Running Head: OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile and Intervention Plan

Nick Druzinski
Touro University Nevada

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile
The client is a 58 year old male who has trigger finger in his right hand. He has a wife
and three kids, ages 19, 22, and 24. He and his wife live in a two-story home in Las Vegas,
Nevada. The client also has a four year old German shepherd who they adopted last year. Some
of the interests the client stated were riding his motorcycle, playing the drums, drawing, and
writing books. The client values his independence in taking care of himself, which he has lost for
the time being. The client also explained how his wife was having a hard time with his injury as
well because it puts more stress on her. The client feels like a burden to his family so he stated
that he wants to get better and be able to use his hand as soon as possible.
This is not the first time the client has been in a hand therapy clinic. Two years ago, he
had carpal tunnel surgery on his left hand. The day after surgery, he had his initial OT evaluation
and started therapy a few days later. He received therapy twice a week for five weeks. Similar to
his current symptoms, he experienced a lot of stiffness and pain after surgery and throughout
hand therapy. The only other time he received therapy was when he had torn his rotator cuff
while working out. He needed surgery and after that surgery, he could not use his shoulder for
five months. After those five months, his status improved drastically so he was able to start
physical therapy.
The client is seeking services because he just had trigger finger surgery. He requires hand
therapy because he cannot move his middle finger due to stiffness, pain, and inflammation. The
client is very concerned because he cannot participate in any of his meaningful occupations and
he cannot take care of himself due to his injury. He is also concerned that he will never have full

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function of his right hand. Since he does not work on weekdays, the client is at home by himself
so he cannot groom himself, prepare a meal, or even clean.
Even with his injury, the client feels successful in taking care of his dog. When he takes
his dog for walks, he uses his unaffected hand because if he tries to use his affected hand, hes
unable to hold the leash. He did state that when he brushes his dog, he tries to use his affected
hand in order to decrease stiffness but he has to stop when the pain is too much. He also stated
that playing fetch is difficult because his affected hand is his dominant hand, making it difficult
to throw a tennis ball. Some barriers that are affecting his success include lack of support, pain,
and access to adaptive equipment. Since his kids moved out and his wife works weekdays, he has
no one at home to assist him. However, on weekends, he has his friends in his band and his wife
to help him with whatever he needs. When he does try to use his affected hand, he says that his
pain levels are so high that he can no longer perform the activity. He stated that the top reasons
why he goes to therapy are to get rid of the pain and to become independent again in meaningful
occupations, especially drumming. Finally, if the client had access to adaptive equipment, some
occupations would be less difficult and he would experience less pain.
Environments and Contexts
One context that the client sees as supporting engagement in occupations is his friends.
The client states that his friends frequently call him to join them in social activities such as going
to the movies, going fishing, and going out to eat. This is an example of the virtual context and
social environment because the client and his friends communicate via text messages and phone
calls. One environment that inhibits engagement in meaningful occupations is his physical

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environment. The client does not have access to certain assistive technology thats required to
engage in certain activities, such as cooking and cleaning.
The client wakes up every morning with his wife and makes breakfast for the both of
them. His favorite meal to make in the morning is eggs, bacon, and toast. He stated that he is the
one usually making the couples meals so that is one role he fulfills every day. He showers,
shaves, and further grooms himself every day. During the day, he practices the drums because he
is in a band. Drumming is his occupation, so its very important that he practices two to three
hours a day. He also takes care of his dog, Otto. This role entails feeding Otto, taking him for
walks, grooming him, and taking him to the bathroom. The client stated that Otto was one of his
best friends so this role means a lot to him. Once a week the client cleans the house which
includes vacuuming, mopping, dusting, etc. He said that hes kind of a clean freak so making
sure his house is clean is very important to him. By the time his wife comes home from work, he
already has dinner made. Cooking for his family gives the client the sense that hes supporting
and taking care of his family.
The client considers himself to be an active participant in engaging in meaningful
occupations. Some occupations that are meaningful to him include drumming, taking care of his
family and dog, writing books, and cooking. Before his injury, the client was drumming two to
three hours every day and had a gig every weekend with his band. Now with his injury, he can no
longer drum since hes unable to hold a drum stick in his right hand. The client has a very close
relationship with his dog because they are usually the only two home on the weekdays. Before
his hand injury, the client would take his dog on multiple walks a day, play fetch with him, feed
him, etc. Now, the client can play fetch with his dog, but hes limited because he cannot grip a
tennis ball with his affected hand. Similar to fetch, the client can walk his dog but with his

