Running head: PROFILE AND INTERVENTION PLAN

Occupational Profile and Intervention Plan: Traumatic Brain Injury

Talia Bartolotta
Touro University Nevada

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Occupational Profile
At the beginning of the initial evaluation, an occupational therapist gathers an
occupational profile of the client. This allows the therapist to gain a thorough understanding of
who the client is and how his or her priorities align with established roles, habits and routines
both in the past and the present (Chisholm & Schell, 2014). The occupational profile also
describes the clients perceived level of functionality and performance in desired occupations.
The Client
Alex is an 18-year-old male who sustained a traumatic brain injury (TBI) on July 4, 2014
secondary to an ATV accident. He was in an acute care facility for six months before being
transferred to sub-acute rehabilitation, where he has resided ever since. While in the hospital, he
underwent a tempoparietal hemicraniectomy to relieve the symptoms and detrimental effects of
the intracranial pressure resultant of the subdural hematoma obtained during the accident. He has
right hemiplegia and poor postural control, which both greatly impact his ability to complete
activities of daily living (ADLs) and instrumental activities of daily living (IADLs). He has been
participating in occupational and physical therapy for nearly seven months.
Before the accident, the client lived with his parents and three brothers. As a family, they
were active in church, which is displayed through the various posters and pictures in Alexs room
at the rehabilitation facility. He was an active teenager who was about to begin his senior year of
high school. The client completed all functional mobility on his own, and now operates his
electric wheelchair with modified assistance. He started his first job at Capriottis less than a
month prior to the accident.

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The client is non-verbal and communicates with a thumbs up or thumbs down response.
When asked, the client expressed an interest in watching soccer, basketball, and movies. He
enjoys spending time with other residents of the facility and likes when his family comes to visit.
Reason for Services
As previously stated, the client sustained a traumatic brain injury nearly sixteen months
ago leading to many functional impairments. The client is seeking occupational therapy services
in hopes of remediating the physical skills, strength, and endurance lost as a result of the
accident. He would like to learn how to implement compensatory strategies to ensure safety and
facilitate independence at home and in the community.
The parents would like their son to achieve several milestones before he is discharged
from inpatient therapy services. They want the client to safely complete transfers independently.
They also stated their desire for a more thorough communication system to be put in place so
they can have a better understanding of the clients wants and needs before he returns home and
they assume the role as the primary caregivers. The implementation of any necessary and
appropriate compensatory strategies or equipment to promote the success of the client are
encouraged by the parents. The parents would also like to receive education on how to properly
care for their son in regards to positioning and transfers.
Occupation Success and Barriers to Success
When asked, the client expressed with a thumbs up and a smile that he feels pleased with
the improvement that he has made in several occupational areas. Although the client is not able
to complete activities at the same level he was prior to the accident, he appears to be happy with
the recent gains he has seen in his overall strength, range of motion, and endurance. The
increases in these areas have led to improvements in more meaningful tasks such as donning and
doffing clothing and completing grooming tasks. He enjoys the freedom to feed himself with
minimal assistance, especially since he was unable to do so just one month before.

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Barriers inhibiting the clients success occur on a personal, familial, and societal level.
On a personal level, poor postural stability is currently hindering the clients performance in
many areas. An unsteady sitting posture that requires maximal assistance to maintain makes it
difficult for the client to doff his gown, don clothing, and complete activities that require balance
and dynamic reaching. The clients premorbid behaviors, in conjunction with the post-injury
behaviors, are also negatively affecting the clients occupational engagement. He frequently
becomes easily frustrated, also inhibiting his ability to attend to an activity from start to finish.
The client is affected at the familial level because his parents do not have the skills or
access to all of the resources needed to bring him home. At this time, they are not comfortable
transferring the client, especially on and off the commode. They do not feel like they can provide
the client with what he needs because of the clients inability to express his needs or desires.
Lack of knowledge and attention at the societal level may have potentially led to the
development of learned non-use in the clients right extremities. Because the clients impaired
hand was not incorporated into any activities before reaching this current rehabilitation facility,
he has developed learned non-use of the right hand. As a result, he is currently experiencing
difficulty with any activities that require bilateral coordination. Therapy caps, limited access to
resources, and individuals intolerance of disabilities also inhibit the client at the societal level.
Environments and Contexts and Their Impact on Overall Success
Overall, the clients contexts and environments are promoting improvements and success
in functional performance. The physical environment where the client currently resides provides
access to a rehabilitation team that daily addresses his present deficits. Within the facility, the
client is provided the space, assistance, materials, and tools needed to complete many activities,

