Running Head: OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile and Intervention Plan

Brianna Pupp
Touro University Nevada

OCCUPATIONAL PROFILE AND INTERVENTION PLAN

Occupational Profile
The Client
The client, BW, is a 79 year old male with a transfemoral amputation of his right leg and
a right shoulder with limited range of motion (ROM) and flexibility due to multiple infections
from a 2007 failed prosthesis. His medical history includes diagnoses of rheumatoid arthritis
(RA) in his hands, peripheral neuropathy, and boutonniere deformity of both thumbs. BW
complains of edema in his left hand carpometacarpal and proximal interphalangeal joints. In
2001 he had a right total hip arthroplasty without complication and healed well.
BW lives in a first floor two bedroom apartment with a ramp to the front door for his
electric wheelchair. He lives with his wife in the Seven Hills area of Las Vegas, Nevada and has
three children and seven grandchildren. Two of his children live out of state, while the third lives
in the area. However, the one in Nevada has three children of her own and a busy schedule of
family activities keeps them from visiting. BW and his wife are homebound due to his inability
to drive because he must pass the Nevada driver license exam first. His wife is a nervous driver
and avoids it when possible. BW stated he would like to pass the exam his first try so he can
rejoin the community, visit friends and family, take advantage of the attractions, and take his
wife out for a night on the town. BW feels he is the main cause of their isolation.
While at home, BWs wife is his main caregiver. Just diagnosed with breast cancer, she
will be starting her own course of treatment. The client tries to assist with household chores, light
cooking, and financial management tasks, as well as completing his activities of daily living
(ADLs) as independently as possible. The client has few hobbies. He does crossword puzzles or
word searches and watches a lot of television. BW explained he misses the leisure activities and
social life that he and his wife used to have prior to his amputation.

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Reasons for Seeking Services

BWs right transfemoral amputation surgery was in Long Beach, California and he
completed driving rehabilitation there as well. The client received training in adapted driving for
a total of two weeks, five days a week for two hours each day. He received his certification to
drive once driving therapy was completed, however, this only approves his ability to drive in
California using adaptive equipment. BW was taught how to drive an adapted four door sedan
with right angle hand controls set up on his left side and a plain spinner knob. Once home and
after receipt of his adapted vehicle, he spoke with the Office of Veterans Services about
receiving training in his new vehicle as it was totally different from the sedan. The Office of
Veterans Services approved services with a driver rehabilitation specialist (DRS).
BWs vehicle is a new 2015 Dodge Grand Caravan with a Summit electric fold out ramp
and floor mounted Carospeed Menox hand control system on his right side. The Carospeed
Menox hand control system moves the accelerator and brake pedals by pulling for gas and
pushing for brake using a toggle switch and is ergonomically designed to conform to a persons
natural hand-wrist-arm motion (Carospeed Menox, 2015). His van also is equipped with a
Guidosimplex stick steer spinner knob that has nine buttons to control 11 secondary vehicle
functions such as the windshield wipers, turn signals, and headlights (Guidosimplex USA, 2015).
The client wants to adapt the van to his specific needs as he has driven on his own and realized
his difficulty with physically driving as well as operation of the different controls within. The
client is concerned with his inability to move his right shoulder through complete ROM as well
as his inability to check his blind spots due to decreased ROM and flexibility of his cervical
spine. The client also noticed he leans left to try and balance his weight due to his amputation.
This causes fatigue in his right upper extremity as he is unable to set his arm on the arm rest of

