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Occupational Profile and Intervention PlanShantel BishoffTouro University NevadaOccupational ProfileThe client is a 43 year old single male who lives in Las Vegas, Nevada. Prior to admission, his mother served as his caretaker and often assisted him with instrumental activities of daily living (IADLs) that required more energy than he had available. He is an only child and has never had contact with his father or distant relatives. The client is an avid smoker of cigarettes and marijuana and considers himself an alcoholic. He does not currently drive, but he does utilize public transit to complete lifestyle needs. The client currently lives in a one bedroom, one bathroom single story studio apartment along with his mother. Neither the client nor his mother are employed, however they do receive income from social security and disability. The client arrived at Horizon Specialty Hospital following hospitalization due to respiratory failure. The client stated that he had been having difficulties breathing for a few weeks and each day he became weaker. He had refused to go to the hospital and eventually lost consciousness and had to be taken to the hospital via ambulance. The client has a vast history of disease and disability. The client is currently ventilated and receiving treatment regarding his chronic obstructive pulmonary disorder (COPD), which he does not manage, congestive heart failure (CHF), respiratory failure, hypertension (HTN), morbid obesity, and has smoked for 30 years. The client is seeking services based on his health problems interfering with his ability to live a productive and meaningful life. His diagnoses challenge his ability to be independent and functional within all aspects of his life. The client’s current concerns are related to his decreased dynamic sitting and standing balance, endurance, strength, functional mobility, and activity tolerance; all of which are inhibiting him from engaging in his desired occupations. He also demonstrates decreased safety awareness and understanding regarding his diagnosis of COPD. He expressed concerns regarding his ability to walk long distances without becoming short of breath, as this is required to utilize public transit to complete his everyday responsibilities for him and his mother. He understands the ultimate detrimental effects smoking will have on his body, but has stated that he refuses to quit. The client considers smoking to be an occupation that assists him in relieving everyday stress and expresses feelings of anxiety when talking about the thought of quitting. The client is able to engage in many aspects of his life independently; however, he does utilize adaptive equipment, extra time and rest breaks in order to conserve energy and complete tasks. Some of these activities include: dressing his upper body, performing personal hygiene and grooming, toileting, feeding, and eating. The client is unable to bathe, dress his lower body, and functionally ambulate without maximal assistance. The client states that the public transit pick-up station is two blocks from his home and that he has to be able to get there by foot in order to complete grocery shopping and errands. Due to the client’s obesity and respiratory failure, he conveys anxiety regarding his ability to perform the duties required within this role. The client desires to be as independent as possible within all aspects of his life. He is adamant about learning how to use adaptive equipment to enable independent dressing and self-care, and states, “it is important I am able to do this, so I do not burden my mother with another thing she has to help me with.” The client desires to regain his functional mobility in order to maintain his role within the household of running errands while utilizing public transit. In order to gain independence within the community, the client needs to be aware of safety precautions and recognize his limits and when to stop and rest. The client also mentioned how much he enjoys going down to Fremont Street and dancing the night away. He stated that he enjoys going to the Gold Spike and mingling with new people while participating in the extra-large games and activities they offer at their facility. He recognizes that he needs to manage his COPD and increase his activity tolerance in order to be successful in this meaningful occupation again. The client states that these are all very important aspects in his life and acknowledges that he would benefit greatly from achieving goals in these areas. The client is very motivated, but is hard on himself when he is unable to participate in an activity for the full length of time. The client is successful in learning and participating in adaptive equipment training. The client is able to transfer from one place to the next utilizing a front-wheel walker, but requires standby assistance. The client is willing to participate in all treatment activities, but refuses to cut back on his smoking habit which is inhibiting complete success within these areas. The client’s level of health literacy is relatively low and presents as a barrier when determining appropriate nutrition to address his obesity while also managing his COPD. The client’s quaint, first level apartment presents