Running head: OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Occupational Analysis and Intervention Plan

Breanna Dickson
Touro University

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

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Occupational Profile

1. Client name: Clyde T.

2. Age: 66
3. Sex: Male
Briefly discuss each of the following:
4. Who is the client? Clyde is a 66 year old retired father of one grown daughter. He
retired two years ago from the dice making industry after 25 years of work due
to an injury. He lives in a single story home in Utah with his wife of 20 years.
Clydes role in the home includes upkeep of light housework and occasional meal
preparation while his wife works at a bank during the day. He mainly watches
television during the day but also enjoys an occasional lunch at a local pub with
his friends.

5. Why is the client seeking services and/or what are the clients concerns relative
to engaging in occupations and in daily life activities? Clyde developed spinal
stenosis two years ago which causes pain in his left shoulder and neck region
which significantly reduces his ROM in his left shoulder. He has tried different
medical procedures to alleviate his pain but none have been successful.
Currently Clyde manages his pain with medications but since he has been
avoiding movement throughout the past two years, his shoulder has become
stiff, especially during extension.

6. What areas of occupation are successful and what areas are causing problems or
risks? Clyde is independent in all areas of occupation but he often struggles with
upper extremity dressing due to his limited shoulder ROM. Although he is able to
don his jacket successfully, he struggles being able to doff it.

7. What contexts and environments support or inhibit participation and

engagement in desired occupations? Clyde is successfully able to get around in
his single story home and in the community but the amount of time it takes to
doff his jacket is frustrating to him. He will sometimes give up trying and wear
his jacket in his house if his wife isnt home to help him take it off. He will often
keep his jacket on when he visits with friends because he is embarrassed for
them to see him struggle with something so simple.

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8. What is the clients occupational history? Clyde has been retired from the dice
making industry for two years. While he was working, his primary role was to
provide an income and assist in home management. Since retiring, meal
preparation has been added to his household responsibilities. Clyde feels that his
days at home are empty and he would like to seek more leisure activities
outside of the home but his pain medication affects his mood and motivation.

9. What are the clients priorities and desired outcomes? Clyde feels that the
thought of struggling to take off jacket is sometimes intimidating enough to
decrease his motivation to leave his house. Clyde hopes that with occupational
therapy he will be able to complete upper extremity dressing and undressing
successfully and that he will be able to increase the range of motion in his left
shoulder.

Occupational Analysis
1. Occupation:
Area(s) of occupation for the client:
Subcategory:
1. Activities of daily living
dressing
2. Instrumental activities of daily living n/a
3. Education
n/a
4. Work
retirement preparation and
adjustment
5. Play
n/a
6. Leisure
n/a
7. Social participation
n/a
2. Values, beliefs, spirituality associated with participation:
Clyde values spending time with his wife and friends as well as
maintaining a neat home. He values working but since he is unable to
because of his injury he hopes to find alternatives that will be as
rewarding to him. Clyde believes it is important for a man to be strong and
his difficulty with undressing has affected his confidence.

3. Contexts:
Context
Physical/space
demands
Social
Cultural

Supports
X

Inhibits

X
X

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Personal
Temporal
Virtual

X
X
X

4. Objects and their properties used:

Tools: none required
Materials: black leather zip-up jacket
Equipment: a firm chair or large solid standing area
5. Social demands:
It is expected that he will doff and hang his jacket when he comes inside from
being outdoors.
6. Sequence and timing:
1. Use pinch grasp to unzip jacket completely
2. Using left hand, pull the right sleeve off the right shoulder
3. Pull right arm behind your body, bringing it to the left side
4. Using left hand, pull the end of the right sleeve until it comes off of the right
arm completely
5. Using right hand, pull the left sleeve off the left shoulder
6. Pull left arm behind your body, bringing it to the right side
7. Using right hand, pull the end of the left sleeve until it comes off of the left
arm completely
7. Body functions required:
Function

How It Is
Used

Judgment

Deciding
which
sleeve to
remove first
Knowing
how to take
off a jacket
if it is fully
zipped
versus
unzipped
Reflecting
on where in
the doffing
process you
struggle and

Concept formation

Metacognition

None

Minimally
Challenged

Greatly
Challenged

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Cognitive flexibility

Insight/awareness

Sustained attention

Selective attention

Divided attention

Short-term memory

Working memory

5
thinking of
different
techniques
to try
Changing
the plan of
undressing
if you
experience
difficulty
Being aware
of ones
own
shoulder
ROM to
determine if
you can
successfully
undress
Focusing on
unzipping
and doffing
jacket
Being able
to focus on
undressing
and not the
television in
the
background
Being able
to have a
conversatio
n while
undressing
Knowing the
zipper is in
being held
between
your thumb
and finger
Knowing
what step in
the
undressing
process you

