Running head: OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile and Intervention Plan

Lauren Hoppe
Touro University Nevada

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Occupational Profile & Intervention Plan

Occupational Profile
Who is the Patient?
Phyllis is an 83 year old female who has suffered a right cerebral vascular accident
(CVA) that has caused left upper and lower extremity paresis. She has a secondary diagnosis of
dementia, which is currently in the early stages. The patient was initially admitted into the
hospital for pneumonia and while in the hospital suffered a stroke. She has now been discharged
from the hospital to a skilled nursing facility (SNF).
She was in the hospital for 3 weeks and has been at the SNF for 1 week now. Since her
admittance into the hospital she has experienced a drastic decline in her cognitive abilities. This
could be due to a combination of cognitive deficits caused by the stroke, exacerbation of her
dementia, the unfamiliarity of the hospital and increased stress triggered by hospitalization. She
is now more confused and agitated than she was prior to her stroke.
Reason for Patient Seeking Services and Patients Current Concerns Relative to Engaging
in Occupations and in Daily Life Activities
The patient is seeking services for the deficits caused by the CVA and is having
secondary issues associated with her dementia. The patient is concerned about not being able to
return home. She is currently unable to complete most of her activities of daily living (ADL)
independently and is dependent in all transfers. Her daughter and niece are also worried that if
function to her left side does not return, that she will be unable to relearn how to perform ADL
tasks with the complications of her dementia. They also fear she will not be able to live alone
anymore, and are nervous that with her more frequent agitations they will be not be able to take
her out in the community.

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She is currently unable to dress herself independently and requires maximum assistance
to dress her upper and lower extremity secondary to left sided paresis. She also requires constant
verbal cueing to complete dressing tasks due to cognitive deficits. She needs maximum
assistance for transfers from bed to wheelchair, toilet transfers, and moderate assistance for bed
mobility. She can sit edge of bed if minimal support is provided for balance. Her cognitive
deficits hinder her ability to sequence tasks and she is easily agitated. During her agitation states
it is nearly impossible to complete therapy because she becomes defiant and yells at the therapist
or nurse working with her.
Ares of Occupations the Patient Feels Successful and Barriers Affecting Her Success
The function of her right side allows her to complete one handed tasks and therefore she
is still able to eat independently and can perform grooming activities such as; brushing her hair,
washing her face and brushing her teeth, with the use of her right upper extremity, but she
requires verbal cueing to complete the task. Her major limiting factors affecting her occupations
are the paralysis of the left side and her cognitive disabilities. On her good days she is
compliant with fewer agitations, and better able to sequence tasks. (ADD MORE?)
Context or Environments that Support or Inhibit Participation/Engagement in Desired
Occupations
Currently, her physical environment in the skilled nursing home is both limiting and
supporting her desired occupations. The skilled nursing facility provides the help and supervision
she needs to complete her ADLs and provide for her basic needs. However, it limits adequate
social support and has taken her out of her familiarity of her home and normal routine. This has
led to an increase in confusion and agitation which has caused a further inhibited her
participation in desired occupations.

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The Patients Occupational History

Phyllis was a stay at home mom and secretary for many years. She stayed home with her
three children and babysat her sisters two children during the day. Once all the kids reached high
school age she started working as a secretary for an elementary school. She is retired now and
has been widowed for 4 years. She currently lives alone in her one story home with her cat. She
was independent in all of her activities of daily living (ADLs) and most of her instrumental
activities of daily living (IADLs). She does not drive anymore and relies on her daughter and
niece to run errands, take her to doctors appointments, and drive her anywhere she needed to go.
Both her niece and daughter live nearby and come by her house a few times a week to check up
on her and help her in any way that she needs it. She enjoys cooking and baking and always has
treats to give to her daughter and niece for helping out.
The daughter and niece stated they hadnt noticed too many issues with dementia, prior to
admittance, except for that she is more forgetful; like forgetting names of friends, doctors
appointments, and forgetting to pay bills. Phyllis attends church every Sunday with her niece and
is in a small bible study on Wednesday nights. She also used to help out in the nursery but does
not like to do that very much anymore since she has been diagnosed with dementia because she
is afraid that she will make a mistake.
The Patients Values and Interests
Prior to admittance into the hospital Phyllis valued her independence and took pride in
her cooking abilities. She attended church every Sunday and volunteered as much as she could.
She enjoys spending time with her family and especially enjoys cooking and baking for them.
She also enjoys sitting on her porch watching the neighborhood kids play and reading.

