Kelsey Puliafico

Occupational Profile
1. Client name: Claire K.
2. Age: 88
3. Sex: F
Briefly discuss each of the following:
4. Who is the client?
Claire was born and raised in Galveston, Texas but later in life moved to Brockton,
Massachusetts where she lived with her husband George. They have been happily married for
close to 60 years. Claire has three grown children- two sons and one daughter. She currently
resides in Cary, North Carolina, in an in-law suite above the garage of her daughter Deborahs
home. She enjoys monthly outings with the Newcomers Club of Raleigh where she is able to
visit with other women from surrounding towns. Claire is also a grandmother to 4 grandsons
and 2 granddaughters. She enjoys baking cookies and knitting hats for babies at Wake Med
Hospital.
5. Why is the client seeking services and/or what are the clients concerns relative to engaging in
occupations and in daily life activities?
Beginning around July 5th, 2014 and ending around July 9th, 2014, Claire had a series of mini
strokes which consequently affected the left side of her body. Doctors concluded the stroke was
thrombotic and they believe her prescription Coumadin helped to keep the stroke to a
minimum. Currently, Claire is having difficulty with left-sided weakness, vocalizing speech, and
some memory. She is left-handed, so the stroke has also caused Claire to have difficulty with
writing and griping her fork to self-feed.
6. In what occupations does the client feel successful and what barriers are affecting his or her
success?
Claire is able to successfully dress herself with minimal assistance, however, takes more time
than she did before her stroke. Some of her barriers are related to her left-sided weakness.
Before her stroke she was able to be more independent with occupations such as feeding and
writing.
7. What aspects of his or her environments or contexts does the client see as supporting engagement
in desired occupations and what aspects are inhibiting engagement?
Claires in-law suite is on the second floor of the house. This has proven to be one aspect of the
environment that inhibits engagement in occupations because she has a hard time climbing the
stairs. Claire does not always want to continue to engage in further occupations after
completing the task of climbing the stairs because she fatigues easily. Some new additions to
her home have helped to support Claires participation in many other meaningful activities. She
has a shower seat and extended shower head so that she is able to sit down in the shower. Now
she uses a walker to help keep her stable when she moves about in her home or in public.

8. What is the clients occupational history?

Claire worked for Nationwide Insurance until retiring at the age of 63. Once she moved to North
Carolina, she started working again part-time at the Cary Towne Center Mall in customer
service. She enjoyed getting out and interacting with people in town and stayed especially busy
gift-wrapping during the holidays. She also volunteers once a week in medical records at Wake
Med hospital.
9. What are the clients values and interests?
Claire is very close with her family and thoroughly enjoys spending time with her grandchildren.
She is a firm believer in working hard for what you want, and states that she likes to instill that
mind set in her children and grandchildren. Although she is married to a Jewish man, she is
strong in her Christian faith and attends Christ the King Lutheran church in Cary, North Carolina.
She likes to knit and uses her skills to make hats for the infants at Wake Med hospital. Claire also
says she enjoys collecting thimbles and displaying them on a shelf in her bedroom. In addition to
her thimble collection, Claire has a large collection of buttons. She has continued to collect all
kinds of buttons over the years after her mother passed the collection down to Claire and her
two sisters.
10. What are the clients daily life roles?
The roles that Claire takes in her daily life are as a wife, mother, and grandmother (even to her
daughter Deborahs dog). She engages in occupations related to those roles each day. Cooking
and cleaning are occupations that Claire is frequently engaged in.
11. What are the clients patterns of engagement in occupations?
Claire follows a similar morning routine each day. She wakes up, makes coffee and then has
breakfast. She usually has the table set for breakfast the night before. Claire is also aware of the
importance of managing finances and likes to check that her checkbook is balance and nothing is
out of order a couple of times each month. A ritual that Claire engages in is prayer before each
meal. She has taught her children and grandchildren to say grace before anyone is able to begin
eating in her kitchen.
12. What are the clients priorities and desired targeted outcomes related to occupational
performance?
Claires concerns are related to her left-sided weakness from her stroke. She wants to gain
strength and endurance over that left side to hopefully be more successful in occupations such
as writing and self-feeding. Fine motor skills need to be refined as well. She has been having
some difficulties with organizing her medications in the small pill boxes which could be
improved through occupational therapy intervention.

Occupational Analysis
1. Occupation: Organizing medications
Categorization of occupation for the client:
Subcategory:
1. Activities of daily living:
2. Instrumental activities of daily living: Health management and maintenance
3. Education
4. Work
5. Play
6. Leisure
7. Social participation
2. Values, beliefs, spirituality associated with participation:
Claire values time that she spends with her family, and recognizes that her medication routines are
an important occupation in her life to keep her healthy.

