Running Head: OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Occupational Analysis and Intervention Plan

Carol Mitchell
Touro Nevada University

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Occupational Profile
1. Client name: Madison Gregory
2. Age: 5
3. Sex: Female
Briefly discuss each of the following:
4. Who is the client?
Madison Gregory is a five year old female. She loves to play Barbies, baby dolls, dress up,
and arts and crafts. Madison has a wide selection of shoes and clothing, and loves to be
fashionable when she goes to school and family functions. Madison lives with her mother,
father, and dog named Rylee. Madison attends kindergarten at her local charter elementary
school. She is social in school and is good at making friends.
5. Why is the client seeking services and/or what are the clients concerns relative to
engaging in occupations and in daily life activities?
The client is seeking services to learn to tie her shoe laces. Madison is attending her first year
of school. She has noticed that there are other children in her class that are able to tie their
shoes. Madisons teacher has also established a rule in the classroom that she will not tie the
students shoe laces. Madisons teacher believes that by the age of five each student should
know how to tie their shoes.
6. What areas of occupation are successful and what areas are causing problems or risks?
Madison is an independent five year old that successfully participates in occupations
including: eating, feeding, bowel and bladder management, functional mobility, sleep, formal
education participation, play exploration and participation, and social participation with
family and friends. Madison is independent in dressing herself, and putting on her socks and
shoes, but is unable to fasten her own shoe laces. At this time her mother and father are tying
her shoe laces. However, at school Madison is required to tie her own shoes, therefore she
must learn do it on her own.
7. What contexts and environments support or inhibit participation and engagement in
desired occupations?
Madison is an only child that lives with her mother and father in a single family home.
Madisons family is a middle class family and both of her parents work full-time positions.
She has her own bed and room in her home. Her bathroom is child friendly with a stepping
stool so she can reach the sink. She attends school Monday through Thursday.
Since Madison was born her parents have been tying her shoe laces. Now that Madison is
five years old and her parents are still tying her shoes they are inhibiting her from learning
the skill of tying her shoes on her own. Madison is aware that other children at school know

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

the skill and that her teacher is requiring her to know how as well. The social expectations
are supporting Madisons participation in learning to tie her shoe laces.
8. What is the clients occupational history?
Madison is able to understand and follow instructions very well. She values being able to do
things independently. Madisons current occupations include being a kindergarten student,
dressing herself, bathing, brushing her teeth, playing, and socializing with friends. Madison
is willing to learn new skills that make her more independent.
9. What are the clients priorities and desired outcomes?
Madison has a great desire to learn how to tie her shoes. She currently knows how to put on
her socks and shoes independently, but is unable to complete the task since she is unable to
tie her shoes properly. She would like to be able to tie her shoes independently, without aid
from her parents or teacher.
Occupational Analysis
1. Occupation:
Area(s) of occupation for the client:
1. Activities of daily living
2. Instrumental activities of daily living
3. Education
4. Work
5. Play
6. Leisure
7. Social participation

Subcategory:
Dressing
Formal education

2. Values, beliefs, spirituality associated with participation:

The client must value independence. The client must believe that knowing how to tie shoes is a
life skill that one must learn. Spirituality is not associated with participation in tying shoes.
3. Contexts:
Context
Physical/space
demands

Social

Supports
Small working space , quiet
noise level, good lighting,
comfortable room
temperature, table and chair,
correct size shoes, laced shoes
School teachers have
expectations that a
kindergarten student should
master the skill of tying a

Inhibits
Incorrect length of shoe laces
Shoes that do not fit properly

The parents doing the task for

the child inhibits them from
learning how to do it on their
own

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Cultural

Personal

Temporal

Virtual

shoe
In the American culture a
child learns to tie their shoes
before the age of six
Five year old female, who is
enrolled in kindergarten,
interested in learning new
skills and becoming
independent
The client is expected to learn
to tie a shoe by the middle of
the school year. It is an
expectation that is put on
many first year school
children
Watching other children on
television tie a shoe

The pressure of learning to tie

a shoe by a certain age
If a young client is not able to
master the skill after several
attempts they easily become
discouraged and want to give
up
All children are different and
putting a specific time frame
on when they should be able to
tie a shoe can be inhibiting

