Running head: OCCUPATIONAL PROFILE AND ANALYSIS

Occupational Profile and Analysis Anthea Mourselas Touro University Nevada

OCCUPATIONAL PROFILE AND ANALYSIS Occupational Profile Questions Who is the client (person, including relevant family, caregivers, significant others; population; organization)? Answers The client is a single 44-year-old male. He has no relatives, caregivers, and/or significant others. Previous to injuries, client has done odd jobs: including construction work, sales, and waiting in restaurants. Hes been on disability for over two years now. Why is the client seeking services, and what are the clients current concerns relative to engaging in occupations and in daily life activities? The client was in a scooter accident over two years ago. He suffered multiple cervical spine fractures. He had a C7 to T1 fusion with a titanium rod surgically placed in his spine. Since recovery, he was able to ambulate independently with a cane. He also was independent in all his activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Five weeks ago he had a really bad fall that left him with a really deep wound on his left lower extremity. He is currently not able to walk, has chronic pain, and was on an IVC filter for increased hypertension. The clients biggest concern is that he wants to be able to walk again, so he can be independent in all his ADLs and IADLs. What areas of occupation are successful and what areas are causing problems or risks? Currently, he is using a bed pan because of his limited mobility. He stressed that he wants to be able to use the toilet as soon as possible. However, with his condition and precautions, he is unable to do so. His current medical conditions are also

OCCUPATIONAL PROFILE AND ANALYSIS prohibiting him from performing any other ADLs out of bed. He can feed himself with supervision and perform grooming tasks with stand by assistance (SBA), but all other ADLs required maximum assistance (Max (A)) to dependent (D). What contexts and environments support or inhibit participation and engagement in desired occupations? Previous to the accident five weeks ago, the client had lived in Las Vegas for about six months, in a single story home. The single story helped supported his environment because he was able to ambulate independently with his cane; he also had a shower chair in his stand-up shower for fatigue when bathing. He was renting a room and living in a house with six other people, he didnt know. He said that there was a lot of noise in the house, and illegal matters such as drugs going on. The environment was inhibiting his participation in desired occupations, because it was not a healthy environment. If the client was able to move to a more stable environment, it could potentially support his desired occupations, however, with only the income from his disability, and no family support this can be difficult. What is the clients occupational history (life The client was born in Ohio. He graduate high-school and started to work in construction. He also used to box for a time

experiences, values, interests, period in his life, and still has a love for the sport. He likes to previous patterns of engagement in occupations, attend boxing matches, one of the reasons why he wanted to move to Las Vegas. He enjoys watching movies and has an

OCCUPATIONAL PROFILE AND ANALYSIS and the meanings associated with them)? What are the clients priorities and desired outcomes? The first thing the client said when asked what his goal was, was to be able to walk again. Primarily, he wants to be independent with all of his ADLs as soon as possible, to give the independence and privacy he desires. He hopes to return to his life and be able to live independently as he was before. extensive DVD collection.

Occupational Analysis What deficits exist in each of the body function categories (mental, sensory, & pain, neuromuscular-skeletal and movement-related, cardiovascular, and respiratory)? Body Functions Categories Bed Mobility Deficits

Mental Functions: Specific Mental Functions: Client was intact with his higher cognitive thinking. He was able to pay attention, listen to direction, and hold a conversation. He showed good short-term and long-term memory because he was able to talk about events from his past and present.

Global Mental Functions:

The client was alert and oriented to person, place, and time.

Sensory Functions and Pain:

The client required reading glasses, however, had good visual awareness of his overall environment and showed no deficits in

OCCUPATIONAL PROFILE AND ANALYSIS this area other than reading. He also had good proprioception, showing he was aware of his body position in space when assisting in bed mobility. Client was in a lot of pain in his back from several of his spinal surgeries. He was in so much pain, that it prevented him from having functional mobility in bed. He was hesitant to move, sit in certain positions, and roll, fearing that it could be painful. Client didnt specify what kind of pain it was (dull, sharp, etc.)