3. Contexts:
Context
Physical/space demands

Social

Cultural
Personal

Temporal

Virtual

Supports
Claire performs the occupation
in her kitchen and requires a
table surface and chair to sit in
while she organizes her
medication. The kitchen is a
very open space, allowing
Claire to move freely without
having to worry about bumping
into furniture.
Claire requires minimal verbal
cues from social peers if she is
confused about which
medication is which, or what
her dosage is.

N/A to occupation
Claire is an 88 year-old, retired
female, living in a second floor
in-law suite apartment.
Claire organizes her medication
for the week ahead on Sunday
morning. She takes about 1520 minutes to organize the
medication.
N/A to occupation

Inhibits

When Claires husband gets

frustrated with her not knowing
what the correct dosage is, the
two of them argue. This distracts
Claire from continuing to
perform her occupation without
interruption.
N/A to occupation

When Claires husband is

impatient and rushes her to
perform the occupation of
organizing her medication this
inhibits her performance.
N/A to occupation

4. Objects and their properties used:

Tools: 1 seven-day pill container with an AM and PM side, small white basket holding medication
containers
Materials: Medications- 5 different medications (Aspirin, Lipitor, Glucosamine, Lopressor and
Coumadin)
Equipment: Large wooden kitchen table space and chair to sit while Claire organizes her medications
5. Social demands:
Claire performs the occupation of organizing her medications in the comfort of her own home, in
her kitchen. She is able to complete most tasks individually, but requires few verbal cues from her
husband and daughter to orient her to which medication is which. Minimal social interaction allows
Claire to concentrate on the task of organizing her medications. Too much social interaction proves
to be distracting to Claires concentration.
6. Sequence and timing:
1. Claire opens kitchen cabinet by reaching overhead and grasping the handle with her left hand.
2. Claire gently pulls open the kitchen cabinet.
3. Claire reaches up to the second shelf and grasps the small white basket containing her
medications.
4. Using her left hand, Claire brings the small white basket containing her medications down and
places it on the kitchen counter.
5. Again, Claire reaches overhead and closes the kitchen cabinet.
6. Using her left hand, Claire picks up the small white basket containing her medication off the
kitchen counter.
7. While holding the basket, Claire pivots and takes 5 steps toward the kitchen table.
8. Claire places the small white basket near the edge of the kitchen table.
9. Claire pulls the kitchen chair away from the table far enough for her to have room to sit down in
the chair.
10. Claire stands in front of the kitchen chair, facing away from it.
11. Claire places both hands on top of the kitchen table for support.
12. Claire lowers herself to sit in the chair and as her buttocks gets close to the chair she flops
down with little control.
13. Claire scoots her chair in close to the table.
14. Claire reaches for her seven-day pill container and brings it close to wear she is sitting.
15. Claire orients herself to the seven-day pill container but looking at each side and determining
that one side is for her morning medications and the other side for nighttime medications.
16. Claire removes the sheet of paper listing what medications she takes and what the dosages are
from the white basket and places it beside her.
17. Claire reads the first medication on her list which is aspirin.
18. Claire finds the aspirin in the white basket and picks it up with her left hand.
19. While holding the aspirin bottle in her right hand, Claire uses her left hand to twist off the top of
the bottle.
20. Claire reads the dosage of aspirin from her medication list One tablet by mouth daily

