1 Running Head: OCCUPATIONAL PROFILE & ANALYSIS

Occupational Profile & Analysis Breanne N. Rowland Touro University Nevada

2 OCCUPATIONAL PROFILE & ANALYSIS Occupational Profile Who is the Client? The client is a 54 year old female who was born in Ogden, Utah and moved to Henderson, Nevada as a younger child. She is one of nine siblings and is extremely family oriented. She has a large family and is the mother of seven children, which includes six girls, one boy, and three dogs. The client has been married for many years and enjoys spending every moment with her husband. She currently lives with her husband, who has recently fallen ill to cancer. Her oldest daughter has taken the role as the caregiver to both individuals. The client lives in a single story home that is large enough for her family. She loves to spend time with her family and dogs. She also loves to exercise, dance, cook, and listen to her husbands music. Family is extremely important to the client and the time spent with them is imperative. She previously attended church on a regular basis, but recently has been unable to attend due to a decrease in health. The client previously attended business school, worked in retail sales, and spent time doing secretarial work. Prior to her diagnosis, the client spent her time volunteering for a crisis pregnancy center and at multiple schools, lecturing on sexual education. Currently, the client attends the Las Vegas Adult Day Care Center six days a week, as well as the Connections group for memory loss one day a week for cognitive behavior and socialization difficulties. Presently, the client is diagnosed with dementia (early onset), hypertension (HTN), depression, and has a history of narcotic abuse. Why is the Client Seeking Services, and What are the Clients Current Concerns? The client is seeking services due to a decrease in independence and performance capabilities in the areas of instrumental activities of daily living (IADLs), social participation, self-direction, and cognitive abilities. The client has many concerns relative to independently

3 OCCUPATIONAL PROFILE & ANALYSIS engaging in occupations that are meaningful to her and daily life activities. She has recently begun showing signs of aphasia and agraphia, which has decreased her ability to communicate. The family also has concerns primarily with independence, social participation, cognitive abilities, and safety. These areas have impacted the clients ability to be self-sufficient and safe without supervision. The clients concerns mainly involve the inability to participate in activities, feeling unsatisfied with life, empty, bored, scared, and helpless. The client is also aware of her cognitive difficulties, which has contributed to her depression. Areas of Occupation that are Successful and Areas Causing Difficulties The areas of occupation that are successful for the client include bathing and showering, bowel and bladder management, dressing, eating and feeding, and functional mobility. The client has maintained her independence during her activities of daily living (ADLs) and continues to function with supervision for safety. The areas of occupation that are causing difficulties include her IADLs, such as caring for others, communication management, financial management, health management and maintenance, home establishment and management, meal preparation, community mobility, and shopping. The client has also faced difficulties in rest and sleep, education, work, play, leisure, and social participation. The areas of occupation that are affected greatly are due to the cognitive impairments associated with dementia. The client has demonstrated a rapid decrease specifically impacting communication management, financial management, home management, and meal preparation. Her communication has decreased due to aphasia and agraphia. The client occasionally has the ability to communicate without difficulties; however, many times she finds it challenging and frustrating. The client no longer has the ability to manage her home, finances, or prepare meals for her family. Her daughter plays the role of the caregiver and manages the tasks that she is no longer able to accomplish.

4 OCCUPATIONAL PROFILE & ANALYSIS Contexts and Environments Supporting/ Inhibiting Participation and Engagement The contexts and environments that support and inhibit the clients participation consist of the temporal, physical, personal and social environments. The temporal context inhibits participation and engagement in desired outcomes due to the diagnosis of dementia. The client frequently is unaware of the day of the week and time of day. These difficulties often leave her confused and disorganized. The physical context supports the clients ability to continue to be independent and safe during her ADLs. This includes limited physical barriers for safety risk factors. The clients personal context supports her in that she is an educated mother who has previously volunteered in the community. Her family has supported her throughout the process and her participation in occupations. Additionally, the social context and environment supports the clients participation and engagement in desired outcomes. The client attends the Las Vegas Adult Day Care Center six days a week. This gives the client the opportunity to socialized with others and engage in activities that are meaningful and desirable. However, the clients social participation has recently decreased and has become a concern of her daughter. The client also has many resources available to her. This includes family support, and a caregiver. She also has many relationships with friends and family that are influential and supportive. Occupational History The client was previously independent in her occupations prior to her diagnosis. She has been utilizing help from her family for the past few years as her condition progressively worsens. Her health and cognitive capabilities have rapidly declined. The clients occupational history revolves around her family, work, school, and leisure activities. She has a large family that includes nine siblings and seven children. The client previously attended business school, worked in retail sales, and spent time doing secretarial work. Prior to her diagnosis, the client

