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Occupational Analysis and Intervention Plan

Lauren Hoppe
Touro University Nevada

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Occupational Profile
1. Client name: Sandra Hoppe
2. Age: 52
3. Sex: Female
Briefly discuss each of the following:
4. Who is the client?
The client is a 52 year old female who has been married to her husband for 26 years, and has
two grown children who are currently out of the house and in graduate school. She works as an
Occupational Therapist in an outpatient clinic. Sandra enjoys staying active by playing tennis,
hiking, jogging, walking her dog, and lifting weights. She attends church every Sunday and is a
part of a small bible study every Wednesday night. She also helps care for her 83 year old dad
with Alzheimers by helping to care for him and taking care of his finances.
5. Why is the client seeking services and/or what are the clients concerns relative to engaging
in occupations and in daily life activities?
The client can no longer enjoy playing tennis due to lateral epicondylitis of her right arm,
when walking and jogging she would have symptoms such as stiffness and achiness that would
cause discomfort. This discomfort would limit certain IADLs such as plugging cords into outlets
or putting dishes away. She began to use compensatory methods while lifting weight so she
could still workout by adapting how she held the weight so it would not bother her elbow.
6. What areas of occupation are successful and what areas are causing problems or risks?
Her leisure activities are affected because the lateral epicondylitis bothers her when she is
playing tennis, walking the dog, and lifting weights. Holding weights palm down caused great
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discomfort so she adapted by holding the weights in a neutral position of the wrist or completely
skip exercises if it was really hurting her. The tension caused by holding the leash while walking
the dog also causes pain and discomfort. Due to the discomfort, she is unable to perform certain
IADLs such as, putting dishes away in higher cupboards. She is also limited at work when she
needs to plug cords into an outlet, this particular action causes increased pain in her elbow.
She is not limited in social participation, rest, sleep or play.
7. What contexts and environments support or inhibit participation and engagement in desired
occupations?
The client lives in a two story house in Casper, Wyoming with her husband and dog. Her two
children are grown and away at college. She has two sisters and a brother that live close by. She
considers herself as a middle class citizen and has a bachelors degree in occupational therapy.
She works in an outpatient rehabilitation clinic that is located 5 minutes from her home. Living
in a small town allows easy access to grocery stores, work and other family members. This helps
to support her IADLs by making community outings relatively simple.
The clients cultural beliefs include raising her family in a Christian atmosphere,
participating in Christian holidays and attending church every Sunday. She also values
education, and a truthful, honest way of life. This supports her social participation occupations
by surrounding herself with many friends and activities involved at her church. Her value in
education supports her work occupation by getting a good education has allowed her to have a
good job which in turn helps to support her leisure and play occupations as well as support her
family.
Cultural aspect promotes participation in the activity because in our society staying active is
considered good and a part of a healthy lifestyle. Tennis itself is seen as widely accepted and
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popular sport in the United States. The social aspect also supports participation because the client
values interaction with her friends and family and tennis gives her the opportunity to spend
quality time with them.
The physical environment in which the client plays tennis can either support or inhibit
depending on location of the tennis court (if the court is indoors or outdoors) and the quality of
the courts. If the courts are outside, weather may make play difficult (too hot, too cold, wind,
rain, snow, bright sun). If the courts are inside it may be easier to play due to the availability to
control the environment (temperature and lighting).
8. What is the clients occupational history?
The clients occupational history includes performing tasks and activities associated with her
job as an Occupational Therapist. The roles that go along with being a mother and a wife such as
caring for others, preparing meals, grocery shopping, driving, cleaning and maintaining the
household. In her past occupations she also enjoyed playing softball, volleyball, tennis, hiking
and walking the dog. She chose to give up softball after a hamstring injury she inquired while
playing. She also attended church every week and volunteered for a basketball program.
9. What are the clients priorities and desired outcomes?
The client would like to maintain her independence and continue to stay active as she ages.
More specifically, she would like to be able to get back to playing tennis, walking the dog, and
performing IADLs without feeling pain or discomfort. She can still perform all of these
activities now but is limited to the amount of time she can participate and has had to make
adjustments in order to continue performing the activities.