21. Claire pours a few of the aspirin into her left hand.
22. Claire uses her thumb and index finger on her right hand to pinch 1 aspirin and places it next to
the pill container.
23. Claire closes the aspirin bottle and puts it back into the white basket.
24. George, Claires husband, steps in and asks why Claire only put one aspirin out and did not put
any into her pill container.
25. Claire states that she needs to take one aspirin tablet each day and George clarifies for her that
meant she needs to place one aspirin into each morning box of her pill container.
26. Claire picks up the aspirin bottle from the white container and opens it using 2 hands again.
27. Again, Claire pours a few aspirin into her left hand and uses her thumb and index finger on her
right hand to pinch an aspirin and put it into the morning box of her pill container.
28. Claire repeats step 27 until she has put 1 aspirin into each morning box of the pill container,
counting the pills 1-7 as she goes as to not lose track.
29. Claire places the aspirin bottle back into the white basket.
30. Claire reads the next medication off of her list and the dosage Lipitor. 1 tablet by mouth daily.
31. Claire finds Lipitor in the white medication basket and takes it out.
32. Again, Claire opens the bottle using two hands. She holds the bottle with her right hand and
opens it with her left.
33. Claire pours the medication into her left hand and then uses her thumb and index finger on her
right hand to pinch the pill.
34. Claire puts 1 Lipitor pill in to each of the morning pill slots, counting as she goes as to not lose
track.
35. Claire double checks that she put the Lipitor pills into her pill container correctly but looking
back at each box.
36. Claire recognizes that she put an extra Lipitor pill into the last pill box and tries to scoop it out
with the index finger on her left hand.
37. Claire has difficulty removing the pill with her left hand, so she adjusts and take the extra pill out
with her right hand.
38. Claire puts the extra Lipitor pills back into the container and closes it up.
39. Claire puts the Lipitor medication bottle back into the white basket.
40. Claire reads the next medication from her list and the dosage, Glucosamine, 1 tablet by mouth
2 times a day.
41. Claire finds the glucosamine bottle in the white medicine basket and takes it out.
41. Again, Claire uses her two hands to open the glucosamine bottle.
42. Claire pauses and then repeats the dosage out loud 1 tablet by mouth 2 times a day.
43. Claire takes a minute to think about what that dosage means and then states that means I take
one in the morning and then one at night.
44. Claire pours a few glucosamine into her left hand and uses the thumb and index finger of her
right hand to pinch 1 pill and place 1 into each morning box of her pill container.
45. Claire goes to close the glucosamine container and George reminds her that if she needs to take
1 pill 2 times a day she needs to put a glucosamine into each of the nighttime boxes of her pill
container too.

46. Claire agrees and, using her right hand, she turns the pill container around so the nighttime side
is facing her.
47. Claire repeats step 44 until she has placed on glucosamine pill into each of the nighttime boxes
of her pill container.
48. Claire puts the glucosamine bottle back into her white medicine basket.
49. Claire reads the next medication and dosage from her chart, Lopressor, take one half tablet by
mouth 2 times daily.
50. Claire picks up a medicine bottle from the white basket and reads the label.
51. Claire does not recognize the medication name so she puts that bottle to the side and states that
she does not think she takes that anymore.
52. Claire pauses to regain her thoughts and her daughter Deborah reminds Claire that she is looking
for Lopressor.
53. Claire looks in the white medication basket and finds Lopressor.
54. Claire opens the bottle with two hands.
55. Claire pours some of the Lopressor pills into her left hand.
56. Claire uses her thumb and index finger on her left hand to pinch the pills and places one into
each of the nighttime boxes of the pill container.
57. Then Claire recognizes that she did not turn the pill container around after she finished placing
her glucosamine pills into the nighttime boxes.
58. Claire turns her medicine container around so that she can put Lopressor pills into the morning
pill boxes as well.
59. When Claire closes up the Lopressor bottle she notices that there are only a couple of pills left
and says she will have to order more.
60. Claire places the Lopressor bottle in the middle of the kitchen table in order to remind her to call
her doctor to order another bottle.
61. Claire reads her last medication from her list and the dosage Coumadin, take one and one-half
tablets on Tuesday & Friday and one pill the rest of the days.:
62. Claire finds the Coumadin bottle in her white medicine basket.
63. Claire opens the Coumadin bottle with two hands and pours some onto the kitchen table
placemat.
64. Claire finds two half tablets and pinches them between her thumb and index finger of her right
hand.
65. Claire looks at her medicine container to find the box for Tuesday morning.
66. Claire puts one half tablet into the Tuesday morning box and then repeats this step to place one
half tablet of Coumadin into the Friday morning box.
67. Then Claire puts 1 full tablet into each morning box counting 1-7 as she puts them into each
morning box slot.
68. Claire puts the extra Coumadin tablets back into the container and closes it.
69. Claire puts the Coumadin bottle back into the white basket.
70. Claire pushes her chair away from the kitchen table and stands up.
71. Claire picks up the white medicine basket off of the kitchen table and returns it to the kitchen
cabinet where she found it earlier.

