OCCT 506: Clinical Reasoning about Occupation Form #5 Student: William Unger Date: 10/16/12 Activity: Cooking dinner

as a quadruple amputee (Based off observations from http://youtu.be/ArN4UawfRLQ)

Client-Activity Intervention Plan Directions: This assignment is to be completed individually. Choose someone that has a disability and observe them performing an occupational activity. Complete the following sections based on your observations. Clients Occupational Profile Craig is a 35 year old retired truck driver who lost all of his limbs to amputation as a result of injuries sustained in a car accident. His upper limbs were amputated just below the surgical necks of the humeri, and his lower limbs halfway down the shafts of the femora. For the past year and a half, Craigs recovery has been carefully monitored by his doctors at Saint Rose hospital. Craig underwent treatment for phantom limb pain using a combination of pharmaceutical pain management and mirror box therapy. Craig was fitted for upper and lower limb prosthetics. While he has experienced functional gains through their use, he reports that they are uncomfortable to wear for extended periods of time, and that he prefers to keep them off when at home. Craig began using an electronic wheel chair 6 months after his accident, controlling its joystick either through the use of prosthetics, or with his remaining upper limb. At his most recent doctors visit 2 weeks ago, Craig and his primary orthopedic physician determined he had reached a level of physiological recovery and absence of pain for it to be safe to regularly engage in household activities again. For the past year and a half, Craigs wife, Cynthia, has attended to all chores and tasks in their house. At his most recent doctors visit, Craig expressed a desire to begin contributing around the house again. Before
(Modified from Hersch, Lamport, & Coffey, 2005)

Client Information

OCCT 506: Clinical Reasoning about Occupation Form #5 his accident, Craig frequently enjoyed cooking meals for himself and his wife. Craigs doctor provided a referral for a home based occupational therapist to address his strong desire to return to this occupation. Strengths Positive attitude with regards to his physiological limitations, motivated to find new ways to adapt. Supportive spouse who understands his desire to return to independence. Strong trunk and neck strength. Home environment is a single story house with no stairs; surfaces in bedroom, bathroom, and kitchen are conducive for access by an individual in a wheelchair. After working with occupational therapists in an outpatient rehabilitation clinic, Craig is now independent with many ADLs, including bathing and some dressing. Weaknesses Inherent physiological limitations as a result of quadruple amputation. Currently unable to engage in many of his favorite occupations, such as cooking, playing video games, and swimming. Occasionally experiences recurring bouts of phantom limb pain, though symptoms have greatly reduced over the past year. Limited tolerance to wearing upper body prosthetics; complains of discomfort. Unable to return to work as a commercial truck driver, currently retired with disability benefits. Dr. Frances Walsh Orthopedic Physician Oasis Orthopedic Center, Saint Rose Hospital 702-555-5950

Referral Information

(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5

Describe the goal of the activity and why the client is completing it Activity Description

Long-Term Goal

Short Term Goal Intervention Goals

Practitioners role

Activity Preparation

Dr. Walsh oversaw Craigs recovery postamputation, and referred him to a home based occupational therapist once his rehabilitation and pain management had reached a level where it would be safe to engage in regular activities around the home. The goal of the activity is for the client to complete the process of cooking two servings of penne pasta without the use of upper or lower body prosthetics. The client is completing this activity because of his strong desire to return to participation in cooking tasks, as it was an occupation which he very much enjoyed prior to his accident. He is engaging in the activity without the use of upper or lower body prosthetics due to his desire to not wear them around the home. Within 8 weeks, Craig will be able to complete both the preparatory tasks of cooking (getting pots, cooking utensils, and dishes out and ready) as well as independently completing the full sequence of cooking and serving penne pasta with marinara sauce for himself and his wife in 45 minute interval. Within 2 weeks, Craig will be able to safely manipulate a medium sized saucepan (~2 quart capacity) with an extra-long handle by holding its handle between his shoulder and head, activate burners on stove, stir pasta as it cooks in boiling water using plastic or wooden pasta server held in mouth, turn off burners on stove, and serve pasta from pot into serving bowl using plastic or wooden pasta server held in mouth within a 30 minute interval. The role of the practitioner in the preparation of the activity will be to select and place the required equipment and materials for cooking penne pasta out on an easily accessible surface in Craigs home kitchen. Prior to first attempting the activity, the practitioner should assist Craig and his wife in choosing new saucepans and cooking

