Running head: OCCUPATIONAL PROFILE AND ANALYSIS

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Running head: OCCUPATIONAL PR
O
FILE AND ANALYSIS

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Occupational Profile and Analysis: John Holly

Anna Suchy

Touro University Nevada























OCCUPATIONA
L PROFILE AND ANALYSIS


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Occupational Profile: John Holly

Client


John Holly is a single, 64 year old male who lives in Las Vegas, NV. He has recently
retired
from Maybelline as a mascara brush designer. He has one brother who lives in Illinois
and another brother who lives in Arizona. He has a few neighbors in his Las Vegas apartment
community who have become his close friends over the past years. Since falli
ng and breaking
his patella, John has begun to think more about what he values in life.

Reason for Seeking Services


John Holly is seeking occupational and physical therapy services due to a recent knee
surgery. He fell and broke his left patella while wal
king with a cane in his kitchen.
Unfortunately, he injured his right knee in a car accident a few years ago, and considered it a
“bad knee” before this fall. John ambulates by wheelchair for the majority of his day but has
slowly started to utilize the fou
r wheeled walker (FWW) with stand by assistance (SBA). He is
seeking skilled treatment to improve his balance and activity tolerance in his right lower
extremity (RLE) and left lower extremity (LLE). His LLE must stay supported and straight for
12 weeks.
However, his right knee needs to gain strength and endurance so he can become Mod


in functional mobility before being discharged from the skilled nursing facility (SNF).


John cannot participate in any activity like he did before his fall because he now

ambulates in a wheelchair. He is worried that his apartment complex’s sidewalks are not
equipped to handle a wheelchair or a FWW, which will affect his ability to visit his neighbors.
He is very nervous about relying solely on his FWW, due to his lack of
confidence in his RLE
and LLE. John wants to get both legs as strong as possible before being discharged home and is
worried that he is not doing enough to speed up the process. When he gets discharged from the
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L PROFILE AND ANALYSIS


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SNF, he wants to be able to visit his neighb
ors, clean his own house, get dressed independently
and cook in his kitchen whenever he desires.

Success and Problem Areas


John can brush his hair and teeth with no problems. However, he has difficulty
ambulating in his environment and reaching objects
that are out of arm’s length (in cupboards
above and below waist level). He also has trouble dressing his RLE and LLE, as he cannot flex
his left knee. Due to decreased muscle endurance and strength, John has trouble walking with a
FWW for more than ten mi
nutes. John has also developed a fear of falling while bathing and
when doing exercises in his room at the SNF.

Contextual Support and Participation


The client lives in the handicap housing unit at his apartment complex. Unfortunately, the
sidewalk going
to his front door is uneven. He will have difficulty ambulating outside and will
need to practice great caution in his FWW and wheelchair. The light switches in the client’s
home are not at wheelchair level. However, the bathroom has hand rails around the
toilet and in
the walk
-
in shower.

Occupational History


The client retired three years ago from his career at Maybelline, working as mascara
brush developer. At the same time of his retirement, he was in a car accident, had back surgery
and his mother got
sick. He has spent the past two years taking care of her until her death a few
months ago. John has not had much time to focus on his hobbies of cooking and working at the
pet shelter over the past few years.

Priorities and Desired Outcomes

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John wants to

be able to safely walk around his home without worrying about falling. He
wants to be safe in his kitchen and be able to cook his favorite meal of macaroni and cheese
without worrying about his knees buckling under him. He wants to be able to get dressed
Mod

, take a shower without falling, clean his own home and use a FWW to visit his neighbors in
the apartment complex where he lives.



















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Occupational Analysis: John Holly


Client participated in an IADL functional mobility kitchen activity. He transferred from
his wheelchair to FWW, walked with his FWW in the kitchen and gathered canned foods from
various cabinet levels. He took a rest break by transferring from the FWW to h
is wheelchair.
After the 5 minute break, he completed gathering the canned food items and finished the activity
by transferring back to his wheelchair.

