Activity Analysis Form

1. Occupation: Cooking Smores Pop 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 2. Objects and their properties required For this activity you will need the following items; Tools: Pizza cutter Cookie sheet Aluminum foil Spoon Cutting board Fork Oven mit Subcategory: Eating Meal preparation and clean up

Participation

Materials: Milk chocolate bare Lollipop sticks Marshmallows Pie crust Egg whites Olive oil Paper towel

Equipment: Oven Lights Refrigerator

Copyright SLACK Incorporated, 2012. Thomas, H. Occupation-Based Activity Analysis: Thorofare, NJ: SLACK Incorporated; 2012.

3. Space demands: Wide, clear counter space Flat floors Well light area Comfortable temperature 4. Social demands: Sharing the kitchen area Using appropriate language Sharing materials Cleaning up after oneself

5. Sequence and timing: 1. Gather all materials 2. Preheat oven to 375 degrees 3. Line foil on cookie sheet 4. grease cookie sheet with olive oile using paper towel 4. Open pie crust package 5. Set aside 6. open chocolate 7. Break apart in segments of three (should end up with 4 quarters of chocolate bar) 8. Unroll pie crust on cutting board 9. Cut crust into one large rectangle with pizza cutter (cut off rounded edges of pizza cutter) 10. Cut into six small squares 11.place one chocolate square in three of the pie crust squares, leaving three squares without chocolate 12. Place one marshmallow on each of the chocolate piece 13. Add plain piece of pie crust dough on top of chocolate and marshmallows 14. Add stick to bottom of dough, place stick half way between chocolate and marshmallow 15. Fold up edges of the dough 16. Press and seal dough using prongs of fork 17. Carefully place smore pop on cookie sheet by grabbing underneath pie crust. Do not use lollipop stick to lift. 18. Shake egg whites 19. Place small amount of egg whites on spoon
Copyright SLACK Incorporated, 2012. Thomas, H. Occupation-Based Activity Analysis: Thorofare, NJ: SLACK Incorporated; 2012.

20. lightly drizzle egg white all over top of smore pop 22 . Open stove door. 23. Place cookie sheet on top rack in stove 24. Set timer 25. Cook for 14-17 minutes, until crust is golden brown 26. open stove 27. use oven mitt to pull oit cookie sheet- caution oven and cookie sheet will be hot! 28. turn off oven 29. let cool for five minutes 30. Press lollipop down into chocolate 31. Carefully pull smores pop off foil using a fork or your fingers-Do not pull off foil by lollipop stick 32. let cool so it doesnt burn your tongue 33. Eat! 34. Enjoy! 6. Body functions required:
Function How It Is Used None Minimally Challenged Greatly Challenged

Judgment

Concept formation

Metacognition

Cognitive flexibility

Insight/awareness

Making sure chocolate is in the middle of the pie crust square Being able to place pie crust on bottom and the layering it in the correct order of chocolate, stick, marshmallow, pie crust Thinking about what steps to do next Problem solve how to cut the pie crust in order to form an appropriate size square for the chocolate to fit on Knowing our limitations

Copyright SLACK Incorporated, 2012. Thomas, H. Occupation-Based Activity Analysis: Thorofare, NJ: SLACK Incorporated; 2012.

Sustained attention

Selective attention

Divided attention

Short-term memory

Working memory

Long-term memory

Discrimination of senses: Auditory Discrimination of senses: Tactile

abilities, using your dominant hand to have precisian when cutting, the dominant hand will give more stability and precision when using the pizza cutter Concentrating putting on the materials in desired areas instead of undesired areas Ignoring noises in background and focusing on task Cooking smores while reading the rest of the instructions Remembering why we have the lollipop stick in our hand Placing the lollipop stick between the chocolate marshmallow and thing what to do next Remembering how to use a pizza cutter Hear the timer go off Knowing the difference between the feeling of

X X

Copyright SLACK Incorporated, 2012. Thomas, H. Occupation-Based Activity Analysis: Thorofare, NJ: SLACK Incorporated; 2012.

Discrimination of senses: Visual

Discrimination of senses: Olfactory

Discrimination of senses: Vestibularproprioception

Multisensory processing

Sensory Memory

Spatial relationships

Temporal relationships

Recognition

Categorization

Generalization

marshmallow and chocolate piece Knowing way around the kitchen and finding where things are Discriminate if the food is spoiled or if the food is burning Having proper posture while making smores pop When eating the smores pop we hold it(tactile), eat it(taste), smell it (olfactory), see what you are eating (visual) Remember how to open package of the marshmallows How far apart you place the smores pop apart To know it takes 14 minutes for the smores pop to cook To recognize the fork vs. the pizza cutter Categorizing what goes on the inside of the smore pop vs. the outside of it Cooking the

Copyright SLACK Incorporated, 2012. Thomas, H. Occupation-Based Activity Analysis: Thorofare, NJ: SLACK Incorporated; 2012.