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his electric wheelchair while using the hand control system. BWs RA and boutonniere
deformity of both thumbs also decreases his ability to use the toggle switch on the hand control
system and the buttons on the spinner knob attached to his steering wheel.
Client Concerns in terms of Engagement
BWs main focus is on regaining his ability to drive legally within the state of Nevada
using his adapted van. As his wife was just diagnosed with cancer and is a very nervous driver,
the client wishes to return to driving so he can drive them to and from the hospital once her
course of chemotherapy and radiation begins. He does not want to count on public transit or
other transportation services as they are not always reliable. Driving will enable the client and his
wife to remain independent allowing them to age in place for a longer period of time.
Successful Occupations and Barriers to Success
Currently the client feels successful when it comes to ADLs and is able to complete them
relatively independently. When describing what a typical day entails, BW was able to describe
what he can complete without the help of his wife. The client is able to transfer to and from his
manual wheelchair to different furniture items such as his bed, the tub transfer bench, and his
electric wheelchair. Using his manual wheelchair, BW wheels himself around the back of his
apartment that includes his bedroom, bathroom, and his office. After getting out of bed, BW uses
the restroom and completes toileting. While he admits transferring to his standard toilet is not the
easiest, he is able to with the addition of the side grab bar on the wall. After using the facilities,
BW can successfully pick out appropriate clothing for the day as well as activities he may have
planned. He can dress his upper extremities by putting in his right arm first, followed by his left,
but uses a dressing stick to don his pants or shorts on his lower extremities while sitting edge of
bed. BW also uses the dressing stick to properly align his left shoe before using a long handled

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shoe horn to slip it on his foot. Some days after picking out his clothing, he transitions to the
bathroom and shower independently using adaptive equipment like a long handled sponge and a
handheld showerhead. BW can setup the necessary supplies as well as transfer to and from the
shower using a tub transfer bench. However, he admits he may forget an occasional item and will
call for his wife rather than transfer back to his manual wheelchair to retrieve the item. After
completion of his shower, BW is able to successfully complete personal grooming tasks such as
combing his hair, brushing his teeth, and applying deodorant.
One barrier encountered at home, is BWs inability to easily use his electric wheelchair
throughout the entire apartment, such as his bedroom and bathroom, but also the kitchen area. To
access the kitchen, BW finds it easier to utilize his manual wheelchair, but this creates a
discrepancy between his height and the counters/appliances. While he can heat up simple meals
in the microwave, he is unable to cook meals on the stove due to inability to see and reach the
back burners safely. Another barrier to client engagement is his inability to easily access the
community due to his lack of a driver license. The client misses driving and the independence
allowed an individual and realizes he needs multiple sessions to practice driving. BW stated he is
frustrated as he is certified to drive in California, but will not be in Nevada until he passes the
driving exam and he finds the whole process time consuming and full of red tape.
Supportive and Inhibitive Aspects of Environments or Contexts
The main supporting factors in BWs life and environment are his wife and their
relationship, his first floor apartment with its open floor plan in the living room, dining room,
and kitchen area, his adapted vehicle, and previous driving rehabilitation completed in Long
Beach, California. These factors make it easier for the client to function as independently as
possible while seated in his manual or electric wheelchair. The clients wife has been supportive

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the past five years and is his main caregiver. BWs first floor apartment allows him a level of
independence he otherwise would not have if he lived with a family member or in a nursing
home. The ramp installed outside his front door allows for BW to come and go as he pleases.
The open space within the front of his apartment enables him to use his wheelchair to retrieve
items he may want. The clients adapted vehicle and the training he received post amputation are
also factors that encourage his occupational performance. While he still needs to practice driving
and pass his driver license exam, his previous training is an experience he can draw on in
adapting the new skills he needs to learn. His van will allow him to access the community more
easily and consistently.
When asked about aspects that inhibit his engagement, the client stated there were three
that he could think of. The small hallways in his apartment make navigating his electric
wheelchair to his bedroom difficult so he uses his manual wheelchair instead. His health
concerns are inhibiting and limits his ability to participate as fully as he wishes. The third
limiting factor is the change in hand controls within his adapted van. He knows with practice and
confidence he will be able to use them, but he is frustrated at the lack of communication about
what he had used to learn between the Office of Veterans Services, the driving rehabilitation
facility in Long Beach, California, and the company from which he received his van.
Occupational History
The client joined the Army at 19 and served for three years. He traveled the world while
enlisted, was stationed the longest in Germany, and enjoyed his time there the most. While
posted in Germany, he learned how to ride and drive a motorcycle which became a hobby of his
once discharged. After being discharged, BW settled in Chicago, Illinois where he worked as a
manager in a beauty supply store for 25 years. While living here, BW was more adventurous and

