Running head: OCCUPATIONAL PROFILE & OCCUPATIONAL ANALYSIS
Occupational Profile & Occupational Analysis
Gerilynn Gobuyan
OCCT 651
Touro University Nevada
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OCCUPATIONAL PROFILE & ANALYSIS
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Occupational Profile & Occupational Analysis
Occupational Profile
Ron Carmichael is a 58-year-old male who lives independently in a one-story home in
Las Vegas, Nevada. There are no steps to enter his home and no architectural barriers inside;
however, there is one-step leading from the back of the home to the backyard area. Ron has been
divorced twice and has a child from each marriage; a son who is 26-years-old, and a daughter
who is 30-years-old. His son lives in New Jersey and his daughter lives in San Francisco,
California. He has no grandchildren.
At home, Ron is modified independent in all activities of daily living and instrumental
activities of daily living; however, he does utilize a shower chair during bathing. He occasionally
receives assistance from either his mother, who visits from New Jersey, or his sister, who resides
in Las Vegas. Ron is very close to his family and enjoys spending time with them during visits.
Ron enjoys watching his sister’s one-year-old puppy while his sister is away at work. When his
mother is in town visiting, he likes to spend time watching different television shows with her,
such as Good Morning America and The Price Is Right. During his afternoons, Ron enjoys
playing and dining at the Green Valley Ranch Resort and Casino.
Three years ago Ron was involved in a motorcycle accident that resulted in a below the
knee amputation of his left lower extremity. After the accident, Ron was given a below-knee
prosthetic for ambulation, which he wears five to six hours a day. When he is not wearing his
prosthetic, he uses his wheelchair for mobility. When at home, Ron avoids going into his
backyard when using his wheelchair due to the single-step leading into the backyard. Prior to his
accident, Ron worked as a union plumber and pipe fitter for 27 years. He currently is on
“disability”. Although he is no longer employed, Ron is still able to participate in one of his most
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treasured interests, motorcycle riding. With the use of his prosthetic and adaptations to his
motorcycle, Ron is able to independently ride his motorcycle around town.
Ron was admitted to Progressive Hospital for pneumonia, respiratory failure, and a
closed head injury, which may have caused a possible concussion. His possible concussion has
led him to engage in unsafe transfers. Ron has had type I diabetes since the age of 10 and uses
insulin to control his blood sugar. During his hospitalization, Ron fell on his amputated limb
causing a slight opening in that area. Ron is currently off of his prosthetic and uses his
wheelchair to move about the hospital. He was prescribed occupational therapy to educate him
on safe transfers, increase his activity tolerance, and increase the strength of his right hand and
fingers.
Ron states that he doesn’t have a lot of concerns regarding his engagement in occupations
and daily life activities. His only concern/problem is the decreased strength in his right hand and
fingers, which make it difficult for him to perform fine motor tasks. This often becomes an issue
when his blood sugar reaches low levels. His family members and the hospital staff provide
assistance with fine motor tasks, such as opening a granola bar wrapper, when needed. Ron’s
home was modified by the previous owner to include hand rails in the bathroom area for added
safety. Although his entire home is not specifically modified for an individual with disabilities,
Ron has learned to adapt to his home environment in order to continue participating in his
desired occupations.
Occupational Analysis
Occupation: Functional transfer
Activity: Transferring from the toilet to his wheelchair in his hospital room bathroom.
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Deficits in Body Functions
Mental functions. As a result of his closed head injury, Ron has an altered mental status
resulting in his decreased safety awareness; however, he is alert and oriented to person, place,
and time. He has no recollection of hitting his head and does not think he has any cognitive
deficits. He can be argumentative and short tempered when others teach him techniques that are
different than what he has taught himself.
Sensory functions & pain. Ron experiences sensory deficits as a result of his type I
diabetes. His right hand shows signs of pitting edema, but does not seem to cause Ron any pain.
Ron has little awareness of his current abilities and his situation; thus affecting his ability to
safely transfer. He experiences no phantom limb pain in his amputated left lower leg.
Neuromusculoskeltal and movement-related functions. Ron’s ability to range his
upper extremities is within functional limits. All of his upper extremities can move through full
range of motion against gravity and can have minimal resistance applied before the extremity
fatigues. His upper and lower extremities show no signs of spasticity or flaccidity. Ron’s lower
extremities are not as strong as his upper extremities due to his amputated lower left leg;
however, he demonstrates good gait patterns when he utilizes his below-knee prosthetic during
ambulation. He has decreased strength in his hands and fingers making it difficult for him to
perform fine motor activities.
Cardiovascular and respiratory system functions. Ron has a history of hypertension
and respiratory failure. He can participate in activities without becoming fatigued easily. His
heart rate and blood pressure are within normal values.
