OCCT 506: Clinical Reasoning about Occupation

Student: Elisa Dick

Activity: Dancing for the Visually Impaired
Video: http://www.youtube.com/watch?v=_CFCos4d0ls

Date: October 7, 2012

Client-Activity Intervention Plan

Directions: This assignment is to be completed individually. Choose someone that has a disability and observe them performing an
occupational activity. Complete the following sections based on your observations.
Client Information

Clients Occupational Profile

Referral Information

Jerry K. is a 32-year-old male who has been legally blind since

birth. He is capable of distinguishing light and dark. While Jerry
has adapted to his impairment well in day-to-day life, his upcoming
marriage has spurred him to learn to dance for his wedding. He uses
a long white cane with a red tip, the international sign for blindness,
when walking outside of his home. He is able to walk to work,
church, his fiances house, and other important places to fulfill his
various roles using carefully set routes with which he is very
familiar. When completing ADLs and IADLs at home, he uses
touch to sense where things are in his carefully arranged cabinets
and refrigerator.
Jerry is seeking services in assistance with dancing because he is
afraid of potential injury to himself or others. He did dance once in
high school, and enjoyed it but ran into another dancer. Because of
this event, he never attempted dancing again. Jerry has since gained
confidence in his abilities as a visually-impaired man, and, with the
encouragement of his fiance, would like to try again. Jerrys
priority is being able to lead while dancing with his fiance at their
wedding and completing the task safely.
Jerry was referred to occupational therapy by his case manager at
the Blind Center of Nevada, Miranda Liu, (702) 642-6000 ext. 15,
1001 N. Bruce Street, Las Vegas, NV 89101. His diagnosis is
visually impaired and is under the treatment of Dr. Frank Wells,
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

Describe the goal of the activity and

why the client is completing it

Activity Description

Long-Term Goal
Intervention Goals

Short Term Goal

Activity Preparation

Practitioners role

Personnel required to complete the

preparation
Required preparation steps and time
for each step

M.D., (702) 672-5300, 143 Warm Springs Blvd., Las Vegas, NV

89101.
The goal of Jerrys therapy is for him to be able dance the first
dance at his wedding with his wife. Jerry is somewhat fearful from
a past injury while attempting dance and needs confidence to
assume his this role. He wants to be able to take an active role in
leading, with his fiance playing a minimum role in assisting him.
Jerry will improve his improve spatial awareness, coordination, and
increase vestibular function to complete the activity safely. Jerry
wants to do this as he is has improved in his abilities as a visuallyimpaired man and wants to take on a new challenge, and then
demonstrate this new ability in the social context of his wedding.
Within 2 weeks, Jerry will be able to dance his entire 4-minute first
dance routine leading his fiance with no assistance.
Within 1 week, Jerry will be able to lead his fiance to dance the
box step for two minutes with moderate verbal cues from his
therapist.
The occupational therapist has ballroom dance expertise and will
teach Jerry the box step dance routine. This will work on his
improve spatial awareness, coordination, increase vestibular
function, and improve self-confidence in the process.
After receiving the referral from Ms. Liu, only the occupational
therapist is required to prepare the activity.
The first step in preparation is to determine the dance in which to
be taught. The OT will use a simple dance she has taught several
times before and is already proficient in teaching, so this step only
takes 5 minutes of reflection. Second, she will locate the music she
has previously used to accompany the dance, and bring in on a CD
to the therapy room this takes 2 minutes to locate the CD at home.
She also insures that the space is ready for the activity, which
consists of visually examining the space for obstacles, which takes
30 seconds. Lastly, she confirms the therapy appointment with the
client via email and tells the two to wear comfortable clothing,
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

Required place and space

Required materials
Required equipment

Safety precautions
Activity
Implementation

Personnel required

Setting and location

Space required

taking 2 minutes to compose and send the email.