Television programs do not

usually show the hard work it
takes to learn the skill,
therefore making it look easy
to the child

4. Objects and their properties used:

Tools:
Shoe that can be laced (5-7 holes)
36 inch shoe lace
Child size sock
Materials:
None
Equipment:
Child size table
Child size chair
5. Social demands:
Learning to tie a shoe is considered to be a milestone that children should master by the
age of five or six. In the American culture, most people wear shoes that have laces,
making this skill almost mandatory for a person to learn.
6. Sequence and timing:
1. Select a pair of socks
2. Select a pair of shoes
3. Walk to the table with the shoes and socks in hand
4. Place the shoes and socks on the table
5. Sit down in the chair
6. Bring the left foot close to the body by bending the knee
7. Grab one of the socks

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

8. Place the sock on the left foot

9. Lower the left foot back down to the floor
10. Repeat steps 6-9 for the right foot
11. Bring the left foot close to the body by bending the knee
12. Grab the left foot shoe
13. Loosen the shoe laces slightly
14. Place the untied shoe on the left foot
15. Lower the left foot back down to the floor
16. Repeat steps 11-15 for the right foot
17. Bring the left foot close to the body by bending the knee
18. Place the sole of the foot flat on the chair to support the foot
19. Tighten the shoe by pulling on the ends of the strings on the right and left side of
the shoe at the same time
20. Hold the lace tight
21. Cross the left and right strings, making an X
22. Place the left string under the right string and pull through creating a new right
and left end
23. Take the left end and make a loop with it
24. Hold the loop tight, do not let go
25. Take the right end and make a loop with it
26. Put the right loop over the left loop, making an X
27. Pinch the area were they cross with one hand
28. Bring the left loop through the hole below the pinched area
29. Pull through while pulling on the right loop at the same time
30. Tighten by pulling on the loops on the right and left side of the shoe
31. Repeat steps 17-30 for the right foot
7. Body functions required:
Function

How It Is Used

Judgment

Deciding when
shoes need to be
worn
Determining the
shoe is untied and
needs to be tied
Determining how
tight the lace
needs to be pulled
Making small
loops rather than
large loops when
tying shoes
Thinking of ideas
to better

Concept formation

Metacognition

None

Minimally
Challenged
X

Greatly
Challenged

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Cognitive flexibility

Insight/awareness

Sustained attention

Selective attention

Divided attention

Short-term memory

Working memory

Long-term memory

Discrimination of senses:

remember the
process of tying a
shoe for the next
attempt
Switching from
the standard
bowknot to the
bunny ears tie if
the standard way
is too challenging
Being aware of
ones own ability
and that it may
take time to learn
a new skill
Maintain focus
and concentration
on the task of
tying a shoe for
the period of time
needed to
complete the task
fully
Maintaining focus
on tying a shoe
while in a busy
setting
Tying a shoe and
answering a
question
Knowing what
step in the shoe
tying process one
is on
Remembering the
sequence of the
steps in the shoe
tying process
Recall how to tie
the shoe
Recall how to put
on a shoe
Not applicable
X

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Auditory
Discrimination of senses:
Tactile

Discrimination of senses: Visual

Discrimination of senses:
Olfactory
Discrimination of senses:
Vestibular-proprioception

Multisensory processing

Sensory Memory

Spatial relationships

Temporal relationships

Feel for the end

of the laces, how
tight the lace is
pulled, and the
texture
See where to
place foot/shoe to
tie or put on, see
where the shoe
lace is placed for
each step
Not applicable
Leaning forward
to tie the shoe
Maintaining
balance while
seated in the chair
or bending down
See and feel the
shoe laces as they
are being tied
Remembering the
step one is
currently on to
perform the next
step to complete
tying the shoe
Knowing the
space between the
body and the foot
and knowing that
the foot must be
brought close to
the body to
facilitate tying the
shoe
Understanding
that tying a shoe
must be done
generally fast, as