to be a fairly beneficial setting in which he is able to function and be independent. The location of the client’s home is also very accessible to public transportation and community venues. He has a very strong support system in his mother and acknowledges that she keeps him motivated while at home. However, there are also various aspects within his home that prove to be barriers as the client plans to discharge home. The studio is equipped with a tub/shower which will require the client to step over to get in; presenting a problem regarding balance. Also, the client’s studio is a motel room so he does not have an actual kitchen in which he can prepare healthy and nutritious meals. This barrier often causes the client to choose to eat fast food or smoke a cigarette instead, as it presents to be more convenient. Occupational AnalysisThe context in which the client received services was in a small therapy gym within the hospital. The room was equipped with a variety of selections regarding weights, games and overall therapeutic materials. The therapy gym has limited space which deters the occupational therapist (OT) from implementing a variety of options during the treatment session, but was selected as it does provide more open space than the client’s shared hospital room. The client was observed while being educated on and introduced to the benefits of adaptive equipment during dressing activities. The client has a very short stature, so when the bed is fully lowered he is still unable to reach the ground with both feet; this inhibits his ability to perform dressing activities appropriately secondary to decreased sitting balance and trunk stability. Due to this limitation, the OT moved therapy to the gym and had the client sit in his wheelchair presenting a better environment to perform this activity. The client was very engaged throughout the education portion of each piece of adaptive equipment and acknowledged whether or not he understood the purpose of each device. After being debriefed on the equipment, the client began practicing lower body dressing using the provided adaptive equipment and compensatory strategies offered by the OT. The client practiced donning and doffing lower body clothing, socks and shoes utilizing the new techniques and verbal cues. The tools proved to be slightly difficult for the client to manage at first as they were all very new to him; due to his decreased strength and endurance, the client showed anxiety and frustration when manipulating the tools and the clothing. A multitude of key observations were observed during the client’s participation within this dressing activity. The setting provided an appropriate amount of space to engage in the activity without physical environmental barriers. The client was motivated to participate in the dressing activity as this is one of his ultimate goals to accomplish before discharge. The client appeared to be uneasy stating the anxiety he experienced when having to utilize adaptations to complete a dressing task. After a demonstration of the adaptive equipment, he expressed interest in being able to utilize the dressing stick, reacher, sock aid, and shoe horn. First the client began to use the dressing stick and reacher to put on his pants. These tools were offered to the client in order to adapt to his inability to bend down towards the ground due to his morbid obesity, respiratory and balance problems. Although difficult, the client was able to manipulate both pieces of adaptive equipment concurrently in order to don his pants around both ankles. The client was excited to accomplish this part of the task as this was the first time since admittance that he was able to don his pants without another individual’s assistance. Once the client was able to get his pants to a level within reach, with assistance from the OT he was able to stabilize himself with his front wheel walker and move from sit to stand to finish donning his pants. The implementation of the adaptive equipment proved to be very beneficial for the client and his ultimate goal of being independent in dressing. During the activity itself, the client experienced shortness of breath while maneuvering his legs and the equipment to successfully don his pants. His decreased dynamic sitting and standing balance made it difficult to utilize the tools with ease. Although the client was very motivated, he also expressed his concern with how challenging it was to manipulate the tools to do what he wanted them to do. The OT reassured him that it may take extra time, but with practice this technique will offer greater independence within his activities of daily living (ADLs). The client’s motivation is remarkable and will be a huge leading factor in his success within this occupation. The client’s inability to successfully perform his ADLs such as dressing, personal hygiene and functional mobility are significantly impacting his ability to successfully engage in essential occupations within his daily life. The client experiences deficits within the mental functions of higher level cognition, attention and emotion. His poor judgment, insight, distractibility and lability of emotions significantly affect his ability to concentrate on the task at hand during dressing. The client’s decreased