72. Claire double checks that her pill container is closed and places it in the center of the kitchen
table so that she can remember to take her medicine the next morning
7. Body functions required:

Function

How It Is Used

Judgment

Claire mentally discriminated between her

different medications when she looked for a
certain one in the white medicine basket.
Claire distinguished different medications by
grouping the pills together that looked the
same.
Claire had to think about the best strategy to
use to sort her medications and make sure she
put the correct pills in each of the boxes in her
7-day medicine container.
When Claire realized she put an extra Lipitor
pill in one of the morning boxes she tried to
scoop it out with her left hand/index finger.
When she had difficulty removing the extra pill
she needed to change her strategy and decided
to try using her other hand.
When Claire looked through the white
medicine basket to find a certain medication
and she picked one out that she did not
remember taking she recognized this and put
that medication off to the side so she would
not confuse it for any of the others. Claire also
recognized when she saw a medication that did
not look familiar to her and asked her husband
or daughter to clarify for her.
Claire paid close attention to which medication
she was placing into her organizer as well as
how much of each pill she placed into the
organizer in order to place the correct amounts
of each.
Claire concentrated on the task of organizing
her medications for the entire length of time
that it took for her to complete the task
While Claire organized her medications, her
husband also watched television. Claire
maintained her focus on her medication
organization and refrained from being
distracted by the television program that was
on in the same room.
While Claire organized her medications she also
carried on brief conversation with her husband

Concept formation

Metacognition

Cognitive flexibility

Insight/awareness

Concentration

Sustained attention

Selective attention

Divided attention

None

Minimally
Challenged

Greatly
Challenged

Short-term memory

Working memory

Long-term memory

Discrimination of
senses: Auditory
Discrimination of
senses: Tactile
Discrimination of
senses: Visual
Discrimination of
senses: Olfactory
Discrimination of
senses: Vestibularproprioception

Multisensory
processing

Sensory Memory

Spatial relationships

Temporal
relationships

and her daughter, which at times took some of

her direct focus away from her medication
organization
When Claire read her medication list she had to
remember what the medication is called in
order to locate it in her white medicine basket.
She also needed to remember the dosage so
she could place the correct amount of the
medication into each box of her pill organizer.
While Claire placed her pills into her
medication organizer she used strategies like
counting the number of pills as she went in
order to not lose track of what she was doing.
Being 88 years old, Claire has been taking
medications for many years. She was able to
recall strategies that she used to organize her
medication in the past and apply them to how
she organized her medications today.
N/A to the occupation

Claire was able to distinguish different pills by

their shape when she held them in her hands or
between her fingers.
Claire was able to distinguish between her
different medications because the pills were
different sizes and colors.
N/A to the occupation
X

Claire used her hands to support her body by

placing them on the kitchen table before she
sat down in the chair. She also moved slowly in
the kitchen because she recognizes that her
balance was weak and she did not want to fall.
Claire used a combination of senses when
discriminating between different medications.
For example she was able to recognize her
medication by looking at its color and holding it
in her hand to determine its shape or texture.
Claire remembered what it feels like to open
the medicine bottle by twisting her hand on the
bottle cover. She is able to open each medicine
bottle the same way by using the strategy from
the previous bottle
Claire had some difficulty with spatial
awareness by overshooting or undershooting
where the medicine organizer was when she
reached over to put pills in the boxes.
N/A to the occupation

Recognition

Categorization

Generalization

Awareness of reality
Logical/coherent
thought

Appropriate thought
content

Mental functions of
sequencing complex
movement
Regulation and range
of emotion

Appropriateness of
emotion
Coping

Behavioral regulation

Body image
Self-concept

Self-esteem
Arousal

When Claire read a medication from her list she

was able to find that same name on the bottle
in her white medicine basket.
Claire used her pill organizer to put her
medications into boxes that let her know which
medications to take in the morning, at night, or
on specific days of the week.
Claire used the same strategy to pick up her
pills (pinching between her thumb and index
finger) for each of her different types of
medications.
N/A to the occupation
When Claire read take 1 tablet twice per day
on her dosage list, she understood that that
meant she needed to take 1 pill in the morning
and 1 of the same pill at night.
While Claire was organizing her medications
she maintained focus on the task and was
conscious of the reasons why she must take her
medications.
Claire used multistep cognitive functions to
plan where she wanted to place her pills in the
medication container and then carried out
those steps.
While Claire organized her medications she
showed positive emotions when she was able
to get all of her pills into the medication box
and frustration when she at first did not
understand a dosage.
When Claire was successful at organizing her
medications she showed positive emotions that
aligned with her successes.
When Claire tried to put a pill in the medication
organizer and had trouble picking it up she was
able to try again without having a breakdown.
Claire was able to direct her behavior in a way
that was appropriate while she organized her
medications. She was able to recognize when
she made a mistake and changed it without
getting overly upset.
N/A to the occupation
Claire recognized her life roles as a wife,
mother, and grandmother. By understanding
those roles she also understood the importance
of engaging in a medication routine so she
maintained good health to perform her roles.
N/A to the occupation
Claire demonstrated an appropriate level of
alertness when participating in the task of