The space to be used is an area within an outpatient rehabilitation
clinic where the OT works. It is a portion of the therapy room
measuring 25 feet by 20 feet. This space is open and contains no
obstacles. The flooring is linoleum with good traction to prevent
slippage. Sounds in the therapy area are an important consideration
as Jerry is hearing-impaired and learns primarily through verbal
cues. Although the space is adjacent to a shared therapy area, it is
fairly quiet as it is a good distance from other clients and is only
used by 2-4 people at a time.
A Bee Gees CD containing the track More Than a Woman will
be used. The OT brings this from home to work for use in the
activity.
A boom box will be used to play the song for the dance routine. It is
already located in the area to be used and is designated for use in
such activities. It is durable for use in therapy and contains a
volume control so that the sound can be set to the appropriate
volume.
The most important precaution is that the space be clear of
obstacles. The OT visually examines the floor to detect objects. She
also looks for any wet spots that could be potentially slippery.
The OT, Jerry, and his fiance will be involved in the activity. The
OT will provide instruction on the dance steps and provide trained
OT specifics on how to make the activity successful for the
visually-impaired. Jerry will learn the dance steps and learn to lead
his fiance in the steps. Jerrys fiance, Midge, will also learn the
dance. She will also provide verbal encouragement to Jerry.
The space to be used is an area within an outpatient rehabilitation
clinic. The clinic is located 3 blocks from Jerrys house. On the
days of therapy, Midge drives to Jerrys house. The couple then
walks together to the clinic.
The space to be used is an area within an outpatient rehabilitation

(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

Required materials
Required equipment

Required steps and time for each

step

clinic where the OT works. It is a portion of the therapy room

measuring 25 feet by 20 feet. This space is open and contains no
obstacles. The flooring is linoleum with good traction to prevent
slippage. Sounds in the therapy area are an important consideration
as Jerry is hearing-impaired and learns primarily through verbal
cues. Although the space is adjacent to a shared therapy area, it is
fairly quiet as it is a good distance from other clients and is only
used by 2-4 people at a time.
A Bee Gees CD containing the track More Than a Woman will
be used.
A boom box will be used to play the song for the dance routine. It is
already located in the area to be used and is designated for use in
such activities. It is durable for use in therapy and contains a
volume control so that the sound can be set to the appropriate
volume.
1. First the OT will teach Jerry and Midge the basic box step.
She will begin with verbal instruction such as right foot
steps back 1 foot, left foot steps back 1 foot.
2. Simultaneously, the OT will teach Midge with opposite
steps to follow Jerry such as right foot steps forward 1 foot,
left foot steps forward 1 foot. The first 2 steps will take 40
minutes to teach in conjunction.
3. Once the basic step has been learned proficiently, Jerry and
Midge will practice it with music. This will make the
activity harder because it will be faster and it will check for
proficiency. This step will take 5 minutes.
4. Now the OT will teach the pair the turning box step. Jerry
will now be responsible for leading Midge in a circular
pattern. The OT gives verbal cues to keep him centered in
the open space to avoid obstacles. This will take 10 minutes.
5. The next step is teaching a front turn. Jerry will need to be
aware of spatial relationships to maneuver Midge under his
arm. This will take 5 minutes. This concludes what will be
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

Domain

taught the first therapy session.

6. To begin the next session, the OT will test for competency
in what was previously taught. Jerry will dance the box step
with front turns to music for 5 minutes.
7. Next the OT will teach Jerry and Midge a back turn. This
will take 5 minutes.
8. The OT will teach Jerry the choreographed routine,
comprised of steps he has already learned. This will take 40
minutes.
9. The end of the song has a dip, which will be taught next.
The OT will be careful to make sure Jerry has spatial
awareness of himself, Midge, and the floor so this is safe.
This step takes 5 minutes.
10. After the routine has been taught comes practice. The next
session will be devoted to practicing the dance with music.
The OT will give fewer verbal cues to keep them centered
on the floor as they progress. The OT will also check that
Jerry has the confidence to lead and that Midge feels
comfortable and safe. This will take 1 hour
Safety precautions
The most important consideration is that the area is clear of
obstacles because Jerry cannot see and could trip or run into them.
It is also important that the flooring surface have good traction and
be free of spills or anything that could cause slipping. The OT will
carefully watch Jerry to make sure he stays in the middle of the area
and does not get too close to the walls, floor, or people. The OT will
work to prevent these accidents by improving Jerrys spatial
awareness, coordination, and increasing his vestibular function.
Another precaution is noise. Because Jerry is visually impaired he
receives information through verbal cues. If the room were to
become crowded and noisy, Jerry might not be able to hear the OT
cues and could run into a wall.
Describe how the activity overall fits Step 1
into the domain(s) of occupational
In step 1, the OT is teaching Jerry the basic box step. For Jerry, this
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

therapy in detail. Consider:

Areas of Occupation
Client Factors
Performance Skills
Performance Patterns
Context & Environment
Activity Demands

activity fits into the category of education. He is learning a new

skill in a structured environment to pursue an area of interest. It
also falls into the leisure category because he is exploring an
interest that he may continue on his own. Social participation is
another important domain. He is interacting with the OT and Midge
during this step. He is in very close contact with his fiance while
they dance which can promote intimacy. Jerrys client factors
include his motivation to learn dance. He values that a couple
should complete a first dance together after they are married. His
belief is that he can acquire this new skill. Jerrys ongoing
dedication to learning new things despite his disability gives
purpose in his life, therefore this step falls under spirituality also.
In order for Jerry to learn, many body structures are required. Very
importantly, he uses his ears to hear the verbal instruction because
he cannot see it. He uses vestibular and proprioception to feel
gravity and know where he is in space in relation to the floor and to
Midge. Touch is important to maintain contact with Midge. He will
use cues to pressure to direct her when he leads.
Many mental functions are required for Jerry to learn the basic step.
He will use sustained attention listening to the instruction and
attention to where he is placing his feet. When learning the box
step, the instructions will be in his short term memory. He may
need to discriminate sounds he hears if other people are talking in
the room. Once he has learned the step, he will use mental
sequencing to carry out the movement pattern. It is important that
Jerry has a high level of consciousness to be cognizant of what he is
learning. Jerry is very emotionally stable and motivated to learn,
which is why he has decided to learn to dance.
Since Jerry is learning a movement, neuromusculoskeletal
considerations are important. For the activity to be safe, he needs a
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

normal range of motion in all joints structural integrity. He will be

using his shoulder, elbow, wrist, finger, and hip joints constantly as
well as spinal articulation as he positions his torso. Jerrys muscles
must have tone, strength, and endurance to power his movements.
Because he is visually-impaired, Jerry must have good muscle
action to right and control his involuntary movements and
coordination to control voluntary movements.
Jerrys cardiovascular system must be healthy as the dance will
increase his heart and respiratory rates. Because Jerry walks often,
his heart is well conditioned. Jerry will also increase his breathing
when sustaining the dance for several minutes to that his body
receives adequate oxygen.
Jerry will ask questions about what he is learning using his voice
and associated structures. This is especially important because of
his visual impairment. It is important that Jerrys digestive and
urinary systems be functional so that he can sustain his therapy for
one hour. Jerrys skin must also be intact and resilient because he
will use his hands to grasp Midges hands and place pressure on her
hands, shoulders, and hips.
This step will require a large space to avoid potential injuries. The
space is clear of objects and has very few other people. The room
must be lit so that the OT and Midge can see what they are doing. It
is important that the room not be too loud so that Jerry can hear
verbal cues. No equipment is used in this step because music is not
yet used. Jerry must wear comfortable clothing and shoes with
traction to make dancing safe and comfortable.
A social consideration is Jerrys relationship with his fiance. She is
very trusting of him and they will communicate while dancing to
ensure they are comfortable and enjoying their selves. Another
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

important activity demand is sequencing and timing. Jerry is

learning the steps of the dance, the order in which they occur, and
the timing intervals between them. To participate in the activity,
Jerry must possess the mental, sensory, and physiological
capabilities explained earlier.
Important performance skills are needed to learn the box step.
Because Jerry is visually-impaired, be must rely heavily on his
motor and praxis skills. He will carry out the sequential motor act
of dancing while pacing his movements, maintaining balance, and
coordinating his body movements.
Likewise, Jerrys sensory perceptual skills will be used extensively.
He will position his body in space in several ways. First, his
extremities will be positioned in relation to the rest of his body.
Second, his body will be positioned in relation to Midges. And
lastly, his body will be positioned relative to the floor. He will use
sensory perception do determine these positions. Jerry will also use
hearing to receive cues from the OT.
Jerry is very balanced emotionally, and is therefore prepared to do
this challenging activity. Others may experience frustration or anger
from the difficulty of the task. Jerry will use cognition to judge
whether a move is safe and use sequencing to carry out the action.
Communication and social skills are important for Jerry. Because
he cannot see how the dance is supposed to look, he relies on verbal
cues and coordination to carry out the movements. He also must
communicate with Midge both verbally, and through tactile cues to
lead her. Verbal communication between the couple is important as
Jerry will not see visual cues such as facial expressions.
Jerry will develop performance patterns when he learns the box
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