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both preferred and non-preferred. For example, he is able to receive help with bed mobility or
transfers whenever he desires, and is able to watch sports or movies in his room at any time.
The clients cultural, personal, and social contexts are also positively affecting the client.
The familys firm belief in the healing ability of Christ provides consistent motivation for the
client, parents, and brothers. The hard work ethic instilled within the parents is evident through
their incessant drive and effort to return the client home, while maintaining steady employment
to support the younger boys. This consistency and persistence will continue to benefit the client
now and after he has been discharged home. Whenever family or friends visit, the client is eager
to sit upright in bed or his wheelchair and attend to the conversation and activity around him.
These frequent mental and physical challenges will help the client gain strength and endurance.
Although most improvements are made within the first twelve months following injury,
skills can be regained after the one year mark but generally occur at a much slower rate (TiptonBurton, McLaughlin, & Englander, 2013). With that being said, the clients temporal context is
impacting him negatively because the accident was nearly fourteen months ago and he has made
significant improvements in only a few areas. On the other hand, the clients age can be a
predictor of success because as a 17-year-old at the time of injury, he had already established
many physical and cognitive skills (Turkstra, Politis, & Forsyth, 2015). The client is only able to
relearn skills that he already possessed and is why research links older age at injury with a more
positive long term prognosis (DePompei, 2010).
Occupational History
As an active and athletic young male, the client regularly participated in a wide variety of
occupations. He competed in various sports including basketball, football, and soccer as an
adolescent and a young teen, but stopped playing at the competitive level once he entered high

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school. His parents contribute this to the clients desire to be with his friends as often as
possible. He hiked at least once a week during the six months leading up to the injury and was
outside as often as possible despite the summer heat. According to the parents, the client was an
avid gym goer and was constantly concerned with being as healthy as possible.
The client had been a student nearly all of his life. He had a history of behavioral
problems, which were addressed through an Individualized Education Plan and the collaboration
of his teachers and parents. In addition to the behavioral issues, the client had difficulty earning
grades that his parents considered satisfactory. The client was frequently encouraged by his
parents to complete his homework, prepare for tests, and eventually pursue a college degree.
As stated before, the client recently begun his first job. While on the job, the client stood
for many hours as he served customers and kept the kitchen and dining area clean. The parents
reported that the client was excited to be earning money of his own and that they were hoping
this structured schedule would help decrease the behavioral problems seen before the accident.
Values and Interests
According to the parents, one thing that the client values most in his life are his
relationships, especially with his friends. It is apparent that the client values his family members
and the company and support they provide, as he lights up each time they come to visit him. His
religion is important to him as is evidenced by the pictures and decorations currently in his room.
The client has not only expressed an interest in returning home, but also in completing as
many activities as possible independently. He is nearly always open to learning new strategies or
how to use adaptive equipment presented to him during therapy. Through yes or no questioning,
the client indicated that he is interested in obtaining his diploma and a new job in the future.
Roles