X
X

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Recognition

Categorization

Generalization

Awareness of reality

Logical/coherent thought

Appropriate thought content

Execution of learned
movements

well as that each

step of tying the
shoe needs to
happen
simultaneously
after the other
Recognizing what
a shoe is and that
it goes on the
foot;
Recognizing the
shoe is untied and
needs to be tied
Categorizing
objects that can
be tied in the
same way, shoes,
ropes, draw string
pants
Practicing tying
the shoe off of the
foot, and then
replicating with
the shoe on the
foot
Aware that
oneself is tying a
shoe in the
present time
Knowing that the
shoe is untied and
needs to be tied
again so tripping
does not occur
Thinking about
tying the shoe and
the steps needed
to complete the
task
Putting a shoe on,
pulling a string
tight, making an x
with two strings

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Coping

Behavioral regulation

Body image
Self-concept

Self-esteem

Arousal

Consciousness
Orientation to self

Being able to
maintain
emotional
stability when
becoming
frustrated or
losing interest
quickly if the task
is too difficult
Maintaining a
good attitude
while trying to
learn and master
the skill
Ability to
regulate behavior
when faced with
errors or negative
outcomes
Not applicable
X
Understanding
the role of being a
kindergarten
student and that
being able to tie
ones own shoe is
mandatory
Having
confidence and
belief in ones
self to overcome
the obstacles
associated with
learning to tie
shoes
A low level of
arousal is
required for tying
shoes
Must be awake in
order to tie a shoe
Ability to know
and respond to

X
X

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Appetite
Sleep

ones own name

Not applicable
Knowing to put
shoes on before
leaving the house
Knowing you do
not need to wear
shoes when
sleeping
Being aware of
other students
that have the
same expectation
to learn the task
of tying their own
shoes
Maintaining an
even-temper
when faced with
obstacles or when
making an error
Motivated to be
independent in
daily activities
including tying
ones own shoes
Controlling
impulse to give
up when the task
becomes
frustrating
Not applicable
Not applicable

Function

How It Is Used

Detection/registration

Mild level of
visual acuity is
required
Seeing and
following the
movement of the

Orientation to place
Orientation to time

Orientation to others

Emotional stability

Motivation

Impulse control

10

X
X

X
X

None

Minimally
Challenged
X

Greatly
Challenged

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Visual modulation

Integration of senses

Awareness at distances

Tolerance of ambient sounds

Location and distance of sounds

Moving against gravity

Taste
Smell
Body in space

hands and then

seeing if the shoe
is tied
Limiting visual
stimuli in the
environment to
promote
concentration on
the task when
first learning to
tie shoes
Visual, tactile,
and
proprioceptive
senses are used
while tying shoes
Placing the foot
close to the body
to better facilitate
the task of tying a
shoe
Tolerance of
background
noises such as
people talking, or
the television
playing while
remaining on task
Not applicable
X
Sitting upright in
the chair, bringing
the leg up
towards the body,
or bringing the
body down
towards the foot.
Not applicable
X
Not applicable
X
Awareness of
where the hands
are placed during
each step of tying
a shoe

11

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Comfort with touch

Localizing pain

Thermal awareness
Joint range of motion

Joint stability/alignment

Strength

Awareness that
the foot needs to
be brought close
to the arms to
better facilitate
tying of the shoe
Touching the shoe
laces and shoes
Aware of pain
caused by pulling
the shoe laces too
tight
Not applicable
X
Leg and hip joint
flexed to bring
the foot towards
the body
Ankle joint flexed
and extended
while tying the
shoe lace
Elbow joint
flexed while tying
Wrist joint flexed,
extended,
supinated, and
pronated while
tying the shoe
All finger joints
used while tying
the shoe
Wrist and finger
stability is
required when
using fine motor
skills to tie a shoe
Ankle and foot
stability is
required to better
facilitate the
action
Must have
strength in upper

12

X
X

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Muscle tone

Muscle endurance

Stretch reflex
ATNR
STNR
Righting and supporting reflex

Eye-hand coordination

Bilateral coordination

Crossing midline

extremity muscles
including
shoulder, arm,
and hand muscles
Muscles in the
wrist and hand
must have normal
muscle tone to
complete the task
Muscle endurance
is needed to
complete the task
over and over
during the
beginning stages

