Running head: INTERVENTION PLAN

Occupational Profile and Intervention Plan for Client Post Open Reduction Internal Fixation
Natasha Arastehmanesh
Touro University Nevada

Occupational Profile
Client
Joy is a 27-year-old African American female who lives in Las Vegas, Nevada. She is
originally from Los Angeles, California and has lived in Nevada for the past 15 years. For the
past 10 years, Joy has been a practicing phlebotomist at the United Blood Services. She obtained
this job through her mother who worked at the United Services call center. Joy has recently

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received an offer for a job promotion as a supervisor. She is also currently training to become a
personal trainer. Her current roles consist of being a life partner, daughter, sister, and niece. She
has two pet Shih Tzus named Bentley and Juicy. She has been with her life partner Chaney for
seven years, and they recently have been married for the past eight months. Joy identifies herself
as a traditional Christian, and her primary language is English.
Services/ Concerns
Joy was seen in an acute care facility for an open reduction internal fixation (ORIF) for a
fracture she sustained on her right acetabulum, pubic ramus, and iliac crest due to a traumatic
motor vehicle accident (MVA). An ORIF is a common surgical procedure where bone fragments
are realigned and secured with pins, nails, screws, or plates (Lawson & Murphy, 2013). In
addition, she also shattered a small portion of her pelvis and sustained a subarachnoid
hemorrhage. After 11 days in an acute care setting, she was transferred to an inpatient
rehabilitation facility (IRF). She is seeking services to make a good recovery and return back
home safely with no further complications. Joy has many concerns about reengaging in
occupations and in daily life activities. Her primary concerns include finishing personal training
school, getting pregnant, and going back to work. She is also concerned about her current pain
level, standing for long periods of time, falling, and the possibility of undergoing another surgery
in the future. Additional concerns include her ability to drive again, engage in sexual intercourse,
and to be able to engage in social gatherings with her friends and family. Lastly, she is also
concerned about her ability to play soccer again with friends and family once she is discharged.
Joys records indicate no prior medical history prior to her ORIF.
Successful Areas and Barriers to Occupational Engagement
Joy feels successful in many occupations. Prior to arriving at the inpatient rehabilitation
facility, Joy was independent in all activities of daily living (ADL) and instrumental activities of
daily living (IADL). She felt successful in shopping, simple meal preparation, care of pets, home

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establishment and management, driving, job performance, laundry and basic ADLs such as
bathing, personal hygiene and grooming, dressing and toileting. She also felt successful in
making decisions about her health, such as making kale smoothies each morning for Chaney and
herself, and exercising three times a week to maintain a healthy lifestyle. After her ORIF, barriers
such as pain in her right leg, and her current emotional state referred to by Joy as an emotional
battle, are a hindrance in her ability to be independent in all ADLs and IADLs. Joy is hopeful in
her recovery and stated how she will not allow her injury to control her, she will control her
injury.
Context/Environment
According to the Occupational Therapy Practice Framework (OTPF), context refers to a
multiplicity of interconnected conditions that are within and surrounding an individual
(American Occupational Therapy Foundation [AOTA], 2014). There are four contexts taken into
consideration when assessing an individual: cultural, personal, temporal, and virtual. Cultural
context includes customs, beliefs, activity patterns, behavioral standards, and expectations that
are an expected part of ones culture that influence an individuals identity and activity choices
(AOTA, 2014). Joys cultural context has an influence on her willingness to cooperate and make
a good recovery. Growing up, Joy was homeless for 10 years in Los Angeles, and homeless for
one more year in Las Vegas. During this time, she changed schools 13 different times and all a
while struggling to find a home to live in with her single mom and grandmother. She does not
want to live in poverty or have to worry if there is enough food on the table each night. Going
through this experience has taught her the value of money and working, therefore Joy is willing
to be as compliant as possible to make a good prognosis in order to make a full recovery and be
able to engage in occupations again, namely working as a phlebotomist.
The personal context which consists of her age, gender, socio-economic status, and
educational status supports Joys engagement in desired occupations. She is young, and has a

