OCCUPATIONAL PROFILE 1

Occupational Profile
Client name: Lorna Hall
Age: 68
Sex: Female
Who is the client?
The client is a homemaker, wife, mother to five grown up children and
grandmother to 15 grandchildren.
Why is the client seeking services?
What are her concerns relative to engaging in occupations of her daily life
activities?
Four years ago the client injured her left knee while exercising on a modified
elliptical running machine. The motion required by the machine resembles the
movement made when doing cross country skiing rather than running. While
exercising the client heard her knee rip. She immediately felt sharp pain that was
later replaced by a dull ache that she described as similar to a toothache type of
pain. The client went to visit her usual General Practitioner who did an x-ray that
showed that the medial meniscus and ligament had been torn. The doctor then
referred her to an orthopedic surgeon who did an MRI on her knee that additionally
showed Osteoarthritis and bone spurs. The client had surgery that involved
trimming her medial meniscus and scrapping her arthritis spurs. After the procedure
client did Physical Therapy for 6 months that mostly included hot and cold packs,
electric stimulation and repetitive exercises that mainly worked her knee joint by
extending and flexing her knee. Upon discharge from treatment the Physical
Therapist recommended that client should continue with the exercises. However
client stated that she did not follow this advice.

OCCUPATIONAL PROFILE 2
The client reported that even after completing the treatment her knee was a
little bit tender but she could walk fine. She felt good for a year but then her knee
started hurting again. The client attributed this to the fact that she had stopped
exercising. In December 2012 she went back to the doctor who gave her cortisone
shots. The client also said that the doctor injected some liquid into her knee joint
and informed that the benefits from this treatment would last about a year and
advised her to continue exercising.
What areas of occupation are successful and what areas are causing
problems or risks?
Most of the clients Activities of Daily Living have been unaffected by this
injury as she is still able to take care of her basic needs of bathing, showering,
dressing and eating. However the client has some difficulty with functional mobility
because she lives in a two-story home that requires her to climb stairs up and down,
but she has developed some compensatory techniques when climbing stairs that
allow her to do this independently. However these compensatory techniques may
result in further impairment if used long term as they involve avoiding flexion of her
affected knee joint which is contrary to the medical advice she has been given. The
client also uses compensatory techniques when walking that involved hiking up her
hip on the opposite side of injury in addition to avoiding flexion of her affected knee
which has resulted in some moderate hip pain.
Client is able to perform most Instrumental Activities of Daily Living such as
taking care of her grandchildren, her home and mobility in the community but she
has stopped taking her dogs for walks as fear and anxiety about knee pain has
made her apprehensive to go for long walks. This activity is now done by her
husband. Shopping for groceries also presents problems as client usually buys her
groceries at Sams Club, a retail bulk store. Because food items come in large
quantities, food packages are vey heavy making it very hard for the client to push

OCCUPATIONAL PROFILE 3
the cart with her hurt knee by herself and then transfer the items into her car. As a
result, the client now needs the assistance of her husband to shop for groceries.
Leisure is another area of Occupation that has been somewhat affected. Due
to her knee injury the client now avoids going for walks, hiking and climbing hills.
What contexts and environments support or inhibit participation and
engagement in desired occupations?
The client stated that when the weather gets cold her knee hurts more which
often interferes with her enjoyment of her winter out of town vacations in her cabin.
The clients home is mostly carpeted which makes it easier for client to walk
around as she mentioned that walking on concrete surfaces results in greater knee
pain than walking on the homes carpet. However living in a two story home is a
disadvantage and client often has to use compensatory techniques in order to avoid
knee pain while climbing stairs.
With regards to foot wear, the client usually walks at home barefoot which
does not cause pain but she stated that she can not longer wear heels that are
higher than two inches.
The time of the day also has an impact on the level of pain as client reported
that she experiences knee pain when she first gets up in the morning. Client stated
that anytime she has to move after being sedentary for a while her knee hurts.
Client has to do a leg warm up every morning by moving her knee around, flexing it
and extending it gently until the pain lessens. Sometimes the client goes to her
back yard where she exercises for a few minutes on a stationary bike in order to
warm up her knee before she attempts to go out for a walk. At times client has to
take a pain killer such as Motrim to ease the pain. In the last month the client has
had to take pain medications four times.
What is the clients occupational history?

