3ill#) ore #pecificall%& #pecificall%& 'e a'le to t%pe ./,;/ ord# per "inute ith no error#) (a% #uffered fro" hi# C-A a'out five "onth# ago& and after one "onth of acute reha'& he #et a per#onal goal of returning to or3 ithin the fir#t ee3 of (ul %)
OCCUPATIONAL PROFILE 2everal environ"ental and conte5tual factor# have 'een either a #upport or a 'arrier to (a%0# occupational perfor"ance) (a%0# ph%#ical environ"ent a# a 'arrier during hi# initial recover%& 'ut he i# a'le to navigate hi# ph%#ical environ"ent fairl% ell no) !e a# having trou'le eight 'earing in 8uadruped po#ition& po #ition& hich i# one of hi# intervention#) 2o& an environ"ental "odification a# "ade& in the for" of a non#lip pad& to help hi# hand h and fro" #lipping hile eight 'earing in a 8uadruped po#ition) (a%0# co"puter 3e%'oard i# challenging for hi" 'ecau#e he ha#n0t 'een a'le to u#e hi# left hand hen t%ping 'ecau#e he hit# the rong 3e%& hold# 3e%# don too long& and e5perience# fatigue in hi# left hand) (a% need# to have ade8uate 3e%'oarding #3ill# to co"plete hi# o' function#) (a%0# or3place or3place and or3load re8uire# ph%#ical endurance& #o thi# i# another area of concern) (a% vie# hi# age a# a # a #upporting conte5t) (a% i# onl% *+ %ear#,old& and he contri'ute# hi# rapid recover% proce## to h i# age) The virtual conte5t ha# 'een another #upportive conte5tual factor) (a%0# coor3er# and e5tended fa"il% have offered hi" #upport through phone call#& te5t "e##age#& an d e"ail#) (a% ha# repeatedl% co""ented on ho "uch #upport he ha# received& and ho he ha# #ta%ed in contact ith hi# coor3er# and friend#) (a%0# prioritie# prioritie# are centered on hi# de#ire to return to or3 ith the ph%#ical #trength& endurance& and function needed to fulfill hi# o' re8uire"ent#) (a% value# hard or3& and he ant# to co"plete hi# o' function# ith ver% li"ited or3 acco""odation#) One of (a%0# 'elief# i# that
OCCUPATIONAL PROFILE he adore# hi# grandchildren) !e derive# "eaning and purpo#e in hi# life fro" the#e i"portant role#) (a%0 dail% role# included or3 role# 'efore h i# C-A) C-A) (a% 'elieve# that he need# to 'e at hi# prior level of function to fulfil hi# or3 role#& role#& #o he i# ver% "otivated to re#tore hi# UE #trength and endurance and hi# e%e,hand coordination) (a%0# progno#i# for functional return of hi# left ar" and hand i# #uita'le for hi# goal) (a% ha# #everal intere#t#) !e eno%# atching "ovie# and ha# a nice ho"e theatre #%#te") !e li3e# to atch coo3ing #ho#& and eno%# coo3ing at ho"e) !e eno%# atching #port# and occa#ionall% goe# to a UNL- ga"e) (a% li3e# to read& and eno%# #ta%ing current on political i##ue#) !e eno%# going out ith (anet to fine re#taurant#) Recentl%& he #tarted #tarted riting a 'oo3 a'out hi# #tro3e and the recover% proce##) (a% ha# #everal dail% d ail% life role#) !e i# a hu#'and& father& grandfather& engineer& engineer& "anager& chef& religiou# "an& and the hand %"an of hi# hou#e) The role# that are "o#t i"portant to (a % are hu#'and& father& grandfather and "anager) (a% value# hard or3& 'ut li3e# to pla% hard too) !e li3e# to entertain fa"il% and friend# and ant# ever%one to have a good ti"e) >efore hi# C-A& (a% had a #pecific activit% pattern) !e or3ed the #a"e #chedule and perfor"ed the #a"e routine#) !oever& hi# hi# pattern# of occupational engage"ent have changed 'ecau#e he ha#n0t 'een or3ing and hi# perfor"ance #3ill# and client factor# have changed dra"aticall%) !e ha# developed a fe different routine#& li3e hi# #leep routine) !e goe# to 'ed later and a3e# up later than he did 'efore) Thing# that ere ea#% to hi" have 'eco"e challenging) (a%0# prioritie# prioritie# are centered on hi# de#ire to return to or3 ith the ph%#ical #trength& endurance& and function needed need ed to fulfill hi# o' re8uire"ent#) !i# prioritie# are centered on occupational perfor"ance and role co"petence in hi# or3 occupation) (a% ha# identified goal# that he ould li3e to or3 on to "eet hi# long ter" goal of returning to or3 in (ul%) !e ant# to
