Running head: OCCUPATIONAL PROFILE AND ANALYSIS

Occupational Profile and Analysis Chrys Quiroz Touro University Nevada

OCCUPATIONAL PROFILE AND ANALYSIS Occupational Profile Client The client, Ms. Snowden, is of Caucasian descent and 58 years old. She has a petite stature, standing at about 5 feet 2 inches tall and weighs about 110 pounds. Ms. Snowden discussed living alone in a one bedroom apartment prior to her admittance to the acute rehabilitation hospital. She stated that the two individuals whom she interacts with frequently are her daughter-in-law and her best friends daughter. She did not discuss details about any significant others or any immediate family members. Ms. Snowden was very independent before undergoing surgery. She worked within the gaming industry for about 30 years as a Blackjack dealer. Ms. Snowden relayed that she had been involved with Circus Circus, then transferred to Luxor, and helped open Mandalay Bay. She appeared to be very proud of the fact that she stayed within a company of sister casinos. Ms. Snowden stated that she spent most of her time working but when she did manage to gain some time to herself, she liked to relax and watch television. She did not state that she was a member of any outside populations or organizations other than being involved in the casino industry. Client Concerns Ms. Snowden is seeking services because she recently underwent a right total hip arthroplasty (THA) with a posterolateral approach secondary to degenerative joint disease. The client was ordered occupational therapy (OT) by the treating doctor to issue adaptive tools, education involving THA precautions, and addressing any concerns about activities of daily living (ADLs). Since this was Ms. Snowdens first elective THA surgery, it was necessary for the client to understand the implications of not following the THA precautions. She needed extensive information regarding how to use the adaptive tools and durable medical equipment

OCCUPATIONAL PROFILE AND ANALYSIS (DME) being recommended and issued. Prior to being explained what OT entailed, Ms. Snowden had no knowledge about this field of rehabilitative services. However, Ms. Snowden was very cooperative and stated that her current concerns were remembering the THA precautions and getting adjusted to them. She did not want to break any of the precautions and wanted to be discharged home so she could participate independently with her ADLs. More specifically, Ms. Snowden stated that she wanted to continue the occupations of ambulating within her home, getting dressed, and toileting on her own, without the help of her daughter-inlaw and best friends daughter. Ms. Snowdens goal was to return to her prior level of independent functioning. Areas of Occupation It would be ideal to stay optimistic in terms of the areas of occupation that are still successful for Ms. Snowden. In reality, however, almost all of her areas of occupation are now causing her difficulties. The two areas of occupation that can still be seen as successful are her leisure and social participation. Once discharged, Ms. Snowden will have more time for herself to engage in leisurely activities that she enjoys doing. Luckily, the activity that she expressed was watching television, which is a non-strenuous activity. In regards to social participation, Ms. Snowden will not be able to interact with the casino patrons on a daily basis, as she did prior to the surgery. However, she will have the opportunity to witness the amount of care that her daughter-in-law and best friends daughter have for her. Engaging in this level of intimacy will allow for Ms. Snowden to be reassured in knowing that there are individuals who care for her well-being. The areas of occupation that are currently causing problems are her ADLs, instrumental activities of daily living (IADLs), rest and sleep, and work. Activities involving education and

OCCUPATIONAL PROFILE AND ANALYSIS play were not discussed with Ms. Snowden. The ADLs that would be affected are showering, dressing, functional mobility, and toilet hygiene. These areas would be difficult to manage due to the precautions that have to be followed at all times during her recovery. For example, Ms. Snowden would have to follow the precautions while she uses a shower chair, long handled sponge, front wheel walker (FWW), reacher, sock aid, and a raised toilet seat; all of which are items that were foreign to her and had not been used prior to the surgery. For Ms. Snowdens IADLs, her community mobility, home management, meal preparation and cleanup, and shopping would be negatively affected. For community mobility, accessing a car was an area of concern. Ms. Snowden also recognized that she would be participating less in meal preparation and cleanup secondary to using a FWW in order to ambulate within her kitchen and decreased standing tolerance. In addition, Ms. Snowden felt that engaging in home management and grocery shopping would be too taxing and difficult to maneuver her FWW. For the area of occupation involving rest and sleep, Ms. Snowden has already shown signs of not being able to sleep without medication due to pain. Lastly, Ms. Snowden stated that she would not be going to work for the duration of her recovery period. Context and Environments Social, physical, virtual, personal, and temporal contexts and environments currently support Ms. Snowdens participation in her chosen occupations. Socially, the presence of her daughter-in-law and best friends daughter, who have agreed to help with meal preparation and home management, will have a positive effect on Ms. Snowden, since they will be able to assist and stay with her during her recovery. In addition, since she has no children to take care of, she is available to focus on herself and her own needs. In regards to the physical context and environment, the built tools and DMEs facilitate engagement in occupations such as bathing,