OCCUPATIONAL PROFILE 4
The client was stay at home mom to five children who are now grown up and
have left the home. Even though the clients children have grown up and she still
stays at home she keeps herself busy by helping to take care of her 15
grandchildren. The client also owns two Miniature Schnauzer dogs that she takes
care of.
The client is very crafty and enjoys quilting, sewing, shopping and doing
Genealogy. She often cooks for the whole family, especially during holidays.
Additionally, she is very active in organizing activities for her extended family, such
as large family reunions that occur annually at a campground in Utah. She often
goes out of town with her husband and extended family to their cabin where they
enjoy the snow in the winter time and the woods in the summer.
The client also engages in volunteer work at church and in the community.
She attends church weekly and helps with activities and she also volunteers as the
secretary to a historical organization which involves helping her husband (who is the
president) with activities and recruiting volunteers for the upkeep of pioneer trails in
the Las Vegas desert. This position mostly involves making phone calls and doing
some computer work. Occasionally the client drives to the trail sites with her
husband.
What are the clients priorities and desired outcomes?
The client stated that she would like to be able to walk two miles without
worrying about pain. The client mentioned that at the moment she has stopped
going for walks because on her last attempt two months ago, her knee started
hurting when she got to the corner of her neighborhood cul-de-sac. She stated that
she had gone for a walk with her husband who continued walking as she sat down
on the curve waiting for him to come back because she was too fearful that the pain
would get worse. Fear often prompts the client to avoid using her affected knee

OCCUPATIONAL PROFILE 5
when she begins to feel pain as she anticipates the pain will get worse if she
continues with the activity.
The client stated that one of the most important outcomes she would like to
see as a result of therapy would be to delay further impairment as worries about
having to have a knee replacement or having hip problems as a result of the way
she compensates when walking.
Occupational Analysis
Occupation: Area(s) of occupation for the client:

Subcategory:

1. Activities of daily living: I observed client engaging in functional mobility as she

went up and down stairs to monitor grandchildren playing computer games in
the clients home office (located upstairs)
2. Instrumental activities of daily living
3. Education
4. Work
5. Play
6. Leisure
7. Social participation
Values, beliefs, spirituality associated with participation:
Because client values independence and would rather take care of others
than being taken care of, successful independent ambulation is very important to
her. She stated that one of her biggest concerns is to end up having to have a knee
replacement or hurting her hip and not being able to walk well enough on her own.
Client gave examples of some friends and colleagues she knows that ended up
having to do these procedures and stated that she does not want to end up like
that.
Client also places a lot of value in the family and taking care of others,
especially her grandchildren and her two Miniature Schnauzer dogs. This involves
ambulation because she enjoys strolling down the malls and shopping for clothes for
her grandchildren, as the client often shows her love and appreciation by buying
gifts and beautiful outfits for her grandchildren. She sometimes enjoys taking the

OCCUPATIONAL PROFILE 6
grandchildren with her to choose outfits at the malls and shoe stores. Ambulation is
also needed to care of her pets by taking them for walks. The client mentioned that
she used to walk her female dog while her husband walked the male dog but now
her husband walks both of her dogs while she stays at home.
Additionally, the client is very religious and has a strong sense of spirituality
which contributes to her passion for doing Genealogy, a part of her Mormon
religious background. Client puts a lot of work into doing Genealogical research
which she completes in her home office located upstairs, which requires her to be
able to walk up and down the stairs independently.
Contexts:
Context
Physical/space
demands
Social
Cultural

Personal
Temporal

Virtual

Supports
X : Carpeted Home

Inhibits
X: there are two sets of
stairs in the home

X: Husband and family are

supportive
X: Client has a supportive
religious culture where
church members are involved
and close to each other.
X: Client has a positive
upbeat personality
X: Client is approaching
her 70s and further
decline may occur if not
prevented
X: Clients computer is
located upstairs
Objects and their properties used:

There are two sets of stairs in the home: one goes from the main floor
containing a kitchen and dining room and a reception area up to the second floor
containing the clients bedroom, an additional bedroom, a restroom and a home
office. The other set of stairs is composed of only four steps and it goes from the
main floor down to the living room, the laundry room, a bedroom, a sewing room