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The Patients Daily Life Roles

Ever since her husband died she has been living alone in her home. Her roles include
being a mother, aunt, homemaker, homeowner, pet owner, friend and church member. She
mainly cares for herself and her pet cat. Her daughter and niece help with home maintenance and
any area she requires assistance.
The Patients Patterns of Engagement in Occupations and How They have Changed Over
Time
Prior to her stoke, Phyllis was independent in many areas of occupations and only
required help in community mobility because she no longer drives herself. She lived alone and
managed well by herself. She now requires assistance with most of her ADLs and IADLs due to
her physical and cognitive deficits. She will no longer be able to live alone and will need
assistance upon discharge. She will require compensatory techniques or assistance from others to
perform ADLs and IADLs until function in her left upper and lower extremities return.
Patient Priorities and Desired Targeted Outcomes
Phyllis states that she would like to return home and be able to cook again. Her family
would like to see her become as independent as possible with dressing, bathing, grooming,
toileting, and functional mobility. They would also like to decrease her agitation states and would
like to see her cook again, because that is what she loved doing. They are primarily looking for
improvement in occupational performance, reengagement in desired occupations, increasing her
overall quality of life and contentment in completing role competence.

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Occupational Analysis
Context/Setting of Occupational Therapy Services
The patients occupational therapy session took place in a skilled nursing facility where
she participated in 40-60 minutes of therapy five times a week. Occupational therapy took place
in the patients room and therapy gym, which was equipped with exercise equipment, a kitchen
and laundry facilities.
The Activity Observed and Patients Performance During this Activity
During the occupational therapy treatment session, Phyllis participated in ADL training
that included; bed mobility, upper and lower extremity dressing, and grooming activities. The
occupational therapist helped Phyllis role from supine to sidelying to sitting at edge of bed. The
occupational therapist (OT) then had Phyllis dress her upper and lower body. Phyllis required
minimum assistance to maintain a seated position at edge of bed and moderate assistance to don
a pullover shirt. She required assistance from the OT to thread her unaffected arm and head
through the corresponding holes and was able to thread her affected arm herself and pull the shirt
down over her torso using her unaffected arm. When the patient donned her pants she was able to
thread her unaffected leg through the pants but needed assistance from the OT to get her affected
leg in the pant hole. She then was able to pull her pants up just below the buttocks using her
unaffected arm and the OT assisted her in pulling them up the rest of the way. During the
dressing activity the OT had to continuously cue Phyllis to stay on task and the OT also had to
verbalize what the next steps of the task were. No adaptive equipment was used in the dressing
process.
While performing her grooming activities the OT setup the required items for brushing
her hair, washing her face, and brushing her teeth. The therapist instructed Phyllis to begin with

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the activity of her choice, but when Phyllis did not respond, the OT gave a more direct cue by
asking her to begin brushing her hair. After Phyllis still did not respond the OT picked up the
brush, placed it in her unaffected hand, and began hand over hand tactile cueing until Phyllis
began to brush her hair independently. Phyllis required many verbal cues to continue brushing
her hair as she would periodically stop before the task was completed. She was unable to reach
the very back of her head so this was completed for her by the OT. Phyllis continued to require
countless verbal cues to redirect attention to finish brushing her teeth and washing her face.
Phyllis became slightly frustrated when she was unable to twist the cap off of the toothpaste in
order to brush her teeth. The OT quickly removed the cap for her and placed toothpaste on her
tooth brush. This was done to avoid an outburst so that they could continue on with the other
grooming activities. Since she had already started to show some agitation the OT placed
water and soap on the wash cloth for Phyllis so that she could wash her face and decrease the
chance of her becoming agitated again. Phyllis also required hand over hand tactile cueing of her
unaffected hand to initiate washing her face.
Key Observations from the Performance of the Occupation or Activity
Phyllis required many verbal and tactile cues to initiate and complete activities. Her
cognitive disabilities hindered her from performing tasks with her unaffected side, using problem
solving strategies, and kept her from staying on task to complete the activities in her therapy
session. She needed to be given step by step directions to complete the task and to direct her
attention to the task at hand. Her physical deficits also made it difficult for her to complete
dressing activity due to poor sitting balance and motor deficits of her left upper and lower
extremities.

