Occupational Analysis and Intervention Johnny V....

OCCUPATIONAL ANALYSIS 1

Occupational Analysis and Intervention

Johnny V. Rider

Touro University Nevada


Occupational Profile

1. Client name: Marina Rider

2. Age: 49

3. Sex: Female

Briefly discuss each of the following:

4. Who is the client?

Marina is a 49 year old woman with five children and one grandchild. She works full-

time as an accountant for a home health agency and part-time as a personal tax accountant

mainly during tax season but has clients all over the country. She is married and lives with

her husband and her youngest daughter who is a sophomore in high school. Her son and

daughter-in-law also currently reside in her basement. She lives in Pleasant Grove, Utah and

enjoys life. Her house has 3 stories, including the basement, and she loves anything to do

with home improvement. She considers herself very “handy” and loves to find projects

around the house. She is active in her church and community as a volunteer. She is extremely

passionate about Habitat for Humanity and helps build houses bi-monthly. After she gets

home from work her favorite things to do include: reading, gardening/yard work, playing

and/or coaching volleyball, going to the gym, attending sports games for her children, and

going for walks with her husband. Marina is quite concerned about asking others for help.

She does not like to depend on others and is already feeling awkward and uncomfortable

asking her family and friends for additional help. She wants to be as independent as possible

and is very motivated for therapy. She has already been thinking about how she can adapt her

work and home environment before talking with an Occupational Therapist. She tore her

peroneus brevis tendon a few months ago and had surgery 2 days ago to repair it. She has

been at home resting since the surgery and this is her first session with an Occupational

Therapist.

5. Why is the client seeking services and/or what are the client’s concerns relative to engaging

in occupations and in daily life activities?

The client recently had surgery to repair a longitudinal peroneus brevis tear on their left

foot. Post-surgical limitations require her to not bear any weight on her left foot for 6 weeks.

Prior to the injury and surgery, Marina looked forward to gardening and yard work daily

when she got home from her job. Now that she is non-weight bearing on her left leg she is

unable to garden and work in her yard and her inability to participate in this chosen

occupation has led to frustration and depression. Marina is seeking occupational therapy

services to help her adapt how she works in the garden and in her yard so she can more fully

participate in this desired occupation for the next 6 weeks as she recovers from surgery. She

is concerned for her safety and her ability to move around her yard while following the

Doctor’s orders and protecting her healing foot. She also needs help learning how to go from


seated-to-standing and standing-to-seated positions. She had a same day surgery and did not

receive any training at the surgical center on how to maneuver around her house, specifically,

how to get up and down without bearing weight on her left leg. She is also nervous about

things like carrying her grandchild up and down stairs when she is in pain or has restrictions

with weight bearing. Her last main concern is how functional she will be within in her home

using crutches and at her work place using a wheelchair and crutches. She did not learn how

to use crutches and has not used them before. She wants a consultation regarding her home

and work environment and advice on how to make them more functional while she is non-

weight bearing on her left leg. She had surgery 2 days ago and will be returning to work in 5

more days. Her husband has been home to help her for these first 2 days after surgery but

now he has to go back to work and she will need to be more independent and mobile around

the house. She also mentioned a concern of having to walk with crutches up and down stairs

in her house.

6. What areas of occupation are successful and what areas are causing problems or risks?

Marina feels that despite her impairment of the left leg, she is still able to take care of

herself. She has not had any issues when it comes to her activities of daily living from her

perspective. She has had help from family and friends for the majority of her instrumental

activities of daily living such as home management, meal preparation and cleanup, shopping

and care of pets. Marina has continued to manage her family’s finances from home and is

perfectly capable of using her laptop to pay bills while in bed. Marina reported getting more

than enough sleep each night and felt that rest and sleep were two things that were definitely

successful in her life. She didn’t feel that she slept too much because she still had work that

she could do from home and that kept her motivated to get up each day. Marina said she had

not gone into the office since her surgery but was planning to go back next week. She was

able to keep in contact with work via email and her cell phone and was even able to do some

light work from home. She was not worried about her job security because her boss knew

about the surgery ahead of time and had helped her work out her time off. She is

disappointed that she can’t volunteer for at least 6 weeks with Habitat for Humanity and is

trying to stay optimistic about it. Play and leisure occupations for Marina have been greatly

impacted. She said that she has stopped exercising, playing sports and avoids going up and

down stairs whenever possible. She has not been able to work in her yard or garden for the

past 4 weeks due to pain and now the recent surgery. Marina talked about not going out with

friends as often as she would like because of the pain when she walks too much. She still had

family visit, but she wished she could go on more walks with her husband and her

granddaughter.

I observed her demonstrate some of her ADL’s and felt that she was able to complete

them safely. The only issue I saw concerning ADL’s is with her functional mobility. Since

her surgery 2 days ago she has mostly stayed in her room because she had family helping and

there is a bathroom attached. She borrowed a miniature fridge from a family member so she

can keep snacks, drink and ice in her room. She still struggles with sitting down and standing


back up, especially with her recliner and the toilet. I agree with Marina’s comments

regarding her IADL’s. The only concern I saw was her participation in religious observance.

She is planning on attending Sunday services but has not left her house yet. This occupation

could pose a potential safety risk if she does not know how to maneuver with crutches up the

stairs at her church and from room to room. Rest and sleep are two occupations that have not

been interrupted with her current impairment. She is actually finding more time to engage in

this area of occupation because of her Doctor’s orders. Education was not impacted because

she does not have any continuing education credits due for a long time and was not pursuing

any formal or informal education prior to the injury and surgery. Her employment situation is

great and she is able to do some work from home to keep her from getting behind. She is sad

that she can’t volunteer like she used to. She explained the type of work she did for Habitat

for Humanity and it is not something she should be engaging in (installing roofing and siding

which requires the use of a ladder) if she wants to follow her Doctor’s orders. She is slowly

realizing that if she is able to recover fully she will be back building houses in less than 2

months and will feel better than before. Although her occupations within social participation

have also been limited with her injury, she has found ways to still spend time with family and

friends and looks forward to being more mobile in the community and walking more with her

family. From my interview with Marina, the main area of occupation that she is not able to

fully engage in is leisure. She is unable to participate in the majority of her leisure

occupations and most of our conversations came back to her longing to garden, do yard

work, play sports and exercise. Her garden has raised planter boxes, small fruit trees, a

vegetable garden bed and some intricate landscaping which all pose potential issues for

mobility with crutches.

