Dani Goddard, OT15

Occupational Profile
1. Client name: Sean
2. Age: 17
3. Sex: male
Briefly discuss each of the following:
4. Who is the client?: Sean is a 17-year-old male who is in the 8th grade; he lives at home with his
mother, Ruthie, who acts as his primary caregiver. Sean has cerebral palsy and attends a school for
children with developmental disabilities. Sean enjoys video games, playing on the computer, and
spending time with close family and friends.
5. Why is the client seeking services and/or what are the clients concerns relative to engaging in
occupations and in daily life activities?: Seans cerebral palsy makes gross and fine motor activities
difficult; he also has trouble with many higher level cognitive functions such as memory, judgment,
sustained attention, and decision-making. His muscle spasticity complicates walking and
independent completion of activities of daily living (ADLs). Seans mother helps him with almost
every aspect of his life at home and states that she is uncomfortable with him trying to learn to do
things independently because she is concerned about his safety. Though he does not perform
cognitively at the same level that his late-teen peers do, Sean is very interested in socializing with
other teenagers and enjoys many typical teen activities such as watching sports and TV, playing
video games, and swimming. He would benefit from being evaluated from an OT perspective first to
address his issues with independent ADLs and then to address IADL and social participation goals.
6. What areas of occupation are successful and what areas are causing problems or risks?: Sean walks
with a walker and is able to navigate most spaces fairly independently. He is most comfortable at
home or in school, and at times he becomes very anxious when he goes out in other public places.
Though he often wishes to visit restaurants or other crowded locations, Sean feels very
uncomfortable when there are too many people around and is easily overwhelmed by noise and
distractions. Sean also struggles with most ADLs because of his muscle spasticity and decisionmaking issues. He is most vocal about wanting to be able to complete basic self-care activities
independently. Sean can dress himself while sitting on the edge of his bed, but his mother always
chooses his outfits and puts on his shoes for him. He states that he would especially like to learn
how to don, doff, and tie his shoes independently so that he can change clothes and participate in
gym (PE) class at school without needing help from his gym teacher.
7. What contexts and environments support or inhibit participation and engagement in desired
occupations?: Since Sean is easily overwhelmed in some social situations, he tends to spend most of
his time at home with Ruthie or at school. He has recently begun attending an after-school program
where he has assistance with homework and is able to socialize with some of his classmates. Sean
states that he enjoys attending the program and has met new friends in his after-school group.
According to Ruthie, he is starting to act more like a teenager and is very self-conscious about

potential judgment from his peers. Ruthie is concerned that participation in the afternoon program
is encouraging Seans conscientiousness about peer opinions but does not want to remove him
because he seems to be enjoying the social aspect of the group interaction.
8. What is the clients occupational history?: Sean enjoys playing video games, watching TV (especially
sports, news channels, and teen programming), browsing social networking sites, and traveling to
visit his dad and older brother, who live approximately four hours away. He completes most ADLs
with the assistance of his mother, but recently Sean has been showing interest in learning more
independent skills. He has also shown more interest recently in socializing with peers and attending
local sporting events.
9. What are the clients priorities and desired outcomes?: Sean states that his first goal for
independent self-care is to learn how to don, doff, and tie his shoes. He says he is embarrassed
when he has to ask for help in completing this activity at school. During evaluation, Sean struggles
with the gross motor requirements of sitting up straight and stretching to reach his feet. He also has
trouble with sequencing and coordinating the fine motor movements required to tie his own shoes.
In addition to learning how to tie his shoes, Sean also expresses an interest in becoming more
involved with IADLs such as meal preparation and laundry. He says, Sometimes Mom makes me
feel like a baby and I know I can do more stuff than she lets me do.

