Running head: OCCUPATIONAL PROFILE & INTERVENTION PLAN

Occupational Profile and Intervention Plan

Danielle E. Goddard
Touro University Nevada

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Occupational Profile
Mr. Miles is a 74-year-old husband, father, grandfather, and retired school teacher. He
was recently diagnosed with chronic lymphocytic leukemia (CLL) and underwent his first round
of intensive chemotherapy treatment in July of 2014. Mr. Miles has experienced a rapid and
significant decline in his overall health status and independence since his diagnosis and first
treatment session. Additionally, he is currently suffering from several other secondary diagnoses
which also require extensive treatment and medical management: pancreatitis (which
necessitated a cholecystectomy), bilateral upper extremity (UE) deep vein thrombosis (DVT),
persistent nausea and vomiting, and upper esophageal sphincter dysfunction with dysphagia and
aspirate pneumonia. Before his cancer diagnosis, Mr. Miles had no significant medical history
with the exception of prescription-controlled hypertension.
Reason for Seeking Treatment
Mr. Miles is currently seeking occupational therapy (OT) services to address extreme
weakness and significant debility secondary to his CLL, chemo treatment, and additional medical
complications/diagnoses. He is concerned that he has lost the energy and endurance to safely
complete even the most basic out-of-bed activities of daily living (ADLs). Before his diagnosis
and subsequent hospitalization, Mr. Miles was independent in all ADLs, instrumental activities
of daily living (IADLs), leisure, work, and community mobility occupations, including driving.
He is now limited to activities that he can complete in his bed with limited energy expenditure.
Mr. Miles requires moderate assistance (Mod A) for bed mobility secondary to generalized
weakness. He is able to roll side-to-side with minimum assistance (Min A) using his bed rails
but requires Mod A to achieve an edge-of-bed (EOB) seated position due to decreased UE and
core strength. Mr. Miles can participate in basic ADL grooming and self-care tasks (e.g. face-

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washing, hair combing, tooth brushing) while sitting up in his bed if the necessary items are set
up for him. He currently requires Min A for utilizing a bed pan but expresses a strong desire to
be able to get out of bed safely and independently in order to utilize a bedside commode (BSC).
He also requires maximum assistance (Max A) for lower body dressing at this time, because he
has not been provided with adaptive equipment (A/E) and becomes too winded and fatigued
when attempting to bend more than ninety degrees at the hip.
Though he is able to complete some basic ADLs in bed with setup assistance, Mr. Miles
does not feel successful when it comes to self-care at this time, especially considering his prior
level of function (PLOF) before his initial hospital admission. He states that he wants to go
home and, more than anything, would love to get a full nights sleep in his own bed. Mr. Miles
explains that he never feels well-rested because he is constantly being awakened in the hospital
setting and is often nauseated during the night. He says that he is glad that he has his own
private room in the long-term acute care hospital (LTACH) setting and is thankful to have the
ease of access to his doctors, nurses, and therapists, but overall he feels that the experience is
draining his energy and is preventing him from healing the way he might expect to at home.
Occupational History
Mr. Miles is a retired high school history teacher and has been married to his wife,
Glenda, for 52 years. He has two grown children and five grandchildren who all live in the Las
Vegas area. Mr. Miles lives in a single-story home and reports using no durable medical
equipment (DME) prior to his most recent hospitalization. Before his diagnosis, Mr. Miles
enjoyed traveling with his wife in their RV, visiting with his children and grandchildren,
volunteering, reading, playing chess, walking his dog, Daisy, and attending weekly church and
bi-weekly Bible study meetings. He also volunteered every Thursday as a tutor for individuals in