step. The organization of the steps forms a routine which will

become automatic once his is proficient. His has two roles in the
activity. In one he is the student, learning the dance from the OT.
The other role is the lead to his fiance in dancing.
The contexts of this step fall into many categories. Culturally, it is
normal in the population of the US for a couple to do a first dance
together after being married. It is also part of the culture for the
man to lead. For Jerry, his personal context is that he is a 32-yearold man with a visual impairment. He has a job and is getting
married soon. Temporally, the activity is occurring on 3 consecutive
Mondays from 4-5PM. This is occurring 4 months prior to Jerrys
wedding so that he will have adequate time to prepare.
The physical environment is the rehab clinic in which the activity
takes place. The social context is the interaction between the OT,
Jerry, and Midge. It is important that they build report for the
activity to be successful.
Step 2
In this step, the OT is communicating to Midge her role as Jerry
leads her. Many of the considerations are the same as those for
Jerry, so I will highlight the differences.
For Midge, learning to dance is also primarily an educational area
of occupation. She is learning in a structured environment from the
OT. She is also enjoying a leisure activity and participating in a
social event.
Midges client factors include her belief in Jerry. She is undertaking
this activity because she believes that Jerry will be successful and
will safely dance with her despite his visual impairment. She also
values being able to dance at her wedding.
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

Midge must possess the same mental, physiological, cardiovascular,

auditory, and sensory perceptual body structures and functions as
outlined above for Jerry. Additionally, Midge has normal vision and
will use it to see the dance steps to be learned. She will also use her
vision to alert Jerry if they are not in the center of the room.
Activity demands are lesser for Midge because Jerry will be leading
her in the dance. She must still possess the sequencing and timing,
performance skills, body structures, and body skills outlined above.
However, she will only need to follow Jerry and not initiate the
dance and direct the movement.
Midges performance skills are very important to the activity, and
are much the same as Jerrys described above Even though she has
normal vision, she still must have spatial awareness in relation to
her body, Jerrys body, and the floor. She will also visually
determine if the couple is too close to the wall. She must possess
emotional regulation to not get scared or upset with either Jerrys
dancing skills or her own.
Like Jerry, Midge is learning a routine. The pattern of the box step
will become more familiar with practice. She will also develop the
habit of feeling for Jerrys lead in the dance. Midges role in this
step is of a dance partner and fiance offering support to her future
husband.
This step will fall into the same contexts and environments as
outlines in step 1 above.
Step 3
Step three is doing exactly what was done in steps 1 and 2, but with
music. In this step it will be especially important for both Jerry and
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

Midge to possess the body structures and functions related to

hearing. The will also use more cognitive processing to sequence
their movements in time with the music. Both will need continued
emotional regulation skills because this step is harder that the ones
before. They will need to cope with the increased difficulty of the
task.
Step 3 also requires two pieces of equipment, the boom box and the
Bee Gees CD. The boom box must be plugged in and set to a
volume where the music can be heard but is not too loud. The CD
must be free of scratches and placed in the boom box.
Step 4
In this step, the OT will teach Jerry the turning box step. Now Jerry
will lead Midge in a gently swirling pattern, not just aligned to the
planes of the walls. This step will have the same areas of
occupation, client factors, activity demands, performance skills,
performance patterns, and context and environment as given for
Jerry and Midge respectfully above.
Step 5
In the next step, the OT will teach Jerry a front turn, and teach
Midge how to follow that turn. Jerry will need to be especially
aware of spatial relationships to maneuver Midge under his arm.
This step involves the same areas of occupation, client factors,
activity demands, performance skills, performance patterns, and
context and environment as given for Jerry and Midge respectfully
above.
Step 6
This step is similar to step 3 above, as it introduces music to test for
competency. The boom box and CD will be used as equipment.
Jerry and Midge will use sensory processing to sync their
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