Occupational Analysis:
1. Occupation: Tying Shoes
Area(s) of occupation for the client:
Subcategory:
1. Activities of daily living
daily self-care routines; dressing independently
2. Instrumental activities of daily living n/a
3. Education
learning a new self-care skill
4. Work
n/a
5. Play
n/a
6. Leisure
n/a
7. Social participation
interacting with caregiver for shoe-tying assistance

2. Values, beliefs, spirituality associated with participation: Sean values his own independence and his
ability to fit in with peers is very important to him at this stage in life. Sean believes that his
classmates will tease him for not being able to completely dress himself independently at school.
His first goal in OT is to learn to don, doff, and tie his shoes independently. This OT intervention will
specifically target Seans ability to tie his own shoes.
3. Contexts:
Context
Physical/space demands

Supports
Having an easily-accessible place
to sit on the floor to tie shoes;

Inhibits
At school where Sean is under
pressure and has many different

Social

Cultural

Personal

having a supporting structure to

help him sit up straight; having a
quiet and non-distracting
environment for learning
Having a supportive caregiver to
assist only if Sean needs and
asks for it
Cultural value of independence,
especially in self-care; school
culture that is sensitive to the
needs of children and teens with
disabilities
Client is motivated to learn a
new independent self-care skill

Temporal

Enough time to complete the

activity or its component steps

Virtual

n/a

distractions

Having no assistance or having a

caregiver who will not support his
desire to independently learn this
skill
Societys assumption that a
teenager should be able to
independently tie his own shoes

Client is easily frustrated,

embarrassed, and distracted
while learning a new skill
Not enough time/being rushed;
OR practicing the same skill too
long and becoming frustrated
n/a

4. Objects and their properties used (tools, materials, and equipment): initially, a shoe-tying practice
board with large laces (different colors for right and left sides of laces can be used to grade the
activity); later, a pair of real shoes (not yet donned); finally, Seans tennis shoes that he often wears
(used for practicing while shoes are on his feet)
5. Social demands: Sean must be able to interact appropriately with his OT and any other caregiver
who may be assisting him; he must be able to control his frustrations and understand that it is
acceptable to ask for help if needed.
6. Sequence and timing:
This sequence is for initial practice with shoe tying board; it is written for a right-handed client.
1. Find a quiet place with a supporting structure (wall, couch, etc.).
2. Find a spot on the floor near the supporting structure.
3. Sit down carefully on the floor.
4. Position your body so that your back rests against the supporting structure.
5. Grip the shoe tying board.
6. Orient the board so that the side with the free laces is close to your trunk.
7. Set the board in your lap.
8. Grasp the right lace in your right hand.
9. Grasp the left lace in your left hand.
10. Pull the right lace toward the midline and cross it over the left lace.
11. Use a pincer grasp with your left hand to hold the laces together where they have
formed an X.
12. Use your right hand to pull the left lace down, under, and through the right lace.

13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.

Grab one lace in each hand.

Pull tightly to form the first knot.
Use your left hand to assist your right in forming a loop with the right lace.
Pinch the loop with your right index finger and thumb close to the shoe.
Grasp the left lace and pull it around the loop.
Use your left index finger to push the lace through the hole made between the bases of
the two laces.
Only push the lace through about an inch, keeping it in a loop as well.
Grasp the emerging loop with your right thumb and index finger.
Grasp the other loop in your left hand.
Pull the loops until they tighten.
Your bow should now be formed.
Check the loops and tails of your bow to make sure they are even.
Repeat if necessary.

7. Body functions required:

Function

How It Is Used

Judgment

Deciding when to tie shoes

and where to sit; judging
whether the bow is even or
not and if the knot is tight
enough
Conceptualizing how the
bow is supposed to look;
identifying the right versus
left laces
Thinking about the cognitive
process of tying a shoe;
being able to control ones
own thought process
Being able to adapt to using
different colors, lengths, and
textures of shoe laces;
ability to overcome
mistakes/back up steps
during process
Clients awareness of when
he needs help in the process
or when he is grasping the
steps appropriately
Being able to pay attention
to the process of tying shoes
long enough to complete it
while maintaining
appropriate thought
processes