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a GED preparation course. Mr. Miles values his roles as a husband, father, grandfather, friend,
member of his church, and volunteer. He also valued his independence and relative health prior
to his cancer diagnosis.
Prior to his hospitalization, Mr. Miles typically awoke by seven every morning to make
coffee and take Daisy for a long walk around his neighborhood. He returned home to make
breakfast with Glenda and read the paper. Mr. Miles then completed any chores he needed to do
around the house before lunch. After lunch, Mr. Miles usually went out into the community with
his wife to run errands or volunteer. He and Glenda served as the primary after-school caregivers
for three of their grandchildren, so later afternoons during the week were dedicated to picking up
the children from school and returning home to help with homework and make snacks. In the
evenings, Mr. and Mrs. Miles typically made an early dinner and enjoyed leisure activities such
as reading or chess. Bible study sessions and other social events were also held in the evenings
several times per week. Periodically, Mr. and Mrs. Miles planned weekend or extended
vacations in their RV. Overall, Mr. Miles reports that he was very satisfied with his life and
occupational engagement prior to his diagnosis.
Mr. Miles patterns of daily occupational engagement began to change when he started
experiencing the symptoms of what he assumed was just a cold: swollen lymph nodes, fatigue,
and a low-grade fever. After several doctors visits, extensive testing, and finally receiving a
CLL diagnosis, Mr. Miles reports that his life changed drastically. His doctors quickly devised a
plan of care which necessitated a central line placement with aggressive chemotherapy treatment.
Mr. Miles was hospitalized for these procedures and reports that his energy level was quickly
sapped as several secondary complications arose, eventually necessitating a cholecystectomy and

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gastrostomy-jejunostomy tube (GJ tube) placement, extending his hospitalization, and severely
limiting his energy and functional mobility.
Client Priorities and Desired Outcomes
Mr. Miles reports that he is primarily concerned with regaining his energy and endurance
in order to participate in everyday activities such as basic self-care and in-home mobility. He
also says, I need to be stronger before I can receive more treatments for my cancer. His main
priority is to discharge home as soon as possible. Glenda is two years younger than her husband
and is in good health. She also enjoys being active and has made it clear to her husbands
doctors, nurses, and therapists that she is willing to help her husband in any way possible when
he goes home. Mr. Miles is concerned with his generalized weakness and knows that he will
need to be strong enough to stand and ambulate at least short distances independently in order to
go home if his wife is to be his primary caregiver. Mr. Miles knows that his strength may not
come back quickly, but he is motivated to begin therapy in order to ensure his own safety and his
wifes piece of mind. At this point in his treatment, Mr. Miles is primarily focused on building
his strength and endurance in order to facilitate safe transfers and functional ambulation,
increasing standing tolerance for basic ADLs, and toileting, bathing, and dressing with little to no
assistance. Though he has never utilized DME in the past, Mr. Miles is concerned about falling
and is therefore open to using a walker for ambulation. He eventually hopes to regain his
independence and is anxious to return to his roles as grandfather, volunteer, and church member.
He also reports feeling depressed about his current health situation and says that his quality of
life will continue to suffer until he is able to become more independent once again.

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Occupational Analysis
Mr. Miles is currently being treated at Horizon Specialty Hospital (HSH), a LTACH in
Henderson, Nevada. During his initial OT evaluation, Mr. Miles was alert and oriented,
answered questions thoroughly, and expressed his motivation to participate in a rehabilitative
program. Glenda was present during the evaluation and vocalized her support for her husband
and his rehab goals. During the evaluation, Mr. Miles OT asked him several questions regarding
his prior and current levels of function. He was guided through a brief UE range of motion
(ROM) and manual muscle testing (MMT) protocol. ROM was classified as within normal
limits though MMT-based muscle strength was impaired in most movements due to overall
weakness, disuse, and debility (average of 3+ strength overall with client and wife reporting a
significant decline in strength over the past few weeks of hospitalization).
Bed mobility was also assessed, and it was noted that Mr. Miles requires Min A for
rolling side-to-side using bed rails and also requires Mod A during the trunk elevation stage of
pushing up from side-lying to sitting EOB. He reported that he is currently utilizing a bed pan
for toileting and requires Min A for rolling and positioning. Mr. Miles attempted to demonstrate
putting on his own socks while sitting up in bed with the head of the bed elevated. However, he
was quickly winded and reported feeling nauseated and fatigued before he was able to reach one
foot. He verbally reported that he wanted to try for the evaluation but usually requires Max A
for lower body (LB) dressing, including donning and doffing underwear, pants, socks, and shoes.
Mr. Miles was able to participate in basic grooming tasks while sitting up in bed (face washing,
tooth brushing, combing hair) utilizing a plastic basin and the bedside table with setup assistance.
Mr. Miles apologized and said he was too nauseated and fatigued to attempt to stand in order to
assess standing and mobility. Glenda reported that the last time he stood was five days prior

