Running head: OCCUPATIONAL PROFILE

Occupational Profile and Intervention Plan

Ayessa Escandar
Touro University Nevada

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Occupational Profile

Client
The client is a 64 year-old male named David, who has been admitted to HealthSouth
Rehabilitation Hospital of Las Vegas due to a motorcycle vehicle accident that occurred two
months ago. The clients home environment consists of living independently in a small mobile
home. David currently resides in North Las Vegas, however grew up living in New Jersey and
for a few years living in California. Therefore, David has no close family living in the state of
Nevada and his only support system is his girlfriend named Jessica. David currently works at the
MGM Grand Hotel as a maintenance worker. However, outside of work the meaningful
occupations he enjoys doing are restoring and riding his motorcycle, reading and writing short
stories, working on model airplanes and cars, working out, biking, and hiking. Specifically,
Davids most cherish moment is walking with his dog and finding a nice scenic area where his
dog can play while he reads a book.
Occupational Therapy Services
David was admitted to HealthSouth Rehabilitation Hospital of Las Vegas due to multiple
fractures in his right lower extremity, right middle finger, wounds in his left leg and arm, and
inability to actively extend and abduct his right thumb. After the accident David was admitted to
a trauma hospital, where he had to undergo two surgeries. The first surgery consisted of
removing his right motorcycle boot from his foot, because during the accident the boot
penetrated into his foot. The second surgery consisted of placing rods and pins in Davids right
foot in order for the multiple fractures to heel. After two surgeries at a trauma hospital, David got
transferred to HealthSouth where he is currently wearing a cast on his right lower leg and splint
in his right middle finger. Therefore, Davids current status is non-weight bear in his right leg
and right middle finger. David is currently seeking occupational therapy (OT) services to

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increase strength in his non-affected extremities and learn compensatory techniques when
performing activities of daily living (ADLs).
Current Concerns
Davids current concern is if he will be discharged before he can weight bear on his right
leg. He is currently using a wheelchair to functionally ambulate around the facility and has not
yet been given the instructions by the doctor on whether or not he can put some weight on his
right leg. David is concerned that if he gets discharge before he can stand, he will not be able to
maneuver in his home. His current home environment is a small mobile home that is not
accessible for using a wheelchair. Another concern of David is if he will ever be able to ride his
motorcycle again. Also, if David does gain back the ability to ride a motorcycle in the future he
is concerned on whether or not he will still have the courage to do so or has his fear of getting
into another accident stop him from forever riding again. Lastly, David also has concern
regarding his inability to actively abduct and extend his right thumb. Specifically, the physician
and other health care therapists have not been able to determine the cause.
Occupational Success and Barriers
When David performs his ADLs in the HealthSouth facility, he was able to perform it
successfully with modified independence. David used adaptive equipment such as a reacher to
grab high and far items and his wheelchair for functional mobility. When David performed his
ADLs he displayed increase strength in his upper extremities. Specifically, when David gets
dressed in the morning he typically just uses a reacher to assist him when putting on his pants.
When David performs grooming activities his strength in his upper extremities allows him to
safely transfer from the bed to the wheelchair and to the bathroom. Therefore, Davids upper

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extremity strength compensates for the fact that he cannot weight bear on his right lower
extremity.
Environmental Barriers
At the HealthSouth Facility David does not have any environmental barriers. David is
high functioning when performing his daily routines which consists of being at a level of
modified independence. However, problems of environmental barriers will occur if David gets
discharged before having the ability to weight bear on his right lower extremity. Specifically, the
first environmental barrier is the graveled pathway that he must go across from the street to the
front of his door step for him to be able to get inside his home. The graveled pathway will make
it impossible for David to cross using his wheelchair. Another environmental barrier is Davids
small mobile home. The pathways in his mobile home that connects the living room to the
kitchen and to the bedrooms are too small for the wheelchair to fit through. Therefore, Davids
physical therapist is now working with him on the use of crutches. However, even with the use of
crutches, David will still have difficulty crossing his graveled pathway because it is not a leveled
surface for the bottom of the crutches to push off of. Therefore, the use of crutches on a graveled
surface is a potential safety hazard.
Occupational History
Before David moved to Las Vegas, he grew up in Westwood, New Jersey and spent a
couple of years living in San Diego, California. When David was 18 he joined the Navy and
spent four years in the military. After David completed his service, he moved to San Diego,
California because he wanted to live somewhere that was walking distance to the beach. While
living in California, his occupational history consisted of working as a security guard, spending
many hours at the beach, going to the gym, and doing leisurely activities with his friends. After
the living expenses was too much for him, David decided to move out of California and move to