Concept formation

Metacognition

Cognitive flexibility

Insight/awareness

Sustained attention

None

Minimally
Challenged

Greatly
Challenged

Selective attention

Divided attention

Short-term memory

Working memory

Long-term memory

Discrimination of senses: Auditory

Discrimination of senses: Tactile

Discrimination of senses: Visual

Discrimination of senses: Olfactory

Discrimination of senses: Vestibularproprioception

Multisensory processing

Sensory Memory

Being able to tune out

environmental distractions
while focusing on the task of
shoe tying
Being able to talk or listen to
music or otherwise
multitask while tying shoes
If a mistake is made,
temporarily remembering
what step to repeat
Problem solving throughout
the process, recalling short
steps and sequencing to
recall where a mistake may
have been made and how to
go back and fix it
Remembering the steps to
shoe-tying, including
eventual muscle memory
If being assisted, being able
to discriminate tone of
questions, auditory cues, or
hints
Being able to feel and
discriminate laces from
other parts of the shoe;
being able to manipulate
laces using fine motor
movements to tie shoes
Ability to see and process
visual cues, ability to
identify the right and left
laces appropriately
Being able to smell and
process odor in the
environment (not directly
related to the task of shoetying)
Positioning body and limbs
correctly during the task;
holding self upright while
sitting or standing; knowing
position of limbs and fingers
in space
Taking in and interpreting
multiple environmental cues
all at once during the
process
Processing and briefly

Spatial relationships

Temporal relationships

Recognition

Categorization

Generalization

Awareness of reality

Logical/coherent thought

storing sensory input, such

as touch while manipulating
laces or auditory input such
as hearing and briefly
processing cues or
directions
Ability to process and
understand the positioning
of laces in fingers and in the
context of each other;
knowing how to follow
directional terms of over,
through, below, under, etc.
in relation to lace
positioning
Being able to complete the
task within an estimated
time frame and
understanding when it is
taking longer than expected;
taking appropriate breaks
during practice periods
Recognizing different sides
of the laces, right versus
left; differentiating laces
from other parts of the
shoe; identifying loops
versus tails
Categorizing laces as
different from other parts of
the shoe; categorizing laces
as items that can be tied
(this concept can later be
generalized to other items)
Generalizing the ability to
tie other objects in a bow
following the same steps
(i.e. apron strings); being
able to complete the activity
in a different environment
Being consciously aware of
surrounding, thought
processes, and the
difference between
thoughts and what is
physically occurring
Understanding how shoe
tying relates to safely and
securely being able to walk
in laced shoes; being able to

Appropriate thought content

Execution of learned movements

Coping

Behavioral regulation

Body image

Self-concept

Self-esteem

Arousal

Consciousness

Orientation to self

follow a logical stepwise

process and repeat distinct
parts of the process in the
case of a mistake
Keeping the thought
process/steps on track, not
letting the mind wander to
other topics or activities
Being able to replicate steps
and eventually rely on
muscle memory after
repetition and practice
Not becoming overly
frustrated or giving up if the
process is not going
smoothly; understanding if a
different shoe has to be
used or a new technique is
attempted
Controlling feelings of
frustration or anger if the
process is not easy to
comprehend or complete
Being familiar with ones
own body size and ability;
knowing where to sit to be
appropriately supported and
have enough space to
stretch and bend forward
Being self-aware of role as
primary shoe-tier and
understanding own desire
to be independent in this
task
Being confident in ability to
learn a new skill and
perform it correctly
Demonstrating alertness
and respond appropriately
to sensory input and
environmental cues such as
knowing when to problemsolve
Being awake during the
shoe-tying process, being
alert enough to focus and
concentrate on the task
Being aware of ones own
identity as the primary shoe-

Orientation to place

Orientation to time

Orientation to others

Emotional stability

Motivation

Impulse control

Appetite

tier and knowing that other

individuals involved (OT,
caregiver) are serving in a
supportive function
Being aware of ones own
location: at home, school, or
out in the community; and
also being aware of
surroundings and knowing
how to choose an
appropriate place to sit or
stand to tie shoes
Being aware of current date,
time, day of the
month/week; being aware
of the appropriate amount
of time usually needed for
shoe tying and knowing how
much time has passed
during attempt
Knowing where others are
located in the surrounding
space; being aware of
personal space and the size
of the area needed to sit
down or stand and tie
shoes; knowing not to stop
to tie shoes in a crowded,
busy place if it can be
avoided
Remaining calm and eventempered during learning
process and attempts; not
becoming overly frustrated,
upset, or inappropriately
jubilant depending on the
success of attempts
Maintaining motivation to
learn a new, independent
skill; being intrinsically
motivated to practice
Resisting the internal urge
to do or say inappropriate
things during the learning
process (not throwing a fit
or cursing, not impulsively
attending to a non-related
task suddenly)
Controlling cravings to eat
and maintaining focus on