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stable job and income which motivate her to make a good recovery and motivate her to reengage
in her desired occupations she engaged in prior to her surgery.
Joys temporal context, which includes the stage of life she is in right now, is a hindrance
in her ability to engage in desired occupations. Prior to the accident, Joy worked full time and
attended school part time. For eight weeks she will be unable to drive to her job and attend
school. She is at a stage in her life where she is able to establish her identity and finally pursue
her dreams of becoming a personal trainer and working as a phlebotomist.
Joys virtual context does not play a role in supporting or hindering engagement in
occupations. Joys social environment, which includes her life partner and her life partners
family, provide a great deal of support, encouragement, and love. When Joy is discharged home,
her life partner has agreed to help take care of Joy and help her engage in occupations she finds
important. Joys physical environment includes her one story spacious home. This factor will
allow Joy to be successful in engagement of occupations such as cooking in a large adaptable
kitchen. The spacious physical environment will also allow Joy to maneuver in her environment
with durable medical equipment without the fear of getting stuck in an area of her home or
falling over furniture.
Occupational History
Joy had many life experiences that have shaped her into who she is today. She was born
in Los Angeles, California and lived there until she was 16-years-old. Her father was not present
in her life because he was incarcerated and is sentenced to a lifetime in jail for homicide and
distribution of illegal drugs. Joy was raised primarily by her single mother, Rolana, and has a
sister, Trianna, from a different father. Joy was homeless for 10 years in Los Angeles, and when
she moved to Las Vegas, was homeless for another year. She attended 13 different schools from
grade school to high school. As a teenager, she experienced alopecia, a disease in which a
stressed state causes the individual to experience hair loss on the scalp. Treatment for this

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condition included taking steroids. This altered Joys mood and often times would cause her to
be angry. Side effects also included weight gain, 80 pounds to be exact, therefore she ceased
taking the medication. This condition caused Joy to experience stress and sadness, because she
would be made fun of by her peers. This led to two failed suicide attempts.
Values and Interests
Joy values affecting peoples lives in a positive way and spending time with her family
and friends. Her interests include shopping, dancing, and reading books she has a particular
interest in motivational books. She also enjoys traveling, cooking, playing soccer, taking long
walks with her dogs, potting plants, and trying different cuisines.
Life Roles
Joy takes on many daily life roles. The most important role to her is being a wife to her
life partner, Chaney. This role provides meaning to Joy because it allows her to participate in
traditional wife roles such as cooking, cleaning, and most importantly providing unconditional
love and support for her life partner. Another daily life role Joy takes on is being a phlebotomist.
This is meaningful to her because this role provides a means for Joy to give back to the
community. In addition to drawing blood, Joy also frequently donates blood.
Patterns in Engagement
Joys engagement in patterns of occupation has changed over time. Before her surgery
she would wake up at 5:30 a.m. each morning to get ready for her day. Her morning routine
would include taking a shower, walking the dogs, making breakfast and lunch, and if she had
enough time, going to the gym. Since her surgery, it takes about 15 minutes just to get to the
bathroom and toilet each morning. Due to her weight bearing restrictions, her morning routine
and patterns of engagement take longer than she anticipated. She has to mentally prepare herself
before she engages in any activity. Since her surgery, the first thing she does each morning is
pray. She thinks more about how thankful she is to have survived the MVA and to not be

