Running head: OCCUPATIONAL PROFILE AND ANALYSIS

Occupational Profile and Analysis II Anthea Mourselas Touro University Nevada

OCCUPATIONAL PROFILE AND ANALYSIS Occupational Profile Questions Who is the client (person, including relevant family, caregivers, significant others; population; organization)? Answers Yvonne is a 64-year-old female who lives alone in a single story home. Her husband passed away in January which left her very depressed. She has four children and eight grandchildren. Two of her children live in town. Her son that lives here is still single and spends a lot of time with her, and her daughter visits at least twice-a-week to help with finances and anything else she needs. Why is the client seeking services, and what are the clients current concerns relative to engaging in occupations and in daily life activities? What areas of occupation are successful and what areas are causing problems or risks? Client is seeking services for tremors and bilateral upper extremity (UE) weakness. She reports that her largest concern for therapy is to decrease her tremors and increase her strength in her UEs. Client stated that she is unable to perform tasks she used to such as cooking, opening jars, and application of makeup. The client has been seeing physical therapy (PT) for pain in her right knee resulting from a preexisting injury, which causes her difficulty standing during ADLs. Client is currently at modified independence for almost all activities of daily living (ADLs) due to increased time. The only ADL where she requires some assistance is preparation of her food while using a knife, such as eating a steak. Activities such as meal preparation cause her difficulty because of her tremors and weakness in her hands. She often spills liquids and has difficulty cutting. Client is

OCCUPATIONAL PROFILE AND ANALYSIS unable to apply her make-up on her eyes without assistance because of the tremors. Unless her daughter is available to help her, she usually goes without wearing any eye make-up which upsets her. She currently drives independently but only short distances such as to doctor appointments and the grocery store. She doesnt like being out of the house for too long because of her knee pain. She is scheduled for a right total knee replacement (TKR), next month. What contexts and environments support or inhibit participation and engagement in desired occupations? Yvonne currently has adaptive equipment including grab bars and a tub transfer bench (TTB) to help with toileting and bathing. Her difficulty maneuvering items in the kitchen cause her to either eat out or have frozen meals at home. She has a housekeeper who does all of the household cleaning, including laundry. What is the clients occupational history (life The client is originally from the Las Vegas area. She has been living in Summerlin now for many years. Her favorite sport is

experiences, values, interests, basketball but she sustained a knee injury during a game on her previous patterns of engagement in occupations, and the meanings associated with them)? high school team and her knee hasnt been the same since. Her family is very important to her. She is a retired pre-school teacher. She raised two full grown children. She had been taking care of her mother, whom she was very close to, when she passed away five years ago. The client stated that she fell into a very deep depression, and she couldnt get out of bed for

OCCUPATIONAL PROFILE AND ANALYSIS months; he eventually worked through her depression and continued on with her life. This past January, after her husband passed away, she became depressed again. Her doctor put her on anti-depressant medication which has helped her manage her depression symptoms but unfortunately increased her tremors in her UEs. She used to meet with her girlfriends for lunch at least once a week but discussed how recently she doesnt feel comfortable meeting them anymore because she feels embarrassed by her tremors. She does continue to see her children and grandchildren throughout the week; they often go out to dinner. However, she misses cooking for family because Sunday family dinners at her home used to be a tradition. What are the clients priorities and desired outcomes? The client stated that she would like her tremors to decrease and her arms to become stronger with less fatigue. She wants to be able to prepare meals again independently and apply her own make-up.

Occupational Analysis What Deficits Exist in Each of the Body Function Categories (Mental, Sensory, & Pain, Neuromuscular-Skeletal and Movement-Related, Cardiovascular, and Respiratory)? Mental functions: Specific mental functions: The client is intact with her higher cognitive thinking. She is able to pay attention, listen to directions, and hold a conversation. She shows good short-term and long-term

OCCUPATIONAL PROFILE AND ANALYSIS memory because she was able to talk about events from her past and present. Global mental functions: The client was alert and oriented to person, place, and time. She talked about her depression, but her medication has helped her to become emotionally stable by managing her symptoms. Sensory functions and pain: The client has good visual awareness of her overall environment. She complains of moderate pain in her right knee and discussed plans for a TKR within the next couple of months. Neuromuscular-skeletal and movement-related functions: The client has limited range of motion (ROM) bilaterally during shoulder flexion and abduction. In addition, the client has limited ROM bilaterally during wrist flexion. The client has decreased muscle strength and endurance in both her UEs. Client also has a weakened grip strength, lateral pinch, two point pinch, and three jaw chuck. The client ambulates independently, however, shows a kyphotic posture deviating to her right due to her knee pain from her preexisting injury. This pain causes her gait pattern to be much slower and less stable while walking. Cardiovascular, hematological, immunological, and respiratory functions: Voice and speech functions digestive, metabolic, and Client is WNL for the following categories. Client is within normal limits (WNL) with all of these functions.