Neuromuscular-skeletal and movement-related functions:

Client had full range of motion (ROM) in his upper extremities and 4/5 manual muscle test (MMT), but had cervical spinal precautions, and was told abduct or flex arm above 90 degrees. His lower extremities had decreased tone. He had several surgeries on his lower extremities (LEs) throughout the last three or four years, including a knee fracture that had left needing a cane for mobility. He needed minimum assistance for rolling in bed during ADLs, mainly needing help with repositioning his lower extremities. He was able to stand in a static position but was dependent because he needed two people for support and safety.

Cardiovascular, hematological, immunological, and

The client has hypertension, which can increase his risk of heart attack. He also complained of feeling dizzy and getting headaches, which can be a symptom of hypertension. This would

OCCUPATIONAL PROFILE AND ANALYSIS respiratory functions: affect his bed mobility, and he would need breaks during movement. Client also reported having several surgeries in his LEs due to poor blood circulation. Skin and related-structure functions: The client had an open wound on his buttocks and left lower extremity from his accident. He had been sent to the facility for wound care to help this heal. This wound caused him discomfort and because of his limited mobility and poor circulation was healing very slowly.

Discuss the activity demands of this task (object needs, space demands, social demands, sequence & timing, required actions or skills). Activity Demands Objects and their properties: Bed Mobility Demands In order for proper bed mobility which included rolling at minimum assistance and moving from supine to a sitting position; the client needed several objects. A bed rail was very important for the client to be able to pull himself with his upper extremities into a rolling position. The bed rail is metallic, smooth, and sturdy. A smooth, soft, white sheet or chuck was used to help reposition the client by gliding him into a proper sitting position. A white, hard neck brace was used to make sure the client had kept his cervical spine during bed mobility to prevent further injury. In addition, soft,

OCCUPATIONAL PROFILE AND ANALYSIS white, fluffy towels, and pillows were used to help position him where he felt most comfortable. The bed must also be adjustable to position his into a static, seated position. The mattress on the bed is firm and comfortable for the client. Space demands: In order for functional mobility in bed, the client needs to have a room big enough to have his bed in the room, as well as any other items he would need to perform these tasks. His bed must be large enough so he is able to have movement in bed. Social demands: The client doesnt have any caregivers, so client education is a key component from the therapists working with him. It is important for him to understand what they expect him to do himself and what they will assist him with during bed mobility. Sequence and Timing: Because this was only his first evaluation, his timing could increase in the future. Rolling from supine to sideline took one minute to position, roll, and reposition. Then, the therapists assessed skin integrity for one more minute. Moving client into supine to sit, took about five minutes including prep, because the client was feeling dizzy, as well as scared of feeling pain from movements. Once the client was positioned in his seated position he was ready for his lunch. Required actions and For bed mobility the client needed to have many performance

OCCUPATIONAL PROFILE AND ANALYSIS performance skills: skills. Cognition and communications skills were used to be able to understand instructions and communicate when he had questions or needed clarifications. Motor and praxis skills were used in gripping the bed rails as well as using the proper strength to help assist him in rolling into sideline. These skills were also used when he was able to help reposition himself using his hand to push down on the mattress when in a seated position.

Identify the performance patterns related to the task and your client (habits, routines, roles). Performance Patterns: Habits: Client and the task Client has a habit of needing a minute to gather himself before starting any type of bed mobility activity. He feels that it helps him gather himself because of his fearfulness that he will feel pain. Routines: The client discussed how he enjoys sleeping in late and prefers his therapy in the afternoon. He also prefers to have his pain medication before therapy to help with any pain during this time. He likes to watch a movie after he performs his basic grooming, hygiene, and bathing tasks in the morning, while he eats his breakfast. Rituals: No rituals were observed or discussed during the evaluation.

OCCUPATIONAL PROFILE AND ANALYSIS Roles: As discussed in the occupation profile, the client is a single 44-year-old male with no family members in his life. He has been on disability for the past two years. Previous to his injuries he worked in construction, sales, and waiting in restaurants.

Identify the performance skills, which are required for this task (motor skills, praxis skills, and communication & interaction skills). Performance Skills Motor and Praxis skills: Bed Mobility Performance Skills Motor and praxis skills were used in gripping the bed rails as well as using the proper strength to help assist him in rolling into sideline. These skills were also used when he was able to help reposition himself using his hand to push down on the mattress when in a seated position. He also knew which precautions to take during mobility to prevent further injury. Communication and social skills: Communication and social skills were used to be able to understand instructions and communicate when he had questions or needed clarifications with the therapists. He was able to communicate about his past and his goals for the future.