X
X

X
X

X
X

Consciousness
Orientation to self

Orientation to place

Orientation to time

Orientation to others
Energy level

organizing her medications. She maintained an

alert state in order to perform the occupation
without making mistakes.
Claire performed the occupation of organizing
her medications while she was awake and alert.
Claire demonstrated an awareness of her
identity by locating her medications in the
white medicine basket. She knew they were her
medications because she read her name and
recognized it as her own.
Claire demonstrated awareness of her location
by seeking out her medication basket from the
kitchen cabinet, and then chose to complete
the occupation of organizing her medications at
her kitchen table.
Claire was aware of the days of the week and
time of day to organize her medications
correctly in the 7-day pill container. When she
read a dosage of two times per day she
understood that she must take that medication
once in the morning and once in the evening.
N/A to the occupation
X
Claire maintained an appropriate drive to
complete the occupation of organizing her
medications.

Function

How It Is Used

Motivation

Although Claire showed some signs of difficulty

with fine motor skills when picking up her pills,
she demonstrated internal incentives to
perform well.
Claire resisted the urge to lash out at her
husband George when he was impatient with
her for misunderstanding a medication dosage.
N/A to the occupation
N/A to the occupation

Impulse control

Appetite
Sleep

Detection/registration
Visual modulation

Integration of senses

Claire recognized different medications based

on their size, shape or color
Claire demonstrated the ability to regulate
visual stimuli and maintain focus on the
occupation of organizing her medications when
the television was on in front of her at the
same time.
Claire utilized her visual and tactile senses
simultaneously to perform the occupation of
organizing her medications. She looked at the

None

X
X

Minimally
Challenged

Greatly
Challenged

X
X

X
X

Awareness at
distances

Tolerance of ambient
sounds
Location and distance
of sounds
Moving against gravity

Taste
Smell
Body in space

Comfort with touch

Localizing pain
Thermal awareness
Joint mobility
Joint
stability/alignment
Muscle power

Muscle tone

Muscle endurance

Stretch reflex
ATNR
STNR
Righting and
supporting reflex

medications in order to guide her hand to pick

them up to put in the 7-day pill container.
Claire demonstrated some difficulty with
recognizing how far away her pill container is
when she overshot the box and placed the pill
on the kitchen table instead.
While Claire was performing the occupation of
organizing her medications the dishwasher was
running and she was able to ignore it.
N/A to the occupation
Claire was able to successfully move about in
her kitchen to set herself up to participate in
the occupation of organizing medications. She
did not demonstrate appropriate balance when
she sat in her chair because she allowed her
body to flop down hard in an uncontrolled
movement.
N/A to the occupation
N/A to the occupation
Claire recognized where she was positioned in
relation to the materials used to organize her
medications
When Claire picked up a pill she did not show
any sign of discomfort with the texture of the
pill touching her skin.
N/A to the occupation
N/A to the occupation
Claire had limited joint mobility in her right
extremity when organizing her medications.
Claire utilized fine motor and grasping skills to
pick up her medications and put them into the
pill-container.
Claire demonstrated appropriate levels of
muscle strength when she is able to pick up a
pill without dropping it.
Claire demonstrated normal tension in the
muscles of her arm when she is moved
medications from their bottle to her 7 day pill
organizer.
Claire was able to repeat the movement of
picking up a pill and placing it into the 7-day pill
organizer to complete the occupation without
becoming fatigued.
N/A to the occupation
N/A to the occupation
N/A to the occupation
Claire was able to adjust her position to
maintain balance.