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Long-term memory

Discrimination of senses:
Auditory

Discrimination of senses:
Tactile

Discrimination of senses:
Visual

Discrimination of senses:
Olfactory
Discrimination of senses:
Vestibular-proprioception

Multisensory processing

Sensory Memory

Spatial relationships

6
are
currently at
Knowing
how to use
a zipper
Ability to
hear zipper
sliding down
track
Feeling the
leather
fabric in
your hands
as you pull
off the
sleeves
Being able
to look
down and
see yourself
undressing

X
Being aware
that you are
standing or
sitting up
while
undressing
Hearing the
sound of the
zipper and
feeling the
release of
fabric
Knowing the
thickness
and
smoothness
of leather
Knowing
what is
around you
so you can
avoid
knocking

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Temporal relationships

Recognition

Categorization

Generalization

Awareness of reality

Logical/coherent thought

Appropriate thought content

Execution of learned
movements

Coping

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anything
over while
undressing
Being aware
of how
much time it
takes you to
doff a jacket
Recognizing
the size of
your jacket
Recognizing
that zippers
and buttons
can be used
to fastened
a jacket
Knowing
how to doff
jackets of
different
materials
Being aware
that you are
at home
taking off
your jacket
Thinking
about the
steps of
doffing your
jacket as
youre doing
it

X
Knowing
how to
position
your arms
and trunk
when
doffing a
jacket
Maintaining
calm if your
zipper

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Behavioral regulation

Body image
Self-concept
Self-esteem
Arousal

Consciousness

Orientation to self

Orientation to place

Orientation to time

Orientation to others

Emotional stability

8
becomes
stuck
Not
becoming
upset
because you
are
struggling
to doff your
jacket

X
X
X
Wanting to
doff your
jacket
because you
feel hot
Need to be
awake to
doff a jacket
Knowing
you are
warm and
doffing your
jacket
Knowing
you are in
your living
room
doffing your
jacket
Knowing
how much
time is
passing as
you doff
your jacket
Knowing if
anyone else
if around
you when
you are
doffing your
jacket
Being able

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Motivation

Impulse control

9
to regulate
your
emotions if
you fail
trying to
doff your
jacket
Have to
want to take
off your
jacket
Not ripping
off your
jacket
because you
are having a
difficult time

Appetite
Sleep

How It Is
Used

Detection/registration

See objects
around you
Focus on
the zipper
Feel your
shoulder in
extension
and see the
jacket
coming off
your arm
Be able to
look down
at the
zipper and
then ahead
at the mirror

Integration of senses

Awareness at distances

Tolerance of ambient sounds

Location and distance of
sounds
Moving against gravity
Taste
Smell

X
X

Function

Visual modulation

None

Minimally
Challenged

X
X
X

X
X
Standing
upright

X
X

Smelling the

Greatly
Challenged

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Body in space

Comfort with touch

Localizing pain

Thermal awareness

Joint range of motion

Joint stability/alignment

Strength

Muscle tone

Muscle endurance

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leather of
the jacket
Knowing
you are
sitting or
standing
upright
Feeling the
leather
material on
your
fingertips
To know
when your
shoulder
has
extended
too far
To know
when to
take the
jacket off
Using your
shoulder
and hands
to pull off
the jacket
Important in
keeping one
arm still
while the
other pulls
Needed to
pull the
jacket off
the shoulder
Need to
facilitate
normal
movement
patterns
Needed
when it is
taking a
long time to
doff the

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jacket
Stretch reflex
ATNR
STNR
Righting and supporting
reflex

Eye-hand coordination
Bilateral coordination

Crossing midline

Fine motor control

Oculomotor control

Gait patterns
Blood pressure

Heart rate

Respiratory rate

X
X
X
To keep
yourself
standing
upright
while
undressing
Reaching for
the zipper
Using both
hands to
assist in
undressing
Using right
hand to take
off left
sleeve
To grasp the
zipper
To see
where on
the jacket to
place your
hands

X
X

X
X

X
Blood
pressure
may
increase
while
standing
and doffing
jacket
Normal
heart rate
since
doffing a
jacket could
be
strenuous
Important to
remember
to breathe
normally