OCCUPATIONAL PROFILE AND ANALYSIS toileting, and dressing. Temporally, electing to have the surgery done during this stage in her life has contributed to the overall convenience of engaging in her chosen occupations. This is due to the fact that, currently, she is not exceedingly active in the community, and has had the opportunity to work, in order to satisfy her financial needs. In regards to her personal context and environment, Ms. Snowden appears to be optimistic and eager to recover. This can help in her initiative to re-engage in occupations in the same manner as she had in the past, once she is deemed fit and receives medical clearance. Lastly, the virtual component of having the television available for Ms. Snowden to pass time allows her to participate in this leisurely activity. Ms. Snowdens cultural context and environment can be viewed as inhibiting her participation and engagement in her desired occupations. Culturally, she may be expected to engage in work. However, due to her surgery, she is unwilling to participate as a card dealer during her recovery. Occupational History Due to the setting being an acute rehabilitation hospital and the patient being cognitively hazy secondary to being medicated with Morphine, an in-depth occupational history was difficult to obtain. Therefore her life experiences, values, interests, previous patterns of engagement in occupations, and the meanings associated with them were very briefly shared. However, some history that Ms. Snowden was able to share was that she really identified herself with her line of work, since being a card dealer filled a majority of her time thus far. Ms. Snowden valued her independence and discussed how she was thankful that she had people to rely on that would care for her, but that ultimately, she wanted to be able to function on her own. She also shared that her patterns of engagement that she performed on a daily basis were going to work, watching her television shows, and performing the fundamentals of life such as eating and sleeping.

OCCUPATIONAL PROFILE AND ANALYSIS Priorities and Desired Outcomes As previously mentioned, Ms. Snowdens priorities were to be able to follow the precautions to facilitate a speedy recovery. She was open to using adaptive tools and DMEs and wanted to learn how to use them safely and correctly. Ms. Snowden specifically stated her interest in continuing to dress, toilet, shower, and prepare her food independently. These are mostly activities that she can complete at home, since she intended to spend most of her time in her one bedroom apartment. However, she was also curious about maneuvering into and out of a car in case she needed to access the community. Ms. Snowdens desired outcome was to be able to live comfortably and still engage in daily occupations, despite her recent surgery. Occupational Analysis The activity that is being analyzed is lower body dressing while using the newly issued adaptive tools. More specifically, the task of donning socks with the assistance of a sock aid will be analyzed. This activity falls under the area of occupation of ADLs. This task is appropriate for the acute rehabilitation hospital because the primary focus of this setting is to prepare the patient for discharge. Since Ms. Snowden is planning to be discharged home and lives alone, she will have to learn how to complete this task independently. Ms. Snowdens recent THA has affected her ability to participate in the ADL of dressing. Therefore, she will have to learn how to function in this task, while being mindful of the THA precautions. Deficits The current deficits that exist in Ms. Snowdens specific mental functions are higherlevel cognitive function, attention, perception, awareness, memory, thought, and mental functions of sequencing complex movement. Since Ms. Snowden was under medication at the time of the intervention, she was having difficulty with sustained attention throughout the

OCCUPATIONAL PROFILE AND ANALYSIS activity. In addition, though the activity of donning socks was demonstrated prior to Ms. Snowden trying the activity, she needed constant cues for what step was next and reminders to not break her precautions. This showed a deficit in her memory and safety awareness. Ms. Snowdens global mental functions of consciousness, orientation, energy, and drive were also affected. Her energy was significantly lower. She took a considerable amount of time to complete the task due to having to rest and contemplate the next step. Ms. Snowdens sensory functions involving pain was altered because of the medication she was taking. Her ability to localize pain was decreased since the Morphine numbed the pain she was experiencing. There were no other sensory functions being affected since her visual, hearing, vestibular, proprioceptive, touch, temperature, and pressure abilities still showed to be intact while she completed the activity. For example, she applied an appropriate amount of pressure while putting the sock onto the sock aid. She was able to maintain visual awareness while she was being taught the activity from a reasonable distance. She had no complaints regarding taste or smell. In regards to neuromusculoskeletal and movement-related functions, there were definite deficits in Ms. Snowdens joints that were directly related to the THA. Ms. Snowdens hip joint mobility and stability were affected during the activity because she could not bend forward past 90 degrees to don her socks. Instead, her trunk had to maintain an upright position, and she could not bring her legs up to her trunk either. This precaution is to ensure that her hip joint would not dislocate out of the socket. In addition, Ms. Snowden had significant internal rotation of her lower extremities at rest. She associated this tendency due to prolonged standing at the casino as a card dealer. This served as an obstacle during the activity because it was imperative that she maintained a lower extremity neutral position. She had to ensure that she was not internally