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often took time to travel as much as he could. He saw much of the United States this way, taking
trips as a tourist with his first wife. They did not have children and divorced after just a few years
together. The client lived as a bachelor until he met his current wife, also previously married and
divorced. He left the beauty supply store he moved to Las Vegas, Nevada with his wife, took a
position as a post man and delivered mail for 19 years before retiring at the age of 66.
Values and Interests
BW is not overly religious, but does believe in God. While he does not attend church he
does pray on a daily basis and tries to live his life according to the Bible. He values family and
friends even as he has grown isolated due to his medical issues. The client tries to speak to all of
his children on the phone at least once a week, but admits he has lost contact with some of his
close friends because of how difficult it is to leave his apartment. BW praises the strength and
determination of his wife and her ability to make their life as normal as possible. Above all else,
BW believes in being a supporter to his wife and wishes he was able to treat her like a queen. He
is a romantic at heart and values her partnership and the support she shows him. As he grew up
in a different era, he believes in chivalry and cannot wait for a night on the town once he has
obtained his driver license.
Daily Life Roles
The most important role to him is that of a husband, as his wife has been very supportive
of him and he wants to make sure she knows just how much he appreciates her. The client is also
a father and a grandfather, for the most part from a distance. BW wishes he was able to see his
children and grandchildren more often, but understands that distance, expense, and scheduling
are not conducive to frequent visits. The client instead communicates weekly by telephone and
makes sure to send birthday cards in the mail for each member of his family. The client is also a

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veteran and a retiree. He served his country for three years and was honorably discharged from
the Army as a Sergeant. Once a civilian he worked as a manager of a beauty supply store and
later, a post man before retiring. He states he appreciates the advantage of Social Security and his
pensions, but he admits he has not been able to truly enjoy retirement. His surgeries and medical
conditions limit his ability to spend time enjoying leisure activities, his family, and friends.
Patterns of Engagement
As the client has aged, his patterns of engagement have changed. When he was younger,
his main focus was child rearing and providing. As his children aged and moved out, his focus
shifted to being a good husband and working until retirement. While he still participated in social
activities with friends and family, his life began to slow down. Now retired, BW spends his time
with his wife, trying to enjoy their retirement as much as they can. With more free time, driving
has become a main concern of his. He wants to be independent and active.
Priorities and Desired Outcomes
BWs main priority is to learn how to use his hand control system and spinner knob
buttons safely and efficiently. He also wants to pass the driver license driving exam the first
time. BW knows with practice and patience, he will increase his driving performance ultimately
ensuring functional independence. Receiving his driver license will enable BW to rejoin the
community to promote social interaction decreasing his feelings of isolation and loneliness as
well as take his wife to and from her doctors appointments and grocery shopping.
Occupational Analysis
Context and Setting of OT Services
BW was observed during the pre-driving assessment and during the on-road assessment
in his apartment complex parking lot and on the side streets surrounding the complex. The

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apartment complex parking lot is a relatively flat surface, with a lot of twists and turns that make
it difficult to see oncoming vehicles. The surrounding area is hilly and has different types of
intersections involving stop signs, yield signs, and traffic lights. The side streets range in traffic
flow from light to heavy and the speed limits range from 35 to 45 miles per hour.
The clients adapted van is a 2015 Dodge Grand Caravan. It has a Summit electric fold
out ramp for easy loading and unloading as well as an EZ lock for his electric wheelchair. BWs
van is equipped with a Carospeed Menox hand control system on his right side for easy
acceleration and braking. The client is also allowed a spinner knob to use with his left hand for
steering purposes and may use this to control secondary functions within his vehicle.
Activity Observed and Client Performance
The client was observed during the pre-driving assessment and the on-road assessment.
During the pre-driving assessment, BW was asked to describe his training experience in Long
Beach, California, including how many hours he completed and the vehicle in which he trained.
He was also asked about his medical issues and how they affect his driving ability. The DRS
asked the client to perform different actions and observed his ROM, flexibility, and dexterity.
BW described his limitations as far as his cervical spine ROM and decreased ROM in his right
shoulder.
After going over BWs physical concerns, the DRS reviewed each of the adapted controls
already set up in his vehicle. Starting with the spinner knob, BW demonstrated how it fit in his
hand as well as tried to recall the nine different buttons and each function or functions it
controlled. Next, the right side hand control system was reviewed and the DRS had the client
practice putting the system into the braking position using the toggle switch. Once both the client