Sleep

the activity (appetite is not

directly related to this
learning activity)
Controlling potential desire
to sleep during the process
(attempting to sleep is not
directly related to this
learning process)

Function

How It Is Used

Detection/registration

Identifying laces, different

colors (especially if right and
left sides are colored
differently, i.e. in the case of
a created shoe-tying board);
distinguish shapes made
while knotting and looping
laces
Filtering out non-essential
background visual stimuli
such as items in the room, a
TV screen, or other
movement
Seeing and touching laces,
shoes, or shoe board while
hearing instructions or cues
and integrating all of these
stimuli to cognitively
process them at once
Being aware of objects in
the center of focus (shoes,
laces) and also those on the
periphery; being able to
judge these viewed objects
and how far away they are
to appropriately grasp
objects within reach when
needed
Ability to filter out nonimportant noises or
background sounds not
needed to provide cuing for
the activity; ability to ignore
background sounds without
becoming distracted by
them while concentrating
on shoe-tying
Being able to identify how

Visual modulation

Integration of senses

Awareness at distances

Tolerance of ambient sounds

Location and distance of sounds

None

Minimally
Challenged

Greatly
Challenged

Moving against gravity

Taste

Smell

Body in space

Comfort with touch

Localizing pain

Thermal awareness

Joint range of motion

far away sounds are from

ones body, i.e. where
therapist or caregiver is
situated while providing
cues or feedback
Being able to use the
appropriate ROM and
muscle strength while
moving against gravity or in
the vertical plane for fine
motor actions of tying
n/a for this activity, though
normal taste receptors
should still be functioning at
all times during this task
n/a for this activity, though
normal olfactory receptors
should still be functioning at
all times during this task
Being able to move body in
relation to other people,
objects, and surfaces
appropriately without
running into or hitting them;
being aware of the direction
and force with which limbs
and digits are moving
Being able to withstand the
tactile presence (texture,
weight, feeling) of laces, a
shoe or shoe-tying board,
and potentially the
hands/touch of an OT or
caregiver
Knowing what
ROM/positions are
comfortable; processing and
responding appropriately to
any pain sensations that
result from inappropriate
positioning of joints, limbs,
or digits
Being aware of the ambient
temperature in the room
and communicating
discomfort or temperatures
which may become
distracting (i.e. working in a
very hot or very cold room)
Having appropriate ROM for

Joint stability/alignment

Strength

Muscle tone

Muscle endurance

Stretch reflex

ATNR

STNR

digits, wrists, elbow, and

shoulders to hold shoe,
position it correctly, and tie
the laces; having
appropriate ROM in spine
and hips to bend forward to
tie shoes
The joints ability to keep
bones in line well enough
for the joints to function
correctly in terms of
functional fine and gross
motor movements
necessary to complete shoetying (grasping/pinching,
turning the wrist, abducting
the arm at the shoulder to
tighten laces, keeping the
vertebrae aligned in order
to sit up straight)
Having sufficient force to
push, pull, tighten, and loop
laces; core strength in order
to sit up without falling over
Having high enough muscle
tone to avoid flaccidity and
therefore allow muscular
movements; also, avoiding
abnormal muscle rigidity
which would decrease ROM
and ability to complete
gross and fine motor
movements due to overtightening
Ability to sustain muscle
contractions long enough to
complete movements such
as looping the lace, pinching
the loop, and pulling the
laces without becoming
fatigued
n/a for this activity as
muscles should not be
stretched to their end
ranges
n/a for this client who is an
adolescent (only applicable
to infants)
n/a for this client who is an
adolescent (only applicable

