INTERVENTION PLAN FOR COMMUNITY CLIENT

Copy/paste one LTG and the matching STG from your evaluation SOAP note. This will be the goal set around which you design your treatment session.

Long-Term Goal: By discharge, client will IND tie his shoelaces using compensatory strategies.

Short-Term Goal: Within 2 weeks, client will IND maintain grasp on shoelace with L. hand while manipulating other

laces through multiple steps with R hand.

What went well with your treatment? Did things go as you planned or not? Explain. What will you do differently
with this next treatment plan?

The past week treatment session went well. Neesha was quick on her feet and made adjustments as needed. Client wanted to
do things which varied from what Neesha had prepared. Neesha wanted to use a stool to limit the clients need to reach as far
but he wanted to practice shoe tying in the most natural environment as possible. So they removed the stool which made the
task a lot more difficult for the client. For this next session I am making a cognizant effort to replicate the clients natural
environment as possible. Client has a particular way he wants his laces too look when tied so I am keeping that in mind as
well. He wants his laces to have two loops and a single knot, so they are easier to take off when needed. If there is a double
knot present he has a difficult time untying his shoes.

OCCUPATIONAL OPM and CPM TREATMENT SESSION GRADING THE ACTIVITY

PERFORMANCE PROBLEM
Specifically identify only the client
factors and/or performance skills
that are barriers to the achievement
of this goal. This should not be a
bullet list, rather you should
describe how the client factor
impacts this client’s performance
of the occupation in the goal.
AND RATIONALE
Identify your OPM and all relevant
CPM’s that best addresses the
performance problem and describe
how each will be used to design
treatment for this client’s specific
problems.
DESCRIPTION
Provide details of how you will set
up the activity and how your
intervention addresses the
performance problem. Your
description should detail how the
activity will be set up to make it
therapeutic.
Choose one client factor or
performance skill that you address
in your treatment session. Describe
one way (only one) that you can
grade the activity up and one way
(only one) to grade the activity
down based on that one factor or
skill.
Factor/Skill:

Client has a strong grip and pinch, PEO: Occupational performance is For this treatment session we are
but movements are ataxic. impacted by the congruency going to work on shoe tying Grade Down: Place shoes in clients
Decreased proprioceptive and between the person, the techniques and adapt them to lap providing more available range
touch sensation impact the client’s environment, and the occupation. incorporate his left hand when to manipulate laces.
 ability to receive feedback and
manipulate objects, when he
cannot compensate with vision.
High tone limits functional
movement within client’s L UE.
Client has demonstrated ability to
fully flex and extend fingers but
does not have fine motor control.
Client’s gross motor function is
also impacted by high tone. Client
has restricted shoulder movement:
internal rotation can move about
70 degrees, abduction about 80
degrees, and flexion about 150
degrees of his shoulder. Client is
able to fully pronate but lacks the
ability to supinate past midline.
Elbow flexion is restricted by
about 20 degrees.
Client compensates for lack of
proprioception and light touch
with vision. Once he takes his
vision off the object he is
manipulating he tends to release
his pincer grasp.
Understanding the client’s priorities
will help maintain a client centered
approach. It is important to
understand the connection between
the clients desired occupations and
the influence the environment has
on his occupational performance.
Understanding the activity demands
of donning a shirt with fasteners
and how the clients motor and
sensory needs are impacted by
those demands will be essential.
Due to the prognosis and time
frame post CVA we will primarily
investigate ways in which
compensatory strategies can be
utilized to meet the activity
demands in increase occupational
performance.
REHAB: This model promotes the
use of compensatory strategies or
equipment to modify the demands
of the activity to help facilitate
occupational performance. We will
use a clip to help keep the laces in
place so he can use his vision on
other steps of the task to
compensate for the lack of
proprioception and light touch.
MOTOR CONTROL: Whereas the
client suffered a R. CVA the use of
high repetitions to help restructure
and establish neural connections.
High repetitions of tying his shoes
will help develop motor control
needed to ensure occupational
performance.
possible to tighten the laces. When a
pincer grasp is needed using the left Grade Up: Have client in seated
hand we are going to stop and focus position requiring extended reach
on just pinching with the left and with his LUE to pinch the laces.
continuing the shoe tying process
with the right hand and not letting
the laces slip with the left. We will
do this over and over again with the
reminder of verbal cues and
potentially HOH assistance. If that is
too difficult and the client is unable
perform the task to his desired level
of quality, I am going to supplement
the required pincer grasp with a clip
to help maintain the laces in place.
We will practice going through the
shoe tying process multiple times.
In our initial evaluation we did not
assess the LE. I want to see if the
client will be able to place his leg on
his opposite knee while in a seated
position to eliminate the need to
reach to the floor while tying his
shoes.
I also want to verify if he can tie his
shoes reasonably tight while they are
off his foot and on his lap. He will
then place the shoe onto the foot
with the laces pre-tied. This also will
reduce the demands of reaching to
the floor which is an effortful
movement for the client.
If previous noted strategies do not
work I will resort to trying to tie the
laces with the non paretic hand only.
I would prefer to use the left hand as
much as possible, but we can resort
to this style if the client has a “just
 get it done preference”

To finish the session I will advise to

client to tie his shoes each day
whenever possible and not resort to
having his personal aide tie them.