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while working with physical therapy (PT) in the acute care hospital. She also reported that he
was unable to ambulate more than five feet (with a walker and support from the PT) and was
only able to stand with assistance at the sink to complete grooming tasks for a maximum of three
minutes in the acute care hospital before becoming too fatigued.
At this time, it seems that Mr. Miles generalized cardiovascular (CV) and muscular
deconditioning and his frequent nausea and vomiting are impacting him most noticeably. These
complications are increasing his fatigue while decreasing his strength and overall ability to
engage in self-care and other meaningful occupations. It was noted during his evaluation that
bending at the waist more than 90 degrees exacerbated his fatigue, shortness of breath (SOB),
and nausea. Mr. Miles reported no previous training regarding A/E for dressing, so OT
interventions will need to include A/E introduction and training in order to decrease overall
exertion. OT treatment will also need to be planned around administration of Mr. Miles
medications, namely those prescribed for nausea reduction. In order to increase Mr. Miles
cardiovascular (CV) endurance and muscle strength and endurance, occupationally-based
interventions will also need to be focused on biomechanical outcomes.
At this point in his hospitalization, there are many domains that are affecting Mr. Miles
ability to successfully engage in his meaningful occupations of choice according to the American
Occupational Therapy Associations (AOTAs) Occupational Therapy Practice Framework
(OTPF). Client factors such as body structures and body functions are impacted overall by his
CLL and related secondary complications (American Occupational Therapy Association
[AOTA], 2014). Mr. Miles muscle strength as well as his CV and muscular endurance have
been very compromised by his prolonged bed-bound status. This as well as his overall fatigue
and nausea have impacted his performance in functional mobility and ADLs. Being removed

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from his natural context of home and community has impacted all of his other areas of
occupation including IADLs, rest and sleep, work (volunteering), play, leisure, and social
participation. Experiencing compromised health and being away from home has also interrupted
his daily habits, routines, and roles. And finally, being confined to acute care and LTAC
hospitals over the past several weeks has physically interrupted his cultural, personal, physical,
and social contexts and environments for an extended period of time (AOTA, 2014).
Prioritized Functional Problem List
The following problem statements are ranked based on immediate need, appropriate
developmental progression, and client priority. These concerns are based on direct observation
of performance and client/caregiver interview. Client abilities are described based on Functional
Independence Measure (FIM) rating criteria. This criteria is used for evaluation, intervention,
and discharge documentation at HSH. Facility-appropriate abbreviations have been utilized as
needed.
Problem One: Bed Mobility
Client requires Mod A for bed mobility 2 to UE & core strength.
Problem Two: Lower-Body Dressing
Client requires Max A in LB dressing 2 to lack of A/E training & SOB, fatigue, &
nausea while bending @ the waist.
Problem Three: Standing for BADLs
Client requires Max A while standing to complete basic grooming tasks 2 to CV
endurance & lower extremity (LE) strength.

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Problem Four: Functional Ambulation

Client requires Max A to functionally ambulate short distances in order to perform
BADLs 2 to debility & fall risk.
Problem Five: Toileting
Client is unable to toilet (I) using BSC 2 to endurance & fall risk during tasks
requiring functional ambulation & LB clothing management.
Justification for Prioritization
Due to Mr. Miles significant debility and current lack of CV endurance, bed mobility and
LB dressing techniques for in-bed dressing should be prioritized first in order to provide safe
achievement of independence in very basic ADLs before progressing to goals requiring fully
upright postures. Principles relating to energy conservation and ideal body mechanics can be
taught by the OT while addressing these first two areas of concern. Just as sitting goals should
be addressed before standing goals in a developmental progression, standing (static) goals should
also be addressed before those which require walking and functional ambulation (dynamic).
Finally, although independent toileting is a client-reported priority, utilizing the BSC will be
addressed last due to the combined components of functional ambulation, standing balance, and
clothing management. Once all of the previous problems and related goals are addressed, Mr.
Miles will be able to utilize his increased endurance, energy conservation techniques, and fall
prevention strategies to work on independent toileting. He will then be able to progress to more
taxing ADL occupations such as showering and ambulating longer distances.
Intervention Plan and Outcomes
The following intervention plan is based on the top two current problem statements
prioritized for Mr. Miles. Client abilities, achievement, and progression toward identified