OCCUPATIONAL PROFILE 7
and a guest bathroom. If the client is on the main floor and needs to use the rest
room she has no choice but to use the stairs, either to go up to the second floor or
down to the guest bathroom. The homes floor is mostly carpeted and so are the
stairs to go up to the second floor. However the stairs going down to the living room
are tiled.
There are two very small dogs in the home that follow the client around and
might put the client at risk for tripping and falling. However the client enjoys the
animals companionship so at the time the animals are emotionally beneficial to the
client.
Social demands:
The client lives in her home with her retired husband but her children and
grandchildren visit often. Due to the clients social life that includes many small
children she must have a lot of stamina to participate in all the family activities that
often occur in her home. When grandchildren visit, client must often climb the stairs
in order to reprimand grandchildren who are using the computer without
permission.
Sequence and timing:
1. Stand in front of the stairs
2. Flex right arm toward the stair hand rail
3. Pronate forearm
4. Slightly bend wrist to the appropriate angle
5. Place right hand on hand-rail
6. Flex fingers around the hand- rail
7. Grip the rail
8. Bend right knee upward
9. Place the right foot on top of the first step
10.Bend left knee upward
11.Place left foot on top of the same step next to the right foot
12.Let go off the hand rail
13.Repeat this sequence again starting from step 2 until reaching the top of the
stairs
Body functions required:

OCCUPATIONAL PROFILE 8

FUNCTION

JUDGEMENT

How It Is Used

Needed to determine how

fast it is safe to go down
the stairs. Example:
running down the stairs
with the eyes closed or
jumping down 5 steps, or
going down stairs wearing
roller skates would
demonstrate poor
judgment, especially
given that the client has
suffered a knee injury.

CONCEPT FORMATION

METACOGNITION

COGNITIVE FLEXIBILITY

INISGITH/AWARENESS

None

Minimal
ly
Challen
ged

X
Needed to self reflect on
how I am performing this
activity and why I am
doing it in a particular
way.
Example: I asked the
client why she always
stepped with her affected
leg first when going down
whereas she always
stepped with her
unaffected leg first to go
up the stairs. Client
thought about it for a
moment and suddenly
realized that this allowed
her to avoid flexing her
affected leg and feeling
pain.
Needed to aid client in
accepting that she cannot
climb the stairs as easily
and quickly as she used
to before the injury.
Needed to judge whether
the injury is getting better
or worse by monitoring
pain when going up and
down the stairs. Deciding

Greatly
Challen
ged

OCCUPATIONAL PROFILE 9
whether the activity
should be avoided or
engaged in, deciding
whether it is safe to do
the activity independently
given the amount of pain.
Realizing whether pain
medication should be
taken.
X
SUSTAINED ATTENTION
SELECTIVE ATTENTION

DIVIDED ATTENTION

SHORT TERM MEMORY

WORKING MEMORY

Whereas climbing stairs

regularly may occur
almost automatically,
doing so with an injured
knee requires more
attention and precaution.
Paying attention to the
level, type and location of
pain while climbing the
stairs.
Paying attention to
climbing the stairs while
answering grandchildrens
questions.

DISCRIMINATORY SENSES:
VISUAL

X
Remembering the
procedure for climbing
stairs

LONG TERM MEMORY

DISCRIMINATORY SENSES:
AUDITORY
DISCRIMINATORY SENSES:
TACTILE

X
X
Needed to perceive the
feel of the stair rail on the
hand and the feel of the
carpet on the soles of
clients bare feet.
Needed to scan the floor
and stairs for objects that
one might trip on such as
toys left by grandchildren
or the dogs following the
client upstairs. Also used
to distinguish where one
stair step ends and the

OCCUPATIONAL PROFILE 10
next begins and to
perceive visually the
placement of the feet.
DISCRIMINATORY SENSES:
OLFACTORY
DISCRIMINATORY SENSES:
VESTIBULAR

MULTISENSORY PROCESSING

SENSORY MEMORY

SPATIAL RELATIONSHIPS

TEMPORAL RELATIONSHIPS

RECOGNITION

X
Needed to discriminate
placement of body and
limbs in space.
Needed to distinguish
sensations of pressure
from sensations of pain as
well as visual information
and integrate all that
information in a whole.
Needed to remember
what the sensation of the
carpet normally feels like
on bare feet.
Needed to determine how
wide, deep and high the
stair steps are and how
far one must flex the knee
to reach the height of the
next step.
Needed to determine how
fast or how slow the
activity should be
performed taking both
safety and time
constraints into
consideration.
Needed to recognize what
I am doing and where I
am as well as why I need
to go either upstairs or
downstairs.