Body Function Deficits


Client exhibited some signs of emotional distress but all other higher mental
functions
were intact. Client has an average BMI and worked out two days a week prior to this fall. Since
the fall, the client’s musculoskeletal movements in his LLE have become impaired. His RLE and
LLE are WBAT. His right knee is weak while his left knee

has a brace on and must stay in
extension for 12 weeks as a precaution to knee surgery. Client’s ROM in right knee is within
normal limits (WNL) but exhibits decreased muscle endurance, strength, and power. The ROM
in his left knee cannot be tested due to

knee precautions. Client’s gait is asymmetrical as his left
knee cannot be moved out of extension.

Mental function.
Client does not appear to have any cognitive, affective, or perceptual
deficits; however, he becomes upset when he thinks too much about hi
s knees and how difficult
the insurance companies have been to deal with. He has no deficits in higher level cognition,
attention, memory, perception, thought, or sequencing. Client was oriented to person, place,
time, and self throughout the entire treatm
ent session.

Emotional.
The client was motivated for therapy today, as he is anxious to leave the
SNF. He goes to the therapy gym on Saturdays, when he has no therapy scheduled, to use the
exercise bike because he does not want to be stuck at the SNF for l
onger than need be.

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Experience of self and time.
Client views both of his knees as disabling. He is happy to
have learned some exercises that will strengthen his right knee while his left knee is healing.
While walking in his FWW, the client smiled and
mentioned that soon, he will not even need his
wheelchair to get around.

Consciousness.
Client commented on how much energy he had since this was his first
therapy treatment session of the day.

Temperament and personality.
When talking before and after the

treatment session, the
client became tearful about his injury and about his mother’s death; however, during the activity,
the client remained emotionally stable. He enjoys sharing his life story and is motivated to get
out of his wheelchair soon.

Energy

and drive.

The client mentioned that he had a good night of sleep and was
looking forward to his therapy session today. He was talkative throughout therapy and showed
good impulse control.

Sleep.
The client did not participate in sleep during therapy; how
ever, he mentioned how
well he had slept the night before.

Sensory functions and pain.

Client has no problems seeing, hearing, tasting, or smelling.
He also has good visual awareness and depth perception.

Vestibular functions
.

Client demonstrates decreased

balance due to his left leg brace and
weak right knee. However, client stabilized himself on the FWW and kitchen counter with SBA.

Proprioceptive functions.

Client was aware of where his limbs were in space during the
activity due to mild pain and weakne
ss. His RUE and LUE are very strong and helped support
him on the FWW and kitchen counters.

Touch function
. Client showed no aversion to touch by the therapist.

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Pain.

Client mentioned that both knees are not very strong and are in mild amounts of
pain. His

right knee is weak and his left leg is in the brace.

Temperature and pressure.
The client is WBAT for his RLE and LLE. He can fully
discriminate temperature and pressure on all areas of his body.

Neuromusculoskeletal and Movement Related Functions

Joint
mobility.
The client’s LLE is in a brace for 12 weeks and cannot be moved out of
extension. His RLE has full ROM, along with his right upper extremity (RUE) and left upper
extremity (LUE).

Joint stability.

Both RUE and LUE are WNL; however, the client’s RL
E and LLE are
weak. His RLE is stronger than his LLE, but is not strong or stable enough to hold him up
without support.

Muscle power.

Client has very little muscle power in his RLE; although he can actively
flex and extend his knee. His LLE can weight b
ear for periods of time under 15 minutes but
cannot be flexed. His RLE and LLE are WBAT.

Muscle tone.

The client’s RLE and LLE have normal tone along with the rest of his
body.

Muscle endurance.

The client’s LLE has very little muscle endurance, as he can only
stand for ten minute increments before becoming fatigued. His RLE also has decreased
endurance, but he can ride on the stationary bike at a slow pace for 20 minute increments.

Motor reflex
es.
The client’s LLE cannot be tested for reflexes, as it must stay in
extension for 12 weeks. The client’s RLE demonstrates normal reflex patterns.

Involuntary movement reactions.