OCCUPATIONAL PROFILE AND ANALYSIS endocrine system function genitourinary and reproductive function: Skin and related-structure functions: Client is WNL with her skin and related-structures.

Discuss the activity demands of this task (object needs, space demands, social demands, sequence & timing, required actions or skills). Activity Demands Objects and their properties: Meal Preparation (Cutting) The objects included a smooth, white dish; a sharp, silver knife; a pointy silver fork; and a blue, sticky, Dycem mat, and a simulated food item (Theraputty) was used in place of food. The Theraputty was yellow, dense, and sticky. Space demands: The physical environment included a well lit room with plenty of counter space. It also included a chair at an appropriate height for the table. Social demands: At times the client may share her table with another client. However, she never had to really share supplies and always behaved socially appropriate. Sequence and timing: Client carried out task by first positioning the plate comfortably in front of her. The Theraputty was already place onto the plate by the occupational therapist. The client then positioned fork and knife onto the putty and began cutting one

OCCUPATIONAL PROFILE AND ANALYSIS section at a time until the piece of Theraputty was completely cut into bite size sections. The client took a little more time than normal to complete the task because of her weakness and tremors in her hands. Required actions and performance skills: The client needed to have cognitive skills so she could be able to understand the task and follow the sequence to complete it. The client also needed emotional regulation skills because this task was difficult for her. It was important that she stay calm and focused and not become frustrated before completion. In addition, sensory-perceptual skills were used to be able to feel the right amount of pressure needed to cut through the Theraputty. Motor-praxis skills were needed to plan her movements and then actually perform them, as well as manipulating the fork and knife to cut the Theraputty with her UEs. Communication skills were needed to understand the directions of the task and to ask questions to the occupational therapist and understand the feedback provided.

Identify the performance patterns related to the task and your client (habits, routines, roles). Performance Patterns: Habits: Client and the task There were no habits that were observed or discussed. However, she did mention that she does not like to drive on the express way and

OCCUPATIONAL PROFILE AND ANALYSIS avoids them as much as possible when discussing the route she takes to get to the facility. Routines: The client prefers to sleep in a little later during the week. She attends therapy and prefers to come to therapy at 1:00 p.m. as opposed to the morning. She comes to therapy three times a week for both occupational and physical therapy. The client goes to the grocery store every Monday, where she buys her already prepared meals. Rituals: The client discussed that her ritual has changed once her debility began. She used to have family dinners at her home every Sunday, however, now that she has difficulty with meal preparation she tends to go out to dinner more. Roles: The clients role is a homemaker, mother, and a grandmother. She takes a lot of pride in her family and is very close to them. She is trying to get better so she can resume her roles such as a cook (for her family) and a friend (attending lunch with friends).

Identify the Performance skills, which are Required for this Task (Motor Skills, Praxis Skills, and Communication & Interaction Skills). Performance skills Motor and praxis skills: Meal Preparation Performance Skills Motor and praxis skills were used to plan her movements and then actually perform them. She then manipulated the fork and knife bilaterally to cut the Theraputty with her hands. This included

OCCUPATIONAL PROFILE AND ANALYSIS having coordination of the fork and knife and keeping the Theraputty stable. She also was able to stabilize her posture while seated during the task of cutting. Sensory-perceptual skills: Sensory-perceptual skills were used during the task by first positioning her body in the right in order to perform the cutting task. Next, she was able to place both arms in the right position to cut. She was able to sense the right amount of pressure needed to cut through the Theraputty. Emotional regulation: The client needed emotional regulation skills because this task was challenging for her. One of her biggest problem areas is cutting through tough meat. It was important that she stay calm and focused and not become frustrated before completion. She was able to complete the activity and then listen to feedback and suggestions to simplify the task. Cognition: The client needed to have cognitive skills so she could be able to understand the task and follow the sequence to complete it. She showed multitasking skills by being able to talk with the therapist while performing the activity. Communication and interaction skills: Communication and social skills were used by acknowledging occupational therapists instructions. In addition, the client was able to initiate and answer questions about the task.