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and the DRS were more comfortable with each other, they commenced the on-road driving
portion of the session.
During the on-road portion the DRS observed BW driving within his apartment complex
parking lot and on the side streets that surrounded the complex. The DRS had BW complete right
and left had turns, accelerating and stopping at stoplight intersections, as well as lane changes.
The client was questioned about the speed limit during times the DRS felt he was driving too
slowly compared to surrounding drivers. She instructed the client which direction to take and
gave constant feedback regarding BWs performance.
Key Observations
The client did well during his initial on-road driving assessment, however, there were
some areas noted that could improve through education and occupational intervention. The main
concerns are the clients inability to rotate his cervical spine or trunk to check his blind spots
properly. This is due to decreased ROM caused by the stiffness of his right shoulder injury and
pain from leaning to his left constantly to accommodate his lower right leg amputation.
The leaning to the left side not only affects his cervical spine and trunk rotation, but
causes fatigue in his right arm as his arm is unable to rest on the arm rest of his power wheelchair
properly. Not only does BW complain of increased fatigue issues, but the fatigue makes utilizing
his hand control system more difficult to move and position correctly. The client finds he has to
over extend his right arm to properly put the floor mounted hand control in the brake position to
shift gears.
A second issue noted is the clients difficulty using the spinner knob and its buttons to
control his turn signals. Due to RA in both hands, the boutonniere deformity of both thumbs, and
his peripheral neuropathy, he is unable to feel the slight definition of each button and has a

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tendency to push the right and left turn signal buttons as well as the front and back windshield
wiper buttons by accident. The RA and deformity of his right thumb also cause issues for BW
when he is trying to use the toggle switch to put his accelerator and brake system into a specific
position to switch gears.
The final observation is the clients difficulty with remembering the different functions of
the nine buttons on the spinner knob that controls 11 different secondary functions of his vehicle.
Not every button has just one function, for example, the windshield wiper buttons both for the
front and the back can adjust the speed of the wipers as well as trigger the release of windshield
fluid, depending on how the button is pushed or held. BW complains that the instruction manual
was not sent with the vehicle so he had to sit and figure out all functions for himself, but has not
had enough time to practice to remember each button function as of yet.
Domains Impacting Engagement
The client does have some age related memory loss and was unable to 100 percent
successfully recall the different functions of each button on the spinner knob after figuring each
function out. While he is able to function independently and pursue normal activities, BW does
admit he has occasional memory lapses where he has difficultly retrieving information easily
(Smith, Robinson, & Segal, 2015). BW also suffers from peripheral neuropathy that affects his
ability to sense the difference between different textures that are similar or lack definition. He
states he does not suffer from any paresthesia or hyperesthesia, just a numbness when trying to
use his fingertips to touch, feel, or pick up small objects. The clients peripheral neuropathy
makes finding the different buttons on his spinner knob difficult and he has to look to visually
pick out the one he wants. The neuropathy paired with his RA also affect his ability to easily use
the toggle switch on the accelerator and braking hand controls.