The client’s gait is asymmetrical because he must
compensate for not being
able to flex his LLE.

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Control of voluntary movement.

Client has control of his voluntary movements.


Gait patterns.

Client exhibits an asymmetrical gait due to the brace on his LLE and his
weak right knee.

Cardiovascular and Respiratory Systems Function


Cardiovascular system function.
The client has no cardiac problems. However, he has
hypertension, which could lead to cardiovascular problems.

Respiratory system function.

Client has no respiratory problems. His digestive,
metabolic, endocrine, skin, ge
nitourinary and reproductive systems are intact.

Activity Demands


Objects and their properties.



Tools:



Cans of food (6)
-

cylindrical, 16 ounces each, smooth



Materials:



None Utilized



Equipment:



FWW
-

aluminum, gray, rectangular, smooth grips



Wheelchair
-

black, hard handles, smooth leather seat



Countertops
-

smooth, hard, wooden, waist height



Cupboards
-
smooth, wooden, hard, shoulder height and knee height

Space Demands

Size.
There should be adequate space to move around in the kitchen and

an acceptable
amount of counter space for the client to support himself when reaching into the cabinets.

Arrangement.
There should be no hazards in the path of the FWW.

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Surface.
The countertops must be clear of extra materials so the client has adequate r
oom
to support himself when reaching into the cupboards and placing the cans on the countertops.

Lighting.

The fluorescent bulbs in the kitchen and natural lighting from the windows
light up the room.

Temperature.

The room temperature should be mild since
the client will be moving
around.

Noise.

The room will have noise, but should not be overly distracting.

Ventilation.

The room should be adequately ventilated, but no fumes will be emitted the
activity.

Social Demands


The client was expected to complete t
his activity with his best effort. During the activity,
the client was very aware of who was around him and who needed to get supplies out of the
cupboards where the intervention was taking place. He openly communicated with the therapist
during the acti
vity.

Sequence and Timing

1.

Client transferred from his wheelchair to a FWW with SBA (2 minutes).

2.

Client walked utilizing his FWW with SBA to each cabinet to check and see if cans were in
the cabinet (5 minutes).

3.

Then he reached for three cans in three diffe
rent cupboards and set each can down before
proceeding to the next can (5 minutes).

4.

Client then transferred to the wheelchair to rest (5 minutes).

5.

Client transferred from wheelchair to FWW again (2 minutes).

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6.

Client walked utilizing his FWW to pick up the r
emaining three cans from the cabinets and
set them on the countertop (8 minutes).

7.

Client finished the activity by transferring back to his wheelchair from the FWW (2
minutes).

Required Action and Performance Skills


Client will have to hold onto the FWW o
r onto the counter top after squaring his FWW
up to the cupboards to reach for the cans due to his decreased balance. He will also have to be
aware of those around him and listen to the therapist’s instructions.

Required Body Functions


The client must
have an intact vestibular system, so he does not fall during the activity.
The client must also have an adequate amount of strength in both lower extremities to hold his
bodyweight up. His right knee must have adequate joint mobility to be able to compens
ate for his
LLE, which is in a brace. He must have good standing endurance to fully complete the task.

Required Body Structures



The activity requires the client to have two limbs that are strong enough hold him up. The
activity also requires the client t
o have joint mobility in at least one lower extremity. The client
must also have adequate vision, adequate hand strength and adequate grip to pick up the cans.

Performance Patterns

Habits.
The client looked around him before getting out of his wheelchair,
as it takes him
longer due to his left leg brace.

Routines.
Since occupational therapy does not follow a routine, the client must be told
what intervention will occur for the allotted time. However, when the client has physical therapy,
he goes straight to

the bike, because he knows he will be doing that during treatment time.

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Rituals.
No rituals were apparent during this activity.

Roles.
The client is a single man returning to his daily routines after a fall that caused
him to break his patella. He mention
ed he is worried about cooking and reaching for items in his
cupboards, so the therapist set up an obstacle course to reach for various cans to prepare the
client for reaching in cupboards outside of the therapy gym. He was an active participant
working on

transfers to and from the wheelchair to FWW, functional mobility around the kitchen
and compensatory techniques to ambulate safely.

