OCCUPATIONAL PROFILE AND ANALYSIS
Occupational Profile and Analysis
Troy Gasner
Touro University Nevada
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OCCUPATIONAL PROFILE AND ANALYSIS
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Occupational Profile
J.E. is a 62 y/o Caucasian male who recent moved to Las Vegas to be closer to his family.
Originally from New York, J.E. worked in construction for over 25 years. J.E. is a recent
widower after being married for over 20 years. The death of his wife was very hard on him, and
he no longer had a desire to do many of the occupations he used to. Because he worked so much,
J.E’s. wife stayed at home and took care of most of the household chores. J.E. became
accustomed to being taken care of, and found it difficult to manage his finances and do
household chores after she passed away. Eventually, his health began to deteriorate, and he felt
retirement was his best option. Fortunately, he still has two healthy children in their 30s, whom
he stays in contact with. After both his sons graduated college, they moved to the west coast to
find careers and start families. Ultimately, J.E. wanted his children to move back to New York to
be closer to him; however this was not possible. He eventually decided to move to Las Vegas to
be closer to his two children and four grandchildren.
Shortly after moving to Las Vegas, J.E. joined a car club that met once a week at a local
casino. J.E. had always been a huge fan of old collectable cars, and loved meeting up with his
friends to show off his 1967 mustang. Being in construction for so many years, he became very
good at using tools and fixing things; however, he began to develop osteoarthritis in his hands.
This made it very difficult for him to work on his car for long periods of time.
Why is the client seeking services?
One Sunday afternoon while working on his car, J.E. began having severe abdominal
pain. After a few hours, it became unbearable so he called for an ambulance. Once he arrived at
the hospital, he began feeling nauseous and vomited. He was diagnosed with a perforated colon.
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He was immediately rushed to the emergency room for surgery. After having a colectomy with
ileostomy, J.E. began to develop gangrene on his left hand. Unfortunately, his vascularity was
compromised during the surgery which resulted in a left hand amputation.
Losing a limb has had a drastic impact on his daily life activities. Living on his own, he is
worried he will not be able to perform his ADL and IADL using only his right hand. J.E. is
concerned that he will not have anyone at home to care for him in case he is unable to do the task
himself. He also seems to be concerned that he will no longer be able to work on his car which
makes him depressed.
Areas of Occupation
Areas of occupation are considered the life activities in which a person engages in. The
greatest area of concern for J.E. is his ADL and IADL. Due to his complication, basic ADL that
may cause problems include: bathing, showing, dressing, eating, feeding, functional mobility,
personal device care, personal hygiene and grooming, and hygiene. I was not comfortable
discussing sexual activity with J.E. so that was irrelevant. Some of these activities will be more
difficult to re-learn than other; however, all of the activities will need to be adapted in some way.
When it comes to IADL, J.E. is concerned with communication management, community
mobility, financial management, health management and maintenance, home establishment and
management, meal preparation and cleanup, safety and emergency maintenance, and shopping.
IADL that will not be affected by his amputation include: care for others, care of pets, child
rearing. J.E. does not have a pet and both of his children are older and have their own families.
J.E. is usually a deep sleeper and rarely has trouble sleeping, but since being admitted, he has not
slept well due to the pain of his colectomy and the amputation of his limb. Sleep preparation and
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sleep participation may be areas of concern when it comes to making the bed and having to toilet
during the night. The only area of education that J.E. has concerns with is informal personal
educational needs or interest exploration because he has to re-learn activities using only his right
hand. Because he is recently retired, he is not concerned with many area of work including:
employment interest and pursuits, employment seeking and acquisition, and job performance.
J.E. can still engage in retirement preparation and adjustments, volunteer exploration, and
volunteer participation. J.E. realizes he will still be able to attend his car meetings with his
friends; however, he is hesitant to continue working on his own car. J.E. is not a very outgoing
person and does not seem to be concerned with areas of play. Leisure is an area that both of
J.E.’s children were worried about after the death of their mother. J.E. use to be a very outgoing
person who loved to travel with his wife. They enjoyed trying new things and experiencing new
places. Since the death of his wife, this is no longer the case. Areas of leisure including leisure
exploration and leisure participation have become an area of concern since losing his limb. This
concern continues with social participation, community, family, and peer friends. J.E. has found
joy in meeting his friends for car shows; however, he no longer likes going out into the
community unless he’s running errands. Furthermore, he seems to feel abandoned by his children
and has not been back to see them since moving to Las Vegas.
