Running head: FIELDWORK PROFILE

Occupational Profile and Analysis of Field or! "lient #ichelle D$ Ashley %ouro &ni'ersity (e'ada

FIELDWORK PROFILE Occupational Profile "lient %he client is a *+ year old o,an- ho is di'orced- and currently li'es at ho,e ith her parents$ After suffering a spinal cord in.ury fi'e years ago- she decided to ,o'e in ith her

parents /ecause her house as no longer functional for her and she as una/le to independently care for herself$ 0er parents ha'e a large single story ho,e- hich they ,odified so it ould /e handicap accessi/le to fit her needs$ %he client is fortunate /ecause she has a 'ery strong support syste, in 0enderson$ (ot only does she ha'e the support of her parents- /ut her /rother also li'es close /y and can help out ith her care$ %he client also has a caregi'er that co,es /y e'ery ,orning to assist ith transfers- lo er /ody dressing and ,eal preparation$ %he client has t o daughters that are currently attending college in Indiana1 due to the distance she does not see the, as often as she ould li!e$ In addition- the client is 'ery acti'e in the co,,unity and has ,any friends that she engages ith on a daily /asis$ 2he stated that she has so,ething planned for e'eryday of the ee!- hich I found encouraging$ Reason for %herapy 2er'ices %he client is see!ing therapy ser'ices /ecause she needed to /e properly fitted for her leg and foot /races$ 2he is deter,ined to al! again and needs to ear /races on her lo er e3tre,ities to pro'ide the sta/ility and support$ "urrently she uses a po er heelchair for ,o/ility- /ut ould one day li!e to ha'e the a/ility to al! ith .ust the use of cane$ %he client recei'ed the /races the last ti,e she as in an inpatient reha/ilitation facility- unfortunately the co,pany did not fit the, properly and she has /een una/le to use the,$ 2he Areas of Occupation %he client has regained so,e independence- ho e'er due to the se'erity of her in.uryshe continues to need ,oderate to ,a3i,u, assistance hen co,pleting daily acti'ities$ In

FIELDWORK PROFILE ter,s of acti'ities of daily li'ing 5ADLs6- the client has the a/ility to perfor, tas!s such as sho ering- dressing her upper /ody- eating and personal hygiene ithout ,uch assistance fro,

others 5A,erican Occupational %herapy Association- )++76$ Functional ,o/ility and lo er /ody dressing are the ,ain areas here she still re8uires ,a3i,u, assistance$ %he client is una/le to transfer out of /ed to her heelchair or fro, her heelchair to other surfaces- in addition she is also una/le to dress her lo er /ody$ %his is an area of great concern for her$ 2he ants to /e a/le to lea'e independently and is hopeful ith continued therapy ser'ices she ill regain the strength needed to transfer herself$ When addressing instru,ental acti'ities of daily li'ing 5IADLs6- the client uses 2!ype to interact ith her daughters- she utili9es pu/lic transportation to ,aneu'er through the co,,unity and go shopping- and she attends church e'ery ee!$ When discussing her participation in IADLs- the category that causes the ,ost concern is ,eal preparation 5AO%A)++76$ E'en though her parents ,ade ho,e ,odifications to ,a!e their ho,e ,ore heelchair accessi/le for her- they did not ,odify the !itchen$ %his ,a!es it challenging for the client to prepare ,eals for herself /ecause she is una/le to reach the ite,s needed to perfor, a coo!ing tas!$ At this point in ti,e- she is dependent on her parents and caregi'er to prepare her ,eals$ %he client has not returned to or!- instead she /eca,e a ,e,/er of a ci'ic center grouphich focuses on helping people ith disa/ilities$ 2he 'olunteers ith the group and helps other indi'iduals ith co,,unity reintegration follo ing an in.ury$ %he client also en.oys ,a!ing .e elry and has a contract ith (ordstro,:s teaching .e elry classes and pro'iding the, ith ite,s to sell in their stores$ Prior to her accident she as a/le to do ,etal or! .e elry pieces /ut is no longer a/le to do this /ecause of contractures in her hand$ Fortunately- she can still string /eads hich allo s her to continue to participate in this ,eaningful acti'ity$

FIELDWORK PROFILE When addressing the different areas of occupation social participation as the area that held the ,ost eight ith the client$ 2he has not allo ed her in.ury to slo her do n$ 2he 'olunteers- has ee!ly shopping and lunch outings ith her friends and continues to stay engaged in co,,unity e'ents$ %he only co,plaint she had is that she ished it as easier for her to tra'el- so she could 'isit friends and fa,ily that li'e out of state$ %ra'eling as a ho//y she en.oyed- she as 'ery ad'enturous prior to her in.ury$ 0er spinal cord in.ury has li,ited her fro, doing certain tra'el acti'ities- thus she continues ith therapy so that one day this ill not /e an issue any,ore$ "onte3t and En'iron,ents %he client<s ho,e en'iron,ent has /een ,odified to support her engage,ent in ,eaningful acti'ites$ 0o e'er- there are still so,e /arriers ithin her en'iron,ent that inhi/it full participation in certain acti'ities$ %he !itchen in her parents house had li,ited ,odification ,ade to it- so the client is still reliant on others to pro'ide ,eals /ecause she is una/le to reach food ite,s or necessary coo!ing tools$ Aside fro, the li,ited use of the !itchen- the client<s