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outcomes will be measured based on FIM rating criteria. Goals have also been written utilizing
facility-specified abbreviations as appropriate.
Long-Term Goals, Short-Term Goals, and Interventions
Long-term goal one. Client will safely perform all bed mobility tasks (I) using proper
body mechanics within 4 wks.
Short-term goal one. Client will demonstrate proper rolling and bed mobility techniques
in order to facilitate bed pan use c modified independence (Mod I)/utilizing bed rails within 2
wks.
Intervention one. Mr. Miles will practice supine-to-side rolling, scooting up in bed, and
moving side-to-side using the bed rails and with Min A from his OT as needed. Breaks between
trials will be provided, and Mr. Miles can utilize the Borg Rate of Perceived Exertion scale to
report his effort using various strategies (i.e. log roll, segmental rolling) until the most energyefficient techniques are identified. The OT will provide education for Mr. Miles and his
caregiver (Glenda) regarding proper positioning for comfort and function, prevention of
contracture, and prevention of skin breakdown. In-bed exercises will also be taught in order to
build up UE and core strength. These exercises will help strengthen the muscles most commonly
utilized for bed mobility and will begin helping to increase Mr. Miles CV and muscular
endurance. According to the OTPF, this intervention utilizes the establish/restore approach in an
attempt to restore core strength, UE strength and ROM, and previously intact bed mobility. It
also aims to prevent further loss of functional movement, contractures, and pressure ulcers
(AOTA, 2014). These secondary impairments are all common in patients who are confined to
their beds secondary to illness, injury, deconditioning, and overall debility.

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According to Zomorodi, Topley, and McAnaw (2012), muscle mass can be lost at a rate
of up to 50 percent in a two-week period for critically ill patients. Decreased mobility secondary
to prolonged bed rest can also lead to loss of skin integrity, risk of infection, and risk of DVT and
other complications. These researchers stress the importance of a graded mobility protocol for
patients in the acute care setting, starting with basic bed mobility and progressing to EOB sitting,
Max A standing, and eventually to staff-assisted ambulation. Zomorodi and colleagues also
indicate the importance of utilizing patient-reported exertion to grade activities and rate patient
effort. This allows the therapist to also quantify progress in endurance over time (Zomorodi et
al., 2012). A similarly-graded protocol can be utilized with Mr. Miles in order to help facilitate
functional mobility progress.
Occupational performance improvement and prevention of secondary complications are
desired OT outcomes of this intervention (AOTA, 2014). Both are equally important aspects of
helping Mr. Miles safely return to his prior level of independent function. Achievement of bed
mobility goals will help Mr. Miles progress to more complex mobility as he continues the
rehabilitation process.
Short-term goal two. Client will safely achieve an EOB seated position to prepare for
functional standing utilizing proper body mechanics c Mod I within 2 wks.
Intervention two. The OT will educate Mr. Miles regarding proper body mechanics and
energy conservation techniques for supine to side-lying to sitting EOB. He will practice with the
assistance of his OT as needed. This activity can be facilitated by providing a stable surface for
pushing up from side-lying to an EOB seated position (Alexander, Grunawalt, Carlos, &
Augustine, 2000). This intervention utilizes an establish/restore approach to help Mr. Miles
further progress in bed mobility goals (AOTA, 2014). It also helps him achieve positions which