Context and Environments
J.E’s cultural background consists of being raised in a military family. He was raised to
be strong and independent. His parents provided him with everything he needed, but he had to
work for it. When he was old enough, he was expected to join the military to fight for his
country. The 20 years in the service built him into the man he is today. After meeting his wife
and starting his family, he told himself that he would work hard to provide for his family. This
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mentality often caused him to work more than spend time with his loved ones. He was very stern
when it came to raising his children; however, he loved them more than anything. When his
children moved to the west coast and his wife passed away, he felt as though he had been
abandoned.
J.E’s personal context included being 62 y/o retired soldier and construction worker. J.E.
enjoyed staying occupied. Even though he was not highly educated, his experience in the field
allowed him to build and fix pretty much anything. His love for classic cars was like his escape
from stress. He enjoyed sharing this hobby with many of his friends.
J.E’s temporal context consists of being an older adult. He lives in an older house in a
community surrounded an older population.
J.E’s virtual context is very limited. He has never been a fan of technology and depends
on the telephone to keep in contact with his friends and family.
A person’s physical context consists of both the natural and built environment. His
natural environment consists of living in the desert of Las Vegas. He enjoys not having to care
for his lawn. His built environment includes living in a one story home with a flight of stairs to
enter the house. J.E. does not have any assistive technology and has not made any modifications
to his home.
J.E. does not have much of a social context. Many of his friends that he met in the
military do not live nearby and they do not keep in touch. Although he was a great provider for
his family, he was not very affectionate with them. Being an active member of the car group, he
found himself to be most close with these friends because they shared a common interest.
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Occupational History
J.E. considers himself a very accomplished man. After graduation high school, he went
directly into the military where he served as an infantryman for 20 years. Unfortunately, he faced
many tragic experiences that seemed to have lasting psychological effects. After returning
home, he got an apprenticeship at a construction company. He remained very loyal and dedicated
to his work for over 25 years. He considers himself the “man of the house” and takes pride in
providing his family with anything they needed. With his experience as a construction worker,
J.E. developed a passion for fixing things. This led to his love for repair classic cars. In his free
time, he enjoys buying old cars and putting them back to immaculate condition. This seemed to
bother his wife because she often felt he spent more time with his cars than he did with his
family. When he was able to break away from his cars, he loved traveling with his wife and kids.
When his kids were younger, they would take road trips around the country. He loved seeing
new places and experiencing new cultures. Traveling in the military, J.E. was familiar what other
countries had to offer, and he wanted to make sure his family had a chance to experience as
many places as possible.
Client’s Priorities and Desired Outcomes
Over the years, J.E.’s priorities and desired outcomes have changed greatly. Since the
death of his wife, his children feel he is a different man. In order to keep himself busy, he would
occupy his time by working on cars and taking on little projects around the house. He expressed
a desire to be a larger part of his grandchildren’s lives; however, he feels like his children have
abandoned him. This is very depressing for him because he has lost the most important person in
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his life and he doesn’t want to lose the rest of his family. Now that he has lost a limb, his
priorities have shifted to learning how to care for himself. His wife spoiled him for many years
and now he must not only learn to care for himself, but with only using one hand. J.E. tries to
look positive and hopes this unfortunate event will bring them closer together.
Occupational Analysis
Body Functions
While at the hospital, I was able to observe J.E. performing ADL including brushing
teeth, combing hair, and washing his face. While watching him perform these ADL, I paid close
attention to his body functions. It was obvious that J.E. had difficulty in neuromusculoskeletal
and movement-related functions, his joint mobility, joint stability, muscle power, muscle tone,
muscle endurance, motor reflexes, and control of voluntary movement, and gait patterns all
seemed to be effected. Following the amputation, J.E. was unable to use his arm so he suffered
decreased muscle tone, strength, and range of motion. Furthermore, because he no longer had a
hand, he seemed to have difficulty with eye-hand coordination and gross-motor control. Because
of the amount of time spent in the hospital bed, J.E. seemed to have difficulty with gait due to
lack of strength and endurance. In order for him to walk, he required a front wheel walker with a
platform for his left arm.