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Occupational Analysis

1. Occupation:
Area(s) of occupation for the client: Subcategory:
1. Activities of daily living
2. Instrumental activities of daily living
3. Education
4. Work
5. Play
6. Leisure playing tennis
7. Social participation

2. Values, beliefs, spirituality associated with participation:
She believes exercise is important and wants to live a healthy lifestyle. She also values the
socialization she enquires with friends and family while playing tennis. She believes in good
sportsmanship because of her Christian values.

3. Contexts:
Context Supports Inhibits
Physical/space
demands
Tennis court on a flat, dry,
even surface, with good
lighting
Playing on a court that is not
lite well, playing while it is
rainy or windy
Social Following the rules of the
game, playing fairly
Not having friends or family to
go play tennis with
Cultural Using tennis as family time,
playing with family members
Not playing tennis because of
outside pressures such as
family does not support them
playing tennis
Personal Female with a bachelors
degree in Occupational
Therapy
Is a 52 year old female, her age
might inhibit her from
recovering as quickly
Temporal Having a set schedule to play
tennis with family members ;
such as every Saturday
Having other obligations that
interfere with tennis
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morning
Virtual Face to face communication People are spaced so far apart
it is difficult to communicate
verbally. Hand signals may be
used

4. Objects and their properties used:
Materials:
Water bottle
Tools:
One tennis racket with appropriate head size and grip size for the person
tennis balls (at least three tennis balls) with the appropriate types of tennis balls (high
altitude or regular)
tennis shoes that are the right size
tennis shorts or tennis skirt with pockets to hold balls
Equipment:
standardized tennis court (indoors or outside)
overhead lighting if playing after the sun goes down or indoors

5. Social demands:
The social demands include; knowing the rules of tennis, the expectations of others
participating in the activity, displaying good sportsmanship, understanding that tennis is a
gentlemans sport and acting appropriately.

6. Sequence and timing:
1. Grab at least two balls
2. Place one ball in pocket
3. Hold other ball in hand
4. Walk to one side of court
5. Have opponent walk to other side of court
5. Stand on appropriate side of court (opposite side of court as opponent)
6. Stand behind baseline
7. Make sure opponent is in position and ready to play
8. Serve ball over the net in opposite box
9. Ball must bounce in opposite service box
10. Watch ball bounce in service box
11. Opponent must hit ball off of one bounce
12. Watch ball as opponent hits ball back
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13. Be ready to run to where ball is hit, never take eye off the ball
14. Run to area where ball will be
15. Only allow ball to bounce one time
16. Position yourself on one side of the ball
17. Swing racket to hit the ball back over the net
18. Watch as your opponent hits ball back
19. Continue to hit ball over net until the point is over
20. The point is over once the ball goes into the net, hits out of bounds or bounces more than
once on one side of the court
21. Repeat play