OCCUPATIONAL PROFILE t%pe at lea#t .+ ord# per "inute& i"prove fine "otor #3ill#& increa#e UE range of "otion 6RO7& increa#e UE #trength& and ph%#ical endurance) After o'#erving (a% progre##& hi# goal of returning to or3 in (ul% #ee"# o'taina'le) Occupational Analysis
O'#ervation of occupation,'a#ed activit% in the outpatient #etting a# infre8uent& and "o#t of the intervention# o'#erved ere 'a#ed on therapeutic e5erci#e and 'io"echanical fra"e of reference) !oever& (a% a# o'#erved perfor"ing the occupation,'a#ed activit% of 3e%'oarding 6t%ping7) !e a# al#o a##e##ed ith #everal fine "otor a##e##"ent# once a ee3? unfortunatel%& the#e a##e##"ent# ere u#ed for therap% intervention# a# ell) There appear# to 'e an enor"ou# di#connect 'eteen the occupation,'a#ed intervention# learned in the cla##,roo" #etting and hat i# actuall% 'eing i"ple"ented in the field) Context and Setting
(a% i# 'eing #een in an outpatient reha' center located in a large ho#pital) The "aorit% of client# o'#erved in thi# #etting ere po#t C-A) C-A) The va#t a"ount of C-A C-A client# i# "o#t li3el% due to the fact that the outpatient reha' i# affiliated and located ithin a large ho#pital 'edcua#e "an% referral# actuall% co"e fro" ithin that ho#pital0# inpatient and acute reha' depart"ent#) (a% a# referred to outpatient reha' fro" the ho#pital) (a% i# a'le to drive hi"#elf to hi# outpatient appoint"ent# no& and he currentl% #ee# 'oth occupational therap% and ph%#ical therap% for one hour .5@3) Once On ce again& thi# #etting #ee"# to focu# "ore on a 'io"echanical fra"e of reference and i# centered on the e#ta'li#h@re#tore approach ithin the occupational therap% practice fra"e or3 6AOTA& 6AOTA& /1;7) Unfortunatel%& client# in thi# #etting perfor" "ainl% rote e5erci#e to help re#tore #3ill# and a'ilitie#& and no real occupation,'a#ed intervention occur#)
OCCUPATIONAL PROFILE Thi# i# unfortunate 'ecau#e the environ"ent and conte5t are e8uall% i"portant to occupational perfor"ance) Activity and Client Performance
(a% initiall% ca"e to outpatient reha' ith ver% li"ited active range of "otion 6ARO7 and li"ited functional u#e of hi# LUE) >ecau#e of hi# left hand ede"a& he had decrea#ed pa##ive range of "otion 6PRO7 in hi# ri#t and di#tal and pro5i"al interphalangeal 6IP7 oint#) Once again& o'#ervation of occupation,'a#ed activit% in the outpatient #etting a# unco""on) o#t of the intervention# o'#erved ere 'a#ed on therapeutic e5erci#e& and the evaluation# and functional a##e##"ent# o'#erved appeared to 'e 'a#ed e5clu#ivel% on a 'io"echanical fra"e of reference) !oever& (a% a# o'#erved perfor"ing the occupation,'a#ed activit% of 3e%'oarding 6t%ping7) The occupational therapi#t anted to a##e## (a%0# a'ilit% to t%pe on the co"puter 3e%'oard 'ecau#e thi# i# one of hi# nece##ar% o' function#& and he had #et it ha# one of hi# top goal#) Thi# a# the fir#t ti"e the OT had a##e##ed hi# perfor"ance #3ill# in thi# occupational,'a#ed activit%) Thi# activit% ould 'e con#idered a o' perfor"ance #3ill under or3 occupation# according to the A"erican Occupational Therap% A##ociation 6/1;7) (a% a# initiall% evaluated ith decrea#ed left #houlder ARO ith internal rotation& #houlder fle5ion and e5ten#ion& el'o fle5ion and e5ten#ion& #upination and prona tion& ri#t