Awareness of reality

Logical/coherent thought

Appropriate thought content

Execution of learned movements

Coping

Behavioral regulation

Body image Self-concept

Self-esteem

Arousal

Consciousness

smore pop in different environment Using the oven to cook the smore and not the refrigerator Knowing the amount of materials that can fit inside smore pop Thinking positively that the smore pop will come out right instead of negatively Having the ability to eat the smores correctly using motor planning Burning your smore and knowing how to handle it or emotional regulation if it doesnt turn out right Frowning if smore tastes bad n/a Perceived ability to make a smores pop Having the confidence to make a smores pop Hungry so we make a smores pop Awake and alert making the smores pop

Copyright SLACK Incorporated, 2012. Thomas, H. Occupation-Based Activity Analysis: Thorofare, NJ: SLACK Incorporated; 2012.

Orientation to self

Orientation to place

Orientation to time

Orientation to others

Emotional stability

Motivation

Impulse control

Appetite

Sleep
Function

Knowing you are in a kitchen making a smores pop Currently at our apartment making a smores pop Knowing the date and time when making the smore pop Knowing appropriate space between yourself and others in the kitchen Being calm while making the smores pop Incentive that you will get to have a yummy treat after you are done making it Not eating someone elses smores pop To eat the appropriate amount of smores pop to match our appetite n/a
How It Is Used

X
None Minimally Challenged Greatly Challenged

Detection/registration

Visual modulation

To see different materials to make the smore pop Seeing the materials to put in our

Copyright SLACK Incorporated, 2012. Thomas, H. Occupation-Based Activity Analysis: Thorofare, NJ: SLACK Incorporated; 2012.

Integration of senses

Awareness at distances

Tolerance of ambient sounds

Location and distance of sounds

Moving against gravity Taste

Smell

Body in space

Comfort with touch

Localizing pain

smore pop Putting marshmallow on top of the chocolate Knowing that the smores pop is on top of the foil/cutting board To be able to make smores pop with the TV on in the back ground Hearing someone walk behind while making the smores pop Walking around kitchen Tasting the pie crust, chocolate and marshmallow, but dont have to taste to make the smores pop Smelling a burnt smores pop Holding the cookie sheet while flexing our elbow to put in stove Picking up the pizza cutter by the handle and not by the sharp side To feel if you bite your tongue while eating the smores pop

X X

Copyright SLACK Incorporated, 2012. Thomas, H. Occupation-Based Activity Analysis: Thorofare, NJ: SLACK Incorporated; 2012.

Thermal awareness

Joint range of motion

Joint stability/alignment

Strength

Muscle tone

Muscle endurance

Stretch reflex ATNR STNR Righting and supporting reflex

Eye-hand coordination

Bilateral coordination

Being aware of smores pop so it doesnt bur our tongue Necessary to use pizza cutter to be able to cut it at different angles Ability to hold the smores pop and bring it to mouth to be able to eat Strong to lift pan out of oven Normal muscle tone to have smooth movement s to eat the smores pop Enough endurance to stand while making the smores pop n/a X n/a X n/a X Able to stabilize yourself while making the smores pop if someone happens to bump you while making it Ability to place chocolate onto square and marshmallow on chocolate Using both hands to press

Copyright SLACK Incorporated, 2012. Thomas, H. Occupation-Based Activity Analysis: Thorofare, NJ: SLACK Incorporated; 2012.

Crossing midline

Fine motor control Oculomotor control

Gait patterns

Blood pressure Heart rate Respiratory rate

Respiratory rhythm Respiratory depth

Physical endurance, aerobic capacity

Voice functions Voice rhythm and fluency Alternative vocalization Digestive system

Metabolic system Endocrine system

down on the pie crust Use while placing cookie sheet in oven Picking up the smores pop Eyes tracing the movement of our hands while working Normal gait pattern walking to the fridge n/a Slight increase while cooking Increase to meet oxygen demands Normal Slightly increased to meet demands Being able to stand for a short period of time while prepping the smore pop n/a n/a n/a Good working digestive system Converting food to energy

X X

X X X

X X

X X X X

X X

Function

How It Is Used

None

Minimally Challenged

Greatly Challenged

Urinary functions Genital and reproductive function

X X

Copyright SLACK Incorporated, 2012. Thomas, H. Occupation-Based Activity Analysis: Thorofare, NJ: SLACK Incorporated; 2012.

Protective functions of the skin

Repair functions of the skin

Sensory responses to heat so we dont get burnt n/a

7. Muscular analysis of movements required: Muscle Shoulder flexion Shoulder extension Shoulder abduction 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 Not Used Minimally Challenged X X Greatly Challenged

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

8. Performance skills required: Skill Motor/praxis Sensory (perceptual) Emotion regulation Cognitive X Communication/social X X None Low High X X How the Skill Is Used Bending and reaching to get cookie sheet out of oven Visually determining the correct size of the pie crust Controlling anger if smore pop breaks Selecting the appropriate tools and supplies to make the smore pop Maintaining acceptable space when cooking with others

Copyright SLACK Incorporated, 2012. Thomas, H. Occupation-Based Activity Analysis: Thorofare, NJ: SLACK Incorporated; 2012.

Copyright SLACK Incorporated, 2012. Thomas, H. Occupation-Based Activity Analysis: Thorofare, NJ: SLACK Incorporated; 2012.