7. What contexts and environments support or inhibit participation and engagement in desired

occupations?

Within Marina’s cultural context there are some aspects that support her participation and

some that inhibit it. Her religious beliefs include rendering service. The fact that she is not

able to volunteer and serve others is causing her much distress. This context has also been

supportive because many of her fellow church members have offered to help and brought

over meals for her and her family to make things easier while she recovers. The expectation

of the society where she lives is that the Mother will take care of the household and the

children. This expectation is tough for her and the pressure inhibits her ability to engage in

her desired occupation leisure participation. Her personal context and environment is

inhibiting as well because her socioeconomic status requires her to work more than full-time

to help support her family. This takes away from her time to engage in desired occupations

within the realms of leisure and social participation. Temporally, she is in a stage of life

when she needs to be preparing for retirement and this added responsibility has kept her

working more than she should be. It has also caused her to have an occupational imbalance

with work being the dominating occupation and taking away from other important

occupations. Marina’s virtual environment supports her participation by allowing her to

communicate with her family that lives far away on a daily basis which brings her happiness.


She uses video chat capabilities to see her granddaughter in between visits. The ability to

work from home and keep in contact via email, fax, and phone, allows her to log more hours

when her family needs extra income. Her physical environment has both positive and

negative aspects. Because she lives in a 3-story house, she has a lot of stairs to navigate and

this has caused her to do less around the house when she is in pain or fatigued. She has had to

ask for more help from her daughter when bringing things up from the basement to the top

level. She is unable to properly maintain the inside of the house by herself. The outside

physical environment supports her desired occupation of gardening in some ways. She has a

manageable yard and garden and enjoys spending time tending to it. There are many places

to sit or kneel and work in the garden when she is too tired to stand. Gardening is one of her

favorite leisure occupations and brings her much happiness. Being able to garden helps

balance her occupations and rejuvenate her when she is feeling tired, overwhelmed or

depressed. Her garden does have raised planter boxes, trees, a vegetable bed and walkways

with flower arrangements which could pose a problem with mobility with crutches or a

wheelchair. Her social environment is very supportive. She said that her entire family is there

for her when she needs them and will continue to help out throughout her recovery. She did

not feel that they expected too much of her, rather she put the high expectations on herself.

She enjoys her occupations of social participation and frequently visits with friends, family

and neighbors. She wishes that these visits were more frequent. She knows that she can count

on her family and friends when she needs additional assistance and that helps to put her mind

at ease so she can take care of herself when necessary. She also has family willing to give her

rides until she can drive, carry heavy items and go grocery shopping.

8. What is the client’s occupational history?

Marina has had previous injuries to the right knee (three surgeries for menisci tears and

arthritis). The Doctor suspects that compensation, along with wear and tear, secondary to

excessive stress on the ankle joint, has caused her current injury, a peroneus brevis tear. This

poses a problem since she will be bearing all weight on her right leg and using it to stand and

sit. Her right knee is weak and she does not feel that it can bear this responsibility. She has

not had any previous ankle problems. She was diagnosed with hip bursitis on her left side 5

years ago and it causes her pain when engaging in competitive sports. She has been an active

individual throughout life and not being able to be active is causing problems for her

psychologically. She played college volleyball and basketball and has always coached or

played in adult leagues. She has raised 5 children and worked part-time while they were still

at home. As soon as her youngest daughter started 1st grade she resumed full-time work. She

works in a typical office environment on the 1st floor of the building. Most of her vacation

time from work is used when her kids and grandchild are visiting. She has a family cabin in

the mountains of Utah and frequently spends her weekends at the cabin hiking and enjoying

the outdoors. Family is the most important thing in her life. Her husband has been in two

major car accidents and was unable to work due to multiple back and neck surgeries for the

past 4 years. He has recently secured employment again. Until last month, Marina was the

main financial supporter for her family and is still trying to rebuild her savings and pay


medical bills for her husband’s surgeries. She still feels that she is responsible for earning

income and supporting the family because she does not know if her husband will be able to

maintain employment. She said that she loves accounting and even if she did not need to

work she would still prepare taxes and help out family and friends with their financial needs.

She loves to solve problems and that is what led her to accounting back in college. She grew

up in Utah, moved to North Carolina when she got married and lived there for 12 years and

then moved back to Utah where she currently resides.

9. What are the client’s priorities and desired outcomes?

First and foremost she wants to be able to work in her yard and garden while she is

recovering from surgery. Not being able to engage in this occupation has been devastating

for her and she feels she will not recover as fast without participation in this occupation.

Working in her yard has always been therapeutic and at this time in her life its therapeutic

value has increased tenfold. Her second priority is to safely move around her home and office

in order to keep working and taking care of herself at home. She wants to keep as much

independence as possible and avoid having to ask for help from others whenever possible.

She also wants to be able to start walking with her husband and continue spending time with

her family. Spending time with her family includes being able to visit them, attend sports

games, go out to eat and participate in family events. Lastly, she wants to resume her role as

a volunteer for Habitat for Humanity when she is able to fully participate in the home

building process. She knows that this will require time and the healing of her leg and that is

why it is last on her priority list.

