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?

The last session was very successful and the client showed more progress than expected when using the NMES for bicep flexion. Because of this, for the
upcoming session I would like to continue with this sort of treatment but on the tricep instead (in hopes that the same improvement will occur). Last session,
dressing proved to be a task that the client no longer needs any guidance from us on during sessions. Next treatment, I will not have the client participate in
dressing and will focus on cooking and drinking water as it relates to tricep extension, bicep flexion, grip, and standing balance.

Long-Term Goal: By discharge, Client will be able to prepare a simple stovetop meal using adaptive
strategies with SBA.

Short-Term Goal: In 4 weeks, client will actively incorporate R arm to IND complete a tabletop meal prep
task.

Describe client factors relevant to
occupational performance problem
in the goals you selected
-Spasticity: in shoulder, elbow, and
fingers
-Motor control: ~10 degrees elbow
flexion, ~3 finger flexion (grip), ~5
degrees elbow extension at end of
ROM, and scapular retraction
-RUE endurance: can sustain
contraction of available movement in
RUE ~ <30 seconds at a time
-Standing endurance: can maintain
standing for ~5 min at a time and
requires rest
-Standing balance: client has
decreased motor control of LLE
-Sensation: no light touch or
proprioceptive sensation in RUE
-Pain: when activating muscles during
elbow flexion/extension and finger
flexion
List and provide rationale for the
OPM and CPM you will be using in
this treatment relevant to this
client’s goals
PEO: This will help us take into account
what can be changed about the person,
environment, or occupation in order to
improve performance.
- Diagnosis and findings from
assessment suggest that we may
be able to change the person by
addressing motor function in RUE.
Motor Control Model: This model
focuses on the use of repetition for
motor learning and creating pathways.
- This concept is applied by having
the client repeat tasks that require
grip in her R hand (opening cans).
Rehab Model: This model focuses on
the client’s remaining abilities, despite
deficits, to attain highest level of
function.
- The use of adaptive equipment
Describe the skilled OT session you
will use to address the client factors
in the first column.
Opening/closing cabinets w/ NMES +
trigger: I will first educate the
client/caregiver on setting up the NMES
for tricep stimulation. Once NMES is set
up, she will stand in front of the cabinet
and wrap her R hand around the handle
with her L hand (after stretching out the
tone of her hand) while flexing her elbow.
She will pull it open using her torso and
scapular retraction while being
encouraged to maintain flexion in the
elbow. To close the cabinet, she will be
challenged to engage her tricep in elbow
extension as much as she can and the
electrical stimulation will be triggered to
assist with the remainder of the
movement. This process will be repeated
~10 times and the client will be
encouraged to sit in her w/c to rest if
Describe one (and only one) way
you can grade the activity in your
treatment session up and down on
one client factor
Client factor:
Motor control of RUE Tricep:
-To grade up, less electrical
stimulation will be triggered during
the movement arc which will require
more IND activation when closing
the cabinet
-To grade down, more electrical
stimulation will be triggered during
the movement arc which will require
less IND activation when closing the
cabinet
while cooking to compensate for needed.
tasks that RUE can’t be
incorporated into is based on this
model.