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Respiratory rhythm
Respiratory depth
Physical endurance, aerobic
capacity

X
X
Standing
and
reaching
requires
some
endurance

Voice functions
Voice rhythm and fluency
Alternative vocalization
Digestive system
Metabolic system
Endocrine system
Urinary functions
Genital and reproductive
function
Protective functions of the
skin
Repair functions of the skin
8. Muscular analysis of movements required:
Muscle
Shoulder flexion
Shoulder extension
Shoulder abduction
Shoulder adduction
Shoulder internal
rotation
Shoulder external
rotation
Elbow flexion
Elbow extension
Wrist supination
Wrist pronation
Wrist flexion
Wrist extension
Thumb flexion
Thumb abduction
Finger flexion
Finger extension
Trunk flexion
Trunk extension
Trunk rotation
Lower extremities

Required?
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
n/a

X
X
X
X
X
X
X
X
X
X

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9. Body structures required:

Category

Body Structure

Nervous system

Frontal lobe
Temporal lobe
Parietal lobe
Occipital lobe
Midbrain
Diencephalon
Basal ganglia
Cerebellum
Brain stem
Cranial nerves
Spinal cord
Spinal nerves
Meninges
Sympathetic nervous system
Parasympathetic nervous system
Eyeball: Conjunctiva, cornea, iris, retina, lens,
vitreous body
Structures around eye: Lachrimal gland, eyelid,
eyebrow, external ocular muscles
Structure of external ear
Structure of middle ear: Tympanic membrane,
Eustachian canal, ossicles
Structures of inner ear: Cochlea, vestibular
labyrinth, semicircular canals, internal auditory
meatus
Structures of the nose: External nose, nasal
septum, nasal fossae
Structure of the mouth: Teeth, gums, hard
palate, soft palate, tongue, lips
Structure of pharynx: Nasal pharynx and oral
pharynx
Structure of larynx: Vocal folds
Heart: Atria, ventricles

Eyes, ears, and

related
Structures

Voice and speech

structures

Cardiovascular
system

Immune system

Arteries
Veins
Capillaries
Lymphatic vessels
Lymphatic nodes
Thymus
Spleen
Bone marrow

Requir
ed?
Check
If Yes
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
n/a
n/a
X

n/a
n/a
n/a
n/a
X
X
X
X
X
X
n/a
n/a
n/a

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Respiratory system
Respiratory system
(continued)
Digestive,
metabolic,
and endocrine
systems

Genitourinary and
reproductive
systems

Structures related
to
Movement

14
Trachea
Lungs: Bronchial tree, alveoli
Thoracic cage
Muscles of respiration: Intercostal muscles,
diaphragm
Salivary glands

X
X
X

n/a

Esophagus

n/a

Stomach
Intestines: Small and large
Pancreas
Liver
Gall bladder and ducts
Endocrine glands: Pituitary, thyroid, parathyroid,
adrenal
Urinary system: Kidneys, ureters, bladder,
urethra
Structure of pelvic floor

n/a
n/a
n/a
n/a
n/a
X

Structure of reproductive system Ovaries,

uterus, breast and nipple, vagina and external
genitalia, testes, penis, prostate
Bones of cranium

n/a

Bones of face
Bones of neck region
Joints of head and neck
Bones of shoulder region
Joints of shoulder region
Muscles of shoulder region
Bones of upper arm
Ligaments and fascia of upper arm
Bones of forearm
Wrist joint
Muscles of forearm
Ligaments and fascia of forearm
Bones of hand
Joints of hand and fingers
Muscles of hand
Ligaments and fascia of hand
Bones of pelvis region
Joints of pelvic region
Muscles of pelvic region
Ligaments and fascia of pelvic region
Bones of thigh
Hip joint
Muscles of thigh
Ligaments and fascia of thigh

n/a
n/a
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X

n/a
n/a

n/a

OCCUPATIONAL ANALYSIS AND INTERVENTION PLAN

Structures related
to
movement
(continued)

Skin and related

structures

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Bones of lower leg
Knee joint
Muscles of lower leg
Ligaments and fascia of lower leg
Bones of ankle and foot
Ankle, foot, and toe joints
Muscle of ankle and foot
Ligaments of fascia of ankle and foot
Cervical vertebral column

X
X
X
X
X
X
X
X

Lumbar vertebral column

Sacral vertebral column

Coccyx
Muscles of trunk
Ligaments and fascia of trunk
Areas of skin: Head, neck, shoulder, upper
extremity, pelvic region, lower extremities,
trunk, and back
Structure of skin glands: Sweat and sebaceous
Structure of nails: Fingernails and toenails
Structure of hair

X
X
X
X
X

n/a
n/a
n/a

10.Performance skills required:

Skill

Require
d?

