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Running head: OCCUPATIONAL PROFILE

Occupational Profile and Intervention Plan


Ayessa Escandar
Touro University Nevada

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Occupational Profile

Client
The client is a 74-year-old female named Jean Steiner, who currently resides in an
assisted living facility named Vintage Park San Martin in Las Vegas, Nevada. Jean was admitted
in the facility in May 2015 due to her progression of Alzheimers disease. The clients current
home/facility environment consists of 30 other residents who all have dementia. Specifically, the
environmental lay out of the facility consists of 15 bedrooms, one large living room, a dining
area, and a backyard. Jean was born and raised in McGill, Nevada. However, spent much of her
adult life moving from place to place due to her husband, Paul being in the military. Jean has two
children, a daughter named Jennifer and a son named David. Both of her children currently
reside outside of Nevada. Specifically, Jennifer and her family live in California, while David
and his family live in Arizona. Nevertheless, many of Jeans siblings and friends still reside in
McGill, Nevada and she continues to get many visits from friends and family. Some of the
activities Jean enjoys participating in, in the facility, are bingo, dancing, and arts and crafts.
However, before she was admitted to the facility Jean also enjoyed the occupations of knitting,
swimming, and gardening.
Needed Services
Prior to moving in the assisted living facility, Jean lived with her sister Elsa and her niece
Elaine. Both Elsa and Elaine were considered her family caregivers. However, when Jeans
Alzheimers disease began to increasingly progress, her family caregivers could no longer
independently take care of Jean. The burden of care was too much for her family members along
with a compromised safety environment for Jean if she continued to reside in her home.
Therefore, Elsa and Elaine, along with Jeans two children David and Jennifer all agreed that it

OCCUPATIONAL PROFILE

was time that Jean stayed in an assisted living facility that specialized with residents who have
dementia. Specific services that are provided in the facility are activities of daily living (ADLs)
assistance, medication administration, three daily meals, housekeeping and personal laundry
services, scheduled transportations, and recreational activities. Therefore, the Vintage Park San
Martin provided Jean with a safe living environment where she could access assistance from
staff members 24 hours a day, every day.
Current Concerns
Before Jean was admitted to the assisted living facility, her familys concerns were Jeans
home safety, inability to perform certain daily tasks without assistance, and overall her
Alzheimers progression. Specifically, because Jean presents a moderate stage of Alzheimers
she currently presents mood and behavior changes, disorientation about events, time and place,
forgetfulness about own personal history and facts, and trouble controlling bladder and bowel.
Therefore, to ensure Jeans safety she was admitted to Vintage Park San Martin. Now that Jean
resides in the facility, the current concern for her family is if Jean will adjust well in the living
environment. It is important to note that Jean recognizes and understands that she has
Alzheimers and knows that she is currently residing in an assisted living facility because of the
disease. Therefore, because Jean is aware of her condition her family fears that it will be more
difficult for her to adjust to the living environment because it is not her home. However, when
talking with Jean, she does mention that she would like to go home, but does not attempt to try to
leave the facility like other residents do. Another concern of the family, is of course, Jeans
inevitable progression of her Alzheimers. They fear that because Jeans signs and symptoms are
progressively getting worse that she is going to become less independent and that one day she
may not even be able to recognize her family members.

OCCUPATIONAL PROFILE

Occupational Success and Barriers


While observing Jean perform various occupational activities in Vintage Park San Martin
facility, she overall required minimal assistance on a few activities while displaying modified
independence on others. Specifically, because Jean was one of the newest residents, she was one
of the higher functioning residents that did not require much assistance compared to others. The
activities that Jean required minimal assistance with, depending on how she was feeling that day,
are with dressing, bathing, toileting, and self-care activities. Specifically for dressing, Jean
required help physical help putting on clothing and selecting appropriate attire. During bathing
activity, Jean sometimes required assistance lathering her body with soap and getting in and out
of the shower. For toileting, Jean could go to the restroom and perform the tasks of toileting with
modified independence. However, occasionally when she had a bowel or bladder accident in her
clothing she required minimal assistance to clean up. As for self-care activities, Jean is able to
perform combing her hair, brushing her teeth, and washing her face with modified independence.
However, when it comes to cutting her nails she requires minimal assistance to cut her nails in a
nice round shape. In addition to other activities that Jean performs with modified independence,
eating, mobility, and performing leisure activities are occupations that she requires no help but
just increase time.
Environmental Barriers
When speaking with Jeans family, one of the reasons they had her admitted to the facility
were due to environmental barriers Jean had while living at her home in McGill, Nevada.
Specifically, sometimes Jean goes through phases where she believes that her signs and
symptoms of her Alzheimers disease is not always present or that severe. Therefore, when living
in her home with her sister and niece, Jean would occasionally attempt to do activities