5 OCCUPATIONAL PROFILE & ANALYSIS spent her time volunteering for a crisis pregnancy center and at multiple schools, lecturing on sexual education. Some of the leisure activities that the client enjoyed included exercising, cooking for her family, baking, painting, and gardening. These activities allowed the client to relieve stress and allowed her to spend time with her family. Many of the clients occupations have focused around family and friends and participating in activities that have a positive influence on her life. Priorities and Desired Outcomes The clients priorities involve maintaining as much independence as possible for the maximum amount of time allotted. She is also concerned with spending as much time with her husband, who is very ill, and her contribution to his care. Other priorities of the clients include participating in activities that are meaningful to her, such as cooking, exercising, socially participating with friends and family, and maintaining an overall positive quality of life. Occupational Analysis Body Function Deficits The deficits in which the client is experiencing involves the functions of the mental, cardiovascular, and voice and speech system functions. The client is experiencing difficulties with mental functions, specifically in higher-level cognition, memory, perception, thought, mental functions of sequencing complex movements, emotions, experience of self and time, orientation, temperament and personality, and energy and drive. The clients higher level cognitive capabilities have been impaired in making judgments, concept formation, insight, and metacognition. She also has challenges with her short term, long term, and working memory. She often finds it difficult to recall information and remember past and present events. The client also has difficulty when recognizing individuals, and does not always have an awareness

6 OCCUPATIONAL PROFILE & ANALYSIS of reality. Mental functions of sequencing complex movements are also challenging at times, specifically during writing activities and learning new tasks. The client is also diagnosed with depression and has a difficult time when managing her emotions. She often becomes emotional over her mother or husband and requires assistance for redirection. The clients experience of self and time is altered due to her depression and dementia. Self-esteem frequently impairs her ability to socially participate with others. She is frequently disoriented to the present, past, place, and time, and often needs assistance for redirection. The clients temperament and personality has been affected due to her depression. She is extremely sensitive and emotional about her family. The client also has difficulties with the cardiovascular system functions. She is diagnosed with hypertension and requires a special diet with low sodium intake. This requires close monitoring by her family and the nursing staff at the Las Vegas Adult Day Care Center. Additionally, the client experiences difficulties with speech and voice functions. These challenges include a frequent impairment to voice, fluency, and rhythm functions due to aphasia. This limits her ability to communicate at times and can be frustrating when expressing herself verbally. Activity Demands The activity that was performed included a memory care task that consisted of the theme of aloha. This was the selected theme of the week for the group session and the activities were planned based on the meaning of aloha. The activity began by introducing oneself to the group and then progressed to thinking, writing, and sharing three individuals who were significant. The task involved cognitive stimulation and self-direction in order to think about three individuals who were significant to the client. The objects and materials required for this task included paper, a pencil, and a desk. The space required for this activity included a room that was

7 OCCUPATIONAL PROFILE & ANALYSIS decorated with the theme to help stimulate positive feelings. This environment was colorful, bright, and large enough to accommodate 16 individuals. The room was positioned in the back of the building, away from distractions and noises. The social demands required the individuals to listen and be polite to others in the group. The individuals in the group were expected to respect one another while sharing. The sequence and timing of the task involved the client to think, write, and share her thought process. This included rationalizing the mental functions required for the planned sequential movements of the tasks. The required actions and skills to perform the tasks involved thinking about individuals who are significant and important, planning the required movements essential to write, and the motor and cognitive abilities to speak and share her thoughts with the group. This activity was very challenging for the client to participate in. She had difficulty with thinking, writing, and sharing her ideas with the group. Performance Patterns The performance patterns related to the task and the client included routines and roles. These are what influence the clients motivations and helps the client continue to participate in daily activities. Performance patterns, such as routines, are vital to the client and the task. The routines of the task and the client involve the memory care group that takes place every week. The client routinely attends the memory care group and participates in similar activities. Many of the activities stay the same, but the theme for the week differs. This activity is done on a regular basis to help stimulate memories and positive feelings for the individuals. The roles of the client involve a set of behaviors that are meaningful. These behaviors include being a mother and a wife. When capable, the client shares with the group that family is the most important part of her life. Due to the progression of the dementia, the clients role as a mother and wife is one of the only patterns that has stayed familiar to her.

