Date implemented:

Client’s Initials and Age: TS (22) & WD (74) Time allotted for session: 30 min (TS) & 60 min (WD)
9/28/18
Diagnosis and any Precautions: TS- diagnosis of SCI ASIA D & minor TBI post-MVA, precautions included fall risk, sternal precautions, L shoulder < 90°, and
cervical collar worn OOB; WD- diagnosis of T12/L1 SCI due to cancerous metastases (ASIA level not rated but some sensation & motor in LE), only precaution
was fall risk
Goal/s being addressed: For both- goals addressed included mod I dressing (changing for TS to I in dressing) & mod I grooming
Activity Demands (setting,
Specific Objectives for this
Intervention Activities materials, and social Modifications (provided during the
activity (list 2-3)
(5) requirements) activity and planned for next session) (5)
(5)
(5)
This pt ended up being a higher level SCI
(ASIA D) so I graded up this entire task to
challenge his abilities. During this session,
the pt completed his LE donning of
underwear, shorts, and socks while sitting
EOB and had minA for CGA. He also did not
need any adaptive equipment to complete
Pt will don LE clothing with use of leg this task. These are both changes from my
Setting: complete in supported
extender. Pt will practice use of leg original plan. The biggest challenge was his
sitting in bed with covers removed
extender prior to dressing by picking orthostatic hypotension that presented once
and clothing beside pt.
up each leg from straight to bent and he stood to pull up underwear/shorts. I
Materials: leg extender, hospital
back. Pt will then receive education monitored his BP throughout his session to
1. Pt will complete LE dressing bed, pants, socks
on how to utilize extender to don LE ensure he remained within safe values. Next
with min A. Social Requirements: provide
clothing (pants & socks) and practice time, I would have provided pt education in
2. Pt will demo use of adaptive verbal direction to OT/family; remain
with OT providing physical and orthostatic hypotension prior to getting to
equipment by completing appropriate throughout dressing
verbal cuing as needed. This activity EOB, and had pt remain sitting for dressing
task in 15 min. Grading: Use large pants and socks
will take first 15 min of session. routine rather than standing until his body is
to make dressing easier. Lay HOB
Why did I choose: In order to go more adjusted to positional changes. Once
down further to challenge dynamic
home, pt needs ability to dress he was able to handle position changes, I
sitting balance to make dressing
self/provide instruction to family would use walker to stabilize him during
more difficult.
members to assist in dressing. portion of routine involving pulling up pants
to decrease reliance on therapist
stabilization. To get more skill from the pt, I
would have him also don shoes and tie at
EOB. The pt achieved both of my objectives
for the session, completing his LE dressing
in 10 min and completing dressing with min
A.
Pt will perform grooming routine Setting: Sitting in wheelchair at sink. This activity did not go as well as I had
1. Pt will complete washing of
while sitting at sink. Pt will request Supplies: bath mit, toothbrush, planned. What went well: pt completed tooth
face with mod I for use of
needed supplies. Pt will then wet toothpaste, u-cuff, sink, soap brushing with setup and no need for adaptive
adaptive equipment (mitt).
bath mit and wash face with physical Social Requirements: provide equipment, pt was able to ID his need to
2. Pt will complete tooth
assistance as needed. Pt then will verbal direction to OT/family; ID brush his teeth, pt kept balance sitting
brushing with mod A.
squeeze toothpaste onto toothbrush needs for that day based on what unsupported at EOB during task, pt able to
and practice brushing teeth with use
of U-Cuff with physical assistance as
needed. For any aspect requiring
physical assistance, pt will provide
verbal direction to OT to help assist
in task. This activity will take next 10
min of session.
Why did I choose: In order to care
for self, pt needs ability to perform
basic hygiene activities or at least
provide instruction to family
members/caregivers to promote
I’nce. Additionally, pt receives
instruction in and practice using U-
Cuff which will be extremely helpful
in performing ADL’s & IADL’s. Last,
grasp on washcloth will assist with
grasp on toilet paper during eventual
toileting/self-catheterization.
Pt will make different shapes with
ball on bedside table and sitting in
bed. Table will be placed directly in
front of pt. Pt will place palm over
ball and reach in varied directions to
address shoulder stability/distal
mobility (pt will ID distance at which
no longer stable) as well as reaching
needed for ADL tasks (grooming,
dressing, bathing, feeding) and
dynamic sitting balance. This activity
will be completed in last 5 min of
session if time permits.
Why did I choose: Pt’s with
incomplete SCI often have
decreased shoulder ROM and
strength that is needed to participate
in all ADL activities. By practicing
reaching while supported, pt may
challenge ability to reach in varying
directions and ID point where pt
loses shoulder stability. Additionally,
by performing this activity, pt is
challenging dynamic sitting balance
and ID center of balance to promote
I in dressing and prevent falls.
1. Pt will reach within 3 in of all
four sides of table 3x.
has already been done (Has pt
already brushed teeth? What else
does pt need to do to get ready for
day?)
Grading: use washcloth rather than
mit to challenge grasp, prop arm up
with pillow to decrease active
shoulder flexion needed to reach
face, build up toothbrush with foam
instead of using U-Cuff to challenge
grasp, use flip top toothpaste to
make opening bottle easier, use 365
toothbrush to decrease need to
supinate/pronate wrist during activity
Setting: Bedside table directly in
front of pt while pt in supported
sitting in bed. Door can be closed to
minimize environmental distraction if
needed.
Materials Needed: varied sizes of
balls, bedside table, hospital bed,
gait belt
Social Requirements: understand
and follow directions, communicate
assistance needs to therapist
Grading: Use bigger ball/don’t use
any material and have pt touch each
corner. Move table further away from
pt/out to side to promote further
reaching. Lay bed down to promote
dynamic sitting balance (could
adjust how far down based on
ability), perform OOB, change height
of table, have pt make shapes in air
with ball rather than on table.
unscrew small toothpaste top. What went not
so well: pt did not want to complete face
washing, pt unable to transfer to wheelchair
due to orthostatic hypotension so completed
grooming at EOB. What I would change next
time: complete entire grooming routine so
therapist able to FIM, give pt warm wet
washcloth rather than asking what he
wanted to do (decreased insight/decision
making due to TBI). During this session, I did
change his position to complete task (sat
EOB rather than at sink) and did not need to
use adaptive equipment. Pt also did not
complete washing face portion of activity, so
I added AAROM in bed to therapy session.
To get more effort from pt, I would not give
him the option to choose what he wanted to
complete that day as presenting the items
would likely lead to more participation for this
pt.
This task was completed with a separate pt,
WD, as postural awareness and dynamic
sitting balance were identified as current
limitations this pt had. What went well: pt
able to complete task fully and had a lot of
buy in to this activity. What didn’t go so well:
pt required a lot of support when sitting EOM,
which was fine with my FWEd present, but
would present a challenge if I were to
complete this independently with pt (could
have him sit in wheelchair rather than EOM).
Since this task ended up being much longer
than originally anticipated since it was
completed with a separate pt, I had to add
additional tasks to activity and up the
challenge as pt was a lower-level SCI (T12-
L1) rather than a cervical injury that is more
common in this setting. What would I do next
time: consider grading more in depth prior to
session, have table at waist level rather than
starting at shoulder level, have pt leave hand
on mat during task, and add more to task to
challenge endurance with this task. What did
I change: pt sat at EOM rather than in bed
with therapist providing mod A to support
balance, pt had hands on mat and then
 progressed to hands in lap. Height of table
progressed from shoulder height to chest
height to waist height to find just right
challenge for pt. Pt then also completed
balloon volleyball task with me to further
challenge postural awareness and dynamic
sitting balance without a table in front of pt.
To better support client’s performance, I
could provide postural awareness activity at
beginning of session (therapist did yoga at
end but would be better to do at beginning to
promote better posture), could have pt sit in
chair or with wedge behind to promote
balance without therapist assist, provide
more cuing for postural awareness/use
kinesiotape as reminder for posture. This
client was extremely engaged and worked
very hard so I think I got as much effort as he
was able to provide. Overall, I’m pleased with
the end result of this activity and really
learned a lot about grading and changing the
environment during session.
S/OT name: Sam Develli