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unaffected, weaker hand due to the inability to form a fist around the leash. The client stated that
before his injury, he would cook every meal for his wife and himself. He would look online or in
books for new recipes to surprise his wife. Now, his wife has to assist him or cook the meals for
them, or he just has food delivered to his house. He stated that its too hard for him to cook with
his non-dominant, unaffected hand. Right now, he cannot cut using a knife, use a roller, or drain
vegetables using a strainer. Even with his injury, the client is still able to fully engage in social
activities with his family. When his family is with him, they assist him in anything he cannot do,
such as cooking, taking care of the dog, cleaning the house, etc.
The clients main priority is to become independent in taking care of himself and getting
back to work as soon as possible. He wants to decrease the stiffness and pain in his middle finger
so he can get back to engaging in meaningful occupations. Some of the occupations he wants to
re-engage in include drumming, writing books, and cooking. He wants to fulfill the role of being
a husband and a father by being able to support and take care of his family.
Occupational Analysis
OT services were done in a large outpatient hand therapy clinic. The clinic consisted of a
round table and four smaller individual tables for one on one therapy. The client engaged in a
seven minute theraputty exercise working on improving grip strength. This exercise consisted of
the client squeezing the medium-resistance putty into a fist and then pinching the putty with his
right middle finger and thumb. Since the medium-resistance putty was too difficult and painful
for him, he was given the easiest level of putty to complete his exercises. When he was given the
different putty, he was successful in squeezing and pinching it without difficulty or pain. The
client participated in this therapeutic exercise for seven minutes, two with the harder putty and

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five with the easier putty. I was actually the one who noticed that the exercise was too hard and
painful for the client. Every time the client would try to squeeze or pinch the putty, he would
form a fist in his other hand and grimace.
There are many domains that impact the clients ability to successfully engage in
occupations. These include social participation (family), sleep participation, sensory functions
(pain), muscle function (power and endurance), motor skills (grip, manipulate, lift), and assistive
technology. Due to his wifes job and his kids moving out of the house, the client has no social
support to help him with daily activities such as cooking, cleaning, or grooming himself. Since
the client experiences a lot of pain in the evening, he finds it difficult to get comfortable and fall
asleep. He also has to wear a splint to keep his fingers in a certain position, which is
uncomfortable for him. Since he isnt getting the recommended hours of sleep, he is often tired
throughout the day, making it hard to accomplish tasks. After surgery and throughout therapy,
trigger finger patients experience a lot of pain. Sometimes, this pain cannot be resolved with
medications, so its difficult to engage in occupations with such high levels of pain. When the
client can perform an activity, despite experiencing pain, he cannot endure the activity for a long
time and doesnt have the strength required to successfully complete that activity. Since he has a
lot of stiffness, inflammation, and pain in his middle finger, the client experiences difficulties
whenever he tries to grip, manipulate, and lift objects. He cannot form a full fist which makes it
impossible to grip objects, such as eating utensils or a hammer. Since he cannot lift heavy
objects, he is limited in everyday activities such as grocery shopping and cleaning the house.
Finally, the client lacks access to assistive technology, which would make difficult activities
easier and less painful. Such technology could include thicker pens and adaptive cookware.

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Problem List
Problem Statement One
Client is unable to hold a drum stick due to his inability to form a fist and decreased pain
tolerance.
Problem Statement Two
Client is unable to hold a pen due to increased inflammation of his middle finger.
Problem Statement Three
Client is unable to form a fist due to decreased flexion of his middle finger.
Problem Statement Four
Client is unable to grasp his motorcycle handle bar due to increased pain and sensitivity of his
middle finger.
Problem Statement Five
Client is unable to pinch putty due to decreased strength in his right middle finger and thumb.
The problem statements are prioritized by the problems most greatly affecting his ability
to live a fully independent life and engage in his meaningful occupations. The inability to hold a
drum stick is the most important problem because he is unable to perform his job requirements.
By not being able to hold a drum stick not only limits him from playing in his band, but it also
causes him to not get paid. In order to take care of his family, the client must be financially
stable. Whenever hes not practicing the drums, the client writes books. Since he cannot hold a
pen, he cannot work on his books, which are very meaningful occupations to him. He enters his
books into competitions, so writing is financially meaningful to him as well, making it very
crucial to restore his abilities. Since he cannot form a fist due to stiffness, the client is limited in
many meaningful activities. For example, its important to him to keep his house clean, but in

