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Occupational Analysis & Intervention Plan

Sotheavy Moeung
Touro University Nevada















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Occupational Profile
1. Client name: Mrs. Smith
2. Age: 55
3. Sex: Female
Briefly discuss each of the following:
4. Who is the client?
Mrs. Smith is a 55 year old graduate student with piriformis syndrome who is currently enrolled in a
masters program for occupational therapy. She attends class 5 days in a typical week and also has a
job on the side as a graphics designer/desktop publisher. Thus, she has to sit the majority of the day
while at school and at home. She is also a wife and mother. She is usually very active and loves to go
hiking, bike riding, and participate in many other outdoor activities. Due to her commitment to
school and work, she finds that she does not have much time to participate in the leisure activities
she loves to do.

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 due to experiencing difficulty sitting in a seat for prolonged periods of
time, specifically through lectures at school. She has a compressed sciatic nerve on the right lower
extremity and has experienced shooting pains going down the leg. She rated the pain level as a 7 out
of 10 for three consecutive days from the time it started. Although she no longer has shooting pains,
she still experiences discomfort sitting on hard surfaces.

6. What areas of occupation are successful and what areas are causing problems or risks?
As mentioned above, the area of occupation she finds most affected is participation in formal education.
She experiences the most difficulty sitting through lectures, as well as sitting while studying. She feels
the most successful when on her feet or sitting on comfortable chairs at home. She also mentioned that
she feels too prideful to bring a donut cushion to school.
7. What contexts and environments support or inhibit participation and engagement in desired
occupations?
Being at home and sitting on soft surfaces supports her lower extremities and in turn allows for more
successful studying. Sitting for prolonged periods of time on hard surfaces, especially on the classroom
chairs, inhibits her ability to be comfortable while participating in school.
8. What is the clients occupational history?
Prior to starting school three months ago, she worked full time in her home-based desktop publishing
business. Her work required her to sit at the computer several hours per day. Additionally, she likes to
go to the gym, attend weekly church services, go on walks and hikes, go on bike rides, and ski and
snowboard. She values the benefits of living an active lifestyle.
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9. What are the clients priorities and desired outcomes?
Her main priority and desired outcome is to find methods that can help her be more comfortable while
sitting through class.

Occupational Analysis

1. Occupation: Sitting through lecture without pain.
Area(s) of occupation for the client: Subcategory:
1. Activities of daily living
2. Instrumental activities of daily living
3. Education formal educational participation
4. Work
5. Play
6. Leisure
7. Social participation

2. Values, beliefs, spirituality associated with participation:
Students generally value quietness during lectures as well as undivided attention between the teacher
and students. In academia, it is believed that the more you pay attention in class, the better you
perform in school.

3. Contexts:
Context Supports Inhibits
Physical/space demands Desk/table is smooth so it is
easy to move around materials
and place arm on surface.

Inhibits movement, stretching,
and standing. Client is confined to
small seated area. Client has to
share counter space with
surrounding classmates. Height of
desk is not ergonomically-
friendly.
Social The classroom setting inhibits lots
of moving around especially
during lecture.
Cultural The culture of a classroom lecture
is usually one consisting of
quietness. Usually movements
create noise which can be a
distraction to others in the
classroom.
Personal Client is in pain when sitting for
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prolonged periods of time.
Additionally, she feels
uncomfortable getting in and out
of seat often during lecture.
Temporal The longer the client sits in the
seat, the more pain she is in.
Virtual n/a n/a

4. Objects and their properties used:
Equipment: desk, chair, laptop.
5. Social demands:
While sitting through a lecture, the client (student) should stay as quiet as possible and not move
around as much to distract surrounding classmates.
6. Sequence and timing:
1. Pull out chair.
2. Sit down.
3. Unpack bag and place necessary school items (including laptop) on desk.
4. Pull chair while seated under desk with proper seated posture.
5. Sit for one to two hours through lecture while paying attention.


