Running head: OCCUPATIONAL PROFILE & INTERVENTION PLAN

Occupational Profile & Intervention Plan

Danielle E. Goddard
Touro University Nevada

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Occupational Profile
Who is the Client?
Jan is a 29-year-old female who experienced a right cerebrovascular accident (CVA) on
December 20, 2013. Prior to her stroke, Jan was physically active and independent in all daily
occupations. She lived in an apartment with a roommate who traveled often, owned and cared
for two pet cats, and worked as a Pilates instructor. Jans CVA has affected almost every aspect
of her occupational life. She now lives with her mother and younger sister in their one-story
home. Jan currently is single; she recently participated in her best friends wedding but reports
that she has been spending much less time with friends since her CVA and often feels isolated
from her previous social structure.
Reason for Seeking Services & Concerns
Jan was referred to the Nevada Community Enrichment Program (NCEP) for
comprehensive and intensive day treatment. She currently receives occupational therapy (OT),
physical therapy (PT), counseling services, and vocational rehabilitation services through NCEP.
Jan is mainly concerned with remediating the physical impairments she incurred from her injury.
Jans CVA severely impacted her left upper extremity (LUE) strength, active range of motion
(AROM), and functionality. At her initial evaluation, Jans LUE AROM and muscle strength
were assessed yielding the following results: shoulder flexion=25 AROM with a 2- muscle
grade; shoulder abduction=30 AROM with a 2- muscle grade; shoulder extension, shoulder
internal and external rotation, elbow flexion and extension, and all movements of the forearm,
wrist, and fingers=0 AROM with a muscle grade of 1. No contractures or limitations to passive
range of motion (PROM) were identified during Jans initial evaluation. However, she does have
a one-inch left shoulder subluxation which reportedly increases her pain during AROM and has

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been addressed by the interdisciplinary team. Jan now uses a shoulder sling to decrease her
subluxation, but there is some question as to whether her use of the sling has decreased the rate
of her return to functional LUE use. Though Jans UE deficits impact most of her daily
occupations, she is right-hand dominant and is therefore still able to complete most tasks with
moderate assistance (Mod A), minimum assistance (Min A), or independently with modifications
(Mod I) or setup depending on the task.
In addition to her LUE limitations, Jan also has some significant concerns regarding her
lower extremity (LE) function. Jan has progressed in physical therapy from using a wheelchair
and now is able to ambulate using a standard cane, though she fatigues easily. Overall, her
balance, coordination, and activity tolerance have all decreased immensely, and these deficits are
very upsetting to Jan. Though she is also concerned with regaining function in her LUE, Jan
feels the most self-conscious with her gait and expresses frustration over having to walk using a
cane. Her PT has been working to remediate issues with gait, but Jan has also been addressing
functional mobility during her OT treatment sessions.
Jans CVA does not seem to have greatly impacted her cognitive, visual, or perceptual
skills. Her mother does report that she is slightly more distractible now, but her therapists note
that she is easily redirected with verbal cues to return to the task at hand and remain mindful of
time-management concerns. Jan initially reported some visual and cognitive fatigue during
evaluation and her first few sessions of therapy, but she now reports that these issues have
declined and are no longer significantly concerning. Her main goals in therapy are to walk
normally again without having to use DME, to regain functional use of her LUE, to return to
work, and to be able to cook, do laundry, shower, and get dressed independently.

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Successful & Unsuccessful Areas of Occupations