e5ten#ion& ri#t fle5ion& finger fle5ion& and finger e5ten#ion) !i# "anual "u#cle te#ting 6T7 a# con#i#tentl% .B@* for "o#t of the a'ove "otion#) !i# hand grip #trength a# *l'# ith hi# noninvolved hand and .1 ith hi# involved) !i# pinch #trength in the involved hand a# a'out one third of hi# noninvolved for , point& .,point& and lateral pinch) !oever& hen entering the fieldor3 e5perience& he a# ithin nor"al li"it# for "uch of hi# UE& ith the e5ception o f hi# hand) Currentl%& he i# i"paired in 'ilateral coordination and fine "otor ta#3#) !e recen tl% #cored . #econd# on the ,
OCCUPATIONAL PROFILE peghole te#t ith hi# involved and / ith hi# involved) !i# feeding and "eal preparation occupation# are "ildl% i"paired due to hi# i"paired fine "otor #3ill# and ARO in hi# left hand) !e i# "odified independent for 'athing& dre##ing& and "eal preparation 'ecau#e it ta3e# hi" additional ti"e to co"plete the ta#3# ithin the#e occupation#) Key Observations
2everal 3e% o'#ervation# ere noted) $hile o'#erving (a% perfor" rote fine "otor ta#3#& it a# noted that (a% had difficult% ith in,hand "anipulation and thu"' oppo#ition) The o'#ervation a# conve%ed to the fieldor3 educator) 2he hadn0t directl% a##e##ed or o'#erved the#e to fine "otor #3ill#& 'ut #he a# indirectl% providing #o"e treat"ent ' % having hi" #8ueeDe a #trengthening 'all and pic3 coin# out of theraputt%) (a% appear# to 'e co"pen#ating for oppo#ing thu"' deficit) The#e deficit# could account for #o"e of (a%0# hand fatigue and decrea#ed fine "otor #3ill# 6E5ner& /1/7) (a%0# in,hand "anipulation i# poor to none5i#tent) none5 i#tent) According to E5ner 6/1/7 in,hand "anipulation "an ipulation i# the a'ilit% to "ove and po#ition p o#ition o'ect# ithin the hand ithout u#ing the other hand& and it i#& perhap#& the "o#t co"ple5 fine "otor #3ill) $or3ing $or3ing on the#e fine "otor #3ill# "a% increa#e the repertoire of intervention# de#igned to increa#e (a%0# occupational perfor"ance) $hile (a% a# o'#erved t%ping on the 3e%'oard& it a# clear that he had difficult% "a3ing i#olated finger "ove"ent# in hi# left hand ) The therapi#t a#3ed hi" to t%pe ith onl% one hand) $hile o'#erving hi" clo#er& it appear# that he i# focu#ing on here hi# finger# are going ith hi# left h and 'ut not ith hi# right hand) !e al#o appear# to have difficult% ith 'ilateral coordination) Thi# could 'e cau#ed '% a #patial deficit a# ell a# ph%#ical deficit#) O'#ervation of (a% donning and doffing a 'utton,up #hirt revealed revealed difficult% ith clothing 'utton#) In,hand "anipulation #3ill# help ith po#itioning of clothing 'utton#& Dipper#& #nap# and lace#) T%ing lace# i# another dre##ing ta#3 that utiliDe#
OCCUPATIONAL PROFILE 'ilateral hand u#e) Increa#ing 'ilateral coordination& in,hand "anipulation& and thu"' oppo#ition #hould 'e included in (a%0# intervention plan)
Domains of OTPF Impacted As mentioned earlier, Jay is having difculty with grip strength, isolated nger movements, bilateral coordination coordination and hand ha nd use, pinch strength, inhand manipulation, and thumb opposition. These difcult areas hinder Jay’s occupational perormance and pose as barriers in Jay’s goal o returning to wor. These specic decits all under perormance sills in the occupational therapy practice ramewor. These decits more specically all under motor sills! grips, manipulates, and coordinates in the rame wor "A#TA, "A#TA, $%&'(. Prioritized Problem List Problem Statement 1
