Cassie Beam
Intervention Session Plan 1
Clients Initials and Age: S.C., 44 years old
Diagnosis: Multiple Sclerosis
Precautions: fall risk (muscle weakness and loss of vision); do not over-stretch or exhaust muscles; frequent breaks may be
needed; possible sensory deficits; check O2 saturation throughout activities
Goal/s being addressed: increase in endurance while standing and completing tasks, increase in fine motor coordination, increase in-hand manipulation,
increase in postural control when sitting in wheelchair
Specific Objectives for this
Intervention Activities
activity (list 2-3)
Objectives: Time spent
standing, number of towels
folded, time spent remaining
balanced
Reason for activity: Patient
has decreased endurance
and spends most time supine unfolded on table, but within
Household management (~15 in bed. Folding laundry while reaching distance to
minutes): Practice folding standing forces weight
laundry (towels of various through the LEs to increase
sizes from clinic) from a endurance while
standing position to increase participating in task that
standing endurance, involves movement in
participation in IADL tasks, different directions of the
and problem-solving. shoulder, elbow, wrist, and
fingers to accommodate for
length of towel. Folding
laundry also uses problem-
solving skills to find the best
way to stay balanced, reach
for the towel, and fold the
towel in the most efficient
way.
Time allotted for session: 45 minutes
Activity Demands (setting,
materials, and social
requirements)
Materials: 2 washcloths, 3
hand towels, 3 bath towels
Environmental set-up: place
walker in front of patient due
to decrease standing balance,
have towels and washcloths
decrease loss of balance,
have a clear space in front of
patient to lay towels when
task completed
Grade up: increase the
number of towels to fold or
practice walking around gym
to gather laundry, bring to
table and fold
Grade down: do activity
while sitting down or use
smaller towels to fold for less
energy expenditure
Date implemented: 9/13/2017
Results (link to activity
objectives; include Modifications (provided during
objective measures of the activity and planned for
performance when next session)
possible)
Results: Pt was able to What went well: Pt reported
stand up with min. assist feeling better after standing for
with one hand on walker a moment to relive pressure off
and one hand on back and buttocks. Pt was able
wheelchair to complete sit- to remain balanced the entire
to-stand transfer. Pt. upright and did not need
maintained balance and assistance to remain standing
stood for 1 minute, then with walker in front.
folded two large towels
and one hand towel using What did not go well: I had
both UEs for a total of 3 some difficulty making the gait
minutes standing while belt tighter on pt as she stood
participating in IADL task due to my own fear of the pt
with contact guard assist falling, but was able to receive
for impaired balance. Pt some assistance from FWE.
used self-awareness,
independently, and took a What would you change: I
rest break for 6 minutes would have liked to have the
while sitting in wheelchair. patient further forward in the
Pt then completed the wheelchair before standing,
same activity of folding two also to have the gait belt
large towels and one hand already snug before standing. I
towel for a total of 3 would also change the
minutes standing with environment I had set up. I
contact guard assist. would have liked the pt fold
Cassie Beam
Intervention Session Plan 1
In-hand manipulation and
fine motor coordination (~15
minutes): Using various coins
of different sizes, practice
moving coins from the palm
Perceptions on the
responses and
performance related to the
activity and specific
objectives: Pt had increase
in standing endurance from
previous evaluation in May
of 2017. During this eval, pt
could only stand for 10-15
seconds before needing a
break, thus a change was
noted as pt stood for 6
minutes total. Pt also
reported not participating
in IADL task, but now has
increased insight to her
own abilities to complete
more tasks around the
home.
Objectives: Number of coins Results: Pt started with 12
Materials: 30 coins of various
placed in container and coins in R hand and placed
sizes, small container to place
distance the container is all coins, using translation
coins in
placed from the patient from palm to tip pinch, in
container 6 inches from pt,
the towels presented in front
of her, but also place folded
towels in a basket or to place
them in a cabinet near the
activity.
Did you change something in
the session: After speaking to
the pt at the beginning of the
session, pt reported having
decreased energy and
endurance. Due to this, I
modified the number of towels
by decreasing the demand of
the activity.
How can you better support
the clients performance or get
more effort and skill from the
client: I would have liked to
simulate a more realistic
activity of laundry by gathering
laundry, sorting into piles for
the wash, and folding a variety
of items while standing and
then placing newly folded
items in to cabinets or hanging
larger items. This would have
increased independence in
household management that
could lead to carry-over in
other IADL tasks.
What went well: Pt was able to
independently problem solve
to retrieve dropped coins with
L hand. Pt was able to tolerate
more coins and translate them
Cassie Beam
Intervention Session Plan 1
of the hand to a tip pinch
using translation and place
the coins in a small container
placed at various distance
from the edge of table.
Practice using right and left