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order to use a vacuum or mop, he needs to be able to make a fist to push them forward. Since he
cannot use his affected hand, he needs to over compensate with his other hand, increasing the
risk of injuring his other side. If the client didnt have a car and the only mode of transportation
he had was his motorcycle, this would be the most important problem. However, he is lucky
enough to also have a car. This problem is still important because riding his motorcycle is a
meaningful occupation for the client. Whenever he needs some time to get away or just have
time to himself, he said he would go for rides on his motorcycle The inability to pinch putty isnt
that big of a problem, however it does mean that the client cannot do certain things. These can
include buttoning buttons on his shirt, tying his shoes, and picking up change from the counter.
This inability doesnt seem like much of a problem but it limits a lot of important minor skills
needed.
Intervention Plan & Outcomes
Long-Term Goal
Client will independently write a chapter of his book using a ballpoint pen in five weeks.
Short-Term Goal
Client will independently write a paragraph of his book in less than twenty minutes in three
weeks.
Intervention
An occupation as a means to increase the clients involvement in writing would be having the
client draw. This activity would be appropriate for him because he stated that one of his favorite
hobbies is drawing pictures. This activity would work on forming a functional grasp on the
pencil which is congruent with his other short-term goal. Working on drawing increases the
clients finger strength, dexterity, and endurance as well as allowing him to engage in one of his

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favorite hobbies. Since the client is engaging in a meaningful occupation, he will be more
motivated to participate in this activity. This intervention would be the longest, lasting 10-15
minutes, depending on his levels of endurance and fatigue. In a study, participants stated that
after performing occupation-based activities in hand therapy, they experienced increased quality
of life, and life satisfaction (Case-Smith, 2003).
Intervention Approach
The most appropriate intervention approach would be establish/restore. The client is trying to reestablish his functional grasp allowing him to return to drawing and writing books.
Short-Term Goal
Client will grip his pen with modified independence using a pencil grip in one week.
Intervention
An intervention that would help the client restore his previous abilities with his hand would be to
perform theraputty exercises. Occupation-based interventions in hand therapy have been shown
to increase AROM, decrease pain, increase strength, and improve functional movement patterns
(Colaianni & Provident, 2010). Using theraputty would help to increase grip strength and to be
able to make a fist. One advantage with using putty is that there are various levels of difficulty
the client can choose from. Clients earlier in the therapy process usually use the easiest putty and
clients near completion of the therapy process typically use the hardest putty. Benefits of using
theraputty include increases in grip strength, finger strength, thumb strength, and fine motor
skills (Colaianni & Provident, 2010). Another advantage to using theraputty is that the grip
patterns used in the exercises imitate real life activities such as holding a key and gripping a door
knob.

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A specific intervention would include two exercises which would take a total of ten
minutes. The first exercise would be to simply roll the putty into a ball, squeeze it, and repeat the
process. This exercise works on increasing grip strength. The second exercise would be to roll
out the putty, similar to rolling dough, and pinch the roll with the thumb and affected finger. This
exercise works on increasing pinch strength and endurance. A study stated that occupation-based
interventions benefit clients by facilitating functional activity, meaningful therapeutic
experiences, and holistic approach to treatment (Ekelman et al., 2014). This intervention can be
used for various diagnoses including carpal tunnel syndrome, lateral epicondylitis, and trigger
finger.
Grade Up
To grade up this activity, the client would use the harder putty instead of using the less-resistant
putty. This activity would require more strength and endurance to be able to complete the five
minute intervention.
Grade Down
To grade down this activity, the client would use the easier putty. This activity would require less
strength and endurance in order to be completed. If the client is already using the easiest putty,
the client can be given playdoh or a foam pad to squeeze on.
Intervention Approach
The most appropriate intervention approach would be establish/restore. The client is trying to reestablish or restore his previous abilities before his injury. In order to write, the client has to have
the strength to grip a pen which is exactly what the theraputty is doing.

