Running head: OCCUPATIONAL PROFILE: MARIE

Occupational Profile: Marie

Elisa Dick
Touro University Nevada

OCCUPATIONAL PROFILE: MARIE

Occupational Profile
Marie is a 65-year-old woman who is at Silver Ridge following a total hip arthroplasty. Her
cheerful demeanor is immediately apparent and she is optimistic about her recovery. She is a
homemaker, widow to her husband who passed away six years ago, and mother to three grown
children. After the death of her husband, Marie moved from Los Angeles to Las Vegas to care for
her ailing mother. She expresses satisfaction her ability to provide care, as her role shifted from
mother to caregiver of her parents. Her mother passed away a few years ago, and her focus has
again shifted to caring for her 92-year-old father. From providing this care, she is quite aware of
adaptive equipment and medical needs.
Marie suffers from osteoarthritis in her right hip, a condition that had progressed to the point
of her dependence on a walker and shower stool. Due to her progressive limitations, Marie and
her orthopedic surgeon decided it was time for a total hip arthroplasty. Marie prepared for the
surgery by attending Nifty Over Fifty, a gym for older adults. She enjoys the gym, and feels part
of a community of older adults with a shared goal of staying active. Marie reported she worked
hard on improving her strength, endurance, and flexibility to help her recovery post-surgery.
Anticipating Maries recovery needs, her brother, Paul, moved into the family home. He is also
elderly, but is able to take over household maintenance, shopping, and driving while Marie
recovers. Marie jokes about the two men, but they seem to form a cohesive, albeit nontraditional,
family unit.
Marie is now three weeks post-op. After spending three days at University Medical Center,
she was discharged to Silver Ridge, a skilled nursing facility. Her status is weight bearing as
tolerated, but she still must observe hip precautions from her posteriolateral approach surgery.
Her incision has healed well without complications, and no longer needs covering in the shower.
Marie is independent in eating and upper extremity dressing, and can travel around the facility

OCCUPATIONAL PROFILE: MARIE

independently in a wheelchair. She prefers to have her meals in the Bistro, a portion of the
facility setup for communal meals. Marie is friendly with other residents and makes small talk,
but says she misses her friends at church. Maries cognitive status is exceptional and I believe
that she finds the other residents to be more impaired.
Marie is enthusiastic at therapy. She has made excellent progress in her recovery, and it is
now apparent she wants to go home. The pain in her right hip has largely subsided and she can
walk with a front-wheel walker with contact guard assistance. Marie understands her hip
precautions, and is hyper vigilant in their application. This has affected her independence in
transfers, standing, and dressing. She requires minimum assistance to transfer from standing with
her walker to a 3:1 seat over her toilet, but has the potential to be modified independent.
Similarly, she completes her grooming tasks seated, but has the weight bearing status and
endurance to potentially complete the tasks standing. Marie is afraid of dressing her lower body
die to her hip precautions, which has been done by a nursing assistant for the duration of her stay.
Marie would like to reintroduce more meaningful occupations to her life. Her main hobby is
sewing, and she makes clothing for her numerous grandchildren. She misses cooking at home
and the independence to plan her own meals. Her family and friends have visited, but she would
like to engage in socialization outside the facility.
The context of the skilled nursing facility has impacted Maries engagement in occupations.
With the exception of therapy, the culture of the facility is to provide a high amount of care and
assistance, on which she has relied on more than is necessary. Most residents watch TV all day,
and the physical environment lacks engaging activities like she has at home, like her sewing
room. Socially, the facility is also lacking; Marie seems to enjoy talking with the rehab staff
more than she seems to enjoy talking with the rehab staff more than she seems to enjoy talking
with the rehab staff more than her fellow residents.