Jan currently requires modifications to independently complete all grooming, oral care,
bathing, and transfer tasks. Any tasks that require bilateral use of the UE prove challenging to
Jan as she has very limited functional strength in her LUE. However, she is able to safely and
independently transfer into and out of the shower using a tub transfer bench (TTB) and can
shower with Mod I secondary to increased time, safety concerns, and adapted equipment (A/E)
use. She can also complete most of her grooming and personal hygiene tasks independently,
though she visits an aesthetician for waxing and requires some Min A for fine motor/bilateral
coordination tasks such as holding a toothbrush while applying toothpaste. Jan is also able to
complete most dressing tasks with Mod I secondary to increased time; however, she struggles to
don her bra independently and requires assistance for this step of dressing.
Jan is able to feed herself independently using her functional RUE, but she does require
Min A for foods that must be cut using a fork and knife. Jan previously enjoyed cooking, and
she expresses significant frustration over not being able to successfully prepare nonmicrowavable meals. Jan reports that she would love to be able to return to fully preparing her
own meals again but is hesitant to purchase too many specialized pieces of adapted cooking
equipment until she decides that she absolutely needs it. Jans mother currently provides
moderate assistance with all household cleaning chores and laundry, but Jan has been assessed in
household management and is able to complete most tasks using A/E and DME. She usually
requires Mod I secondary to increased time for small chores (i.e. dusting, making a bed) or Min
or Mod A for some laundry-related tasks (she is unable to carry large loads of laundry while
ambulating at this time). Jan is independent in paying her bills online. Her two pet cats are
currently being boarded, so pet care has not been assessed.

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Another area of concern for Jan is community mobility. She is currently unable to drive
and must rely on the Regional Transportation Commission of Southern Nevada (RTC transit) to
travel to and from NCEP daily. She also tires during community outings where she must
ambulate long distances using her cane (i.e. during grocery shopping and the weekly NCEP
community group outing). However, Jans endurance and activity tolerance are increasing, and
she reports that she is able to stand and walk for much longer periods now than she was just a
month ago. Though her endurance is increasing, Jan is still unable to participate in her favorite
leisure activity and previous work occupationPilates. Jan misses practicing Pilates but
recognizes that her physical impairments as well as her affected balance and activity tolerance all
prohibit her from fully participating at this time. As a previous Pilates instructor, Jan is
concerned about what she will do in the future as a career. She is eager to continue therapy with
the goal of returning to as much independence as possible.
Supporting & Inhibitory Contexts and Environments
Jan is currently living with her mother and sister in a single story home with few
environmental barriers at this time. Jans home now also has some DME modifications (i.e. a
tub transfer bench), so she is able to complete most ADL and IADL tasks independently or with
Mod or Min A (for tasks that require BUE use). She is able to ambulate independently using a
cane, so most environments are accessible for her. Supportive physical environments allow Jan
to ambulate free of barriers and offer places to sit and rest. Inhibitory environments include
grocery stores, large shopping centers, or areas where the heat can exacerbate her fatigue. Jans
previous work environments (an athletic gym and a physical therapy clinic) are also inhibitory.
She feels very uncomfortable and self-conscious walking into the gym where she used to work

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and worries about trying to explain her CVA and its impact to previous coworkers. Jan typically
avoids her prior work settings and spends most of her time at home and at NCEP.
Clients Occupational History
Prior to her CVA, Jan attended college and earned her bachelors degree. She spent
several years exploring various career options and enjoys acting, modeling, and instructing
fitness classes. Pilates instruction provided Jans main source of income at the time of her CVA.
She spent most of her time teaching or preparing for Pilates classes at the gym or in the clinic
where she worked. Jan also taught private Pilates lessons to friends, family members, or other
clients to supplement her income. Prior to her stroke, she enjoyed cooking, spending time with
friends, caring for her pet cats, and staying active. Jan previously lived with a roommate who
traveled often, so she was primarily responsible for maintaining their apartment and attending to
any maintenance issues. Jan valued her independence, self-care, health and wellness, and her
interpersonal relationships; her therapy goals are focused on regaining as much independence as
possible and returning to work. She currently spends a limited amount of time with her friends
and admits that she feels uncomfortable around many of her old acquaintances because of her
CVA-related physical impairments.
Clients Priorities & Desired Outcomes
Jans primary goal is to regain her ability to practice Pilates and return to living and
working independently. Though she can provide verbal instruction, she feels that she will not be
able to meet the requirements of becoming a Pilates instructor once again until she can
physically participate fully. Jan seems resistant to exploring other potential career opportunities
at this time. Overall, Jan wishes to increase her LUE and LE coordination, strength, and AROM.
She wants to increase her standing, static, and dynamic balance. She is driven to walk normally