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Digestive, metabolic, and endocrine system function. Ron has no deficits in his
digestive function; however, his metabolic and endocrine system functions are affected by his
type I diabetes.
Skin and related-structure functions. As a result of his fall in the hospital, he has an
opening at the location of his amputation, which is currently covered with a sterile dressing. As
mentioned earlier, his right hand shows signs of pitting edema. There are no signs of pressure
ulcers developing on his skin.
Non-applicable functions. Ron shows no deficits in the following areas due to his ability
to communicate and perform bowel and bladder management independently: voice, speech,
genitourinary, and reproductive functions.
Activity Demands
Objects and their properties. Ron utilized several different tools and equipment to help
him transfer from the toilet to his wheelchair. After completing toilet hygiene and bladder
management, Ron used the grab bars to help move from a sit to stand position. The grab bars are
mounted on both sides of the bathroom walls surrounding the toilet and are made with stainless
steel. He then used his wheelchair to help him transfer from a standing position to a sitting
position in his wheelchair. Ron’s uses an 18” x 16” standard wheelchair with removable arms
and footrests.
Space demands (relates to physical context). This activity is typically performed
indoors within the confines of a bathroom or restroom. Ron performed this activity within his
hospital room bathroom, which is larger than a typical home bathroom. Ron used a standard
toilet and did not require a raised toilet seat to perform this activity. It is important that toilet
area, as well as the entire bathroom, have plenty of room for individuals with wheelchairs to
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access and maneuver. The open area is typically 5 feet by 5 feet to allow for a 360 degree turn.
The grab bars are located at a height that is easily accessible for patients when transferring on
and off the toilet. The bathroom doorway has no threshold and is wide enough to allow a
wheelchair to pass. It is also important to have adequate lighting within the bathroom for safety
during bathing and toileting activities.
Social demands (relates to social environment and cultural contexts). While
performing the activity, Ron was accompanied by one other individual. Typically, Ron would
perform this activity privately as it occurs after performing bowel and/or bladder management.
Sequencing and timing. The steps carried out to perform this activity are similar to a
typical toilet to wheelchair transfer; however, Ron has modified the activity for his needs. Before
initiating the steps required, it is important that brakes on Ron’s wheelchair are engaged so that it
is not moving during the transfer. The first step requires Ron to move from a sit to stand position
so he can adjust his clothing after using the toilet. To achieve this step, Ron uses holds onto the
grab bars located on both sides of the toilet to stabilize his body as he moves into a standing
position. Once in a standing position, he grabs the left arm rest of his wheelchair using his left
hand and places his left amputated leg onto the seat of the wheelchair. He then transfers the rest
of his body to his wheelchair by pivoting his right foot until his body is facing towards the toilet
rather than away. It is important that he keep his balance throughout the entire activity to reduce
the risk of falls during the transfer.
Required actions and performance skills. In order to complete this activity, Ron needs
to be able to grip the grab bars and determine how to move his limbs during the transfer. Before
performing the transfer, it is important that Ron ensure that his wheelchair is fully locked in
place and that any unnecessary tools and/or materials are removed from the seat of his
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wheelchair. During the transfer, Ron must recognize when he is feeling unsteady or unbalanced
and remember to return back to a seated position on the toilet before attempting the transfer
again. If at any time Ron feels that he needs additional assistance to perform the activity, it is
essential that he ask for help from one of the hospital staff (e.g., therapists or nurses).
Required body functions. Throughout the activity, Ron must be fully conscious and
aware of what he is doing to ensure proper execution of the activity. In addition, Ron must be
aware of his body position during the transfer. Ron needs to be able to move all joints in his
body, excluding those removed due to the amputation, to safely move through the different steps
required for the transfer. When pushing down on the grab bars to move from a sit to stand
position, Ron must have enough muscle power and endurance to move his body through the
entire movement and remain balanced on one leg.
Required body structures. To be able to safely perform this activity, Ron needs the
following body structures: two eyes, head, neck, trunk, two arms, and two legs. Although this
activity is typically completed using two legs and two feet, an individual such as Ron can
perform the task using one full leg and an amputated leg.
Performance Patterns
Habits. Before toileting, Ron closes the door to the bathroom to ensure privacy. He
automatically holds onto the grab bars alongside the toilet to help him stand upright after
completing toileting. He repeatedly puts his left amputated leg onto the wheelchair before
transferring his entire body to the wheelchair.
Routines. Although his transfer techniques are deemed unsafe by the therapy staff, Ron
continues to follow the same sequence of steps to transfer off the toilet and into his wheelchair.
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When he has completed the activity, Ron uses the bathroom sink to wash his hands and paper
towels to dry his hands before exiting the bathroom.
Roles. Ron is an unemployed divorcé and a father to a son and daughter. Prior to being
admitted to the hospital, Ron cared for his sister’s one-year-old puppy during the day and visited
local casinos in the afternoon.