X
X

X
X

X
X
X
X

X
X
X
X

Eye-hand coordination Claire had some difficulty guiding her hand to

the correct pill box.
Bilateral coordination Claire used both hands to open her pill bottles.
She held the bottle with her right hand and
unscrewed the top with the left.
Crossing midline
Claire reached across the center of her body to
place pills into the boxes on the far side of the
7-day pill container.
Fine motor control
Claire utilized fine motor skills when she picked
up her medications between her thumb and
index finger and then placed them into the 7day pill organizer. She did not successfully
engage in these fine movements 100% of the
time.
Gross motor control
Claire walked around in her kitchen to gather
her supplies for the occupation of organizing
her medications.
Occulomotor control
Claire was able to look for and recognize her
medications directly in front of her and across
the table.
Gait patterns
Claire moved slowly in her kitchen so that she
could maintain her balance when she walked.
Blood pressure
Claires blood pressure maintained a normal
rate when organizing her medications.
Heart rate
Claires heart beat maintained a normal range
while she organized her medications.
Respiratory rate
Claires respiratory rate was within normal
range when organizing her medications
Respiratory rhythm
Claire maintained a normal respiratory rhythm
when organizing her medications.
Respiratory depth
Claire showed signs of normal respiratory
depth when organizing her medications.
Physical endurance,
N/A to the occupation
aerobic capacity
Voice functions
While Claire organized her medications she
read the medication list and dosages out loud,
and also carried on a conversation with her
husband and daughter.
Voice rhythm and
At times Claire stuttered when she spoke if she
fluency
had difficulty getting her words out.
Alternative
N/A to the occupation
vocalization
Digestive system
Claires digestive system was working at a
normal rate when she is organized her
medications.
Metabolic system
Claires metabolic system was working at a
normal rate when she is organized her
medications.

X
X

X
X
X
X
X
X
X
X

X
X
X

Endocrine system

Claires endocrine system was working at a

normal rate when organizing her medications.

Function

How It Is Used

None

Urinary functions
Genital and
reproductive function
Protective functions of
the skin
Repair functions of
the skin

N/A to the occupation

N/A to the occupation

X
X

N/A to the occupation

N/A to the occupation

Minimally
Challenged

8. Muscular analysis of movements required:

Muscle
Shoulder flexion
Shoulder extension
Shoulder abduction
Shoulder adduction
Shoulder internal rotation
Shoulder external rotation
Elbow flexion
Elbow extension
Wrist supination
Wrist pronation
Wrist flexion
Wrist extension
Thumb flexion
Thumb abduction
Finger flexion
Finger extension
Trunk flexion
Trunk extension
Trunk rotation
Lower extremities

Not used

Minimally challenged
X
X
X
X
X
X

Greatly challenged

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

9. Performance skills required:

Skill- Motor

How It Is Used

Aligns

Claire positioned herself close to

her table while interacting with her
medications in order to prevent
excessive leaning onto the table.
Claire moved slowly around her
kitchen in preparation for

Stabilizes

None

Minimally
Challenged

Greatly
Challenged

Greatly
Challenged

Positions

Reaches

Bends

Grips

Manipulates

Coordinates

Moves

Lifts

Walks

Transports

organizing her medications in order

to maintain good balance.
Claire sat close enough to the table
to be able to reach all of her
medications and the 7-day pill
container.
When Claire first sat down at her
kitchen table she had to extend her
arm across the middle of the table
to bring the 7-day pill container
closer to her.
Before beginning to organize her
medications, Claire sat down in the
kitchen chair and leaned forward
prior to sitting to help position
herself. Claire lost some control of
her body position towards the chair
and plopped down hard.
Claire pinched her medications
between her thumb and index
finger when transferring them from
their bottles to her 7-day pill
container.
Claire used fine motor movements
of her fingers to pick up and
transfer her medications from their
pill bottles to her 7-day pill
organizer.
Claire used both hands to open her
pill bottles. She held the bottle with
her right hand while twist the top
off with her left.
When Claire sat down at the
kitchen table to begin organizing
her medications she noticed that
the 7-day pill container was out of
her reach so she brought it closer
to her.
Claire was able to reach overhead
and bring the white medicine
basket down from the kitchen
counter.
Claire ambulated in the small area
of her kitchen to gather materials
needed to organize her
medications.
Claire carried the white basket
containing her medications from
the kitchen counter to the kitchen

Calibrates

Flows

Endures

Paces

table prior to starting to organize

her medications.
Claire moved her arm and hand
towards her 7-day pill container
with such force as to not knock it
from the table.
Claire was able to move her arm
and hand from the pill bottles to
the 7-day pill container without
making choppy movements.
Claire followed through with the
entire task of organizing her
medications without needing to
stop and rest.
Claire worked at an appropriate
tempo over the course of
organizing her medications.