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Las Vegas where living expenses are cheaper. In Las Vegas, Davids occupational history
consisted of working as a limo driver, security at various hotels, and currently a maintenance
worker at the MGM Grand hotel.
Daily Life Roles, Values, and Interests
Davids daily life roles consists of working as a maintenance worker at a hotel, riding his
motorcycle, writing short stories, and working out at the gym. However the one life role that
David holds the utmost importance is being a motorcyclist. David not only drives his motorcycle
as a means of transportation, but values the freedom he feels on the road when he cruises with
his friends. On Davids spare time, he and a couple of friends will spend many hours just
cruising around the town or go on short road trips to sight see. Davids interest in motorcycles
also go beyond riding one. David also enjoys fixing his motorcycles and personalizing it by
adding features that he likes. Specifically, David has spent thousands of dollars fixing up and
restoring two of his motorcycles. Therefore, when David got into a motorcycle accident, not only
was he devastated about the injuries he had incurred, but he was sad that the motorcycle that he
has worked on for many years was totaled.
Changes in Engagement of Occupations
With Davids inability to extend and abduct his right thumb and non-weight bear status
on his right lower extremity and right middle finger, has caused him to not be able to return back
to his current job as a maintenance worker at the MGM hotel. Specifically, Davids job requires
that he has the ability to walk without the use of durable medical equipment. Additionally,
Davids job also entails the bilateral use of his hands in order for him to accomplish job related
tasks. However, the doctor has also ordered David to refrain from the use of his right middle
finger. Therefore, until David has the ability to weight bear on his right leg without the use of

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durable medical equipment he will not be able to return to work. As for David riding his
motorcycle, he is unsure on whether or not he wants to ride a motorcycle again. Even if David
gains back the abilities and strength in his right lower extremity that will permit him to drive a
motorcycle he is not sure if he is still brave enough to do so. Therefore, David will have to find
another means of transportation if he will choose to no longer ride his motorcycle.
Desired Outcome and Priorities
Davids desired outcome is to have the ability to weight-bear on his right lower extremity
before he gets discharged. However, on my last day of fieldwork Davids social workers told him
that he would be discharged the next day. Therefore, Davids priority since he cannot weight-bear
on his right leg yet, was to learn how to functionally ambulate with the use of crutches before he
leaves. Since Davids stay at HealthSouth he has not yet practiced using crutches and was fearful
that he only had two sessions to learn how to use it with both the physical therapist and
occupational therapist. Also, because Davids mobile home is small his priority was not only to
learn how to use crutches, but have the ability to learn how to perform his ADLs with the
assistance of the crutches. Therefore, this required Davids last two session with the occupational
therapist to learn compensatory strategies, balance, and coordination when maneuvering around
his small home. Specifically, David wanted to practice using crutches while he was in the kitchen
and bathroom because those are the smallest areas in his mobile home.
Occupational Analysis
Context and Setting of OT Services
David received occupational therapy services in an inpatient acute rehabilitation facility,
named HealthSouth. HealthSouth is a medium size facility that provides home based patient
care. David had five day a week, 90 minutes occupational therapy services which consisted of a