7. Body functions required:
Function How It Is
Used
None Minimally
Challenged
Greatly
Challenged
Judgment Deciding
where to hit
the ball so
that it is
difficult for
your opponent
to hit it back
X
Concept formation Looking at
where the ball
is hit, your
position on
the court and
the position of
your opponent
and deciding
on the best
way to hit the
wall
(backhand,
forehand,
overhead) and
where to hit
the ball to
X
Metacognition Thinking
about what
skill you can
improve on to
continue to
get better as a
tennis player
for the next
X
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game
Cognitive flexibility Deciding to
use a forehand
or backhand
when the ball
is coming
directly at you
X
Insight/awareness Knowing your
limitations as
a player and
not trying to
perform a
slice shot
when you
have never
practiced it
before
X
Sustained attention Concentrating
on hitting the
ball in the
correct place
X
Selective attention Ignoring
people
cheering and
staying
focused on the
game and
where the ball
is
X
Divided attention Talking to
your opponent
while playing
X
Short-term memory Flipping a
coin to decide
who gets to
serve first and
remembering
if they said
heads or tails
after the coin
is flipped
X
Working memory Trying
different ways
to hold the
racket to
improve
backspin
X
Long-term memory Having X
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played the
game before,
remembering
the rules of
the game
Discrimination of senses:
Auditory
Hearing your
opponent call
out the score
X
Discrimination of senses: Tactile Feeling the
vibration in
your hand
when you hit
the ball off
center versus
when you hit
the ball off of
rim of racket
X
Discrimination of senses: Visual Discriminatin
g between the
shape of the
ball and the
shape of the
racket
X
Discrimination of senses:
Olfactory
The smell of a
freshly
opened pack
of tennis balls
vs
X
Discrimination of senses:
Vestibular-proprioception
Positioning
yourself
around the
ball in order
to have proper
technique
when hitting it
back
X
Multisensory processing Seeing where
the ball is on
the court
(visual)
positioning
your body to
hit the ball
(vestibular-
proprioceptio
n) and feeling
the vibration
of the ball off
X
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your racket
(tactile)
Sensory Memory Feeling a ball
and deciding
if it is worn or
new by the
feeling of how
much fuzz is
on it
X
Spatial relationships Knowing the
size of the
court and
where the net
is to know
how hard to
hit the ball in
order to get
over the net
but stay inside
the court
X
Temporal relationships Knowing how
long a normal
tennis game
should take
and how long
your game is
taking
X
Recognition Recognize the
difference
between the
service court
line and the
baseline
X
Categorization Categorizing
the different
types of
rackets (small
head, large
head, round
head) and
using the one
you like most
to play tennis
with
X
Generalization Playing on an
outdoor tennis
court and
being able to
X
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play indoors.
Also playing
on a grass
tennis court
and being able
to play on a
clay tennis
court
Awareness of reality Understandin
g that if she
plays at night
she will need
artificial light
in order to see
the ball
X
Logical/coherent thought Knowing the
proper clothes
to wear to
play tennis
X
Appropriate thought content Thinking
about your
strategy to the
game while
playing it and
not being
focused on
what you are
going to do
after the game
X
Execution of learned movements Having the
ability to
serve the ball
over the net
by using
motor
planning
X
Coping Having proper
emotional
regulation if
your opponent
scores a point
on you or
wins the game
X
Behavioral regulation Smiling after
scoring a
point or
frowning after
hitting the ball
X
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into the net
Body image Poor body
image may
affect
participation
in the activity
and they may
not participate
due to the
cloths you
have to wear
or because of
embarrassmen
t of not being
in shape
X
Self-concept Perceived
ability to play
tennis
X
Self-esteem Having the
confidence to
play and
participate in
tennis
X
Arousal Moving out of
the way of a
ball flying at
you
X
Consciousness Being awake
and alert to
play tennis
X
Orientation to self Understandin
g you are
playing tennis
X
Orientation to place Playing tennis
at a tennis
court instead
of in the
backyard
X
Orientation to time Deciding
when is the
best time to
play tennis. In
the morning
when it is
cooler outside
vs. in the
afternoon
when it is
X
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hotter
Orientation to others Being able to
identify her
opponent and
know her
name and
being able to
identify the
other people
on the next
court as
strangers
X
Emotional stability The ability to
stay calm and
even-
tempered
while playing
tennis, even if
frustrated

Motivation Playing tennis
is fun and
enjoyable but
will also keep
you in good
shape

Impulse control Resisting the
urge to throw
your racket
when you are
frustrated
with the game

