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Running Head: OCCUPATIONAL PROFILE & INTERVENTION 1

“Callie” An Acute Care Patient with Alzheimer’s: Occupational Profile & Intervention Plan

Lauren A. Hawkins

Touro University Nevada

OCCUPATIONAL PROFILE AND INTERVENTION 2

Occupational Profile

Patient

The patient is a pleasant 82-year-old female named “Callie”. Callie is a patient who has a

history of Alzheimer’s dementia, most likely in the beginning to middle stages. Before her

admittance to Centennial Hills Hospital, Callie received the diagnoses of bronchitis and a urinary

tract infection (UTI) in an urgent care clinic in Las Vegas, Nevada. The physician prescribed her

Levaquin in order to manage the bronchitis. Even after the medication, Callie reported chills,

fever, unproductive cough, and stopped eating and drinking. Soon after receiving those

diagnoses at the urgent care clinic, Callie woke up with pain in her right shoulder and a large

bruise on her right cheek. Her daughter and son-in-law took her to the emergency department

for an examination.

In the emergency department, she received an x-ray for her shoulder pain. In addition,

the doctor completed a quick assessment of her current mental status. She was admitted for a

right displaced distal clavicle fracture and declining mental status. Her family reported that her

mental condition has been deteriorating. She has a history of a wrist fracture and hip fracture,

both with unknown causes. She also has a history of smoking cigarettes and hypertension. The

medical report stated that she currently smoke. However, it is unsure how much or if she is

receiving assistance from her family to continue this habit. Callie was unable to recall falling or

the cause of the injuries. Her family noted that she had been hallucinating for several days prior

to her hospital admission. Upon admittance, Callie reported living with her daughter and son-in-

law in a single-story home. She is retired and has been for at least 15 years and is a native to the

Las Vegas area. Callie had been on the orthopedic floor of the hospital for one day prior to the

occupational therapy evaluation. Her hallucinations were minimal after one day and she was not

a risk to herself or others.


Purpose of Evaluation and Patient Concerns

The patient was referred to occupational therapy services by her admitting physician for

education on clavicle fracture precautions and skilled instruction in activities of daily living

(ADLs) while maintaining those precautions. In addition, the doctor needs an assessment on

Callie’s level of cognition and mental status, as it has been recently declining. The therapist

recommended providing strategies for the patient to increase independence and safety due to her

dementia. The patient was unable to voice her concerns regarding her occupations, however her

daughter was concerned about her mother’s ability to return to living in her household and

complete ADLs with modified independence to minimal assistance.

Again, Callie was unable to express her barriers, but with information from her daughter

and clinical observation, the therapist can infer some barriers. The patient’s dementia and

general body weakness has made it impossible for her to live independently and complete many

activities without assistance. She requires verbal cues from her daughter and son-in-law in order

to complete ADLs. Due to her body weakness and impaired balance, she does not complete any

IADLs such as meal preparation or driving, as her family considers it too dangerous for her.

Callie did not state when she felt successful, as she was confused throughout the treatment

session. Success should come for her when simple activities are completed with minimal

dependence. Prior to her accident, she was able to dress herself occasionally and bathe herself

with modified independence. Continuing these skills would be a success for Callie.

Due to Callie’s dementia, she has difficulties completing her role as mother. Currently

her daughter takes care of her, reversing their roles. She has not been a worker for some years.

The patient was unable to recall her career when she was younger. Callie’s daughter stated that

as her dementia has progressed and she has become more debilitated, her roles and occupations


have changed. She has spent less time talking and playing on the computer. Her daughter stated

that when she feels good, she would play her computer game for hours on end. Since her injury,

she has been unable and uninterested in playing. She spends most of her time indoors and enjoys

completing crossword puzzles and word searches. She watches television with her family at the

end of the night prior to going to sleep.

Callie was unable to state her interests and occupations completed at her home.

According to her daughter, there is a dog in her house, but Callie does not have any part in caring

for it. Her daughter said on her better days she enjoyed taking short walks around the

neighborhood, watching television at night, but mostly she played the computer game. She said

this game has been her main source of entertainment for the past 15 years. Other than the few

activities mentioned, Callie does not have any other stated interests.

Patient and Family Goals

Callie’s daughter was able to discuss her goals for her mother, as she serves as her

caretaker. Her daughter would like her mother to return to live with her. Discharging Callie to a

skilled nursing facility or memory care unit will be last alternatives. She would like Callie to be

able to complete her ADLs with modified independence to minimum assistance as she was

before her injury. In addition, her daughter wants to prevent another injury similar to this one.