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The client assumes many roles through his day-to-day life. He is the son of two loving
parents, a brother to three younger siblings, as well as a grandson, nephew, and a cousin to many.
Before the accident, the client had a large group of close friends with whom he spent most of his
time both in and out of school. Unfortunately, this external support system has dwindled over
the course of the clients recovery. As reported by his parents, the client enjoyed the
responsibilities that all of his relationships carried, as he took pride in being able to provide
physical and emotional support to many. The parents also stated that they observed a sense of
independence in the client through his employment at Capriottis. The clients repeated poor
performance on his report cards indicated that the client did not place emphasis on his role as a
student.
Engagement in Occupations
The client was independent in all ADLs and IADLs before the accident occurred. He did
not require any assistance with cognitive tasks, and performed at a high physical level in
basketball, soccer, hiking and gym activities, such as lifting weights. He was able to
communicate verbally, as well as through written language.
As a result of the injury, the client lost this functional independence. The diversity of his
occupational engagement has decreased significantly, with the client no longer being able to
complete most of his desired occupations. He requires at least a minimal assistance for all tasks.
Since admission to the rehabilitation facility in January of 2015 to now, the client has
made many improvements. Upon arrival, the client was unable to respond to any stimuli whether
it be auditory, tactile, visual or kinesthetic. The client has slowly regained strength, endurance,
and cognitive capacity. He is currently able to follow three step directions with minimal verbal

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cueing. The client has recently required minimal to moderate assistance with grooming and
feeding tasks, rather than being completely dependent like he has been since the accident.
Priorities and Desired Targeted Outcomes
Both the client and the family have expressed high expectations in regards to the level of
independence that will be reached. As was discussed previously, the parents targeted outcomes
include independent transfers, establishing a more thorough communication system for the
client, and ensuring that the client be as independent as possible in self-care tasks. They would
like the client to continue to fulfill his role as a son, brother, grandson and cousin while
remaining healthy and avoiding any secondary complications associated with acquired traumatic
brain injuries. Both the client and the family hope that he will be able to engage in desired
occupations as independently as possible to ensure a maintained sense of well-being and,
therefore, increase the clients quality of life. Despite the reliance on a wheelchair, the client
strives to be rehired at Capriottis or at a similar place of employment.
Occupational Analysis
An occupational analysis is completed to assess the clients functional performance level
through observation of the completion of daily activities. It allows the occupational therapist to
identify the strengths and weaknesses of a client in order to assist in the development of the
intervention plan. As a whole, the occupational analysis provides objective data, whereas the
occupational profile is routed upon subjective data (Chisholm & Schell, 2014).
Activity Performance
The client routinely completes several activities within one treatment session. One
observed activity required the client to grab a poker chip with his left hand while crossing
midline. The poker chip was then brought back across his body to be placed in the bin directly in

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front of him. As the left arm engaged in this task, the right hand was placed on the bed in an
attempt to encourage weight-bearing through the upper extremity. Because the client required
maximum assistance to maintain this seated position, the right hand quickly returned to its
resting contracted position. Throughout the entire activity, the client required also required many
verbal, tactile and visual cues to sequence and complete the entire task.
Key observations. The client displayed significant weakness in his proximal trunk,
causing impaired balanced and motor movements of the arm and fingers. The client was unable
to sit upright independently edge of bed and required maximum assistance to do so. He appeared
to fatigue quickly, resulting in an increased number of cues as the task progressed.
Setting of Occupational Therapy Services
The client is being seen in an inpatient sub-acute rehabilitation facility. The client resides
within this setting because he currently requires more assistance than his parents are able to
provide him at home. Within this setting, he is being seen by occupational and physical therapy
to promote successful occupational engagement. His therapy sessions focus on increasing
independence in ADLs and IADLs by addressing present deficits in strength, right side neglect,
and poor proximal stability. Intervention should also include the implementation of
compensatory strategies and adaptive equipment to address both cognitive and physical deficits,
and recommendations regarding potential environmental modifications (Reed, 2014).
Occupational Therapy Domains Impacting Performance
All five of the components found within the domain of occupational therapy are
interrelated and of equal importance (AOTA, 2014). A change, whether positive or negative, in
any one of the five areas causes a change in another area. Deficits that the client is experiencing
in each of the five domains are listed below.