(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 utensils if those they already own are not conducive to the type of manipulation Craig will engage in (saucepans and utensils with extra-long, heat resistant handles). Initially, the preparation will be completed either by the practitioner or Craigs wife. The long term goal, however, is for Craig to be able to prepare all equipment and materials himself. When Craig eventually takes over the preparatory activity, he will implement special strategies for manipulating objects, including: grabbing and moving saucepan by grasping handle between the side of head and shoulder, opening drawers by biting onto thick cord tied to the handles and pulling back with neck, flexing at the trunk to bring head towards drawer to pick up and move pasta server by grasping it between the teeth, closing drawer by pushing with trunk or side of head, sliding serving bowl close to stovetop using side of head or shoulder. The majority of preparatory tasks could eventually be completed by Craig independently. Without the use of prosthetics, however, applying the force to turn the sink on and off will still likely require assistance from a second party. This potential issue could be addressed by implementing some kind of modification to the sink to be easily turned on and off. Additionally, while pouring the pasta out of its container and into the saucepan is possible using a grip between the head and shoulder, it is significantly more challenging than the other steps, and would likely be the last preparatory step Craig would learn to do independently. 1. Take out one medium sized saucepan with an extra-long handle from a storage space on edge of kitchen counter and move to surface near sink (20 seconds).

Personnel required to complete the preparation

Required preparation steps and time for each step

(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 2. Put saucepan in sink and turn on faucet. Fill saucepan of the way with water then turn the faucet off. Move saucepan on top of a burner on the stove (2 minutes). 3. Take out one pasta server from a low level kitchen drawer and place it on kitchen counter (20 seconds). 4. Close drawer (10 seconds). 5. Slide serving bowl from storage spot on kitchen counter close to countertop near saucepan on burner (10 seconds). 6. Pour out 2 servings of uncooked penne pasta from plastic container near cooking space into the saucepan on burner. (15 seconds) This activity must be prepared in the kitchen on a clean countertop, preferably as close as possible to the stove area to facilitate quick transfers between stovetop and countertop. The counter should be as free from clutter as possible, and the kitchen environment conducive for free movement in a wheelchair (floors cleared of obstacles, adequate space for passage). At least two servings of uncooked penne pasta. Enough water to fill up of the saucepan. One medium sized saucepan with long, heat resistant handle (2 quart capacity) One wooden or plastic pasta server with long, heat resistant handle. Stove (preferably electric) with burner switches located on the front surface, in line with countertop edge. One plastic container with a hinge lid for holding uncooked penne pasta. One serving bowl (2 quart capacity). Prior to preparation, care must be taken that all equipment is stored in drawers or areas without sharp edges or objects. When Craig eventually engages in the preparation himself, he will likely not be using any prosthetic attachments on his arm, and will

Required place and space

Required materials

Required equipment

Safety precautions

(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 therefore be reaching to grab many items with his mouth or between his shoulder and head. The presence of any sharp corners or objects in the storage spaces could potentially expose Craig to injury. As much as possible, the activity will be completed by the Craig. The practitioner will remain close by to provide verbal guidance or physical support if necessary. As with the sink in the preparatory activity, turning the burner of the stove on and off may be difficult for Craig to complete independently without the use of prosthetics. As a result, this step may require assistance from a secondary party, or installation of special modifications to the stove controls. The practitioner will also ensure the safety of the client by remaining vigilant of any safety hazards that might arise while the client is still mastering the task. Cleanup of the heated saucepan filled with water should initially be done either by the practitioner or Craigs wife. If after becoming more proficient with moving the unheated saucepan Craig wishes to perform the cleanup activity himself, he should wait for the pot and water to completely cool before attempting to move it with his head and shoulder. If Craig attempts to practice the activity outside of therapy time, his wife Cynthia can take over the supervisory role as needed. The setting will be in the same general area of Craigs kitchen where the preparatory activity was conducted: on a clean kitchen surface with materials and equipment easily reachable by Craig, and on a nearby stovetop. The space required will be similar to that required for the preparatory activity: the environment must be free from obstacles which would obstruct movement in an