Her daughter worries about leaving her mother unattended, however, she works full-time in the

community, validating this concern.

Since Callie’s dementia has progressed, her muscles have weakened and her body overall

is debilitated. This may be due to the actual progression of the disease or her decrease in

physical activities due to more time spent in bed and less interest in activities. This has

decreased her health and wellness. Her current smoking habit also contributes to this decrease.


Occupational Analysis

Context of Occupational Therapy Evaluation

The occupational therapy session occurred in the patient’s hospital room for 30 minutes.

The reason for the session was an evaluation. During the evaluation, the therapist focused on the

impact Callie’s dementia had on her overall cognition. The therapist was concerned with her

ability to return home safely, recall and follow her precautions secondary to her clavicle fracture,

and her levels of independence with various tasks. When we first entered Callie’s room, she

alerted us that she had wet herself. The therapist utilized the task of changing her adult

undergarment to evaluate Callie’s abilities. This activity is considered an activity of daily living

(ADL) in the Occupational Therapy and Practice Framework (OTPF; American Occupational

Therapy Association [AOTA], 2014). It is under the category of toileting and toilet hygiene.

Occupational Performance

Callie was able to follow directions if repeated several times by the therapist. She

required verbal cues throughout the task. She was able to use her arm strength to roll to one side

with the assistance of the bedrails. The therapist asked Callie to stand in order to put a clean

undergarment on her. She was considered contact guard assistance for standing, but when asked

to take several steps forward, she required minimal assistance. Standing and walking both were

quite uncomfortable for Callie as evidenced by her grimacing and repeated asking if she can sit

down yet. Due to the nature of the activity of assisting the therapist with the undergarment

change, the therapist was able to able to assess her cognition in addition to her physical abilities.

It was positive that Callie was able to recognize that she soiled herself. It shows that she

still has recognition and communication abilities. While the therapist was preparing to change

the undergarment, she assessed Callie’s memory and recall ability. She was asked the date and


why she was in the hospital in order to evaluate her alertness and orientation. She was unable to

provide the date, but was able to state that she “broke her shoulder” in reference to why she was

in the hospital. To evaluate her memory further, she asked questions about her home life

including whom she lived with, what type of house, and how she injured herself. She was able

to provide whom she lived with and that they lived in a one-story house. As previously

mentioned, she was unable to recall the cause of her injury. She was quite confused throughout

the session and only answered questions about 50% of the time, sometimes only with additional

prompting from the therapist. Overall, her memory was consistent with her diagnosis of

Alzheimer’s dementia as she lacked awareness to the present and struggled with long-term

memory.

Key Observations

There were several key observations I picked up from this evaluation session. First, was

that Callie’s body was quite debilitated. She was weak in both her upper and lower extremities,

making standing extremely difficult when she is unable to use her upper extremities to assist in

rising out of bed. This poses a great safety risk, as her standing balance is poor. Though she

cannot remember the cause of her clavicle fracture, her family believes she tripped or fell and

was unable to right herself. In comparison to her standing balance, her sitting balance was

acceptable as evidenced by her ability to sit on the edge of bed for several minutes while the

therapist was cleaning her and changing her undergarment.

Another observation was that her memory and attention was quite impaired, as was

expected for her diagnosis of Alzheimer’s dementia. This is important for several reasons. The

first is that she has precautions to maintain for her right clavicle fracture. According to the

occupational therapist, with her right arm, she is unable to raise it, extend it, or cross midline


with it. She is unable to recall these precautions due to her confusion and difficulties with

memory, which increases her risk for further injuring her clavicle. Her memory impairments

also make medication management difficult, as she is unable to remember to take her

medications without prompting from her daughter. Callie also does not complete any cooking in

the house, most likely because she lacks the attention span and short-term memory to complete

the task safely. This raises questions of the occupational therapists referral for Callie’s

placement post-discharge since Callie has difficulty completing basic ADLs independently or

even with supervision.

Affected Domains

Due to the deficits caused by the rehabilitation diagnosis of right broken clavicle, several

of Callie’s domains are affected as specified by the OTPF. Callie’s occupations are most

affected. She was able to complete most of her ADLs with modified independence prior to her

clavicle fracture. Due to the clavicle precautions imposed on her, she is unable to use both hands

to complete tasks as she had previously, such as face washing, dressing, and bathing. Her

increased debility has negatively affected her endurance, lifting ability, and flow while

completing simple tasks. In combination with her debility, her balance makes it difficult to

stabilize herself while walking and navigate through a room, which may be the cause of her

clavicle fracture.