neuromusculoskeletal and movement-related functions of joint mobility and stability and muscle functions regarding power, tone and endurance are constant factors that prevent the client from performing appropriate movement patterns in a correct and beneficial manner. Cardiovascular, hematological, immunological and respiratory system functions within maintenance of blood pressure, respiration rate, rhythm and depth as well as physical endurance, aerobic capacity, stamina and fatigability are definitive factors that limit the client’s daily performance in the activities that are essential and meaningful to him. These deficits are detrimental within the client’s lifestyle as a whole and decrease his overall sense of self-efficacy. The client’s ability to interact and move within his environment is severely impacted by his performance skills due to decreased ability to align and stabilize himself during occupational performance. He was also unable to bend at the trunk and reach a small distance, ambulate safely to his desired destinations, and appropriately endure and pace himself throughout the activity. These performance skills were directly related to his inability to complete his occupations independently.There are several performance patterns that affect the client from independently and productively participating in everyday activities. The client has acquired a habit of smoking which continues to be detrimental within occupational performance as he has continued to smoke for the past 30 years. If the client is able to diminish this dominating habit, he may be able to decrease the prevalence of health complications and improve his overall quality of life. The client’s sedentary lifestyle also presents with limitations regarding physical activity and his ability to regain appropriate depth of respiration. These choices impact his occupational performance in a negative manner and could influence the success he may have in active participation and increased activity tolerance while decreasing symptoms of dyspnea and fatigue.Problem ListProblem statement one. Client requires max (A) to manage COPD due to poor judgment and ↓ safety awareness.Problem statement two. Client requires max (A) in LE dressing activities due to ↓ balance, SOB & ↓ trunk stability.Problem statement three. Client requires mod (A) in functional mobility due to ↓ dynamic standing balance, SOB, ↓ endurance, & ↓ safety awareness.Problem statement four. Client requires mod (A) in functional shower transfers due to ↓ balance, SOB, ↓ strength, & ↓ safety awareness.Problem statement five. Client requires mod (A) in grooming and hygiene activities due to ↓ balance, ↓ strength, SOB & ↓ activity tolerance.Priority and Justification of ReasoningManagement of the client’s COPD is ranked as the first and most problematic due to the issues this delinquency causes within his lifestyle. According to the World Health Organization, smoking cessation is the single-most effective way to slow the disease progression. Providing health education to improve the client’s health literacy regarding the disease may also play a role in improving skills, ability to cope with the illness, and overall health status. It has been proven to be effective in accomplishing certain goals, including smoking cessation within the current COPD population. Being able to manage and control this disease will increase the client’s ability to succeed in his daily occupations while also decreasing the negative feedback that may be present if left unmanaged.The client’s inability to independently dress his lower body is an area that the client is adamantly concerned about. He has stated apprehension regarding his role within the household of being able to go out into the community to retrieve groceries and run daily errands for him and his mother. He also recognizes that his weight is a problem and would cause increased stress on his mother if he were to depend on her to perform this occupation for him. The client also stated that he valued being able to put his nice clothes on and go to Fremont Street and dance the night away. This is an occupation that is valuable and meaningful to the client and without the ability to dress himself he could not participate in these activities. The client’s ability to functionally ambulate and transfer from one area to the next is currently limited due to his decreased balance, stability and activity tolerance. The client does not have a vehicle and is the main provider for his home. In order to complete his responsibilities within this role, he has to have the ability to functionally ambulate and maneuver himself within the community. He also has to be able to transport items while utilizing public transportation. His ability to be functionally mobile is also generalizable throughout his everyday tasks and duties and necessary to participate in an active lifestyle. The client conveys that he does not want to live his life doing sponge baths and would like to participate in the occupation of showering with ease.Lastly, the client would like to perform all self-care activities independently. Although this problem is listed last, it is something the client would like to perform independently. All of the preceding problems, if adjusted may help lead into independence within