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mix of group, concurrent, and individual therapy sessions. Each day David had an OT session, all
the OT had to do was provide him with information on where the therapy session would take
place and David would get ready with modified independence and meet the OT at the location.
Specifically, most of Davids OT sessions would be held in a rehabilitation room or a simulated
room. The rehabilitation room consisted of many different work out equipment such as,
stationary bikes, dumbbells, activities that worked out fine and gross motor skills, simulated
stairs, and therapeutic devices. The rehabilitation room was a large room that also consisted of
many tables and mats that the physical and occupational therapists would share during their
sessions. In addition, David also engaged in OT therapy sessions held in a simulator room. The
simulator room consisted of a kitchen and bathroom, which was created to simulate the
appearance of a typical home.
Client Performance
During the last therapy session I observed, David found out that he was going to be
discharged the next day. Davids priority during his last two OT sessions was to learn functional
mobility skills with the use of crutches instead of a wheelchair. During the last session I was able
to observe, the OT utilized the simulator room and the facilitys hallway for David to practice
using crutches. In the simulator room David practiced how to go between a seated and standing
position with the aid of his crutches. While David was practicing sit to stand, sometimes would
appear off balance. However, due to his arm strength he would quickly stabilize himself so that
he would not fall. Next, the OT taught David compensatory strategies with the use of his
crutches while he was in the kitchen. Specifically, the OT demonstrated how to use the crutches
while he washed his hands in the sink or grabbed materials from the kitchen cupboards. During
this activity, David struggled with balancing because his crutches would often slip off the hard

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wood floor that was in the kitchen. Therefore, because David has carpet in his home kitchen the
OT had David practice using his crutches in the facilitys hallway where carpet was present.
Having David practice on carpet was easier for him to balance. However, the OT would have
him take frequent breaks so that he does not get overly fatigue and loose balance.
Key Observations
When David practiced using crutches in the simulated kitchen, key observations that was
observed was his functional mobility techniques with the crutches. Specifically, when David
went from a seated to standing position from a chair, he first attempted to stand up bilaterally
using the crutches as a method of assistance to stand up. However, David would often stand up
with difficulty because he did not have a steady base of support by holding the crutches the way
he did. Therefore, the OT taught David to put both crutches in one hand and use his other hand to
push off of the chair handle to gain a more stabilize support when standing up from a chair.
Another component during Davids use of the crutches that was observed to be a health hazard,
was how David would press his armpits against the top of the crutches. In this case, David
should not have his armpit against the crutches because in the armpits the presence of nerves,
arteries, and lymph nodes could be potentially damaged. Therefore, Davids hands should be the
base of support that hold his bodys weight. Lastly, when David functionally ambulated in the
kitchen, he would often overshoot the distance of where the crutches should go. This resulted
David in having difficulty remaining balance and finding the proper base of support because his
crutches would be too far forward while his leg and body was placed far behind the crutches.
Domains of the OTPF
The most significant client factor that impacts Davids ability to successfully engage in
occupations is his decrease skill of joint stability (American Occupational Therapy Association

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[AOTA], 2014). Specifically, because David is non-weight bear in his right lower extremity and
in his right middle finger, it is more difficult for David to maintain the proper base of support and
balance when performing functional mobility and ambulation. When David performs transfers
with the use of a wheelchair or crutches as a method of assist, he has to do it slowly in order to
maintain stability in the joints upper extremities so that he does not fall. Therefore, David has to
be more conscientious of his joint stability in his upper extremities to compensate for his nonweight-bear status in his right leg and middle finger.
The performance skills that most significantly impacts Davids ability to successfully
engage in his occupations is his inability to walk (AOTA, 2014). Specifically, in order for David
to return back to work, as a maintenance worker, he will have to have the ability to work without
the use of any durable medical equipment. David has not been able to work for the past two
months and stated his urgency to go back to work as soon as possible to earn money. In addition,
Davids inability to walk will also make it difficult for him to maneuver around in his home.
Davids small mobile home makes it non accessible for a wheelchair to fit through. Even with
the use of crutches, David expressed that he will still have some difficulty using it in his small
home.
Furthermore, due to the multiple fractures David incurred during his accident, Davids
performance pattern, specifically his role of being motorcyclist has been impacted (AOTA,
2014). Before Davids accident he and his friends use to go on short road trips once a month just
to ride their motorcycles. However, since the accident David has now missed two road trips and
counting. Although, David is now somewhat fearful of riding his motorcycle in the future a large
part of his identity and time went riding and fixing his motorcycle.