Appetite n/a
Sleep n/a



Function How It Is
Used
None Minimally
Challenged
Greatly
Challenged
Detection/registration Being able to
identify the
shape of the
tennis ball as
it flies
through the
air
X
Visual modulation Being able to
focus on the
flight of the
ball and
X
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filtering out
other visual
stimuli such
as the kids
playing in the
pool located
next to the
tennis court
Integration of senses Hearing and
seeing the ball
bounce
X
Awareness at distances Knowing how
far away the
ball is to run
for the ball or
how far to
reach the
racket out in
order to hit
the ball
X
Tolerance of ambient sounds To be able to
play tennis
with the
sound of kids
playing in the
pool next to
the tennis
court
X
Location and distance of sounds After
accidently
hitting the ball
outside of the
tennis court,
being able to
listen to
where it hit to
judge how far
it went and
where it
landed
X
Moving against gravity Running
around the
tennis court
X
Taste n/a X
Smell n/a X
Body in space Movement of
upper and
lower
X
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extremity in
order to
position body
to hit the ball
Comfort with touch Comfort with
clothes
touching the
body, with the
feel of the
racket, and
with the feel
of the racket
in your hand
X
Localizing pain Feeling a pain
in your
thumb, upon
inspection
you can see a
blister
forming
X
Thermal awareness Touching the
water bottle to
see determine
if it is hot
from sitting in
the sun
X
Joint range of motion Normal range
of motion
(ROM)
needed in the
shoulder to
reach
overhead
when serving
and during net
play, spine
ROM needed
in order to
perform a
proper
forehand/back
hand and
normal ROM
in lower
extremities in
order to move
around the
court
X
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Joint stability/alignment Ability to
hold and hold
racket and
perform a
backhand
swing
X
Strength Strength to hit
the ball over
the net to your
opponent
X
Muscle tone Normal
muscle tone to
play tennis
X
Muscle endurance Enough
endurance to
play through
an entire
game of
tennis
X
Stretch reflex n/a X
ATNR n/a X
STNR n/a X
Righting and supporting reflex Ability to
stabilize
yourself when
thrown off
balance after
quickly
reaching for a
ball
X
Eye-hand coordination Ability to hit
ball with
tennis racket
X
Bilateral coordination Using both
hands to
perform a
backhand
swing
X
Crossing midline Performing a
forehand
swing (start to
same side of
body and
finish across
the body)
X
Fine motor control Grabbing a
ball from your
pocket
X
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Oculomotor control Eyes tracing
the movement
of the ball as
it passes back
and forth
across the net
X
Gait patterns Normal gait
pattern
running
around the
court
X
Blood pressure Normal
response in
blood
pressure
during
exercise in
order to
continue to
play tennis
X
Heart rate Normal
response to
heart rate
during
exercise,
should
increase as
intensity of
exercise
increases
X
Respiratory rate Increase in
order to meet
oxygen
demands
X
Respiratory rhythm Slightly faster
to meet
oxygen
demands
X
Respiratory depth Increased to
meet oxygen
demands
during
exercise
X
Physical endurance, aerobic
capacity
Being able to
stand and
move around
at a moderate
to high
X
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intensity level
for the
duration of
the game
Voice functions n/a X
Voice rhythm and fluency n/a X
Alternative vocalization n/a X
Digestive system Good working
digestive
system
X
Metabolic system Converting
food to energy
to sustain
activity
X
Endocrine system Release of
hormones to
sustain energy
needs
X
Urinary functions n/a X
Genital and reproductive function n/a X
Protective functions of the skin n/a X
Repair functions of the skin n/a X


8. Muscular analysis of movements required:
Muscle Required?
Shoulder flexion Greatly
Challenged
Shoulder extension Greatly
Challenged
Shoulder abduction Greatly
Challenged
Shoulder adduction Greatly
Challenged
Shoulder internal rotation Greatly
Challenged
Shoulder external rotation Greatly
Challenged
Elbow flexion Greatly
Challenged
Elbow extension Greatly
Challenged
Wrist supination Greatly
Challenged
Wrist pronation Greatly
Challenged
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Wrist flexion Greatly
Challenged
Wrist extension Greatly
Challenged
Thumb flexion Greatly
Challenged
Thumb abduction Minimally
Challenged
Finger flexion Greatly
Challenged
Finger extension Minimally
Challenged
Trunk flexion Greatly
Challenged
Trunk extension Greatly
Challenged
Trunk rotation Greatly
Challenged
Lower extremities Greatly
Challenged