Her diagnosis of Alzheimer’s was also a reason she was admitted to the hospital. Within

the past week, her memory and overall cognition has significantly decreased, affecting the

performance of her occupations. Callie is unable to complete her role as a mother due to her

cognitive deficits secondary to the dementia. Most aspects of her processing skills are affected.

She is unable to attend and heed to tasks due to decreased attention. In addition, she


demonstrates difficulty sequencing simple tasks as demonstrated by difficulties following

directions for bed mobility to assist the therapist with changing the undergarment. These

cognitive deficits in combination with the physical deficits make her a safety risk, as she is

unable to attend to tasks, such as walking in her room, while also having poor stabilization while

walking.

Callie also displayed several bouts of frustration throughout the session, which is

expected due to her altered orientation to people and place. While the therapist was providing

her directions to assist her in the changing task, Callie commented, “I’m frustrated. I hurt and I

don’t know what to do”. This indicates the difficulties Callie has with understanding reality and

the impact that has on her as a person. She is surrounded by unfamiliar faces and in a strange

place, which is difficult for her to comprehend as it has broken her familiar routine. In addition

to the inability to adapt and generalize to different situations, Callie has difficulty with social

interaction skills. She does not look or turn toward the social partner. She also has difficulty

replying to questions asked by the therapist, as evidenced by her needing prompting to respond

to questioning. She consistently repeated the same questions throughout the session, which is an

example of regulation. All of these deficits together exemplify her difficulties participating in

her daily occupations. The physical and cognitive deficits pose a safety and independence

concern while her social deficits demonstrate her difficulties with getting the necessary care,

including medical care, due to her inabilities to express her thoughts and needs.

Patient Problems

From the evaluation of Callie, I can infer several problems that are relevant to her and are

affecting her daily life. The following are in order of importance of the patient.


1. Callie requires moderate assistance while completing grooming tasks due to right clavicle

precautions and decreased short-term memory.

2. Callie requires minimal assistance for functional ambulation due to decreased balance

and overall weakness due to increased time in bed.

3. Callie requires >three verbal cues in order to complete a simple task due to deficits in

sequencing.

4. Callie requires minimal assistance for self-feeding due to incoordination while utilizing

her non-dominant hand to feed and weakness.

5. Callie requires minimal assistance for bed mobility due to body debility and a right

broken clavicle.

Justification of Patient Problems

One of the goals her daughter mentioned was that she wanted her mom to return home

and to complete her ADLs as she did previously with modified independence. This is a problem

as her daughter has difficulty providing her the moderate assistance she currently needs. Due to

this increase in assistance, an increase in the caregiver burden on her daughter and son-in-law

has occurred. The cause of the increase comes from her inability to employ the precautions

during the activities, causing her pain and discomfort. In addition to the pain, it is a necessity to

maintain the precautions for the healing process. Therefore, this ranks as first on her problem list

due to the need to instruction and education from the therapist on compensatory strategies to

maintain the precautions with the potential implementation of adaptive equipment (A/E).

Completing her ADLs is one of the few tasks she can will be able to complete with only

modified independence. Therefore, assisting her to rehabilitate her abilities will decrease the

caregiver burden and help Callie feel successful.


Difficulties with functional ambulation ranks second on Callie’s problem list due to the

safety risk it creates. From the evaluation, it became obvious that when she stands, it is difficult

to right herself. This becomes more troublesome for Callie when she tries to walk. Her daughter

stated that they have various types of durable medical equipment (DME) at home, but her mother

does not use it. That information, in combination with observations, makes her therapist aware

that she is a fall risk. If she did fall to fracture her clavicle, then we need to work on her balance

and potentially reeducate her and her family on the importance and proper use of DME. In

addition, Callie would benefit from exercises improving her balance and endurance.

The need for caregiver cues and prompts to complete simple tasks again increases the

caregiver burden due to the increased time needed to complete tasks. This is an issue because

she requires supervision for nearly every task she completes. This is ranked third on her list due

to the need for her to correctly sequence tasks in order to increase her independence. Sequencing

is involved in many ADLs such as brushing teeth, bathing, and toileting and toileting hygiene.

For her to increase her independence and return to her previous level of functioning as modified

independent, she needs to improve on her sequencing abilities and potentially adopt strategies for

assistance.

