Date implemented:

Client’s Initials and Age: E.S., 78 y.o. Time allotted for session: 30 min
9/19/18
Diagnosis and any Precautions: (1) Heart failure and pulmonary edema (admitted to hospital because of SOB,
rapid weight gain, and increased leg edema); Fall risk
Goal/s being addressed: (1) Pt will demo good dynamic standing/sitting balance in order to increase I’nce w/ADLs such as dressing, bathing,
and grooming.; Pt will demo increased endurance through completion of daily self-care routine w/ mod I for use of adaptive technique, time,
and/or equipment.; Pt will demo UE ROM WFL I’ly and will be able to follow multi-step instructions w/o more than 1 verbal cue.
Activity Demands (setting,
Specific Objectives for this materials, and social Modifications (provided during the
Intervention Activities
activity (list 2-3) requirements) activity and planned for next
(5)
(5) (5) session) (5)

Materials: Sticky notes and a

1. Pt will I’ly perform R&L
shoulder AROM to reach sticky
Pt will sit upright and remove 2
notes behind back w/o losing
sticky notes (5x/hand) from his
sitting balance.
lower back to address shoulder
extension and internal rotation
2. Pt will engage in activity w/ no
needed to pull down a shirt in
more than 1 rest break.
order to increase I’nce in UE
dressing.
3. Pt will I’ly follow multi-step
3-4 minutes
instructions for the activity w/ no
more than 1 verbal cue.
chair to sit on.
Environment: 2 sticky notes will
be placed on hospital gown at
the lower back. Pt will sit upright
in chair with feet flat on the
ground. Make sure there are no
pillows or blankets on the chair
that will block the UE ROM.
Grade up: Perform this activity
while standing to work on
dynamic and static standing
balance.
Grade down: Only have one
sticky note behind the back,
rather than two, and/ or
decrease the number of reps per
hand.
He performed this activity in his chair,
which went well because he was able to
sit upright with his feet flat on the
ground. This task provided a just right
challenge for this pt, however what did
not go well was finding a good place to
put the sticky notes as the hospital
gown needed to be readjusted to avoid
trying to stick them directly onto his
skin. During the session, the two sticky
notes lost their stickiness, so I had to
replace them with fresh sticky notes two
different times. Next time I will try this
activity with stickers rather than sticky
notes so that they are able to stay on
and not fall off right away.

Materials: hospital socks, chair This activity went smoother than I

1. Pt will I’ly perform UE AROM to sit on, and optional sock aid thought it would. I thought the pt would
Pt will don and doff socks
necessary to reach over and and reacher. have a more difficult time reaching his
(3x/foot) while sitting upright to
touch ankles. Environment: Space around feet due to leg edema. However, pt was
address dynamic sitting balance
chair decluttered, sock aid and fairly flexible while sitting in his chair
needed to increase I’nce in LE
2. Pt will maintain dynamic reacher within reach if needed. and was able to reach down and doff
dressing.
sitting balance w/o assistance his socks without much challenge.
4 minutes
during activity. Grade up: Increase number of However, donning his socks proved to
reps to work on activity be more difficult than expected because
tolerance. the leg edema made it impossible for
 Grade down: Use of sock aid to
don socks and/or use of reacher
to doff socks.
him to cross his foot onto the opposite
leg to don the sock. After realizing that
this was too challenging, I modified the
activity by having him use a sock aid to
don socks. Next time I might have him
start with the sock aid so he doesn’t
become frustrated or discouraged right
off the bat.

Materials: pen, and chair to sit

on.
Environment: therapist stands to This activity went well. At first the height
either side of pt and holds pen and distance of the pen was way too
up and out to the side. Make easy for the pt. I modified the height and
sure chair is secure and locked held the pen even farther out to the side
Pt will reach up and cross
1. Pt will maintain the same, and that pt is safe. which increased the challenge. Pt was
midline with contralateral hand
starting speed for at least 50% engaged in the activity because I was
to grab pen from therapist
of the time. Grade up: Increasing the height continually changing height and distance
(3x/hand) in order to target
that the pen is held at and/or of the pen to keep him interested and
shoulder flexion and adduction
2. Pt will maintain or increase have it further outside the pt’s active in the task. What didn’t go well
needed to remove items from
degrees of shoulder AROM used center of gravity. Could also was that since he was sitting in a chair
tall cabinets or hanging items in
in first reach and grab of the have the pt standing rather than with arms he started to compensate by
closets.
activity. sitting during this activity. leaning on to those arms instead of
2-3 minutes
Grade down: lowering the height practicing his core strength and balance.
that the pen is held at and/or Next time, I would like the have the pt
having them use the ipsilateral stand with his walker to better simulate
hand to reach the pen rather the environment of reaching or a cabinet
than the contralateral which or hanging clothes in the closet.
requires them to cross midline.