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Occupations
As discussed previously, nearly all of the clients occupations are inhibited by his current
state. He is no longer independent in any area of occupation. Lack of independence has resulted
in minimal occupational engagement.
Client Factors
The client experiences deficits in numerous client factors as a result of his injury. He
displays impairments with voice and speech functions due to the direct impact to the left,
dominant hemisphere of the brain. Secondary impairments include poor joint stability and
mobility, as well as decreased muscle power, tone and endurance.
Performance Skills
Multiple insufficiencies in motor, process, and social skills limit the clients engagement
in occupations. Some of the motor skills impacted include positions, manipulates, coordinates,
calibrates, flows, and endures. The client has difficulty positioning himself correctly in his
wheelchair at the table during mealtime or at the sink for ADL completion. He has trouble with
both gross and fine motor movement, as is evidenced through inaccurate and abrupt movements
and difficulty manipulating and coordinating items such as silverware and a toothbrush.
The client shows deficits in five process skills: attends, handles, initiates, continues and
sequences. All of these inhibit the clients ability to begin or sequence an activity without cueing.
He also requires repetitive verbal, auditory, and tactile cues to maintain engagement and focus
during activities.
Nearly all of the clients social interaction skills are inhibited because he is nonverbal. He
is unable to produce speech, and is therefore unable to ask questions and clarify concepts that he

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does not understand. His only method of communicating is through a thumbs up or thumbs down
response, a cry, a smile, or laughter.
Performance Patterns
Nearly all of the clients previous habits, routines, roles and rituals have been
discontinued due to the accident. He no longer completes his morning routine, does not go to
work or to church weekly, and cannot engage in activities with his friends and family on a daily
basis. He has established new routines that include specific meal, television, and activity times.
Intervention Plan and Outcomes
The intervention plan should be developed in conjunction with the information gathered
from the occupational profile and analysis. It begins by creating problem statements that identify
the occupations affected, the problems contributing factor and how these impact the clients
occupational performance. Once these deficits are identified, long term goals (LTG) and short
term goals (STG) can be established while collaborating with the client to determine his or her
priorities for therapy (Schultz-Krohn & Pendleton, 2013). Activities for intervention are chosen
after the goals are created and the clients habits, roles, and routines are thoroughly understood.
The remainder of this section discusses the problems, goals, and interventions identified
for the client described in the occupational profile. The time frames associated with the goals
have been determined by the setting and the rate the client has been progressing thus far. The
clients current functional ability, support system, and contexts were considered throughout. The
literary works utilized when choosing intervention activities will also be included.
Functional Problem Statements
Five problem statements highlighting the clients current deficits were established. The
first states that the client is unable to complete grooming activities independently due to

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decreased proximal stability. The second addresses the clients impaired communication with the
statement: client is unable to verbalize his basic wants and needs due to damage of higher
language centers. Due to inactivity and the affected arm not previously being utilized, the third
problem statement addresses these areas by stating that the client is unable to independently feed
himself due to poor bilateral coordination secondary to learned non-use. The fourth problem
statement, client is unable to complete dressing activities independently secondary to decreased
postural stability, also addresses occupations of the client that are impaired by poor trunk control.
The fifth and final problem statement states that the client is unable to safely complete transfers
independently due to decreased strength in his extremities as a result of poor proximal stability.
Justification for order of problem statements. The problem statements have been listed
in order of importance. Although the parents have stated independent transfers as one of their
priorities for the client, it cannot be accomplished first. The clients poor proximal stability must
first be addressed because motor development after brain injury occurs in the same pattern as it
does as an infant: from proximal to distal (Mariani, 2010). The communication device will be
implemented after proximal strength is acquired because fine motor skills are needed to operate
the device and fine motor skills will not be refined until proximal strength is established.
Although bilateral control and improvements in learned non-use would increase occupational
engagement, they cannot be addressed until proximal control is established. Independent
transfers will not be attempted until the client gains more strength and stability in his trunk.
Addressing Problem Statement 1
Long term goal. Client will complete 4/5 grooming tasks c Min (A) while maintaining
head alignment by 1/1/15.