How the Skill Is Used

Grasping the zipper and pulling it down, using

one hand to pull the sleeve off the other arm

Sensory
(perceptual)

Knowing to doff the jacket when you are too

warm, feeling the material of the jacket

Emotion
regulation

Cognitive

Communication/s
ocial

n/a

Motor/praxis

Minimally used; not having an emotional

outburst because you are struggling to doff the
jacket
Deciding if you should attempt doffing your
jacket based on your pain and range of motion

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11.Performance patterns:
Parts of this occupation has elements of which of the following: (check all that
apply)

Pattern
Useful habit

Describe
Using both arms and hands to assist in doffing your jacket

Relying on someone else to remove your jacket

Dominating
habit
Routine

Ritual

Choosing to wear favorite leather jacket when going out with

friends instead of another jacket

Role

Role as member of larger society and dressing appropriately

for the weather

Doffing jacket as soon as you enter from outside

Intervention Plan
1. Identify 1 objective and measurable goal of the intervention:
With practice every day for 14 days, Clyde will be able to successfully doff his
jacket 95% of the time in fewer than 2 minutes.
a. According to OTPF what type of outcome is this? Improvement in
occupational performance

2. Intervention approach:

n/
a
X

Approach
Create/promote

Describe

Establish/restore

Clyde is restoring his skill of being able to doff his jacket in a

timely manner

n/
a
X

Maintain

n/
a

Prevent

Modify

Clyde may be introduced to compensatory strategies to help

with his limited shoulder ROM

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3. Activity selection
a. Activity selection: Identify 1 example of each for the intervention plan
Activity
Occupationbased
intervention
Purposeful
activity
Preparatory
method

Describe
Clyde will practice taking off his jacket in front of a mirror as
soon as he comes inside his house
Clyde will practice unzipping and removing jacket from a
mannequin within a certain amount of time once a day
Clyde will stretch left shoulder for 10 minutes in the morning
and exercise daily with a light dumbbell

b. Discuss how activity selection relates back to occupational profile and

occupational analysis
i. Clyde is expected to remove his jacket when coming in from
outside and he will be able to practice in a mirror since he has a
large mirror in his hallway. Clyde has jackets of other materials
but enjoys wearing his leather jacket because it makes him feel
special. When he goes to lunch with his friends, he wants to be
able to doff his jacket in the pub without needing help. Since
Clyde is retired, exercising his shoulder would be a good way for
him to occupy his time and seeing his progress could be
motivating for him.
c. Discuss how activity selection will support achievement of client
identified goals and goal of the intervention plan
i. Clyde wants to be able to doff his jacket in less than 2 minutes.
If he stretches regularly, he should be able to increase the
limited range of motion in his left shoulder. By practicing
removing a jacket from a mannequin, it will allow him to practice
removing the jacket from the mannequins shoulders which is
where he experiences the most difficulty in the doffing process.
By practicing in the mirror, it will allow Clyde to see where he
struggles and allow him to think of other techniques he could try.
4. Describe how intervention can be graded or adapted and why
a. If the range of motion in Clydes left shoulder is unable to be increased
due to structural changes, he can be taught a one-handed undressing
technique as an adaptation. The intervention can be graded down by
him practicing taking of jackets of other materials that are easier to
manipulate than leather which can be stiff. If Clyde is successful in
doffing his jacket in 2 minutes, the intervention can be graded up by
having him try to doff in 1 minute.
5. Safety concerns and/or precautions

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a. It is important Clyde knows his pain and range of motion limits so he
doesnt cause any damage to his affected shoulder by trying to push
himself too hard.
6. Discuss the role of the occupational therapy practitioner during the
intervention
a. Dressing is an activity of daily living (ADL) which is in the scope of
practice of occupational therapy. Clyde has a physical limitation that
interferes with his ability to undress so the role of the occupational
therapist in Clydes case is to teach him stretching exercises,
encourage him to not give up, and teach compensatory strategies if
needed.
7. Discuss what is expected of the client during the intervention
a. Clyde will be expected to practice his daily stretches as directed. He
will be expected to complete undressing on the square board until he
has mastered it. Clyde will also be expected to tell the occupational
therapist if he has any pain and he will need to continue to practice
and stretch regularly even after he has mastered doffing his jacket in a
timely manner.