movements to the tempo of the music. This step will have the same
areas of occupation, client factors, activity demands, performance
skills, performance patterns, and context and environment as given
for Jerry and Midge respectfully above.
Step 7
In this step the OT is teaching the couple an additional turn. This
step will have the same areas of occupation, client factors, activity
demands, performance skills, performance patterns, and context and
environment as given for Jerry and Midge respectfully above.
Step 8
This step is very important as the actual routine will be taught in
conjunction with the music. Although the routine is comprised of
elements in which Jerry and Midge are already proficient, they will
not learn a specific pattern of movement. Jerry and Midge will now
use mental body functions to be attentive in learning the routine and
will commit the routine to long-term memory. This will require
continued practice to that the routine stays familiar in their minds.
In this step, the activity demand of sequencing and timing also
increases. Both the order of the moves (sequence) and how they
sync with the music (timing) are especially important. The dance
will also become a performance pattern for Jerry and Midge as the
routine is practiced daily. Otherwise, this step will have the same
areas of occupation, client factors, activity demands, performance
skills, performance patterns, and context and environment as given
for Jerry and Midge respectfully above
Step 9
In this step, the OT teaches the final part of the routine, a dip at the
end of the song. This movement increases the activity demands, so
that the importance of client factors will also increase. Both Jerry
and Midge will need increased attention on the task because it is
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

potentially dangerous. The sensation of pressure will be very

important because Jerry will hold Midge very tightly as he gently
bends her over. Jerry will need proprioception and vestibular
functions and structures to gauge his position to the floor so that he
does not bend over too far. He will also need more muscle strength
to hold Midge as he leans her over. This step will have the same
areas of occupation, client factors, activity demands, performance
skills, performance patterns, and context and environment as given
for Jerry and Midge respectfully above.

Process

Discuss how you have utilized the

occupational profile, activity
preparation, and activity
implementation to achieve
occupational therapy outcomes.

Step 10
In this step the routine will be practiced several times with music.
The OT will give minimal verbal cues as Jerry is not quite
proficient in the activity. The couple will continue to repeat this
step at home by practicing the routine every day until their
wedding. Through practice the routine is habit, becoming a routine
for both Jerry and Midge in their performance patterns. This step
will have the same areas of occupation, client factors, activity
demands, performance skills, performance patterns, and context and
environment as given for Jerry and Midge respectfully above.
From Jerrys occupational profile I learned that Jerry is very
functional and confident despite his disability. Using this
knowledge I designed an activity that would be the right fit for
Jerry, both challenging an attainable. From his profile I learned his
fiance was very supportive of Jerry and willing to participate in
the activity, therefore the activity of a paired dance is appropriate.
I used the occupational profile and my analysis of Jerrys situation
to devise the intervention plan. When preparing the activity it gave
me an idea that safety considerations would be important in
choosing the space. Implementing the plan was successful because
the design of the plan builds checking for competence and
understanding into the steps, very important when learning an
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

increasingly complex activity. Jerry and the OT collaborated in

finding a learning style that was effective through communication
and trial and error. The results were that Jerry was able to learn the
dance safely and enjoyed doing so.

SOAP Note

Subjective

Objective

Assessment

Jerry is now able to add the occupation of dancing to his life. By

dancing, he is staying in shape physically and participating in a
social activity that will build his relationship with Midge, resulting
in increased health and wellbeing. The outcome of the intervention
is that Jerry will be able to do a first dance at his wedding, fulfilling
a goal of both Jerry and Midge.
The following SOAP note will pertain to Jerrys first session,
although steps for both his first and second sessions are given
above.
Jerry was excited to participate in the dance activity, although he
expressed some apprehension as to the safety of both himself and
his fiance, Midge. Midge accompanied Jerry to the intervention
and reported she was willing to participate and confident in Jerrys
abilities.
Jerry participated in dancing activity for 1 hour to improve spatial
awareness, coordination, increase vestibular function, and improve
self-confidence so that he may participate in social dance. Using
aural processing to learn steps, Jerry sustained activity for 10
minutes with minimal tactile and maximum verbal cues. After a
break he sustained 30 minutes of dance with moderate verbal cues
only. The last 20 minutes only minimal cues were required.
Jerry made excellent progress learning to dance by heightening his
spatial awareness, improving coordination, and increasing his
vestibular function to overcome his visual impairment. With one
more session, Jerry should be able to improve his sensory
perceptual skills and improve his confidence to enable his
participation in dance so that he may engage in the occupations of
(Modified from Hersch, Lamport, & Coffey, 2005)

OCCT 506: Clinical Reasoning about Occupation

Plan

leisure and social participation.

Continue working on Jerrys perceptual skills so that Jerry will
require fewer verbal cues when dancing, therefore improving his
self-confidence.

(Modified from Hersch, Lamport, & Coffey, 2005)