1. Pt will complete multiple steps Materials: wash cloth, soap,

of face washing in the correct
order w/ no more than 1 verbal
Pt will stand at sink side for
cue.
completion of face washing with
set up to target increased I’nce
2. Pt will I’ly perform dynamic
in daily grooming routine.
reaching movements forward,
5 minutes
across and to the side of the
body in order to accomplish
activity.
walker, gait belt
Environment: set up foam soap
and wash cloth next to the sink
and make sure the path is clear
and declutter the area around
the sink. Have walker ready and
set in place in front of the pt
before they start to ambulate to
the sink.
Due to extra time needed in other
activities, there was not enough time to
complete this intervention with the pt.
Next time I think I will start with this
intervention after the warm activity so
that he is able to directly practice
completing his ADLs.

Pt will march in place for 20sec,
30 sec, and then 40 sec, for a
total of 2x through complete set
(w/10 sec rest in between each
of the 3 marching periods and
an optional 1min break between
1st x and 2nd x through complete
set) in order to address dynamic
standing balance and hip flexion
needed to increase I’nce for
stepping into a tub.
4-6 minutes
S/OT name: Maddie Collins
Find one peer-reviewed article that supports the intervention you planned/provided. At the bottom of your plan, paste the abstract and
citation and then in your own words describe how this supports your intervention plan. (5)
Grade up: Have pt retrieve a
clean cloth and soap from
cabinet above sink before
beginning face washing routine.
Grade down: Having the pt sit at
EOB or in chair and provide
them with dry soap and a warm
wash cloth to wash their face
without having to stand sink
side.
Materials: walker, gait belt, chair
or bed to rest on between the 2
sets.
Environment: make sure gait
belt is on pt and that there is a
surface they can sit down on This seemed easy for him for the first
behind them if they need to rest 20 second period, but then by the first
(EOB or a chair). Walker should 40 second period he had significantly
be directly in front of pt and the slowed down and decreased the
1. Pt will maintain dynamic
floor should be clear of clutter amount he raised his feet off the floor.
standing balance during activity
and tubes/wires. During the session I had to change the
with Mod I for use of a walker as
amount of time he was marching so that
extra support.
Grade up: Increasing the he could actually practice raising his
periods of marching and/or LEs to the correct height to clear a tub.
2. Pt will tolerate activity for 1st
decreasing the resting periods Next time I would start out with 3 reps of
time through complete set w/o
between the 3 marching periods 20 second marching with 10 second
needing to sit down.
in a set. Can also increase the breaks in between for the first set. Then
total number of times going for the second set I would still have it be
through a set from 2 to 3. 3 reps of 20 second marching but this
Grade down: Decreasing the time there would only be 5 second
periods of marching and/or breaks in between.
increasing the resting periods
between the 3 marching periods
in a set. Can go through entire
set just once, rather than twice.
Wolf, T. J., Chuh, A., Floyd, T., McInnis, K., & Williams, E. (2015). Effectiveness of Occupation-Based Interventions to Improve Areas of Occupation
and Social Participation After Stroke: An Evidence-Based Review. The American Journal of Occupational Therapy, 69(1), 6901180060p1
6901180060p11. http://doi.org/10.5014/ajot.2015.012195

Abstract:

This evidence-based review examined the evidence supporting the use of occupation-based interventions to improve areas of occupation and social
participation poststroke. A total of 39 studies met the inclusion criteria and were critically evaluated. Most of the literature targeted activity of daily
living (ADL)–based interventions and collectively provided strong evidence for the use of occupation-based interventions to improve ADL
performance. The evidence related to instrumental ADLs was much more disparate, with limited evidence to support the use of virtual reality
interventions and emerging evidence to support driver education programs to improve occupational performance poststroke. Only 6 studies
addressed leisure, social participation, or rest and sleep, with sufficient evidence to support only leisure-based interventions. The implications of this
review for research, education, and practice in occupational therapy are also discussed.

This article supports my intervention plan because it reviews several studies indicating the benefit of using occupation-based interventions to
improve ADL performance. Prior to his hospitalization, my pt was a community dwelling older adult who was independent in all ADL activities.
Having him practice these activities of daily living that he used to engage in independently, such as washing his face, will improve his ADL
performance when he returns home. While performing actual ADLs in acute care is often difficult, I made sure that my intervention activities mocked
specific aspects on an ADL activity so that my pt will increase his I’nce in ADL performance. For example, while he did not have a shirt available to
practice putting on, the sticky note activity simulated the exact movements he’ll need to complete to pull down a shirt behind his back.

Total: 27 points