Righting and supporting reflex

Eye-hand coordination

Bilateral coordination

Crossing midline

Fine motor control

Oculomotor control

to infants)
The bodys ability to right
itself and restore balance
while sitting on the ground
and leaning toward the feet
or standing and leaning to
tie shoes
Eye-hand and eye-foot
coordination are both used
to help the hand navigate
appropriately around the
foot, move the foot as
needed (if the shoe is
already donned), and
coordinate gross and fine
motor movements of the
arm and hand such as
reaching, grasping, and
pulling the laces
Using both hands in
synchronization to help tie
shoes; coordinating the
actions of one hand while
doing something different
with the other (i.e. pinching
the loop at the base with
one hand while pulling the
lace around it with the
other)
Crossing or meeting at the
middle of the body to reach
and manipulate the shoes
and laces (either with the
shoe board or shoe in the
lap or reaching all the way
to the feet while stretching)
Being able to manipulate
and coordinate the small
joint movements of the
hand and digits while
pinching, grasping, looping,
using a pointed finger,
pulling, or pushing laces to
create a bow
Controlling the movements
of the small eye muscles in
order to focus on objects
near and far, shift eyes from
right to left without moving
the head, and coordinate

Gait patterns

Blood pressure

Heart rate

Respiratory rate

Respiratory rhythm

binocular vision all during

the shoe tying process
Not used directly during this
activity unless the client is
walking around in search of
an ideal place to sit to tie
shoes
Blood pressure is not
directly related to this
specific activity but should
be naturally regulated by
the body during this task
(i.e. it should remain steady
and normal); it should not
be greatly taxed or affected
by shoe-tying unless an
unexpected issue occurs
(unless the client becomes
frustrated, suddenly
alarmed, or overly relaxed)
Heart rate is not directly
related to this specific
activity but should be
naturally regulated by the
body during this task (i.e. it
should remain steady and
normal); it should not be
greatly taxed or affected by
shoe-tying unless an
unexpected issue occurs
(unless the client becomes
frustrated, suddenly
alarmed, or overly relaxed)
Respiratory rate pressure is
not directly related to this
specific activity but should
be naturally regulated by
the body during this task
(i.e. it should remain steady
and normal); it should not
be greatly taxed or affected
by shoe-tying unless an
unexpected issue occurs
(unless the client becomes
frustrated, suddenly
alarmed, or overly relaxed)
Respiratory is not directly
related to this specific
activity but should be
naturally regulated by the

Respiratory depth

Physical endurance, aerobic capacity

Voice functions

body during this task (i.e. it

should remain steady and
normal); it should not be
greatly taxed or affected by
shoe-tying unless an
unexpected issue occurs
(unless the client becomes
frustrated, suddenly
alarmed, or overly relaxed)
Respiratory depth is not
directly related to this
specific activity but should
be naturally regulated by
the body during this task
(i.e. it should remain steady
and normal); it should not
be greatly taxed or affected
by shoe-tying unless an
unexpected issue occurs
(unless the client becomes
frustrated, suddenly
alarmed, or overly relaxed);
extreme bending at the
waist or stretching may also
cause some decrease in
respiratory depth depending
on the extent to which the
client bends over
Adequate physical
endurance and aerobic
capacity for this activity
should be similar to that of
any low-impact occupation;
physical endurance should
include the muscles ability
to endure slightly prolonged
gross and fine motor
movements of the arm,
forearm, hand, and digits
and should also include
enough core endurance to
maintain balance and
upright posture; aerobic
capacity should not be taxed
or greatly affected as this
activity is very low-impact
and is usually completed
while sitting down
Voice functions such as
speech production are only

Voice rhythm and fluency

Alternative vocalization

Digestive system

Metabolic system

Endocrine system

Urinary functions

appropriate for this activity

if the client is working with
another person such as an
OT or caregiver and needs
to verbally communicate
questions, comments, or
concerns
Voice rhythm and fluency
would be practiced by a
client during verbal
communication who needed
to control tone, flow, and
tempo while expressing
emotion to another person
The client may use
alternative vocalizations if
he decides to hum or
whistle or if he becomes
frustrated and begins crying
Digestive system function is
not directly related to this
specific activity; it should
not be greatly taxed or
affected by shoe-tying but
should be naturally
regulated by the body
during this task
Metabolic system function is
not directly related to this
specific activity; it should
not be greatly taxed or
affected by shoe-tying but
should be naturally
regulated by the body
during this task
Endocrine system function is
not directly related to this
specific activity; it should
not be greatly taxed or
affected by shoe-tying but
should be naturally
regulated by the body
during this task
Urinary system function is
not directly related to this
specific activity; it should
not be greatly taxed or
affected by shoe-tying but
should be naturally
regulated by the body