OCCUPATIONAL PROFILE

independently that she should not be performing due to safety considerations. For example, Elsa
stated that Jean enjoys cooking and that it used to be an occupation she would do on a daily basis
before she had Alzheimers. However, in her current stage it was not safe for Jean to cook meals
using an oven or stove for the fear the she could burn the house down or get herself hurt.
Nevertheless, when Jean was living at home, she had multiple attempts of trying to cook meals
because she believed she could still do it. Another incident at home where Jeans family feared
for her safety were incidents when Jean would walk to local areas in her community.
Specifically, Jean would attempt or in some cases would walk to her friends homes or to the
grocery store. Although the area of Jeans home was a small community where everyone knew
each other, Jeans family still feared that one day she could go missing or get hurt if she
continued to leave her home by herself even though she has been told not to do so.
Occupational History
Jean was born and raised in McGill, Nevada with her three siblings Elsa, Daniel, and
Alison. When Jean was 17-years-old she met the love of her life, Paul Steiner and wedded when
they were 18-years-old. Once Paul graduated high school he joined the navy and both Jean and
him moved to San Diego, California to start off their new life together. Throughout their many
years of being married, Jean spent the first 12 years of their marriage moving to different states
due to Pauls job. However, after Paul finished his military duties they finally settled back in
their home of McGill, Nevada where they continued to raise two children David and Jennifer.
Throughout Jean and Pauls marriage, Jeans occupation always entailed of being a homemaker.
However, once Paul opened a railroad business, Jean helped run the business while also
attending to her home duties. In addition to Jeans occupational history, this was an area in her

OCCUPATIONAL PROFILE

life that she really could remember. When communicating with Jean about past events she was
always very vivid about past memories and was fixated on stating the same stories.
Daily Life Roles
Jeans daily life roles consists of being a mother, sister, grandmother, and friend.
Although, Jean now resides in an assisted living facility keeping in contact with her family and
friends are very important to her. When getting to know Jean throughout the four weeks of
fieldwork, she spent almost all of her time talking about memories and events of her family and
friends. Even though there has been some role reversal between Jean and her children, such as
her son and daughter taking on more of a caregiver role, Jeans motherly role still persists. For
example, when Jean talks about her son David she is concerned that he may be having early
signs of Alzheimers disease. Jean understands that her children have a high percentage of having
Alzheimers disease because she has it. Therefore, because Jeans motherly role is still an
important and instinctive role for her, she still lectures David about staying healthy and seeing a
doctor at least once a year.
Values and Interests
Before Jean moved to the assisted living facility, some of the leisure activities that she
enjoyed doing were knitting, swimming and gardening. Specifically, Jean enjoyed knitting
because she loved giving knitted presents to her family and friends, such as pot holders, scarves,
and decorative pieces for their homes. Gardening was another leisure activity that Jean grew up
loving to do because it was a hobby that her and her mother use to do together. Lastly, an activity
that Jean use to do to stay physically healthy while enjoying quality time with her family was
swimming. Jeans describes that swimming was a weekly and necessary activity for her and her
family to beat the Nevada heat. Now that Jean resides in Vintage Park San Martin, the

OCCUPATIONAL PROFILE

activities that she enjoys participating in are bingo, dancing, and arts and craft activities.
Specifically, Jean describes that bingo is a fun game because it entails of winning a prize. In
addition, Jean enjoys marking arts and craft because she can decorate her room with the items
she has made or give it to her nieces and nephews when they visit.
Changes in Engagement of Occupations
The leisure activities that Jean use to participate in when she lived at home has changed
since moving in an assisted living facility. Jean describes that the leisure activities that she use to
do at home can either no longer be done in the assisted living facility or she does not have the
ability to do it any longer. For example, swimming is an activity that the facility does not provide
the residents an opportunity to participate in, therefore Jean has no allotted time to engage in it.
As for the activity of knitting, Jean stated that she could no longer knit because it has become a
taxing activity that is too difficult for her to complete. In addition, to other occupations that have
been impacted due to the increasing signs and symptoms of Jeans Alzheimers disease, are her
abilities to perform activities of daily living and instrumental activities of daily living (IADL)
independently. Specifically, Jean no longer engages in any IADL activities because she no longer
has the cognitive ability to do so. For example, one of the daily occupations and role of Jean was
being the cook of her household. However, since she was diagnosed with Alzheimers disease the
occupation of cooking transitioned from a simple to complex task that was too difficult and
unsafe to perform. As for ADL activities, Jean can still perform most ADLs with modified
independence, but her need for assistance has been increasing for the occupations of bathing,
dressing, and toileting.