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Problem List

1. The client is unable to restore & fix his old motorcycle due to his NWB status in his R
middle finger & inability to ext. & abd. his R thumb.
2. The client is unable to write short stories using his dominant hand due to his NWB status in
his R middle finger & the inability to abd. his R thumb.
3. The client is unable to work out using heavy weights due to weak grip strength in his R hand.
4. The client is unable create model airplanes & cars due to his inability to ext. his R thumb.
5. The client is unable to return to work as a maintenance worker due to his NWB status in his
R LE & use of W/C for amb.
Prioritization of Problem List
The number one priority of the client is to be able to return to his leisure activity of
restoring his motorcycle. Although the client is not sure on whether he will ride a motorcycle
again. David still wants to continue restoring motorcycles and possibly selling them. David was
adamant that if riding motorcycles will no longer be a role in his life, he still wants to continue
some aspect to motorcycling as an occupation. Therefore, it is important in the intervention to
address compensatory strategies that David will use when restoring skills of building a
motorcycle.
The second priority of the client is to be able to address his inability to write using his
dominant hand. Davids non-weight bear in his right middle finger and inability to actively
abduct and extend his thumb has caused him difficulty when writing. Specifically, this has
interfered with Davids leisure activity in writing his own short stories. David has also been more
inclined to want to write after being in several different healthcare facilities for the past 2 months
because all he does is sit in bed for many hours of the day. Also, since David will not be
returning to work anytime soon, he wants to be able to spend some days just writing short
stories. David has also expressed that in his home he only owns an old laptop that sometimes

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does not even work properly. Therefore, David writes everything on paper, from his short stories
to creating a grocery lists.
The third problem the client would like to address is his inability to work out using heavy
weights. At the facility the client is able to use light weights to work on strengthening and ROM
in his upper extremities. However, the client is concerned that once he gets discharge he will be
unable to exercise again using heavier weights because he has decrease grip strength from his
inability to use his right middle finger.
The fourth problem David would like to address is his lack of ability to create model
airplanes and cars due to his inability to actively control his right thumb. Specifically, because
David is unable to actively abduct and extend his thumb he cannot properly hold the tools
necessary to build model airplanes and cars. Therefore, David expressed that he once tried to
build a small model car with the use of his non-dominant hand. However, got frustrated because
his left hand lacked the proper precision and control necessary to build the car.
The last problem David would like to address is his inability to return to work due to his
non-weight bear status in his right lower extremity. Specifically, David has stated that not being
able to return to work would be his number one problem. However, David has stated that he
cannot address his non-weight bear issue until the physician allows partial weight bear on his
right leg. Therefore, Davids main concern is his ability to restore skills in building his
motorcycle, which in adversely works on the same fine motor skills necessary for his job of
being a maintenance worker.

Intervention Plan and Outcomes

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Long Term Goal 1: David will indep. build a component of his restored motorcycle using
compensatory strategies by 2 wks.
Short term goal 1. David will indep. build a small model motorcycle using
compensatory strategies by 1 wk.
Intervention.
Client will participate in activities that increase dexterity and hand function in order to
engage in his leisurely activities. Specifically, the client will use the Baltimore Therapeutic
Equipment (BTE) to practice ROM, strength, grip, and fine motor skills that are entailed of
building a small model motorcycle. The tools used in the BTE such as the pinch and grip tools,
serve as a work simulator that will imitate the same movements that are required for building a
model motorcycle. The BTE is a device that can been seen in many rehabilitation settings and
routinely used by occupational therapist due to its many functions (Bhambhani, Esmail, &
Brintnell, 1994). Also, because the BTE is a work-simulated device it encourages clients to
participate in functional motions that enhances occupational performances (Prochazka, Thronton,
& Dodd, 2011, p. 365).
The intervention approach that will be used is the restoration approach (AOTA, 2014).
The intervention is to restore the clients abilities and skills of building a model motorcycle so
that he can once again participate in a meaningful occupation of his. Davids previous skills
consisted of increased grip strength and ROM in all his fingers. The intervention outcome that
can be attained through the intervention is for David to have the opportunity to participate in his
desired leisure occupation (AOTA, 2014). Since Davids accident, he hasnt had the opportunity
to participate in any of his leisure occupations because of his weakness in his hand grip and