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Long-Term Goal
Client will independently drum his favorite song using both drum sticks in five weeks.
Short-Term Goal
Client will independently grip his drum stick in both hands in 2 weeks.
Intervention
The third intervention that would be used would be the power web. This therapeutic exercise
helps to increase forearm pronation and supination, finger extension, and thumb opposition
(Colaianni, Provident, DiBartola, & Wheeler, 2015). According to another study, clients with
upper-extremity injuries showed significant positive gains in functional measures following
client-centered occupational therapy services (Case-Smith, 2003). There are two specific
activities that would be incorporated into this intervention. The first would be to take the power
web, without placing the fingers in the holes, and place the palm of the hand onto the web. The
activity would look like the client is pushing his hand against the web. This activity is used to
increase finger extension. The second activity would be to place the fingers into the web holes
and flex the fingers. This resistance activity is used to increase thumb opposition and finger
strength and endurance. Both of the exercises would last five minutes, making this intervention
ten minutes long.
Intervention Approach
The most appropriate intervention approach would be establish/restore. By performing power
web exercises, the client will restore his previous strength and endurance.
Short-Term Goal
Client will independently twirl drum sticks both clockwise and counterclockwise in three weeks.

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Intervention
The final intervention that would be used would be Chinese therapy balls to improve manual
dexterity and strength. In a study, participants described the experience of occupation-based hand
therapy exercises, such as Chinese therapy balls, to be beneficial in increasing occupational
performance (Colaianni, Provident, DiBartola, & Wheeler, 2015). This exercise consists of
rotating a pair of therapy balls in the palm of the hand. This activity can be done either palm up
or palm down, depending on the level of difficulty for the client. This activity would be done for
five minutes. One advantage with this exercise is that in order to successfully rotate the balls, the
client needs to use all of their fingers. By using all of their fingers, the client is also gaining
range of motion in every finger. In that same study, participants also stated that they experienced
psychosocial benefits in addition to the physical benefits (Colaianni, Provident, DiBartola, &
Wheeler, 2015).
Intervention Approach
The most appropriate intervention approach would be restore/establish. In this intervention, the
client is trying to restore his manual dexterity and strength to where they were before the injury.
In order to even be able to participate in meaningful occupations, the client needs to be
able to have adequate strength, endurance, and range of motion without experiencing pain. With
this said, these interventions focus mainly on increasing the clients strength, endurance, and
range of motion.
Outcomes
The three outcomes that these interventions hope to achieve include role competence,
participation, and quality of life. The goal of these interventions is to improve the clients

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performance in his meaningful occupations as soon as possible. By performing the activities in

this intervention, the client should be able to effectively meet the demands expected of him in his
occupations. For example, in order to write books or draw, the client should be able to hold a
pencil or pen with a functional grasp with no pain or difficulty. At the end of therapy, the client
will be able to participate in all of his meaningful occupations with no barriers. Finally, the client
will have an increased sense of life satisfaction because he will be able to participate in all of the
activities that make him happy.
Precautions and Contraindications
While performing theraputty exercises, make sure the putty isnt too hard for the client to
squeeze or pinch because it might be too painful, causing secondary injuries. The earlier in the
therapy process, the easier the putty should be. Once the client progresses in therapy, the putty
difficulty can be increased. However, some clients may progress quicker than others so careful
monitoring should be done. While performing moist heat packs as preparatory activities, make
sure theres six to eight layers of towels between the heat pack and the client in order to reduce
risks of burning the client. While performing any other therapeutic exercises which may include
clothes pins, Chinese therapy balls, or the spider web, be cautious of overexertion or hand/wrist
pain. Its normal for the client to experience some pain but if the pain levels are too high, the
activity should be stopped immediately in order to avoid secondary injuries or making the
current injury worse. Precautions should be taken with clients with diabetes mellitus or
rheumatoid arthritis. Another precaution is to not use cryotherapy on clients with nerve injury or
repair, sensory impairment, peripheral vascular disease, cold intolerance, or lupus (Schell &
Gillen, 2014). Finally when performing ultrasound on a client, make sure the head is appropriate
for the body location. For example, for the palm of the hand, the small head of the transducer