)lient is unable to perorm daily wor tas o typing *%-'% words per minute due to decreased ne motor sills and paresis $o )+A. $or3 i# a "eaningful occupation to (a%? an occupation that ha# "eaning 'e%ond Rationale $or3 "onetar% value) (a% derive# #ignificant purpo#e and "eaning fro" or3& and he ant# to return to or3 a# #oon a# he feel# capa'le of effectivel% perfor"ing hi# o' function#) According to the therapi#t& (a%0# progno#i# #hould allo for hi# goal of returning to or3) !oever& !oeve r& one of (a%0# concern# i# 3eeping up ith the or3load de"and#) (a% doe# a lot of t%ping at or3 'ecau#e he i# re8uired to #u'"it report#& re#pond to e"ail#& create #chedule#& and order part#) (a%0# perfor"ance in thi# ta#3 i# 'elo the average re8uire"ent for hi# role a# "anager) "anager) (a%0# (a%0# occupational therapi#t 6OT7 #hould con#ider intervention for increa#ing hi# perfor"ance #3ill# in thi# area a# ell a# adaptive technolog% and other "odification# that "a% increa#e hi#
OCCUPATIONAL PROFILE perfor"ance) For e5a"ple& there i# #peech to te5t #oftare that could acco""odate hi# occupational de"and#) Problem Statement ! •
Client re8uire# "od 6I7 ith "eal preparation due to fine "otor #3ill i"pair"ent#& decrea#ed 'ilateral coordination& and decrea#ed grip #trength)
Rationale (a% ha# difficult% ith cutting and chopping food and opening container# due to
hi# decrea#ed grip #trength in hi# left hand) (a% i# right hand do"inant& #o he i# accu#to"ed to holding ar# and container# in hi# right hand& and ti#ting the lid# off ith the left hand) (a% al#o ha# difficult% holding hi# food ite"# in place hile cutting and chopping food for "eal preparation) Coo3ing i# a "eaningful occupation for (a%& #o hi# OT #hould con#ider thi# pro'le" high on the priorit% li#t) Problem Statement " •
Client re8uire# "od 6I7 for UE LE dre##ing due to decrea#ed grip #trength and fine "otor #3ill# o LUE pare#i#)
Rationale# (a% ha# difficult% perfor"ing dre##ing activitie# that re8uire "anipulation of
'utton#& #nap#& Dipper#& and tie#) Although Although dre##ing i# and A4L A4L of ut"o#t i"portance& i"portance& thi# a# #elected .rd on the priorit% li#t 'ecau#e (a% can perfor" the occupation? it u#t ta3e# hi" additional ti"e to co"plete it) In addition& it a# lo on (a%0# priorit% priorit% li#t) Problem Statement $ •
Client re8uire# "od 6I7 for 'athing due to decrea#ed grip #trength& #houlder internal rotation& and 'ilateral coordination o LUE pare#i#)
Rationale (a% ha# difficult% perfor"ing the A4L of 'athing@#hoering 'ecau#e of hi#
decrea#ed grip #trength and 'ilateral coordination) Thi# occupation a# not directl% o'#erved ithin the inpatient #etting& 'ut (a% #tated that it a# a pro'le" area for hi") 2ince it a# not
OCCUPATIONAL PROFILE directl% o'#erved& #i"ulation a# o'#erved to #ee hat perfor"ance #3ill# or client factor# ere hindering perfor"ance) Again& (a% can perfor" the activit%& 'ut it ta3e# hi" additional ti"e) 2o& thi# pro'le" a# lo on the priorit% li#t) Problem Statement % •
Client i# una'le to perfor" or3 #3ill# re8uiring "anipulation of #"all part# due to fine "otor #3ill i"pair"ent# o LUE pare#i#)
Rationale (a% ha# difficult% ith fine "otor ta#3#) Thi# i# a o' perfor"ance re8uire"ent&
'ut he doe#n0t perfor" the#e ta#3# fre8uentl% 'ecau#e he i# the "anager) "anager) Although Although thi# related to hi# or3& and hi# or3 i# "eaningful to hi"& he perfor"# thi# far le## than he doe# other o' perfor"ance area#) Al#o& Al#o& the other pro'le" #tate"ent# addre## the perfor"ance #3ill# #3ill# of grip#& "anipulate#& and coordinate#) &ntervention Plan ' Outcomes Long(term )oal 1 Client ill t%pe an average of * * ord# per "inute for 1* "inute# ith le## than ; error#
u#ing 'oth hand# ithin ; ee3#) S*ort(term )oal 1a Client ill tolerate 1* "inute# of t%ping