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The client also has decreased joint mobility and ROM within his right shoulder and
cervical spine. As motor abilities are necessary to drive while adhering to the rules of the road
and expectations of the law, these deficits currently affect BWs ability to drive safely at this
time (Prost, 2014). BW is unable to flex his right shoulder past 90 degrees without compensating
by shifting his weight to the left. This affects his ability to shift the vehicle into gear due to the
fact that his gear shift is set into the dashboard. His decreased cervical spine ROM also inhibits
his ability to check his blind spots properly and he uses his mirrors instead. However, the use of
only his mirrors will not enable him to pass the driver license driving exam (Department of
Motor Vehicles, 2014).
Problem List
1. Client requires MOD check blind spots 2 cervical spine ROM.
BW requires moderate assistance and verbalization from the passenger regarding his
blind spots when driving. The client only utilizes the side mirrors and rear view mirror due to
decreased cervical spine ROM. As the inability to check his blind spots independently can lead
to an accident, it is important to address this so BW can drive without fear of causing injury.
2. 2 peripheral neuropathy, client unable (I) turn on/off control buttons on spinner knob s
looking.
Due to peripheral neuropathy, the client is unable to feel the difference between the
buttons on the spinner knob because each button is roughly the same size, texture, and height.
This leads him to take his eyes off the road to visually locate the button he wants which makes it
dangerous for him and others around him. He also has trouble turning the buttons on and off one
at a time without looking and often accidently pushes more than one causing a distraction.
3. Client suffers fatigue in (R) arm 2 inability remain upright in neutral alignment.

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The client complains of increased fatigue in his right arm while driving for long periods
of time due to his leaning towards the left when sitting in his electric wheelchair. He feels off
balance because of his transfemoral amputation and adjusts to be more comfortable. However,
this leaves his right arm unable to rest on the armrest while accelerating or braking. As time
passes, it becomes difficult to move the hand control system into the correct position needed.
4. Client unable engage toggle switch use hand control system 2 ROM (R) fingers.
Due to the clients diagnosis of RA, he suffers from mild joint deformity in his
metacarpophalangeal joints. This affects his joint ROM and makes it difficult to properly engage
the toggle switch as needed. His ability to release the toggle switch when the hand control is
placed in the brake position is also impaired as he has to approach the switch from the other side.
As the toggle switch is required to correctly use the hand control system, it is important to avoid
any unnecessary accidents due to improper usage.
5. Client unable pick up items from floor, such as seat belt connector 2 balance.
BW is unable to pick up any items that fall on the floor without feeling like he may fall
out of his electric wheelchair. Due to decreased balance from his transfemoral amputation and
his decreased trunk stability, he needs assistance from another with retrieving items. The client
wants to increase his independence in all aspects of his life including driving and does not want
to depend on another person to help him get situated.
Intervention Plan and Outcomes
Long Term Goal One
Client will demonstrate ability check blind spots (I) using proper over shoulder
technique & mirrors c/in 30 days.

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Short term goal one. Client will identify 10/10 roadway signs held in blind spots by OT
using peripheral vision & cervical spine ROM c 2> VC c/in 20 days.
Intervention. The client will be taught the Hartford Insurance Exercise for Mature
Drivers program. The study conducted to research the benefits of this home exercise program
(HEP) reported the participants experienced greater ease when turning their heads and bodies to
check their blind spots and further scan the environment (The Hartford, 2013). The HEP focuses
on increasing strength, ROM, flexibility, and coordination and should be completed once a day
within 15 to 20 minutes.
Approach. The establish, restore approach will work to remediate BWs cervical spine
ROM that is impaired due to his affected right shoulder and the compensatory use of his left
shoulder (Yoo, 2014). This approach was designed to change client variables that impact
occupational performance (American Occupational Therapy Association [AOTA], 2014).
Participating in a HEP will introduce physical activity back into BWs sedentary life, increasing
his ROM enabling better rotation of his neck to safely check his blind spots when driving.
Outcome. The HEP will increase BWs cervical spine ROM and improve his driving
performance by enabling him to safely check his blind spots. This intervention will also improve
the clients quality of life by enabling him to fully participate in meaningful occupations outside
of his home which addresses occupational justice and BWs ability to access opportunities that
others within the community are able to easily participate in (AOTA, 2014).
Short term goal two. Client will prepare salad while seated, using ingredients from (L),
cutting in front of him bowl on (R).c 4> VC c/in 10 days.
Intervention. BW will sit at his dining room table with ingredients to make a salad on his
left side. He will be asked to cut the vegetables in front of him before transferring them to a bowl

