Intervention Plan Template:

Clients Name:

Strengths and Barriers:

Strengths (be sure to include the framework domain) (1 point):

1)

2)

3)

4)

5)

Barriers (be sure to include the framework domain) (1 point):

1)

2)

3)

4)

5)

Solutions Statements to Problem Areas:

Occupational Performance deficit and problem (*please note, you may not duplicate an area of occupation or client factor from any of the other problem statements):

Patient performs _______________ (occupation) with _______________ (level of assist) secondary to ______________ (client factor) (2 points).

Treatment Method 1 (no more then 3 sentences-methods may not be repeated) (2 points):

Rationale 1 (no more then 3 sentences) (1 point):

Treatment Method 2 (no more then 3 sentences-methods may not be repeated) (2 points):

Rationale 2 (no more then 3 sentences) (1 point):

STG (2 points):

LTG (2 points):

Occupational Performance deficit and problem (*please note, you may not duplicate an area of occupation or client factor from any of the other problem statements):

Patient performs _______________ (occupation) with _______________ (level of assist) secondary to ______________ (client factor) (2 points).

Treatment Method 1 (no more then 3 sentences-methods may not be repeated) (2 points):

Rationale 1 (no more then 3 sentences) (1 point):

Treatment Method 2 (no more then 3 sentences-methods may not be repeated) (2 points):

Rationale 2 (no more then 3 sentences) (1 point):

STG (2 points):

LTG (2 points):

Occupational Performance deficit and problem (*please note, you may not duplicate an area of occupation or client factor from any of the other problem statements):

Patient performs _______________ (occupation) with _______________ (level of assist) secondary to ______________ (client factor) (2 points).

Treatment Method 1 (no more then 3 sentences-methods may not be repeated) (2 points):

Rationale 1 (no more then 3 sentences) (1 point):

Treatment Method 2 (no more then 3 sentences-methods may not be repeated) (2 points):

Rationale 2 (no more then 3 sentences) (1 point):

STG (2 points):

LTG (2 points):

Occupational Performance deficit and problem (*please note, you may not duplicate an area of occupation or client factor from any of the other problem statements):

Patient performs _______________ (occupation) with _______________ (level of assist) secondary to ______________ (client factor) (2 points).

Treatment Method 1 (no more then 3 sentences-methods may not be repeated) (2 points):

Rationale 1 (no more then 3 sentences) (1 point):

Treatment Method 2 (no more then 3 sentences-methods may not be repeated) (2 points):

Rationale 2 (no more then 3 sentences) (1 point):

STG (2 points):

LTG (2 points):

Treatment Session:

Treatment Session (limited to 3 pages-double-spaced, please note only 3 pages will be reviewed, anything over the 3rd page will not be reviewed, therefore please be sure to be succinct, yet provide the required information within the 3 page limit):

STG (s) being addressed:

CPT Code(s) utilized (identify the amount of time you are billing under each, ie. Ther act (97530): 15, Self care (97535): 30 and Ther ex (97110): 15):

Session (Separate out by billing code if applicable, ie. If providing 15 min. of ther act, 30 of self-care and 15 ther ex. These codes should be specified at the beginning of each being described):

Evidence:

References

Sample Intervention Plan

Carl Belgarde

OTB 530 1H

Professor Cheryl Boucakis OTD, OTR/L

Bay Path University

February 11, 2018

Intervention Plan

INTERVENTION PLAN

Name: Betty Smith

Strengths:

1) client requires min assistance in order to feed herself (area of occupation)

2) client requires min assistance for grooming (area of occupation)

3) client requires min assistance with transfers, using a RW for steadiness (performance skills)

4) client is able to follow commands of task after one repetition of directions (client factors)

5) client is oriented to person, place and time (client factors)

Barriers:

1) client exhibits weakness in UE and LE; requires mod assist for toileting (client factors)

2) client exhibits decreased AROM in UE and LE; is dependent on dressing tasks (client factors)

3) Client has decreased balance; Fair – in static balance; Poor + dynamic balance (performance skills)

4) Client exhibits behaviors that may put her at risk for falls (performance patterns)

5) Client experiences numbness and difficulty with grasp in her left hands (client factors)

Solutions Statements to Problem Areas:

1) Patient performs UE/LE dressing with dependence secondary to impaired AROM in BUE

Treatment Method 1: Client will participate in repetitive task activities by retrieving clothes from the top drawer.

Rationale 1: By allowing client to repeatedly pick out a piece of clothing from the drawer will help increase ROM in her UE in order to perform dressing tasks.

Treatment Method 2: Client will perform donning/doffing socks utilizing a sock aid /dressing stick.

Rationale 2: engaging client in use of sock aid will improve client’s ability to don /doff socks due to limited AROM on BUE.

STG- The client will be able to don a pull over sweater with mod assistance, in 2 weeks.

LTG- The client will be able to put on an entire outfit with supervision in order to increase ROM in UE/LE, in 4 weeks.

2) Patient performs bathing with max assistance secondary to impairments in balance.

Treatment Method 1: The patient will perform bathing task in upright seated position sitting on tub bench using long-handled sponge/loofa for 10-15 minutes.

Rationale 1: The client will work on increasing balance by performing bathing tasks to wash the body thoroughly. The use of a tub bench is a valuable tool to promote safety while maintaining sitting balance.

Treatment Method 2: The client will engage in energy conservation strategy utilizing the tub bench as well as enhancing safety.