Personnel required

Activity Implementation

Setting and location

Space required

(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 electric wheelchair, and the kitchen counter surfaces should be as clear as possible to aid in ease of object manipulation. As a result of the preparatory activity, the pasta and water will be contained within the saucepan on the inactive burner. One medium sized saucepan with long, heat resistant handle (2 quart capacity) placed on burner of stove. One pasta server with long, heat resistant handle to manipulate pasta. Stove (preferably electric) with burner switches located on the front surface, in line with countertop edge. One serving bowl (2 quart capacity) to spoon cooked pasta into. 1. Turn on stove burner to high heat to begin heating water. If the controls for the burners are on the edge of the stove, Craig could potentially push in on it with the remaining portion of his arm in an internally rotated position. He could then continue to apply pressure forwards as he rotates externally, thereby turning the heat up to a desired level. If the controls are not reachable, however, Craig will likely require assistance with this step. Wait for the water to reach a boil (approximately 12 minutes). Areas of Occupation: This step would primarily be considered an instrumental activity of daily living, as it is a step of a cooking activity. Since Craig likes to cook as a hobby, however, it could also be considered a kind of leisure activity. Client Factors: Beliefs This step of the activity demonstrates the belief that there is an inherent positive and rewarding quality of cooking ones own food, as well as cooking for others. Body structures This step requires the use of the remaining