CATEGORIZATION
GENERALIZATION

AWARENESS OF REALITY

X
Needed to generalize the
way I climb up and down
the stairs at home to the
way I do it somewhere
else as well as doing it
with or without shoes.
Needed to discern that I
am really climbing stairs
instead of thinking about

OCCUPATIONAL PROFILE 11
it or dreaming about it.
LOGICAL COHERENT
THOUGHT
APPROPRIATE THOUGHT
CONTENT

EXECUTION OF LEARNED
MOVEMENTS

COPING

BEHAVIORAL REGULATION

BODY IMAGE

SELF CONCEPT

X
X
In this case the client is
using compensatory
techniques to climb up
and down the stairs that
she learned from her
therapist in order to make
the activity safer and less
painful. This involves
bringing one foot to a
stair step and bringing
the next foot to the same
stair step instead of the
one higher up. This
technique reduces
straining and weight
pressure on the knee
joints.
Needed to cope with knee
pain
Needed to regulate
inappropriate or
unhealthy behaviors that
may occur as a response
to emotional frustration
and pain.
Client may think about
whether she needs to
loose weight in order to
relieve weight pressure on
her knees.
Now that client has an
impairment she may view
herself as less healthy
which may affect the way
she approaches this task
with regards to how
carefully she does the
activity. Client may no
longer perceive herself as
strong and healthy which
may result in performance

X
X

OCCUPATIONAL PROFILE 12

SELF ESTEEM

AROUSAL

CONSCIOUSNESS

ORIENTATION TO SELF

ORIENTATION TO PLACE

OREINTATION TO SELF

OREINTATION TO OTHERS

EMOTIONAL STABILITY
MOTIVATION

anxiety.
Self esteem may affect
also the way client
approaches this activity. If
client has a poor concept
of herself with regards to
how strong and capable
she sees herself she may
begin to avoid performing
this activity.
Client needs to be alert in
order to go up and down
the stairs. Pain
medications may affect
the clients level of
arousal.
Client needs to be
conscious to perform the
activity
Client needs to pay close
attention to her body and
the movements she
makes when she performs
this activity
Client needs to closely
pay attention to where
she is at and monitor the
floor for possible objects
that may increase the risk
of falling.
Client needs to pay
attention to her body
positioning when
performing this activity
and how well she is
balancing her body in
order to avoid falls.
Client needs to be aware
and careful with
grandchildren and dogs
running up and down the
stairs as she tries to do
the same.

X
Client needs to be
motivated to go upstairs

OCCUPATIONAL PROFILE 13

IMPULSE CONTROL

enough to withstand knee

pain.
Impulse control may be
needed when
experiencing sharp knee
pain.

APPETITE
SLEEP

FUNCTION

DETECTION/REGISTRATION
VISUAL MODULATION

INTEGRATION OF SENSES

AWARENESS AT DISTANCES

X
X

How It Is Used

Minimal
ly
Challen
ged

Greatly
Challen
ged

X
X

X
X
Needed to work against
gravity while climbing up
the stairs as well as being
able to resist the pull of
gravity when coming
down the stairs in order to
avoid descending too
quickly.

TASTE
SMELL
BODY IN SPACE

None

Used to detect the

outlines of the stair steps.
Used to regulate eye
muscles in order to look
at stairs that are close
versus stairs that are far
away.
Used to integrate
incoming information
from visual and tactile
sensations involved with
climbing the stairs.
Used for awareness of
how far away the floor
surface is, especially with
the varying heights of the
stair steps.

TOLERANCE OF AMBIENCE
SOUNDS
LOCATION AND DISTANCE OF
SOUNDS

MOVING AGAINST GRAVITY

X
X
Needed to be aware of
location of the body and

OCCUPATIONAL PROFILE 14

COMFORT WITH TOUCH

LOCALIZING PAIN

limbs in order to regulate

adequate positioning to
accomplish the task
effectively.
Being comfortable with
the feel of the carpeted
stair steps on the sole of
the feet as well as
tolerating pressure from
body weight on limbs and
joints, particularly the
painful injured left knee.
Being aware of the
location of pain on the left
knee in order to be
vigilant of whether the
pain is spreading to the
hip due to poor
compensation techniques.