Rationale 2: The act of bathing is a multistep process and requires enough balance to transfer into the tub correctly. The patient will improve steadiness and allow for less assistance as they progress with this task.

STG- The client will be able to perform tub transfer utilizing a RW with mod A in two weeks in order to participate in bathing task.

LTG- The client will be able to perform tub transfer utilizing a RW with close supervision in 4 weeks in order to increase independence in bathing task.

3) Patient performs toileting with mod assist secondary to weakness in BUE/BLE.

Treatment Method 1: Train client to properly pull clothing down before sitting on the toilet. Repeat at least 3 times.

Rationale 1: Proper hygiene is part of the toileting process. Training the client to pull clothing up and down at the toilet adequately will improve both UE strength through a functional task/ADL

Treatment Method 2: Train client to ambulate with RW from bed to toilet and transfer onto toilet. Repeat at least 3 times per day.

Rationale 2: Toilet training is also a multistep process and requires a certain level of strength in order to complete the task properly and smoothly. Repeating this task allows for better carryover and helps increase functional strength.

STG- The client will increase BUE strength to 3+/5 in order to pull up/down clothing and sit at the toilet with mod assist in 2 weeks.

LTG- The client will be able to ambulate at least 10 ft. to the toilet and safely transfer onto toilet seat in order to perform hygiene/toileting task in 4 weeks.

4) The patient performs meal prep with min assist secondary to difficulty opening packages and manipulating utensils.

Treatment Method 1: Train the patient to properly prepare a simple meal prep such as peanut butter and jelly sandwich with decreased difficulty in fine motor movements.

Rationale 1: By practicing the task of making a PB&J sandwich the patient will increase ability to use fine motor movements. By practicing opening the jars of peanut butter and jelly the patient will also increase grip strength in both hands.

Treatment Method 2: Train the patient to grasp utensils with grip handles and instruct her to scoop three different food of her choice such as cereal, vegetables, meat or rice, and eat.

Rationale 2: By repeating this tasks with different foods, it will allow client to have a good carryover with meal prep. The task of simple meal prep will enable the patient to gain her grip strength and increase proprioception to both hands.

STG – The patient will be able to prepare a simple meal prep such as PB&J sandwich with CGA in 2 weeks in order to improve IADL’s

LTG – The patient will be able to properly utilize utensils to bring food to mouth with independence in 4 weeks.

Treatment session & billing Codes

STG: The client will be able to put on a pull over sweater with mod assistance, in 2 weeks.

Self-Care (97535) 30 minutes

Treatment 1: Patient participates in upper body dressing sitting at edge of bed. OT instruct client to don sweater placing her left arm inside the sleeve first follow by the right arm with verbal cue, to complete task. OT instruct the client to repeat the steps 5 times in order to improve carryover. Patient also engages in lower body dressing sitting at edge of bed utilizing a dressing stick to don/doff pants with verbal cue for safety by training a person on dressing techniques; the therapists allow the client to work on their gross motor and increase ROM through a functional task. The client will practice the task until they achieved the act of appropriately putting on the clothes. Instruct patient on how to don a pull over sweater, by placing the weak UE first in the sleeve first is an energy proficient and precise way. According to Ryan and Sullivan (2011). This technique is appropriate for patients recovering from stroke. Although Betty did not have a stroke, she has limited B UE AROM, therefore donning one arm at a time is ideal for energy conservation.

Ther Act (97530) 15 minutes –

Treatment 2: Patient participates in static sitting balance at edge of bed with support to increase sitting tolerance during self-care. Dynamic sitting balance forward trunk flexion, reaching across midline for different objects in order to improve trunk control. Weight shifting activity sitting at edge of bed in order to improve dynamic sitting balance during dressing tasks. Upper body dressing is a multistep process and involves proper mobility, technique, and balance to maintain upright positioning. Assistance from the occupational therapist is used as needed. The therapist should encourage as much independence as possible. According to Bonder & Dal Bello. (2009). The ability to maintain balance is crucial for the successful performance of most ADLs.

Ther Ex (97110) 15 minutes

Treatment 3: Patient participate in UE’ strengthening in supine consisted of shoulder flex, abd, with one pound dumbbell 10 times x 3 reps. Thera putty to increase grip strength. Biceps curls utilizing 2-pound weight bar 10 times x reps. UBE for 5mmns to increase strength, OT instructs the patient to properly fulfill multistep tasks of upper body dressing especially practicing to don and doff clothing before transfer. Self-care involves a series of steps including the ability to don each arm inside the sleeve and able to pull the shirt down after donning your arms in the sleeve. Performing self-care is one major ADL that fulfills quality of life and is important for the client to be able to perform self-care independently. According to Mohamed (2017). The exercise training should replicate as close as possible the tasks performed in daily life so that the older adults can be motivated and greater effects can be elicited. Performance of an activity can be improved by training in that activity.

References

Bonder, B.; Dal Bello- Hass, V. (2009) Functional Performance in Older Adults. Philadelphia, PA: FA Davis

Mohammed, R. (2017). Effect of Functional Task Training versus Traditional Strengthening Exercises in Improving Functional Reach among Elderly Population. Indian Journal of Physiotherapy & Occupational Therapy, 11(3), 227-232. doi:10.5958/0973-5674.2017.00109.

Ryan, P.A., & Sullivan, J.W. (2011). Activities of daily living adaptations: Managing the environment with one-handed techniques.

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