9. Body structures required:


Category

Body Structure
Required?
Check If
Yes
Nervous system Frontal lobe X
Temporal lobe X
Parietal lobe X
Occipital lobe X
Midbrain X
Diencephalon X
Basal ganglia X
Cerebellum X
Brain stem X
Cranial nerves X
Spinal cord X
Spinal nerves X
Meninges X
Sympathetic nervous system X
Parasympathetic nervous system X
Eyes, ears, and
related
Eyeball: Conjunctiva, cornea, iris, retina, lens, vitreous
body
X
structures Structures around eye: Lachrimal gland, eyelid,
eyebrow, external ocular muscles
X
Structure of external ear X
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Structure of middle ear: Tympanic membrane,
Eustachian canal, ossicles
X
Structures of inner ear: Cochlea, vestibular labyrinth,
semicircular canals, internal auditory meatus
X
Voice and speech
structures
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
Cardiovascular
system
Heart: Atria, ventricles X
Arteries X
Veins X
Capillaries X
Immune system Lymphatic vessels X
Lymphatic nodes X
Thymus
Spleen
Bone marrow
Respiratory system Trachea X
Lungs: Bronchial tree, alveoli X
Thoracic cage X
Respiratory system
(continued)
Muscles of respiration: Intercostal muscles, diaphragm X
Digestive, metabolic, Salivary glands
and endocrine
systems
Esophagus X
Stomach X
Intestines: Small and large X
Pancreas X
Liver X
Gall bladder and ducts X
Endocrine glands: Pituitary, thyroid, parathyroid,
adrenal
X
Genitourinary and Urinary system: Kidneys, ureters, bladder, urethra X
reproductive systems Structure of pelvic floor X
Structure of reproductive system Ovaries, uterus, breast
and nipple, vagina and external genitalia, testes, penis,
prostate

Structures related to Bones of cranium X
movement Bones of face X
Bones of neck region X
Joints of head and neck X
Bones of shoulder region X
Joints of shoulder region X
Muscles of shoulder region X
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Bones of upper arm X
Ligaments and fascia of upper arm X
Bones of forearm X
Wrist joint X
Muscles of forearm X
Ligaments and fascia of forearm X
Bones of hand X
Joints of hand and fingers X
Muscles of hand X
Ligaments and fascia of hand X
Bones of pelvis region X
Joints of pelvic region X
Muscles of pelvic region X
Ligaments and fascia of pelvic region X
Bones of thigh X
Hip joint X
Muscles of thigh X
Ligaments and fascia of thigh X
Bones of lower leg X
Knee joint X
Muscles of lower leg X
Ligaments and fascia of lower leg X
Bones of ankle and foot X
Ankle, foot, and toe joints X
Muscle of ankle and foot X
Ligaments of fascia of ankle and foot X
Structures related to Cervical vertebral column X
movement
(continued)
Lumbar vertebral column X
Sacral vertebral column X
Coccyx X
Muscles of trunk X
Ligaments and fascia of trunk X
Skin and related
structures
Areas of skin: Head, neck, shoulder, upper extremity,
pelvic region, lower extremities, trunk, and back
X
Structure of skin glands: Sweat and sebaceous
Structure of nails: Fingernails and toenails
Structure of hair





10. Performance skills required:

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Skill Required? How the Skill Is Used

Motor/praxis

Yes

Picking up the tennis racket to play tennis
Pacing movements to swing the racket
Adjusting body position in response to were the ball is
Sensory (perceptual)

Yes

Visually determining how far away the net is
Being able to maintain balance by vestibular input due
to position changes
Emotion regulation

Yes

Controlling anger or frustration during the game
Continuing to play even when frustrated or not playing
well
Cognitive

Yes

Problem solving how to hit the ball
Following the rules of the game

Communication/soci
al

Yes


Communicating with your opponent if the ball is in or
out
Communicating who gets to serve first



11. Performance patterns:
Parts of this occupation has elements of which of the following: (check all that apply)
Pattern Describe
X Useful habit Bouncing the ball three times before the serve to help refocus and
catch breath before the next play

X Dominating habit Hitting your racket on your shoe after missing a point
X Routine Following the routine of the game (serve and play until point is won)

X Ritual Shaking hands with your opponent after the match is over

X Role Participating in the role of a tennis player


Intervention Plan
1. Identify 1 objective and measurable goal of the intervention:
The client will find a tennis racket, with the help of a tennis professional, which has the
appropriate grip size for the size of her hand and a lighter racket within the next month.
a. According to OTPF what type of outcome is this?
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The goal is considered adaptation because the client will modify the objects and
its properties used in tennis in order to prevent pain from her lateral epicondylitis.