Genital and reproductive function

Protective functions of the skin

Repair functions of the skin

during this task (i.e. the

client should maintain
continence during the task,
even while potentially
bending or stretching)
Neither genital nor
reproductive system
function are directly related
to this specific activity; they
should not be taxed or
affected by shoe-tying but
should be naturally
regulated by the body
during this task
The skin (especially the
epidermis covering the
fingers and palms) serves to
protect the internal body
structures and fluids from
contact with bacteria or
microorganisms in the
outside world during shoe
tying
The repair functions of the
skin should not be taxed
during this activity unless
the client is somehow
injured while completing it
(i.e. a cut or abrasion to the
skin would need to heal)

8. Muscular analysis of movements required:

Muscle
Shoulder flexion
Shoulder extension
Shoulder abduction
Shoulder adduction
Shoulder internal rotation
Shoulder external rotation
Elbow flexion
Elbow extension
Wrist supination
Wrist pronation
Wrist flexion
Wrist extension
Thumb flexion
Thumb abduction

Required?
X
X
X
X
X
X
X
X
X
X
X
X
X
X

Finger flexion
Finger extension
Trunk flexion
Trunk extension
Trunk rotation

Lower extremities

X
X
X
X
(Possibly, if client
turns while talking
to OT or caregiver,
for example)
X

9. Body structures required:

Category

Body Structure

Nervous system

Frontal lobe
Temporal lobe
Parietal lobe
Occipital lobe
Midbrain
Diencephalon
Basal ganglia
Cerebellum
Brain stem
Cranial nerves
Spinal cord
Spinal nerves
Meninges
Sympathetic nervous system
Parasympathetic nervous system
Eyeball: Conjunctiva, cornea, iris, retina, lens, vitreous body
Structures around eye: Lachrimal gland, eyelid, eyebrow,
external ocular muscles
Structure of external ear
Structure of middle ear: Tympanic membrane, Eustachian
canal, ossicles
Structures of inner ear: Cochlea, vestibular labyrinth,
semicircular canals, internal auditory meatus
Structures of the nose: External nose, nasal septum, nasal
fossae

Eyes, ears, and related

structures

Voice and speech

structures (*Used
especially if client is
speaking to another
individual or is
producing alternative
vocalizations)

Structure of the mouth: Teeth, gums, hard palate, soft

palate, tongue, lips
Structure of pharynx: Nasal pharynx and oral pharynx

Required?
Check If
Yes
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X

X
X

Cardiovascular system
(*Used to maintain
blood pressure and
basic body functions
during activity; not
directly related to
participation in this
occupation.)

Immune system
(*Used to maintain
basic protective body
functions during
activity, especially if an
injury is present; not
directly related to
participation in this
occupation.)

Respiratory system
(*Used to maintain
normal respirations and
basic body functions
during activity; not
directly related to
participation in this
occupation.)

Digestive, metabolic,
and endocrine systems
(*Used to maintain
basic body functions
during activity; not
directly related to
participation in this
occupation.)

Structure of larynx: Vocal folds

Heart: Atria, ventricles

X
X

Arteries
Veins
Capillaries
Lymphatic vessels

X
X
X
X

Lymphatic nodes
Thymus
Spleen
Bone marrow
Trachea

X
X
X
X
X

Lungs: Bronchial tree, alveoli

Thoracic cage
Muscles of respiration: Intercostal muscles, diaphragm
Salivary glands
Esophagus

X
X
X

Stomach
Intestines: Small and large
Pancreas
Liver
Gall bladder and ducts

X
X
X
X
X

Genitourinary and
reproductive systems
(*Used to maintain
basic body functions
and continence during
activity; not directly
related to participation
in this occupation.)