OCCUPATIONAL PROFILE #tring one,'%,one) Fir#t& the client pic3# up 'ead# one,'%,one and put# the" into hi# pal" until he ha# a handful of 'ead#& hich re8uire# finger,to,pal" tran#lation) Then& the client hold# a handful of 'ead# and 'ring the 'ead# fro" pal" to finger 6pal",to,finger tran#lation7 to #tring the 'ead# onto the #tring) The #tring i# held in the other hand& uninvolved hand& hile 'ead# are 'eing #trung onto the #tring& encouraging 'ilateral coordination) $hen client fini#he# fini#he# #tringing enough 'ead# to co"plete co "plete the nec3lace& the client then tie# the to end# together& hich again re8uire# 'ilateral coordination) In addition to in,hand "anipulation and 'ilateral coordination& the activit% al#o or3# on ri#t rotation& e%e,hand coordination& finger fle5ion& finger e5ten#ion& ri#t e5ten#ion& and pro5i"al #ta'iliDation) Thi# intervention utiliDe# e#ta'li#h@re#tore intervention approach) It utiliDe# e#ta'li#h 'ecau#e (a% ha# never "ade a nec3lace out of 'ead# 'efore) It utiliDe# the re#tore part of thi# thi# approach 'ecau#e it i# re#toring 'ilateral coordination and in,hand "anipulation that he once o nce had 6AOTA& /1;7) Literature revie+ I"ple"enting intervention# that i"prove in,hand "anipulation and 'ilateral coordination can i"prove perfor"ance in other occupation# that re8uire fine "otor #3ill#) According to E5ner 6/1/7 in,hand "anipulation i# the a'ilit% to "ove and po#ition o'ect# ithin the hand ithout u#ing the other hand) In,hand "anipulation i# one of the "o#t co"ple5 fine "otor #3ill#) The intervention or3# on in,hand "anipulation& 'ilateral coordination& ri#t rotation& e%e,hand coordination& finger fle5ion& finger e5ten#ion& ri#t e5ten#ion& and pro5i"al #ta'iliDation& hich are fine "otor #3ill# that can increa#e (a%0# occupational perfor"ance in the o' #3ill of 3e%'oarding) E5ner 6/1/7 revieed #everal #tudie# that te#ted functional de5terit% a"ong children) The #tudie# that ere revieed utiliDed intervention hich focu#ed on in,hand "anipulation) "an ipulation) The re#ult# of the#e #tudie# #ugge#t that practicing ta#3# that re8uire in,hand "anipulation can increa#e functional de5terit%& de5terit%& a# "ea#ured '% the a"ount of ti"e re8uired to rotate and place 1,peg#) E5ner 6/1/7 al#o #ugge#t# that in,
OCCUPATIONAL PROFILE hand "anipulation i# #ignificantl% correlated ith functional de5terit%? hile& grip and pinch #trength i# not) Thi# i# di#concerting 'ecau#e "an% therapi#t center functional de5terit% intervention on a 'io"echanical fra"e of reference& u#ing grip and pinch #trengthening e5erci#e#) The nec3lace intervention provide# an occupa tion a# "ean# that or3# on fine "otor #3ill# nece##ar% for 3e%'oarding and provide# a fini#hed product that the client can 'e p roud of) Occupation,'a#ed intervention#& li3e thi# one& on e& can increa#e "otivation& #elf,efficac%& #elf,efficac%& and #elf, e#tee"& hich ill ulti"atel% increa#e occupational perfor"ance) &ntervention 1b Client ill t%pe
Literature review. epetitive tas practice "T( is regularly used to improve occupational perormance perormance ater a stroe. stroe. According to ilsen et al. "$%&/(, T is goal directed and utili0es re1uent repetition o tas-related movements. 2aving Jay type 3A, 4, 5, 67 and 36, 5, 4, A7 with his let hand or / minutes utili0es re1uent repetition o tas-related movements. ilsen et al. "$%&/( conducted an evidenced-based review o &8 T studies and ound that &* out o the &8 studies had positive ndings. These ndings support
OCCUPATIONAL PROFILE
the use o T to improve occupational perormance ater a stroe. 9sing T or this intervention promotes motor relearning.