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without having to use a cane and wants to increase her overall endurance and activity tolerance.
Jan wishes to regain her independence in all ADL and IADL tasks, including donning and
doffing her bra, shoes, and AFO independently; cooking for herself (not microwave meals); and
completing laundry and home care tasks. She is working toward using her LUE for tasks such as
holding and cutting with a knife while self-feeding, pulling up her pants using both hands, and
hugging with both arms (all client-specified goals). She hopes to be able to discontinue wearing
her arm sling eventually but says that at this point it helps her feel more secure regarding her
shoulder subluxation. Jan hopes to return to driving as soon as possible but realizes that her
current physical deficits would compromise her safety and reaction time. She is also focused on
establishing strategies for decreasing anxiety and increasing assertive communication in her
interpersonal relationships.
Occupational Analysis
Context/Setting of OT Services
Jan is currently receiving all OT, PT, and counseling services at the NCEP day-treatment
facility. She attends NCEP five days a week, Monday through Friday, for roughly six hours a
day. Jan has been treated at NCEP since mid-February of 2014. She receives occupational
therapy interventions daily to address her current UE deficits. She also participates in group
activities, community outings, and program-sponsored events throughout the week.
Additionally, Jan has been provided with a home exercise program to complete in the evenings
and on the weekends. Roughly every two to three weeks, Jan is formally reassessed by her OT
to measure progress. Every two weeks, Jan and her mother also attend an interdisciplinary client
conference to address her overall goals and progress in the program. I personally have observed
Jan during one of these interdisciplinary meetings as well as on two community outings and

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while instructing another client at NCEP in a Pilates session. Below I will focus on the second
community outing, where Jan attended the Saving Strokes event and practiced golfing for the
first time in her life.
Activity & Performance Observed
On Friday, May 16, Jan and many of the other clients from NCEP traveled to Angel Park
Golf Club to participate in Savings Strokes, an event organized to bring individuals in the
community who have experienced ABI together for a fun day of practicing golf skills. When Jan
first arrived, she seemed very wary of the activity and did not seem excited to participate. She
told me she had never golfed before and only had very limited experience playing putt-putt, so
she was not confident in her golfing abilities (and especially not in her one-handed golfing
abilities). I encouraged her to give it a try and she reluctantly walked over to the first hole at the
putting station. I helped her set up her golf ball as Melody (her OT and my fieldwork educator)
showed her how to position her club for a one-handed swing. Jan attempted the swing and sunk
the putt, making a hole-in-one! She became more relaxed and even chatty after that, moving
through all of the putting holes and on to the chipping circuit. Though she was always hesitant
after transitioning and required two brief rest breaks to manage fatigue, Jan participated in every
station offered and even received some one-on-one coaching from a golf professional on how to
effectively drive the ball one-handed.
Key Observations of Activity
Overall, Jan seemed to really enjoy the Saving Strokes event. She fully participated in
every station and often had to be reminded that it was time to move on to the next activity
because she was so engrossed with practicing. While golfing, Jan exhibited a stable base of
support (BOS) and strong standing balance. She was able to position herself and the ball