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paralyzed as a result of the accident. Since the accident, her body temperature easily drops,
creating an experience of coldness in addition to body aches, especially in her left lower
extremity. This has caused her to pace herself in order to conserve energy for other activities.
When she engages in a laborious activity, she easily fatigues. This has forced her to be more
patient with herself.
Client Priority and Outcomes
Joys main priority is to find her purpose in life. Since the MVA, she feels different and
feels that she has been given a second chance to live and wants to know why. She plans on
becoming a better person through focusing on her roles as wife, friend, and individual. She stated
when tragedy hits, you realize you dont have as much time. She plans on continuing to
exercise, eat healthy, walk her dogs, and socialize with friends and family. In all of this she also
wants to be more spiritual and focus on her growth. In terms of occupational performance she
plans on becoming independent in all ADLs and IADLs.
Occupational Analysis
Occupational Therapy Services
Joy is currently in an IRF recovering from an ORIF. Typically patients in this facility
receive 90 minutes of occupational therapy and 90 minutes of physical therapy for a combined
three hours of therapy a day. On average, patients stay 10-14 days. Typically patients are
medically stable in this setting, and are believed to be capable of benefiting from rehabilitation
(Schultz-Krohn & Pendleton, 2013). Patients participate in therapy in hopes of gaining functional
independence in ADLs and IADLs. The goal of occupational therapy in an IRF is to maximize
performance skills in daily occupations while all movement precautions are observed during
completion of ADLs (Lawson & Murphy, 2013).
Activity Observed
Joy participated in a 90-minute occupational therapy session. The occupational therapist
went into her room at their meeting time and found Joy sitting in a manual wheelchair. She first

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asked Joy about her pain level in which she reported a burning sensation in her left lower
extremity, causing her to be in pain. Then, the occupational therapist and Joy went to the therapy
gym, where Joy started the session off by pedaling her arms on the recumbent bike for 15
minutes. Next, Joy completed 100 repetitions with 10 pound weights on the Rickshaw for 30
minutes. She completed three sets of 20 repetitions with a flex bar for 15 minutes. For the next
30 minutes she completed three sets of 20 repetitions of bicep curls, horizontal chest press, and
overhead press exercises with three pound weights.
Key Observations
There were many key observations I noticed throughout the session. Joy displayed a
determined and motivated demeanor throughout the treatment session and participated in each
task the occupational therapist asked her to complete. She would display facial expressions that
indicated she was experiencing pain and towards the middle of each repetition, Joys muscles
would start to fatigue and she would take a rest break. Due to the frequency of rest breaks, Joy
was unable to complete each set. I also noticed that the occupational therapist only had her
complete activities in her wheelchair, as opposed to standing or using a front wheel walker. Due
to the painful sensation in her left lower extremity, the occupational therapist did not want to
exacerbate Joys condition, therefore she had her complete all activities seated in her manual
wheelchair.
Impacted Domains
According to the OTPF, occupations are different types of life activities, individuals,
groups, or populations engage in. They include activities of daily living, instrumental activities
of daily living, rest and sleep, education, work, play, leisure, and social participation (AOTA,
2014). Based on my observations, Joys ability to engage in occupations such as driving and
community mobility, showering, lower extremity dressing, toileting and toilet hygiene,
functional mobility, care of pets, shopping, meal preparation and cleanup, job performance,

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formal education participation, and leisure are the main domains that are significantly impacted.
This inability is due to decreased static standing balance, pain and non-weight bearing
restrictions on her left lower extremity, and a decrease in upper extremity strength, and
endurance.
Client factors such as pain, muscle power and endurance, and gait patterns have been
impacted by her surgery and weight bearing restrictions. Since her surgery, her doctor has
prescribed her to not bear any weight on her left lower extremity for eight weeks or until she is
otherwise cleared by her physician.
Her performance skills such as walking, endurance, and bending have also been affected.
These performance skills will get better with time, but are currently hindered as a result of the
surgery. Furthermore, Joy is in a recovery state and therefore has to abide to weight bearing
restrictions impacting her ability in these performance skills.
Performance patterns which include habits, routines, rituals, and roles are also impacted
by her current condition (AOTA, 2014). Joys habit of going for a jog when she feels stressed has
been impacted by her current condition. She knows that she will be unable to cope with her stress
this way and will need to find an alternative method such as meditation or mindfulness. Her daily
routine include preparing meals for her wife and herself, taking out the dogs, exercising,
commuting back and forth to her job, grocery shopping, and going to school part time in hopes
of becoming a personal trainer. She will be unable to complete these routines as independently as
she was prior to her surgery. Eventually when her pain subsides, and she regains her strength and
is able to bear weight again on both lower extremities, she will slowly reintegrate these activities
into her daily routine. Joys ritual of volunteering at a convalescent home on holidays for adults
with mental and physical disabilities, may be temporarily harder to get to because she is unable
to drive herself to this facility. She would complete this volunteering activity on special holidays
such as Thanksgiving and Christmas. She felt this was a part of her identity and reinforced values