OCCUPATIONAL PROFILE: MARIE

Marie expresses a strong desire to return home, which to her represents a return to her
previous way of life. She is concerned about getting around at home and following her hip
precautions. She wonders if she will be able to navigate enclosed areas, such as the bathroom,
with her walker. Marie has expressed her faith in her brother to provide care for herself and her
father, but is nervous about this change. Marie wants to be able to complete her dressing
independently and increase her endurance for standing tasks, such as grooming and cooking. As
a more long-term goal, Marie plans to return to driving, but is waiting for clearance from her
surgeon first.
Occupational Analysis
I observed Marie completing grooming tasks in her bathroom at Silver Ridge. When she
arrived at the facility almost three weeks ago, she was on toe-touch weight bearing status due to
her total hip arthroplasty. At that time, she began completing her grooming tasks seated in the
bathroom with the assistance of a nursing assistant. Since then, she no longer has weight bearing
precautions and is able to stand and walk with a front wheel walker. However, she is hesitant to
complete grooming tasks standing due to fear of falling and her comfort with the current routine.
Body Functions
Marie has the necessary mental functions, including attention and sequencing, to
complete grooming tasks. Emotionally, she is fearful of returning to standing during these
activities. She has the necessary sensory and pain functions, including visual acuity,
proprioception, and touch to find and pick up objects such as her toothbrush. Marie has had some
declines to her cardiovascular system due to immobilization following her surgery, but is easily
able to endure the task. Her vocal, digestive, endocrine, genitourinary, reproductive, and
integumentary systems are intact and do not affect performance.

OCCUPATIONAL PROFILE: MARIE

The neuromusculoskeletal functions of her right hip joint and her pelvis and femur have
been affected by the surgery. The joint is now stable, although somewhat weak. The mobility of
the joint is affected, as she cannot abduct, cross, internally rotate, or flex her hip past 90. Her
muscles have need weakened from both the surgery and disuse. When Marie completes her
grooming tasks seated, these factors do not affect her performance. However, Marie has regained
a great amount of function, and has the potential to complete these tasks standing.
Activity Demands
The equipment Marie uses for grooming are her armchair, counter, and sink. The counter
in her room is lower to accommodate seated tasks. Her tools include her toothbrush, hairbrush,
cup, hand towel, and makeup brushes. Materials include toothpaste, soap, lotion, dental floss,
cosmetics, and hairspray. Some of the tools and materials are provided by the facility and some
she requested from home due to her personal preferences. The physical environment of the
bathroom is spacious to accommodate adaptive equipment and is well lit. Socially, the bathroom
is shared by her roommate and is frequented by facility staff.
Marie has a specific sequence in which she completes her grooming activities. She
performs her morning tasks in this sequence: wash face, wash hands, brush teeth, style hair, and
apply makeup. Each task has a typical duration of time, such as two minutes for teeth brushing.
As she moves to the next task, she requests the needed items from an aide.
The required actions and performance skills for grooming are typical of the tasks. Motor
and praxis skills are needed to pick up objects. Touch and sensation is needed to apply the
correct pressure to her face and teeth. Cognition is needed to sequence tasks, such as applying
toothpaste to the toothbrush, brushing teeth, rinsing mouth, and rinsing and putting away
toothbrush. Verbal communication skills are required, as Marie asks her aide for objects. Typical

OCCUPATIONAL PROFILE: MARIE

body functions and structures are also necessary. Marie uses her upper extremities to grasp and
manipulate objects, requiring muscle strength and joint range of motion. Her eyes locate objects,
and touch discerns their application.
Performance Patterns
Marie has been completing her grooming tasks for decades, and follows certain patterns
when engaging in this occupation. Her grooming tasks are part of her everyday morning and
evening routine. She completes activities in the same order for roughly the same amount of time
each day. The way she applies her toothpaste and her arrangement of cosmetics on the counter
are habits. She automatically uses these movement patterns without conscious thought. Marie
does not consider her grooming routine to be ritualistic. While some view hair brushing or
makeup application to be ritualistic, she considers these actions purely utilitarian. Her role in
completing grooming occupations has changed since her surgery. While her prior occupation was
as in independent individual, she now does these tasks as a patient, as she receives help from a
medical aide.
Performance Skills
Marie uses motor skills to reach for and grasp objects used for grooming, such as her
hairbrush. She coordinates her body movements when she does this, such as engaging core
muscles for trunk stability when leaning to one side to reach. Sequences of movements, such as
brushing her teeth, are performance patterns. She uses several sequential steps to carry out the
task. In order to carry out these motor and praxis skills, Marie needs sensory perceptual skills.
She visually assesses the location of objects, and uses proprioception to feel where her body is in
space. Timing is also used, such as spitting toothpaste into the sink at the same time she leans
over the sink.

