Running head: PROFILE AND ANALYSIS

Occupational Profile and Occupational Analysis James Stewart Touro University Nevada OCCT 630

Profile and Analysis Occupational Profile Who is the client? Rita is a 72-year old woman from Mesquite, NV. She has lived in or near Mesquite for most of her life. She has been married to her husband, Russell, for 45 years. Russell has his own set of health problems which are starting to limit his activities. Both of them are mostly independent, being able to take care of themselves. They have 3 children, all boys, who live in

different states across the country. None of them live close to home. All of the boys have married and now have children. Rita is the grandmother of 7 grandchildren. Why is the client seeking services, and what are the clients current concerns relative to engaging in occupations and in daily life activities? Rita is seeking services because of shoulder pain and decreased ability to move her shoulder. Decreased ability to move her shoulder is due to the pain and limited range of motion (ROM). Her greatest worry is her increasing inability to perform activities of daily living (ADLs) tasks. She is also seeking services because she fears that these problems will increase in the future. She visited her doctor and discussed her concerns. He found that some years before she had torn one of her rotator cuff muscles which had then reattached somewhere else. The doctor then referred her to occupational therapy services. What areas of occupation are successful and what areas are causing problems or risks? Rita finds that most of her occupations that occur in the morning are becoming problematic. Most of these occupations are included in ADLs such as dressing, bathing, and grooming (American Occupational Therapy Association [AOTA], 2008). Specific tasks she is unable to perform are hooking her bra, wash her back, and comb the back of her hair. This is when the shoulder is most stiff, painful, and has less ROM. Occupations that occur after she has

Profile and Analysis begun moving and using her shoulder are more successful for her. Most of these occupations occur in the afternoon and night. They fall under instrumental activities of daily living (IADLs), rest and sleep, and leisure. Specific occupations in these areas include home management and maintenance, preparing meals, and sleep preparation (AOTA, 2008). Social participation with

her family and friends is her most successful occupation. She shows exceptional skill in this area and is able to socialize with most people in a friendly way. What contexts and environments support or inhibit participation and engagement in desired occupations? Rita finds that contexts and environments that encourage less movement and activity inhibit her participation in desired occupations. Within the home, the bedroom and living room are example of such environments because she is laying down to rest or sitting and watching TV. Rita finds that contexts and environments that encourage more movement and activity support her participation in desired occupations. Within the home, the kitchen and her garden are examples of such environments. They promote moving of the shoulder to grab, move objects, and manipulate objects. What is the clients occupational history? Rita says that she has always sought to get the most out of life. In her youth, she used to go whitewater rafting and hot air ballooning. She also says that she loves to move and used to run every day, but age has limited her to walking. Recent knee problems now prevent her from walking everyday like she used to. Since becoming a wife and mother, she takes care of her home, cooks, and entertains. Over time she has come to love these occupations, most particularly taking care of her home. In her later years, she has also taken up gardening. What are the clients priorities and desired outcomes?

Profile and Analysis Ritas priorities are to decrease the pain in her shoulder and to increase her ROM. When

these goals are accomplished she hopes to more easily engage in her desired occupations such as performing her morning ADLs. Occupational Analysis The only occupations that I saw Rita perform were based on therapeutic exercise. The one exercise that was most meaningful to her and most occupation-based was washing the wall with a washcloth with her arm above her head. This activity would fall under the area of occupation of IADLs because it would help lead her cleaning and maintaining her home. The following questions will be based on this activity. Charts are based on information provided by the Occupational Therapy Practice Framework: Domain and Process 2nd Edition (AOTA, 2008). What deficits exist in each of the body function categories? Mental Functions Specific Mental Functions

Global Mental Functions

Sensory & Pain

Rita shows no signs of deficits in this area. She shows good judgment and attention. She has excellent coping skills, good memory, and an excellent self-esteem. Rita shows no signs of deficits in this area. She is fully conscious and aware of her surroundings. She is emotionally stable and motivated to do her best in therapy Sensory: Rita may have some impairment in visual acuity and hearing due to age. Other sensory areas may also be affected because of age, but appear fully intact and without any deficits. Pain: Rita feels pain her shoulder area possibly from pulled muscles, muscle weakness, and nerve impingement. Pain is dependent on activity involvement and time of day.