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and beliefs she holds close to her such as giving back to the community. This holds a deep
meaning for Joy because she received services and aid when she was homeless. This is her ritual
and way of giving back, except this time, these individuals do have a home, but may not have
love and support. Joys role of being a wife, employee, and friend are affected by her inability to
fulfill the expectations of these roles.
Problem Statements
1. Patient requires minimum assistance with functional transfers due to decrease strength in
upper extremities.
2. Patient requires minimum assistance in toileting due to decrease static standing balance.
3. Patient unable to complete lower extremity dressing due to pain in bending at left hip.
4. Patient requires minimum assistance in shower transfer due to decrease strength in upper
extremities.
5. Patient requires minimum assistance in toilet transfer due to decrease balance.
These problem statements are arranged from most important to least based on Joys
priorities, diagnosis, and the setting she is in. Individuals in IRF typically begin occupational
therapy one to three days post-surgery and when they are prepared to start getting out of bed
(Lawson & Murphy, 2013). Joy has expressed fear in falling while transferring from her bed to
wheelchair. This fear has caused her to soil her sheets and thereafter has caused her to feel
dependent on others. Although her life partner has agreed to take care of her, there may be
instances where she will be left alone at home and will need to perform the transfer
independently. Becoming more independent in transferring will ensure safety, decrease risk of
falls, and eventually increase self-efficacy in ability to complete transfers. This is important to
address as the first problem statement because gaining independence in transferring will ensure
access to completion of ADLs in a safe and effective manner. According to a study by
researchers Magaziner et al. (2000), recovery in chair rising speed (which entails strength)
precedes recovery in walking speed; both of these functional limitations plateau before the
ability to walk independently reaches its peak (p.7). Although Joy wants to be independent in

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walking, she will initially need to work on being able to rise and transfer from one surface to
another such as bed to wheelchair, and in doing so building the appropriate strength. Eventually,
the therapist can slowly incorporate ambulation techniques from this transfer. Occupational
therapy interventions in an IRF focus on educating patients on compensatory strategies for
dressing, toileting, functional mobility, bathing, feeding, personal care, and participating in
sexual activity (Vaughn, 2014). Toileting and dressing are activities that will be addressed in the
IRF and are imperative skills to master prior to discharge. Joy has also expressed the importance
of regaining her ability to be independent in toileting and dressing as she was prior to her
surgery. She is unsatisfied with the time it takes her each morning to complete toileting. Shower
transferring and toileting transferring are important to address to avoid falls and secondary
complications. Some of these transfer techniques will be addressed when the occupational
therapist addresses transferring from the bed to wheelchair. The therapist will inevitably work on
strengthening the same muscle groups in fostering these transfer techniques.
Intervention Plan and Outcomes
Long-term goal #1
Patient will perform functional transfers with modified independence within two weeks.
Short-term goal #1
Patient will perform edge of bed to wheelchair and wheelchair to edge of bed transfer while
adhering to weight bearing restrictions with supervision within one week.
A loss of strength or decrease in strength has been associated with a decline in functional
performance (Orr, Raymond, & Singh, 2008). Occupational therapists begin to facilitate
remediation of the muscles and joints surrounding the site through strengthening exercises and
movement (Vaughn, 2014). Joy does not have enough arm strength to complete transfers
independently. In order to address her decrease in strength, Joy will participate in progressive
resistance training (PRT) exercises. PRT include strength training exercises with progressive
overload where muscles exert a force against an external load or contract isometrically (Orr et