parents ,ade ,odifications to the rest of the house so it is heelchair accessi/le- and she is a/le to access ite,s in her /edroo, and /athroo, ith ease$ %his supports her a/ility to /e ,ore independent ith other acti'ities hile in the ho,e en'iron,ent$ %he client is 'ery acti'e in the co,,unity and has access to pu/lic transportation hich she is than!ful for$ 0er only co,plaint in regards to the transportation situation is that she has to plan her day /ased on their schedule- hich can so,eti,es /e pro/le,atic /ecause they do not al ays arri'e on ti,e$ %he client ,entioned that she<s hopeful one day she ill /e a/le to ,odify a 'ehicle so she can transport herself to and fro, social e'ents$

FIELDWORK PROFILE %he client has a strong social support syste, and spends the ,a.ority of her day interacting ith friends and fa,ily$ 2he utili9ies different de'ices hich allo her to 2!ype and stay connected ith her daughthers that li'e out of state$ When she is out in the co,,unity she ,eets up ith her friends to engage in lunch dates and shopping acti'ities- hich /ring her .oy$ 2he also stays in'ol'ed ith church e'ents and holds .e elry ,a!ing classes at a near/y co,,unity center- these are all occupations she find ,eaningful and is /lessed she still has the a/ility to participate in the,$ Occupational 0istory %he client li'ed alone in "hicago prior to her accident$ 2he as a uni'ersity professor and as in the process of co,pleting her PhD in social or!$ In )++> she fell fro, a ladder hile doing house or! and suffered a "? spinal cord in.ury$ 0er house in "hicago as not handicap accessi/le- so she ,o'ed to 0enderson to li'e ith her parents and /e closer to her /rother$ 0er priorities ha'e changed a little- she is no ,ore concerned ith li'ing life and staying acti'e in the co,,unity$ 2he places less e,phasis on career goals and reali9es there is ,ore to her life that .ust a .o/$ 2he feels that prior to the in.ury her career consu,ed her and it hindered her a/ility to engage in social e'ents$ %he acti'ities she finds the ,ost 'alua/le no

include social engage,ent ith her fa,ily- friends and co,,unity e'ents- as ell as continuing to /e an acti'e ,e,/er in her church$ 2he en.oys ,a!ing .e elry and hopes that ith continued therapy she can regain function in her lo er /ody- allo ing her to tra'el ,ore$ "lient<s Priorities %he client<s priorities are centered around her regaining strength and function in her lo er e3tre,ities$ 2he /elie'es /y acco,plishing this goal she ill /e a/le to perfor, ADLs and IADLs ith ,ore ease and she ill also /e a/le to tra'el ,ore /ecause she ould not /e

FIELDWORK PROFILE dependent on her po er heelchair$ 2he reali9es that due to the se'erity of her in.ury this is a challenging goal- /ut feels that ith continued therapy ser'ices- this goal is attaina/le$ Occupational Analysis %he occupation@/ased acti'ity I o/ser'ed the client perfor,ing as a dressing acti'ity$

%he occupational therapist as co,pleting a ree'aluation on the client- and anted to assess her independence le'el in regards to dressing her upper and lo er /ody$ Lo er /ody dressing holds the greatest concern for the client /ecause she currently needs ,a3i,u, assistance to co,plete the tas!$ &lti,ately she ould li!e to perfor, lo er /ody dressing independently and stop relying on her caregi'er for assistance ith this ADL$ During the therapy session the occupational therapist pro'ided the client ith adapti'e e8uip,ent such a dressing stic!- long handled reacher and long handled shoe horn to aid in her a/ility to co,plete lo er /ody dressing ith less assistance$ In addition- the therapist pro'ided educational training on ho to use the e8uip,ent and helped the client pro/le, sol'e hen there as an issue$ %he therapist /elie'ed ith practice- and slight ,odifications to the de'ices- the client ould /eco,e proficient in using the e8uip,ent and ould reach her goal of independently dressing her lo er /ody$ An occupational analysis 5%a/le 16 is pro'ided /elo to sho a ,ore detailed /rea!do n of the deficits e3hi/ited /y the client hen perfor,ing the lo er /ody dressing tas!$ %a/le 1 Occupational Analysis of "lient