Long-term Goal 2 Client ill coo3 ho"e"ade chic3en tortilla #oup 6I7 u#ing 'a#ic ingredient# ithin ; ee3#) S*ort(term )oal !a Client ill de"on#trate the a'ilit% to open three ti#t open ar# u#ing A@E A@E ithin ee3#) S*ort(term )oal !b Client ill cut three #eparate ingredient# u#ing 'oth UE 6I7 ithin three ee 3#) &ntervention !a Client ill participate in a ga"e of to## and catch u#ing a four inch eighted therap% 'all to i"prove hand function) Thi# intervention u#e# the e#ta'li#h@re#tore intervention approach for re#toring hi# fine "otor #3ill# for the o' perfor"ance of t%ping) The intervention al#o utiliDe# create and pro"ote approach for increa#ing #elf,efficac% 6AOTA& /1;7) The client ill 'e a#3ed to through the 'all at pitch,'ac3 tra"p and then catch the 'all) The client ill u#e the involved UE) The intervention ill #trengthen "u#cle# in the hand and UE hile alloing for #o"e thu"' oppo#ition "ove"ent) A c%lindrical gra#p i# u#ed to catch and thro the 'all& and a c%lindrical c %lindrical gra#p and di#c gra#p i# often u#ed to open lid# and ar# around the 3itchen)
Literature review. (a% li3e# to coo3& 'ut coo3ing often re8uire# opening and clo#ing lid#& ar#& and container#) 2trengthening gra#p ill increa#e perfor"ance in the#e ta#3# a# ell a# increa#e fine "otor #3ill) According to 2chepen# 6//7& repetitive intervention or3ing on gra#p can increa#e functional ta#3# re8uiring fine "otor #3ill#) The #tud% u#ed /"inute intervention# three ti"e# per ee3 for #i5 ee3# to i"prove h and function in adult# #uffering fro" a C-A) C-A) The% u#ed #everal of the a##e##"ent# introduce in the .* cour#e& li3e the inne#ota "anual de5terit% te#t and nine,hole peg te#t) The #u'ect# had #ignificant i"prove"ent ith increa#ed gra#p force& gro## coordination& and functional ta#3#& The#e finding#
OCCUPATIONAL PROFILE #ugge#t that the cho#en intervention ould 'e appropriate for (a% 'ecau#e it ould increa#e hi# overall fine "otor #3ill# and gra#p #trength& and gra#p #trength i# neede d for hi" to open and clo#e ar#& lid#& and container# in the 3itchen hen preparing "eal#) &ntervention !b Client ill pla% a hungr% "an ga"e ith tenni# 'all and 'ead#) Client ill hold a tenni#
'all ith a #lit in it and #8ueeDe the 'all in hi# involved hand place 'ead# in one at a ti"e ith other hand) After 'ead# are placed he ill #8ueeDe 'all to re"ove 'ead#) The tenni# 'all i# "ade to loo3 li3e a "an and the #lit in the 'all i# hi# "outh) Thi# intervention a# actuall% p erfor"ed ith the client) Although thi# ga"e i# reall% for children& (a% actuall% eno%ed it) Go Gou u can "a3e it "ore fun for the client and "ore challenging '% placing a countdon ti"er in front of the" and giving the" an a"ount of 'ead# ' ead# that i# #o"ehat challenging to put in in that ti"efra"e) Thi# activit% or3# on 'ilateral coordination& grip #trength& and thu"' oppo#ition) The intervention al#o utiliDe# create and pro"ote approach for increa#ing #elf,efficac% 6AOTA& 6AOTA& /1;7) Literature Revie+ According to $olf $olf and >ir3en"eier 6/117& otor #3ill# practice i# u#ed to re"ediate "otor #3ill# ith client# ho have had a #tro3e) A repetitive "otion help# ith "otor relearning and cortical re#tructuring) Pic3ing up #"all ite"#& #8ueeDing the 'all and or3ing ith 'oth ha nd# help# ith re"ediation of "otor #3ill#& hich increa#e# the client0# occupational perfor"ance in "an% ta#3# re8uiring fine "otor #3ill#) Re"ediation involve# #everal factor#& #uch a# repetitive practice of "otor ta#3#& i"proving #trength& relearning of #en#ori"otor relation#hip#& and i"proving functional pe rfor"ance ith hole ta#3# 6$olf >ir3en"eier& /117) Although the intervention doe# not include hole ta#3#& it doe# focu# on i"proving #trength& relearning #en#ori"otor relation#hip#& and repetitive practice) The intervention ill i"prove (a%0# a'ilit% a'ilit% to hold ite"# in one hand han d and cut or chop ith the other& a# ell a# increa#e hi# overall fine "otor #3ill# and increa#e cortical re#tructuring) The