THERMAL AWARENESS
JOINT RANGE OF MOTION

JOINT STABILITY/ALIGNMENT

STRENGTH

MUSCLE TONE

X
Needed to flex and extend
knee and hip joint when
climbing up and down the
stairs.
Being able to maintain
flexion or extension of the
knees as well as being
able to stabilize knees,
hip and trunk in order to
maintain balance and
perform successful
ambulation up and down
the stairs.
Being strong enough to
push off from lower stair
step and onto the higher
step as well as being able
to resist gravity when
coming down the stairs.
Having enough muscle
tone in order to allow for
contractions strong
enough to move the
skeletal system, joints
and maintain balance on
the lower limbs.

OCCUPATIONAL PROFILE 15

MUSCLE ENDURANCE

Having enough endurance

to keep going until either
the top or the bottom of
the stairs is reached.

STRETCH REFLEX
ATNR
STNR
RIGHTING AND SUPPORTING
REFLEX
EYE-HAND COORDINATION

BILATERAL COORDINATION

CROSSING MIDLINE
FINE MOTOR CONTROL

OCULOMOTOR CONTROL

GAIT PATTERNS

BLOOD PRESSURE

HEART RATE

RESPIRATORY RATE

X
X
X
May be needed if client
looses balance while
performing the activity
Being able to coordinate
visual information about
the stair hand rail and
positioning of the hand.
Being able to coordinate
the motion of the right
and the left lower limbs
while going up and down
the stairs

X
Needed to grasp the hand
rail
Needed to control eye
muscles while looking at
the environment.
Compensation techniques
used by the client to
avoid feeling pain on the
injured knee have
resulted in somewhat
abnormal gait patterns.
Needed to regulate the
pumping of the blood
throughout the body that
oxygenate the muscles
being used during the
activity
The heart must beat at an
appropriate rate to pump
enough blood throughout
the body to oxygenate the
muscles being used.
Must be increased in
order to provide enough
oxygen to perform this
physically strenuous
activity

X
X

OCCUPATIONAL PROFILE 16
RESPIRATORY RHYTHM

RESPIRATORY DEPTH

PHYSICAL
ENDURANCE/AEROBIC
CAPACITY

Rhythm must be stable

and regular
Depth must be adequate
in order to avoid either
hyperventilation or
insufficient oxygen to
perform the activity
Aerobic capacity and
physical endurance is
needed to complete this
strenuous activity

VOICE FUNCTIONS
VOICE RHYTHM AND FLUENCY
ALTERNATIVE VOCALIZATION
DIGESTIVE SYSTEM

METABOLIC SYSTEM

ENDOCRINE SYSTEM

URINARY FUNCTIONS

X
X

X
X
X
This function is not
directly used during this
activity but it is needed in
order to maintain optimal
body functioning and
health in order to
continue to function and
operate efficiently.
This function is not
directly used during this
activity but it is needed in
order to maintain optimal
body functioning and
health in order to
continue to function and
operate efficiently.
This function is not
directly used during this
activity but it is needed in
order to maintain optimal
body functioning and
health in order to
continue to function and
operate efficiently.
This function is not
directly used during this
activity but it is needed in
order to maintain optimal
body functioning and
health in order to
continue to function and
operate efficiently.

OCCUPATIONAL PROFILE 17
GENITAL AND REPRODUCTIVE
FUNCTIONS
PROTECTIVE FUNCTIONS OF
THE SKIN
REPAIR FUNCTIONS OF THE
SKIN

X
X
X

Muscular analysis of movements required:

Muscle
Shoulder flexion
Shoulder extension
Shoulder abduction
Shoulder adduction
Shoulder internal
rotation
Shoulder external
rotation
Elbow flexion
Elbow extension
Wrist supination
Wrist pronation
Wrist flexion
Wrist extension
Thumb flexion
Thumb abduction
Finger flexion
Finger extension
Trunk flexion
Trunk extension
Trunk rotation
Lower extremities

Required?
Yes
No
No
Yes
No
No
Yes
No
No
Yes
No
No
Yes
No
Yes
No
Yes: Slight for
balance
No
No
Yes

Body structures required:

Category

Body Structure

Nervous system

Frontal lobe
Temporal lobe
Parietal lobe
Occipital lobe
Midbrain
Diencephalon
Basal ganglia

Requir
ed?
Check
If Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

OCCUPATIONAL PROFILE 18

Eyes, ears, and

related
Structures

Voice and speech

structures

Cardiovascular
system

Immune system

Respiratory system
Respiratory system
(continued)
Digestive,
metabolic,
and endocrine
systems