Skill- Process

How It Is Used

Paces

Claire maintained an appropriate

tempo of performance while
organizing her medications.
Claire paid close attention and
maintained focus on her
medications and organizing them in
her 7-day pill container.
Claire made the decision to
organize her medications into the
7-day pill container and followed
through until completion of the
task.
After she referred to her
medication dosage list, Claire
picked the appropriate medication
from the white medicine basket to
organize in her 7-day pill container.
Claire utilized the 7-day pill
container to organize her
medications as it is intended to be.
Claire stabilized her 7-day pill
container when she put her
medications in it so that it would
not move around on the table.
When Claire did not understand a
dosage she read from her
medication list she asked her
husband for clarification.
After Claire finished organizing one
medication for the week, she

Attends

Heeds

Chooses

Uses

Handles

Inquires

Initiates

None

Minimally
Challenged

Greatly
Challenged

Continues

Sequences

Terminates

Searches/locates

Gathers

Organizes

Restores

Navigates

Notices/responds

moved on to the next medication

on her list.
Once Claire determined which
medication to organize next she
followed through with placing that
medication into her 7-day pill
container for each day.
Claire followed an appropriate
order of steps to organize each of
her medications in her 7-day pill
container.
Claire followed through with each
step of task to organize her
medications.
Claire read the medications she
was supposed to put into her 7-day
pill container from her medication
list and then found that same
medication in the white medicine
basket where she keeps the
bottles.
Claire brought all materials needed
to organize her medications to the
kitchen table prior to beginning the
task. She also made sure to pick up
any extra pills that she had poured
out of the bottle and replaced
those back into their respective
medication bottles.
Claire set up her work station in a
logical manner and used a 7-day pill
container to maintain order of her
medications.
After Claire finished filling her 7day pill container with her
medications for the upcoming
week Claire returned the white
medication basket back to the
kitchen cabinet, leaving the
workspace as it was originally.
Claire moved around in her kitchen
in a safe manner and did not bump
into any objects such as the kitchen
table or chairs.
Claire recognized that the 7-day pill
container was too far away for her
to reach when she first sat down at
the kitchen table. She moved it
closer to her in order to make

Adjusts

Accommodates

Benefits

organizing her medications easier.

Claire also recognized that she used
up all of a medication and needed
to order more for the next week.
Claire moved a basket out of the
middle of the kitchen table in order
to make room for her medication
basket and pill container.
Claire recognized her difficulty with
the fine motor skills of pinching her
medications between her thumb
and index finger and took a bit
more time than usual to maneuver
the small pills as to not drop them
on the floor.
N/A to the occupation
X

Skill- Social
interaction

How It Is Used

Approaches/starts

Claire initiates social interaction by

saying her husbands name to get
his attention.
Claire annunciates her speech so
that her husband is able to hear her
when he is seated across the room.
N/A to the occupation
X

Produces speech

Gesticulates

None

Minimally
Challenged

Greatly
Challenged

Speaks fluently

Claire pauses in her speech at times

because she loses her train of thought
or has trouble getting her words out.

Turns Toward

Claire maintained her seated

position at the table while she
engaged in the task of organizing
her medications however made an
effort face her husband when
asking questions.
Claire looked up from her
medications to make eye contact
with her husband when she spoke
to him.
Claire positioned herself at the
kitchen table to organize her
medications so that she could
easily interact with her husband at
the same time.
N/A to occupation
Claire maintained appropriate
social behaviors while she engaged
in the occupation of organizing her
medications.
When Claire needed clarification
about an instruction on her

Looks

Places self

Touches
Regulates

Questions

X
X

medication list she proceeded to

ask without hesitation.
Replies
When Claires husband responded
to her questions about a
medication she responded to him
acknowledging that she heard him.
Discloses
Claire felt that her husband was not
being patient with her and she
expressed that opinion with him.
Expresses
Claire appropriately explained to
emotion
her husband that she did not
appreciate him being impatient
when she had difficulty putting her
medications into the pill container.
Disagrees
N/A to occupation
Thanks
N/A to occupation
Transitions
N/A to occupation
Times response
Claire responded to her husband in
a timely manner so he knew that
she heard what he said.
Times duration
Claire spoke in concise statements
as not to ramble while she carried
on a conversation with her
husband during the time spent
organizing her medications.
Takes turns
Claire recognized the need to give
others opportunity to talk and did
not interrupt her husband when he
spoke to her.
Matches language Claire maintained appropriate
volume and tone of voice when she
was engaged in conversation.
Clarifies
Claire repeated a question she had
about her medication dosage when
her husband was unable to hear
her.
Acknowledges and Claire responded with words and
encourages
phrases such as okay, or thank
you, to communicate that she
heard the message from her
husband.
Empathizes
N/A to the occupation
Heeds
Claire asked questions to her
husband to help her accomplish the
task of organizing her medications.
Accommodates
Claire maintained conversation
related to the task of organizing her
medications in order to use her

X
X
X
X

X
X

time efficiently and complete the

task in a timely manner.
N/A to the occupation

Benefits

10. Performance patterns:

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

Pattern
Useful habit

Describe
After putting a medication in her pill-container, Claire checks back over to
make sure she has put the correct medications in each of the boxes, prior
to moving on to the next medication. This is a useful habit because it
prevents Claire from missing a medication or taking the wrong
medication.