OCCUPATIONAL PROFILE intervention ga"e ill i"prove (a%0# fine fine "otor #3ill# and gra#p #trength& hich ill increa#e (a%0# occupational perfor"ance in hi# IA4L of "eal preparation and lei#ure occupation of coo3ing) Precautions and Contraindications One of the "o#t i"portant precaution# ith (a% i# hi# ede "a) Preparator% "ethod#& li3e retrograde "e##age& can 'e u#ed 'efore 'e fore intervention# if hi# hand ha# additional #elling) (a% #till ha# pro'le"# ith h%perten#ion& and although he i# on "edication& hi# 'lood pre##ure ha# 'een high occa#ionall%) (a%0# (a%0# 'lood pre##ure #hould 'e ta3en 'efore ever% intervention #e##ion) !%perten#ion i# a contraindication for therap%& e#peciall% if an% gro## "otor activitie# and "u#cle #trengthening i# to 'e included in therap %) Precaution Precaution hen i"ple"enting intervention# re8uiring cutting of food are nece##ar% too) In#uring a #afe environ"ent and #afe hand po#itioning during cutting i# i"portant) One #hould al#o 'e aare of #u'lu5ation of the #houlder for client# ho are po#t #tro3e) ,re-uency and .uration Intervention# ill 'e i"ple"ented ithin a /,"inute #e##ion) It i# reco""ended that (a% attend three /,"inute #e##ion per ee3) (a %0# treat"ent #e##ion# ill occur on onda%#& $edne#da%#& $e dne#da%#& and Frida%#) F rida%#) Thi# afford# hi" a da% to re#t in 'eteen each #e##ion da%) Thi# i# i"portant 'ecau#e (a% #ee# 'oth ph%#ical therap% and occupational therap% 'ac3,to,'ac3 each vi#it) (a% #ho# good potential for re#toration of previou# occupational perfor"ance and good 'enefit fro" therap% three ti"e per ee3) )rading /p and )rading .o+n Hrading up and don can 'e done for the nec3lace "a3ing intervention '% having hi" hold "ore or feer 'ead# in hi# hand& increa#ing or decrea#ing the #iDe o f the 'ead#& increa#ing or decrea#ing the gauge of nec3lace lace@#tring& and putting "ore or feer 'ead# onto #tring) One could al#o #ta'iliDe "ore pro5i"al e5tre"itie# or allo propping of pro5i"al e5tre"itie# to
OCCUPATIONAL PROFILE grade don the occupation,'a#ed occupa tion,'a#ed intervention) The rea#on for grading up or don i# to provide the client ith the <u#t,right challenge)= Primary ,rame+or0 The Per#on,Environ"ent,Occupation,Perfor"ance 6PEOP7 "odel i# a good fit for occupation,'a#ed intervention# 'ecau#e it i# client,centered) The 'io"echanical fra"e of reference ha# it# place in the e#ta'li#h@re#tore approach too) The P EOP "odel provide# a great philo#ophical 'a#e to guide intervention) The PEOP "odel de#cri'e# de#cri'e# the interaction 'eteen intrin#ic factor# 6client factor#7& and e5trin#ic factor# 6environ"ental factor#7) Intrin#ic factor# and e5trin#ic factor# can either #upport or re#trict occupational perfor"ance& #o the goal i# to "odif% the#e factor# to #upport perfor"ance in de#ired activitie# and ta#3# 6>au" Chri#tian#en& //*7) (a%0# "u#cle ea3ne## and fatigue i"pede hi# occupational perfor"ance) (a% ha# trou'le gra#ping ite"# ith enough force to 'e #ucce##ful in #o"e of hi# "eal preparation ta#3#) (a% i# una'le to perfor" "an% of the ta#3# needed at or3 too) an% of (a%0# (a%0# "otor #3ill# have 'een i"pacted fro" hi# C-A& hich can i"pact p#%cho#ocial area# a# ell) (a% ha# a #trong #ocial #upport #%#te" in place& hich i# a po#itive e5trin#ic factor that #upport# occupational perfor"ance) ClientCaregiver 2raining and 3ducation Education can 'e provided for ph%#ical "odification #ugge#tion& u#e of dura'le "edical