these occupations as well. The client is motivated and determined to be able to take care of himself and regain the ability to participate in his life roles. Success within these occupations will further increase the client’s overall quality of life.Intervention Plan & OutcomesLong Term Goal OneClient will demonstrate COPD management techniques c mod (I) daily within 2 wks. Short term goal one. Client will demonstrate appropriate energy conservation techniques by implementation of pursed lip breathing responses during daily activities c min (A) within 1 wk. Intervention. The treatment plan will begin with education for specific breathing techniques (pursed lip and diaphragmatic). The client will be instructed on how to incorporate these breathing techniques into his daily routine. He will then be provided with more education in energy conservation and compensatory strategies to allow him to be more efficient. This will allow the client a better understanding of COPD exacerbation management while also increasing his level of health literacy regarding this topic. Discussion about adaptive equipment needs will also be addressed and recommendations made in order to increase independent participation while decreasing fatigue. The client will participate in an upper extremity exercise program to increase endurance, and will be provided with handouts to encourage him to continue with the exercises once discharged. The exercise program will include wrist weights that will be applied while participating in a game of his choice. Some of the aforementioned games he likes to participate in at the Gold Spike include connect four and giant Jenga, these games will be incorporated into his treatment regimen to increase endurance in meaningful occupations. The activity may be graded up by increasing the amount of weight on the wrist along with the length of time available to complete the activity. The activity may also be graded up by having the client perform dynamic standing in order to complete the activity. The activity may be graded down by decreasing the weight provided on each wrist, providing a game that takes a shorter amount of time and allowing the client to stay sitting while participating in the activity. The OT will also incorporate rest breaks in order to add ease to the treatment session. Intervention approach. The most appropriate intervention approach for the above activity would be the prevent approach. The client’s inability to manage his COPD appropriately puts his occupational performance skills and patterns at risk. Preventing COPD exacerbations requires that the client be able to recognize early warning signs by developing an action plan in order to halt the symptoms before they mature and further deter the client’s progress. By addressing the risk factors associated with COPD exacerbations, the client will have a greater tolerance for activity and an increased quality of life (AOTA, 2014). Evidence. Pursed lip breathing is a technique used by many COPD patients in order to reduce dyspnea while exercising, performing ADLs or even at rest. Ramos, Vanderlei, Ramos, Teixeira, Pitta, & Veloso (2009) assessed the effects of pursed lip breathing at rest on the behavior of heart rate and its variability, and on variations in blood pressure, respiratory rate and pulse oxygen saturation in subjects with COPD. The authors stated that the cardiorespiratory phenomenon similar to respiratory sinus arrhythmia has been associated with better efficiency in pulmonary gas exchanges, thereby producing better alveolar perfusion and ventilation. The results of the study during the breathing cycle resulted in an increase in heart rate during the inspiratory phase, followed by a decrease during the expiratory phase. This occurred because calm and placid inspiration leads to parasympathetic inhibition, thus increasing heart rate as muscle sympathetic activity is suppressed. In contrast, during calm and placid expiration, there is a decrease in heart rate due to parasympathetic activation, further influencing autonomic cardiac modulation (Ramos et al., 2009). Outcome. Overall occupational performance will increase as the client achieves the outcome of participation. Utilizing this type of intervention will allow the client the ability to participate in many dynamic activities functionally, efficiently and effectively, which will further increase his ability to independently participate within his roles at home. The outcome of participation that will be achieved through this type of approach will allow access to participation in meaningful and enriching occupations as well as resources to increase satisfaction within personal endeavors (AOTA, 2014). Short term goal two. Client will practice mindfulness based techniques daily to ↓ stress and avoid COPD exacerbation triggers c min (A) within 1 wk. Intervention. Stress and anxiety can make the client feel short of breath and increase COPD exacerbations. Shortness of breath can lead to even more anxiety, faster breathing, and fear. A client with COPD cannot avoid stress; it is part of daily life. However, developing effective ways to manage stress and learning to relax can help prevent shortness of breath and avoid panic. In an effort to address these factors, the OT will introduce seated