A second area that J.E. seemed to have difficulty in was cardiovascular, hematological
and immunological function. Before being admitted to the hospital, J.E. did not have any signs of
HBP, hypertension, or hypotension. Because of the vasculature complications, J.E. developed
postural hypotension and required pressure garments when getting out of bed. Fortunately, J.E.
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did not have any problems with his cardiovascular system. He did seem to have difficulty
breathing if he over exerted himself, or if he was placed in a certain position while lying in bed.
J.E. did not have any problems with mental functions. He had high-level cognition, good
memory (short-term, long-term, and working), attention to detail, thought, sequencing, and
experience of self and time. He did seem to struggle slightly with proprioception and knowing
where his affected arm was in space. He had limited sensation on his affected side near the site
of the amputation. Even though he was not very expressive, it was easy to notice when he
became frustrated. He seemed to have good coping skills and high self-esteem when he
accomplished a goal. When it came to global mental functions, J.E. was oriented to person,
place, and time and seemed to be emotionally stable. He had a drive to get better and was very
diligent during the therapy sessions. J.E. expressed that he has never had difficulty sleeping, but
with the recent surgery and pain, finds it difficult to fall asleep. Overall, J.E. was a very pleasant
man and most of the therapist enjoyed working with him.
Most of J.E’s. sensory functions seemed to be intact including: hearing functions, taste
functions, smell functions, touch functions, and temperature and pressure. J.E’s, visual functions
seemed to be normal; however, I was not able to find out his level of visual acuity. Like
previously mentioned, he only seemed to have proprioceptive deficits with his affected arm.
J.E’s. pain function was definitely intact because he often complained of phantom pain in his
affected arm.
J.E’s. skin and related-structures seemed to have a number of problems. His nails were
dark purple and his skin was scaly to the touch. Unfortunately, his fingernails and toenails had
not been cut in a few weeks and were digging into his skin. These complications were a result of
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both bad circulation and not having proper care. His hair was normal and he really enjoyed
combing his hair because he said it made him feel like a new man.
Activity Demands
During a therapy session, I was able to observe J.E. doing basic ADLs including brushing
his teeth, combing his hair, and washing his face. In order for him to perform these tasks, he
required a toothbrush, toothpaste, comb, washcloth/towel, and soap. He also required a sink to
get water from and spit into when he was done.
The space demands for J.E. to complete his ADLs included a bathroom with enough
room for J.E. to fit his walker and IV machine into. He also needs a sink with enough space to
hold the toothbrush, toothpaste, comb, and washcloth.
Social demands of the client when performing these ADLs include communication and
interaction with a caregiver. He must ask the caregiver to get him the supplies as well as
supervise him when going into the bathroom.
J.E. had no problems with sequencing but he did require extra time in order to complete
the tasks. He was always aware of where the items were located.
The required actions and performance skills necessary to complete these ADL included
being able to grasp the tooth brush and comb, control his arm up to your mouth and over your
head, sequence steps, walk to the restroom, and squeeze the tooth paste and wash cloth. J.E. must
be able to tolerate the sensation of warm water on his hands, face, and in his mouth. He must also
have good proprioception and be aware of where his hand is in space. It is important to have fine
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motor skills to control the tooth brush within his mouth. Being able to ask for help if needed is
another important required skill.
Performance Patterns
While observing J.E. perform his ADL, I could tell he was a man of habit. Before
brushing his teeth, he would rinse his mouth and gargle the water before starting. He seemed to
follow the same routine which included brushing his teeth, then combing his hair, and finally
washing his face. He did not seem to have any obvious rituals; however he always liked to look
at himself in the mirror when he was finished with his ADL. Being a recent widower, J.E. roles
include being an independent man that needs to be able to care for himself. He is also a
grandfather and wants to be able to play with his grandchildren.
Performance Skills
In order to accomplish the ADL, J.E. needs both motor and praxis skills. The motor skills
include, reaching and gripping the toothbrush, twisting the cap off the tooth paste, and squeezing
the toothpaste and washcloth, coordinating body movement to raise his hand to his mouth, and
manipulating the toothbrush and comb in the hand. Praxis skills are also needed including having
skilled movement, sequencing actions, ocular and oral-motor skills, completing the task within
the spatial context, and carrying out learned movements. Maintaining balance while standing at
the sink was also difficult for J.E..