Find one peer-reviewed article that supports the intervention you planned/provided. At the bottom of your plan, paste the abstract and
citation and then in your own words describe how this supports your intervention plan. (5)

Ozelie, R., Gassaway, J., Buchman, E., Thimmaiah, D., Heisler, L., Cantoni, K., Foy, T, Hsieh, C., Smout, R., , Kreider, S. E. D., & Whiteneck, G
(2012). Relationship of occupational therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord
injury: The SCIRehab Project. The Journal of Spinal Cord Medicine, 35(6), 527-546.

Background/objective: Describe associations of occupational therapy (OT) interventions delivered during

inpatient spinal cord injury (SCI) rehabilitation and patient characteristics with outcomes at the time of
discharge and 1-year post-injury.
Methods: Occupational therapists at six inpatient rehabilitation centers documented detailed information about
treatment provided. Least squares regression modeling was used to predict outcomes at discharge and 1-year
injury anniversary for a 75% subset; models were validated with the remaining 25%. Functional outcomes for
injury subgroups (motor complete low tetraplegia and motor complete paraplegia) also were examined.
Results: OT treatment variables explain a small amount of variation in Functional Independence Measure (FIM)
outcomes for the full sample and significantly more in two functionally homogeneous subgroups. For patients
with motor complete paraplegia, more time spent in clothing management and hygiene related to toileting
was a strong predictor of higher scores on the lower body items of the self-care component of the discharge
motor FIM. Among patients with motor complete low tetraplegia, higher scores for the FIM lower body self care
items were associated with more time spent on lower body dressing, manual wheelchair mobility
training, and bathing training. Active patient participation during OT treatment sessions also was predictive of
FIM and other outcomes.
Conclusion: OT treatments add to explained variance (in addition to patient characteristics) for multiple
outcomes. The impact of OT treatment on functional outcomes is more evident when examining more
homogeneous patient groupings and outcomes specific to the groupings.
Note: This is the third of nine articles in the SCIRehab series.

Support for Intervention: My intervention plan focused primarily on occupations needed to return to previous living situation/to be discharged from impatient rehab.
This study supports focus on LE dressing for both motor complete tetraplegia and paraplegia in order to improve FIM scores in these areas and thus improve
independence in lower body self-care. Additionally, all my activities focus on active pt participation which was shown to predict improved FIM in this setting. Although
my pts ended up not being motor complete SCI, I still feel this study is valid to supporting focus in these areas during OT in the inpatient rehab setting.

Total: 27 points