hand during task. During this
activity, practice postural
stability and holding neck
straight in alignment
Reason for activity: Patient
has decrease fine motor
coordination and dexterity as
shown by the 9-hole peg test
by having greater than
normal limits for age group.
Practicing fine motor
coordination and in-hand
manipulation can increase
independence in removing
screw tops, paying for items
at a store, and counting and
placing medications in the
appropriate pill box. This
activity also practicing
postural stability while sitting
in the wheelchair while
keeping the neck up to
increase participation in ADL
tasks.
Environmental set-up: small
container placed on a flat
surface that has enough
room to increase the
distance needed to reach for
the container, coins placed in
front of patient on the table,
patient is placed in front of
task at an appropriate height
Grade up: decrease time
allotted to manipulate coins;
increase distance needed to
reach container; decrease
size of the opening on the
container; stand up during
activity
Grade down: decrease
distance needed to reach
container; increase time
allotted; place coins in a cup
rather than small container
independently. With L
hand, pt performed same
task of translating 12 coins,
but dropped 4 coins when
translating. Pt
independently picked up
coins with left hand and
completed task. Pt then
translated and placed 20
coins with R hand in the
container 10 inches from pt
with min cues for keeping
upright posture and head.
Pt translated and placed
another 20 coins with R
hand at 14 inches from pt,
independently.
Perceptions on the
responses and
performance related to the
activity and specific
objectives: Pt demo
difficulty with translation
with L hand, specifically
moving coin from ulnar to
radial side of palm. With R
hand, pt demo increase
fine motor coordination.
to tips of thumb and index
finger while the distance of the
container increased.
What did not go well: Pt
complained of neck stiffness
and some pain when trying to
keep head up, thus resulting in
a continued R lateral flexion of
neck.
What would you change: I
would have changed the
container that the coins were
placed in. I did not have access
to a piggy bank. This would
have increased the demand of
coordination and maintaining
the coin at the tip pinch.
Did you change something in
the session: Pt voiced that she
wanted more practice with R
hand during activity so that she
can use it more often. I then
made the task harder by
increasing coins and distance
after each completion for R
hand.
How can you better support
the clients performance or get
more effort and skill from the
client: Using a piggy bank to
increase demands on fine
motor coordination could
increase effort and skills to give
Cassie Beam
Intervention Session Plan 1
Grocery shopping (~15-20
minutes): With various
objects set around the room
with various price tags,
practice walking and
scanning around the gym for
items on a list. When all the
items on the list have been
gathered, practice paying for
each time using in-hand
manipulation for coins. When
looking for items on the list,
practice visual scanning with
emphasis on postural control
during static and dynamic
standing.
Materials: coins and paper
money of various worth,
Objectives: Number of items
small to large items that
gathered before a break is
would be appropriate to buy
needed and time spent
in a grocery store, paper and
standing/walking around gym
pens to write lists, price tags
to gather items
Environmental set-up: using
Reason for activity: Due to
the gym as set up, have the
the decrease in endurance,
OT table be the checkout
doing a mock grocery
after the groceries have
shopping experience in the
been gather. On various
gym would give the patient
shelves around the gym,
reassurance of safety. Pt
place items with price tags
does not normally participate
taped to them. Make sure a
in IADL tasks, even those in
clear walk way is established
the home. this activity also
between each item around
increases pts practice with
the gym to have a walker
visual scanning as pt
comfortably fit through. If
maintains lateral flexion most
there are other patients and
of the time. While standing,
therapists in the gym, use
both static and dynamic,
area around OT table, but
postural control is needed to
still having enough space for
succeed in IADL tasks.
a walker to easily maneuver
to gather items.
motivation to pt that she can
complete more fine motor
activities at home than
previously state. Another way
to support performance would
be to practice medication
management using similar
techniques with organizing
beads into small containers,
but reinforcing gross grasp to
open bottles and then translate
from palm to tip pinch.
What would you change: If I
would have tried to complete
this activity again, even with
the same comment of
decreased endurance, I would
have asked my pt to walk and
gather one or two items and
then sit down and work on in-
Did not perform this hand manipulation while
activity due to time paying for items.
constraint, but also per
patient report, I do not How can you better support
have the endurance to do the clients performance or get
that today. The humidity more effort and skill from the
has me down and I have client: I would have given
low energy. further motivation to complete
the activity. With a completed
activity, pts can feel more
motivated to try these same
activities, or similar ones, at
home and in the community if
possible. Also getting more
effort and skill from the pt
through further engagement
with increasing the standing
Cassie Beam
Intervention Session Plan 1

