Rebekah Strobel

OC TH 6060
Application to Practice Paper

Subjective

Chelsea’s situation might not be the most ideal. She struggles with many things like getting Commented [PP1]: No identifier in the body of the note.

along with friends, understanding social cues, and participating in various activities. There is not

information about how Chelsea feels about her own situation, but there is information on how

her mother feels. Chelsea’s mother is very concerned about her daughter’s fear of participation in

biking and skiing. Her mother is frustrated with the morning routine of getting Chelsea ready as

she often times has tantrums. She is also concerned with Chelsea’s social abilities and skills

because Chelsea often interrupts, doesn’t get along with others, and has trouble making and

keeping friends.

Objective

Occupational Profile

Chelsea is a 10.5-year-old female and lives in a single-story home with her mother, father, and

two younger brothers. Chelsea was referred to therapy over concerns of occupational

engagement including bike riding, skiing with the family, and grooming tolerance. Chelsea

struggles with social participation due to the fact that she struggles to get along with others and Commented [PP2]: Omit the word struggles forever. Just
say what she does or doesn’t do. This will be your baseline.
she often interrupts people. She often times uses unkind language with peers. Chelsea’s mother

works part time and her father is a full-time banker. Her mother and her father are her primary

caregivers but her brother John often helps out. John helps Chelsea with learning new games and

playing outdoors. Chelsea attends school in a regular classroom setting with moderate assistance

from an aide. Her classes include functional skills classes, adaptive PE classes, and speech and

language therapy. Chelsea has trouble with balance and uses a handrail while going up and down
stairs. This inhibits her participation in gross motor activates like PE and dancing. For leisure,

Chelsea enjoys playing on the slide and jungle gym, swimming, and riding roller coasters.

There is more information needed to know about Chelsea. We need to know more about

her habits, role, rituals, values, beliefs, and spirituality. In addition, we need to know about

cultural context and her body functions. It would be helpful to know what some of her personal

goals are for therapy, not just the ones her mother has for her. It would be helpful to know what

sensory issues she has. We also need to know why Chelsea uses unkind words to others. Is she

being bullied? The case study did not mention how much assistance she is receiving. It would be

useful to know just how much assistance she needs. We also need to know if there are other Commented [PP3]: And for what.

leisurely occupations she is engaged in or would like to engage in. Finally, her level of cognitive

and physical development would be useful to know. We will obtain this information through

interviews and observation.

Domain Analysis

Areas of Occupation: Chelsea participates in her morning routine of ADLs and IADLs with

assistance from her mother. This is mostly successful with the exception of having her hair

brushed and selecting clothing. These cause tension between her and her mother. Chelsea

receives assistance from a classroom aide. She participates in a functional skills class, adaptive

physical education, and speech and language therapy. Some of her other occupations include

slides, swimming, and roller coasters.

Social Participation: This is an area that Chelsea struggles in. She is friendly and talkative but

she often interrupts others when speaking. She has difficulty making and keeping friends, and

uses unkind words. She interacts with her family and she accepts assistance from her brother

John while learning new games and when playing outside.

Performance Skills: Chelsea has moderate balance impairments but she can walk and move

sufficiently. We need to know more about her process skills and what her strengths and barriers

might be. She might be struggling with processing as her brother has to help her learn new

games. She also demonstrates issues with social interaction skills. Commented [PP4]: Use a more descriptive word

Performance Patterns:

Habits: Chelsea seems to have a habit of saying unkind words in social interactions. She has a

habit of responding negatively to situations where she in unbalanced physically like skiing. She

also has a habit of responding negatively when her mom is brushing her hair and selecting her

clothing.

Routine: Chelsea helps complete her morning routine with assistance from her mother. She gets

dressed, makes her bed, and puts her dirty clothes away. She also attends school regularly.

Rituals: We do not know about her rituals.

Roles: Chelsea is a daughter, sister, student, and classmate.

Activity Demands: Chelsea’s cognitive disability may impact her ability to participate in ADLs

and IADLs. She is friendly and talkative with the therapist, but has difficulty with expectations

of others during social interactions, however, she struggles with social interactions in a school Commented [PP5]: Exchange this word with a more
descriptive word or phase
environment. Her inability to balance could impact engagement in meaningful occupations and

may cause a safety concern.