When discussing Callie’s medical history with her daughter, she noted that Callie has not

been eating as much lately. This may be due to her bronchitis and overall “feeling sick” as she

reported. However, many patients with Alzheimer’s struggle to eat when the disease manifests.

Callie and her caregivers need to receive education on the dangers of malnutrition and extreme

weight loss which many persons with Alzheimer’s experience. In addition, there are several

strategies such as creating a dinner routine and modifying the textures of food to encourage


Callie to begin eating once again. Due to the simple suggestions that could be implemented when

she returns home, this is ranked fourth on her list.

Callie requires minimal assistance for bed mobility due to the difficulties maintaining her

clavicle precautions and overall body weakness. Callie could not comprehend that she was

unable to utilize her right arm to move from supine to edge of bed. Due to her lack of

understanding, Callie needs to receive instruction on compensatory methods to move to edge of

bed. Numerous strategies can be utilized in addition that this form of bed mobility is only

temporary; therefore, this problem is ranked fifth on the list of importance. In addition, many

patients with Alzheimer’s experience delirium when entering an unfamiliar place. Once her

delirium diminishes, Callie may regain the cognition to understand her clavicle precautions.

Intervention Plan

Long-Term Goal 1: Patient will utilize a checklist in order to complete grooming tasks for her

morning routine with modified independence within five sessions.

Short-term goal 1. Patient will type a checklist of her typical morning routine with

supervision within one session with less than four verbal prompts.

Intervention. Since the patient has knowledge about using technology and is unable to

use her dominant hand for writing, she would be able to type the checklist. In addition, she

enjoys spending time on the computer as evidenced by her time spent playing her computer

game. The therapist will be available for supervision assistance and verbal prompting, but the

patient will be in control of typing the list and stating what her morning routine used to and now

will consist of. According to research, it is important for patients to keep the same schedule

when possible due to memory issues that accompany Alzheimer’s dementia (Abreu & Yancy,

2011). One way to keep this consistent is by utilizing a checklist. In addition, when at all


possible, the patient should be given the opportunity to make choices or make their own

decisions (Hellen, 1998). However, the therapist will be supervising to make appropriate

suggestions or prompt the patient. The intention is that the patient will be more willing to

engage in the process due to the use of the computer.

The most appropriate intervention approach for this goal is creation. According to the

OTPF (AOTA, 2014), creation occurs when the patient is provided with new experiences or

techniques in order to enhance occupational performance. Since Callie did not have a checklist

or daily schedule prior to occupational therapy, this is a new technique for her. By providing this

for her, the therapist hopes to enhance her occupational performance and independence within

her natural environment. The expected outcome for this intervention will be participation. Since

Callie enjoys spending time on the computer and has been unable to due to her sickness,

participating in this occupation should be personally satisfying (AOTA, 2014).

Short-term goal 2. Patient will wet the toothbrush, put toothpaste on the brush, and

complete the task of brushing teeth using her non-dominant hand with supervision within two

sessions with one verbal prompt or less.

Intervention. The patient will practice brushing her teeth as a step towards her long-term

goal of completing her morning routine with modified independence. The therapist will need to

break the steps of this task down, as simplifying the task often helps patients comprehend the

task (Hellen, 1998). The patient may struggle initially due to the use of the non-dominant hand,

however, the hope is that she will be able to adapt while her dominant shoulder is healing.

Wood, Womack, and Hooper (2009) state that encouraging independence and participation in

activities, such as hygiene and grooming, can increase a patient’s quality of life. Therefore,


when the patient is able to complete a task, staff need to provide the opportunity and the proper

support.

Modification is the most appropriate intervention approach according to the OTPF

(AOTA, 2014). Underneath the term of modification is compensation, which is what Callie is

doing with this intervention. The therapist is encouraging her to complete her ADL activity of

oral hygiene by utilizing her unaffected non-dominant hand. This strategy is promoting

participation in activities by ways of compensating for the disability. The overall outcome of the

intervention is to improve her performance in the occupation of oral hygiene. She was able to

complete this activity before; therefore by modifying it, we are improving her current level back

to where she was prior.

Down grading. If the patient is unsure during the task, the therapist may grade the task

down by mirroring the task by brushing their teeth with their own toothpaste and toothbrush to

demonstrate the task to the patient. The task may further be graded down by having the therapist

complete set-up for the patient by squeezing the toothpaste onto the toothbrush and wetting it.

Up grading. If the patient is making progress with the task, the therapist may add another

step to the task as having to retrieve the toothbrush or toothpaste from the medicine cabinet or

drawer in their hospital room. This adds another cognitive component to the task.