efforts with dynamic and static

Grade up: increase items on can translate into further
the list; increase the distance endurance for other
between items; decrease occupations.
time allotted

Grade down: only practice

paying for items; gather
one or two items rather than
a list; increase time provided;
have someone push a
wheelchair around the gym
to gather items
S/OT name: Cassie Beam

Systematic Review of Occupational Therapy-Related Interventions for People with Multiple Sclerosis: Part 2. Impairment.

Abstract: This article is the second part of a systematic review of studies on occupational therapy-related intervention for people with multiple sclerosis (MS).
The objective of this systematic review was to critically appraise and synthesize the applicable findings to address the following focused question: What is the
evidence for the effectiveness of interventions within the scope of occupational therapy practice for people with multiple sclerosis? Part 1 (Yu & Mathiowetz,
2014) reviewed evidence for the effectiveness of activity- and participation-based interventions for people with MS. In contrast to the top-down approach,
enabling occupational performance can be achieved through remediating impaired personal abilities. Therefore, Part 2 focuses
on occupational therapy interventions targeting impairment. Studies included in this review focused on improving client factors and performance skills in people
with MS, including cognition, emotional regulation, and motor and praxis skills.

Chih-Huang, Y., & Mathiowetz, V. (2014). Systematic Review of Occupational Therapy-Related Interventions for People With Multiple Sclerosis: Part 2.
Impairment. American Journal Of Occupational Therapy, 68(1), 33-38. doi:10.5014/ajot.2014.008680

From various searches through the literature, most of it links fatigue management and self-care closely to OT, but the patient I had seen in an outpatient
setting had already had this education from my FWE and previous therapists. When looking into her chart, I found that she had decreased fine motor
coordination, decreased endurance, and decreased motivation to remain standing for activities. While I could not find great evidence for specific
interventions, generally there has been moderate to high correlation with exercise and continued use of motor skills for the management of multiple
sclerosis. There is strong evidence that supports physical activity, specifically aerobic exercise, progressive resistance training, and yoga. While my
Cassie Beam
Intervention Session Plan 1

patient did not have the endurance to participate in highly demanding physical activity, the goal of the therapy session was to facilitate physical activity
and encourage more exercise while completing tasks at home. Exercises, even at low intensity, can improve endurance and lower and upper extremity
strength, something that my patient was lacking in. There were two activities that were highly influenced by exercise (household management and
grocery shopping) and one of these did not occur due to a lack of endurance. The goal was show my patient that everyday activities have some
components of low intensity exercises if done in a manner that is supportive to their safety. This systematic review is supportive of my intervention plan
in the way that low-intensity exercises should be incorporated in ones life, even if they are done while doing ADL/IADL tasks. Patients may complain that
they do not have enough time in the day for exercises, but thinking of task analysis and incorporating small exercises into everyday tasks will lift that
burden and increase the quality of life.