Body functions required:
Function How It Is Used None Minimally
Challenged
Greatly
Challenged
Judgment Not make too
much noise
when
unpacking
backpack.
x
Concept formation Orient self and
school
materials to
face teachers
projected
power-point.
x
Metacognition Reflect on past
lecture classes
and choose
appropriate
seating
distance to
teacher in
order to hear
x
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him/her.
Cognitive flexibility Move seats if it
is not an ideal
position.
x
Insight/awareness Awareness of
being more of
a visual or
auditory
learner.
x
Sustained attention Maintain
attention on
lecture until
teacher
finishes talking.
x
Selective attention Pay attention
to lecture and
not being
distracted by
peers talking.
x
Divided attention Pay attention
to lecture and
where the
attendance
sheet is in the
room.
x
Short-term memory Remember
where the pen
is placed in
order to grab it
again to use.
x
Working memory Know what
lecture slides
have passed
and what is the
next slide
coming up.
x
Long-term memory Naturally know
how to use
highlighters,
pens, and
pencils from
memory.
x
Discrimination of senses: Auditory Know the
difference
between the
squeaking
noise of a
peers shoes
walking on
x
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linoleum floors
versus the
squeaking
noise of the
teacher writing
on the white
board.
Discrimination of senses: Tactile Understands
the difference
between the
feeling of
paper versus
the feeling of
the desks flat
surface.
x
Discrimination of senses: Visual Knows the
difference
between the
anatomy
teacher and
the skeleton in
the room by
sight.
x
Discrimination of senses: Olfactory Ability to
distinguish
between the
smell of a
highlighter/
marker versus
the smell of a
cup of tea.
x
Discrimination of senses: Vestibular-
proprioception
Knows where
the arms are in
order to reach
for a cup of hot
tea.
x
Multisensory processing Sees the steam
of the hot tea
as well as the
feel of the
temperature of
the mug to
decipher if it is
too hot to
drink.
x
Sensory Memory Knows the
taste of the tea
to see if there
is enough sugar
x
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and feeling of
the mug to see
if it is too hot
to drink/hold.
Spatial relationships Knows how far
the laptop is to
extend arm out
to type.
x
Temporal relationships Knows when it
might be time
for a break.
x
Recognition Knows the
difference
between the
size of a book
versus the size
of a piece of
paper.
x
Categorization Ability to place
anatomy
materials
together and
kinesiology
materials
together.
x
Generalization Ability to study
in the
classroom and
transfer the
same habit to
home setting.
x
Awareness of reality Understands
that there
needs to be
presence in the
classroom in
order to learn.
x
Logical/coherent thought Knows to use a
pen to write
instead of a
stapler.
x
Appropriate thought content Thinks about
the topic at
hand during
the lecture.
x
Execution of learned movements Proper
placement of
fingers on
laptop and
x
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then type using
pads of fingers.
Coping Continuies to
take notes
even if the
teacher is
talking too fast.
x
Behavioral regulation Not making too
much noise
when moving
so not to
disrupt the
classroom.
x
Body image Accepts that
the body is
undergoing
piriformis
syndrome and
it has to move
around a lot
during class.
x
Self-concept Understands
that the client
has piriformis
syndrome and
ironically may
have to treat
future clients
with the same
disability.
x
Self-esteem The self-
esteem
decreases
when having to
deal with a
disability
(piriformis
syndrome) in
front of others.
x
Arousal Alert enough to
answer a
question if
asked by
professor.
x
Consciousness Stays awake to
pay attention
in class.
x
Orientation to self Knows that the
teacher is
x
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referring to the
client when he
calls out her
name.
Orientation to place Knows that the
client is in the
classroom
setting.
x
Orientation to time The client
knows that she
is attending the
morning class.
x
Orientation to others Knows that the
person
standing in
front of the
class lecturing
is the professor
and those also
seated at the
desks are
peers.
x
Emotional stability Ability to keep
calm during
class even if
the piriformis
syndrome is
causing
shooting pains
down the leg.
x
Motivation Continues to sit
through the
lecture and
take notes so
that client can
perform well
during exams.
x
Impulse control Controls the
need to
massage and
ice the affected
leg during
lecture.
x
Appetite Drinks hot tea
to help stay
awake and to
keep hydrated
during class.
x
Sleep n/a x
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Function How It Is Used None Minimally
Challenged
Greatly
Challenged
Detection/registration Decipher
between a pen
and a pencil.
x
Visual modulation Pay attention
to the current
slide being
presented in
the power-
point.
x
Integration of senses Feels and sees
if too many
pieces of paper
are grabbed.
x
Awareness at distances Gauge how far
the laptop is to
type on.
x
Tolerance of ambient sounds Tolerate the
noise of peers
typing on their
keyboards
during class.
x
Location and distance of sounds Knows how far
the pen fell
from its
original spot
from the noise
it makes.
x
Moving against gravity Moves arm
against gravity
to grab the
highlighter.
x
Taste Tastes the
sweetness of
the tea.
x
Smell Smells the
fragrance of
the tea.
x
Body in space Knows where
the arms are to
pull the chair in
to sit on as well
as where the
buttocks are to
place gently on
the chair.
x
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Comfort with touch Gently types on
the laptop
keyboards.
x
Localizing pain Leg pains
become worse
from sitting
prolonged
periods of time
with piriformis
syndrome.
x
Thermal awareness Awareness of
how hot the
mug is that
holds the tea.
x
Joint range of motion Uses range of
motion to grab
the pens and
pencils out of
the backpack.
x
Joint stability/alignment Stability of
shoulder joint
to reach for the
attendance
sheet from a
peer sitting at
another table.
x
Strength Has enough
grip strength to
bring the
laptop from
the backpack
to the desk.
x
Muscle tone Has enough
muscle tone to
move
textbooks
around the
desk area.
x
Muscle endurance Has enough
muscle
endurance to
raise arm out
to type during
whole lecture.
x
Stretch reflex n/a X
ATNR n/a X
STNR n/a X
Righting and supporting reflex n/a x
Eye-hand coordination Sees the piece x
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of paper and
grabs it to
write on.
Bilateral coordination Uses both arms
to hold the
laptop to place
on table.
x
Crossing midline Crosses midline
to grab for
writing
instruments
(pen, pencils,
highlighters.)
x
Fine motor control Picks up a pen
that fell on the
ground using
pincer grasp as
well as
separating
papers that are
stuck together.
x
Oculomotor control Watches the
professor as he
walks around
the class.
x
Gait patterns Walks straight
without
limping due to
the piriformis
syndrome.
x
Blood pressure Sits for a long
period of time
which can
cause blood to
pool in the
lower
extremity.
x
Heart rate Heart rate
increases from
anxiety and
pain from the
piriformis
syndrome.
x
Respiratory rate n/a x
Respiratory rhythm n/a x
Respiratory depth n/a x
Physical endurance, aerobic capacity n/a x
Voice functions n/a x
Voice rhythm and fluency n/a X
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Alternative vocalization n/a X
Digestive system n/a X
Metabolic system Energy to
partake in class
comes from
the breakdown
of food intake.
x
Endocrine system n/a x
Urinary functions n/a x
Genital and reproductive function n/a x
Protective functions of the skin n/a x
Repair functions of the skin n/a x