OCCUPATIONAL PROFILE: MARIE

Marie has no cognitive impairments, and uses the same skills to carry out these activities
as she did prior to her surgery. She uses personal judgment when applying makeup to her liking.
She selects tools and sequences her activities using cognition. Since she now uses an aide when
completing these tasks, there is now communication and interaction with another person. She
displays gratitude toward her aide, which is appropriate for the situation. Her emotional
regulation is appropriate for the situation, and she does not get frustrated by her new need for
assistance.
Body Functions and Structures
To complete grooming tasks, cognitive abilities are required. Memory to recall the task,
attention to the task, sequencing of activities, and recognition of tools are necessary. Higher
global functions, such as the motivation to complete tasks, orientation, and level or arousal are
also required. Various sensory systems must be intact. Vision is used to locate items, and
proprioception and touch is used to retrieve them. Smell and taste is useful although not essential
to see if items like lotion or toothpaste smell and taste normal and are not expired. The sensations
of pain and temperature are necessary to perform these tasks safely. Without temperature
sensation, a burn from excessively hot water could occur. Pain sensation is important when
brushing ones teeth to be aware of sensitive areas and possible problems with oral hygiene.
Neuromusculoskeletal elements of grooming include trunk stability, upper extremity
strength and range of motion, and muscle endurance to complete all tasks. Marie currently
completes these tasks seated, but if they were done standing then lower extremity strength,
control, stability, and range of motion would also be required. Although grooming tasks are not
physically taxing, cardiovascular abilities are required for activity tolerance. Respiration must be
adequate to supply the body with oxygen. Blood pressure should be stable to avoid dizziness

OCCUPATIONAL PROFILE: MARIE

when maneuvering. Skin should be intact and be able to tolerate washing and holding objects
without compromising integrity. Voice, digestive, metabolic, endocrine, genitourinary, and
reproductive functions are not specifically required for grooming tasks, but disturbances in these
systems could potentially interfere with successful activity completion. In addition to the
functions included here, the corresponding structures are also required to carry out these tasks.
Contexts
There are cultural contexts of grooming that dictate the societal norm. It is expected that
one engages in tooth brushing a minimum of twice a day, and maintains adequate grooming to
look presentable. The temporal contexts of grooming are also cultural, as these activities are
typically performed in the morning and before bed at night. The personal contexts of grooming
will vary from person to person. Marie considers these tasks utilitarian; she puts effort into
making sure her hair is neat and wears a small amount of makeup. Some individuals may put
more or less emphasis on physical appearance in regards to grooming. This also relates to
temporal contexts, whereas it takes Marie about 15 minutes to complete all grooming tasks,
others may take as little as five minutes or as long as hours to complete the same tasks. The
physical context of grooming is usually done in a bathroom. A sink, surface area, mirror, and
lighting typically make up the environment.
Problem List
1.
2.
3.
4.
5.

Client is Max A in LE dressing 2 THP.

Client has impaired functional mobility 2 low endurance.
Client is Min A transferring FWW<-> 3:1 2 fear of breaking hip precautions.
Client requires setup for seated grooming tasks due to fear of standing on R leg.
Client is unable to engage in sewing activities 2 inaccessible sewing room at home.

OCCUPATIONAL PROFILE: MARIE

When I met Marie, she was close to discharge, yet still relied on a nursing assistant for lower
extremity dressing. I thought this could easily be addressed by her OT using a hip kit, and was
surprised that no instruction had been included in her therapy. I make this my first priority
because she has the cognition, upper extremity function, and willingness to learn this task. I
believe that a skilled instruction in the use of a hip kit for dressing will result in great functional
gains.
My second priority is to increase her overall endurance. This will improve many other areas
of her functioning, such as functional mobility and activity tolerance. Hopefully, she will see this
improvement and give her more confidence. Her lack of confidence is affecting her
independence in transfers and grooming. She has relied heavily on facility staff, but needs to
prepare for discharge home. By improving her tolerance, and with more instruction on transfers
and energy conservation, she should be about to become more independent in transfers and
grooming.
From Maries home evaluation, I saw that her sewing room is very cluttered and inaccessible
to her by walker. Projects and supplies fill many tables and floor space, leaving little room for
her to maneuver safely. She uses a folding chair at her sewing machine, and is unable to transfer
to and from the chair due to the lack of armrests. By rearranging this room, it can be accessible
to her by walker and enable her to return to this much-loved hobby. This is the lowest priority on
my list, because improvements in endurance and transfers will be necessary first to engage in her
hobby independently.
References
American Occupational Therapy Association. (2002). Occupational therapy practice
framework: Domain and process. American Journal of Occupational Therapy, 56, 609639.

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