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will help promote occupational engagement, will help him build core strength, and will prepare
him for more complex functional ambulation.
A study completed by Alexander et al. (2000) discovered the relative difficulty of various
bed mobility tasks ranging from rolling (using a side rail, without the use of a side rail, and with
arms crossed) to sitting up in bed or transitioning from supine to an EOB seated position. This
study identified the most difficult components of bed mobility tasks based on participant ability
to complete each motion independently. Participants included young adult controls, well older
adults living in congregate housing, and a sample of elderly individuals residing in skilled
nursing facilities. It was shown that tasks requiring core strength and stability which did not
allow the use of UE assistance were the most difficult for both older adult participant groups.
Tasks which require upper limb facilitation of trunk elevation were also shown to be particularly
difficult, especially in those older adults who experienced UE weakness. Alexander et al. (2012)
recommended the use of a stable surface under the supporting UE in order to promote side-lying
to sitting EOB success. This could be replicated in the clinical setting by utilizing a hard-backed
book, slide board, or other solid surface to provide graded resistance for the UE which extends in
order to push the trunk into an upright position. This intervention targets improvement of
occupational performance outcomes (AOTA, 2014). In this case, occupational performance
consists of bed mobility in order to prepare for standing and eventual functional ambulation.
Long-term goal two. Client will complete LB dressing c setup assistance and use of A/E
within 4 wks.
Short-term goal three. Client will demonstrate use of A/E for donning underwear, pants,
& socks in bed c Min A within 2 wks.

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Intervention three with graded variations. The OT will introduce and demonstrate the
use of various A/E to aide in dressing tasks. Mr. Miles will practice donning his underwear and
pants using a dressing stick and reacher while avoiding fatiguing positions (such as bending too
far forward at the hip). He will also practice utilizing a sock aide for donning hospital socks.
This activity can be graded up if the OT requires Mr. Miles to sit EOB while utilizing A/E for LB
dressing. Sitting EOB will require Mr. Miles to utilize more core strength and will recruit the
use of more large muscles, therefore further challenging muscle strength and endurance. Lower
body dressing can be graded down if the OT provides Mod A or helps Mr. Miles with the more
difficult task steps such as properly positioning his pants, pulling garments over his hips, and
correctly positioning the sock aide.
This intervention utilizes the modify approach by introducing A/E and modified
positioning in order to decrease energy expenditure and negative symptoms relating to bending at
the waist repeatedly or for a prolonged period of time (AOTA, 2014). According to a study
completed by Mann et al. (2005), in a population of frail elderly, dressing aids were more
favorably rated and more commonly used than many other adapted personal hygiene devices.
Per participant report, utilizing A/E for dressing also decreased dependency on caregivers and
increased functional independence in self-care tasks, therefore increasing overall quality of life.
This study overall was aimed at identifying what types of dressing problems were most common
and which types of dressing aides were most favorably rated. Overall, it was found that shoe
horns, sock aides, and dressing sticks were the most commonly owned, utilized, and preferred
dressing A/E items. While reachers were less commonly utilized for dressing according to this
study, participants who did own them overall rated their efficacy highly (Mann et al., 2005).
This research justifies the use of A/E by older adults who are struggling with dressing tasks and

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supports the OT assumption that A/E can be widely efficacious for promoting independence in
self-care occupations.
This intervention targets several outcomes, namely improvement of occupational
performance, quality of life, participation, and role competence (AOTA, 2014). The overall goal
of this intervention is to remediate deficits and increase independence in LB dressing tasks.
However, regaining independence in basic self-care occupations also enhances quality of life by
increasing self-efficacy and helping the client return to meaningful occupational participation.
Short-term goal four. Client will safely utilize energy conservation techniques while
donning shoes with Mod I @ EOB within 2 wks.
Intervention four. The OT will educate Mr. Miles regarding pursed-lip breathing
techniques and energy conserving positions with proper body mechanics for tying shoes (e.g.
sitting EOB and crossing legs to bring feet closer to the core rather than bending head toward the
floor). The OT will also provide education regarding the use of long-handled shoe horns and
other A/E options such as elastic laces. Mr. Miles will demonstrate techniques while practicing
donning various types of shoes (slip-on with no ties and shoes with laces) with and without A/E
in order to identify preferred methods. This intervention utilizes both the establish/restore and
modify approaches in order to help Mr. Miles regain independent function in shoe tying (AOTA,
2014). Mr. Miles will regain the muscle strength and endurance to complete this task but can
also utilize modified techniques (positioning, breathing techniques, and A/E) in order to achieve
independence while conserving energy.
According to a study completed by Lyons, Lambert, Balan, Hegel, and Bartels (2013),
cancer diagnoses and subsequent treatment protocols typically affect the occupational
engagement of older adults drastically. According to the study, engagement decreases overall