Cerebellum
Brain stem
Cranial nerves
Spinal cord
Spinal nerves
Meninges
Sympathetic nervous system
Parasympathetic nervous system
Eyeball: Conjunctiva, cornea, iris, retina, lens,
vitreous body
Structures around eye: Lachrimal gland, eyelid,
eyebrow, external ocular muscles
Structure of external ear
Structure of middle ear: Tympanic membrane,
Eustachian canal, ossicles
Structures of inner ear: Cochlea, vestibular
labyrinth, semicircular canals, internal auditory
meatus
Structures of the nose: External nose, nasal
septum, nasal fossae
Structure of the mouth: Teeth, gums, hard
palate, soft palate, tongue, lips
Structure of pharynx: Nasal pharynx and oral
pharynx
Structure of larynx: Vocal folds
Heart: Atria, ventricles

Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes

Arteries
Veins
Capillaries
Lymphatic vessels
Lymphatic nodes
Thymus
Spleen
Bone marrow
Trachea
Lungs: Bronchial tree, alveoli
Thoracic cage
Muscles of respiration: Intercostal muscles,
diaphragm
Salivary glands

Yes
Yes
Yes
No
No
No
No
No
No
Yes
Yes

Esophagus

No

Stomach
Intestines: Small and large
Pancreas
Liver
Gall bladder and ducts

No
No
No
No
No

Yes
No
No
No

No
No
No
No
Yes

No

OCCUPATIONAL PROFILE 19

Genitourinary and
reproductive
systems

Structures related
to
Movement

Structures related
to
movement
(continued)

Endocrine glands: Pituitary, thyroid, parathyroid,

adrenal
Urinary system: Kidneys, ureters, bladder,
urethra
Structure of pelvic floor

No

Structure of reproductive system Ovaries,

uterus, breast and nipple, vagina and external
genitalia, testes, penis, prostate
Bones of cranium

No

Bones of face
Bones of neck region
Joints of head and neck
Bones of shoulder region
Joints of shoulder region
Muscles of shoulder region
Bones of upper arm
Ligaments and fascia of upper arm
Bones of forearm
Wrist joint
Muscles of forearm
Ligaments and fascia of forearm
Bones of hand
Joints of hand and fingers
Muscles of hand
Ligaments and fascia of hand
Bones of pelvis region
Joints of pelvic region
Muscles of pelvic region
Ligaments and fascia of pelvic region
Bones of thigh
Hip joint
Muscles of thigh
Ligaments and fascia of thigh
Bones of lower leg
Knee joint
Muscles of lower leg
Ligaments and fascia of lower leg
Bones of ankle and foot
Ankle, foot, and toe joints
Muscle of ankle and foot
Ligaments of fascia of ankle and foot
Cervical vertebral column

No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Lumbar vertebral column

Yes

Sacral vertebral column

Coccyx

Yes
Yes

No
No

No

OCCUPATIONAL PROFILE 20

Skin and related

structures

Muscles of trunk
Ligaments and fascia of trunk
Areas of skin: Head, neck, shoulder, upper
extremity, pelvic region, lower extremities,
trunk, and back
Structure of skin glands: Sweat and sebaceous
Structure of nails: Fingernails and toenails
Structure of hair

Yes
Yes
No

No
No
No

Performance skills required:

Skill

Require
d?
Yes

Motor/praxis

Yes
Sensory
(perceptual)

Emotion
regulation

Yes

Yes
Cognitive

Communication/s
ocial

Yes

How the Skill Is Used

The client must plan her movements and
sometimes use compensatory techniques that
include a modified gait in order to avoid too
much pain on her knee when walking up and
down the stairs. Some compensatory techniques
include moving one foot up to one step and then
placing the other foot on the same step right
next to the first foot instead of on the step
higher up. Client does this to avoid straining her
affected knee too much and using it as a support
to her healthy limb rather than as a lever to
propel herself up the stairs.
The client must be aware of her surroundings
and observe the flooring surface to avoid
tripping as well as paying attention to sensations
in her lower limbs by monitoring for pain in order
to safely climb up and down the stairs.
The client must regulate emotional reactions to
pain as well as to her slower performance and
modified gait patterns.
The client must be cognitively aware and
capable to make decisions with regards to
whether it is safe to engage in climbing stairs
given her level of pain at that moment, or decide
to take pain medication if the pain is too great.
Client must also have good cognitive skills to
allow for good judgment and avoid doing the
activity too quickly or recklessly.
The client must be able to communicate
effectively in the event that she needs to ask for
assistance if something went wrong while
performing this task.