2. Intervention approach:

Approach Describe
Create/promote

Establish/restore

Maintain

X Modify Modify the size of grip on racket and decrease the overall weight of
the racket to minimize the amount of strain placed on the lateral
forearm flexors.

Prevent


3. Activity selection
a. Activity selection: Identify 1 example of each for the intervention plan
Activity Describe
Occupation-based
intervention
Playing a short game of tennis with the appropriate tennis racket that
had been fit to them. Also, playing tennis with a lighter ball such as a
foam ball or racket ball in order to decrease the amount of stress
placed on the lateral forearm flexors, while still allowing the client to
engage in tennis.

Purposeful activity Dusting her blinds
Preparatory
method
Performing pain management techniques such as ice, massage and
heat.



b. Discuss how activity selection relates back to occupational profile and
occupational analysis
The activity selection is a crucial step in the intervention process, it should be an activity
that is meaningful to the client. The information gained in the occupational profile can help to
determine what activities interest the client and are most meaningful to them. As a therapist, we
should pick activities that are gradable, adaptable, have a definite end point and require several
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body systems. The occupational analysis aides in determining all factors involved in the activity
so the therapist can determine if the activity will encourage mastery of the skill and give the
client a sense of accomplishment once completed.
c. Discuss how activity selection will support achievement of client identified goals
and goal of the intervention plan
Activity selection will help to support achievement of client identified goals and goals of the
intervention plan through participation in meaningful activities, and by working toward
established goals set by the therapist and client in the occupational profile. The occupation based
intervention was playing tennis using a lighter racket and lighter tennis ball. This activity is
meaningful to the client and allows the client to continue to participate in tennis while recovering
from her lateral epicondilitis. The purposeful activity chosen for this client was dusting. This
allows similar movements to the ones used in tennis. Dusting is also still meaningful to the client
because it is part of her IADLs and fits into her role as a mother and wife. The preparatory
methods used were ice packs and heat packs to implement a pain management program.
4. Describe how intervention can be graded or adapted and why
An intervention is graded to provide the client with a just right challenge. Therapeutic
interventions should challenge the client but still allow them to successfully complete the
activity. If therapy becomes too challenging for the client they may become frustrated and give
up. In order to provide the just right challenge, grading up and grading down are used to adjust
the activity as needed to stimulate success. Grading up is done to give the client a greater
challenge, while grading down is used when the activity is too difficult for the client. To grade
an activity the therapist should look at the activity demands, the context and environment in
which the activity takes place, the sequence and timing and the social demands of the activity,
and then examine each one to determine where the activity can be made more challenging and
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where it can be made easier. For example, if the activity takes place in a loud environment with
many distractions, try eliminating any distractions to grade the activity down.
Adapting an activity is changing, modifying, or alternating the whole activity or parts of the
activity so the client can successfully complete the occupation. The goal of adapting is to
increase client participation and overall independence. This can be done by finding alternative
methods of completing the activity or by using adaptive equipment.
5. Safety concerns and/or precautions
The client has pain of the right lateral epicondyle with certain movements. Caution should
be taken when performing movements that extend the wrist because, this could cause strain on
the muscles and increase inflammation.
6. Discuss the role of the occupational therapy practitioner during the intervention
The role of the Occupational Therapist (OT) in intervention is to guide an evidence based
intervention that is goal directed and client centered. The OT should be there every step of the
intervention process to insure progress is being made and to adapt or grade an activity as needed.
The therapist should reevaluate and adjust intervention to ensure short and long term goals are
met and most importantly, the therapist should be there to encourage the client so that they can
succeed in meaningful occupations and live life as independently as possible.
7. Discuss what is expected of the client during the intervention
The client is expected to be a part of therapy and be compliment with the intervention plan.
They are encouraged to ask questions and openly discuss any hesitations they may have with
therapy. It is important for the client to be honest with the therapist about pain levels or
hesitations so that therapy can be most beneficial.

Running head: OCCUPATIONAL ANALYSIS 26

References
American Occupational Therapy Association (2008). Occupational therapy practice framework:
Domain and process (2nd ed.) American Journal of Occupational Therapy.