Occupational Analysis

1. Occupation:

Area(s) of occupation for the client: Subcategory:

1. Activities of daily living

2. Instrumental activities of daily living

3. Education

4. Work

5. Play

6. Leisure Leisure Participation: Gardening

7. Social participation

2. Values, beliefs, spirituality associated with participation:

Marina values optimism. She feels that she is happier and more optimistic when she takes

time for herself and works in her garden. She also values the beauty of the earth and wants to

make her surroundings prettier and utilize the ability she has to grow food and beautiful


plants. She believes that when you use your own hands to grow food that you will appreciate

it more and waste less. She believes that hard work builds character and idleness is contrary

to our purpose on earth. She believes that all people can benefit from spending more time in

nature and find more happiness in life by witnessing the miracle of nature. Marina believes

that by working with her hands outside in nature that she can be closer to her God. She feels

that gardening is a time when she can tune out the world and focus on listening to her spirit

and finding direction in her life. Gardening is a spiritual experience for her and it allows her

to ponder the progress in her life and think about how she can help those that she cares about.

Gardening is a very important leisure occupation in her life and contributes to her values,

beliefs and spirituality.

3. Contexts: Gardening

Context Supports Inhibits

Physical/space

demands

Her garden is small enough that

she can easily work in it without

becoming tired. She has a stool

that she can sit to conserve energy

as well. The layout is convenient

for her to work in an organized

fashion and her tools and

equipment are located in the

garage next to her garden in an

organized way easy to reach.

Relating to her recent injury, her

garden does not have solid, smooth

surfaces for walking. There are not

stone paths. It is surrounded by dirt

or grass. This is inhibiting when

she has to use crutches as they sink

in the ground and are less stable.

There is also not enough room to

maneuver around planters with a

wheelchair. She also has a very

diverse landscape with planter

boxes, vegetable beds, trees, grass,

flower beds, etc. Although she has

a stool, it is not adjustable and may

be hard to use with her

impairment.

Social Her friends and family give her

time to work in her garden alone

and are there to help when she

needs it. Many of them ask her

about her garden and love to

receive gifts of vegetables or

flowers. Because many of her

friends and family also participate

in this occupation she has support

from them in the form of advice,

lending of tools and conversations

about gardening.

When neighbors stop to talk with

her they take away time from her

participation in her leisure

occupation of gardening.

Cultural Gardening is a culturally

acceptable occupation where

Marina lives and many of her

neighbors also participate in this

In Marina’s culture the

expectations of a Mother are very

strict and dominate any leisure

occupations. Sometimes, leisure


occupation as a part of their

leisure time.

participation is seen as a negative

thing when a Mother takes time for

herself when she should be caring

for her family. Sometimes the

concept of what a perfect Mother

should be like inhibits her

participation in her own leisure

occupations such as gardening.

Personal Her age allows her more time in

the garden because she does not

have to take care of little children

and her youngest daughter is very

independent. Who she is as a

person and her values, beliefs and

spirituality all support her

participation in gardening.

The fact that she works a full-time

job and an additional part-time job

means she has less time to devote

to gardening.

Temporal The stage of life she is currently

in allows her time to spend

outside. She does not have little

children running around ruining

her garden anymore because they

are all grown up.

Her current health problems and

past knee surgeries can be

inhibiting because she is in pain or

too tired to garden sometimes and

has to postpone her participation in

this occupation. Her recent surgery

has complicated her ability to

garden and she has foregone any

gardening since the surgery.

Because her husband is currently

out of work at the time she has

added responsibilities to earn

money to support the family and

allows her less time to participate

in leisure occupations.

Virtual Marina frequently talks to family

and friends about gardening and

the ability to text quickly or call

on a cell phone supports her

ability to garden. The fact that she

can put in her Bluetooth headset

and talk to her children while

gardening is a blessing for her

and allows her more time to tend

to her garden.

There is a downside to having

communication at her fingertips;

Marina frequently is interrupted

while gardening by phone calls,

texts, and emails from work

requiring her to stop gardening and

take care of business.

4. Objects and their properties used: differentiate between tools, equip, materials, etc.

Tools: Marina uses most of the typical garden tools such as: handheld garden spades and

hoes, pruning scissors, small rakes, hand tiller, mini shovels, and pocket snips.


Materials: Marina uses various kinds of compost and plant fertilizer to help things grow.

Occasionally she has topsoil delivered to replenish her garden. She needs water and sunlight

in order for her plants to grow and she provides the water.

Equipment: Marina has gardening gloves that are very thick and protect her from thorns, a

belt that holds her small tools and a gardening stool. These are considered equipment because

these objects equip her for gardening. She also has a 5-gallon bucket to put weeds in after she

has pulled them. She also has a hose and a large watering pale to water her garden. She has

the typical motorized garden equipment such as a weed eater, lawn mower, blower, edger

and tiller. She said that she rarely uses these and they typically help her get her garden ready

for planting in the spring and then stay in her garage for the most part.

5. Social demands:

Because Marina gardens by herself there are minimal social demands. On occasion she

will have a family or friend join her for conversation while she works in the garden. The

same goes with talking on her Bluetooth while gardening; occasionally she will chat with her

children while spending time in her garden. She does still consider the expectations of others

in her social context and realizes that she may be interrupted by them. She mentioned that

sometimes her neighbors will stop by while she is working in her garden. She also is

cognizant of her familial relationships and the expectations that she needs to care for her

family which limits how much time she can spend in her garden.

6. Sequence and timing: Picking strawberries.

1. Walk to the garage.

2. Pick up a 1-gallon empty plastic bucket from the shelf using the handle.

3. Carry the empty plastic bucket by the handle using one arm.

4. Walk outside to the garden while carrying the empty plastic bucket.

5. Walk to the strawberry planter box.

6. Kneel down next to strawberry planter box close enough to reach the strawberry plants.

7. Set the plastic bucket down next to you within arms reach.

8. Grab a strawberry plant gently with your left hand and lift it up.

9. Find an individual strawberry stem that has a strawberry attached.

10. Hold the individual strawberry stem firmly with your left hand.

11. Grab an individual strawberry attached to the stem you are holding with your left hand

gently using your right hand.