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al., 2008, p. 319). Research has shown that PRT not only promotes strengthening muscles, it may
also improve body composition, blood pressure, metabolic health, blood pressure, cognition, and
sleep and reaction time (Orr et al., 2008). Joy will utilize a variety of equipment such as elastic
bands, Rickshaw, and free weights. She will complete three sets of 15 repetitions with various
weights. These exercises will be completed in her wheelchair to strengthen muscles in her arms
and shoulders necessary for propulsion and transferring. After completing these prepatory
exercises, Joy can practice a purposeful strengthening activity: wheelchair pushups. Wheelchair
pushups require Joy to lift herself using the arm rests of the wheelchair. She will complete this
activity seated in her wheelchair with the wheels locked. Once she is up in the wheelchair, she
will extend her arms and lock her elbows holding this position for 15 seconds, then sit back
down. This act of wheelchair pushups is a component of completing wheelchair to edge of bed
transfer. During the transfer, the patient will need to utilize upper extremity strength to transfer
themselves safely and efficiently. This occupation based intervention will also assist in relieving
pressure soars from sitting in a wheelchair for a long period of time. This intervention will
restore a sense of independence because by allowing her to independently initiate and complete
transfer from edge of bed to wheelchair and vice versa. From there, she will then be able to
complete other ADLs such as grooming and getting dressed. According to the OTPF, the most
appropriate intervention approach for this intervention is the restoration approach (AOTA, 2014).
Joy was in the acute care facility recovering from her surgery for nine days. During her time
there, she barely got out of bed because of the pain she was experiencing. Her sedentary state
contributed to her decrease in strength. Implementing the restore intervention approach, will help
restore her upper extremity muscle strength to become more independent in functional transfers.
According to the OTPF, the outcome is the culmination of the occupational therapy process, and

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for Joy, the most appropriate outcome is improvement (AOTA, 2014). Through this intervention
she will achieve an increase in occupational performance, specifically functional mobility.
Short-term goal #2
Patient will perform stand pivot transfer from wheelchair to car with supervision within one
week.
Transferring from a wheelchair to another surface such as a toilet, bed, or car is a
necessary component in completing daily routines, especially for Joy (Arva, Schmeler, Lange,
Lipka, & Rosen, 2009). Joys demonstration in her ability to transfer from wheelchair to
passenger seat of a car with supervision, will allow her to meet her personal goal of going back
to work, and will also create a sense of autonomy. The intervention will focus on education in
positioning and techniques in completing the stand pivot transfer effectively. The occupational
therapist will first demonstrate proper positioning and completion of the transfer. After the
demonstration, the occupational therapist will first ask Joy to verbalize the technique back to the
occupational therapist then to her life partner. Then she will demonstrate the transfer utilizing her
life partners car which is a white Nissan Altima in the IRF parking lot. In order to retain this
information long term and to transfer it to an out of rehab context, teaching this information to
others known as the teach back method, will facilitate with this acquisition process. According to
researcher Tamura-Lis (2013), this evidence based approach asks patients to repeat in their own
words what they have learned and need to know prior to discharge using a non-shaming
approach. It is an opportunity to check for client understanding, and if necessary re-teaching
pertinent information. This approach has been shown to be effective in all health care settings,
and further optimizes patient learning, comprehension, and satisfaction. Teach-back method
promotes health care literacy and promotes enhanced communication skills between patient and
health care provider (Tamura-Lis, 2013).

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A stand pivot transfer requires a client to be able to come to a standing position and pivot
on one or both feet. This technique is utilized with patients who experience a general loss of
strength and balance which is evident is Joys case. This technique will allow Joy to observe
weight bearing precautions by encouraging the less affected lower extremity to accommodate
most of the body weight while pivoting to the car. These techniques including scooting to the
edge of wheelchair, placing feet flat on the floor, heels pointed towards the surface they are
transferring to, leaning forward pushing off arm rests, pivoting on unaffected limb until she can
feel the seat against the back of her legs, and slowly lowering herself onto the seat while holding
onto the dashboard (Bolding, Adler, Tipton-Burton, Verran, & Lillie, 2013). The wheelchair
should be positioned at a 30 degree angle and locked prior to transfer. The most appropriate
intervention approach for this goal is the establish approach (AOTA, 2014). Since Joy has never
had to transfer from a wheelchair to a car, this is a skill she has not yet developed. The outcome
and end result of this occupational therapy process is improvement in occupational performance
(AOTA, 2014). This outcome will increase Joys functional mobility. In doing so, she will be
able to get into the passenger seat of a car to further facilitate engagement in occupations.
Long-term goal #2
Patient will prepare a five-step meal with front wheel walker in rehab kitchen with modified
independence within two weeks.
Short-term goal #1
Patient will make a smoothie in rehab kitchen with supervision with front wheel walker within
one week.
Physical therapy is currently working with Joy on ambulating with a front wheel walker.
Occupational therapists will take this one step further and incorporate activities of daily living
while utilizing a front wheel walker. In order to address her deficit in static standing balance, she
will engage in an occupation as a means activity of potting plants while standing with a front
wheel walker in the therapy gym. This activity can be graded down by having Joy sit in