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Domains of the OTPF Most Significantly Impacting the Patients Ability to Successfully
Engage in Occupations Based on Patient Observation
Phyllis is seeking services due to physical and cognitive deficits secondary to right side
CVA and dementia. In Phylliss current condition her ability to engage in occupations has been
drastically decreased primarily due to deficits in her client factors and performance skills.
Specific client factors affecting her ability to successfully engage in occupations are her deficits
with specific mental functions including; attention; as she is easily distracted and lacks
concentration skills, memory; as she suffers from short term memory loss due to dementia,
thought; due to lack of ability to discriminate between reality and delusions, emotional; as she is
unable to regulate emotions and becomes easily agitated, and higher-level cognitive ability, as
she presents with decreased judgment, metacognition and executive functions. Global mental
functions affecting engagement in occupations include deficits in orientation to place, time, self
and others (AOTA, 2014).
Other body functions significantly impacting performance include muscle functions,
movement functions, and sensory functions of the left upper and lower extremities. Without
these functions Phyllis is unable to move or feel on the left side of her body which greatly
impacts her ability to perform occupations requiring use of the left upper and lower extremity.
Performance skills affecting performance also include; motor skills of the left upper and
lower extremities. Phyllis is unable to stabilize herself when interacting with tasks and objects
without support. She also present with deficits in gripping, manipulating or coordinating objects
with her left hand. She does not have motor deficits in her right upper and lower extremities.
Her cognitive deficits have caused problems with her process skills. She has issues heeding,
attending to a task, continuing performance of a task, and requires verbal and tactile cues to

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complete activities. She also has difficulties sequencing tasks and requires cues to initiate the
next step of each task.
Problem List
Problem Statements
1.
2.
3.
4.
5.

Pt. requires Max (A) to sequence dressing activity 2* cognition

Pt. requires Max (A) for UE & LE dressing 2* (L) side hemiplegia
Pt. unable to regulate emotions 2* cognition
Pt. requires Max (A) for w/c bed transfers 2* LE strength
Pt. requires Mod (A) for self-grooming 2* cognition & (L) UE function

Problem Statement Justification

Phyllis has both physical and cognitive deficits that are hindering her performance and
need to be addressed in order for her to become more independent in her basic ADLs. The first
problem statement addresses a cognitive deficit inhibiting her from completing tasks. More
specifically this addresses her decreased ability to sequence a dressing task. This problem
statement is listed first because it is important for her to be able to understand what steps are
required for dressing. This step comes before her ability to perform the dressing task because in
order for her to one day be able to dress herself as independently as possible she will need to be
able to establish the order of dressing before she physically completes the task.
The second problem statement will then address her ability to physically perform upper
and lower extremity dressing due to her functional limitations. The CVA she suffered has caused
great physical limitations and she is unable to dress herself due to these deficits. Increasing her
ability to perform dressing activities will increase her overall independence.
Her third problem statement once again addresses her cognitive deficits but is now
focusing on her decreased ability to control her emotions. Phyllis becomes easily agitated during
therapy sessions which greatly impacts the outcome of therapy due to time spent calming her

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down before she will continue with the intervention plan. By decreasing her agitation therapy
sessions will be able to continue and Phyllis will be more likely to participate in therapy.
The last two problem statements once again address Phylliss functional ability. She
currently requires maximum assistance to transfer to and from her bed to her wheelchair due to
decreased strength and function in her left lower extremity. This greatly limits her independence
because she has to rely on the help of others when preparing for occupations requiring transfers
and functional mobility. She can no longer be independent with her functional mobility when she
requires so much help from others.
Her last problem statement addresses her decreased ability to perform self-grooming
activities due to left upper extremity paresis and decreased cognition. However, she does have
full use of her right hand and can perform some grooming tasks with her non-affected side, but
continues to require assistance with the sequencing aspect of the task. Since she is able to
complete some of these activities with the use of her non-affected side this issue fell lower on the
list, but would still be important to address during therapy to increase her overall independence
with her ADLs.
Intervention Plan & Outcomes
Patient Goals & Intervention Plan

Long Term Goal 1: Pt. will be Min (A) for UE & LE dressing VC by 8 wks
Short Term Goal 1: Pt. will be Mod (A) for UE & LE dressing VC by 4 wks
Intervention 1: This intervention will include teaching compensatory dressing tasks for
more immediate independence while simultaneously working on regaining function of
the affected side with the use of motor learning. This will be done in order to increase
function and regain adequate movement of the effected extremities. Hand over hand
tactile cueing will be used as needed to facilitate normal movement patterns. Sequential