Process skills were necessary for J.E. when completing his ADLs. He needed sensoryperceptual skills including positioning the body, being able to visually locate the toothbrush and
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tooth paste, knowing where his hand was in space, rinsing his mouth with warm water, keeping
his balance at the sink, and not overexerting himself while standing. The emotional regulation
skills required included persisting with the task even though he was used to having two hands,
utilizing relaxation techniques and being able to control his emotions, and using emotional
regulation when asking for help.
J.E. did not seem to have and problems with cognition. He was able to properly select
tools, organize the activity, prioritize, and sequence. He was aware of the importance of ADL
and very much enjoyed doing them. When it came to multitasking, he did not seem to have any
problems, but due to his recent amputation, often needed verbal cues on how to do the task in a
modified way.
Even though J.E. was a very soft spoken person, he did not have any problems with
communication and social skills. He was a very pleasant man who was able to use gestures,
initiate conversations, taking turns while talking, and acknowledge what another person was
saying. He also had a very nice sense of humor and a positive attitude.
Body Functions
The body functions required for J.E. to complete his ADLs include mental functions in
order to recognize the task, sequence the task, use his memory, focus attention, and control
energy expenditure. Sensory functions including proprioception, touch, vestibular, and
temperature are necessary for J.E. to complete the task. Having visual and hearing functions
would make the task much easier, however they not required. The nueromusculosketal and
movement-related functions are required in order for J.E. to move the toothbrush to his mouth or
the comb to his hair. These functions include joint mobility, joint stability, muscle power, muscle
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tone, muscle endurance, motor reflexes, and controlled voluntary movement. Gait pattern were
influenced by this task; however, these ADL could be performed without gait. Cardiovascular
functions are needed to control his heart rate so he doesn’t get tired while walking to the
bathroom. Hematology and respiratory functions were influenced by his breathing while standing
at the sink. Voice and speech function were not influenced by this task. It is important for J.E’s
digestive, metabolic, and endocrine system functions to be working, but they were not directly
influence by this task. It is important that skin and related-structure function were working
properly to protect him from the warm water and toothpaste. Fortunately, J.E. did not have any
wounds on his hands or there might have been reason for concern.
The body structures that were influenced by J.E. completing his ADL included structures
of the nervous system, eyes, mouth, and structures of the cardiovascular, immunological, and
respiratory (heart and lungs). Structures related to the digestive, metabolic, and endocrine
systems did not have a direct impact; however they need to be working properly. Most
importantly, the structures related to movement and skin related structures were influenced by
the tasks. Structures involved in voice and speech were not required in order for J.E. to complete
his ADL.
Contexts
The contexts related to the performance of this intervention include cultural, personal,
temporal, physical, and social. Spending most of his life being cared for by his wife, J.E. must
now learn to not only be independent, but to modify how he does things by only using his right
hand. J.E’s personal context includes being a retired construction worker and grandfather who is
motivated to return home so he can hopefully see his grandchildren. As far as his temporal
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context is concerned, J.E. is worried that no one will care for him so he wants to be as
independent in ADL as possible. J.E’s. physical environment will change drastically due to his
medical condition. With the loss of a limb, J.E. will need to use adaptive equipment and modify
his home to allow him to be as independent as possible. After receiving therapy and getting
discharged, J.E. is hoping his social context will change and he will see his grandchildren more.
J.E’s. virtual context did not relate to the intervention.
Problem List
1) Pt. needs Mod Ⓐ in dressing 2◦ L hand amputation
2) Pt. needs 20 min. to perform ADLs due to modified technique s/p L hand amputation.
3) Pt. needs Min Ⓐ t/f supine EOB secondary to s/p left hand amputation.
4) Pt. requires CGA when performing ADL at sink due to ↓ balance.
5) Pt. is unable to amb. > 20’ due to ↓ endurance.
This is the order I would prioritize my problem list. Learning how to use modified techniques
and adaptive equipment will be very important for J.E., especially when he returns home. In
order for J.E. to go home, he will need to be at least Mod I in dressing and ADLs. J.E. will need
to increase his strength and endurance before he will be able to walk and stand for long periods
of time. These areas should improve with time and the help of PT.
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References
American Occupational Therapy Association. (2008). Occupational therapy practice framework:
Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625-683.