OCCUPATIONAL PROFILE 21

Performance patterns:
Parts of this occupation has elements of which of the following: (check all
that apply)

Pattern
Useful habit

Describe
The client does a leg warm up before engaging in activities
that might be painful to her knee.

Dominating
habit

The client has adopted some compensatory techniques that

have now become habits and may be detrimental to the
integrity of her knee joint in the long run.
These Dominating habits include:
-When going down the stairs client puts forward her affected
leg first and follows with her non involved leg. This is due to
the fact that the leg that goes first can remain in knee
extension while the leg that stays behind when going
downstairs has to have knee flexion which is painful for the
client.
-When going upstairs client puts forward her non involved leg
first and her affected leg follows. This is due to the fact that
the leg that goes first when going upstairs must have knee
flexion which is painful for client whereas the leg that follows
can remain somewhat extended.
This abnormal gait pattern to climb up and down stairs allows
the client to avoid flexing her affected knee that remains
mostly extended and stiff. The client continues to avoid
flexing the affected joint which results in non-use of that joint
and could eventually lead to the joint becoming harder to
bend over time.

Routine

The clients morning routine often includes using her

stationary bike in order to warm up her knee after remaining
inactive throughout the night.
The client likes to get ready to go out by doing her hair and
make up in her vanity located in her master bedroom.
Because her bedroom is located upstairs this ritual requires
for her to climb up and down the stairs.
The client is a grandmother and this role sometimes involves
climbing up the stairs to check on grandchildren who often
sneak in her home office located upstairs to use her
computer to play video games without permission from their
parents and client.

Ritual

Role

OCCUPATIONAL PROFILE 22
Intervention Plan
Identify 1 objective and measurable goal of the intervention: According
to OTPF what type of outcome is this?
The client stated that she would like to be able to go for walks without having
to stop prematurely because it hurts too much. She stated that her goal is to be
able to go for a two mile walk regularly. According to the OTPF this is a Health goal
because it involves physical capacities.
Intervention approach:

Approach
Create/promote

Establish/restore

Maintain

Modify

Prevent

Describe
Taking a swimming class would promote health by keeping
the client engaged in physical activity. Even if the swimming
stroke does not require knee flexion such as the front crawl
technique, participating in swimming could strengthen leg
muscles as well as helping the client be more physically fit
and perhaps loose some weight which might contribute to
overall health.
Focusing on a swimming stroke that uses knee flexion such
as the breast stroke or even just walking under water could
help client use her knee joint again while minimizing the
impact of gravity and weight on her affected knee. Even
though client is not able to walk two miles on concrete she
might be able to walk two miles under water and over time
strengthen her joint and build enough endurance to walk
longer distances on concrete surfaces as well.
Doing warm up exercises each morning and making sure to
stretch and flex her knee before getting back up after periods
of inactivity will help maintain the clients ability to flex her
knee joint.
The client could move her home office downstairs so she
doesnt have to walk upstairs so often during the day.
Alternatively client could move to a single story home if her
circumstances allow her to do so.
The client could do some exercises to strengthen her hip joint
as well. The client mentioned that in the past, her modified
gait begun to affect her hip joint and she begun to
experience hip pain as well. The client wants to avoid
developing a hip problem so perhaps doing some exercises
that strengthen the hip joint could help prevent further
dysfunction.

OCCUPATIONAL PROFILE 23
Activity selection: Identify 1 example of each for the intervention plan
Activity
Occupationbased
intervention

Purposeful
activity

Preparatory
method

Describe
The client is a pet owner and likes to walk her dogs but she
has stated that she can only walk to the corner of her cul-desac, so she has given up her walks with the dogs altogether.
However going for a short walk is better than not going at all
so perhaps she could walk her dogs to the corner of the culde-sac every day and she can gradually build up to a longer
walk.
The client enjoys shopping for clothes for her grandchildren
at the mall so she could go for walks at the mall to exercise
her knee while she shops. The client mentioned that going to
the mall and looking at the boutiques distracts her from the
pain and she is often able to walk for longer distances
because she is enjoying herself.
Because the client is concerned about doing too much and
causing pain she could start by taking a walk at the
Recreation Center indoor pool. The client mentioned that she
has friends at church that have injured their knees and hips
who attend aerobic classes in the pool at this center and she
would enjoy participating with her friends as a way to
socialize and exercise her knee by minimizing weight under
water.
The warm up exercises that she does on her stationary bike
should also be continued.

