INTERVENTION PLAN FOR COMMUNITY CLIENT WITH REFLECTION

Copy/paste one LTG and the matching STG from your evaluation SOAP note. This will be the goal set around which you design your treatment session.
For this and all subsequent weeks, please answer the following questions before designing your treatment plan for the next week. If you were unable to see
your client the past week, you do not need to answer these questions. Answer the questions based on the treatment that you implemented:

What went well with your treatment? Did things go as you planned or not? Explain. What will you do differently with this next treatment plan?
Beginning the session this week was a little bit more difficult than previous weeks. This was due to her talking and the experience of greater tone due to the
cold. As she was talking, I kept trying to reinforce that she should be performing weight bearing exercises. For the most part she was pretty good about weight
bearing and talking, but I feel like we could have done some additional stretching, but I felt bad interrupting her even to the extent that I did. The client really
enjoyed this treatment session as it focused on one of the occupations that she enjoys, Liverpool Rummy. The one problem that I immediately noticed when
playing this game, is that she became very distracted in the elements of the game rather than therapy. We asked the client to explain the rules of the game to
us and then she became very focused on the cards in the discard pile because someone can “buy the card”. This interfered with the quality of the movement in
her LUE. She was cued to focus on finger extension when reaching out to grab the card on her turn, and by the next turn, she had forgotten the cue. It was
hard to bring her back to targeting the left-hand movement rather than just playing the game. If we were to do Liverpool Rummy again, I would begin the
session by stating that the purpose of the activity was not to actually play the game, but to help improve control of voluntary movement through engagement in
an occupation. Another problem with this session was that the client did not want to stand. Standing helps break up the flexor synergy in her LUE, which then
allows her to have more control over her fingers. However, the client did not want to stand because that is not how she typically plays the game. Getting the
client to deviate from her typical routines and habits has definitely been a challenge as we continue her intervention. Overall, I was pleased with how much the
client enjoyed the session, as she stated that she wants to play Liverpool Rummy every week in therapy. From this session, I learned that we need to cue more
in order to complete the correct movement throughout the entire session. It would have also been beneficial to play a two-player card game. By playing with
less people, this would allow the client more opportunities to participate in the targeted movements.

Long-Term Goal: By April 13, 2018, the client will demonstrate improved balance to participate in
household tasks that require use of the left upper extremity while bending at the waist with no loss of
balance.

Short-Term Goal: By March 16, 2018, the client will vacuum the house while holding the cord with the
left hand to prevent tripping over the cord.