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inability to abduct his thumb. Therefore, the BTE will be a great device that assist David in
restoring skills necessary for him to participate in building model motorcycles.
Short term goal 2. David will cook a 2 course dinner cc Mod. (I) using compensatory
techniques by 1 wk.
Intervention.
Client will prepare a two course meal that consists of cooking steak, baking brownies,
and making fresh orange juice. By having the client cook steak, the client will hammer the steak
to tenderize it using a large grip handle. The action of tenderizing the steak will simulate the
same action of using a hammer when the client restores his motorcycle. The client will also
squeeze fresh orange juice by using an orange juice squeezer to simulate the action of turning
nobs or hand tools. Lastly, the client will bake brownies in order to increase strength and ROM
in the wrist when steering the brownie mix. The strengthening and ROM in the wrist will assist
the client when using tools that are needed for restoring his motorcycle. The use of functional
meal preparation has been frequently used by occupational therapist because it has shown to
improve fine motor skills better than tabletop activities (Neistadt, 1994). Creating a meal is an
activity that enhances the clients skills which is essential to community independence (Neistadt,
1994). Nevertheless, the clients skills that are learned when cooking a meal could also be used
towards skills needed when he participates in his leisure activities.
The intervention approach that will be used in this intervention is a restoration approach
(AOTA, 2014). Specifically, the client use to have the abilities that were necessary for building a
motorcycle. However, since the clients motorcycle accident he has not reestablished the skills
necessary for using hand tools. The client can regain the appropriate skills necessary for using
hand tools when restoring a motorcycle, by engaging in cooking activities that simulate the same

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actions. Therefore, the outcome of the intervention is for the client to improve his fine motor
skills (AOTA, 2014). Specifically, the client will improve his grip strength, ROM, and hand
coordination when preparing a meal.
Long Term Goal 2: David will write a 1 pg. short story c his R hand Mod. (I) using A/E by 2
wks.
Short term goal 1. David will write a short list cc his R hand Mod. (I) using a hand
orthosis by 1 wk.
Intervention.
In order for the client to write with his dominant hand the use of an orthosis will be
implemented when the client writes. Due to the clients inability to weight bear on his right
middle finger and lack of ability to abduct his thumb, it is important for the client to utilize an
orthosis device that requires no use of his right middle finger, while isolating his thumb for use.
A functional splinting may be used to allow individuals to adapt or hold writing utensils in order
to improve accuracy when manipulating a pencil (Graunhaug, 2005, p. 404). A thumb abduction
splint can be used by the client to passively move his thumb from a fixed flexed position to an
abduction position that is necessary for writing. Hand splints are a commonly utilized by
occupational therapist because it has been as an effective tool in improving ROM and spasticity
in the upper extremities (Cormican & Chockalingam, 2011). Along with the use of a hand splint,
a large pencil with a pencil grip will also be utilized so that the client can maintain as much grip
necessary to hold the pencil in place as the client writes. With the use of the thumb abduction
splint and the pencil grip, the client will practice writing legible words with an extended fingers
grasp. Specifically, a functional activity that the client will engage in will be writing a goal list
for when he gets discharged from the facility.

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The intervention approach that is utilized in this intervention is establish (AOTA, 2014).
The clients previous writing grasp was a tripod grasp. However, with the clients inability to use
a tripod grasp, the client must establish a new skill of writing with an extended finger grasp with
the assistance of a thumb abduction splint. With the clients establish new skills in writing, the
intervention outcome is to improve his writing ability (AOTA, 2014). Currently, the clients
writing ability is poor and illegible. However, with the assistance of a hand splint the client can
improve his writing legibility and speed.
Short term goal 2: David will paint on a medium size canvas cc his R hand Mod. (I)
using A/E by 1 wk.
Intervention.
The client will paint on a medium size canvas in order to increase his fine motor skills.
The purpose of painting is to simulate the action of writing, however in a way that requires less
precision, so that the clients hands will not get easily fatigued. Specifically, the client will utilize
a tennis ball with an inserted paint brush so that he could practice gripping through the use of a
device that increases the gripping area. Due to the clients inability to use his middle finger, his
ability to grip small objects are minimized. In addition, the tennis balls circumference shape also
allows the clients flex thumb to remain passively in an abducted position. Through the activity
of painting, the client can elicit the fine motor skills necessary for writing on a paper. The use of
craft, such as painting, has been one of the therapeutic tools occupational therapist have used as
an intervention (Pollanen, 2005). Specifically, using crafts as a therapeutic agent provides
multiple benefits that can be attained through both motor and processing skills necessary to
accomplish meaningful occupations (Pollanen, 2005).