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practice will be given in order to ease cognitive difficulties associated with dressing and
to focus on learning normal motor movement. The occupational therapist will also use
backward chaining to help dress the patient. This strategy is a natural reinforcement and
helps to lessen frustration with the activity while still allowing active participation from
the patient (Helfrich, 2014).
This intervention uses compensatory strategies for dressing and is considered a
modifying approach because she will be taught a way to change the activity demands of
the task so that she can perform them independently. The main focus of this intervention
will be to restore function of the left upper and lower extremity using motor learning and

expected outcomes include greater participation in ADLs (AOTA, 2014).

Short Term Goal 2: Pt. will be (MOD I) dynamic sitting balance using affected arm for

support by 4 wks
Intervention 2: The patient will first be aligned in a functional sitting position using
verbal and tactile cues to sit with feet flat on the floor, equal weight bearing through both
ischial tuberosities, with a neutral to slight anterior pelvic tilt and neutral spine. The
patient will then perform dynamic sitting while supporting herself with her affected arm
to gain proprioceptive and sensory input. The patient will then participate in a simple
occupation based activity, such as grooming, to promote stability of the trunk while the
upper extremity is reaching for objects. The therapist will provide facilitation to the
effected extremity to help maintain weight bearing through the effected arm while the
patient is reaching with the non-effected extremity. The intervention uses a restoration
approach to regain the patients dynamic sitting balance and expects outcomes in

occupational performance improvement (AOTA, 2014).

Long Term Goal 2: Pt. will sequence dressing task supervision using visual aids by 8
wks

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Short Term Goal 3: Pt. will sequence dressing activity Min (A) using visual aids & VC

by 4 wks
Intervention 3: For this intervention the therapist will first create a supportive
environment to increase attention to task performance and decrease distractions within
the environment. This will include labeling drawers and cabinets with pictures of the
actual items found in the drawers, ensuring all items are consistently found in the same
spot, and the room is de-cluttered with only necessary items in her room. When Phyllis is
performing an ADL task the room will be quiet with the least possible amount of
distractors. This portion of the intervention uses a modify approach to help decrease
distractibility (AOTA, 2014).
The next portion of the intervention will include the patient and therapist creating
a memory aid; such as a memory book, that Phyllis will use to help her help her sequence
the proper order of dressing. This memory book will also provide her with an established
routine that not only Phyllis can use but the interdisciplinary team can use to ensure
consistency of her routine. This portion of the intervention uses an establish approach to
create a routine for the patient. Both interventions anticipate outcomes in occupational

performance improvement (AOTA, 2014).

Short Term Goal 4: Pt. will follow 2 step commands Min (A) using 2 VC by 4 wks
Intervention 4: The patient will participate in simple two-step cooking task performed
while seated in the kitchen. The patient will follow verbal instructions given by the
therapist to prep for cooking activity. The therapist will provide verbal cues as needed to
complete activity at first and decrease verbal cues as the intervention continues. This
intervention uses a restore approach to help reestablish the patients ability to follow
commands in hopes to improve performance in sequencing activities and improve
participation in desired occupations. The therapist will once again provide the most

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optimal environment for Phyllis to work in as mentioned before, which uses a modifying
approach to achieve outcomes in improvement in performance and increased
participation in desired occupations (AOTA, 2014).
Justification for Intervention Plan 1
In order for Phyllis to become independent in dressing tasks she can first learn
compensatory strategies for donning and doffing her clothing. The intervention will also focus on
functional gain of her left upper and lower extremity, because this is a major priority in helping
her gain her independence with activities of daily living and dressing specifically. This will be
done using task-oriented approach and motor learning. Phyllis will be provided hand over hand
tactile cueing and verbal cues to relearn how to dress herself using normal patterns of movement.
Phyllis will use her own clothing and be allowed to practice the task in a sequential order to help
with cognitive deficits. A study by Chan, D., Chan, C., & Au (2014) investigated the use of
sequential function based task strategy in a six-week motor learning program for improving
balance and functional performance for patients who had suffered a stroke. The results showed
motor relearning was effective in improving the participants balance function and self-care
activities. Motor learning promotes the regaining of normal movement through task-oriented
practice with appropriate feedback, and active participation of the client (Chan, D., Chan, C., &
Au, 2014).
Justification for Intervention Plan 2
The second intervention focuses on increasing Phylliss dynamic sitting balance.
Increasing her dynamic sitting balance is an integral part of maintaining stability and mobility
needed during the use of daily activities and is needed for proper movement of the distal
extremities. Poor trunk control can lead to insufficient recovery in the performance of activities