OCCUPATIONAL OPM and CPM TREATMENT SESSION GRADING THE ACTIVITY

PERFORMANCE PROBLEM
Specifically identify only the client
factors and/or performance skills
that are barriers to the
achievement of this goal. This
should not be a bullet list, rather
you should describe how the client
factor impacts this client’s
AND RATIONALE
Identify your OPM and all relevant
CPM’s that best addresses the
performance problem and describe
how each will be used to design
treatment for this client’s specific
problems.
DESCRIPTION
Provide details of how you will set up
the activity and how your intervention
addresses the performance problem.
Your description should detail how
the activity will be set up to make it
therapeutic.
Choose one client factor or
performance skill that you address
in your treatment session. Describe
one way (only one) that you can
grade the activity up and one way
(only one) to grade the activity
down based on that one factor or
skill.
performance of the occupation in
the goal.
Client Factors: Control of
voluntary movement is a barrier
that is inhibiting the client from
participating in her goals due to the
high tone in her LUE as a result of
the stroke. Due to the CNS injury,
a disruption in the cortical
connection to the LUE is interfering
with her ability to grasp,
manipulate, coordinate, and reach
(performance skills).
When mixing all of these client
factors and performance skills into
tasks that require balance, the
demands of the task are even
greater. The client is currently able
to bend at the trunk and pick up
objects with her right hand with no
support and no loss of balance.
However, when trying to bend over
and pick up an item with the left
hand, the client is unable to do it
without holding on to a supportive
surface and potentially loses her
balance.
As the client participates in an
activity her tone increases, and as
more joints participate in the
activity, the more it affects her tone
in the distal part of the extremity.
This is currently impacting her
ability to use her left hand in the
household tasks that require a
variety of body positions and
movements. Due to the flexion of
the shoulder, elbow, and fingers in
correlation with her tone, the client
has a harder time extending her
fingers to grab items as needed.
Due to a disruption in the cortical
connection, isolated finger
OPM: PEO
The PEO model will allow us to
assess various aspects (the client,
the occupation, and the
environment) in order to determine
how they impact her occupational
performance and participation. With
regards to our client, the client
wants to improve her performance
of the left hand (the person) in order
to carry out various activities
(household tasks) within her home
(the environment). By assessing
each of these factors and identifying
a congruence between them, we
can enable occupational
performance.
CPM: Motor Control/Motor
Learning
The client has sustained a CNS
injury due to her stroke.
Hemiparesis to the left side of her
body has occurred due to the
disruption of the signals from the
brain to the extremity muscles.
Intervention will focus on improving
the cortical connection from the
brain to the left upper extremity in
order to allow her to perform
occupations in a more functional
way. A main intervention technique
for the motor control model is
repetitive task practice. Based on
this intervention, the client will
perform very repetitive movements
during this Wii activity. In addition,
the Wii will allow the client to
participate in these repetitive
movements while standing and
moving which will help with
improving balance, a critical
element that she needs in order to
For this session, we will engage the
client in a game of bowling utilizing
the Wii. The Wii remote will be
placed in the client’s left hand. Prior
to engaging in the game, the client
will be educated on the purpose as
to why we are playing the game (to
work on balance and in-hand
manipulation). We will briefly discuss
how movements practiced in this
activity can transfer to activities that
she participates in everyday
(coordinating body movements for
household tasks). The client will
engage in bowling with only one of
the therapists so that it increases the
amount of times that the client will
repeat/participate in the associated
movements and allow the other
therapist to provide the appropriate
cues that the client needs to change
her position. For the first two turns,
the client will only do the upper
extremity motions of the task (elbow
flexion, index finger flexion to hold
button, elbow extension, shoulder
extension, and then shoulder flexion
and index finger flexion extension).
The finger extension component of
the task can be graded in order to
increase performance (ex. rather
than performing full finger extension,
the client can produce enough finger
extension so that the finger can slide
off of the button). After the client has
an understanding of the demands for
the LUE, incorporating the lower
extremities can then be introduced.
The client will stand while
manipulating the Wii remote in order
to increase the demand for trunk
control to maintain balance.
Throughout the session, the client
Factor/Skill: Coordination
Grade Up: In order to participate in
the Wii game (ex. bowling) the
client will have to coordinate all
body movements to complete the
process. For example, she will have
to manipulate the Wii remote in her
left hand while producing the
movements at the shoulder, elbow,
wrist, and fingers in addition to
movements in her LE to properly
take the number of steps before
releasing the ball (proper button on
remote).
Grade Down: To decrease the
demands of the task (bowling), the
client can be seated in a chair with
proper sitting posture (90-90-90 at
hips, knees, ankles). The chair
should not have an armrest so that
it does not interfere with her LUE
movements. This will limit the body
movements to the LUE allowing her
to solely focus on movement of the
shoulder, elbow, wrist, and fingers
without incorporating the balance
component.
movements are difficult. This
makes it difficult for the client to
pinch or grasp items effectively
and produce active extension of
her fingers to remove the item
once completed.
participate in the household tasks
that she has identified as important
(vacuuming and being able to bend
over and pick up items from the
floor such as her sheets from the
laundry basket).
will be cued for correct position of
the LUE and how she can
incorporate ulnar and radial deviation
of the wrist and/or how to improve
finger movement. The client will be
cued at least three times during the
game to stop and perform weight
bearing exercises to help decrease
tone.