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on his right making sure to rotate his spine when moving from one direction to the other. This
will reinforce the HEP and help keep BW engaged in physical activity that supports safe driving
(National Institute on Aging, 2011).
Approach. Restoring the clients ability to successfully rotate his cervical spine enables
him to check his blind spots. By using the establish, restore approach, BW can focus on
increasing the repetition of cervical spine rotation during daily activities making it easier each
time he attempts to view his blind spots independently (Britton, Harris, & Turton, 2008). The
repeated use of cervical spine rotation will increase his overall functional independence.
Outcome. Preparing a salad will increase BWs role competence as a husband as he will
know he can help with meal preparation. It supplements his cervical spine ROM and improves
the clients occupational performance by encouraging use of a specific skill set in a different
setting during an activity BW enjoyed (Ferguson & Trombly, 1997). Health and wellness is
addressed as preparing a salad shows the client he can participate in more activities than he
previously believed. This will increase his awareness of occupational balance and how important
it is to seek out activities that will stimulate him cognitively and engage him physically.
Long Term Goal Two
Client will (I) turn on/off turn signals using spinner knob s looking 10/10 c/in 30 days.
Short term goal one. Client will identify 3 textures in off-road course adapt spinner
knob buttons for easy recognition while driving c Min c/in 10 days.
Intervention. As BW has peripheral neuropathy from his RA, sensory re-education (or
re-training) will be used to help the client meaningfully interpret the altered sensations he may or
may not be able to feel (Phillips, Blakey, & Essick, 2011). During an off-road assessment, the
client and DRS will use different materials such as felt, foam, hook velcro, or sand paper to test

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BWs fingertip sensory perception to make identification of the buttons easier. The off-road
assessment will allow for a controlled environment for easy maneuvering while BW practices
with his adapted spinner knob (Dickerson, Stressel, Justiss, & Luther-Krug, 2012).
Approach. The establish, restore and modify approaches were used as BW has peripheral
neuropathy that affects his fingertips. He is unable to feel each button on his spinner knob
separately and has to visually locate the one he wants. Adapting the spinner knob buttons with
textured materials will differentiate the closely spaced buttons and their heights. Sensory reeducation will promote the production of plastic changes in the somatosensory cortex to
compensate, in a small way, for the impairments BW has in hopes of restoring some sensory
perception in his fingertips (Phillips, Blakey, & Essick, 2011).
Outcome. The outcome expected is improvement in BWs occupational performance and
quality of life. By adapting the spinner knob making it easier to identify the different buttons, the
client will be better able to keep his eyes on the road making him a safer driver. Sensory
perception changes and plasticity will carry over into other areas of his life and allow BW to
explore or participate in activities and occupations which he otherwise did not think he could.
Short term goal two. Client will complete 60 minute drive using adapted 2o fx buttons
turn on/off turn signals c 3> VC c/in 20 days.
Intervention. The client will participate in on-road driving with the DRS to physically
practice using his adapted van with the pressure of the surrounding vehicles. By increasing the
complexity of the environment, it increases the visual awareness of contextual and
environmental hazards required of the driver (Unsworth & Baker, 2014; Dickerson et al., 2012).
BW will be unable to take his eyes off the road to use his adapted equipment, it will hopefully
become second nature.