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wheelchair while completing the activity and can be graded up by providing distractions, or
utilizing a longer and wider pot. Utilizing a longer and wider pot requires more endurance and
activity tolerance while adding more steps to complete the activity. Occupation as a means
refers to use of therapeutic occupation as the treatment modality to advance someone toward an
occupational outcome (Gray, 1998). Potting plants while standing works on the same
underlying skills and abilities, such as dynamic standing, while engaging in an activity that is
meaningful to the patient. Using occupation as a means can be a valuable tool in an individuals
recovery because it can supplement, enhance, or act as a catalyst for healing of the body (Gray,
1998). Utilizing occupations in therapy to address performance is supported by current motor
learning research. This research supports the use of practicing skills with variety in a more
naturalistic context (Gray, 1998). The most appropriate intervention approach for this goal is the
restoration approach (AOTA, 2014). Since her ability to complete tasks while standing has
decreased due to non-weight bearing restrictions on her left lower extremity, these interventions
will aide in restoring this ability. The outcome of this intervention will be improvement in
occupational performance, specifically meal preparation (AOTA, 2014).
Short term goal #2
Patient will mix baking ingredients in bowl with supervision in ADL kitchen using front wheel
walker within one week.
Balance is the ability to maintain a center of gravity and control posture appropriately
during various activities (Cho, Lee, & Song, 2012). Balance can be classified as either dynamic
or static. Static balance is the ability to stand still on a stationary floor. Static standing facilitates
an individuals ability to engage in ADLs (Hamby, 2011). In order to facilitate static standing
balance, the occupational therapist will have Joy engage in a virtual reality balance training
activity utilizing a balance board game system (Wii Fit balance board) while utilizing her front
wheel walker. The Wii Fit balance has a variety of games that incorporate various sport options.

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Since Joy enjoys playing soccer, she will participate in the virtual reality game of soccer heading.
Various studies have proven the effectiveness of virtual reality gaming in improving static and
dynamic balance among many populations including hip fractures (Giotakos, Tsirgogianni, &
Tarnanas, 2007). Results from a randomized control study utilizing the Wii Fit virtual reality
gaming system displayed improved balance and postural stability in addition to improved
confidence with functional activities (Rendon et al., 2011). The most appropriate intervention
approach for this goal is the restoration approach (AOTA, 2014). Since Joy is on non-weight
bearing restrictions on her left lower extremity, this has caused her sway during static balance to
increase. By implementing this intervention, she will be able to restore her ability to maintain
static standing balance while engaging in occupations such as cooking and toileting. The
outcome of this intervention will be improvement in occupational performance (AOTA, 2014).
By restoring her ability to engage in static standing balance she will be able to ultimately address
her concerns in completing toileting activities.
Precautions and Contraindications
Typically when patients undergo an ORIF, weight-bearing restrictions are prescribed as a
precaution to protect the surgical site from excessive forces. Joys surgeon has put Joy on nonweight bearing restrictions on her left lower extremity for eight weeks. Contraindications to
engaging in therapy include deep vein thrombosis which could lead to a pulmonary embolism.
Deep vein thrombosis is a common manifestation in patients undergoing surgery for hip
fractures, especially when it is coupled with immobility associated with severe pain. This
complication can increase rehabilitation time and may increase mortality rates (Lieberman &
Lieberman, 2002). The treating physician will typically have a hold order on the patient in this
case, until further notice. Typically, anticoagulants and anti-embolism stockings are administered
to control this phenomenon from worsening or even occurring in the first place.
Frequency and Duration of Intervention Plan