Required materials

Required equipment

Required steps and time for each step

(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 portion of Craigs upper extremity and its related muscles, a functioning nervous system, and at least one functioning eye. Body functions Mental functions: This step requires sustained attention to the task at hand, memory of the sequence of steps, and perception of physical sensations as the step is executed. Sensory functions and pain: This step requires sensory integration of sensations of sight and touch to interact with objects. It also requires proprioceptive and vestibular functions to properly move through space. Finally, it requires awareness of touch, pain, and thermal conditions to avoid any injury from the hot surfaces. Neuromusculoskeletal and movement related functions: This step requires range of motion and stability of the glenohumeral joint, and enough muscle strength to apply pressure and turn the stove control. Performance Skills: Motor and praxis skills: Craig must be able to coordinate and grade movements of the upper body to manipulate the stove controls. Sensory-perceptual skills: Craig must visually determine where the dial of the stove control has turned to. Cognitive skills: Craig must be able to judge the amount to turn the stove control. Performance Patterns: Roles: By participating in this activity, Craig is taking on the role of a caretaker for the family by providing for cooking needs. Context and environment: Cultural: The belief that independence is an important part of being a productive member of society. Personal: 35 year old retired truck driver who likes to cook. Temporal: A person 1.5 years into their recovery after a serious accident. Physical: Working in the kitchen of his home. Social: The activity was performed to take
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 on roles in the house so that his wife doesnt have to be the only one contributing. Activity Demands: Objects and their properties: Manipulating a round stove control. Space demands: Requires adequate space to move around in wheelchair. Sequencing and timing: Craig must apply pressure to the button prior to turning it, otherwise it will not move. 2. Carefully manipulate control for burner on stove to lower heat enough to keep the water at a low boil. Pick up the pasta server off edge of counter by biting the handle end of it so that the handle is perpendicular to the body. With pasta server in mouth, carefully bend forward at the waist to bring the utensil into the water and stir the pasta as it cooks. Do this once every 2 minutes for the duration of cooking time. If desired, the pasta server can be placed back on the countertop in between stirring (15 minutes) Areas of Occupation: This step would primarily be considered an instrumental activity of daily living, as it is a step of a cooking activity. Since Craig likes to cook as a hobby, however, it could also be considered a kind of leisure activity. Client Factors: Beliefs This step of the activity demonstrates the belief that there is an inherent positive and rewarding quality of cooking ones own food, as well as cooking for others. Body structures This step requires the use of the remaining portion of Craigs upper extremity and its related muscles, the muscles and structures of the jaw and mouth to manipulate and hold the pasta server, a functioning nervous system, and at least one functioning eye.
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 Body functions Mental functions: This step requires sustained attention to the task at hand, memory of the sequence of steps, and perception of physical sensations as the step is executed. It also requires awareness of the passage of time in order to avoid overcooking the pasta and to intermittently stir. Sensory functions and pain: This step requires sensory integration of sensations of sight and touch to interact with objects. It also requires proprioceptive and vestibular functions to properly move through space. Finally, it requires awareness of touch, pain, and thermal conditions to avoid any injury from the hot surfaces. Neuromusculoskeletal and movement related functions: This step requires range of motion and stability of the glenohumeral joint, mouth, tongue, and jaw, with enough muscle strength to apply pressure and turn the stove control, hold the pasta server between teeth, and manipulate pasta server with tongue if adjustment is needed. Performance Skills: Motor and praxis skills: Craig must be able to coordinate and grade movements of the upper body and head to manipulate the stove controls and stir with the pasta server. Sensory-perceptual skills: Craig must visually determine where the dial of the stove control has turned to and visually attend to the movement of the pasta server in the hot water. Cognitive skills: Craig must be able to judge the amount to turn the stove control and how frequently to stir the pasta. Performance Patterns: Roles: By participating in this activity, Craig is taking on the role of a caretaker for the family by providing for cooking needs. Context and environment: Cultural: The belief that independence is an important part of being a productive member of society.
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 Personal: 35 year old retired truck driver who likes to cook. Temporal: A person 1.5 years into their recovery after a serious accident. Physical: Working in the kitchen of his home. Social: The activity was performed to take on roles in the house so that his wife doesnt have to be the only one contributing. Activity Demands: Objects and their properties: Manipulating a round stove control and long cylindrical pasta server. Space demands: Requires adequate space to move around in wheelchair. Sequencing and timing: Craig must apply pressure to the button prior to turning it, otherwise it will not move. Craig must also stir every few minutes to keep the pasta rotating in the hot water. 3. Carefully manipulate control for burner on stove to turn the heat off once the pasta is fully cooked. Making sure the concave surface of the pasta server is facing up (it can be rotated in the mouth by rolling with the tongue and teeth), carefully scoop some of the cooked pasta into the server by dipping down and up with the head and neck. Allow excess water to drain over the pot for a few moments before turning trunk to bring the pasta server over the serving bowl. Tilt the head to the side to dump pasta from server into bowl, and repeat for the remaining pasta (5 minutes). Areas of Occupation: This step would primarily be considered an instrumental activity of daily living, as it is a step of a cooking activity. Since Craig likes to cook as a hobby, however, it could also be considered a kind of leisure activity. Client Factors:
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 Beliefs This step of the activity demonstrates the belief that there is an inherent positive and rewarding quality of cooking ones own food, as well as cooking for others. Body structures This step requires the use of the remaining portion of Craigs upper extremity and its related muscles, the muscles and structures of the jaw and mouth to manipulate and hold the pasta server, a functioning nervous system, and at least one functioning eye. Body functions Mental functions: This step requires sustained attention to the task at hand, memory of the sequence of steps, and perception of physical sensations as the step is executed. It also requires awareness of the passage of time in order to know when that enough time has passed for excess water to drain from the pasta. Sensory functions and pain: This step requires sensory integration of sensations of sight and touch to interact with objects. It also requires proprioceptive and vestibular functions to properly move through space. Finally, it requires awareness of touch, pain, and thermal conditions to avoid any injury from the hot surfaces. Neuromusculoskeletal and movement related functions: This step requires range of motion and stability of the glenohumeral joint, mouth, tongue, and jaw, and neck with enough muscle strength to apply pressure and turn the stove control, hold the pasta server between teeth, turn the neck to the side to dump pasta, and manipulate pasta server with tongue if adjustment is needed. Performance Skills: Motor and praxis skills: Craig must be able to coordinate and grade movements of the upper body and head to manipulate the stove controls and scoop and dump with the pasta server. Sensory-perceptual skills: Craig must visually determine where the dial of the
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 stove control has turned to and visually attend to the movement of the pasta server in the hot water. He must also be able to determine when the pasta server is sufficiently placed over the serving bowl to know when it is safe to tilt his head to dump. Cognitive skills: Craig must be able to judge the amount to turn the stove control, determine whether or not he is successfully scooping pasta, judging the appropriate time to dump the pasta, and determining when he no longer needs to scoop pasta from the saucepan into the serving bowl. Performance Patterns: Roles: By participating in this activity, Craig is taking on the role of a caretaker for the family by providing for cooking needs. Context and environment: Cultural: The belief that independence is an important part of being a productive member of society. Personal: 35 year old retired truck driver who likes to cook. Temporal: A person 1.5 years into their recovery after a serious accident. Physical: Working in the kitchen of his home. Social: The activity was performed to take on roles in the house so that his wife doesnt have to be the only one contributing. Activity Demands: Objects and their properties: Manipulating a round stove control and long cylindrical pasta server. Space demands: Requires adequate space to move around in wheelchair. Sequencing and timing: Craig must apply pressure to the button prior to turning it, otherwise it will not move. Craig must also scoop the pasta prior to dumping it in the bowl. 4. At this point, the practitioner or Craigs wife are free to dump out the hot water in the sink and leave it in the basin to be cleaned. If Craig
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 wishes to move the pot from the stove to the sink to dump the water out on his own, he should wait for the pot and water to completely cool off before attempting (10 seconds if done by practitioner or 2nd party, ~30-40 minutes of cooling time if attempted by Craig to ensure safety) Areas of Occupation: This step would primarily be considered an instrumental activity of daily living, as it is a step of a cooking activity. Since Craig likes to cook as a hobby, however, it could also be considered a kind of leisure activity. Client Factors: Beliefs This step of the activity demonstrates the belief that there is an inherent positive and rewarding quality of cooking ones own food, as well as cooking for others. Furthermore, this step demonstrates the belief for personal responsibility in cleaning up the materials of an activity one engaged in. Body structures This step requires the side of Craigs head, the surface of his shoulder, a functioning nervous system, and at least one functioning eye. Body functions Mental functions: This step requires sustained attention to the task at hand, memory of the sequence of steps, and perception of physical sensations as the step is executed. It also requires awareness of the passage of time in order to avoid picking up the pot when it or the water inside is still hot. Sensory functions and pain: This step requires sensory integration of sensations of sight and touch to interact with objects. It also requires proprioceptive and vestibular functions to properly move through space. Finally, it requires awareness of touch, pain, and thermal conditions to avoid any injury from the hot surfaces.
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 Neuromusculoskeletal and movement related functions: This step requires range of motion and stability of the glenohumeral joint, head, and neck to grasp the handle of the saucepan. Furthermore, it requires the ability to manipulate the joystick control of his electric wheelchair to move himself to the sink, most likely with a portion of the trunk. Performance Skills: Motor and praxis skills: Craig must be able to coordinate and grade movements of the upper body and head to manipulate and move the saucepan from the stove top to the sink. Sensory-perceptual skills: Craig must visually determine where to place the handle of the saucepan on his shoulder before pressing the side of his head against its superior surface. Cognitive skills: Craig must be able to judge when it is safe to attempt to move the pot. Performance Patterns: Roles: By participating in this activity, Craig is taking on the role of a caretaker for the family by providing for cooking needs. Context and environment: Cultural: The belief that independence is an important part of being a productive member of society. Personal: 35 year old retired truck driver who likes to cook. Temporal: A person 1.5 years into their recovery after a serious accident. Physical: Working in the kitchen of his home. Social: The activity was performed to take on roles in the house so that his wife doesnt have to be the only one contributing. Activity Demands: Objects and their properties: Manipulating a long cylindrical handle of a sauce pan and the thin joystick of an electric wheelchair. Space demands: Requires adequate space to move the wheelchair from the area of the stove to the sink.
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 Sequencing and timing: Craig must allow adequate time to pass before attempting to move the saucepan, must position the handle properly on the shoulder prior to pressing on its superior surface with his head, and dump out the water in the sink before setting the pot down.