12. Hold the strawberry plant with your left hand securely.

13. Pull the individual strawberry carefully with your right hand until it separates from the

plant.

14. Place the individual strawberry from your right hand in the bucket carefully.

15. Repeat steps 8-14 until you have as many strawberries as you want.

16. Pick up any loose strawberry stems or leaves that may have broken off with your hands.

17. Carry the loose strawberry stems/leaves in your hand to the compost bin.

18. Throw the loose strawberry stems/leaves into the compost bin.


19. Walk back to the 1-gallon bucket filled with strawberries

20. Pick up the bucket carefully using the handle

21. Carry the bucket with one hand securely on the handle and the other hand supporting the

bottom of the bucket carefully

22. Walk back into the house while carrying the bucket carefully

23. Place the bucket of strawberries on the counter next to the sink gently

7. Body functions required:

Function How It Is Used None Minimally

Challenged

Greatly

Challenged

Judgment To judge when a plant is dead or

dying and what to do about it. Judge

how much water, soil, fertilizer, etc. is necessary. Decide how much time she

can spend in the garden with all of her

other responsibilities. Judge how far

apart to plant things, best time of year,

conditions, etc.

X

Concept formation Must be able to mentally organize like

plants and flowers. Understand

relationships between plants and

optimal planting conditions.

Understand the idea that plants will

grow and change over time.

X

Metacognition Must be able to analyze problems such

as an unusual cold front and problem

solve how to fix it such as covering

plants with mesh or a tarp. Learning

and organizing new information

regarding new seeds that you want to

try planting.

X

Cognitive flexibility There is a lot of potential for error

with gardening and she must be able

to change strategies and shift from

various ideas. If the neighbor’s dog

digs up her flowers she has to look at

different ways to protect her plants

and replant the destroyed ones or try

different plants. If some of the plants

are not growing properly she may

have to try different strategies and use

different materials or move the plants

to a different location.

X

Insight/awareness She must know her weaknesses and

strengths when it comes to the

different tasks of gardening. She needs

X


to realize that she can’t work on her

knees for hours because she has had

previous injuries/surgeries. She needs

to know how to adapt gardening to her

weaknesses/strengths.

Sustained attention She needs to focus on gardening long

enough to not over water plants or

miss weeds that are growing. She does

have the ability for breaks so this is

not greatly challenged.

X

Selective attention Because she is outside and there are a

lot of things going on at the same time

(birds chirping, dogs barking, cars

driving by, music from the neighbors,

people walking, etc.) she has to select

which stimuli to focus on (gardening).

She cannot control the external stimuli

and must learn to tune those things

out.

X

Divided attention Occasionally she talks to family or

friends on the phone with a headset

while gardening and when she does

this she must divide her attention

between the conversation and

gardening.

X

Short-term memory This is used when watering plants. She

needs to remember how long she has

been watering an individual plant or

planter box.

X

Working memory She has to be able to remember which

plants she has watered, which plantar

box she has weeded, which plants she

has pruned all while she is working in

the garden. These memories will then

guide her actions for the rest of her

time in the garden.

X

Long-term memory She needs to remember gardening

strategies that worked/failed in the

past so she can repeat the good things

and not the bad things. She needs to

remember how to plant seeds, tend her

garden, and how she has done it in the

past. She needs to remember the

things her Mother taught her about

gardening as well.

X

Discrimination of

senses: Auditory

She needs to know whether or not her

motorized gardening equipment is

working properly and that can be

X


discriminated by listening to the

motor.

Discrimination of

senses: Tactile

Marina must discriminate between the

different textures of the plants, soil,

fertilizer, tools, etc. constantly while

working in the garden.

X

Discrimination of

senses: Visual

Marina uses her ability to perceive and

interpret all of the visual information

she sees in her yard. She must

interpret when she sees dying plants,

rocks, dried out or soaked plants, etc.

X

Discrimination of

senses: Olfactory

Rarely she will need to discriminate

between rotten and ripe smells of

produce and if smoke is coming from

the motor on one of her tools.

Fertilizer has certain smells that are

also important to recognize.

X

Discrimination of

senses: Vestibular-

proprioception

As she gardens, Marina is constantly

moving and needs to know what

direction, how fast/slow she is

moving, and the positions of her head

and body in space as she changes

positions from standing to sitting to

kneeling to bending over and so forth.

She also needs to understand and

regulate how quickly her body parts

are moving when pulling weeds and

holding a watering can. She frequently

bends over and then comes back to an

upright position when working in each

planter box.

X

Multisensory

processing

With all of the stimuli from the yard,

garden and being outside,

multisensory processing is important.

Marina needs to integrate all of the

sensory information to better interpret

what is going on.

X

Sensory Memory Because Marina is interacting with her

environment, including objects,

constantly while gardening, this is

used greatly. All sensory information

that Marina experiences will lead her

to another piece of information and

then to action.

X

Spatial relationships She will be moving around in the yard

and in between plantar boxes and

plants in the garden which will require

X


the ability to understand the position

of things in relation to her and other

objects. She will also be manipulating

tools and equipment.

Temporal

relationships

Marina needs to understand how much

time as gone by when watering plants

and tilling the earth. She can’t water

or till too long or she will kill the

plants.

X

Recognition She needs to recognize what her tools,

materials and equipment is and which

parts are sharp as opposed to dull. She

must recognize sensory information as

well.

X

Categorization When planting she needs to categorize

plants by similar needs so all the

plants that need a lot of sunlight are

together and in the right spot or all the

plants that need shade are in a shadier

place of the garden.

X

Generalization Almost all of her gardening takes

place in her own yard which does not

require generalization. However, she

does go to Home Depot for gardening

classes and needs to generalize the

information she learns and apply it to

her garden at home even though she

learned it in the Home Depot store.