Hatha Yoga to the client. This type of intervention will incorporate slow-paced stretching techniques with some simple breathing exercises and seated meditation. During this time, the client will be educated on the beginners’ poses and relaxation techniques in order to become more comfortable with yoga. The client will incorporate learned breathing techniques, meditation and yoga poses into a 45 minute session. The client will also be provided with handouts regarding the different poses and ways to adapt if they present with increased difficulty. The positioning and breathing techniques involved within this intervention will also be easily generalizable into the client’s daily activities. Intervention approach. The prevent approach will be beneficial during implementation of this intervention as it introduces a self-initiated routine that will further support a healthy lifestyle while incorporating mindfulness and breathing techniques to further deter negative psychophysiologic factors such as stress and anxiety (AOTA, 2014). Evidence. Raub (2002) sought to understand the health benefits of yoga for healthy people and for people compromised by musculoskeletal and cardiopulmonary disease by performing a thorough literature review. It was concluded that through body- and breath-control, including relaxation techniques, Hatha Yoga clearly has additional benefits for cardiopulmonary endurance. Some of the acknowledged benefits within this review manifested within improved lung capacity, increased oxygen delivery, decreased respiration rate and decreased resting heart rate, resulting in overall improved exercise capacity. Yoga breathing while performing postures, especially relaxation postures, also was shown to significantly reverse the physiologic effects of stress (Raub, 2002).Outcome. Overall preventative outcomes will assist the client by enhancing his ability to overcome involved barriers associated with increased activity during occupational performance. This type of intervention will help address the limitations currently present within the client’s lifestyle by identifying and reducing the onset and incidence of unhealthy conditions and risk factors associated with COPD exacerbations (AOTA, 2014). Long Term Goal 2Client will perform LE dressing c mod (I) using A/E within 2 wks. Short term goal. Client will don & doff pants using A/E c min (A) within 1 wk. Intervention. The client has stated numerous times how important it is to him to be able to dress himself. He acknowledges his weight problem and desires to find a way to be able to dress his lower body independently. He currently has trouble performing these tasks not only due to his weight, but also due to the dyspnea, fatigue and decreased balance he experiences after attempting to complete this activity. The intervention will start with client education regarding energy conservation and the use of adaptive equipment to enable his independent participation. The OT will provide strategies for the client to dress himself using a dressing stick and reacher while also utilizing energy conservation and pursed lip breathing techniques to decrease his shortness of breath and fatigue. Once the client grasps the concept of each tool, he will participate in the dressing activity while sitting, utilizing the dressing stick and reacher concurrently to don his underwear and pants. The therapist will request that the client’s mother bring in nice clothes the client wears during his outings to Fremont Street to further increase the meaning and importance of this dressing activity. By providing this clothing, the client may generalize this task into real life experiences, further inspiring him to continue on in the activity successfully while increasing his sense of self-worth and accomplishment. Intervention approach. The modify approach will be utilized during this intervention in order to simplify the energy expenditure necessary for the client to complete the task or skill successfully. Using this type of approach, the intervention will support performance in the natural setting, while offering adaptations to the performance and steps of an activity to ensure completion and achievement (AOTA, 2014). Evidence. Bendixen, Waehrens, Wilcke, and Sorensen (2014) aimed to understand ADL task performance amongst COPD patients and to investigate whether age, gender, and routine COPD characteristics correlated with the self-reported ADL ability. More than 90% of the participants reported increased effort and/or fatigue when performing the ADL tasks. Despite the inability to prove gender and routine significance in COPD exacerbations, the problems reported by patients regarding ADL task performance were recognized as potential and important areas for rehabilitation. Findings also suggest that improvement in physical capacity through exercise may be obtained through a combination of compensatory interventions such as adaptation to the environment and prioritizing daily tasks (Bendixen et al., 2014).Outcome. The outcome will focus on maximizing participation by allowing the client to feel a sense of overall well-being. Offering ways in which the client can engage in desired occupations that are personally satisfying will assist in increasing his determination during a specific