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The intervention approach that is used in this intervention is modification (AOTA, 2014).
The use of a tennis ball to paint is an adaptive equipment that modifies the clients ability to
successfully paint and practice the movement of writing. The intervention outcome that will be
attained from this intervention is also improvement (AOTA, 2014). The use of adaptive
equipment will improve the clients ability to write by increasing grip strength and learning
compensatory techniques that will be required of him when he uses a writing utensil to write on a
paper.
Precautions and Contraindications
Two main precautions to take account when David engages in occupational therapy
activities are his non-weight bear status in his right middle finger and possible side effects that
could occur from his pain medication. Davids non-weight bear status makes it difficult for him
to work on activities that require increased grip strength or activities where he has to pinch small
items. However, it is important that David continue to not put any pressure or weight on his right
middle finger in order for his fractures to heal. The pain David incurs from the multiple fractures
in his right lower extremity has caused his reliance on pain medication. Therefore, it is important
to be conscientious and monitor if David is not feeling well.
Frequency and Duration of Intervention Plan
The frequency and duration of the intervention plan will take place 5 times a week for 90
minutes for the next 2 weeks. Specifically, the amount of frequency and duration is due to
Davids insurance coverage and also due to his physical status. Davids physical status is that he
is high functioning and can do all his ADLs with modified independence. Therefore, the
insurance company will most likely discharge David within the next 2 weeks. Also, because
David can perform many of his ADLs with modified independence he has good potential for

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accomplishing the activities that are consisted in the intervention plan. Therefore, David has the
proper strength and endurance to accomplish OT therapy services that consists of 5 times a week
for 90 minutes. However, on days that David receives pain medication and may be producing
side effects that make him feel ill, his sessions can be shortened or implemented with frequent
breaks.
Grading Up and Down
One of Davids short term goal is to be able to cook a two course meal with modified
independence by one week. One example of grading up the activity would be to create a three
course meal. This would require David to increase his endurance because it would take more
time and increase his use of hand dexterity necessary to accomplish the activity. One example of
grading down the activity would be to implement adaptive equipment during several components
of Davids meal preparation. Specifically, when David bakes brownies he could use a power tool
that electronically stirs the brownie mix. David could also utilize an electric orange squeezer,
which requires him to not have to manually turn the orange to squeeze it, but instead pulls a lever
down as the device electronically turns and squeezes the orange. The use of power tools is still
therapeutic for the client because it simulates the use of using power tools that are necessary
when fixing his motorcycle.
Primary Framework
The Canadian Model of Occupational Performance (CMOP) was the theoretical
framework that was used when creating the intervention plan. Specifically, the CMOP takes into
consideration the relationship between the person, environment, occupation, and most
importantly spirituality. For the client, Davids spirituality towards his meaningful occupation of
being a biker is what intrinsically motivates him to facilitate meaningful goals. Therefore,

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because the CMOP uses spirituality as the core of the model, Davids most meaningful
occupations was prioritized and used as a goal setting. Therefore, selecting appropriate
interventions for David was guided by his meaningful occupations of being a biker.
Client Training and Education
An important aspect before having David engage in OT activities is to first educate him
on his weight-bear status and side effects that could occur from his pain medication. Davids
non-weight bear status on his right lower extremity is easier for David to remember because he is
using a wheelchair for functional mobility throughout the facility. However, it can often be more
difficult to remember to not weight bear on a finger because individuals use their hands with
most activities throughout their day. Therefore, it is also important to train David on
compensatory strategies on how to perform occupational activities throughout the day that will
eliminate the use of his right middle finger. Another aspect to educate David on are side effects
that he may incur from his pain medication. It is important for him to be able to recognize when
the side effects may be occurring when he is participating in an occupation so that he can take
breaks.
Response from Client
Davids progression in his goals will be assessed and monitored using the Canadian
Occupational Performance Measure (COPM) and through the use of daily progress notes.
Specifically, the COPM will be utilized in the beginning and the last session of his intervention
plan to determine if there is an increase in his performance and satisfactory levels. The COPM
would be a good assessment tool to utilize because it not only assesses how David performs his
occupation but takes into account how satisfied he is with his performance level. Although, the

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COPM will only be utilized at the beginning and end of the intervention plan, daily progress
notes will also be closely monitored to determine daily progression.

References

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