Running head: OCCUPATIONAL PROFILE

Occupational Profile and Analysis of Fieldwork Client Michelle D. Ashley Touro University Nevada

OCCUPATIONAL PROFILE Occupational Profile Client The client is a 78 year old man, who is a widower, and currently lives in a single story home with his daughter and grandson. Prior to moving to Las Vegas, the client lived in Pennsylvania with his wife and their four children. The client and his wife moved to Las Vegas for his career as a professional boxer. After the clients wife passed away in 2007, his health started to deteriorate, which is what ultimately determined the move into his daughters house. The client has an extensive list of medical issues that he is dealing with, these include: Boxer Parkinsons disease, acute bronchitis, atrial fibrillation, benign prostatic hyperplasia, cognitive disorders (memory impairment), headaches, and hyperlipidemia. His daughter has taken an

active role in his life and ensures all his needs are met, which contributes to his overall happiness and well-being. The clients daughter works during the day, so he attends an adult day care center on a weekly basis, allowing him to become more social and engage in meaningful activities during the day. The client is fortunate because he has a very strong support system in Henderson and the Las Vegas area. His son visits often, and he has additional family that lives in the area. His daughter and son assist him with activities of daily living (ADLs) and instrumental activities of daily (IADLs) when necessary (American Occupational Therapy Association, 2008). Purpose for Seeking Services and Current Concerns The client is not currently receiving occupational therapy services. He is attending the Adult Day Care Center of Las Vegas due to a recent incidence of falls and cognitive decline. The client still seems very aware of his environment; however, his last Mini Mental Status Examination (MMSE) score was 19 out of 30, suggesting moderate cognitive impairment (MMSE, 2013). This is most likely a result of the progression in his Parkinsons disease. The daughter is concerned with her fathers health and felt that being in an adult day care

OCCUPATIONAL PROFILE environment would be beneficial for him. Allowing him to engage in a variety of activities, and hopefully increase his strength, range of motion, and socialization skills. Occupational Performance

According to his chart, the client is still able to complete some daily tasks independently. However, he requires minimum to moderate assistance to accomplish the majority of his ADLs and he is unable to perform most of his IADLs. His daughter and adult day care staff provide assistance in the needed areas. In terms of ADLs, the client is able to eat and feed himself independently. He needs assistance with bathing, toileting, dressing, oral hygiene, grooming, mobility, and transfers. Through my observations of the client while at the adult day care facility, it seems that his cognitive impairments are not the cause of the need for assistance. His fear of falling and limited range of motion appears to be the reason assistance is required to complete his daily tasks. The Parkinsons disease has affected his gait pattern, as well as hindering full use of his upper extremities. While at the adult day care center the client utilizes a manual wheelchair to decrease is risk of falling. When he is at home, he tends to use a walker with stand by assistance provided by his daughter. Additionally, the client needs help with all of his IADLs. These include: shopping, cooking, meal preparation, housework, medication management, transportation, and financial management. His daughter aids in helping him accomplish these tasks. The staff at the adult day care center mentioned that his daughter also coordinates all of his transportation needs to and from the facility. Context and Environments

OCCUPATIONAL PROFILE The adult day care environment is conducive to the clients needs. The client spends the majority of his time in the large activities room. This room provides enough space for him to maneuver his wheelchair, and the tables are spaced far enough apart that they do not impede his

mobility. The tables utilized for eating and playing games are an adequate height for him to stay seated in his wheelchair, and have full functional use of his extremities. In regards to the clients home environment, his chart stated that he lives in a single story home. This was the extent that was known about his home environment. Occupational History The client lived in Pennsylvania with his wife and children prior to moving to the Las Vegas area. He was a professional boxer and moved to Las Vegas for work. For many years he held a career as a middle weight boxer. He has retired from that profession, but still enjoys talking about his career and reminiscing on his life then. He mentioned that he would still like to incorporate boxing activities into his life, but finds it more difficult now due to his Parkinsons symptoms, and the effect they have on his body and mind. He now finds joy in participating in a variety of activities offered at the adult day care center. The clients favorite activities include, music therapy, playing cards, playing bingo, sign language and ball toss. The client is also an active member at his church, and enjoys attending church events in the community. Due to limited resources and the clients limited social ability, this was the extent of information obtained in regards to his current and past occupational roles. Clients Priorities and Desired Outcomes The clients priorities include participating in activities that allow him to strengthen his upper extremities and increase his range of motion. This will also allow him to become more independent with his ADLs, requiring less assistance from the adult day care staff and his