Identify the body functions and body structures primarily influenced by this task. Body Functions and Structures Structures related to movement are primarily influenced by this task. The task I observed specifically involved his upper

OCCUPATIONAL PROFILE AND ANALYSIS extremity strength to be able to provide assistance in rolling from supine to sideline as well as supine to a sitting position. Bed mobility is very important for the client because of his lack of functional mobility outside of bed. In addition, his skin is another structure that is influenced by this task because he cannot be putting constant pressure on it or it will not heal.

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Comment on the contexts that specifically relate to the performance of this intervention (cultural, physical, social, temporal, virtual, personal, spiritual). Contexts and Environments Cultural Performance of Task The client engages in typical American patterns of behavior including for example, he shook hands when he was introduced to the therapy staff. No other cultural customs, beliefs or patterns were observed or discussed. Personal The client is a 44-year-old male originally from Ohio. He used to work in construction, sales, and was a server at different times in his life. He graduated high-school and attended some community college classes. He used to box and still enjoys watching the matches. He is currently on disability, and is in a lower socioeconomic status. Temporal The client was in a scooter accident over two years ago and has been on disability since the accident. The client had a really bad fall five weeks ago when he was hospitalized. He

OCCUPATIONAL PROFILE AND ANALYSIS had moved to Las Vegas from Ohio six months ago. He prefers to have his therapy in the afternoon after he receives his pain medication. He likes to watch movies in the morning after his morning routine of ADLs. Virtual He uses his cell-phone to communicate with his friends, via text messaging and phone calls. He allows the television to help pass his time in the hospital. He uses the call light to get assistance for bed mobility and other matters. He also uses the remote to control the beds position. Physical Currently, the client is in a hospital room, which includes a bed, dresser to store person items, and a bathroom. Unfortunately with his limited functional mobility he is mostly limited to his bed in this environment. Previous to his recent injury, he lived a single story home. The single story allowed him to be able to ambulate independently with his cane; he also had a shower chair in his stand-up shower for fatigue when bathing. Social The client doesnt have a spouse, significant other, or caregiver; however, he has many friends he likes to keep in contact with. He also has roommates in his current home but he discussed how he didnt really spend any time with them. In Las Vegas, his close friends he has he met at boxing matches he would attend, they too have a love for the sport.

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OCCUPATIONAL PROFILE AND ANALYSIS Spiritual The client did not discuss anything about spirituality, and nothing was observed.

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Problem List Identify at least 5 different problems relevant to the client and state these in the format of a problem statement. 1. Client requires SBA for grooming/hygiene due to safety for spinal precautions. 2. Client requires Max (A) for toileting due to lack of endurance during bed mobility and spinal precautions. 3. Client requires Max (A) for upper body dressing due to pain and cervical spinal precautions. 4. Client requires Max (A) for bathing due to fatigue and limited mobility. 5. Client requires (D) for lower body dressing due to lack of mobility in LEs and spinal precautions. Prioritize your problem list and justify your reasoning. The top 2 problems will be the basis of your next The problem statements above are prioritized. The reason I chose grooming/hygiene as the first priority was because it was something that client can become successful at quickly, therefor feel a sense of accomplishment and encouraged to keep trying

assignment, Evidenced Based his other goals. The second problem I chose was toileting. Intervention Plan Although being able toilet even with CGA, would be a long-term goal, the client stressed that this was very important for him. He asked if we could take him to the bathroom because he didnt want to use the bed pan anymore. I wanted to make this one a

OCCUPATIONAL PROFILE AND ANALYSIS priority because of the importance to him. Next, I chose upper body dressing because although he is currently at Max (A), I believe he could improve quickly with the right type of clothing and/or adaptive equipment. Next, I felt the client could improve in his bathing skills. With the deficits observed as well as what was intact, I felt he would be able to do more of the bathing himself, and could eventually increase these skills with the right adaptive equipment. Lastly, I chose lower body dressing. I chose this one last because of the severity of his wound on his LE. I think it is important to let it heal before working on this skill, however, it is still important and the therapist could provide client education to explain the proper techniques for this ADL.

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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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