Client factors:

Values, beliefs, and spirituality: We need to know more. She seems to value independence and

family.

Mental functions: She sometimes throws tantrums in the morning which means emotional

functioning might be a problem. She can remember her morning routine and initiate and
complete tasks that are routine to her. We need to know more about what she does at school

including attention level, cognitive level, memory, and thought. We also know her personality

can change depending on her environment and external circumstances.

Sensory functions: Vestibular functions could cause some of her balance issues. She could have

more sensory issues that were not mentioned.

Muscle/movement function: As far as we know, there are no issues with mobility or muscle tone,

power, and endurance. Her balance issues could cause some of inability to participate in

occupations.

Body structures: These are intact as far as we know.

Contexts

Cultural: We need to know more

Personal: She is 10.5-years-old, middle class, and participates in school with aides and receives

additional support in her functional skills class, adaptive PE and speech and language therapy.

Temporal: Chelsea struggles with things that typical 10-year-olds would not struggle with. She

has difficulties all year round. Her morning routine is listed as the hardest for her.

Virtual: We need to know more

Physical: Home, outpatient clinic, school

Social: Parents, classmates, two brothers, teacher, therapists, aids Commented [PP6]: Well done

Assessment

Outcomes

Some targeted outcomes for Chelsea include improving and enhancing occupational performance

in her daily routines of life, specifically brushing her hair and choosing her clothes. Another

outcome is participation. We want Chelsea to be able to participate effectively in social activities

and interactions. We want to be able to increase Chelsea’s well-being so that both her and her

family is satisfied with her occupational performance.

Priorities

The first priority for Chelsea includes teaching her appropriate social interaction techniques in

order for her to be able to engage in meaningful occupations, friendships, and relationships. This

falls under social participation. The other priority is for her to increase her level of appropriate

temperament and emotional regulation so that she can engage in her morning routine. This falls

under occupational performance.

Intervention Plan

Chelsea’s intervention plan will include using 3 models: Ecology of Human Performance, the

Social Participation model, and the Dynamic Interaction model.

The Ecology of Human Performance is about increasing satisfaction with performance

range. Relevant postulates of change include performance range resulting from the interaction of

skills and abilities, and supports and barriers in the environment. Another postulate of change is

prioritizing on what the person wants and needs to do (Dunn, 1994). These relate to Chelsea

because we want to focus on something she needs to do (her morning routine) by focusing on the

interaction of her skills and what supports and barriers in her environment (her hair brush and her Commented [PP7]: fragment

mother). For the intervention, we will work on changing something in her environment, her hair

brush, to make it softer and personalized. We will also work on having her mother be more of a

support for her in hair brushing. This will increase her satisfaction with her performance range.

The Social Participation model is about supporting and enhancing social participation of

children who have disabilities (Olson, 2010). This model is fitting for Chelsea as she is young

and has Down’s Syndrome. One very fitting postulate of change from this model states that if a
therapist assists a child’s caregiver to develop strategies that support a child’s participation in

daily family routines, then the child will be able to better function in those daily family routines.

The goal is for Chelsea to work with both her and her mother to establish an effective morning

routine. This model is supported in research. It was found that a mother’s emotions can affect her

child’s emotional regulation. By working with the mother, it was proven that skills can be taught

that could increase emotional regulation (Hu, 2017). This is needed for Chelsea. Commented [PP8]: and her mother

The Dynamic Interaction Model is about obtaining optimal occupational performance by

decreasing activity limitations, enhancing self-awareness, and promoting cognitive strategy

through balance between the person, activity, and environment (Pendleton, 2011). One postulate Commented [PP9]: this is the editor, not the author

of change states that if a client is struggling during a task, the therapist can facilitate performance

by providing cues, teaching strategies, or reducing the demands of an activity. This postulate of

change will be used in her emotional regulation of her morning routine through the use of verbal

cues. This model and intervention is also supported in research. In research, it was found verbal Commented [PP10]: and teaching strategies? I am sure
her mother gives her verbal cues. How will you specifically
use this model with Chelsea?
cuing can help people who have Down Syndrome better complete tasks (Digby, 1990).