Profile and Analysis Neuromusculoskeletal & Movement-Related Functions

5 Joint Mobility: Rita shows limited AROM in her shoulder. All 6 planes of movement of the shoulder are somewhat affected. Joint Stability: Ritas scapula and glenohumeral joint show decreased stability because the muscles keeping these joints in place are weakened with some muscles having changed insertion areas. Muscle Power: Rita shows decreased strength in her shoulder. Muscle Tone: The muscles tone in Ritas shoulder appears normal. Rita shows no other deficits in this area such as gait patterns, involuntary and voluntary movement, and reflexes. Cardiovascular: Rita appears to have no deficits in this area, but could potentially have high blood pressure due to age. However, her active lifestyle would most likely keep her blood pressure low. Respiratory: Rita appears to have no deficits in this area. Her active lifestyle most likely keeps her lungs active and working properly.

Cardiovascular & Respiratory

Discuss the activity demands of this task Object Needs Space Demands Washcloth Wall Wall located indoors Clutter-free environment around the wall with enough space that allow for arm movement (nothing in front of the wall or objects on the floor around the wall) Comfortable indoor environment with normal indoor temperature and good lighting No social demands are required because washing the wall involves no social component. If one were to

Social Demands

Profile and Analysis

6 socialize during the activity, then she would need to stay on task while doing so. Sequence: o Grab washcloth o Lift arm above head o Bring washcloth against wall surface o Scrub wall in a circular pattern Timing: Make sure to perform ten repetitions of scrubbing in a circle before ending task. Grabbing the washcloth Continuing to hold a grip on the washcloth while scrubbing Stabilization of the wrist and elbow Keeping the arm above the head Movement of the shoulder in horizontal abduction, horizontal adduction, flexion, and extension

Sequence & Timing

Required Actions or Skills

Identify the performance patterns related to the task and your client Habits Through this activity it is hoped that Rita will develop the habit of cleaning in a circular pattern rather than only a two plane pattern (e.g. up/down, left/right). Having this habit, Rita will better develop her shoulder muscles and decrease deficits. This activity is meant as a therapeutic exercise to help increase muscle strength in the shoulder in order to increase independence in daily life. Rita should start to incorporate this exercise into her daily routine so as to increase the muscle strength in her shoulder. Also, Rita cleans her home on a daily basis. The activity of washing the wall falls within the routine that she already established for herself. Cleaning of her house, such as washing the walls, falls within Ritas role as wife. She, and most likely her husband, expects that she maintain a clean home.

Routines

Roles

Profile and Analysis

Identify the performance skills, which are required for this task Motor Skills One would need to bend the arm to reach for the washcloth, grasp the washcloth in the hand, move and balance the arm above the head, move the arm and shoulder in a circular pattern, and stand while task is being performed. One would need to maintain balance while the arm is moving, feel the pressure of the washcloth against the wall to know that washcloth is actually scrubbing against it, know that the arm is positioned above the head, and the ability to see the washcloth and the wall that needs to be cleaned. One would need to persist through task even though it may be difficult with current deficits or may become fatigued over time. One needs to sequence tasks in proper order such as grabbing the washcloth before attempting to scrub the wall. One would need to judge when breaks may be needed to rest the shoulder because of pain or too much fatigue. No communication or social skills are involved because this activity is performed without social interaction.

Sensory-Perceptual Skills

Emotional-Regulation Skills

Cognitive Skills

Communication & Social Skills

Identify the body functions and body structures primarily influenced by this task Body Functions Mental Functions

One would need to maintain attention to the task of washing the wall, memory of washing the wall in order to continue to repeat the action, the ability to emotionally cope when fatigue sets in or have loss of independence, be aroused and conscious, and show motivation to continue with exercise in order to improve independence.