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appropriately and used her right hand for swinging the club. Because it was in the sling, Jan
never attempted to engage her LUE in swinging the club (even though I think she would have
been able to with a little practice and using her right hand for stabilization). It seems that she is
still fearful of exacerbating her subluxation and causing herself pain. However, she was active,
engaged, and overall positive throughout the experience. She stayed outside in the sun for at
least 90 minutes, only took two brief rest breaks in the shade, and never complained of
significant pain or fatigue. I was really impressed with Jans overall participation and activity
tolerance during the Saving Strokes event.
OTPF Domains Impacting Performance
At this point in her rehabilitation process, Jan is currently affected most by the client
factors that affect her physical capabilities as well as her general motivation and affect. Jan has
expressed extreme frustration regarding how slowly her rehabilitation has been progressing. She
is disheartened by the slow progress she has seen in regaining LUE function and realizes that she
is going to have to progress pretty far before she is able to participate in Pilates again and return
to work. In therapy, Jan is usually compliant but often seems to struggle to maintain motivation
and enthusiasm. She has shared with her therapists that she has lost a lot of confidence and often
feels self-conscious in public. She also struggles to express herself assertively without becoming
upset or showing her frustration. Motivation, openness to experience, self-expression, and
confidence are all considered aspects of temperament and personality under the global mental
functions subcategory of the American Occupational Therapy Associations (AOTA)
Occupational Therapy Practice Frameworks (OTPF) client factors category. Motivation as
related to self-empowerment is also related to beliefs under the values, beliefs, and spirituality
subcategory of client factors (AOTA, 2014).

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Physical client factors (body functions) which are inhibiting Jans successful return to full
function include her limitations to strength and ROM of her LUE, her impaired balance and
coordination, and her generally decreased activity tolerance. According to her initial evaluation,
Jan was able to exhibit only limited ROM in her shoulder (flexion and abduction), and was not
able to independently extend, internally rotate, or externally rotate her LUE at the shoulder. She
also was unable to voluntarily bend or flex her elbow, pronate and supinate her forearm, flex and
extend her wrist, isolate finger movements, or execute any functional grasps. These specific
body functions directly impact her daily occupations. Though some of the movements lost due
to Jans CVA have been partially remediated, her strength and AROM still limit her functional
performance greatly. In conjunction with her affected body functions, Jan has also experienced
some motor deficits (OTPF: performance skills). Affected motor skills include grasping, moving
(objects and self), coordination, stabilization, walking, and balancing. These deficits are all
being addressed through occupational and physical therapy treatment at NCEP (AOTA, 2014).
Problem List
The following problem statements, goals, and interventions are based on Jans most
recent re-evaluation from May 8, 2014. As of this date, Jan has increased her LUE AROM to
30 of shoulder flexion, 55 of shoulder abduction, and 75 of elbow flexion. Other formal LUE
AROM measurements were not assessed during her most recent reevaluation.
Problem One: UE Strength and ROM
Jan is unable to participate in many preferred ADL, IADL, and leisure activities
secondary to decreased LUE ROM and strength.
Limited LUE ROM and strength are prioritized at the top of Jans problem list because
they affect almost every area of her occupational life. She is unable to completely dress, prepare

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meals for herself, drive/navigate the community, and participate in Pilates independently due to
her UE deficits. Remediating her loss of LUE function is a top priority for both Jan and her
therapists at NCEP.
Problem Two: Dependence in IADL Meal Prep
Jan requires Mod A to prepare 2-step microwave meals secondary to decreased activity
tolerance & inability to use her bilateral upper extremity (BUE).
Jans main objective is to return to living independently, and meal preparation is a huge
aspect of self-care competence. Jan also previously enjoyed cooking for herself and for friends,
so she is motivated to regain functional use of her LUE in order to return to this aspect of
independence. Jan has no problem using A/E for cooking at NCEP but is hesitant to move
forward with buying her own A/E for her home environment. Jan is very nutritionally-conscious,
so she wants to be more independent in cooking for herself in order to avoid constantly having to
eat microwaved or convenience meals.
Problem Three: Motivation and Affect
Jan is periodically unable to participate fully in the NCEP day-treatment program because
of decreased motivation and inability to moderate personal frustration with her slow
rehabilitation progress.
Jans therapists (PT and OT) have expressed that they believe that part of the reason she
is progressing slowly is due to her outward lack of motivation and negative affect. She often
expresses frustration with her sustained deficits but is not very open to utilizing A/E in the home
or exploring alternative career options. She expresses frustration with the slow progress of her
LUE rehabilitation; however she is still fearful of exacerbating her subluxation and therefore
wears her sling constantly, limiting occupation-based function with her LUE or BUE. Her