Long-Term Goal 2: Patient will functionally ambulate at least 20 feet in the hospital waiting

room while using a front-wheeled walker with modified independence in five sessions.

Short-term goal 1. Patient will complete a dynamic standing activity for three minutes

while completing a simple task with supervision within two sessions.

Intervention. As stated in the occupational profile, in the past, the patient has enjoyed

working on either word searches or crossword puzzles. Though she has not completed any


recently due to her acute delirium, she previously enjoyed this leisure activity. Creating

interventions around the patient’s interests helps them accept the treatment according to

researchers Letts and colleagues (2011). Therefore, by including a familiar and enjoyable task

during Callie’s treatment, she should be more engaged and willing to stand. Because she is

weak, has low endurance, and has deficits in balance, she would not want to stand on her own.

By including an enjoyable leisure activity, she should be more engaged to increase her endurance

and overall balance, therefore using this intervention as a means to the end goal of functionally

ambulating. Therapists are always encouraged to utilize meaningful activities within

interventions for this population as it promotes normalization in their life (Hellen, 1998).

The most appropriate intervention approach for each idea for this goal is restoration.

Before her fall and stay in the hospital, Callie was able to stand and ambulate with no assistance.

Due to her increased time in bed and lack of eating, Callie has become weak and her balance has

suffered. Since this is an acute impairment rather than a chronic one, the restoration approach is

applicable. We can help restore Callie’s dynamic standing balance as should not be permanently

impaired due to her fall. This outcome will focus on both occupational performance

improvement and participation. We want to improve Callie’s ability for dynamic standing, but in

addition, we also want her to participate in occupations, specifically leisure activities, that she

previously found enjoyable. By doing this, she could enhance her quality of life and fulfill a

desire she has.

Short-term goal 2. Patient will functionally ambulate to the restroom in her hospital

room utilizing adaptive equipment with modified independence within two sessions.

Intervention. The patient will utilize her front-wheeled walker in order to functionally

ambulate to the restroom. The purpose of this intervention is to work on the actual activity of


ambulating with modified independence of the adaptive equipment. This activity is simpler than

ambulating in the waiting room due to the lack of obstacles and varying terrain as the waiting

room will have (ex: tile, carpet, etc…). Before her injury and acute onset of delirium, she was

able to ambulate to the restroom by herself and complete the activity of toileting and toileting

hygiene with supervision. We need to continue to work on this in order for her to increase her

independence in this ADL. Since she is a fall risk, this becomes even more important that she

gains strength, confidence, and the ability to utilize adaptive equipment for safe ambulation

(Hellen, 1998). Researchers Jensen and Padilla (2011) noted successful interventions that

utilized standing balance, ambulation, and increasing endurance were all utilized to decrease fall

risks. This specific intervention is utilizing the ambulation as a means to an end.

Two intervention approaches are most appropriate for this goal instead of a single one. In

one respect, we are restoring Callie’s strength and endurance to help her return to functionally

ambulating as she was prior to the fall. In comparison, we also are working educating her with

adaptive equipment and strategies in order to prevent another fall, which according to the OTPF

(2014) would be prevention. These two approaches work together. If we do not restore her

previous levels of endurance, strength, and balance, then we cannot prevent an injury from

happening. However, providing her with education and equipment will also help prevent it from

reoccurring. Therefore, this goal would benefit from two intervention approaches. Similar to the

intervention approaches, the outcome will focus on prevention as well. We want to prevent

Callie from falling again. By implementing this intervention, we hope to give her body what it

needs and the education for equipment to prevent it.

Precautions and Contraindications


Due to the complexity of Callie’s diagnoses, the therapist must keep in mind several

precautions and contraindications while working with her. One precaution a therapist must keep

in mind is that persons with Alzheimer’s dementia get distracted very easily. Their attention is

limited. Working on improving attention and understanding that it is a normal aspect of

dementia will help the session run smoother. Another precaution is that these persons often have

poor judgement. They may think they can do tasks that they cannot. The therapist should be

supportive if the patient wants to attempt a new task, however, they must be close by, possibly

have a helper, and use clinical reasoning and stop the task if it gets too dangerous (Hellen, 1998).

Another precaution of working with her is her cognitive and emotional instability.

Patients with dementia often have aggression and agitation, though it occurs mostly in the later

stages. However, because Callie is in an unfamiliar place and completing things she does not

want to do, agitation is a possibility. If this occurs, the therapist should attempt to reframe and

refocus the patient and attempt calming strategies (Hellen, 1998). If they are unable to calm

down, their agitation turns into a contraindication. The therapist should alert nursing staff,

determine the patient is in a safe place, and should stop the session.