Dominating habit

Routine

Taking medications is a part of Claires everyday morning routine.

Through participation in the occupation of organizing her medications in
the 7-day pill container Claire is able to efficiently use her time during the
mornings, as she does not have to spend extra time taking out all of the
medications each day.

Ritual
Role

Intervention Plan
1. Identify 1 objective and measurable goal of the intervention:
Over the next month Claire will prepare a meal for herself and her husband at least 2
nights per week, using adapted equipment as needed, in order to increase dexterity and
fine motor skills.

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

This is an occupational performance outcome. More specifically, the outcome would fall
under the improvement category of occupational performance because Claires fine
motor skills were intact prior to her stroke. Since the onset of the stroke, Claires
difficulty with fine motor skills has affected her ability to engage in certain occupations
with the same successes she had prior to the stroke, including organizing her
medications.

2. Intervention approach:

Approach
Create/promote

Describe

Establish/restore

Since her stroke, Claire is now experiencing difficulties performing fine

motor skills that she did not have trouble with before. This has made
engaging in occupations like organizing her medications more difficult.
Claires role as a wife also requires her to perform other occupations
requiring fine motor skills such as cooking and cleaning. These are
meaningful occupations for her because she enjoys providing for herself
and her husband. By engaging in an establish/restore intervention, Claire
will be able to work towards regaining the ability to perform fine motor
skills that will allow her to return to a functional level as close as possible
to her prior level.

Maintain
Modify
Prevent

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

Describe
Preparing a meal- Claire will prepare a meal for herself and her husband at
least 2 nights a week. This occupation is meaningful for Claire because it is
something that she engages in as part of her role as a wife. She will have
many opportunities to engage in fine motor skills to increase her
independence in other activities of daily living.

Activity

Preparing a food list- Claire will prepare a list of items and gather those
needed to prepare the meal.

Preparatory method

Passively moving the joints of the Claires hands and wrists to prepare them
for the movements required when preparing a meal.
Claire will perform a series of hand-strengthening exercises in order to
increase hand function and fine motor skills.

Preparatory task

b. Discuss how activity selection relates back to occupational profile and occupational
analysis
Having Claire engage in the occupation of preparing a meal, as an intervention, relates
back to the occupational profile and occupational analysis in a number of ways. First,
Claire shared with me that one of her life roles is being a wife. She engages in
occupations such as cooking and cleaning to fulfill the set of behaviors that are expected

of her as a wife. Those activities are meaningful to her because she enjoys providing for
her family. Those activities require the use of many fine motor skills that Claire currently
experiences difficulty with due to her recent stroke. Claire takes a number of
medications each day in order to maintain her health. She uses a 7-day pill organizer to
keep track of all of her medications and when to take them over the course of each
week. Organizing her medications is more difficult since her stroke because this
occupation also requires fine motor skills.
c. Discuss how activity selection will support achievement of client identified goals and
goal of the intervention plan
Claire wants to get back to engaging in the occupations she participated in with little
difficulty prior to her stroke. Again, since she had her stroke she has been having
difficulty with fine motor skills and participating in a cooking intervention using adaptive
equipment will help her to hopefully regain those skills.
4. Describe how intervention can be graded or adapted and why
a. Grading up: Claire will prepare a meal with ingredients from scratch. This would be
considered grading up because it will require more work on Claires part.
b. Grading down: Claire will purchase pre-made meals to serve for her and her husband so
she does not have to cook the meal on her own. This would be grading down because
Claire would not have to do any of the cooking, she would only need to serve the food.
c. Adaptation: Claire will prepare the meal using adapted utensils to compensate for
weakened grip strength and fine motor skills.
5. Discuss any safety concerns and/or precautions
Safety in the kitchen is a priority for a cooking intervention. Prior to engaging in the
activity I will need to be sure Claire understands how to safely use the stove, oven and
other kitchen appliances. It is important to address hand washing to keep food clean
and safe.
6. Discuss the role of the occupational therapy practitioner during the intervention
The OT will visit the Claire in her home for intervention services. This way Claire will be
able to engage in the intervention in her own kitchen, making it more meaningful and
relevant to her. The OT will provide assistance, as needed, such as verbal cueing.
7. Discuss what is expected of the client during the intervention
Claire will be expected to actively participate in the intervention. She will make
decisions about what meal she would like to prepare and ask for assistance as needed.