OCCUPATIONAL PROFILE

Desired Outcome and Priorities


Jeans desired outcome is to maintain her level of function, physically and mentally, for
as long as she can. Specifically, Jean is one of the few residents that can functionally ambulate
without the use of durable medical equipment. Therefore, Jean would like to continue staying
physically strong so that she does not have to rely on caregivers to assist with ambulation.
Another important priority for Jean, is to be able to continue performing self-care activities with
minimal assistance. Specifically, Jean would like to continue to have the independence to
perform ADLs without having to wait for caregivers to attend to her. Lastly, the most important
priority for Jean is to be able to maintain her cognitive abilities, specifically the ability to lessen
memory loss.
Occupational Analysis
Context and Setting of Services
Jean currently does not receive occupational therapy (OT) services at Vintage Park San
Martin. However, Jean does receive 24 hour caregiving services and occasional nurse services at
the assisted living facility. Each day at the facility consists of three provided meals for Jean,
along with scheduled recreational activities that the residents can choose to participate in.
Depending on what activity is currently taking place, the activities could be held in the dining
hall, living room, or in the backyard. Specifically, most of the activities are held in the living
room which consists of a large open floor plan that can comfortably accommodates 30 residents.
In addition, the living room consists of reclining sofas and chairs, and portable tables so that the
residents can participate in scheduled activities that are provided by the staff members.

OCCUPATIONAL PROFILE

Client Performance
One activity that the residents participate in on a daily basis is a 15 minute morning
stretch after breakfast has concluded. This particular stretching activity consists of both
performing sitting and standing stretching exercises. Depending on each residents physical level
the resident can choose to perform the entire activity sitting down. Specifically for Jean, she is
one of the few residents who does not have to use durable medical equipment to assist with
functional ambulation. Therefore, Jean is able to perform the segments of the stretches that can
be done standing up in a standing position.
Key Observations
As Jean engaged in the stretching exercises, key observations that was observed was her
quality of movement and postural positions. As Jean sat in a seated position and performed
various bilateral upper extremity movements, her starting position consisted of a posterior pelvic
tilt, misaligned shoulders, and a kyphosis curvature of the spine. Jeans increase of abnormal
posture plays a factor in her quality of movements. Specifically, Jeans posterior pelvic tilt and
kyphotic position impacted her ability to perform stretches that required reaching forward and on
her side. In addition, Jeans misaligned shoulders appears to impact her ability to perform
symmetrical, bilateral upper extremity movements. For example, when Jean bilaterally reached
upward, her right upper extremity extended further than her left.
Domains of the OTPF
The most significant client factors that have impacted Jeans ability to successfully
engage in her daily occupations is her decrease of mental functions (American Occupational
Therapy Association [AOTA], 2014). Specific mental functions that have been affected due to
Alzheimers disease are Jeans memory, executive functions, and emotional regulation abilities

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(AOTA, 2014). Jeans decrease of memory has been most evident when she shares stories about
her family, however cannot quite remember every persons name or how they are related to her.
In addition, Jeans inability to recall the location of where she places her personal items in her
room has caused many instances of misplaced or lost belongings. Specific loss of executive
function, such as planning and executing have also caused significant impact in Jeans ability to
perform ADLs. For example, Jean has difficulty completing dressing and bathing independently
because she is unable to determine the necessary steps that she needs to perform next in order to
accomplish the whole activity. Lastly, Jean also demonstrates challenging emotional regulation
behaviors, such as restlessness. Specifically, when Jean cannot find an item in her room she will
not engage in any leisure or ADL activities until the item has been found.
Problem List
1. Client occasionally cannot recall family members when looking through photo albums due to
decrease of memory abilities.
2. Client requires Min (A) in dressing due to inability to properly sequence the necessary articles
of clothing.
3. Client occasionally urinates in her pants due to inability to recognize the sensation of needing
to use the toilet.
4. Client requires occasional assistance in searching for personal belongings in her room due to
inability to retrace steps.
5. Client requires Min (A) in bathing due to inability to think & plan about the various tasks
necessary to complete an entire bath.