One contraindication is working with the patient past mid-afternoon (~2:00 p.m.) if the

patient is known to sundown. Sundowning occurs is the mid to late afternoon and early evening.

The patient will grow restless, agitated, paranoid, and potentially combative (Hellen, 1998). It is

contraindicated to complete treatment during this time, as it will be unproductive and potentially

harmful. Hyperorality is another symptom of Alzheimer’s that can be dangerous. Hyperorality

occurs when the patient has the urge to put all objects in their mouth. Including certain toxic

substances or sharp objects within the intervention is contraindicated. Even if these items are not

included in the session, the therapist should still proceed with precaution with other items if the


patient is known for this behavior. Wandering is another typical behavior of patients with

Alzheimer’s. Leaving the patient alone, even for one minute, is contraindicated if they are

known for wandering.

Frequency and Duration

I would suggest Callie receives services three to four times per week during her stay in

the hospital. This is appropriate because she is in acute care and will be staying no longer than a

week according to her estimated length of stay. Each session will be 30-45 minutes, which is

typical for Centennial Hills acute care therapy.

Primary Framework

The guiding frame of reference for this intervention plan was the rehabilitation reference.

According to Schultz-Krohn and Pendleton (2013), the rehabilitation frame of reference focuses

on getting the patient back to his/her previous level of functioning or at least their highest level

of functioning as possible. The therapist must focus on the patient’s current abilities and

adaptive equipment to restore their performance (Schultz-Krohn & Pendleton, 2013). This is

relevant to Callie as prior to her injury and sickness, she was functioning at an modified

independence level.

This model helped guide her goals by utilizing information gained during the evaluation.

The therapist utilized her current abilities and added equipment to enhance her performance.

Since her injury (clavicle fracture) is not permanent as is her delirium and confusion attributed to

her hospital admittance, this frame of reference is preferable. In addition, her difficulties with

balance and endurance are not permanent; they are able to be attended to during therapy. When

her dementia progresses and she declines, then potentially the compensatory model will be

utilized, but until her deficits are permanent, we want her to continue functioning at her high


level. Creating a checklist, receiving education on DME, and focusing on rehabilitating her

balance and endurance, all are strategies that coincide with the goals of the rehabilitation frame

of reference.

Patient/Caregiver Education

The patient will receive education and training on DME. She will need to know how to

use the equipment properly within the home and throughout the community. The caregiver also

needs to receive education on the importance of using the equipment. They both will need to

understand how it will help decrease chances of another fall and will help stabilize her mother

while ambulating. In addition, the therapist will need to provide the caregiver information on

any adapted equipment that will be provided for her mother. The therapist should also give the

caregivers realistic expectations for what Callie will be able to complete when she returns home.

This may entail them providing her more assistance or verbal prompts for completion of tasks.

Last, the caregivers should be provided with options for Callie, whether it be a respite service or

an adult daycare so they will have to worry less. This education will be provided prior to

discharge. It will not be an issue as Callie’s daughter visits often and is open to receiving

suggestions for her mother’s independence. The training for Callie will be provided throughout

the therapy sessions.

Response to Interventions

Callie’s response will be monitored throughout the sessions. The therapist could utilize

the Functional Independence Measure (FIM) in order to document her progress. However, due

to time constraints and short stays, this may be too lengthy of an assessment. Using a simple

pain scale, such as having her rate her pain 1-10 is an easy way to evaluate and reevaluate her

progress. Observations will also be utilized as a form of non-standardized assessments. With


the use of clinical reasoning, the therapist will be able to note progress toward the patient’s goals.

The patient will be able to verbalize if they are enjoying the intervention and if it is too difficult

or hard for them to complete. In addition, Callie’s family can also provide input on how they

think the sessions are going and if they would like any changes.


References

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S1–S48.http://dx.doi.org/10.5014/ajot.2014.682006

Hellen, C. R. (1998). Alzheimer’s disease: Activity focused care (2nd ed.). Boston, MA:

Butterworth-Heineman.

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Letts, L., Edwards, M., Berenyi, J., Moros, K., O’Neill, C., O’Toole, C., et al. (2011). Using

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Louis, MO: Elsevier Mosby.

Wood, W., Womack, J., & Hooper, B. (2009). Dying of boredom: An exploratory case study of

time use, apparent affect, and routine activity situations on two Alzheimer’s special care


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