X

Awareness of reality Marina must be aware of what plants

can and can’t grow in Utah. There are

many things that simply cannot grow

in the higher altitude and cold climate

no matter how much you tend to them.

X

Logical/coherent

thought

If and when problems arise in her

garden, Marina needs to reason her

process of solving the problem in a

logical manner. She employs common

sense when making simple decisions

regarding her garden.

X

Appropriate thought

content

Marina needs to think about gardening

things when gardening if she is going

to adequately take care of all of her

plants. She needs to think about

appropriate tools and materials needed

to help her garden thrive.

X

Execution of learned

movements

Marina has to control her movements

when grabbing weeds and pulling

them out of the ground. She has to

X


mentally plan and control the skilled

movements of picking fruit or

vegetables off of the main plant

without breaking or harming the base.

Many of the movements are also

intrinsic to normal development like

picking up the bucket or pouring the

water out of a pitcher.

Coping There is always a possibility of having

plants die or not reach maturity and

Marina will need to be ready to cope

with the loss and the disappointment

after working so hard.

X

Behavioral

regulation

Marina must regulate her behavior

when things go wrong in her garden

such as a dog digging through her

flowers.

X

Body image X

Self-concept X

Self-esteem X

Arousal Marina must be alert enough to

respond to the stimuli outside in her

yard. She is using sharp tools as well

as motorized tools and must be alert

enough to safely handle them.

X

Consciousness She must be conscious to work in her

garden.

X

Orientation to self X

Orientation to place Marina must be aware of her location

in order to act upon it. She needs to

realize she is in her own yard and can

work in her garden.

X

Orientation to time She needs to know what month, time

of day, season, etc. for proper planting

and also to know when to harvest and

what the weather will be like. Time of

week is important because she has a

busy schedule and has more free time

to devote to gardening on the

weekends.

X

Orientation to others Most of her gardening is done alone;

however, sometimes she interacts with

family and friends either on the phone

or when they walk by. She needs to be

aware of who they are when they call

or visit her garden.

X

Emotional stability Gardening requires a calm

environment and Marina mentioned

X


how it has a spiritual aspect for her as

well. Within her occupation of

gardening, emotional stability is

required for her to function properly

and enjoy it as a leisure occupation.

Motivation Marina has to wait all season for her

seeds to grow and produce their

fruit/vegetables/flowers and she has to

maintain the motivation to keep

working even though she may not see

the benefit or end product for a long

time.

X

Impulse control Marina needs to exercise impulse

control when harvesting strawberries

and raspberries, which are two of her

favorite fruits, and wait until she has

washed/cleaned them before eating

them.

X

Appetite X

Sleep X

Function How It Is Used None Minimally

Challenged

Greatly

Challenged

Detection/

registration

Marina needs to detect basic shapes,

light and color of the visual stimuli in

her garden. There is not a high level of

visual acuity required but gardening

does require detection of objects in

order to further actions.

X

Visual modulation She has to modulate all of the visual

information in the background of her

garden. She has to filter out her

neighbor’s yard, house, fence, plants,

etc. When she is reading information

on seed packets she also needs to filter

all the visual information to find what

she needs, which is usually

recommended spacing for planting.

X

Integration of senses Integrating information from sight and

touch is utilized the entire time Marina

is pulling weeds, trimming plants,

removing dead leaves/branches,

picking vegetables and fruit, etc.

X

Awareness at

distances

Marina needs to focus on objects that

are near to her. She does not need to

focus on far objects outside of her

garden.

X


Tolerance of

ambient sounds

Anytime you are outside there are

ambient noises such as cars, planes,

animals, kids playing and much more.

Marina needs to tolerate these sounds

and experience them as simply

background noise and not allow it to

interfere with her gardening.

X

Location and

distance of sounds

X

Moving against

gravity

Marina leans forward outside of her

center of gravity many times as she

reaches down to work at the ground

level. She sits, stands, kneels and

moves about her garden to work on

different areas. The position of her

head changes constantly.

X

Taste X

Smell She does need to detect changes in the

smell of produce to know if it has

become rotten and passed the optimal

harvest time.

X

Body in space Since gardening requires a lot of

movement, Marina needs to be aware

of her body parts and which direction

they are moving. Most of what she

does allows her to see her hands and

feet moving so this function is only

minimally challenged.

X

Comfort with touch All of gardening requires touching

different things. Marina has to be

extremely comfortable with touch and

contact with dirt, bugs, manure, water,

plants, flowers, vegetables, fruits, etc.,

all with different textures.

X

Localizing pain Marina has to push, pull, bend over,

kneel, stand, and sit a lot during

gardening. She has to be able to

respond to discomfort and determine

where on her body pain is coming

from. With her recent surgery, this has

become more challenged and she has

to be aware of her lower extremity

more.

X

Thermal awareness Having contact with the motorized

equipment requires thermal awareness

in order for Marina to not burn herself

when the motor has heated the outside

casing of the lawnmower or tiller.

X


Joint range of

motion

Gardening places demands on almost

all of the joints of the body: fingers,

spine, hips, knees, ankles, etc. Marina

needs adequate range of motion to

move her body parts when bending,

kneeling, reaching for tools, leaning

forward, pulling weeds, picking up

vegetables, etc.

X

Joint

stability/alignment

Stress is placed on Marina’s joints

when she is carrying fertilizer bags,

pushing the lawnmower, pulling

stubborn weeds, lifting a bucket of

vegetables, etc. The joints involved

must be stable to allow for proper

alignment and movement.

X

Strength Marina needs to maintain various

postures throughout gardening which

requires a decent amount of strength.

She moves both with and against

gravity throughout the occupation.

When sitting next to flowers and

pulling small weeds, minimal strength

is needed. When pushing a

lawnmower, carrying fertilizer bags,

digging out dead bushes, etc. maximal

strength is necessary to fully

participate independently.