activity. Minimizing the amount of energy necessary to complete the dressing tasks will support independence while also decreasing COPD exacerbations.Short term goal. Client will don & doff shoes & socks using A/E c min (A) within 1 wk. Intervention. As mentioned earlier, the client is adamant about achieving independence with lower body dressing due to his roles and responsibilities within his household. The client stated that he needs to be able to wear good walking shoes as this is his main mode of transportation to the public transit bus stop. He is not currently able to perform this activity due to his weight, dyspnea and decreased endurance. The intervention will start by educating the client on the sock aid and shoe horn. Once the education has been provided, the client will participate in the activity by utilizing the sock aid to don socks on both feet followed by donning shoes using the shoe horn. Once the client has completed the activity, the therapist will ask him to repeat the steps and ways to use each piece of adaptive equipment in order to further ensure awareness and understanding of the devices.Intervention approach. The approach utilized with this intervention is designed to modify the client’s abilities during occupational performance in order to enhance participation and decrease inhibitors within the dressing task. The intervention also aims to promote self-awareness, self-efficacy and self-esteem by allowing for completion and success of the activity (AOTA, 2014). Evidence. Marcelo and Jardim (2006) aimed to evaluate the functional performance of COPD patients, focusing on the use of techniques of energy conservation when performing ADL tasks. The activities were chosen based on the difficulties in ADLs that the patients participated in most within their daily lives. Test completion was performed with and without energy conservation techniques. Dyspnea, the most limiting factor for COPD patients, was evaluated and measured using the Borg scale. Analysis of the data showed that the perception of dyspnea decreased significantly when patients performed the ADL activity of donning/doffing shoes using energy conservation techniques (Marcelo & Jardim, 2006).Outcome. The desired outcome this type of intervention will strive to achieve will be to increase the quality of life for the client of interest. This type of outcome focuses on the dynamic appraisal of the client’s life satisfaction as a whole. The client’s perception of achievement, hope for the future, self-concept, functionality, and independence will all have the ability to increase dramatically within participation and success of this activity (AOTA, 2014). Addressing these skills will further assist the client in establishing the ability to be more independent within his current lifestyle while decreasing the negative factors often associated with COPD exacerbations. Frequency and DurationThe client will be treated five times per week for 30 to 45 minute treatment sessions. The client will continue to work on desired goals and outcomes until the treating physician has determined completion and success in occupations, further leading to discharge. The client’s level of function and respiratory status will ultimately determine how long each treatment session will last. Currently, the client is able to participate in 45 minute treatment sessions utilizing five minute breaks when necessary. Precautions and ContraindicationsDiet and exercise are essential to proper management of COPD. However, several precautions and contraindications accompany these necessary lifestyle choices. Often times the client will have trouble taking a full breath due to less oxygen delivered to the muscles, blood and brain causing fatigue. It is important that the client take the time to work up to a more intense exercise regimen in order to condition the body properly while adhering to safety precautions. Although client’s with COPD may have weak muscles and a limited supply of oxygen for their function, performing the appropriate routines will prove to be beneficial. Acknowledging exercises that may be detrimental to success is a stressed precaution such as not performing isometric activity due to the contraindication it presents within an individual’s performance. Breathlessness and breathing restrictions are common complaints of those who suffer from COPD, and it can deter many planned exercise routines. Building cardiorespiratory endurance before undertaking certain types of exercise can save a client from that fearful, breathless feeling that can occur (Ramos et al., 2009). It is important to remind the client that if they cannot talk and exercise concurrently, they are working too hard. Checking vital signs, specifically pulse oximetry is necessary and pertinent to safe participation within all activities as well as managing an oxygen tank. Chest pain during increased aerobic intensity is a contraindication and activity should be stopped immediately. Although there are many precautions to consider before participating in activity, it is important to acknowledge all of the benefits a client will receive from participating in the occupations as well. Primary Framework UtilizedThe Person-Environment-Occupational-Performance Model (PEOP) was used in order to address initial goals