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across all areas of occupation but is most noticeable in IADL, social, and more highly physically
challenging leisure activities even three months after cancer treatment is discontinued. ADL
activities such as dressing are typically only affected in the most acute phases of treatment or in
patients who experience significant debility secondary to their diagnoses. Fatigue, nausea,
change of priorities, and SOB are the four most common reasons that participants reported
caused a decrease in their occupational engagement. However, the authors also note that it has
been shown in previous literature that decreased engagement in occupation can actually increase
fatigue and overall decreases quality of life. Lyons et al. stress the importance of modifying
occupations to increase engagement and decrease energy expenditure. This can include adapting
the actual occupation by utilizing energy conservation methods or A/E (Lyons et al., 2013). The
methods utilized in this intervention help target some of the most common causes of
occupational disengagement and also Mr. Miles reported problematic symptoms: fatigue, SOB,
and nausea which are exacerbated by LB dressing tasks.
This intervention mainly aims to target improvement of occupational performance (LB
dressing, specifically donning shoes) by introducing modified tools, postures, and techniques in
order to make the task more achievable. It also provides for more participation in everyday
occupations and provides Mr. Miles with tools for independence and role competence in self-care
(AOTA, 2014).
Precautions and Contraindications
Mr. Miles has several precautions that should guide his treatment process. First and
foremost, his generalized muscular and CV deconditioning should be considered so that
therapeutic activities will appropriately challenge but not over-exert him. His lower extremity
weakness should also be considered as every precaution should be taken to prevent falls,

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especially once he progresses to standing and functional ambulation. Significant precaution

should also be taken to prevent opportunistic or hospital-acquired infections, as Mr. Miles has
recently undergone chemotherapy treatment and therefore likely has compromised immunity.
This can be accomplished by strict compliance with universal precautions as well as treating Mr.
Miles in his own room as much as possible. Since Mr. Miles also has a recent history of bilateral
UE DVT, it is also important to refer to his chart regularly and communicate with the nursing
staff regarding any recent labs that have been taken. This will help the OT judge whether his
prothrombin time and international normalized ratio (PT/INR) levels are within therapeutic range
before interventions requiring physical exertion are initiated. If PT/INR levels are not within a
therapeutic range, Mr. Miles could possibly be at risk for developing a blood clot which could be
dislodged during physical activity. This is an incredibly dangerous scenario, so it is important
for his therapists to always be aware of his DVT risk and current lab findings.
To date, Mr. Miles has undergone two different tests to assess the effectiveness of his
swallowing and his risk for aspiration. Per his chart and consultation with his speech language
pathologist (SLP), Mr. Miles failed both the fiberoptic endoscopic evaluation of swallowing
(FEES) examination and a modified barium swallow (MBS) study. Failure of both the FEES and
MBS assessments indicates that Mr. Miles is currently at high risk for aspiration and associated
aspirate pneumonia (a condition for which he is currently being treated with intravenous
antibiotics). Mr. Miles recently received a GJ tube placement, but he often complains of thirst
and frequently requests water by mouth (PO). At this time, administration of PO foods and
liquids is contraindicated for Mr. Miles until he is cleared by his SLP for oral feeding.