Identify the body functions and body structures primarily influenced by this task.

OCCUPATIONAL PROFILE AND ANALYSIS Body Functions and Structures In the meal preparation task that I observed, the main body structures utilized were structures related to movement, and of course eyes and ears. The structures related to movement included the upper extremities. When cutting you need to have grip strength for the fork and knife. You need to have range of motion for the fingers, wrist, elbows, and shoulders. You need muscle strength through both UEs and steadiness of the hands to be able to stabilize the food. Muscles of the trunk were also used in order to stabilize the body while performing the task. Eyes were used to be able to look at the task and be aware of what she was cutting. Ears are used to be able to listen and follow directions.

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Comment on the Contexts that Specifically Relate to the Performance of this Intervention (Cultural, Physical, Social, Temporal, Virtual, Personal, Spiritual). Contexts and Environments Cultural The client engages in typical American patterns of behavior for example, she shook hands when she was introduced to me. No other cultural customs, beliefs or patterns were observed or discussed. Personal The client is a 69-year-old retired pre-school teacher. She is a mother and grandmother who values family more than anything. Temporal The client retired from working about 20 years ago to take care of her ill mother. She is currently within the young-old adult Performance of Task

OCCUPATIONAL PROFILE AND ANALYSIS population. The task took about 15 minutes to complete and was completed in the afternoon. Virtual The client was able to fill her functional status summary onto the computer in the facility, where it asked questions on her opinion of her physical status. She needed to know how to use the computer including typing skills and navigation skills. Physical The task took place in an outpatient rehabilitation facility at Summerlin Medical Center. The facility includes a lot of gym and therapy equipment. Her meal preparation task specifically took place at a long table where she was able to have sufficient space to complete the task. Social The client is now widowed; however, her children and grandchildren are still a big part of her life. During therapy she is very friendly with the therapy staff. Spiritual Nothing spiritual observed or discussed during the task.

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Problem List Identify at least 5 different problems relevant to the client and state these in the format of a problem statement. 1. Client requires SBA during feeding preparation due to decrease in safety from bilateral tremors and weakness in UEs. 2. Client requires Min (A) during meal preparation due to decreased activity tolerance 2 to debility. 3. Client requires Mod (A) using a disk grasp with ulnar deviation during ADLs and IADLs due to overall weakness and poor grip

OCCUPATIONAL PROFILE AND ANALYSIS strength in hands. 4. Client requires Mod (A) to apply makeup due to bilateral tremors in hands. 5. Client requires Min (A) to write legibly due to bilateral tremors in hands. Prioritize your problem list and justify your reasoning. The top 2 problems will be the basis of your next assignment, Evidenced Based Intervention Plan The five problem areas I wanted to focus on all dealt with the clients main goal for herself, which is to decrease her UE tremors and increase her strength. The first problem statement is really important for the client to work on because it is preventing her from socializing with her friends because it is making her self-conscious. In addition, its a safety hazard to use a sharp knife while not being able to stabilize and coordinate her movements while cutting her food. In the second problem statement, increasing activity tolerance will not only help her to complete a meal preparation activity but will increase her endurance to complete other activities faster and more efficiently. Something she discussed was not being able to open jars because of her lack of grip strength, so working on strengthening those muscles while in an ulnar deviated disk grasp position as well as some adaptive strategies, could be very beneficial for improving at not only this task but other ADLs and IADLs as well. The last two problem statements show how her tremors really affect her functioning. She is no longer able to apply her make-up without assistance. When her daughter is available, she helps her but

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OCCUPATIONAL PROFILE AND ANALYSIS if not she usually goes without wearing any. Writing is another area she struggles with affecting the legibility of her legibility of her handwriting. The fact that she used to be a teacher and taught handwriting and now is unable to write herself, makes her feel insecure. She could benefit from different adaptive equipment and techniques for both of these areas. Overall, if these problem statements were used to guide her intervention, it would increase her overall quality of life.

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Reference American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625-683.