X

Muscle tone Because normal tone is required to

allow for smooth muscle control and

Marina needs smooth muscle control

to garden, this is a necessary function.

Smooth movements are essential to

gardening properly.

X

Muscle endurance Gardening allows for frequent breaks

if necessary. Marina does not need to

stand for long periods of time. She

changes from standing to sitting to

kneeling if needed. She does need

some endurance to mow the lawn, pull

weeds in the entire garden, harvest

multiple vegetables and repeat some

motions over and over again.

X

Stretch reflex X

ATNR X

STNR X

Righting and

supporting reflex

Walking on uneven terrain and

moving from dirt to grass to pebbles

poses risks of falling or tripping.

X


Righting and supporting reflexes are

necessary to automatically react and

restore alignment of the trunk by

increasing tone in the trunk and/or

limbs.

Eye-hand

coordination

Marina has to utilize eye-hand

coordination with all visual stimuli

that guides her movements. She may

see a weed and then move towards

that weed to pull it from the ground.

She has to pick up tools and use them

properly. She has to turn on the

outside water line by turning a knob.

X

Bilateral

coordination

Each hand and its fingers have

individual movements when

manipulating plants, vegetables, fruits,

weeds, handheld tools and the soil. To

pick a vegetable/fruit one hand has to

stabilize the plant while the other pulls

the produce from the plant. To plant a

seed one hand has to pull the dirt away

while the other hand puts the seed in

the ground and then they both help

spread the dirt properly.

X

Crossing midline Gardening requires dynamic

movement of the trunk especially

when Marina is kneeling or sitting

next to her planter boxes and reaching

across her body to pick up things,

water plants, pull weeds, adjust the

soil and so on. The direction of her

head also crosses over on both sides to

get a better look at her plants and

flowers.

X

Fine motor control The smaller muscles of her hands are

utilized when manipulating the pocket

snips and pruning scissors as well as

when she is picking strawberries and

raspberries.

X

Gross motor control Bringing weeds up and over to the

bucket. Lifting a watering pale and

watering the plants. Movements of the

trunk. Standing, sitting, kneeling and

moving from each position to the

other.

X

Oculomotor control She has to look at objects that are

stationary but not ones that are

moving. She also needs to look at her

X


entire garden, spanning across sections

to make sure her sprinklers are

watering each area properly.

Gait patterns Functional mobility around her garden

and yard is required because a

wheelchair will not fit. Walking is

required to reach most of her garden

and the terrain is quite diverse.

X

Blood pressure Within normal limits. X

Heart rate Within normal limits. X

Respiratory rate Within normal limits. X

Respiratory rhythm Within normal limits. X

Respiratory depth Within normal limits. X

Physical endurance,

aerobic capacity

For Marina, gardening includes

mowing and edging the lawn around

her garden. This is physically taxing

and requires prolonged movement and

increased respiratory and heart rates.

X

Voice functions Only used when talking to family or

friends on the phone which is

sometimes a part of her occupation of

gardening.

X

Voice rhythm and

fluency

Only used when talking to family or

friends on the phone which is

sometimes a part of her occupation of

gardening. She needs her family and

friends to understand what she is

saying.

X

Alternative

vocalization

X

Digestive system X

Metabolic system X

Endocrine system X

Urinary functions X

Genital and

reproductive

function

X

Protective functions

of the skin

Gardening requires contact with

elements of nature, tools, equipment,

etc. and although Marina wears

gloves, other parts of her body have

contact and there is still

pressure/shearing forces against the

skin of her hand when digging,

pruning, pulling weeds, etc.

X

Repair functions of When Marina does have blisters or X


the skin small cuts on her skin from working in

the garden she needs her wound-

healing functions to work so she can

get back to gardening.

8. Muscular analysis of movements required:

Muscle Required?

Shoulder flexion X

Shoulder extension X

Shoulder abduction X

Shoulder adduction X

Shoulder internal rotation X

Shoulder external rotation X

Elbow flexion X

Elbow extension X

Wrist supination X

Wrist pronation X

Wrist flexion X

Wrist extension X

Thumb flexion X

Thumb abduction X

Finger flexion X

Finger extension X

Trunk flexion X

Trunk extension X

Trunk rotation X

Lower extremities X

9. Body structures required:

Category

Body Structure

Required?

Check If

Yes

Nervous system Frontal lobe X

Temporal lobe X

Parietal lobe X

Occipital lobe X

Midbrain X

Diencephalon X

Basal ganglia X

Cerebellum X

Brain stem X

Cranial nerves X

Spinal cord X


Spinal nerves X

Meninges X

Sympathetic nervous system X

Parasympathetic nervous system X

Eyes, ears, and

related

Eyeball: Conjunctiva, cornea, iris, retina, lens, vitreous

body

X

structures Structures around eye: Lacrimal gland, eyelid, eyebrow,

external ocular muscles

X

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

X

Voice and speech

structures

Structures of the nose: External nose, nasal septum,

nasal fossae

X

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

palate, tongue, lips

X

Structure of pharynx: Nasal pharynx and oral pharynx X

Structure of larynx: Vocal folds X

Cardiovascular

system

Heart: Atria, ventricles X

Arteries X

Veins X

Capillaries X

Immune system Lymphatic vessels X

Lymphatic nodes X

Thymus X

Spleen X

Bone marrow X

Respiratory system Trachea X

Lungs: Bronchial tree, alveoli X

Thoracic cage X

Respiratory system

(continued)