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therapists have tried to encourage Jan to use her LUE more at NCEP but are worried that she is
neglecting her home exercise protocols and refuses to use her LUE outside of the day-treatment
program.
Problem Four: Lower Extremity Balance and Coordination
Jan is unable to participate independently and safely in many preferred ADL, IADL, and
leisure tasks due to her limited balance and LLE coordination.
Jan is very concerned about her abnormal gait and the fact that she still requires a cane
for safe ambulation. She has made significant gains in physical and occupational therapy since
she started the program at NCEP and has progressed to walking with a cane from requiring a
wheelchair for all ambulation. However, Jans current deficits still require her to use other inhome DME such as a TTB in order to ensure safety. She typically avoids many occupations
which require lower body coordination and endurance such as grocery shopping, practicing basic
mat Pilates, and completing household chores even though her therapists have cleared her for
these activities and encourage them as occupationally-based and therapeutic.
Problem Five: Assertive Communication and Socialization
Jan is currently unable to effectively communicate her needs and is fearful of socializing
with past acquaintances because she is uncomfortable explaining her current physical status.
Jan has severely limited her own socialization and at times reports that she is bored and
lonely at home. She reports that she has a hard time communicating her needs and desires
assertively and often uses passive-aggressive techniques when communicating with her mother
and sister. Jan feels that she will not be able to return to work until her hemiparesis is completely
remediated, because she fears that she will be judged by her coworkers, supervisors, and clients.
She states that she would be uncomfortable discussing her CVA and its resulting deficits with her

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old coworkers and clients and has therefore avoided situations where she may need to talk about
her injury. She has also avoided many of her friends and states that she feels conspicuous in
groups of peers. Jan could benefit from assertiveness training, psychosocial interventions to help
her cope with her altered physical status, and activities that promote more peer interaction and
positive socialization.
Intervention Plan and Outcomes
Long-Term Goals, Short-Term Goals, and Interventions
Long-term goal one. Jan will increase LUE AROM to at least 70 of flexion, 70 of
abduction, and 90 of elbow flexion with muscle grades of 3+ or more within two months in
order to promote more active bilateral engagement in ADL, IADL, work, and leisure activities.
Short-term goal one. Jan will increase LUE AROM to 40 of flexion with a 2+ muscle
grade within one month.
Intervention one with graded variations. Jan will set out plastic cups on a low table
utilizing her LUE at 25-30 AROM of flexion to prepare for the groups lunch daily. To grade
this activity up, Jan will use a 1lb wrist weight while completing this exercise, will use heavier
drinking glasses, or will increase the angle of flexion. To grade this activity down, Jan will
practice fewer lifting reps to 25-30 with zero resistance (i.e. not lifting a cup).
According to the OTPF-3 (AOTA, 2014), this intervention utilizes the establish/restore
approach in order to remediate Jans LUE deficits by increasing functional AROM and strength.
It is supported by research completed by Poole, Burtner, & Stockman (2009) which indicates that
therapists can use the Framework of Occupational Gradation (FOG) in order to slowly increase
AROM and strength in the affected upper extremity of a client with hemiparesis. This article
states that the task should be designed around the clients priorities and hand dominance, and Jan

