INTERVENTION PLAN FOR COMMUNITY CLIENT WITH REFLECTION

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.
For this and all subsequent weeks, please answer the following questions before designing your treatment plan for the next week. If you were unable to see
your client the past week, you do not need to answer these questions. Answer the questions based on the treatment that you implemented:

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?

Our last treatment went well in that we were able to get through all of the tasks we had planned. I think we did a good job giving cues and helping our client
position her body for optimal performance. While she was doing a dough-kneading task, she suddenly became emotional and said that she was mad at her left
arm. This was a bit of surprise for us because until that point things had been going well. We were able to talk to her for a bit about how she was feeling and
she gained control of her emotions, but for the rest of the session she seemed more distant than usual and eager to leave. Aside from that emotional moment, I
thought the session went well, but I’ve realized that I have a hard time not internalizing the feelings that the client exhibits during sessions. When she’s happy,
I’m happy, but when she is frustrated and upset, I get frustrated and upset (with myself after the session). This is something I really need to work on moving
forward so that I can maintain a healthy therapeutic relationship with future clients. Also, next time a client gets emotional, I might spend more time talking to
her to really get to the root of the problem and making sure she’s okay to continue.

Long-Term Goal: Within 6 weeks, client will use LUE 75% of opportunities during multi-step meal prep tasks.

Short-Term Goal: Within 4 weeks, client will use LUE 50% of opportunities during multi-step meal prep tasks.

OCCUPATIONAL
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.
LUE Hemiparesis
Client factors that are barriers in
the client using her LUE for meal-
prep tasks include lack of muscle
coordination and muscle
endurance, and client tires easily
and has poor coordination when
OPM and CPM
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.
OPM: PEO
PEO is relevant for this client
because in order to optimize
her performance, we need to
consider the client as a
person, her personality, and all
of her strengths and
weaknesses; her
TREATMENT SESSION DESCRIPTION GRADING THE ACTIVITY
Provide details of how you will set up the activity Choose one client factor or
and how your intervention addresses the performance skill that you
performance problem. Your description should address in your treatment
detail how the activity will be set up to make it session. Describe one way
therapeutic. (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:
Treatment Activity: Making Fruit Salad Grip (specifically pinch and
release)
During this session we will be making fruit salad
with grapes, clementines, canned pineapple and Grade up: Have her pull the
canned fruit cocktail (in pull-tab cans), with grapes off stems with her L
homemade whipped cream made from hand for more or all of the
powdered sugar and whipping cream. task.
doing kitchen tasks like mixing
ingredients, chopping vegetables,
and opening cans and jars. Even a
task as simple as opening the
refrigerator with her LUE is tiring
and requires a lot of her strength.
Hypertonicity is also a problem—
client has difficulty releasing her
grip on items (oven handle,
refrigerator door, utensils, jars).
When she does release, it requires
a lot of time and concentration and
she becomes frustrated. Presence
of tone prevents her from flexing
and extending her shoulder as far
as she would like (past 20 degrees
for flexion, past 10 degrees for
extension), especially when
reaching for items, and from
gripping and releasing her grip.
Because of her deficits in the
above mentioned client factors,
client has difficulty stabilizing items
(a bowl when stirring, vegetable
when chopping), reaching (for
needed kitchen items in high or
low cupboards), gripping and
releasing grip, manipulating small
items (jar, eggs, stirring spoon,
cookie dough), and coordinating
her L arm with her R during
bimanual meal-prep tasks.
environment—which is
primarily her home and as far
as we know has not been
adapted; and the occupations
in which she wishes to
engage—mainly kitchen tasks
and typing. Planning
treatments that consider the
compensatory strategies she
already uses, her home
environment, and the tasks
that she needs to do will be
important as we plan
treatments.
CPM: Motor Learning
Motor Control/Motor Learning
is the best complementary
model to use with this client
because repetition to restore
neural pathways will be key in
helping client to regain
function. This model is based
on the idea that through
functional repetition of activity,
the body’s CNS can
reorganize and motor skills
can be re-learned and then
generalized.
Practicing tasks that require
functional movement of the
LUE (in this treatment--
opening cans, pulling grapes
off stems, stabilizing bowl
while mixing) will strengthen
those same neural-motor
pathways and help client
develop patterns/routines of
incorporating her LUE into
kitchen tasks and recognizing
that she has more function
than she might think.
For this activity we will be in the client’s home, Grade down: Allow her to
so we will be using her kitchen tools and stabilize the stems with her L
equipment. In order to help client stay in a calm hand and pull the grapes off
flow state during session, we will experiment with R for the whole task.
with playing music of her choice as she
completes the activity.
Client will begin the activity in seated position.
With her L elbow and forearm resting on the
table, she will first open the two cans of fruit
(pineapple and cocktail)—she will stabilize the
can with her L hand and pull the tab with her R
hand. She will use her LUE to dump contents of
can into a bowl.
For the grapes, client will maintain the same
seated position and, for the first half of the
grapes, will stabilize the stems with her L hand
and pull the grapes off with her R hand. For the
second half, she will switch hands so that she is
stabilizing the stems with her R hand and pulling
the grapes off with her L hand. During this
portion of the activity, we will emphasize that
she can go as slow as she needs to, and it’s
okay if she squishes the grapes between her
fingers, we just want her to be using it. Using
her L hand for this portion will also help work on
the grip and release, and this task will also
provide some proprioceptive input, since the
grapes require some force to pull off the stem.
For the clementines, we would like to see how
client normally peels them before we intervene.
Depending on her performance, we may
incorporate backward chaining by starting the
peel for her and then have her hold the
clementine with her L hand and finish the peel
with her right.
To make the whipped topping we will have client
move to standing (over the lower kitchen table)
in order for her to keep her arm in extension,
thus eliminating the need to control shoulder
and elbow. Client will hold measuring cup with L
hand and pour whipping cream with R hand,
and then supinate with L hand to dump
 whipping cream into bowl (this is a planned
success, as we know client can perform this
task with her L hand). The same process will be
used for the powdered sugar.

To combine ingredients, client will remain in

standing and use LUE to dump bowl of fruit into
bowl of whipped topping. Using a piece of
dysem to help stabilize, client will hold bowl with
L hand (focusing on stabilizing the shoulder)
and mix with R hand.

Home Program:

The home program we will be leaving with our client is a challenge that we called the “Love Your Left” challenge. During our session this week we will
collobarate with CC to come up with 9 tasks that she does at least one time every day that she can do with her left hand (feeding the dog, grabbing the mail,
etc). We will leave a calendar with the tasks clearly outlined and hang it up in a visible spot in the house. CC will do 3 tasks for each of the 3 weeks we’ll be
gone (3 tasks the first week, 3 the second week, 3 the third week) and will take pictures of herself doing them. At the end of the 3 weeks, if she completed the
challenge we will have some kind of reward (probably a certificate) and we will use the pictures she took to create a collage of her using her left hand to
encourage her to “love her left.”