Goals

Long-term: Within six weeks, Chelsea will independently complete her morning grooming

routine without having an emotional outburst through emotional regulation techniques.

Short-term:

Within 2 weeks, Chelsea will have fewer temper tantrums by utilizing compensatory strategies Commented [PP11]: During morning routine?

with minimal assistance.

Within 1 week, Chelsea will be able to initiate her hair grooming routine with moderate verbal

cueing.

Intervention Approaches and Types

Approaches

Modify: Provide Chelsea with a personalized hair brush that she likes to prevent emotional

outbursts. This idea is supported by research. It was found that when children with Down

syndrome are able to make their own choices, they are happier and better regulated (Bourke,

2014).

Establish: Collaborate with the mother to help Chelsea effectively brush her hair. This was

supported in a study recently conducted that found if mothers were taught better emotional

regulation, their children would have better emotional regulation as well (Hu, 2017).

Types

Preparatory methods: Provide Chelsea a swing to sit in before grooming in order to better self- Commented [PP12]: Preparatory task

regulate. Swinging is supported by research and can fall into the Social Participation Model. It

was found that focusing on sensory integration in therapy will enable optimal intervention. By

starting the intervention session with a sensory technique, Chelsea will be more emotional Commented [PP13]: emotionally

regulated and able to participate in the social occupation of having her hair brushed (Jaarsveld,

2016).

Preparatory method: Provide verbal cues to Chelsea while she is brushing her hair. Verbal cuing Commented [PP14]: I’m not sure this is a preparatory
method
falls under the Dynamic Interaction Model and has been found to help people with Down’s

Syndrome better complete tasks (Digby, 1990).

Intervention Session

One intervention session for Chelsea would include meeting with her and her mother. I would

start the session with swinging her back and forth in a swing. This could be good for Chelsea

because she loves roller-coasters and the vestibular input is calming for her. This would take 10 Commented [PP15]: Some vestibular input is calming,
but not all (biking and skiing)
minutes. For the next 10 minutes, we would work on decorating a new soft hair brush that I had
told her mother to bring. We would decorate it together with stickers and glitter. After we had

decorated the brush, I would have Chelsea practice sitting still and emotional regulated while her Commented [PP16]: spelling

mother brushes her hair. I would provide verbal cues if she started to get annoyed. I would also

let Chelsea take a turn brushing her own hair. We would then end the session and Chelsea would

be able to take the brush home with her.

 References

AOTA (2014). Occupational therapy practice framework: Domain and process (3rd edition).
American Journal of Occupational Therapy, 68, S1-S51. Commented [PP17]: italicize
Commented [PP18]: double space references-APA
Bourke, J., Foley, KR., Girdler, S., Leonard, H., Scott, M. (2014). “I have a good life”: the
meaning of well-being from the perspective of young adults with down syndrome.
Disabil Rehabil, 36(15), 1290-8. Commented [PP19]: not APA

Digby, E., Weeks, D., Gray, S (1990). Manual and oral praxis in adults with down’s syndrome. Commented [PP20]: &
Neuropsychologia, 48(12), 1307-1315

Dunn, W., Brown, C., & McGuigan, A. (1994). The ecology of human performance: A
framework for considering the impact of context. American Journal of Occupational
Therapy, 48, 595-607

Hu, Y., Wang, Y., Liu, A. (2017). The influence of mother’s emotional expressivity and class
grouping on Chinese preschool’s emotional regulation strategies. Journal of Child Family
Studies, 26, 824-832.

Olson, L. J. (2010). A frame of reference to enhance social participation. In P. Kramer & J.

Hinojosa (Eds). Frames of Reference for Pediatric Occupational Therapy (3rd ed., pp.
306-348). Philadelphia: Lippincott Williams & Wilkins.

Pendleton, H., & Schultz-Krohn, W. (2011). Pedretti’s occupational therapy for physical Commented [PP21]: You need the author-these are the
dysfunction (7th ed.). St. Louis: Mosby Elseiver. editors

Van Jaarsveld, A. (2016). Sensory processing, praxis and related social participation of 5-12 year
old children with down syndrome attending educational facilities in Bloemfontein, South
Africa. South African Journal of Occupational Therapy, 46(3), 15-20.