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is very focused on restoring her LUE abilities in order to participate in cooking, meal
preparation, and other ADL and IADL tasks. This intervention would promote outcomes based
on the achievement of improvement of occupational performance while increasing Jans quality
of life, participation, and role competence (AOTA, 2014).
Short-term goal two. Jan will increase her LUE AROM to 65 of abduction with a 2+
muscle grade within one month.
Intervention two. Jan will abduct her LUE as far as possible while practicing Pilatesinspired exercises daily in supine (gravity minimized), side-lying, or standing positions (both
against gravity).
This intervention also utilizes the establish/restore approach to help Jan increase her
shoulder abduction AROM in her LUE (AOTA, 2014). It is supported by an article published by
Owsley (2005) which describes the application of clinical Pilates in order to introduce assistive
movement (PROM or AAROM), dynamic stabilization (controlled AROM), and ultimately
functional reeducation (AROM with a functional purpose). This article describes how to use
Pilates-inspired exercises in a rehabilitation setting in order to retrain muscles for functional
movement patterns and strengthen them using resistance (Owsley, 2005). This approach would
be very beneficial for Jan, especially since she is a previous Pilates instructor and ideally wants
to return to her former career. This intervention approach would serve to meet the following
outcome criteria: occupational performance improvement, quality of life, participation, rolecompetence, and well-being (AOTA, 2014).
Long-term goal two. Jan will cook a basic four-step meal (i.e. spaghetti, grilled chicken
and vegetable skillet, etc.) on the stovetop using Mod I within one month.

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Short-term goal three. Jan will complete a two-step chopping and cooking activity
using A/E safely with Min A within two weeks.
Intervention three. Jan will stand at the counter (using DME as needed to assist with
dynamic standing balance) to chop vegetables using A/E as needed (i.e. cutting aid, adapted
cutting board, rocker knife, etc.) and Min A during a group cooking project in the NCEP kitchen.
She will use her affected LUE to weight-bear or stabilize the cutting board during this activity.
This intervention also utilizes the establish/restore approach as well as the modify
approach to allow Jan to practice functional tasks in order to restore her LUE function while also
utilizing A/E as needed to compensate for her UE motor deficits (AOTA, 2014). This
intervention is supported by evidence included in Chapter 33 of Pedrettis Occupational Therapy
(Gillen, 2013) which states that the affected UE should be used for weight-bearing, supported
reach, or object manipulation during occupational engagement in order to increase UE function.
This intervention will help Jan achieve the outcomes of improved occupational performance, will
increase her independence and quality of life, and will also increase her occupational
participation as well as her role competence and well-being (AOTA, 2014).
Short-term goal four. Jan will increase her functional standing activity tolerance in
order to safely and successfully complete a three-step (~15-20 minute) stovetop meal with only
one brief break (less than five minutes) within two weeks.
Intervention four. Jan will practice energy conservation techniques by gathering all
necessary items at the beginning of the cooking activity and standing at the stovetop to make a
basic pasta dish using DME and A/E as needed (i.e. cane, walker with basket, pot stabilizer).
This intervention utilizes both the establish/restore and the modify approaches. It allows
Jan to practice skills that will help her to regain her independence during cooking tasks by

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building her endurance while simultaneously allowing her to use energy conserving and adapted
techniques (AOTA, 2014). It is supported by suggested occupational therapy interventions found
in Willard & Spackmans Occupational Therapy (Sachs, 2014). According to the text,
recommended interventions include task-specific training and utilizing adaptive/compensatory
techniques and technology such as energy conservation and A/E. This intervention would target
outcomes such as improved occupational performance and would increase quality of life,
participation, role-competence, and well-being (AOTA, 2014).
Precautions and Contraindications
Due to her limited LLE coordination and function as well as her limited LUE protective
extensions, Jan is still classified as having fall precautions. Her LUE shoulder subluxation
should also be considered during intervention planning but should not limit her involvement
significantly. Jan is otherwise in good health and has no additional precautions or
contraindications for treatment.
Frequency and Duration of Treatment
Based on NCEP standards, Jan has been attending the program five days a week (Monday
through Friday) since February. Her therapists recommend that she complete at least one more
month of comprehensive therapy at NCEP. However, her insurance has recently denied payment
for the remainder of the program and therefore Jan is required to discharge at the end of May,
2014. Further treatment is indicated, and Jan would benefit from continued outpatient
occupational and physical therapy at least two to three times a week for a minimum of 60
minutes. Outpatient treatment should continue for at least two more months or until Jan achieves
her treatment goals.
Theoretical Framework