and implement appropriate interventions. The PEOP model assesses the client’s intrinsic factors, extrinsic factors, and the occupations of importance to the client’s well-being such as activities, tasks and roles. Utilizing this framework will enable the client to experience a sense of accomplishment while creating a reinforcing positive cycle for the client who will experience intrinsic satisfaction and extrinsic rewards as well. It is client-centered in that it values and requires the active involvement of the client in determining intervention goals. This model recognizes impairments when they limit performance participation, but also views the client in context, including consideration of abilities and strengths that a client can use to enable performance. Ultimately, the client determines performance goals to which therapy is targeted. The client’s intrinsic factors are addressed by providing education to increase the client’s health literacy regarding physiological factors of the disease as well as offering compensatory strategies in order to maintain self-esteem. When the client is provided with adaptive equipment and supported in his meaningful activities, he is more likely to be successful and have a good attitude within these areas of interest. Utilizing this model, the OT may provide strategies in which the client will increase performance in ADLs while also increasing his depth of understanding regarding aforementioned benefits. Recommendations were provided to the client regarding home modifications in order to increase his success rate of independent ADL performance. The context was also considered in order to better serve the client. Adaptive equipment and durable medical equipment were determined to facilitate ease within transition to his home environment. The above mentioned goals, desires and outcomes are based on the client’s priorities and the roles and occupations he values. Client and Caregiver Training and EducationClient and caregiver education will be provided based on their level of health literacy through interactive communication with the therapist and staff. It is pertinent that the client and his mother recognize the benefits as well as precautions and contraindications regarding his diagnosis. Instruction and demonstration will be provided within all aspects of the interventions in order to ensure that the client understands the concepts being taught. Providing compensatory strategies involving energy conservation and adaptive equipment will help ensure client safety and awareness while improving overall physical performance. Collaboration with the client and his mother regarding COPD exacerbations, nutrition and exercise will be crucial to the client’s overall success in his daily activities. Providing uniformity within each treatment approach will encourage success by offering stability and decreasing confusion and frustrations.Client ResponsivenessThe client’s responsiveness to the intervention process will be monitored and acknowledged amongst the progression of goal achievement and assistance level during each session. Daily progress notes regarding assistance levels will be written in order to specifically determine and compare generalization and transferability of learned skills to various environments and contexts. If verbal cues and redirection exceed the suggested level of assistance, goals and intervention approaches will be adapted and modified to better suit the client’s current abilities. Activities will be graded up or down in response to the client’s performance and will be documented to verify the achieved outcome of treatment. The client shows great potential for success in completion of the interventions presented and is motivated to participate in activities that will help him gain independence in meaningful activities. Success within these activities will increase his ability to perform ADLs and IADLs necessary to further enhance overall independence and participation. ReferencesAmerican Occupational Therapy Association. (2014). Occupational therapy practice framework:Domain and process (3rd ed.). American Journal of Occupational Therapy, 68 (Suppl. 1),S1-S48. doi: 10.5014/ajot.2014.682006Bendixen, H. J., Waehrens, E. E., Wilcke, J. T., & Sorensen, L. V. (2014). Self-reported quality of ADL task performance among patients with COPD exacerbations.?Scandinavian Journal of Occupational Therapy, 21(4), 313-320. Retrieved from , V. & Jardim, J. (2006). Study of energy expenditure during activities of daily living using and not using body position recommended by energy conservation techniques in patients with COPD. Chest. 130(1), 126-132. doi: 10.1378/chest.130.1.126Ramos, E. M. C., Vanderlei, L. C. M., Ramos, D., Teixeira, L. M., Pitta, F., & Veloso, M. (2009). Influence of pursed-lip breathing on heart rate variability and cardiorespiratory parameters in subjects with chronic obstructive pulmonary disease (COPD).?Brazilian Journal of Physical Therapy,?13(4), 288-293. Retrieved from , J. A. (2002). Psychophysiologic effects of Hatha Yoga on musculoskeletal and cardiopulmonary function: A literature review.?The Journal of Alternative & Complementary Medicine,?8(6), 797-812. doi:10.1089/10755530260511810 ................
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