Safety precautions

Domain

The primary safety precaution for this activity is preventing any burns as a result of coming into contact with hot surfaces of the stove, the heated saucepan, or the boiling water in the saucepan. Every precaution should be made to ensure Craig does not come into direct contact with any of these hot surfaces. These precautions apply for the practitioner or Craigs wife as well, but would be much easier to avoid. Describe how the activity Areas of Occupation: overall fits into the This activity was an instrumental activity of domain(s) of occupational daily living, as it was engagement in therapy in detail. cooking. It could also have been considered Consider: a leisure activity, as Craig reported that prior to his accident, he enjoyed cooking for fun. Areas of Occupation Client Factors: Client Factors Beliefs This activity supported the belief of Performance Skills Performance Patterns an inherently rewarding quality in cooking ones own meal. Context & Body structures This activity required the Environment use of the head, neck, mouth, jaw, Activity Demands glenohumeral joint, and torso. It also required at least one functioning eye, and a functioning nervous system. Body Functions Mental functions: This activity involved attention, perception, judgment, and memory across a variety of sequenced steps of cooking. Craig had to remain conscious and aware throughout its duration. Sensory functions and pain: This activity combined the senses of sight, touch, proprioception and balance, and the ability to detect pain or heat. These sensations guided Craig through the activity, and served as