Structures related to
movement

Structures related to
movement (continued)

Endocrine glands: Pituitary, thyroid, parathyroid, adrenal

Urinary system: Kidneys, ureters, bladder, urethra
Structure of pelvic floor

X
X
X

Structure of reproductive system Ovaries, uterus, breast and

nipple, vagina and external genitalia, testes, penis, prostate
Bones of cranium
Bones of face
Bones of neck region
Joints of head and neck
Bones of shoulder region
Joints of shoulder region
Muscles of shoulder region
Bones of upper arm
Ligaments and fascia of upper arm
Bones of forearm
Wrist joint
Muscles of forearm
Ligaments and fascia of forearm
Bones of hand
Joints of hand and fingers
Muscles of hand
Ligaments and fascia of hand
Bones of pelvis region
Joints of pelvic region
Muscles of pelvic region
Ligaments and fascia of pelvic region
Bones of thigh
Hip joint
Muscles of thigh
Ligaments and fascia of thigh
Bones of lower leg
Knee joint
Muscles of lower leg
Ligaments and fascia of lower leg
Bones of ankle and foot
Ankle, foot, and toe joints
Muscle of ankle and foot
Ligaments of fascia of ankle and foot
Cervical vertebral column
Lumbar vertebral column
Sacral vertebral column
Coccyx

X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X

Skin and related

structures

Muscles of trunk
Ligaments and fascia of trunk
Areas of skin: Head, neck, shoulder, upper extremity, pelvic
region, lower extremities, trunk, and back
Structure of skin glands: Sweat and sebaceous
Structure of nails: Fingernails and toenails
Structure of hair

X
X
X
X

10. Performance skills required:

Skill

Motor/praxis

Required?

yes

yes
Sensory (perceptual)

Emotion regulation

yes

yes
Cognitive

Yes, if
another
Communication/social person is
present

How the Skill Is Used

Moving around in environment; interacting with shoe-tying
board, laces, and furniture in the room; motor planning and
sequencing steps of the process, especially when learning
them for the first time
Detecting, identifying, and processing sensory information
from the surrounding environment such as tactile (touch)
sensations (textures, grasping discreet items), verbal cues
from the caregiver or OT, and visual stimuli such as colors
and shapes
Appropriately controlling expression of negative emotions
such as frustration or impatience and positive emotions
such as excitement at success
Mentally arranging and planning the steps of the process,
using memory to retrieve past learning, judging how shapes
and actions should look (forming a loop, knowing how to
pull the laces tightly, judging whether the bow is even),
selecting an appropriate place to sit to aid in balance,
potentially multitasking while talking to OT or caregiver and
completing next step; being able to attend to and focus on
the task while tuning out outside distractions
Properly forming and vocalizing questions or comments for
OT or caregiver, being able to hear and process any
comments, cues, or feedback from that person

11. Performance patterns:

Parts of this occupation has elements of which of the following: (check all that apply)

Pattern

Describe

Useful habit

Learning to tie his own shoes is a useful habit that Sean will be able to
employ in order to dress more independently. This skill will help him gain
confidence both at home with his ADL routine and at school, where he
hopes to be able to dress himself fully for his PE class.

Dominating habit

n/a for this occupation

Routine

Tying shoes can be part of the daily routine of dressing independently. For
Sean, this routine skill is important because he has to wear tennis shoes
every day so that he can avoid falls and walk safely with his walker. Part of
Seans daily self-dressing routine will eventually include donning and tying
his own shoes.

Ritual

n/a for this occupation

Role

Seans role as a student dictates that he change clothes for PE daily at

school. He is currently struggling to doff, don, and tie his shoes
independently. Once Sean learns to tie his shoes, this new skill will tie into
his role as a student, teenager, and participant in class as he increases his
level of independence.

Intervention Plan
1. Identify one objective and measurable goal of the intervention:
a. Objective: To become more independent in self-care/dressing skills.
b. Goal: Sean will reach his goal when he is independently able to tie his shoes without
requiring assistance or cueing.
c. According to the OTPF, what type of outcome is this?: Occupational Performance:
Improvement
2. Intervention approach:

Approach
Create/promote

Describe

Establish/restore

Learning to tie his own shoes will help Sean establish a previously nonexistent independent dressing skill.