7. Muscular analysis of movements required:
Muscle Required?
Shoulder flexion x
Shoulder extension
Shoulder abduction x
Shoulder adduction x
Shoulder internal rotation
Shoulder external rotation
Elbow flexion x
Elbow extension x
Wrist supination x
Wrist pronation x
Wrist flexion x
Wrist extension x
Thumb flexion x
Thumb abduction x
Finger flexion x
Finger extension x
Trunk flexion x
Trunk extension x
Trunk rotation x
Lower extremities x

8. Body structures required:


Category

Body Structure
Required?
Check If
Yes
Nervous system Frontal lobe x
Temporal lobe x
Parietal lobe x
Occipital lobe x
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Midbrain X
Diencephalon X
Basal ganglia X
Cerebellum X
Brain stem X
Cranial nerves X
Spinal cord X
Spinal nerves X
Meninges X
Sympathetic nervous system X
Parasympathetic nervous system X
Eyes, ears, and related Eyeball: Conjunctiva, cornea, iris, retina, lens, vitreous body X
structures Structures around eye: Lachrimal gland, eyelid, eyebrow,
external ocular muscles
X
Structure of external ear X
Structure of middle ear: Tympanic membrane, Eustachian
canal, ossicles
X
Structures of inner ear: Cochlea, vestibular labyrinth,
semicircular canals, internal auditory meatus
X
Voice and speech
structures
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
Cardiovascular system Heart: Atria, ventricles X
Arteries X
Veins X
Capillaries X
Immune system Lymphatic vessels X
Lymphatic nodes X
Thymus X
Spleen X
Bone marrow X
Respiratory system Trachea X
Lungs: Bronchial tree, alveoli X
Thoracic cage X
Respiratory system
(continued)
Muscles of respiration: Intercostal muscles, diaphragm
Digestive, metabolic, Salivary glands X
and endocrine systems Esophagus X
Stomach X
Intestines: Small and large X
Pancreas X
Liver X
Gall bladder and ducts X
Endocrine glands: Pituitary, thyroid, parathyroid, adrenal X
Genitourinary and Urinary system: Kidneys, ureters, bladder, urethra
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reproductive systems Structure of pelvic floor
Structure of reproductive system Ovaries, uterus, breast and
nipple, vagina and external genitalia, testes, penis, prostate

Structures related to Bones of cranium
movement Bones of face X
Bones of neck region
Joints of head and neck X
Bones of shoulder region X
Joints of shoulder region X
Muscles of shoulder region X
Bones of upper arm X
Ligaments and fascia of upper arm X
Bones of forearm X
Wrist joint X
Muscles of forearm X
Ligaments and fascia of forearm X
Bones of hand X
Joints of hand and fingers X
Muscles of hand X
Ligaments and fascia of hand X
Bones of pelvis region X
Joints of pelvic region X
Muscles of pelvic region X
Ligaments and fascia of pelvic region X
Bones of thigh X
Hip joint X
Muscles of thigh X
Ligaments and fascia of thigh X
Bones of lower leg X
Knee joint X
Muscles of lower leg X
Ligaments and fascia of lower leg X
Bones of ankle and foot X
Ankle, foot, and toe joints X
Muscle of ankle and foot X
Ligaments of fascia of ankle and foot
Structures related to Cervical vertebral column X
movement (continued) Lumbar vertebral column X
Sacral vertebral column X
Coccyx X
Muscles of trunk X
Ligaments and fascia of trunk X
Skin and related
structures
Areas of skin: Head, neck, shoulder, upper extremity, pelvic
region, lower extremities, trunk, and back