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The Person-Environment-Occupational Performance Model (PEOP) was used to design

this intervention plan. This model looks at the relationship between the client, their inhibitory or
supporting environments, and their occupational performance capabilities in order to
appropriately set goals and plan interventions. As of right now, Jans home environment is not
inhibitory; however, she is living with her mother and sister and wants to return to living
independently, so her daily occupations need to be practiced and/or adapted so that she can
complete them with little to no help. For this purpose, an occupational adaptation approach was
also utilized for several of the interventions planned for Jan. Though she is hesitant to purchase
a lot of additional A/E for her home environment, Jan is still open to utilizing adaptive
technology until her functional deficits are remediated if it means that she can return to living
independently sooner.
Client/Caregiver Education and Monitoring Client Responses
Based on the structure of NCEPs day-treatment program, all clients are assigned a
professional advocate who ensures that they are receiving the appropriate training and education
from each therapist. The clients advocate also helps to establish goals and assess progress in the
program. Though Jans advocate is her physical therapist, she also receives regular one-on-one
treatment with NCEPs OT and OTA. These treatment sessions allow time for the OT/OTA to
provide education and training regarding A/E and techniques, home exercise programs, and
specific OT-related interventions. Jans mother is also involved with her bi-weekly
interdisciplinary team client conference and is free to ask questions and receive feedback and
instruction throughout the progression of the program by scheduling a meeting with her
therapists.

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Jans response to treatment has been and will continue to be monitored during her
treatment at NCEP. Her desired goals and outcomes will continue to be revisited formally during
her client conferences and reassessments; they will also be addressed informally during daily
treatment sessions. Jans goals have been established based on her desire for independence in
various occupations, and treatment goals and interventions will continue to be prioritized
accordingly. If Jan wishes to discontinue or change a goal, she is free to discuss it with her
therapists, her advocate, or her program case manager. Per reassessment protocols, Jans LUE
AROM goals will be documented after formal goniometer measurements are taken. This
procedure will be completed every two weeks. Achievement of other occupation-based goals
will be assessed using observation methods during on-going treatment sessions at NCEP.
Conclusion
Overall, Jan shows good potential for continuing to benefit from receiving occupational
and physical therapy at NCEPs comprehensive day treatment center. She wishes to continue
focusing her OT treatment on remediating her hemiparesis-related deficits, especially in her
LUE. Jan has struggled at times to maintain intrinsic motivation for continuing therapy;
however, she is highly motivated to return to work and has been told that it is normal for CVAand hemiparesis-related deficits to require extended rehabilitation. Despite the fact that she feels
her progress is slow, Jan has come very far since she began treatment at NCEP in February and
has already overcome many of the limitations her CVA imposed. With continued therapy and
appropriate modifications, Jan will likely be able to return to living independently, working, and
driving within the next year.

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References
American Occupational Therapy Association. (2014). Occupational therapy practice framework:
Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1),
S1-S48. http://dx.doi,org/10.5014/ajot.2014.682006
Gillen, G. (2013). Cerebrovascular accident/stroke. In H. M. Pendleton & W. Schultz-Krohn
(Eds.), Pedrettis Occupational Therapy: Practice Skills for Physical Dysfunction (pp.
844-880). St. Louis, MO: Elsevier Mosby.
Owsley, A. (2005). An introduction to clinical Pilates. Athletic Therapy Today, 10(4), 19-25.
Retrieved from http://www.pilates-place.co/upload/Information%20about%20Pilates.pdf
Poole, J. L., Burtner, P. A., & Stockman, G. (2009). The Framework of Occupational Gradation
(FOG) to treat upper extremity impairment in persons with central nervous system
impairments. Occupational Therapy in Healthcare, 23(1), 40-59. doi:
10.1080/07380570802455524
Sachs, L. (2014). Cerebrovascular accident. In B. A. B. Schell, G. Gillen, M. E. Scaffa, & E. S.
Cohn (Eds.), Willard & Spackmans Occupational Therapy: Twelfth Edition (pp. 11301132). Baltimore, MD: Lippincott Williams & Wilkins.