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Prioritization of Problem List


The number one priority for the client is to continue to be able to recognize her family
members and friends in person and through photos. Specifically, Jean enjoys sharing stories
about her family and encourages visitors to look through her photo albums. The one problem that
Jean demonstrates as she showcases her photos in her room, is her decreasing ability to recognize
the individuals in the photo and where the photos were taken place. However, when Jean revisits
her photo albums in another time of the day, she can periodically recall and recognize individuals
in the photos whom were unrecognizable earlier in that day. Therefore, because Jeans family
plays great importance in her life, maintaining her cognitive abilities is an important problem
that should be addressed.
The second priority of the client is to be able independently dress herself in the morning
and before she goes to bed. This is an important goal for Jean because she has expressed that she
cannot start and end her day without wearing the proper attire necessary to engage in daily
activities. However, one problem with requiring assistance with dressing is that Jean has to wait
for a staff member to attend to her before she can continue with her day. Specifically, in some
cases staff members could take increasing amount of time before they could assist Jean because
of the number of other residents who also need assistance with dressing. Therefore, Jean has
resorted in some instances to independently dress herself, but often gets frustrated and
emotionally exhausted when trying to select and sequence the proper attire.
The third priority of the client is to be able manage bladder incontinence. Specifically, her
top priority with bladder management is to be able to recognize when she needs to use the
bathroom and reacting quickly enough to the sensation of needing to use the toilet. One
particular situation that bladder leakage occurred was when a musical band came to the facility

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to play live music for all the residents. Jean expressed that when she realized that she had
urinated in her pants in front of the facilitys guests, she felt increasingly embarrassed about the
situation because everyone could see that a large wet area was emerging on the back of her pants.
Although, toileting accidents seldomly occur for Jean, she is afraid that this is the beginning of a
regular toileting problem that could continue to progress to a severe issue.
The fourth priority for the client is to be able to manage her personal belongings, such as
having the ability to independently locate items in her room that she needs. Specifically, Jean has
occasionally misplaced items that she considers as important due to the fact that she cannot recall
the last place where she kept it. However, this is not considered one of the top three priority
problems because the ability of maintaining her cognitive functions will be addressed through
the first priority interventions.
The fifth priority of the client is to be able to bathe herself with caregiver supervision
instead of Min (A). Specifically, because bathing is an activity that is hazardous and can increase
risk for falls, having a supervision level of assistance, should be maintained to ensure Jeans
safety. In addition, because the activity of bathing does not occur on a daily basis for Jean,
bathing was not one of the top three priorities.
Intervention Plan and Outcomes
Long-Term Goal 1
Client will create a scrapbook of family members & friends cc assist. from family members by 6
sessions.
Short-term goal 1. Client will create a family tree cc VC assist. by 2 sessions.
Intervention. Client will participate in an occupational-as-a-means activity that consists
of baking brownies. The client will first construct a sequential list on the necessary steps for

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baking brownies, then will bake the brownies with assistance once the written steps are
complete. The list of steps for baking brownies will elicit the same intervention strategies for
creating a family tree by having Jean recall familiar information in an orderly fashion.
Specifically, the purpose of creating a family tree is for Jean to stimulate long-term memory
while engaging in a task that is meaningful. Just as family is important to Jean, cooking was once
an occupation that was important and that she enjoyed. Therefore, baking brownies is an activity
that can be fun and motivational for the client. The intervention approach is to prevent increasing
cognitive declines, such as decrease in memory, by promoting activities that require the client to
recall past information and memories (AOTA, 2014). Lancioni, Pinto, Martire, and Tatulli (2008)
stated that instructional strategies are considered essential to improve the overall cognitive and
functional conditions of a person with deterioration caused by Alzheimers disease (Lancioni,
Pinto, Martire, & Tatulli, 2008). Therefore, the intervention outcome is for the client to
participate in an activity that she enjoys while recovering the ability of performing an occupation
that she use to do (AOTA, 2014).
Short-term goal 2. Client will categorize & label chosen photos for a scrapbook cc VC
assist. by 3 sessions.
Intervention. Client will participate in an arts and craft leisure activity that will be
utilized to increase cognitive stimulation by creating a scrapbook memory aid. Requena, Maestu,
Campo, Fernandez, and Ortiz (2006) research suggest that cognitive stimulation is effective at
improving cognition and that a combination of cognitive stimulation and medication is the most
effective (Requena, Maestu, Campo, Fernandez, & Ortiz, 2006). Specifically, the scrapbook will
serve as a form of cognitive stimulation that will assist Jean in remembering faces, places, and
names. Therefore, with the assistance of family members and the therapist, the client will choose