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of daily living, mobility, and increase risk of falls. In particular, studies have shown a decline in
trunk control in patients recovering from a stroke (Helmy, et. al., 2014). Providing an
intervention to help strengthen core muscles to improve in dynamic sitting balance can provide
the right base to increase participation in daily activities. A study was conducted where 40 stroke
patients were assessed to determine the extent of trunk muscle impairment and if these
impairments affected overall balance and participation in functional activities. The study found
that there was a significant correlation between decreased trunk muscle control and their ability
to perform functional activities. The study stated that poor trunk stability following a stroke
impacts performance in functional activities because the trunk is the central key point of the
body that provides proximal stabilization (Helmy, et. al., 2014). Therefore increasing dynamic
sitting balance will support movement of the extremities to lead to Phylliss ability to dress
independently.

Justification for Intervention Plan 3

A study by Hopper et. al. (2011), found evidence that external compensatory strategies
such as memory books help to reduce the load of the persons own memory and aim at
improving the performance of daily living tasks for people with dementia. Labeling drawers,
providing verbal prompts and physical demonstration were all shown to increase performance in
daily living tasks (Hopper, et. al,. 2013).
Research has supported the use of memory books to improve completion in everyday
living tasks such as ADLs. Evidence has shown that using a memory book to help set up a plan
for tasks to do in the future helps to better orient and focus the patient on what tasks should be
completed and when. The memory book can include items such as a daily log used to record,

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store, and retrieve information. The research on memory books found that the individuals who
used a memory book reported fewer memory problems. This memory book would also be used
to help other members of the interdisciplinary team follow an exact routine to better orient
Phyllis and provide her with the consistency she needs to reach her goals (Hopper, et. al,. 2013).
Research has also shown that when working with patients with cognitive deficits
developing routines can increase the persons ability to deal with stress and increase their
feelings of control and safety. Routines are found to be especially important for the older
population and help to establish balance in their lives following physical and mental declines.
Routines were also found to be preferred by individuals with cognitive declines or deficits, such
as dementia. There has also been strong evidence associated between the use of routines and
those with cognitive deficits. It is hypothesized that this association exists between the two
because routines allow individuals to feel safe, comfortable and provide a sense of predictability.
When a person has dementia establishing a routine is very important to decrease stress and
agitation in their daily routine. Normalizing their day can give them the power of predictability
and decrease conditions of emotional distress caused by new environments or changes in their
routines (Bergua, et. al., 2006). By developing a memory book that establishes a set routine the
whole interdisciplinary team can follow, it can be very beneficial to the patient.
Justification for Intervention Plan 4
This intervention focuses on an occupation based activity to help relearn sequencing
activities of daily activities. During this intervention the therapist will provide two step verbal
commands in hopes that the patient will be able to listen to the directions and then follow the
steps to complete the activity. In a study by Tilborg, Kessels, and Hulstijn (2011), 10 patients
with dementia were taught two novel daily tasks by either modeling or verbal cues. At the end of

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their training session the participants demonstrated learned performance of the daily task. The
study concluded that patients with mild dementia are able to learn new skills using verbal cues
and modeling. This study supports using verbal cues to teach tasks to patients with dementia and
is predicted that by learning new skills with verbal cues she will be able to also learn and
sequence other activities (Tilborg, Kessels & Hustijn, 2011).
Precautions and/or Contraindications for the Patients Intervention Plan
Precaution should be taken to avoid any triggers that may agitate Phyllis during treatment
sessions or overwhelming environments or tasks. The occupational therapist should strive for a
just right challenge in order to get the most out of therapy. The therapist should also consistently
look for any signs of subluxation of her left upper extremity since these are common with stroke
patients, and take preventative measures to decrease her chances of obtaining one. Vital signs
should also be monitored on a regular basis to ensure the patient is ready for therapy and is
responding to therapy appropriately. The therapist must also be able to provide a just right
challenge for interventions involving sitting balance while maintaining safety to prevent falls.
Frequency and Duration of Intervention Plan
Therapy sessions will be 40-60 minutes in length 5 times a week in order to reach the
clients goals. The therapy sessions will take place in her hospital room as well as in the therapy
gym area where a kitchen and laundry facilities are located. Therapy will continue for up to 8
weeks or as needed to meet the patients goals of therapy as long as progress continues to be seen
or arrangements will be arranged for discharge to a more suitable facility.
One Example of Grading Up and One Example of Grading Down
One intervention involves the patient participating in a simple cooking activity. To grade
this activity up the OT could have the patient collect all needed materials and cooking items from