OCCUPATIONAL PROFILE AND ANALYSIS rotating, as it is a THA precaution. For the specific activity of donning socks, Ms. Snowdens right lower extremity muscle power, endurance, and gait pattern was not observed. However, it can be expected that these three components would be negatively affected, thus having to utilize a FWW. Lastly, Ms. Snowdens control of voluntary and involuntary movement reactions, motor reflexes, and muscle tone were unaffected by the surgery as shown in her ability to maintain a seated position throughout the activity. Ms. Snowdens cardiovascular, hematological, immunological, and respiratory system functions did not seem to be significantly affected by the THA. Though her heart rate and blood pressure were being monitored, it was more so to ensure that her normal levels were being maintained. Voice and speech functions, digestive, metabolic, and endocrine system functions, and genitourinary and reproductive functions had no observed deficits and all appeared to be within normal limits. She was able and willing to speak and voice her questions throughout the treatment. Using the restroom and consuming food was not involved in the activity of donning socks. Ms. Snowdens skin and related-structure functions were affected at the location of the incision. She was administered a thromboembolism deterrent (TED) hose to wear after the surgery. Ms. Snowden had to stay mindful of the area, while she completed the activity, to ensure that she would not cause further damage and to allow for her skin to heal properly. Activity Demands The necessary objects for the activity were the chair, socks, sock aid, and a reacher. The chair was needed to support her body while she performed the activity. The chair structure was hard, durable, and had soft cushions for seated comfort. The sock was soft, stretchable,

OCCUPATIONAL PROFILE AND ANALYSIS lightweight, and made of cotton. The sock aid had a hard, plastic portion which served to support the foot and a rope that was tough, which served as a means to maneuver the adaptive tool. The reacher was long, metal, and had a pinching mechanism at one end. This allowed Ms. Snowden to access her lower extremity without violating the precautions. All objects are identified as tools except for the chair, which is equipment. The space demands needed for this activity are a well-lit area, with adequate space to maneuver all of the adaptive tools, and a flat surface to help with balance. A space demand to also consider is the noise level. Ms. Snowden would benefit from a quiet environment to facilitate concentration. Lastly, by having the room at a comfortable temperature, no extra blankets or coverings were needed, which may have interfered with the completion of the activity. In regards to social demands, there were no immediate considerations that had to be followed during the actual implementation of the activity. This is due to the fact that since it was during Ms. Snowdens treatment, it was expected of her to don her socks. However, when Ms. Snowden does complete the activity on her own, it would be socially and culturally expected for her to not carry out the activity in public. This can be seen as rude or unsanitary if she were to don her socks in front of an individual without asking for their permission. The process used for Ms. Snowden to don her socks was to gather her tools and remain seated on the chair. She had to completely fit the sock onto the sock aid while being mindful of which part was designated as the top and the bottom. Then, she had to use the reacher to transfer the sock aid towards her right lower extremity. Next, Ms. Snowden had to lift her leg and insert her foot into the sock aid. Then she had to manipulate the rope towards her body until the sock

OCCUPATIONAL PROFILE AND ANALYSIS was completely on her foot. Lastly, Ms. Snowden had to use the reacher to grab the sock aid and remove it from her lower extremity. Ms. Snowden finished the activity in about 10 minutes. The required actions and performance skills needed were for Ms. Snowden to feel the tools. She had to grip onto the sock aid and determine how to move her upper extremities in order to maneuver the adaptive tool throughout the activity. Ms. Snowden had to know when her foot was inserted fully into the sock aid. Donning socks for the first time required Ms. Snowden to know when to ask for assistance when she forgot the next step. She also had to select which tool was next during the process. Performance Patterns The performance patterns that can be identified as Ms. Snowdens habit is that she likes to don her right sock first, and then her left. When she returns home, Ms. Snowden also has a drawer that she puts all of her socks in, so she will have a set location to access them. She did not have any specific routine of when she put on her socks. The times when she does wear socks are if her feet are cold, and if she will be leaving the house and wearing shoes. Ms. Snowden does not have any rituals regarding her socks. Her role as a member in a society that is familiar with socks allows for her to be open to using a sock aid and reacher to don her socks. Performance Skills The motor skills that are necessary for the activity of donning socks were for Ms. Snowden to reach for the adaptive tools without breaking any of her hip precautions and to pace her timing to limit fatigue. Ms. Snowden had to activate her core muscles and maintain her trunk stability so that she would not lose her balance during the activity. She needed finger dexterity in order to hold onto the various adaptive tools and to be able to manipulate the trigger mechanism of the reacher.