8 OCCUPATIONAL PROFILE & ANALYSIS Performance Skills The performance skills that are required for the task include motor and praxis, sensoryperceptual, emotional regulation, cognition, and communication and interaction skills. The motor and praxis skills that are required include coordinating sequential body movements to write and manipulate the pencil in the hand, reaching for the tools for the activity, and maintaining balance during the seated activity. Sensory-perception skills that are required for the client include positioning her body in the chair during the activities, hearing and looking at the other individuals who are talking, visually determining where to write on the paper, and timing the appropriate time to talk without interrupting others. Emotional regulation skills include responding to other individuals in the group, persisting in the writing and speaking task despite frustrations, controlling emotions and behaviors towards others during the activity, recovering from distractions and redirecting self, and displaying emotions that are appropriate for the situation. Cognitive skills include selecting the appropriate tool to write with, sequencing the tasks required for the activity, including writing, organizing ideas to write on the paper, creating ideas, and multitasking. Communication and social skills consist of looking at the individual who is talking, gesturing and facial expressions to show emotions, maintaining distance between the other individuals, initiating and answering questions asked, taking turns talking, and acknowledging others who are talking. Body Functions and Body Structures The body functions primarily influenced by this task include the mental, sensory, neuromusculoskeletal, and voice and speech functions. The mental functions involved include higher-level cognition, attention, memory, perception, thought, mental functions of sequencing complex movements, emotions, experience of self and time, consciousness, orientation,

9 OCCUPATIONAL PROFILE & ANALYSIS temperament and personality, energy and drive, and sleep. Specific mental functions involved in this task include concept formation, attention, cognitive flexibility, multi-sensory processing, short-term and long-term memory, recognition, awareness of reality, logical/coherent thoughts, execution of learned movement patterns, coping and behavior regulation, and self-concept. Sensory functions included for the task involve seeing, hearing, vestibular, proprioception, and touch. Specifically, this consists of detection/registration, visual awareness of the environment, listening to others, sensation of moving against gravity, and awareness of body position. The neuromusculoskeletal functions consist of joint mobility, joint stability, muscle tone, muscle endurance, and control of voluntary reactions. This involves joint range of motion to write, postural alignment to sit during the activity, degree of muscle tone, hand-eye coordination, bilateral integration, crossing midline, and fine-motor skills required for the writing task. Voice and speech required functions include voice functions, fluency, and rhythm in order to share ideas, and participate in group discussions. The body structures that are required involve structures of the nervous system, eyes and ears, voice and speech, and structures related to movement. Context and Environment The contexts that specifically relates to the performance of this intervention include the personal, physical, and social contexts. The clients personal context involves being a 54 year old female, who is a wife and a mother to seven children. The client relates many of her activates to her family due to the joy they bring her. The physical context relates to the performance of the activity due to the setup of the built environment. The built environment is decorated with the theme of aloha to enforce cognitive stimulation for the group participants. This includes having leis, an umbrella, a palm tree, tropical smoothies, flowers, and hawaiian decorations and music.

10 OCCUPATIONAL PROFILE & ANALYSIS The social environment consists of the other individuals who attend the memory care group. This includes 12 other individuals, nurses, and facilitators. Problem List 1. Impaired memory & executive functioning results in Max VC and safety concerns during SMP. 2. Individuals emotional behavior results in social participation. 3. Depression and anxiety limits clients ability to participate in social events 4. Inability to perform math calculations limits clients ability to manage money . 5. Client requires Max VC to complete home management tasks due to memory and executive functioning.

11 OCCUPATIONAL PROFILE & ANALYSIS References American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy 62, 625683.