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labeled cupboards and also decrease the amount of verbal and tactile cues given to the patient
during the cooking task. To grade down this activity the therapist could have all necessary items
already set up. The OT could also increase the amount of verbal and tactile cues given to the
patient during the task.
Primary Framework Utilized for Intervention Plan and How the Framework Guided
Intervention Planning/Goal Setting
The PEOP model was utilized to guide intervention planning. This model focuses on the
importance of the environment, the occupation as the primary outcome of interest, and views the
person as a whole. The environment was one of the primary components taken into consideration
during the intervention planning. Providing an optimal environment including; labeling drawers
and decreasing clutter, was important to allow the patient to focus on the task at hand and
decrease the chances of confusion and agitation as much as possible (OBrein & Hussey, 2014).
This model also approaches the person with a holistic view and acknowledges the mind,
body and spirit as well as incorporating the persons values, interests, skills and abilities.
Throughout the intervention there was integration of treatments addressing both persons
cognitive deficits and physical deficits to address the patient as a whole. This was done to try to
incorporate all aspects impacting the patient because the model centers its belief on all
characteristics of the person and environment working together to affect occupation (OBrein &
Hussey, 2014).
Patient/Caregiver Training and Education in Intervention Plan
Caregiver and patient education will be incorporated into the intervention plan by
educating them on the disease process of dementia, how to cope with this process, and most
importantly how caregivers should interact with the patient. Strategies will be given to the family

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and caregiver on how to adapt the environment to enhance participation, how to decrease
agitation and what to do once agitation has already set in. The family will also be educated on the
effect of the stroke and how they can help facilitate movement to encourage the use of the
patients affected side. They will also be educated on the use of the memory book and the
importance of keeping to a routine and how this will help Phyllis with her cognitive and physical
deficits.
How Response to the Interventions will be Monitored and Assessed Towards Progress of
Patients Goals
The patients response to intervention will be monitored by the increase in progression
towards her goals and by her tolerance and acceptance of the intervention plans. It will also be
objectively measured through the use of the Functional Independence Measure. With this
assessment both her cognitive and physical levels of assistance can be measured and progress
can be determined. The FIM is a great tool to use because it provides measurements for both
cognitive ability and functional ability (Rogers, Gwinn & Holm, 2001).

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References
American Occupational Therapy Association. (2014). Occupational therapy practice framework:
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S1-S48. http://dx.doi.org/10.5014/ajot.2014.682006
Bergua, V., Fabrigoule, C., Barberger-Gateau, P., Dartigues, J., Swendsen, J., & Bouisson, J.
(2006). Preferences for routines in older people: associations with cognitive and
psychological vulnerability. International Journal of Geriatric Psychiatry, 21(10), 990998. doi:10.1002/gps.1597
Helfrich, C. A. (2014). principles of learning and behavior change. In B.A.B Schell, G. Gillen &
M.E. Scaffa (Eds). Willard and Spackmans occupational therapy (12th ed., pp. 588-601).
Lippincott Willams & Wilkins

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Helmy, H., Emara, T., Mously, S., Arafa, M., Mansour, W., & Kafrawy, N. (2014). Impact of
Trunk Control on Balance and Functional Abilities in Chronic Stroke Patients. Egyptian
Journal of Neurology, Psychiatry & Neurosurgery, 51(3), 327-331.
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Hopper, T., Bourgeosis, M., Pimentel, J., Qualls, C., Hickey, E., Frymark, T., Schooling, T.
(2013). An evidencebased systematic review on cognitive interventions for individuals
with dementia American Journal of SpeechLanguage Pathology, 22(1), 126-145.
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OBrein, J., & Hussey, S. (2012). Introduction to Occupational Therapy (4th ed.). St. Louis, MO:
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Rogers, J., Gwinn, S., Holm, M. (2001). Comparing activities of daily living assessment
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Tilborg, I., Kessels, R., & Hulstijn, W. (2011). How should we teach everyday skills in
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