Structure of skin glands: Sweat and sebaceous X
Structure of nails: Fingernails and toenails X
Structure of hair

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9. Performance skills required:

Skill Required? How the Skill Is Used

Motor/praxis

X

Pulls chair in to sit; moves around textbooks, laptop, and
backpack.
Sensory (perceptual)

x

Differentiates between different writing instruments and
other school materials.
Emotion regulation


x
Does not scream when there is a shooting pain going up and
down the legs (piriformis syndrome) during class.
Cognitive

x

Understands the materials presented in the power point
slides.
Communication/social


X

Answer and ask questions to teacher and peers during class.


10. Performance patterns:
Parts of this occupation has elements of which of the following: (check all that apply)
Pattern Describe
x Useful habit Turns to the chapter in the textbook for more visual representation of the
power point slides.

x Dominating habit Bites pen when nervous or anxious.

X Routine Turns on the laptop to pull up the current power-point for the class.

X Ritual Sits on the same side of the classroom every school day.
x Role Being a graduate student in an occupational therapy program.



Intervention Plan
1. Identify 1 objective and measurable goal of the intervention:
a. According to OTPF what type of outcome is this?
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Adaptation such as bringing a donut cushion to sit on during class should be utilized to
help sooth pain and to prevent further pinching of the sciatic nerve. The donut cushion
will help to decompress the piriformis muscle, which in turn, will alleviate the
entrapment of the sciatic nerve. This can help soothe the shooting pain localized around
the lower extremity on the affected side as well as prevent further damage to the body
structures involved.

2. Intervention approach:

Approach Describe
Create/promote Performance patterns: Take stretch breaks every half hour in the back of
the room so to not disrupt the rest of the class.

Establish/restore Client factors: Collaborate with the school to fundraise for more ergonomic-
friendly chairs and tables or counter-height desks.

Maintain Performance patterns: Maintain piriformis stretches at home before coming
to class every morning.

Modify Activity demands: Modify the clients seating by placing a donut cushion
under the gluts so that the muscle is resting comfortably for a prolonged
period of time.
Prevent Performance skills: Prevent clients poor posture when sitting in class by
helping client to keep an erect spine (such as using a pillow) to take weight
off of the affected muscle.


3. Activity selection
a. Activity selection: Identify 1 example of each for the intervention plan:
Activity Describe
Occupation-based
intervention
Utilize a donut cushion during class to evenly distribute body weight and
reduce pressure on affected body parts.

Purposeful activity Practice good posture in variety of settings.
Preparatory method Do piriformis stretches every morning to build the affected muscle to be
stronger to sit in class.



b. Discuss how activity selection relates back to occupational profile and occupational
analysis:
The occupational profile gives information about the clients needs and
problems/concerns in regards to the clients occupation. Assessment tools are used to
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analyze the occupational performance through observing, measuring, and inquiring
about factors that may help or hinder the occupational performance. Based on these
important factors, activity selection is required to help the client reach her goal.

c. Discuss how activity selection will support achievement of client identified goals and
goal of the intervention plan
Based on certain activity selections, this can help or hinder the client to reach his/her
occupational goals. The right activity selection can help boost the client to meet goal
expectations faster. For example, my client Mrs. Smith, will undergo the activity of
doing preparatory stretches in the morning before class so that the injured muscle can
become stronger and allow her to engage fully in her occupation as a student in class.

4. Describe how intervention can be graded or adapted and why:
Since Mrs. Smith is in class the majority of the day, she does not have time to focus on
remediating her injury, thus adaptive equipment, such as a donut cushion, can be used to help
alleviate pain.

5. Safety concerns and/or precautions:
Some safety concerns are sitting for prolonged periods of times and not getting up to stretch to
allow for blood flow around the affected area.

6. Discuss the role of the occupational therapy practitioner during the intervention:
The occupational therapist helps to guide the client to achieve the best outcome possible and to
give client-centered approach with therapy. The therapist will pay attention to the clients main
occupation and what the clients intended outcome is so that an intervention plan can be
created to address that. The therapist will try his/her best to effectively meet the needs of the
clients while maintain therapeutic rapport throughout the sessions.

7. Discuss what is expected of the client during the intervention.
The client should follow the intervention plan as best as possible and to keep in mind health and
safety throughout each and every therapy session. The client should not exert more than what
he/ she is capable of and understands his/her bodies limitations. Additionally, the client should
respect and work with the therapist as best as possible so that the goals are met sooner than
later.