INTERVENTION PLAN FOR COMMUNITY CLIENT
Copy/paste one LTG and the matching STG from your evaluation SOAP note. This will be the goal set around which you design your treatment session.
LTG 1: By discharge, the client will independently don socks, shoes, and AFO brace while incorporating his LUE
using compensatory strategies.
STG 1: In 2 weeks, the client will be able to don L shoe over heel while incorporating his LUE using compensatory
strategies with min A.
OCCUPATIONAL
PERFORMANCE PROBLEM
Specifically identify only the client
factors and/or performance skills
that are barriers to the
achievement of this goal. This
should not be a bullet list, rather
you should describe how the client
factor impacts this client’s
performance of the occupation in
the goal.
Client factors:
The client factors impacting the
client’s ability to independently don
his L shoe and sock are minimal
proprioception in his hand, absent
touch functions (light touch), lack
of control of voluntary movement in
his fine motor skills and muscle
tone (high tone) resulting from the
hemiparesis effects of his R
thalamic hemorrhage.
Performance Skills:
OPM and CPM
AND RATIONALE
Identify your OPM and all relevant
CPM’s that best addresses the
performance problem and describe
how each will be used to design
treatment for this client’s specific
problems.
OPM: PEO
The PEO Model will enable me to
create the most optimal solutions
for the client as I take each factor
(support and barrier) into
consideration to effectively modify
the task and environment as
needed to fit the client’s needs and
promote greater occupational
performance and participation.
Person: The client is a 69 y/o male
with a R thalamic hemorrhage
resulting in L hemiparesis, high
TREATMENT SESSION DESCRIPTION
Provide details of how you will set up the
activity and how your intervention
addresses the performance problem.
Your description should detail how the
activity will be set up to make it
therapeutic.
Activity Set Up:
Overall Therapy Outline:
1. Client-centered music
2. MT homework review
3. Teach compensatory strategies
to don L sock & shoe.
4. Education on discuss safe and
effective footwear options
specific for the shower – fit client
for safe footwear
5. LLE Mirror Therapy (as per
client request) implementing
motor and sensory exercises
GRADING THE ACTIVITY
Choose one client factor or
performance skill that you
address in your treatment
session. Describe one way
(only one) that you can grade
the activity up and one way
(only one) to grade the activity
down based on that one factor
or skill.
Factor/Skill: Grip
Grade Up: Client will grip the
tongue of L shoe with L hand to
don over heel.
Grade Down: Client will grip
the shoe horn to assist donning
shoe over heel.
The performance skills currently
impacting the client’s performance
with the goal of donning his L sock
and shoe are positions, reaches,
grip, manipulates and coordinates.
Because of his L sided
hemiparesis, high tone, and overall
weakness he has difficulty
reaching down far enough with his
LUE and the lack of motor control,
create an inability to effectively grip
his sock/shoe to pull them on and
manipulate laces to tie them. He
also has difficulty positioning his
LUE because of a lack of
proprioception and light touch, he
cannot feel when his left hand is
touching the lacks to use his pincer
grip. Also, he has difficulty
coordinating his LUE along with his
right to pull on sock/shoe and tie
laces making task more difficult
and time consuming.
tone, extensor synergy, and soft
tissue shortening.
Environment: The environment is
dressing in his home in preparation
for work and donning his shoes
back after showering to be able to
exit safely.
Occupation: Donning his L
sock/shoe
CPM: Motor Control/Learning
Model
The Motor Control/Learning Model
is important to implement b/c of the
client’s R thalamic hemorrhage
resulting in L hemiparesis. His
stroke caused a disruption in the
cortical connection between his
brain and motor movement of his L
side. The focus of treatment will be
to promote more repetitious motor
movements from the LUE to rebuild
motor pathways associated with
donning his socks/shoes. While the
top-priority will the functional
activities of donning sock/shoe,
other parts of therapy will consist of
adding functional supplementary
exercises using Mirror Therapy to
target LLE (as per client request).
CPM: Rehab Model
The Rehab Model will be supportive
to the client by implementing
6. HEP explanation and
instructions (see “HEP –
Treatment Plan” attached below)
Supplies:
- Strapping
- Shoe horn
- Water shoe options for shower
- Mirror Therapy supply kit
Donning L Sock/Shoe
First, the client will receive a
demonstration of how to use a simple
strapping method that anchors around
his torso and allows him to pull up his L
ankle upon his R knee providing better
visual and physical LUE access to
donning his L sock/shoe.
Client will implement L hand in gripping
the strap to pull L ankle up to R knee,
grip sock to pull up onto foot, grip shoe
and pull over heel, use a shoehorn (if
needed).
Donning shower shoe
Client will determine best footwear
option to wear into/out of the shower,
then will practice donning water shoe.
Client will implement strapping
compensatory approach to assist in
donning water shoe. Client will discover
safe and time effective shower shoe
donning options to increase
independence when exiting the shower.
Mirror Therapy LLE & LUE
Therapist will lead client through motor
and sensory retraining to gain repetitious
practice in specific exercises and
functional movements to rebuild motor
compensatory methods to support
and enable the client’s occupational
performance of donning
socks/shoes by changing the
environment and/or task as needed
with supportive technology. The
compensatory method that will be
implemented will be implementing a
strap to support his L ankle upon
his R knee to gain better visual and
LUE access to his foot, and having
the client choose safe and time
effective footwear he can easily don
in the shower to safely exit
independently.
pathways. Client will receive this list as
HEP homework.
Upper extremity exercises:
 Writing on paper write anything
you choose for 1-page
 Do individual finger raises – 15
reps
 Individual finger reaches – 15
reps
 Touch each finger to thumb – 15
reps
 Brushing hair – see homunculus
brain mapping on back
 Choose 1 instrument to tap along
to the rhythm during several
songs (ex: follow the percussion
beat or guitarist strumming or
pianist in different songs you
choose)
 Sensory: Run hands through rice,
beans, sand
Lower extremity exercises:
 Ankle point & flex – 15 reps
 Toe-in & toe-out – 15 reps
 Ankle circles (R & L) – 15 reps
 Toe tap (rainbow back and forth)
– 15 reps
 Eversion & inversion of ankle – 15
reps
 Sensory: Run feet through rice,
beans, sand
How Intervention Will Be Therapeutic:
This intervention will be therapeutic
because (1) it will include client
education and training how to utilize
compensatory methods to don
socks/shoes on LLE, (2) teach and
support client to further implement his
LUE by gripping during different stages
of donning sock/shoe to ensure
repetitive movement of LUE in order to
rebuild neuropathways, (3) provide client
with safe and time effective footwear
solutions to increase independence
when exiting his shower