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OCCUPATIONAL PROFILE AND ANALYSIS The sensory-perceptual skills that Ms. Snowden utilized were visually locating the next tool that she needed and to hear the instructions that were given to her. She had to correctly time when to insert her foot into the sock aid, as well as to feel when her foot had reached the endpoint of the sock. Lastly, Ms. Snowden required the ability to position her body and appropriately respond if she could sense that she was breaking her hip precautions. The emotional regulation skills that were being implemented were persisting through the task even if it seemed difficult. She had to recover from unsuccessful attempts of applying the sock onto the sock aid. Essentially, Ms. Snowden was successful in regulating her emotions because though she would be corrected, she still appeared to be optimistic, willing, and determined to complete the activity. The cognitive skills that are needed for this activity were recalling the steps that were just taught and demonstrated to her. Next, Ms. Snowden required the ability to select the next tool to be used in the process of donning her socks. She also had to sequence the activity since there were specific steps for completing the activity. Lastly, Ms. Snowden had to know which part of the sock was the bottom, which was indicated by the heel, and which was the top portion. The communication and social skills that were required for this task were to be able to look and listen when being taught or given cues. Additionally, Ms. Snowden needed to acknowledge when being spoken to and resist from interrupting. She also had to gesture or ask for help whenever she reached a dilemma. Lastly, she had to communicate appropriate responses when asked a question during the treatment session. Body Functions and Body Structures The required body functions that were used during this activity were grip strength in order to hold onto the ropes of the sock aid, joint mobility of her upper extremity in order to

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OCCUPATIONAL PROFILE AND ANALYSIS maneuver the tools around her body, finger mobility in order to manipulate the reacher, and dexterity to apply the sock onto the sock aid. Ms. Snowden needed memory and attention to maintain focus on the activity. Lastly, she required cardiovascular function to complete the task. The required body structures that were needed for this activity were her two eyes to see what she was doing, her two ears to hear any cues or reminders, her mouth to ask any questions, her 10 fingers to manipulate the tools, her hands to hold onto the sock aid, her arms to allow herself to reach for the needed tool, her trunk to maintain an upright position, and her lower extremity which was the targeted area of the activity. Contexts Related to Performance The contexts that specifically relate to the performance of this intervention are cultural, personal, and physical. Culturally, it would be ideal to perform this activity in private for sanitary reasons. It would not be socially acceptable to don socks in a public area. Ms. Snowden will wear her socks based on the personal contexts and conditions of when her feet are cold or when she wears shoes. Temporal, virtual, physical, and social were not discussed or mentioned during the treatment. It is not safe to assume that Ms. Snowdens friends expect her to wear socks (which would be a social context and environment) or that Ms. Snowden prefers to wear socks outside to protect her feet from rocky terrain (which would be a physical context and environment). Problem List Five Problem Statements 1. Client requires stand-by assistance to perform toilet transfers secondary to decreased safety awareness following hip precautions.

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OCCUPATIONAL PROFILE AND ANALYSIS 2. Client is unable to safely perform lower body dressing secondary to decreased AROM in right lower extremity. 3. Client requires stand-by assistance to perform shower transfers secondary to decreased safety awareness following hip precautions. 4. Client requires stand-by assistance for meal preparation secondary to decreased standing tolerance. 5. Client is unable to access the community secondary to decreased safety awareness following hip precautions via entering and exiting a vehicle. Justification The top three priorities on the problem list are to address lower body dressing and transfers onto the toilet and into the shower. This is because each of these occupations deals with Ms. Snowdens independence in activities that involve protecting her modesty. The occupation of toilet transfers is ranked first because it is not an option for her to use a catheter, and any DME she chooses will require her to transfer onto it. Toilet transfers and lower body dressing is ranked as the top two because each of these activities requires her daily involvement. Showering is ranked number three because this is an occupation that she will not perform on a daily basis and if desired, will wipe her body with a washcloth every other day. The occupation of meal preparation is ranked fourth because this was the next activity that entailed daily engagement. However, it does not deal with her modesty and she is open to being assisted with meal preparation. Community mobility is ranked last because Ms. Snowden does not show the desire to access her community on a daily basis, but does show curiosity on entering and exiting a vehicle, in the event that she will have to leave the apartment.

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

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