Profile and Analysis

8 As shown, Rita shows no deficits in this area that would affect her ability to perform these tasks. One would need to see the washcloth and the wall, have an awareness of the body in space, and have minimal pain in standing or when arm is moving. Rita shows deficits in this area because she feels pain in her shoulder when performing an activity right after being inactive for a period of time. One would need to have full ROM of the shoulder, extension of the wrist, flexion of the fingers, extension of the elbow, stability of the scapula and glenohumeral joint while performing activity, adequate muscles strength to move the arm in a circular pattern, adequate muscles strength in the legs to maintain standing, and voluntary control of muscles of the arm. Rita shows deficits in her limited ROM of her shoulder, some instability of her scapula and glenohumeral joints, and decreased strength in her shoulder muscles. One would need to have a stable heart rate during movement, have adequate blood pressure during movement, and maintain breathing while performing the activity. As shown, Rita shows no deficits in this area that would affect her ability to perform these tasks. One would need an intact nervous system, intact cardiovascular and respiratory system, intact muscles and bones of the arm, and intact skin of the arm. Rita only shows problems with the muscles in her shoulder. One of the muscles was torn and then reattached to a different location.

Sensory Functions & Pain

Neruomusculoskeletal & MovementRelated Functions

Cardiovascular & Respiratory

Body Structures

Comment on the contexts that specifically relate to the performance of this intervention

Profile and Analysis Cultural

9 Being an American, Rita has a high priority on her being independent in her tasks and activities. She wants to complete this activity without help and be able to do as much as she can by herself Rita lives in a one-story house that has multiple walls that would possibly need to be cleaned at some point. Rita mentioned that she loves to entertain and visit with friends. Having a clean home in which to entertain is most likely important to her. How often she entertains would be influenced by how often she is able to clean her home. At this stage in her life, Rita finds more meaning from cleaning her home because she is losing the ability to do other things. Cleaning her home is still something that she is able to do. Time of day is also affected by Ritas ability to clean. Mornings are more difficult because of increased pain and decreased AROM whereas afternoons are easier because pain is decreased and AROM is increased. No virtual context applies to this activity because the activity does not require the means of a cell phone, computer, or other such virtual device This task of washing the wall is meaningful to Rita both because of her age and gender. Being a woman, she is more likely the one who takes care of the home full-time. Being older, she most likely has a higher emphasis on home care and home management. Defining the spiritual context as finding meaning in life, this activity is meaningful to Rita because she finds great meaning through activity and exercise. She also finds this activity meaningful because it focuses on home management, one of her current passions.

Physical

Social

Temporal

Virtual

Personal

Spiritual

Profile and Analysis Problem List

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Identify at least 5 different problems relevant to the client and state these in the format of a problem statement 1. Client is unable to hook her bra 2 pain and AROM in R shoulder. 2. Client is unable to comb her hair 2 pain and AROM in R shoulder. 3. Client is unable to wash her back 2 pain and AROM in R shoulder. 4. Client requires mod I to clean her home 2 time from fatigue in R shoulder. 5. Client is unable to grab cooking items from a high shelf 2 AROM and muscle weakness in R shoulder. Prioritize your problem list and justify your reasoning The main reason that Rita is seeking services is based on her decreased independence in her ADLs. She also listed increasing her independence in her ADLs as her main priority during therapy. For these reasons, the three ADL tasks that she is unable to perform are listed first in the problems list. Secondly, Rita also mentioned that she highly values independence and that she needs to be independent because her husband has his own health problems. For this reason, hooking her bra and combing her hair are listed first so that her husband does not have to help with these tasks. The reason washing of the back is listed third is that this can easily be compensated for with a long-handled brush or sponge. The last two problems are listed last because Rita does not mention them as a priority for treatment. Home maintenance and cleaning is more meaningful to Rita than cooking. For this reason, cleaning the home is listed before grabbing items from a high shelf.

Profile and Analysis References

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American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625-683.