How Intervention Addresses the

Performance Problem:

This intervention will improve more

opportunities for the client to implement
his L grip to participate in donning his L
sock/shoe by implementing the strap to
support his L ankle on his R knee,
providing him with better access and the
ability to visually see that where his LUE
is touching to he will be able to visually
see what his L hand is touching engage
more of his L grip thereby increasing
LUE repetitions and motor training to
increase fine motor function.
 HOME EXERCISE PROGRAM - INTERVENTION PLAN FOR COMMUNITY CLIENT

Goals for the 3-week Break:

LTG 1: By discharge, the client will independently don socks, shoes, and AFO brace while incorporating his LUE
using compensatory strategies.

STG 1: In 2 weeks, the client will be able to don L shoe over heel while incorporating his LUE using compensatory
strategies with min A.

LTG 2: By discharge, the client will increase typing speed by 10 wpm while incorporating LUE using compensatory
strategies.

STG 1: In 2 weeks, the client will accurately use the shift key in 4/5 trials while incorporating his LUE using
compensatory strategies.

OCCUPATIONAL OPM and CPM TREATMENT SESSION GRADING THE ACTIVITY

PERFORMANCE PROBLEM
Specifically identify only the client
factors and/or performance skills
that are barriers to the
achievement of this goal. This
should not be a bullet list, rather
you should describe how the client
factor impacts this client’s
performance of the occupation in
the goal.
AND RATIONALE
Identify your OPM and all relevant
CPM’s that best addresses the
performance problem and describe
how each will be used to design
treatment for this client’s specific
problems.
DESCRIPTION
Provide details of how you will set up
the activity and how your intervention
addresses the performance problem.
Your description should detail how the
activity will be set up to make it
therapeutic.
Choose one client factor or
performance skill that you
address in your treatment
session. Describe one way
(only one) that you can grade
the activity up and one way
(only one) to grade the activity
down based on that one factor
or skill.

Client factors: OPM: PEO Activity Set Up: Factor/Skill: Control of

The client factors impacting the
client’s ability to type and/or
independently don his L shoe and
sock are minimal proprioception in
his hand, absent touch functions
(light touch), lack of control of
voluntary movement in his fine
The PEO Model will enable me to
create the most optimal solutions
for the client as I take each factor
(support and barrier) into
consideration to effectively modify
the task and environment as
needed to fit the client’s needs and
HEP Overall Therapy Outline:
7. Client-centered music
8. Mirror Therapy functional
sensory and motor retraining.
10-30 min/day, daily
9. Mental Imagery: listen anytime
everyday 10+ minutes/day
voluntary movement
Grade Up: Client will engage
LUE in fine motor control
preparatory and functional tasks
during Mirror Therapy.
motor skills and muscle tone (high
tone) resulting from the
hemiparesis effects of his R
thalamic hemorrhage. He has
difficulty feeling the laces and then
utilizing his fine motor control to tie
laces and grip to don sock and
shoe over heel.
In typing he lacks light touch
sensation in his LUE making it very
difficult to feel when he is pressing
on the keys. Also because he has
minimal proprioception in his hand
he doesn’t notice when L finger
move positions, and his lack of fine
motor control makes it very difficult
to use dexterous movements
needed to effectively type, and
finally his abnormally high tone
due to his flexor synergy make it
difficult to not press on keys.
Performance Skills:
The performance skills currently
impacting the client’s performance
with the goal of donning his L sock
and shoe are positions, reaches,
grip, manipulates and coordinates.
Because of his L sided