FIELDWORK PROFILE Aody Functions

#ental functions: %he client as alert and oriented to person- place and ti,e$ 2he did not e3hi/it any cogniti'e deficits hile perfor,ing her acti'ity$ 2ensory functions and pain: %he client as li,ited /y lac! of sensory function during the dressing acti'ity$ 2he still has no feeling throughout her lo er e3tre,ity$ 2he also has contractures in /oth hands- hich cause her pain and this li,ited her a/ility to use the adapti'e dressing e8uip,ent$ (euro,usculos!eletal: %his category is here the client<s deficits arise$ 2he poor .oint ,o/ility and strength in her hands- and she has no ,uscle po er- ,otor refle3es or 'oluntary ,o'e,ent in her lo er e3tre,ities$ %he clients hands also ha'e increased ,uscle spasicity and /eco,e painful hen she tries to use the, for e3tended periods of ti,e$ 0er lo er /ody ,uscles re,ained flaccid throughout the acti'ity$ "ardio'ascular and Respiratory: %he client<s cardio'ascular and respiratory function re,ained sta/le hile co,pleting the acti'ity$ Due to the le'el of her in.ury her respiratory function has pro/a/ly decreased /ut if asn<t e'ident during the acti'ity$ Benitourinary: %he client uses a catheter to assist in /ladder function$

Aody 2tructures

All of the /ody structures aid in the co,pletion of the acti'ity$ 0o e'er- the ,ain structures addressed ith the dressing acti'ity are the hands and the lo er e3tre,ities$ O/.ects and their properties: %he tools and ,aterials needed carry out this acti'ity include: a long handled reacher- long handled shoe horndressing stic!- the client<s clothes- and a /ed ith handrails so the client can log roll herself side to side and hold on to the railing as she pulls her pants up$ 2pace de,ands: %his acti'ity re8uires the space of a typical reha/ilitation roo, ith good lighting$ %he physical en'iron,ent should /e clear of any ite,s that could cause a safety issue$ 2e8uence and ti,ing: %he therapist first educated the client on the different adapti'e de'ices- then allo ed the client to perfor, the tas! using the e8uip,ent to the /est of her a/ility$ Roles: When perfor,ing the dressing acti'ity- the client !ept reiterating that she ants to /e an independent o,an again$ 2he ants to engage in ,ore tra'eling acti'ities- and doesn<t ant to /e hindered in her a/ility to /e ,o/ile$

Acti'ity De,ands

Perfor,ance Patterns

FIELDWORK PROFILE Perfor,ance 2!ills #otor and Pra3is: %he client had a difficult ti,e ,anipulating the adapti'e de'ices due to li,ited .oint ,o/ility in her hands$ Additionally- she has ,uscle spasicity and pain in /oth hands hich aids ith o/.ects ,anipulation pro/le,s$ 2ensory: %he client as a/le to position her /ody to allo for ,a3i,al use of the adapti'e de'ices$ E'en though she has li,ited use of her hands- she still has ade8uate sensation and is a/le to locate the ite,s needed for dressing$ 0er lo er /ody is the only area here she has no sensation$ E,otional Regulation: %he client did not e3hi/it any e,otional regulation issues throughout the course of the therapy session$ 2he responded appropriately hile engaging in the dressing acti'ity$ "ogniti'e: %he client did not ha'e any issues related to cogniti'e function during the therapy session$ "o,,unication: %he client e3hi/ited strong co,,unication s!ills throughout the dressing acti'ity$ 2he initiated and ans ered 8uestions ith pertinent infor,ation and ac!no ledged the occupational therapist co,,ents hen pro'iding pro/le,@sol'ing ad'ice$

"onte3ts

%e,poral: When doing a dressing acti'ity- the client stated she has less pain in the afternoon- so for future reference it ould /e /eneficial for the therapist to schedule dressing assess,ents during the afternoon$ Physical: Ensuring the roo, is setup to ,a3i,i9e the client<s functional perfor,ance$ During the dressing acti'ity the occupational therapist set out the clothes- so it ould /e easier for the client to reach her ite,s$ %he therapist also pro'ided education on ho to use the long handled reacher to o/tain clothing ite,s that ,ight /e out of reach$

Pro/le, List Aased on the infor,ation gathered through the occupational profile and analysis a pro/le, list has /een created to address the client<s ,ain concerns$ Due to the client<s desire to /eco,e independent ith lo er /ody dressing the pro/le, list is focused around this concern$ In addition- the client ,entioned that she ould li!e to /e ,ore in'ol'ed ith her ,eal preparation$ With proper ho,e ,odifications and caregi'er education this goal should /e attaina/le$ %he pro/le, list is inclusi'e to this issue as ell$

FIELDWORK PROFILE 1$ "lient una/le to independently perfor, lo er /ody dressing due to i,paired lo er e3tre,ity functioning$ )$ "lient li,ited in a/ility to use adapti'e de'ices due to ,uscle spasicity in /oth hands$ 4$ "lient una/le to perfor, coo!ing acti'ities due to a lac! of heelchair accessi/le !itchen ,odifications$ ;$ "lient una/le to independently transfer to 'arious surfaces due to a lac! of strength and sensation in her lo er e3tre,ities$

>

=$ Decreased ,uscle strength and sensation of lo er e3tre,ities results in the need for caregi'er assistance in IADLs such as ,eal preparation and cleanup$

References A,erican Occupational %herapy Association 5)++76$ Occupational therapy practice fra,e or!: do,ain C process$ 5)nd ed$6$ A,erican Dournal of Occupational %herapy- *)5*6- *)=@ *74$