Discuss how activity selection relates back to occupational profile

and occupational analysis
The activities selected above relate to roles that are important to client.
Taking her dogs for a walk fulfills her role of pet owner as well as taking care of
others. Going for walks at the mall to look for bargain outfits for her grandchildren
helps her fulfill her role as a grandmother. Taking acquatic exercise classes with her
church acquaintances allows her to socialize with other people who share her
spiritual beliefs and way of life.
Discuss how activity selection will support achievement of client
identified goals and goal of the intervention plan

OCCUPATIONAL PROFILE 24
Taking her dogs for short walks, even if she only walks to the corner of her
neighborhood cul-de-sac, will allow the client to gradually build endurance and
slowly increase the distance of her walks. Going for walks in the mall might help
distract the client from the pain and the fear that prevents her from walking longer
distances. Another suggestion is to use an exercise watch that measures the
distance she walks while in the mall because the client might not realize how far
she is able to walk when she is distracted. If she can see that she is capable of
walking longer distances when distracted she might become confident enough not
to fear the pain as much when trying to go for walks around her neighborhood.
Doing aquatic exercises that encourage knee flexion will allow the client to use her
joint with minimal weight bearing and doing it with a group of friends who already
attend the class might provide greater motivation than performing rote exercises at
home by herself. The client mentioned during the interview that she never did the
exercises that her physical therapist recommended once she was discharged and it
was up to her to regularly exercise her knee joint at home.
Describe how intervention can be graded or adapted and why
The dog walks can be easily graded by starting with shorter walks and
building up to longer walks. The client can also walk under water to grade down
weight bearing, then move up to waking on concrete once she is stronger and
eventually she could walk up hill and go on more demanding hikes when she is
strong enough. These activities will make climbing stairs in her home easier and
less painful as the client becomes stronger.
Grading the activity down at the beginning will allow the client to build
endurance as well as become more confident as she improves. Additionally, doing
exercises under water and minimizing weight and gravity might reduce pain
discomfort afterwards. This will ease the clients fears and anxiety about being

OCCUPATIONAL PROFILE 25
physically active due to the pain and discomfort that follows strenuous activity.
Slowly grading the activity up as the client improves will allow her to progress at a
steady pace with minimal risk of aggravating her injury by doing too much too soon.
Safety concerns and/or precautions
Because walking her small dogs can increase the risk of falls as small moving
animals can be a tripping hazard, the client should be accompanied by her husband
or a friend when she participates on this activity. Additionally, the client should be
accompanied by someone when she goes to the mall in case her knee begins to
hurt too much to allow her to return to her car and drive home. The client may
want to use a shopping cart or device to carry her purchases in order to avoid
carrying too much weight while shopping. When participating in aquatic activities
the client may want to wear special aquatic shoes to avoid slipping on wet floors.
Discuss the role of the occupational therapy practitioner during the
intervention
The role of the occupational therapist is to encourage the client and help her
increase motivation being that client has mentioned that she often gives up and
becomes sedentary. The therapist is also important in helping educate the client
and remind her about the importance of engaging in activity and the risks and
consequence of long term non use of her knee joint. At the same time the therapist
can provide reassurance and emotional support to ease the clients fear of pain.
Additionally, the therapist can help determine the just right challenge by
objectively assessing the clients performance by helping her keep track of her
progress with regards to how much she has gradually increased her walking
distance and/or endurance. This continual assessment will be helpful in determining
when it is time to increase the level of challenge as client improves.
Discuss what is expected of the client during the intervention

OCCUPATIONAL PROFILE 26
The client is expected to put the effort necessary to implement the activities
that are part of the treatment plan. The client is also expected to openly
communicate with the therapist by letting her know if she has been experiencing
too much pain or if she feels she is getting worse. The client should also feel
comfortable enough to openly discuss any emotional issues that may be negatively
affecting her performance such as feeling discouraged, depressed, hopeless or
lacking motivation to continue engaging in the activities selected as part of the
treatment plan. This will keep the therapist well informed so she can reassess the
client and perhaps make changes to the treatment plan if the activities are not
helping. The therapist will also be able to refer the client to an additional specialist
such as a mental health counselor if the impairment begins to affecting mental
health and level of engagement in occupational therapy.