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Short term goal 1. Client will wash face & brush teeth c Mod (A) while sitting EOB by
10/1/15. This goal will be addressed first because development occurs in a proximal to distal
manner. According to Pope-Davis and Jordan (2013), without control of the trunk, accurate and
controlled movements of the distal extremities are not possible. The client will complete the
activity while sitting edge of bed because the uneven surface will inevitably challenge the
clients core stability due to clients current level of strength throughout the trunk.
Intervention and Supporting Evidence. While sitting edge of bed, the client will reach
outside of his base of support to grab the items to wash his face and brush his teeth. Reaching
and crossing midline will challenge rotation of the trunk, therefore, increasing strength and
stability. As he reaches with his left hand, he will be prompted to bare weight through the right
arm to increase awareness of the arm and promote neuroplasticity (Takeuchi & Izumi, 2013).
To further increase postural stability, the client will be required to complete dynamic
weight shifting during a meaningful activity. While being supported edge of bed, the client will
toss a basketball into baskets placed varying distances from him. As he reaches to grab the
basketballs from different buckets placed around him, he must weight shift to both the affected
and the non-affected side, depending on where the bucket is located. Weight shifting not only
helps increase awareness and strength of the affected side but also increases proximal stability.
Once the client has retrieved the basketball from the buckets around him, he must manipulate it
within his hand into a proper throwing position. If the client retrieves a ball with his right hand,
he must transfer it to the left hand before throwing. This in-hand manipulation and bilateral
passing encourages neuroplasticity and enhances the development of motor skills (Nudo, 2013).
Once the ball is ready to be thrown, he will aim towards the baskets placed in front of him.
Repeating these motions many times is a critical component of encouraging neuroplasticity

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(Kimberley, Samargia, Moore, Shakya, & Lang, 2010). This intervention uses the
establish/restore approach in hopes of improving the clients occupational performance by
remediating the clients postural stability and use of the right upper extremity.
This activity can be graded up or down to help achieve the just-right challenge, which is
crucial for achieving maximal gains (Skidmore, 2015). To make the activity harder, the buckets
the client must retrieve the basketballs from can be placed farther away, higher, or lower. All of
these positions require the client to reach further outside of his base of support to grab the
basketball. The amount of trunk strength and stability needed increases as the throwing distance
is lengthened, therefore, moving the target baskets farther away will also increase the difficulty
of the activity. To decrease the demands of the activity, the ball can be placed in the clients lap
or directly in front of the client while being held by the therapist. This limits the amount of
postural stability required to complete the activity as it decreases the distance the client must
reach. The target baskets can also be moved closer reduce the stress placed on the trunk.
Short term goal 2: Within 10 treatment sessions, client will (I) maintain an upward eye
gaze with proper head alignment for 30 seconds while completing a grooming activity.
Intervention and Supporting Evidence. The client will position his wheelchair in front of
the bathroom mirror. A neutral or anterior pelvic tilt will be facilitated to encourage correct
alignment and normal patterns of movement. All four sections of the spine will be moved
through the available range of motion in flexion, extension, rotation, and lateral flexion. Both
upper extremities will actively or passively move through the entire range. Ensuring a functional
range of motion is present and maintaining this this range of motion is critical to the clients
successful occupational engagement (Killingsworth, Pedretti, & Pendleton, 2013).