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Typically, patients who undergo an ORIF, will receive the surgery in an acute care setting
and transfer to an IRF when medically stable and able to tolerate three hours of therapy a day.
Often these patients will reside in the IRF for two weeks and receive occupational therapy for 90
minutes and physical therapy for 90 minutes five times a week. Joys short term goals are set to
be achieved in one week whereas her long-term goals are set to be achieved in two weeks prior
to her discharge. In this interdisciplinary setting, communication amongst the healthcare team is
vital in order to discuss each patients ongoing process, and discharge plans in coordinating
individual intervention programs (Lawson & Murphy, 2013).
Primary Framework
The primary framework utilized for this intervention plan is the person-environmentoccupation-performance (PEOP) model. The PEOP is a holistic, client-centered, top-down
ecological model utilized with various populations. In this model the person includes values and
interests that are important, meaningful, and enjoyable to the individual (Brown, 2014). With this
being said, one of Joys interests include playing soccer, thus her interventions implemented this
interest and allowed her to engage in a virtual reality game of soccer heading. The environment
which includes physical, social, and cultural components was also considered in this
intervention. When practicing wheelchair to car transfers, the natural environment (i.e. parking
lot) was utilized versus a simulated car in a therapy gym. Occupations which are goal directed
meaningful pursuits that typically extend over time were addressed in Joys intervention plan
(Brown, 2014). She will engage in activities and tasks in her intervention that will lead to
accomplishing her short term goals and eventually her long term goals, which are occupation
based. Occupational performance is the product that is associated with the convergence of the
person, environment, and occupational components of the model. Joys occupational
performance in functional mobility and meal preparation was achieved through her interventions

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to meet her goals. Although aspects of the biomechanical frame of reference were utilized
throughout one intervention, but ultimately more weight was focused on restoring functional
skills and occupational performance.
Client/Caregiving Training and Education
Common caregiver concerns include feeling overwhelmed and lethargic by the demands
placed on caregivers, frustration with lack of communication between health care providers in
different stages of recovery(i.e. acute care to inpatient rehab), and access to more information
and resources on the patients condition (Vaughn, 2014). According to a study by Cummings et
al. (1998), patients who sustained a hip fracture and had a greater number of social supports were
more likely to have a complete recovery in their prior level of function. Therefore, engaging
family and caregivers on the importance of this factor is a vital component to patient recovery.
During each occupational therapy session, a family member, caregiver, or friend should be
present so any questions they have can be answered. During the session, the occupational
therapist will also educate on appropriate supervision recommendations and instruction
pertaining to activity precautions (Lawson & Murphy, 2013). Instructional booklets and handouts
may also be provided to address any additional questions or concerns.
Progress of Goals
The patients response to the intervention will be monitored and assessed towards the
progress of goals through daily observations. A formal assessment such as the Functional
Independence Measure (FIM) will be utilized to track the functional progress in ADLs and
IADLs. A patients self-report in satisfaction with improvement towards goals is an informal
assessment that can also be utilized. In addition, the time it takes to complete an activity can
display progression of goals. In Joys case, not soiling her sheets and completing toileting while
adhering to weight bearing restrictions in a timely manner indicates progression towards her
goals.
References

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American Occupational Therapy Association. (2014). Occupational Therapy Practice