13

X
X
X
Righting posture
and alignment
during the task is
needed if the
body becomes
unbalanced while
leaning forward
or to one side
High level of eye
hand coordination
is needed to
ensure the visual
and hand
precision needed
to complete each
step of tying a
shoe
Both hands are
used when tying
the shoe
Both arms are
used in tying the
shoe therefore
one arm must
cross midline,

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Fine motor control

Oculomotor control

Gait patterns

Blood pressure

Heart rate

Respiratory rate

Respiratory rhythm

Respiratory depth

depending on
which shoe is
being tied
Requires a high
level of fine
motor control to
complete the
steps of tying a
shoe, crossing
laces, looping,
swooping
Focusing on what
position the laces
are in and the
placement of the
hands
Reaching for the
laces
Walking to the
closet or bedroom
to obtain socks
and shoes
Normal blood
pressure rates
needed to
perform tasks
Normal heart
rates needed to
perform tasks of
activity
Normal
respiratory rates
to perform tasks
of activity
Normal
respiratory
rhythm to
perform tasks of
activity
Normal
respiratory depth
to perform tasks
of activity

14

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Physical endurance, aerobic

capacity
Voice functions
Voice rhythm and fluency
Alternative vocalization
Digestive system

Metabolic system

Endocrine system

Urinary functions

Genital and reproductive

function
Protective functions of the skin

Repair functions of the skin

Not applicable

Not applicable
Not applicable
Not applicable
Digestive system
needs to be
working at a
normal level to
perform tasks of
activity
Metabolic system
needs to be
working at a
normal level to
perform tasks of
activity
Endocrine system
needs to be
working at a
normal level to
perform tasks of
activity
Urinary system
needs to be
working at a
normal level to
perform tasks of
activity
Not applicable

X
X
X

Rubbing on the
shoes laces
repetitively when
practicing
Not applicable

8. Muscular analysis of movements required:

Muscle
Shoulder flexion
Shoulder extension
Shoulder abduction

Required?
X
Not applicable
Not applicable

15

X
X

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

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

16

X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X

9. Body structures required:

Category

Body Structure

Nervous system

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

Eyes, ears, and

related
structures

Required
?
Check If
Yes
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Voice and speech

structures

Cardiovascular
system

Immune system

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

Genitourinary and
reproductive systems

Structures related to
Movement

17

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

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

X
X
X
X
X
X
X
X
X
X
X
X

Salivary glands
Esophagus

X
X

Stomach
Intestines: Small and large
Pancreas
Liver
Gall bladder and ducts
Endocrine glands: Pituitary, thyroid, parathyroid,
adrenal
Urinary system: Kidneys, ureters, bladder, urethra
Structure of pelvic floor
Structure of reproductive system Ovaries, uterus, breast
and nipple, vagina and external genitalia, testes, penis,
prostate
Bones of cranium
Bones of face
Bones of neck region
Joints of head and neck
Bones of shoulder region

X
X
X
X
X
X

X
X
X
X
X

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Structures related to
movement
(continued)

Skin and related

structures

18

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
Lumbar vertebral column

X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X

Sacral vertebral column

Coccyx
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

X
X
X
X
X
X

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

19

10. Performance skills required:

Skill

Required?

How the Skill Is Used

Coordinating both hands together, grasping shoe

laces, maintaining stability of the body and arms
while tying the shoe laces, coordinating fine motor
skills in response to tactile and visual information
Visually focusing on the shoe lace and the action of
crossing, looping, swooping and pulling; locating
and maintaining the placement of the fingers on the
shoe lace
Persisting in the task despite frustration and
difficulty
Sequencing the steps for tying a shoe, problem
solving on how to maintain the loops while
swooping and pulling the laces
Maintaining composure and emotional stability
when the task does not go as planned

Motor/praxis
X
Sensory (perceptual)

Emotion regulation

X
X

Cognitive
X
Communication/social

11. Performance patterns:

Parts of this occupation has elements of which of the following: (check all that apply)
Pattern
X Useful habit
Dominating habit