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should be used. If the wrong sized head, frequency, or duty cycle are used, the client is at risk for
being burned.
Frequency and Duration
The client will participate in hand therapy two times a week for five weeks for 45
minutes a day at the Bronstein Hand Center.
Framework
The primary frame of reference utilized for this intervention plan is the biomechanical
frame of reference. The primary focus of this frame of reference is to remediate impairment at
the client factor and impairment level (Schell & Gillen, 2014). Specific therapeutic techniques
that are based on this theory include strengthening and range of motion exercises. This
intervention plans focus is to remediate the abilities of the client through promoting muscle
strength. According to this frame of reference, optimal functioning is determined by the ability to
engage in functional levels of range of motion, strength and endurance (Schell & Gillen, 2014).
The theraputty exercises, chinese therapy balls, and power web all focus on increasing strength,
endurance, and range of motion. In order for the client to return to his meaningful occupations,
he needs to restore strength and optimal functioning in his affected hand. The goals of the
intervention were created to increase and maintain independence in meaningful occupations such
as drumming and writing.
Training and Education
Client and caregiver education is a very important part of therapy because when the client
and their family become knowledgeable of the benefits of therapy, they become more motivated,
which increases occupational performance. Before each activity is performed, the therapist will
explain to the client what the activity is, the purpose of the activity, and the benefits of properly

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performing it. In addition to all of this, the therapist will demonstrate what to do and what not to
do to avoid injury. The therapist can also give the client worksheets to take home on proper
performance, frequency, and duration. If the client does not have enough cognitive ability to
understand the activities and safety concerns, the therapist can demonstrate and explain the
activity to the caregiver. The therapist can also give extra copies to the caregiver to assist the
client at home. The therapist can also re-explain or demonstrate the activities each time the client
comes into therapy to ensure proper form and safety. Finally, if the therapist sees the client
progressing or regressing in certain exercises, the therapist can show them how to grade the
activity up or down.
Clients Response
The clients response to the intervention will be assessed by administering the Quick
Dash Questionnaire and assessing his pain levels at each visit. Before each session, the therapist
will ask the client what his pain level is. The scale will range from one to ten, with one being no
pain and ten being the most pain hes ever been in. With this number, the therapist can decide
whether or not the intervention is helping the clients health and well-being. If the client is
experiencing low levels of pain that means that the intervention is working as well as benefiting
the client.
The Quick Dash Questionnaire measures physical function and symptoms in people with
musculoskeletal disorders of the upper limb (Colaianni & Provident, 2010).The questionnaire is
a very good tool to use for therapists who want to monitor pain and function in individual clients.
Progression can also be monitored by simply seeing the clients progression in his specific
intervention activities. For example, if the client starts using the easiest putty and ends with the

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hardest putty, this can be seen as a significant improvement in function. Some other assessment
tools that can be utilized in hand therapy to track progress of clients include using the
dynamometer, pinch gauge, and goniometers. The dynamometer measures the clients strength,
goniometers measure range of motion, and the pinch gauge measures the clients pinch strength.

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References
Case-Smith, J. (2003). Outcomes in hand rehabilitation using occupational therapy services.
American Journal of Occupational Therapy, 57, 499-506. doi: 10.50.14/ajot.57.5.499
Colaianni, D. & Provident, I. (2010). The benefits of and challenges to the use of occupation in
hand therapy. Occupational Therapy in Health Care, 24(2), 130-146. doi:
10.3109/07380570903349378
Colaianni, D. J., Provident, I., DiBartola, L. M. and Wheeler, S. (2015), A phenomenology of
occupation-based hand therapy. Australian Occupational Therapy Journal.
doi: 10.1111/1440-1630.12192
Ekelman, B., Hooker, L., Davis, A., Klan, J., Newburn, D., Detwiler, K., & Ricchino, N. (2014).
Occupational therapy interventions for adults with rheumatoid arthritis: an appraisal of
the evidence. Occupational Therapy in Health Care, 28(4), 347-361. doi:
10.3109/07380577.2014.919687
Schell, B.A.B. & Gillen, G. (2014). Overview of theory guided intervention. In B. A. B. Schell,
G. Gillen, & M. E. Scaffa. (2014). Willard & Spackmans occupational therapy (12th
ed.). Philadelphia: Lippincott Williams & Wilkins.