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Once the client has assumed a functional position, he will look upward onto the bathroom
shelf to locate and identify the items required to shave his face. He will receive assistance as
needed to apply shaving cream to his face, guide and control the razor as he completes the
appropriate strokes across his cheeks, and rinse his face once the activity is complete. With both
verbal and tactile cues in conjunction with physical assistance, the client will be encouraged to
maintain proper head alignment with eyes focused to ensure accuracy of movements and safety
while shaving. This intervention was created to re-establish the head alignment and neck strength
the client had before the accident through the establish/restore intervention approach.
Developing proper head alignment will hopefully improve the clients occupational performance
in ADLs, IADLs, as well as social and leisure activities.
Addressing Problem Statement 2
Long term goal. By 4/1/16, client will (I) utilize a voice output device to communicate
his wants and needs. According to Turkstra et al. (2014), individuals possess the ability to learn
new procedures and concepts despite the cognitive deficits incurred after a TBI.
Short term goal 1. By 11/15/16, client will (I) choose desired food items for each meal
time within 2 minutes when given picture icons of 3 food choices.
Intervention and Supporting Evidence. This intervention was designed to promote role
competence by remediating, through the establish/restore approach, the clients ability to
socialize with his family, friends, and medical team. Improved communication will hopefully
allow the client to eventually resume his roles as a student and employee. Intervention will begin
by allowing the client to choose his desired outfit when given two options. Once dressing has
been completed, the communication board with laminated pictures, Velcro, and writing will be
introduced. The client will be educated on its purpose and how to properly use it. Once he

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displays a basic understanding of the board, the client will be asked to categorize words and
items on the board. The categories will include clothes, grooming supplies, food, and leisure
activities. This will test his understanding of the concept and process of the device and the
meaning of the words provided. The development and progression of the clients fine motor
skills and pinch strength will also be assessed through the manipulation of the laminated pieces.
Fine motor accuracy will be important as the client is later introduced to a voice output device.
Implementing this communication board before the voice output system will allow the therapist
to determine which system is appropriate based off the clients cognition and fine motor skills.
Including the family members and caregivers during the implementation of the
communication device is essential as an active support group is a primary component of success
in communication development and maintenance (Maeder, Fager, Collins, & Beukelman, 2012).
As the client continues to implement the device into his daily activities, the family members can
provide feedback and assistance as needed. Educating the clients interdisciplinary team on the
implemented device and protocol will also promote successful use of the device.
Short term goal 2. By 1/1/16, with Mod (I), client will relay his emotions through use of
a voice output communication device when asked by others how he is feeling.
Intervention and Supporting Evidence. Before the client is able to accomplish the goal
listed above, he must possess and display an understanding of emotions. Through use of the
Proloquo2Go app on the iPad, the client will practice linking emotions to pictures or behaviors.
For example, he will match behaviors, such as a smile, with the word happy. This activity was
chosen because the client frequently used an iPhone before the accident and is comfortable with
the apple system. Because the client previously used his phone extensively, it can be assumed
that incorporating technology will motivate the client. Finding what motivates the client

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encourages program compliance, better outcomes and increased generalization (Skidmore,

2015). Once it is verified that the client can properly classify these emotions, he can be
challenged to identify these emotions within himself by pointing to a picture that will be
produced verbally by the device. Single word answers will be encouraged before full sentences
because sentence formation is a higher-level function that comes after word identification and
production (Turkstra et al., 2014). Using single words rather than full sentences uses the modify
approach by simplifying the requirements typically associated with explaining emotions and
feelings. By modifying the way the client currently communicates, it is believed that the clients
participation and engagement in desired occupations will increase.
The client will also complete a sports game of his choice on the iPad. This game must
require fine motor skills in order to refine these skills for use of the voice output device.
Neuroplasticity and the established learned non-use will also be addressed during this
intervention as the client is challenged to hold and stabilize the iPad with his right hand.
Precautions Associated with Rehabilitation after Traumatic Brain Injury
Due to the severity of the clients injury, there are many precautions and contraindications
that must be considered during treatment. As addressed in the chart, the client is at risk for
encephalopathy due to the craniectomy that was performed to stop the internal bleeding. As a
result of decreased activity, the client is at risk for deep vein thrombosis, hydropneumothorax
pneumonia, and pachymeningeal enhancement hydrocephalus. It is also important to remember
that the skills individuals with brain injuries acquire during therapy are not always generalizable,
and therefore should be followed up with an evaluation within the discharge environment (Reed,
2014).