Framework: Domain and process, (3rd ed). American Journal of Occupational Therapy,
68 (Suppl.1). http://dx.doi.org/10.5014/ajot.2014.682006
Arva, J., Schmeler, M. R., Lange, M. L., Lipka, D. D., & Rosen, L. E. (2009). RESNA position
on the application of seat-elevating devices for wheelchair users. Assistive
Technology, 21(2), 69-72. doi: 10.1080/10400430902945587
Bolding, D., Adler, C., Tipton-Burton, M., Verran, A., & Lillie, S. M. (2013). Mobility. In H.
McHugh Pendleton & W. Schultz-Krohn (Eds.), Pedrettis Occupational Therapy:
Practice Skills for Physical Dysfunction (7th ed. pp. 233-294). St. Louis, MO: Mosby
Elsevier.
Brown, C. E. (2014). Ecological models in occupational therapy. In B. A. B Schell, G. Gillen, &
M. E. Scaffa (Eds). Willard & Spackmans occupational therapy (12th ed., pp.494-504).
Philadelphia: Lippincott Williams & Wilkins.
Cho, K. H., Lee, K. J., & Song, C. H. (2012). Virtual-reality balance training with a video-game
system improves dynamic balance in chronic stroke patients. The Tohoku journal of
experimental medicine, 228(1), 69-74. doi: 10.1620/tjem.228.69
Cummings, S. R., Phillips, S. L., Wheat, M. E., Black, D., Goosby, E., Wlodarczyk, D., ... &
Hulley, S. B. (1988). Recovery of function after hip fracture the role of social
supports. Journal of the American Geriatrics Society,36(9), 801-806. doi: 10.1111/j.15325415.1988.tb04263.x
Giotakos, O., Tsirgogianni, K., & Tarnanas, I. (2007). A virtual reality exposure therapy (VRET)
scenario for the reduction of fear of falling and balance rehabilitation training of elder
adults with hip fracture history. In Virtual Rehabilitation, 2007, 155-158. doi:
10.1109/ICVR.2007.4362157

INTERVENTION PLAN

19

Gray, J. M. (1998). Putting occupation into practice: Occupation as ends, occupation as

means. American Journal of Occupational Therapy, 52(5), 354-364. doi:
10.5014/ajot.52.5.354
Hamby, J. R. (2011). The nervous system. In Smith-Gabai, H. (Ed.), Occupational therapy in
acute care (pp. 183-298). Bethesda, MD: AOTA press.
Lawson, S., & Murphy, L. F. (2013). Hip fractures and lower extremity joint replacement. In H.
McHugh Pendleton & W. Schultz-Krohn (Eds.), Pedrettis Occupational Therapy:
Practice Skills for Physical Dysfunction (7th ed. pp. 1074-1089). St. Louis, MO: Mosby
Elsevier.
Lieberman, D. V., & Lieberman, D. (2002). Proximal deep vein thrombosis after hip fracture
surgery in elderly patients despite thromboprophylaxis. American journal of physical
medicine & rehabilitation, 81(10), 745-750. doi: 10.2060-200210000-00005
Magaziner, J., Hawkes, W., Hebel, J. R., Zimmerman, S. I., Fox, K. M., Dolan, M., ... &
Kenzora, J. (2000). Recovery from hip fracture in eight areas of function. The Journals of
Gerontology Series A: Biological Sciences and Medical Sciences, 55(9), M498-M507.
doi: 10.1093/gerona/55.9.M498
Orr, R., Raymond, J., & Singh, M. F. (2008). Efficacy of progressive resistance training on
balance performance in older adults. Sports Medicine, 38(4), 317-343. doi:
10.2165/00007256-200838040-00004
Rendon, A. A., Lohman, E. B., Thorpe, D., Johnson, E. G., Medina, E., & Bradley, B. (2012).
The effect of virtual reality gaming on dynamic balance in older adults. Age and
ageing, 41(4), 549-552. doi: 10.1093/ageing/afs053
Schultz-Krohn, W., Pendleton, H. M. (2013). Application of the occupational therapy practice
framework to physical dysfunction. In H. McHugh Pendleton & W. Schultz-Krohn (Eds.),
Pedrettis occupational therapy: Practice skills for physical dysfunction (7th ed. pp. 2854). St. Louis, MO: Mosby Elsevier.

INTERVENTION PLAN

20

Tamura-Lis, W. (2013). Teach-back for quality education and patient safety. Urologic
nursing, 33(6), 267. doi: 10.7257/1053-816X.2013.33.6.267
Vaughn, P. (2014). Appendix I: Common conditions, resources, and evidence: orthopedic
conditions. In Boyt Schell, B. A., Gillen, G., Scaffa, M. E. (Eds.). Willard & Spackmans
Occupational Therapy (12th ed.). Philadelphia, PA: Lippincott Williams & Wilkins