Describe
Learning to tie a knot

X Routine

Pulling the shoe laces tight following the crossing step and prior to
looping the laces
Using the standard bow knot to tie a shoe

Ritual
X Role

The role of being a child in kindergarten that is required to

participate in learning to tie ones own shoes
Intervention Plan

1. Identify 1 objective and measurable goal of the intervention:

Complete the sequence of steps needed to tie a shoe. This goal can be reached by first
learning to tie the shoe off of the foot. Place the laced shoe untied on the table with the

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

20

toe of the shoe facing away from the client. Then facilitate the tying process. Once this is
mastered the client can then practice tying the shoe on ones own foot.
a. According to OTPF what type of outcome is this?
Occupational performance: Beginning the task with the shoe off of the foot is a way
of grading the activity of tying shoes down. As the client gradually improves, the
therapist may grade the activity up by having the client place the shoe on the foot and
then practice tying the laces. Over time this outcome produces the client with the
ability to complete the activity on their own.
2. Intervention approach:

Approach
Create/promote

Establish/restore

Maintain

Modify

Prevent

Describe
Create a regular practice schedule to help the client in remembering
the sequence of steps
Provide the client with other ways to practice the skill of tying a knot,
using a shoe string board, others shoe laces, or draw string pants
Establish occupation performance patterns to maintain the skills
learned
Modify the process by first having the client learn on a shoe that is not
placed on the foot
Modify the activity by having the client learn the bunny ear method
if the standard bow knot is not successful
Prevent learning how to tie a shoe incorrectly by taking time to learn
the skills, and repeating them correctly

3. Activity selection
a. Activity selection: Identify 1 example of each for the intervention plan

Activity
Occupation-based
intervention
Purposeful activity

Describe
Tie ones own shoes every morning before school

Preparatory
method

Practice tying other objects with laces such as a shoe lace board, or the
shoe off of the foot

Repetitively practicing tying ones own shoe

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21

b. Discuss how activity selection relates back to occupational profile and

occupational analysis
The client is a five year old kindergarten student that is required to learn to tie her
shoes. The skill is new to the young client, therefore scaffolding and grading is
needed to provide the client with the best learning experience. The occupational
analysis shows that the task of learning to tie a shoe for the first time can be
frustrating and discouraging. By providing scaffolding and grading in this
activity the young child will remain engaged and will steadily progress to be able
to tie ones own shoe.
c. Discuss how activity selection will support achievement of client identified goals
and goal of the intervention plan
The clients goal is to master the skill of tying ones own shoes. The current goal
of the intervention is be able to complete the sequence of steps needed to tie a
shoe. By choosing to begin the intervention with the activity of tying a shoe that is
off of the foot will better prepare the client to master the steps. Once the steps are
mastered on the free shoe then the client can transfer the skill of tying the shoe to
a shoe that is placed on ones foot.
4. Describe how intervention can be graded or adapted and why
The skills are new to the young client, therefore, scaffolding and grading is needed to
reduce frustration and loss of interest. The activity can be graded down by tying a free
shoe on a table in front of the client, or by tying a shoe lace board. The therapist can also
grade the activity down by teaching ties such as the bunny ear knot. The activity can be
graded up by placing the shoe on the clients foot, as well as teaching different types of
ties other than the standard bow knot.
Throughout the learning process the therapist can provide scaffolding by helping the
client hold the laces taut, make the loops, hold the loops together prior to the swoop
phase, and aid in pulling the loops tight.
5. Safety concerns and/or precautions
Safety concerns include preventing the client from pulling the shoe too tight, restricting
blood flow to the foot.
6. Discuss the role of the occupational therapy practitioner during the intervention
The role of the occupational therapy practitioner during the intervention will be to ensure
safety, guidance, as well as explanation of the process of tying the shoe.
7. Discuss what is expected of the client during the intervention

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

22

During the intervention, the client is expected to have the ability to maintain focus on the
task for a length of time. The client is expected to participate in the learning process and
be able to tie ones own shoe after one full week of practice. The client will gain
confidence by mastering the skill on a free shoe and will be able to complete the activity
on ones own shoe.