(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 queues of what to do next. Neuromusculoskeletal and movement-related structures: This activity required many muscles and joints of the upper body, head, and neck. These muscles and joints were used to manipulate utensils of cooking without the use of a full upper extremity. Performance Skills: Motor and praxis skills: This activity required Craig to move in a variety of ways that, prior to his accident, would have seemed somewhat unconventional in the realm of cooking. Sensory perceptual skills: Craig used his sensory perceptual skills to interact with his environment throughout the course of the activity. Senses of sight, touch, proprioception, vestibular, and pain all provided queues for the details of the environment. Cognitive skills: Craig implemented various cognitive skills throughout the activity, such as judging the appropriate time to check on the pasta, determining when to move to the next step, and engaging in safety precautions to avoid injury. Performance Patterns: Roles Throughout this activity, Craig took on the role of a caretaker for himself and his wife by serving as the cook and providing a meal. Context and environment: Cultural: The belief that independence is an important part of being a productive member of society. Personal: 35 year old retired truck driver who likes to cook. Temporal: A person 1.5 years into their recovery after a serious accident. Physical: Working in the kitchen of his home. Social: The activity was performed to take on roles in the house so that his wife doesnt have to be the only one contributing. Activity Demands: Objects and their properties: Craig
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 interacted with a variety of objects throughout the course of the activity. Manipulation of these objects required an adapted approach compared with how he would have acted upon them before his accident. For example, because he no longer could grip the pasta server with his hands, he had to adapt to using his mouth. While objects properties remained unchanged, their impact on the activity differs significantly from Craigs pre-accident perspective. Space demands: The activity required a clear and open cooking space through which Craig could easily move around in his electric wheelchair. Sequencing and timing: Craig had to follow sequencing within individual steps as well as across the activity as a whole. Timing played an important role in the cooking of the pasta, as over or under cooking would result in a less desirable outcome. The occupational profile was utilized to determine what kind of activity Craig would find motivating and enjoyable, in this case cooking. The activity preparation was utilized to establish a starting point for the activity implementation that would provide Craig with an immediate opportunity for success, thereby motivating him to work at the more challenging aspects of the activity in the future. By having tasks already prepared which might prove overly challenging and frustrating at first to Craig (such as manipulating the head of the faucet and filling the pot with water), he had the opportunity during the activity implementation to engage in a meaningful activity well within his level of functioning. Overall, the activity worked to achieve his initial goal of returning to activities around the house by providing him an outlet for participating in a daily household task. C. was enthusiastic about being able to

Discuss how you have utilized the occupational profile, activity preparation, and activity implementation to achieve occupational therapy outcomes.

Process

SOAP Note

Subjective

(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation Form #5 engage in household activities again, particularly in one he really missed. C. looked forward to increasing the demands of the activity in future therapy sessions. C. engaged in a penne pasta cooking activity for roughly 35 minutes. During this activity, he required 6 instances of direct physical assistance when handling the pasta server in his mouth. C. was able to turn on the control knob for the stove burner successfully after 8 attempts, and at the end of the cooking activity turned it off successfully after 5 attempts. C. scooped and strained pasta from the saucepan using the pasta server held in his mouth 4 times total, successfully dumping the pasta into the serving bowl 3 times, and prematurely dumping the pasta onto the countertop 1 time. Pasta cooked was the equivalent of one serving. C. was patient and motivated throughout the session, and seemed eager to continue to practice over the coming week. His manipulation of the pasta server provided him with the greatest difficulty during the task, but physical assistance was required less frequently towards the end of the activity, suggesting some mastery was being acquired over time. C. demonstrated increased competency manipulating the control nob for the stove over the course of the session. With continued practice and OT intervention, C. is very likely to be able to independently complete all activities practiced during todays session with a high degree of success. Continue to practice manipulation of the stove control knob, address complications with manipulating pasta server with mouth, increase quantity of cooked pasta to 2 servings.

Objective

Assessment

Plan

(Modified from Hersch, Lamport, & Coffey, 2005)