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Frequency and Duration of Intervention Plan

The clients recent growths in active participation during therapy have resulted in an
increase in the frequency of services. He will be seen by occupational therapy five days per
week for 45 minutes each time. These services will continue until the client is discharged,
intervention is no longer increasing functionality, the client requests to discontinue therapy, or
until he has regained all the skills and abilities that were lost. The client will be reassessed
formerly on a quarterly basis, along with informally on a daily basis to determine the
effectiveness of the intervention plan. The occupational therapist will make changes to the
intervention plan and/or determine a timeframe for discharge from therapy as he or she sees fit.
Framework Guiding Intervention Plan
The primary model used to guide this intervention plan is the Model of Human
Occupation (MOHO). Through MOHO, the clients occupational performance is assessed in
relation to his or her daily habits, routines, and priorities, as well as the contexts and
environments in which these occupations occur (Schultz-Krohn & Pendleton, 2013). The goals
of the individuals are determined in order to create an intervention plan that incorporates
activities that motivate the client. Since the primary goal of this plan is to help the client regain
skills he had before the accident, it is important that neuroplasticity occur. As previously
discussed, neuroplasticity is greatest when the client engages in occupations that are meaningful
to them or those that they are motivated by (Skidmore, 2015), thus making MOHO an
appropriate model to guide this intervention.
Client and Family Education
Ensuring that the client and family members receive proper education is a key component
of any successful treatment plan (James, 2014). Education can include a multitude of topics from

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use of durable medical equipment, to the most effective time to take medication, or to the proper
positioning for mealtime. It is imperative to remember that this education can be delivered in a
variety of ways and should match the learning style of each client and family member.
Education must be a primary component of intervention for the remainder of therapy due
to the clients current level of function. Emphasis should be placed on transfers in order to ensure
the safety of both the client and the caregiver. Education on proper bed mobility and wheelchair
positioning techniques will help decrease any potential secondary complications.
The client and caregiver should be educated on all available treatment opportunities,
technology, and equipment in conjunction with how to implement the strategies and treatment
already put into place. Both client and caregiver must be aware of the clients physical and
mental limitations. All parties should be educated on the importance of adhering to the home
exercise programs prescribed.
Assessing the Clients Response to Intervention
Several measures will be used to continually monitor the progress of the client.
Measurements of the right upper extremity will be taken to assess any changes in range of
motion as weight bearing and use of that extremity continue to increase. Second, the parents and
members of the interdisciplinary team will be routinely asked for his or her perception of the
clients level of performance. The client will be monitored for any behavioral and/or physical
changes or improvements in functional performance in order to determine the effectiveness of
the current intervention. The client will be seen by his physician regularly to evaluate any
medical changes.

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References

American Occupational Therapy Association (2014). Occupational therapy practice framework:

Domain and Process (3rd ed.). Baltimore, MD: AOTA Press.
Chisholm, D. & Schell, B. A. B. (2014). Overview of the occupational therapy process and
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occupational therapy (12th ed.). (pp. 266-280). Philadelphia: Lippincott Williams &
Wilkins.
DePompei, R. (2011). Pediatric Traumatic Brain Injury. Retrieved from
http://www.brainline.org/content/2011/01/pediatric-traumatic-brain-injury_pageall.html
James, A. B. (2014). Activities of daily living and instrumental activities of daily living. In B. A.
B. Schell, G. Gillen, & M. E. Scaffa (Eds.), Willard and Spackmans occupational
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Killingsworth, A. P., Pedretti, L. W., & Pendleton, H. M. (2013). Joint range of motion. In H.
M. Pendleton & W. Schultz-Krohn (Eds.), Pedrettis occupational therapy: Practice skills
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Kimberley, T. J., Samargia, S., Moore, L. G., Shakya, J. K., & Lang, C. E. (2010). Comparison
of amounts and types of practice during rehabilitation for traumatic brain injury and
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Maeder, J. M., Fager, S., Collins, K., & Beukelman, D. R. (2012). Representation of potential
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