e8uip"ent 64E7& and ho"e therap% and e5erci#e progra"#) It0# po##i'le po##i'le for (a% to u#e adaptive technolog% to aid in hi# 3e%'oarding need#& thi# "a% re8uire training) (a% al#o can 'e given ho"eor3 in the for" of #pecific ho"e e5erci#e#) e5er ci#e#) It i# al#o i"portant to educate the client and caregiver a'out the #pecific deficit# and diagno#e#& hat to e5pect fro" therap%& and ho to get the "o#t pout of therap%) The client #hould 'e continuall% educated throughout therap % #e##ion#
OCCUPATIONAL PROFILE too) The therapi#t #hould ala%# educate the client on hat the% are or3ing on and h% the intervention a# #elected) Response to &ntervention A##e##"ent# are often ta3en to gage the outco"e o utco"e of therap%) $hile $hile increa#ed occupational perfor"ance and 8ualit% of life a re the ideal outco"e#& it i# "uch ea#ier to "ea#ure dail%& ee3l% and "onthl% progre## ith ph%#ical ph %#ical "ea#ure"ent#& li3e T& ARO& PRO& grip #trength& and pinch #trength) 2ince pare#i# and ede"a in the LUE i# (a%0# pro'le" area#& the "aorit% of a##e##"ent# ill 'e "ea#ure# of ph%#ical #trength) The circu"ference of digit# and hand can 'e ta3en for ede"a) The Functional Independence ea#ure 6FI7 #core# can 'e u#ed to "onitor A4L#? A4L#? hoever& (a% i# alread% at the independent or "odified independent level for A4L#) Te#t#& #uch a# the inne#ota& peg,hole te#t& and grooved peg,'oard te#t& can 'e u#ed to a##e## fine "otor #3ill#) A 'a#eline #hould 'e e#ta'li#hed to effectivel% "ea#ure progre##) Clinical o'#ervation #hould 'e u#ed in conunction ith a##e##"ent# #o the client0# perfor"ance perfor"ance a'ilitie# can 'e further e5plored) Thi# allo# the therapi#t to ad u#t intervention plan# to the need# of the client) Outco"e "ea#ure# are perfor"ed tice a ee3 for (a%) ea#ure"ent# for (a% have included T& RO& RO& Hrip #trength& pinch #trength& inne#ota "anual de5terit% te#t& groove peg,'oard te#t& and "ea#ure"ent# for hi# ede "a) Intervention "a) Intervention planning& "onitoring of progre##& and di#charge planning ill 'e con#idered fro" outco"e "ea#ure#)
OCCUPATIONAL PROFILE
Reference# A"erican Occupational Therap% A##ociation) 6/1;7) Occupational therap % practice fra"eor3: 4o"ain and proce## 6.rd ed)7) American ed)7) American Journal of Occupational Therapy, 6862uppl) 6862uppl) 17& 21,2;+) http:@@d5)doi)org@1/)*/1;@aot)/1;)+// >au"& C))& Chri#tian#en& C) 6//*7) Per#on,environ"ent,occupation: An occupation,'a#ed fra"eor3 for practice) In C) Chri#tian#en& C) >au"& () >a##,!augen 6Ed#)7& Occupational therapy: Performance, participation, and well-being 6.rd ed)& pp) ;., 7) Thorofare& N(: 2lac3 Incorporated) Conti& H) E)& 2chepen#& 2) L) 6//7) Change# in he"iplegic gra#p folloing di#tri'uted repetitive intervention: a ca#e #erie#) Occupational Therapy International, 6 6.,;7& 6.,;7& /;, 19) doi: 1/)1//@oti)9 E5ner& C) 6/1/7) Evaluation and intervention# to develop ha nd #3ill#) Ca#e,2"ith& ()& O0>rien& () C) 6Ed#)7& Occupational Therapy for !hildren "6th ed#$ 6pp)9*,.;7) ar%land !eight#& O: o#'%) Nil#en& 4) )& Hillen& H)& Heller& 4)& !reha& )& O#ei& E)& 2alee"& H) T) 6/1*7) Effectivene## of intervention# to i"prove occupational perfor"ance of people ith "otor i"pair"ent# after #tro3e: An evidence,'a#ed revie) American Journal of Occupational Therapy& Therapy& 6%617& 6%617& /11+//./p1,/11+//./p) $olf& $olf& T) >ir3en"eier& R) 6/117) Intervention to increa#e perfor"ance and participation folloing #tro3e) Chri#tian#en& C) atu#3a ) 6Ed#)7&&a 6Ed#)7&&ay' y' of li(ing: Inter(ention 'trategie' to enable participation ")th ed#$) ed#$) >ethe#da& 4: AOTA Pre##)
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