Performance Skills

Motor skills.
Client’s pace is slow and steady. He has to concentrate on where he places
his FWW so he d
oes not trip while walking. He must also be aware that his LLE cannot be
moved out of extension, so he must compensate with his RLE.

Sensory perceptual skills.
The client must have the ability to distinguish cans in the
cupboard from other items by looking

at them.

Communication skills.
Client is looking toward his destinations (each cupboard) while
walking with his FWW. He is also looking at who is around him in the room. He openly
communicates with the therapist and maintains appropriate space during conv
ersation.

Body function.
Client has mobility in his RLE and adequate muscle strength in both
lower extremities to support himself by standing for ten minutes. He also has muscle strength in
his upper extremities and a healthy cardiovascular system. The cli
ent has decreased endurance,
balance, and coordination, but can still successfully complete this activity.

Voice and speech function.
The client’s voice functions, fluency,

and rhythm were
utilized during this task as the client was very talkative and soci
al.

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Body structure.
Client is cognitively aware. His only physical deficits lie in his lower
extremities, as both are impaired. Client’s ROM in his RLE is WNL but the ROM of his LLE
was not tested as it cannot be moved out of extension. . The client’s RLE
has decreased muscle
power, making it difficult for him to compensate while weight bearing.

Contexts

Cultural.
Client acknowledged that he keeps all of his baking supplies in one cupboard,
his pasta supplies in another and canned food in his pantry.

Physi
cal.

Client lives in a ground level apartment home that was designed for a
handicapped individual. Unfortunately, his apartment complex has uneven sidewalks.

Social.

Client does not have any family living locally as his brothers live in Illinois and
Arizo
na. However, the client has many close friends and neighbors, as he has lived in his current
apartment community for a few years.

Personal.

Client is a 64 year old male who has recently retired from his job as a mascara
brush designer.

Temporal.

Client recently lost his mother and his role as her caretaker. Since then, he has
been picking up his old hobbies of cooking and going to the pet shelter again.

Virtual.

Client uses his cell phone to keep in contact with his siblings and friends.

Spiritua
l.

Client has done a lot of reflecting since his fall and has become more
appreciative of those who have helped him recover throughout the process.

Problem List

1.

Client requires SBA to safely ambulate 15 feet around the kitchen using a FWW.

2.

Client has diffi
culty ċ dynamic and static balance while he is standing at the counter
& reaching for the cans.

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3.

Client cannot transfer from FWW↔ wheelchair without Min

.

4.

Client’s fear of falling has kept him from doing exercises to improve the endurance
and strength in h
is RLE and LLE in his room, when therapy is not in session.

5.

Client needs extended time (3X as long) to walk 15 feet with a FWW 2˚ to ↓ muscle
endurance & strength in his RLE and LLE.

Justification


John Holly is a motivated individual who enjoys socially i
nteracting and working out in
the therapy gym. John does not want to bring a wheelchair home, as he desires to only ambulate
using a FWW. His priorities include being able to safely ambulate in his home, increase his
standing and dynamic balance, improve h
is transfers, resolve his fear of falling, increase the
strength in his LLE and RLE and increase his standing and walking tolerance.


The deficits John exhibits impair his ability to be independent in his environment as he
cannot be functionally mobile ar
ound his home or community, which impacts his ADLs and
IADLs. If John can regain the strength, endurance and power in his RLE, then he will be more
prepared to remediate his RLE when the brace can come off. Emphasizing strengthening, weight
bearing and en
durance will help John master walking with a FWW in the coming months.
Because John desires to live alone independently, emphasizing lower extremity strengthening is
important so he can complete his ADLs and IADLs.






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References

American Occupational Therapy Association (2008). Occupational therapy practice framework:

Domain and process (2
nd

ed.)
American Journal of Occupational Therapy, 62
:625
-
683.