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Frequency and Duration of Treatment

Per HSH rehabilitation policy, any clients who show good potential for benefitting from
OT treatment and are highly motivated should be treated daily (at least five times per week) as
tolerated. Therefore, Mr. Miles will likely receive 30-60 minutes of treatment per day as long as
he can physically participate for that duration of time. Mr. Miles will likely be treated for several
weeks at HSH until he can tolerate longer therapy sessions (long-term goals are based on an
estimated length of stay of four weeks). When he is able to participate in 90-minute treatment
sessions, he will be discharged to an inpatient rehabilitation hospital as long as his medical
condition is stable and he no longer requires intravenous medication administration.
Theoretical Framework
The interventions included in Mr. Miles plan of care were created primarily with the
rehabilitation frame of reference (FOR) in mind (Schultz-Krohn & Pendleton, 2013). This FOR
focuses on the clients rehabilitative potential and how to achieve the highest possible level of
function with current health status carefully considered. The rehabilitation FOR allows for the
use of compensatory and modified techniques as well as A/E in order to promote independent
functioning. While it is very important to help Mr. Miles regain muscle and core strength as well
as muscular and CV endurance (all biomechanically-based goals), it is just as important to allow
him to become as independent as possible in order to increase quality of life and occupational
engagement. Since Mr. Miles has CLL and several other serious secondary conditions, it may be
more realistic to allow him to utilize some compensatory techniques until his health status
stabilizes enough for him to pursue purely biomechanically-based treatment options. However,
both FORs have and should be utilized in conjunction to plan holistic, achievable goals and
graded interventions for this client (Schultz-Krohn & Pendleton, 2013).

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Client/Caregiver Education and Monitoring Client Responses

Mr. and Mrs. Miles will likely be educated together regarding treatment plans and
interventions since Mrs. Miles is often at her husbands bedside. Education will be provided by
the OT for utilizing proper body mechanics, positioning and movement protocols to reduce
contractures, DVT, and skin breakdown, and the use of A/E for dressing and engagement in other
occupations. Education will also be provided regarding energy conservation, scheduling of
fatiguing occupations, and adapted techniques. Before Mr. Miles is transferred, the OT will
review topics previously taught in order to assess Mr. Miles ability to remember and generalize
information. The OT will also discuss discharge information with Mr. and Mrs. Miles and will
provide a home exercise program and tips for adapting the home environment in the event that he
is discharged home rather than to an inpatient rehabilitation facility.
Mr. Miles response to intervention will be constantly measured based on established FIM
criteria for each individual area of concern. Official re-evaluations of progress will likely happen
weekly or bi-weekly so that the plan of care can be revised as needed. The OT will discuss goals
and progress with Mr. Miles and will provide justification and reasoning for each intervention
before it is administered. Goals and priorities shared by Mr. Miles will help shape individual
interventions and the plan of care as a whole. If Mr. Miles is not progressing as expected, the OT
will discuss this issue with him and will brainstorm other ways to achieve goals such as trying a
new theoretical framework for planning interventions or collaborating with the interdisciplinary
team.
Conclusion
Based on his independent PLOF and his significant motivation, Mr. Miles is a great
candidate for OT treatment and exhibits good potential for rehabilitative success. He has a

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strong support system comprised of his wife, children, grandchildren, friends, and church
community. Though Mr. Miles has experienced marked debility since his diagnosis of CLL, his
therapists must also consider and plan around the secondary complications he is currently
experiencing. These complicationsincluding aspirate pneumonia, bilateral UE DVT, and
generalized CV and muscular deconditioningmust all be considered and addressed throughout
the treatment process. With comprehensive treatment and continue monitoring for additional
complications, Mr. Miles is expected to make significant gains in recovery before he is
discharged home.

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References
Alexander, N. B., Grunawalt, J. C., Carlos, S., & Augustine, J. (2000). Bed mobility task
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American Occupational Therapy Association. (2014). Occupational therapy practice framework:
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S1-S48. http://dx.doi,org/10.5014/ajot.2014.682006
Lyons, K. D., Lambert, L. A., Balan, S., Hegel, M. T., & Bartels, S. (2013). Changes in activity
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Mann, W. C., Kimble, C., Justiss, M. D., Casson, E., Tomita, M., & Wu, S. S. (2005). Problems
with dressing in the frail elderly. American Journal of Occupational Therapy, 59(4), 398408. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16124206
Schultz-Krohn, W., & Pendleton, H. M. (2013). Application of the occupational therapy practice
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