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and label each photo with the individuals names and the places the photos occurred. The
approach to the intervention is to restore memory loss by providing techniques that enable the
client to retain memory functions (AOTA, 2014). The process of creating the scrapbook and the
finalized product will be utilized as a coping technique for memory loss that will provide Jean
with the ability to separate fact from fiction and remembering past events. The outcome of the
intervention is to improve and enhance quality of life by retaining the clients confidence and
independence for as long as possible (AOTA, 2014).
Long-Term Goal 2
Client will dress herself & select appropriate clothing for both morning & night attire cc Mod (I)
by 6 sessions.
Short-term goal 1. Client will select appropriate attire for a family outing cc less than 2
VC by 2 sessions.
Intervention. Client will participate in activities that consist of environmental
modifications and compensatory strategies. In order for the client to participate in the ADL
activity of dressing, specifically selecting an appropriate attire to go out with family members.
The intervention will consist of modifying her closet so that the client will not be overwhelmed
when selecting certain articles of clothing. Specifically, the environmental modification will
consist of reorganizing her closet so that all her clothes will be in order (from top to bottom),
such as the top shelves will consist of items she will put on first, while the bottom shelves will
consist of items she will put on last. In addition, the client will also label each shelf with the
appropriate name of specific clothing and label the steps for dressing in order to maintain
organization and assist in remembering the proper steps. The intervention approach is to modify
the clients environment to simplify the task sequence and assist with cognitive impairments in

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completing dressing routine (AOTA, 2014). Chard, Liu, and Mulholland (2009) stated in a study
that environmental modifications for persons with Alzheimer disease can improve performance
in ADL in those living in as assisted living facility (Chard, Liu, & Mulholland, 2009).
Specifically, this study looked at clients functional change with the use of environmental
modifications and found that it was an effective method for improving engagement (Chard, Liu,
& Mulholland, 2009). Therefore, the intervention outcome is for the client to be able to improve
performance in dressing routine by modifying the environment to suit Jeans needs (AOTA,
2014).
Short-term goal 2. Client will dress herself in the morning cc Mod (I) using dressing A/E
by 3 sessions.
Intervention. In order for the client to successfully dress herself with modified
independence, Jean will be trained in the use of dressing adaptive equipment. The use of adaptive
equipment is important for the client to utilize because individuals who have Alzheimers disease
not only face cognitive challenges, but physical challenges as well. For example, clients may
experience a decline in muscular strength and range of motion. Therefore, Jean will be
specifically trained on the use of button hooks, zipper pulls, shoe horn, and sock aid to assist her
in dressing independently. The intervention will also consist of practicing the use of dressing
adaptive equipment of various different articles of clothing and everyday items that consists of
buttons and zippers. The intervention approach is to modify Jeans dressing routine, such as
simplifying the task to assist with physical declines (AOTA, 2014). Swann (2008) stated that
dressing can be one of the most difficult activities to accomplish for people with cognitive and
physical impairments due to the upper limb strength, range of movement, functional grip,
dexterity, and sensation needed to complete the activity (Swann, 2008). Therefore, scholarly text

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encouraged the use of adaptive equipment to gradually reduce the range of active movement and
assist people who have problems with dexterity and other impairments (Swann, 2008). The
intervention outcome is to improve occupational performance by providing compensatory
strategies that will make the activity possible to complete independently (AOTA, 2014).
Precautions and Contraindications
Some precautions and contraindications that is important for therapist to be aware of for
clients with Alzheimers disease are wandering, behavioral impulsivity, and safety awareness.
Specifically, it is important to be alert to wandering behavior and prevent wandering away from
safe environment because this could potentially place Jean in a harmful situation. In addition, a
safe environment is necessary to reduce the risk for falls because many clients, like Jean, are
experiencing physical declines such as a slower and less coordinated gait pattern. Behavioral
impulsivity, such as verbal and physical aggression may also be prevalent during specific hours
of the day and in most cases for Jean this occurs during sun downing. Therefore, scheduling
activities or therapy sessions should be best planned during the hours when Jean experiences less
behavioral impulsivity.
Frequency and Duration
The frequency and duration of the specific intervention plan will take place once a week
for 60 minutes for the next two months. However, the continuation of OT services should
continue even after she has accomplished her two long term goals because Jean can continue
benefitting from OT services in other areas of her life and as the Alzheimers disease progresses.
However, because Vintage Park San Martin is a memory care assisted living facility, which is
considered a non-traditional setting, insurance companies typically do not cover OT services or
will not cover it for extended period of time.