OCCUPATIONAL PROFILE daughter. The client would also like to have increased opportunities to interact with his peers to promote socialization. In addition, the client would like to regain stability and balance in his lower extremities, thus decreasing his risk of falling and increasing his confidence with functional mobility. Occupational Analysis The occupation-based activity I observed the client performing was a leisure activity called ball toss. During this activity the adult day care participants are placed in a large circle,

they can stand or be seated and they toss a large beach ball around. The goal of this activity is to promote socialization with the individuals around you, as well as keeping the ball from touching the floor. This is an ideal activity for the client to engage in because it provides him with an opportunity to socialize with his peers, and it requires him to use his upper extremities, thus increasing his range of motion. During the activity the client stayed seated in his wheelchair to decrease the risk of falling. The wheelchair also provides additional support, allowing him to move around when hitting the ball from different angles. An occupational analysis (Table 1) is provided below to show a more detailed breakdown of the deficits exhibited by the client when performing the ball toss activity. Table 1 Occupational Analysis of Client

OCCUPATIONAL PROFILE Body Functions

Mental functions: The client was alert and oriented to person, place and time. He did not exhibit any cognitive deficits while performing the activity. He was able to sustain the needed attention to complete the activity and appropriate judged how hard to hit the ball. The client was also emotional stable and pleasant throughout the entire game. Sensory functions and pain: The client did not complain of any pain while performing the activity. His sensory functions seemed intact but the Parkinsons disease has affected his proprioceptive functioning and tactile feedback. Neuromusculoskeletal: This category is where the client exhibited the biggest deficit due to his Parkinsons symptoms. The client had impaired gross motor coordination when trying to hit the ball. This can also be attributed to bradykinesia, causing him to move a little slower. The client also had rigid muscle tone, causing him to be stiff and inflexible in his upper extremity when he was trying to hit the ball. Cardiovascular and Respiratory: The client has a pacemaker, atrial fibrillation and acute bronchitis. However, these medical conditions remained stable while completing the activity and did not seem to impact his performance when tossing the ball. Voice and Speech: The clients voice and speech functions are not an issue and did not hinder him in engaging in the ball toss activity. He was able to converse with the individuals sitting next to him in the circle with ease. Digestive, Metabolic, and Endocrine: These systems did not impede the clients ability to perform the activity. Genitourinary: The client is incontinent and is assisted with toileting every two hours. The activity was performed after he had toileted so this was not an issue. Skin and related-structure: The client is an older adult; therefore skin integrity could be a concern. His skin was intact with no signs of wounds or cuts, and did not interfere with his performance in the activity.

OCCUPATIONAL PROFILE Body Structures

All of the body structures aid in the completion of the activity. However, the main structures addressed with the ball toss activity are the upper extremities, trunk and eyes. The activity required the client to engage his trunk muscles in order to maintain a stable posture to hit the ball from different angles. In addition it required him to use his upper extremities, promoting full range of movement in his arms and hands. Lastly, he required the use of his eyes to focus on the ball to determine the appropriate time to hit it. Objects and their properties: The tools and materials needed to carry out the ball toss activity include: an inflatable beach ball, chairs. Space demands: The physical environmental requirements include a large, open room free of clutter. The room should have good lighting so individuals with impaired vision can see the ball. The room should be at a comfortable temperature, not too cold or hot. Older adults can have a harder time with temperature regulation, so it is important to be aware of that during the activity. Social demands: The staff needs to ensure that all the participants understand the rules of the game and what is expected of them. For the ball toss activity, the main goal is to keep the ball from touching the floor. Sequence and timing: The client participated in the activity for 30 minutes. A personal care assistant at the facility starts the activity by toss the ball to a client and then it continues by each person hitting the ball when it comes to them. Required actions and performance skills: The client needed to be able to determine how to move his limbs to control the ball and hit it towards the individual he was aiming for. He also needed to be able to communicate with other around him, as well as understand the rules of the game. This was good for him because it promoted socialization with his peers. Required body functions and structures: The client required joint mobility to perform the ball toss activity. This became difficult for him depending on where the ball was coming from because he has limited range of motion in his upper extremities. The activity also required the client to be alert and aware so he could hit the ball when it came his way. In terms of body structures, all were required, but the most relevant were his eyes and upper extremities.