Muscles of respiration: Intercostal muscles, diaphragm

Digestive, metabolic, Salivary glands

and endocrine

systems

Esophagus

Stomach

Intestines: Small and large

Pancreas

Liver

Gall bladder and ducts

Endocrine glands: Pituitary, thyroid, parathyroid,

adrenal


Genitourinary and Urinary system: Kidneys, ureters, bladder, urethra

reproductive systems Structure of pelvic floor X

Structure of reproductive system Ovaries, uterus, breast

and nipple, vagina and external genitalia, testes, penis,

prostate

Structures related to Bones of cranium

movement Bones of face

Bones of neck region

Joints of head and neck X

Bones of shoulder region X

Joints of shoulder region X

Muscles of shoulder region X

Bones of upper arm X

Ligaments and fascia of upper arm X

Bones of forearm X

Wrist joint X

Muscles of forearm X

Ligaments and fascia of forearm X

Bones of hand X

Joints of hand and fingers X

Muscles of hand X

Ligaments and fascia of hand X

Bones of pelvis region X

Joints of pelvic region X

Muscles of pelvic region X

Ligaments and fascia of pelvic region X

Bones of thigh X

Hip joint X

Muscles of thigh X

Ligaments and fascia of thigh X

Bones of lower leg X

Knee joint X

Muscles of lower leg X

Ligaments and fascia of lower leg X

Bones of ankle and foot X

Ankle, foot, and toe joints X

Muscle of ankle and foot X

Ligaments of fascia of ankle and foot

Structures related to Cervical vertebral column X

movement

(continued)

Lumbar vertebral column X

Sacral vertebral column X

Coccyx X

Muscles of trunk X

Ligaments and fascia of trunk X

Skin and related

structures

Areas of skin: Head, neck, shoulder, upper extremity,

pelvic region, lower extremities, trunk, and back

X


Structure of skin glands: Sweat and sebaceous X

Structure of nails: Fingernails and toenails X

Structure of hair

10. Performance skills required:

Skill Required? How the Skill Is Used

Motor/praxis

X

Planning and carrying out sequential movements with

correct timing and transitions between movements.

Pulling weeds, tilling the ground, watering specific

plants, etc. without destroying the plant or ruining the

garden. Coordinating the use of both hands and

controlling both fine and gross motor movements such

as planting seeds or carrying a big bucket for the

weeds. She needs to be able to right and support her

trunk when bending over to pull weeds. She has to

cross midline and have eye-hand/foot coordination for

kneeling, walking, standing, and maneuvering around

the garden.

Sensory (perceptual)

X

She has to differentiate between textures and smells in

the garden. She needs to know if a plant feels hard and

brittle or if it is soft and pliable. She has to be able to

discriminate sounds outside and everything that she

sees. She has to be able to identify plants, tools, etc.

using visual, tactile and olfactory senses. When

smelling vegetables and fruits she needs to

differentiate between good and bad smells to know if

it is rotten or ripe.

Emotion regulation

X

There is a high possibility of error with gardening due

to weather and outside forces. If it rains too much or

too little and some of her plants die she needs to be

able to regulate her emotions and cope with the loss. If

neighbor kids play in her garden or a dog digs up her

flowers or a bird eats her vegetables she has to

regulate her emotions and possible retaliation

behaviors. She needs impulse control to not lose

control when something happens to her garden.

Cognitive

X

In order to garden you have to follow steps. First,

prepare the ground. Then buy seeds and plant them.

Water the seeds, pull the weeds and so on. She has to

plan and manage her way through the steps of

gardening and select the appropriate objects,

environment and timing. Many of the mental functions

such as judgment, cognitive flexibility, awareness,


attention, etc. are required to garden independently

and successfully.

Communication/social

X

For the most part communication/social skills are not

needed when Marina is able to garden alone. When

she goes to the store to buy tools, materials and

equipment she has to communicate with employees.

On occasion she talks to neighbors walking by or

family on the phone while she is gardening and must

demonstrate appropriate social skills and etiquette.

11. Performance patterns:

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

Pattern Describe

X Useful habit Marina always puts her gloves on before she does anything else. This

keeps her hands clean and protected even when she is gathering her

tools from the garage. She also has a habit of washing her hands when

she is done gardening using the sink in her garage before coming

inside.

Dominating habit

X Routine She has a regular routine for gathering her tools and equipment and for

putting them away that makes sense due to location and use. First she

puts her gardening gloves on. Because of how her storage is set up in

the garage, she always pulls the lawn mower out first and puts it away

last. She grabs her handheld gardening tools after the lawnmower is

moved and after the lawn is mowed (if necessary) and puts them away

first.

X Ritual Marina grows zucchini every year to make zucchini bread for

Thanksgiving. She also grows pumpkins for her kids and grandkids to

carve every year for Halloween.

X Role Gardening provides Marina (Mother and Spouse) with vegetables and

fruits that she can use to feed her family.

Intervention Plan

1. Identify 1 objective and measurable goal of the intervention:

Because Marina listed working in her garden as a top priority and has not been able to

garden since her surgery, the intervention goal addresses this occupation.

-Marina will engage in gardening by walking from her kitchen to her garden with a

shoulder bag using crutches and sit on an adjustable gardening bench. She will then pick

a few vegetables or berries and put them in the shoulder bag. She will bring the produce

back to the kitchen by putting the bag over her shoulder and walking with her crutches.


She will complete this by Friday at the end of the occupational therapy home session. She

will follow the Doctors orders regarding weight bearing on her affected lower limb

throughout the performance of this occupation.

a. According to OTPF what type of outcome is this? Occupational Performance.

2. Intervention approach:

Approach Describe

Create/promote

X Establish/restore Eventually Marina will need to restore skills and abilities that she has

lost due to her injury and surgery relating to performing her

occupation of gardening. Gradually increasing the amount of time

working in the garden, distance walking in the garden, weight of

harvested produce she can carry, etc. would be in line with this

approach.

X Maintain Maintain independent gardening by teaching safe ambulating

techniques with crutches and how to sit/stand with non-weight bearing

lower limb.

X Modify Currently, intervention would simplify or reduce the tasks of

gardening to make it less taxing physically. Providing DME such as

crutches and a higher/adjustable gardening bench to make it easier to

walk and sit.