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Grading Up and Down


One of Jeans intervention consists of listing steps for baking brownies as an occupationas-a-means activity. One example or grading up the activity would be to list steps for creating a
more complex meal, such as making spaghetti with meat balls from scratch. This activity would
be considered grading up because listing the steps of making spaghetti would require more steps
compared to baking brownies. One example of grading down the activity would be to list the
steps of pre-made brownies in comparison to listing the steps of making brownies from scratch.
This activity would be considered graded down because the steps required of making pre-made
brownies requires less ingredients then making brownies from scratch.
Primary Framework
The Canadian Model of Occupational Performance (CMOP) was the theoretical
framework that was utilized when creating an intervention plan for Jean. Specifically, the CMOP
takes into consideration the relationship between the person, environment, occupation, and most
importantly spirituality. For the client, Jeans spirituality towards maintaining personal
relationships with family members, such as having the capability to remember who they are and
past events that they share together is a meaningful occupation that intrinsically motivates her to
achieve meaningful goals. Therefore, because the CMOP uses spirituality as the core of the
model, Jeans most meaningful occupations was prioritized and used as a goal setting. Therefore,
selecting appropriate interventions was geared towards maintaining independence and
compensatory strategies that addressed cognitive retraining that enhance memory skills.
Client Training and Education
Client training and education will be addressed during the intervention such as training
on the use of compensatory strategies for the daily occupation of dressing. Specifically, Jean will

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be trained on the use of dressing adaptive equipment, such as on how to utilize a reacher, button
hook, zipper pull, and sock aid during the various components of dressing activity. Jean will also
be educated on how to dress herself using a step by step instruction guide and how to utilize her
re-organized closet. Specifically, it is important to educate Jean on the importance of placing
clothing articles in the correct labeled spaces to ensure that when selecting appropriate wardrobe
she will not become overwhelmed and frustrated with locating items.
Response to Intervention
Jeans progression in her goals will be assessed and monitored using the Canadian
Occupational Performance Measure (COPM) and through the use of daily progress notes.
Specifically, the COPM will be utilized in the beginning and the last session of her intervention
plan to determine if there is an increase in her performance and satisfactory levels. The COPM
would be a good assessment tool to utilize because it not only assesses how Jean performs her
occupation but takes into account how satisfied she is with her performance level. Although, the
COPM will only be utilized at the beginning and end of the intervention plan, daily progress
notes will also be closely monitored to determine daily progression.

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References
American Occupational Therapy Association [AOTA]. (2014). Occupational therapy practice
framework: Domain and process (3rd ed.). American Journal of Occupational Therapy,
68(Supp.1), S1-S48. doi:10.5014.ajot.2014.682006
Chard, G., Liu, L., & Mulholland, S. (2009). Verbal cuing and environmental modifications:
strategies to improve engagement in occupations in persons with Alzheimer disease.
Physical & Occupational Therapy in Geriatrics, 27(3), 197-211.
doi:10.1080/02703180802206280
Lancioni, G., Pinto, K., Martire, M., & Tataulli, A. (2009). Helping persons with mild or
moderate Alzheimers disease recapture basic daily activities through the use of an
instruction strategy. Disability & Rehabilitation, 31(3), 211-219.
doi:10.1080/09638280801906438
Requena, C., Maestu, F., Campo, P., Fernandez, A., & Ortiz, T. (2006). Effects of cholinergic
drugs and cognitive training on dementia: 2-year follow-up. Dementia and Geriatric
Cognitive Disorders, 22, 339-345. doi:10.1159/000095600
Swann, J. (2008). Managing dressing problems in older adults in long-term care. Nursing &
Residential Care, 10(11), 564-567. doi:10.12968/nrec.2008.10.11.31415

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