Activity Demands

OCCUPATIONAL PROFILE Performance Patterns Roles: The client stated that he enjoys participating in the ball toss activity because it reminds him of hitting a speed bag when he was a boxer. Due to the progression of his Parkinsons disease he is unable to continue his normal workout routine. This activity feels that void for him. Routines: The client values routines and has become accustom to playing the ball toss game every day. He has good emotional regulation so if the staff decides to play a different game he doesnt complain. However, he stated that it is something he looks forward to each day he attends the facility.

Habits: According to the staff, the client has gotten in the habit of always sitting next to the same people during the ball toss game. He now feels comfortable with these individuals and has starting socializing more during the game. Performance Skills Motor and Praxis: The client had difficulty keeping up with the pace of the activity due to a decreased ability to produce fast movements with his upper extremity. His ability to bend and reach for the ball was also limited due to decreased range of motion in his upper extremities. However, the movements he did make were purposeful and in the right direction. Sensory and Perceptual: The client did not exhibit any issues with visual, auditory or proprioception during the activity. These skills seemed intact for the ball toss activity. Emotional Regulation: The client did not exhibit any emotional regulation issues throughout the course of the activity. He responded appropriately while engaging with his peers and waited patiently until it was his turn to hit the ball. Cognitive: According to the clients chart he has moderate cognitive impairment; however these issues did not interfere with his performance during this activity. The client was able to judge when to hit the ball and how much force to use. He was also able to sequence his movements appropriately. Communication: The client exhibited good communication and social skills with his peers during this activity. Socialization is an area for improvement with the client and he is showing progress by increasing his interactions with others.

OCCUPATIONAL PROFILE Contexts

Temporal: This activity was performed in the morning, which the client prefers because he feels that his range of motion is better in the morning. Physical: The ball toss game is always performed in the large activities room. This is more conducive to the clients needs because he needs more space to provide better mobility due to his wheelchair. Personal: The client enjoys participating in the ball toss game because it reminds him of boxing. He stated that aiming and hitting the ball in the air mimics hitting a speed bag. Social: The client always sits next to the same individuals during the ball toss game, which promotes socialization and participation in the activity. Virtual: There is not virtual component to this game.

Problem List 1. Client unable to perform daily exercises due to impaired motor coordination. 2. Client unable to perform toileting independently due to decreased functional mobility. 3. Client limited in ability to socialize during group activities due to a decrease in self-confidence in social situations. 4. Client limited in ability to participate in sign language activity due to decreased range of motion in upper extremities. 5. Client limited in ability to perform ADLs due to decreased muscle strength in upper extremities. Justification of Problem List Based on the information gathered through the occupational profile and analysis, I prioritized the problem list to address the clients main concerns. These concerns include the clients desire to engage in social activities, increase functional mobility and regain range of

OCCUPATIONAL PROFILE

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motion in his upper extremities. By addressing these concerns and desires the client will be able to participate in more activities offered at the adult day care facility. In addition, the client mentioned that he would like to regain independence in completing his ADLs, specifically toileting. This would decrease his need for assistance in completing this activity while at the adult day care facility. With proper intervention strategies and cooperation of the adult day care staff, the clients goals should be attainable. Allowing him to engage in meaningful occupations and regain independence in his life.

OCCUPATIONAL PROFILE References

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American Occupational Therapy Association (2008). Occupational therapy practice framework: domain & process. (2nd ed.). American Journal of Occupational Therapy, 62(6), 625683. MMSE. (2013). The total MMSE score [Website]. Retrieved from http://faculty.pepperdine.edu/shimels/Courses/Files/MMSE.pdf