Maintain
Modify
Prevent

3. Activity selection
a. Activity selection: Identify one example of each for the intervention plan
Activity
Occupation-based
intervention

Describe
Sean will learn how to tie his own shoes while they are being worn. He will
be required to lean down and reach his feet, balancing independently while
completing the task of tying his shoe.

Purposeful activity

Sean will practice shoe tying initially using a shoe-tying board (a cardboard
picture of s shoe with laces strung into it) which has half of the shoe-lace
colored to indicate right and left sides of the lace. The colored lace will also
help Sean identify which sides he needs to be grasping/pinching/looping as
he moves through the process with the help of his OT.

Preparatory method

Sean will practice picking up small items such as beads, coins, or magnets to
strengthen his pincher grasp and fine motor finger movements.

b. Discuss how activity selection relates back to occupational profile and occupational
analysis: Sean primarily desires to be more independent with basic ADLs such as
dressing. He believes this will make him more confident in school when he needs to
complete activities such as tying his shoes independently. The above interventions will
help him achieve the objective of becoming more independent which was one of his
main concerns according to his occupational profile. Each intervention can be adapted
or graded appropriately to make it fit Seans needs and emerging skills. The preparatory
and purposeful activities listed above will help him build the skills he will need to learn
to tie his shoes independently.
c. Discuss how activity selection will support achievement of client identified goals and
goal of the intervention plan: Sean will first strengthen his pincher grasp, fine motor
coordination, and hand-eye coordination while completing the preparatory methods
above. These skills are all required in order to learn to tie shoes. He will then learn the
basic steps of shoe-tying and will be able to practice them on a shoe board with the
assistance of an OT and the added help of the colored laces to help him remember and
identify steps. This step is also important because it allows Sean the opportunity to
practice with the shoe board, which he can position close to his core where it is easy to
see and will not require excessive stretching. Sean can then begin moving the board
farther away as his skills continue to become stronger and he is able to more
independently remember the steps of tying his shoes. Eventually, Sean will practice
tying his own sneakers, which will be on his feet. These sneakers will not have laces
colored differently for the left and right sides and will require cognitive generalization of
the steps previously learned. The location of the shoes (on his feet) will also require
Sean to lean over while simultaneously balancing and stretching, therefore further
challenging him.
4. Describe how intervention can be graded or adapted and why:

a. This activity can be graded down in order to focus on one aspect of the intervention at a
time (i.e. remembering the steps, balancing independently, practicing the fine motor
movements) or to decrease potential frustration with the learning process. Examples of
grading down include:
i. Using a shoe board with different color shoe laces for right and left sides
(previously described), using adaptive laces (i.e. Hickies from Brookstone),
utilizing cueing or hand-over-hand guidance from OT or caregiver, leaning
against a supportive surface, using a song to remember the steps
b. This activity can be graded up in order to challenge Sean or help him further practice
emerging skills. It can also be graded up to help him practice in different environments
and therefore will strengthen his ability to generalize the use of the steps in many
practical scenarios. Examples of grading up include:
i. Standing while tying shoes, balancing core independently instead of leaning on
wall or piece of furniture, decreasing the time available to complete this task,
increasing potential distractions
5. Safety concerns and/or precautions: Seans cerebral palsy and subsequent muscle spasticity
makes it difficult for him to complete gross and fine motor activities without his muscles
becoming too rigid. Safety precautions for this activity would include having him a secure place
where his balance could be gradually challenged. Too much stretching would also need to be
avoided as spasticity may be exacerbated by rapid or forceful movements.
6. Discuss the role of the occupational therapy practitioner during the intervention: An OT working
with Sean during this activity could provide verbal, visual, or tactile cues to help him remember
and correctly complete the steps of shoe-tying. The OT would also be able to ensure that the
environment is safe and that Sean is being appropriately challenged during the learning process
without becoming frustrated.
7. Discuss what is expected of the client during the intervention: Sean would be expected to
participate fully, attend to the task at hand, and ask questions if needed. He would be
encouraged to interact with the OT or caregiver but not depend on them during steps he has
previously learned to complete independently. However, Sean would be instructed to ask for
help if he began feeling too frustrated. He would also be expected to provide feedback as
needed during the process.