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Approach. The create, promote approach is used by providing BW the opportunity to

drive on the open road with other vehicles. Each experience will be different because traffic is
ever changing and this will build a knowledge base for the client to draw from when driving
alone as well as prepare him for his driver license exam. Driving on the road is more meaningful
and purposeful than participating solely in classroom or driver simulator education and the client
is more likely to learn how to use his adapted equipment safely (Ferguson & Trombly, 1997).
Outcome. The outcome focuses on client participation and improvement in occupational
performance. The chance to practice on the roads surrounding his apartment in his adapted van
will increase his confidence as well as skill level as he learns how to consistently pay attention to
the environment. As the idiom states, practice makes perfect and the clients ability to pass his
driver license exam depends on his ability to follow the rules of the road while driving in his
adapted vehicle to prove he is a safe and responsible driver.
Precautions or Contraindications
As the client is 79 years old, the HEP should be approved and BW cleared to engage in
physical activity by his physician (The Hartford, 2013). BW should also be cautioned to pace
himself during exercise so as not to overwhelm his cardiovascular system and risk injury (Roth,
n.d.). The client should be aware of his own limitations when driving and adapt his driving
accordingly. If BW finds he is uncomfortable driving at night or on busy roadways, he can adapt
his driving routines by running errands during the day or avoiding heavily used streets (Saisan,
White, & Robinson, 2015).
Frequency and Duration of Intervention Plan
The Office of Veterans Services is willing to pay for two driving sessions with a DRS
after which Veterans Services will take into consideration any recommendations made and

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review BWs case before deciding to pay for any more sessions. BW would benefit seeing a
DRS at least four different times, once a week for approximately two and a half to three hours.
The client should have a minimum of 10 hours at the end of the driver rehabilitation. The
sessions with the DRS will be carried out in the clients neighborhood and other familiar areas.
Grading of an Intervention
The intervention to be graded to accommodate BW is salad preparation. Grading the
intervention up, the client will be required to retrieve the items from the refrigerator and transfer
them to the table before cutting them for the salad. To grade the intervention down, BW may use
pre-cut vegetables that were previously purchased from the grocery store.
Primary Framework
The Person Environment Occupation Performance model is the primary framework used
with BW. As he is in driving rehabilitation, the relationships between each factor should be
looked at as well as everything from who he is, the environment he drives in, to the actual
occupation of driving influence his occupational performance (Law et al., 1996). As the local
environment cannot be changed, the main focus will be on changing client and occupational
factors. When considering the client, his main focus is receiving his Nevada driver license. His
motivation is increasing his and his wifes functional independence and the opportunity to take
advantage of the community and their status as retirees. BWs medical issues were the main
contributor to the goals set for his interventions. As his van already was adapted in a general
way, it needed fine tuning to better fit his needs. This included adapting the spinner knob to
make it easier for BW to safely use. The occupation of driving is meaningful in and of itself and
as to what it means to the client and society. While driving is universal in its concept and
technique, BW has had adapted controls installed to make driving controllable by hand. By

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considering these factors and adapting different items to better fit the client, it increases his
independence and quality of life.
Client/Caregiver Training and Education
The client and his wife will be educated on older driver safety. The American
Occupational Therapy Association promotes older driver safety awareness week. It aims to
promote a persons understanding of mobility and enable older adults to stay active within their
community (American Occupational Therapy Association [AOTA], 2015). Both BW and his
wife may be provided information on changes that can affect driving and when it is time to be
reevaluated as a driver. As BW may take medication prescribed him, he should always read and
follow the directions and precautions. Some medications, both prescription and over-the-counter,
can cause drowsiness, nausea, or jittery and hyper feelings and it is important to reiterate BW
should not drive until he knows how they may affect him (Full Circle of Care: Hands-on Help
for Family Caregivers, 2010).
Monitoring Client Response
BWs occupational performance and progress will continually be monitored through
observation, client report, and reevaluation (Chrishom & Boyt Schell, 2014). Observations will
be used during all interventions, especially during on-road driving. Data will be collected
objectively as well as any subjectively. Client report is very important as BW will be driving
during the week to improve his abilities. It is during these independent practice sessions that the
client will need to take note of concerns to bring to the DRSs attention. Reevaluation is
important especially if any adaptations are made during the intervention process. As adaptations
change the way BW drives, it is imperative to discuss anything that makes him uncomfortable.

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References
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