X Prevent Prevent falls and injury by teaching Marina how to walk with crutches

properly on uneven terrain and how to move to and from a seated and

standing position safely while not bearing weight on affected lower

limb.

3. Activity selection

a. Activity selection: Identify 1 example of each for the intervention plan

Activity Describe

Occupation-based

intervention

Completes gardening using crutches, an adjustable garden bench and a

shoulder bag to carry tools and harvested produce.

Purposeful activity Practices safe ways to walk on uneven terrain with crutches.

Preparatory

method

Provides strengthening exercises for the upper extremities or the right

lower extremity because of increased demands with the use of

crutches.


b. Discuss how activity selection relates back to occupational profile and

occupational analysis

-Section of meaningful activities is not possible without knowing the

client and what is important to them. Obtaining the occupational profile enables

the Occupational Therapist to select appropriate, meaningful, therapeutic and

beneficial activities for the intervention. When analyzing the activities selected

the therapist must utilize the information from the occupational profile to decide if

the activity will be possible. Knowledge of client factors learned during the

gathering of the occupational profile will guide the activity analysis and provide

the answers to whether or not a particular activity will be suited for the client.

After learning more about who Marina is, what is important to her, and where she

finds happiness through the occupational profile, I was able to select an activity

that was meaningful to her. After selecting the activity, I was able to thoroughly

analyze how she completes that activity which gave me information to use as I

developed an intervention plan. I needed to know what body functions and

structures are necessary in order to evaluate if she could complete the activity.

The activity demands helped me to see where Marina may struggle and which

areas of the activity I may need to adapt or educate her on how to participate

safely. Without the occupational profile and the occupational analysis I could not

have chosen a meaningful activity that Marina could participate in and would

provide therapeutic benefits.

c. Discuss how activity selection will support achievement of client identified goals

and goal of the intervention plan

-Activities selected by the therapist must coincide with the client’s

identified goals. By choosing meaningful and appropriate activities the client will

be more motivated to participate in therapy and work harder. If the activities

match the client’s goals then we know the client will see the therapeutic benefit,

generalization, and participate more fully. Since the client is always involved in

setting goals for the intervention plan, the same concept applies here and

meaningful activities that are in line with the client’s identified goals will support

engagement in occupation and intervention goals/outcomes. In this specific

intervention, selecting activities for Marina to work in the garden will help her

achieve her goal of resuming leisure participation in the garden. The training and

practice she will receive with this activity in using crutches and walking on

uneven terrain will carry over to her second goal of being more mobile in her

house and at her work. Learning to sit and stand without bearing weight on her

left foot while working in the garden can also be generalized to sitting on the

toilet and standing back up which is another goal Marina identified.


4. Describe how intervention can be graded or adapted and why

-Marina was previously able to engage in gardening without any problems until

she had an injury and then surgery to correct the impairment. She is now unable to bear

weight on her left foot, has an orthotic device on that foot and cannot bear weight for 6

weeks. Prior to her surgery she was less active due to increased pain from the injury.

Intervention is aimed at helping her re-engage in her desired occupation of gardening.

She knows how to garden but needs help using DME, specifically crutches, compensating

for the non-weight bearing foot and adapting how she gardens. Grading up could include

not teaching her techniques to walk with crutches, sit/stand with one limb, navigate stairs

and uneven terrain and letting her figure these things out by herself. Adding obstacles or

decreasing the amount of time to complete the tasks but working in the garden for a

longer amount of time would also grade up the activity. Another possibility is adding

distractions such as people trying to talk to Marina while gardening, loud noises, or

things happening in the background. Grading down could include teaching techniques to

walk with crutches, providing a demonstration, visual and verbal cues, removing

obstacles, avoiding uneven terrain, increasing the amount of time to complete tasks and

decreasing the overall time spent in the garden, or providing an adjustable garden bench

for sitting and taking breaks. There are many more ways to grade up or down with this

intervention. Reasons for doing so would be to provide Marina with the “just right

challenge.” If therapy is too easy or too hard her level of functioning will not improve.

Grading allows the therapist to help Marina to work her way back to her previous level of

functioning without getting overwhelmed, frustrated or feeling like it is a waste of time.

Grading also allows the therapist to show the client their progress which can boost morale

and motivation. Grading activities allows the practitioner to use multiple body systems

within the activity as well.

5. Safety concerns and/or precautions

-There is a safety concern with ambulation and the use of crutches since Marina

has never used them before. She is at a high risk for falling. She has been in bed for 2

days and prior to that her activity levels had decreased so she has had some muscle

atrophy and loss of balance due to inactivity. Trying to carry heavy produce, tools, etc. is

a safety risk if it is attempted before she is ready or without proper adaptation. Grading

the activity up too fast when Marina is not ready can also pose safety concerns.

Precautions include edema from the recent surgery, pain medication Marina is taking, the

non-weight bearing orders from the Doctor, joint stiffness, pain, awareness/insight, and

dizziness to name a few.

6. Discuss the role of the occupational therapy practitioner during the intervention

-Along with the client, the occupational therapy practitioner’s role is to develop

the intervention plan which includes outcomes/goals. To consult, educate and advocate

for the client. To implement the intervention, constantly evaluate and re-evaluate the


models of practice, frames of reference and intervention methods chosen. Monitor the

client’s response to intervention. Include the client in all process of the intervention.

Utilize his/her therapeutic use of self and motivate the client. Support the health and

participation of the client through engagement in their desired occupations.

7. Discuss what is expected of the client during the intervention

-Along with the occupational therapy practitioner, the client is expected to help

develop the intervention plan. Provide information about their desired occupations and

goals. Keep an open line of communication with the therapist and let him know of any

changes, including but not limited to pain, interest, comfort level, and fatigue. Work hard

and stay motivated. Utilize immediate feedback while performing the occupation and

problem solve with the therapist to improve occupational performance and overall

functioning levels.

Occupational Analysis and Intervention Johnny V....

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