hemiparesis, high tone, and overall
weakness he has difficulty
reaching down far enough with his
LUE and the lack of motor control,
create an inability to effectively grip
his sock/shoe to pull them on and
manipulate laces to tie them. He
also has difficulty positioning his
LUE because of a lack of
proprioception and light touch, he
cannot feel when his left hand is
promote greater occupational
performance and participation.
Person: The client is a 69 y/o male
with a R thalamic hemorrhage
resulting in L hemiparesis, high
tone, extensor synergy, and soft
tissue shortening.
Environment: The environment is
dressing in his home in preparation
for work and donning his shoes
back after showering to be able to
exit safely.
Occupation: Donning his L
sock/shoe
CPM: Motor Control/Learning
Model
The Motor Control/Learning Model
is important to implement b/c of the
client’s R thalamic hemorrhage
resulting in L hemiparesis. His
stroke caused a disruption in the
cortical connection between his
brain and motor movement of his L
side. The focus of treatment will be
to promote more repetitious motor
movements from the LUE to rebuild
motor pathways using Mirror
Therapy functional exercises.
Grade Down: Client will
observe his mirrored “LUE”
Supplies: participating in preparatory and
- Mirror Therapy supplies for 3-4 functional tasks during Mirror
weeks Therapy.
- Mental imagery audio
- Mental imagery highlighted
research
Home Exercise Program (Part 1):
Mirror Therapy
Client will continue to implement mirror
therapy to gain repetitious movement to
rebuild neuropathways of functional
motor movements and sensory
retraining for more optimal LUE
function. Client will receive a list of
exercises and functional MT tasks as
homework. A LE MT program will also
be provided as per client’s request.
Home Exercise Program:
Mirror Therapy
Upper extremity exercises:
i. Writing on paper write anything
you choose for 1-page
ii. Do individual finger raises – 15
reps
iii. Individual finger reaches – 15
reps
iv. Touch each finger to thumb – 15
reps
v. Brushing hair – see homunculus
brain mapping on back
vi. Choose 1 instrument to tap along
to the rhythm during several
songs (ex: follow the percussion
beat or guitarist strumming or
pianist in different songs you
choose)
touching the lacks to use his pincer
grip. Also, he has difficulty
coordinating his LUE along with his
right to pull on sock/shoe and tie
laces making task more difficult
and time consuming.
The performance skills impacting
the client’s ability to type are
manipulate and coordinate.
Because of his high tone, lack of
fine motor control, and extensor
tone resulting from his stroke, he
has difficulty with dexterous
movements of his individual
fingers.
vii. Sensory: Run hands through rice,
beans, sand
Lower extremity exercises (optional):
i. Ankle point & flex – 15 reps
ii. Toe-in & toe-out – 15 reps
iii. Ankle circles (R & L) – 15 reps
iv. Toe tap (rainbow back and forth)
– 15 reps
v. Eversion & inversion of ankle – 15
reps
vi. Sensory: Run feet through rice,
beans, sand
Home Exercise Program (Part 2):
Mental Imagery & Research Handout
Client will listen to a personalized
mental imagery audio daily during the
3-4 weeks break. Audio will guide client
through meaningful activities he has
expressed are difficult and has a desire
to improve (donning socks/shoes,
typing, and buttoning buttons, and
cutting food). The mental imagery will
be described vividly by combining the
visualization with as much sensory
information as possible, adding specific
details, and asking client to imagine
them in real time. Sensory details will
include feeling, hearing, smelling, and
tasting. While the therapist will provide
this mental imagery audio recording,
the client will be encouraged to write up
and record his own mental imagery
practice in his own voice to make it
more believable to his brain.
How HEP Will Be Therapeutic:

Mirror Therapy:
The existing evidence supports the
positive effects of mirror therapy in
stroke patients on the following
domains:
• Improving motor function and ADLs
• Reducing pain
• Reducing neglect
• Reducing sensory impairment

Mental Imagery/Practice (MP):

Mental imagery practice has shown to
improve motor function, increase
feelings of autonomy, and motivate
stroke patients to work even harder. MP
is where the same musculature and
neural structure are activated during
mental practice as during physical
practice of the same task. MP improves
movement via significant cortical
reorganization of the brain and create
observable motor change. Research
shows most changes were observed in
distal impairments (wrist extension and
pincer grasp). Subjects reported new
ability to perform components of ADLs.
These new abilities transferred to the
new ability to perform other important
ADLs. Also, MP increases affected arm
use and function even years after
stroke.

How HEP Addresses the

Performance Problem:
Mirror Therapy will include preparatory
and functional tasks aimed increase
number of repetitions the LUE receives
to rebuild neuropathways to the brain
that will improve LUE motor control.
This will be in preparation for later
engaging in fine motor functional tasks
of donning socks/shoe/AFO brace and
typing to relearn the motor skills
required to perform these and other
ADLs. Sensory retraining is part of MT
to visually observe the mirrored LUE
feel what the RUE is feeling to provide
training to the brain of what different
sensations feel like--thus rebuilding
sensory function that is strongly
connected to motor function.

Music is always added to therapy

sessions b/c evidence supports
auditory-motor coupling, and emotion-
motivation effects due to the
playfulness and emotional impact of
music which will be useful in MT to
increase motivation, repetitions, and
fine motor function.

The client will be guided through Mental

Imagery/Practice to encourage him to
visualize himself effectively using his L
fingers and hands in meaningful
occupational activities to improve LUE
fine motor function.