Performance Skills
Motor and praxis skills. In order to move from a sit to stand position, Ron must be able
to bend his trunk slightly forward and push down on the grab bars. During the entire transfer, he
needs to coordinate his body movements and maintain his balance to prevent a fall from
occurring. If he feels unstable at any point during the transfer, he needs to be able to adjust his
body position before initiating any further steps.
Sensory-perceptual skills. Before transferring his body from a standing to a sitting
position in his wheelchair, Ron needs to safely position his body. Once he has safely positioned
himself, he then needs to visually locate the arm rests of his wheelchair and position his left leg
on the seat of the wheelchair. He then needs to position his left hand on the wheelchair arm rest
and maintain his grasp on the grab bar using his right hand. Next, Ron must time the appropriate
moment to transfer the rest of his body onto the wheelchair. The transfer is complete once Ron
has safely positioned his body in a seated position in his wheelchair.
Emotional regulation skills. Ron typically performs this activity independently;
however, in situations where he is assisted by another individual, it is important that he display
appropriate emotions and not raise his voice when he becomes frustrated. He often becomes
impulsive and short-tempered when working with others on functional transfers. When Ron is
working with others, he must control his temper towards others and respond appropriately.
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Cognitive skills. Before beginning the activity, Ron must sequence the steps needed to
perform the transfer. While in a dynamic standing position, it is important that Ron be able to
multitask; adjusting his clothing while trying to remain his dynamic standing balance. Ron needs
to judge whether or not he can complete the transfer independently or needs additional assistance
from another individual.
Communication & social skills. When Ron is receiving assistance from either a hospital
employee or family member, he needs to acknowledge the other individual and take turns
speaking during a conversation. If Ron is attempting the transfer independently, but has stand by
assistance available, he must be able to verbalize to the other person when he needs help with the
transfer.
Context and Environment
Cultural. When different members of the interdisciplinary team come to visit Ron, he
greets them saying “hello” and often engages in short conversation.
Personal. Fifty-eight-year-old unemployed divorcé who lives independently.
Temporal. Ron has been a left leg below the knee amputee for the past three years. He
has been receiving occupational therapy at Progressive Hospital in Las Vegas, Nevada for the
past two weeks.
Virtual. Ron uses his cell phone to communicate with his loved ones (i.e., children,
sister, mother, and girlfriend) while he is in the hospital.
Physical. Ron is currently being treated at Progressive Hospital, which is a long-term
acute care facility with 24 beds. Ron’s hospital room is located at the end of one of the two
hospital wings. His room is designed to accommodate two patients; however, Ron is the sole
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occupant in the room. His bathroom and bed are located near the room’s entry way and are
across from one another.
Social. Typically during the activity, Ron has no interaction with other individuals.
However, if he is working on practicing safe and functional transfers in the bathroom, he will be
accompanied by the occupational or physical therapist.
Spiritual. There is no spiritual context related to the performance of this activity and Ron
has not expressed any spiritual concerns.
Problem List
1. Ron is unable to complete a writing task due to limited grip strength & coordination of
dominant Ⓡ hand.
Ron’s inability to complete a writing task is the first problem statement because he
expressed the importance of being independent in money management. In addition, the decreased
strength and coordination in his dominant hand also prevent him from performing additional fine
motor skills without difficulty.
2. Ron requires Mod Ⓐ in LE dressing due to ↓ endurance & strength in UE & LE.
I chose this as Ron’s second most important problem because of his status prior to his
hospitalization. Ron stated that he was able to independently performing both UE & LE dressing
tasks before coming to the hospital.
3. Ron demonstrates ↓ safety in functional transfers due to impaired judgment & ↓ awareness of
current abilities.
As mentioned in the occupational profile, Ron experienced a closed head injury that may
have resulted in a concussion. It is suspected that his closed head injury may have impacted his
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cognitive judgment and awareness of his current abilities; thus, affecting his ability to safely
engage in functional transfers.
4. Ron requires Mod Ⓐ for safe bathing due to poor endurance & ↓ UE coordination.
Bathing is an activity that typically requires 10-15 minutes to complete. Currently, Ron
can only tolerate less than 10 minutes of the activity before becoming fatigued. It is important to
increase his activity tolerance so that he can engage in ADLs and IADLs independently.
5. Ron requires Sup 𝑐̅ bed mobility 2° fall risk.
Ron has reported that he has a history of falling while engaging in occupations, bed
mobility included. Improper bed mobility can potentially cause Ron to fall off his bed and onto
the floor, which may result in an injury to his left amputated leg.
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References
American Occupational Therapy Association. (2008). Occupational therapy practice framework:
Domain and process (2nd ed.). Baltimore, MD: AOTA Press.
Wrightsman, W., Adaptations, DME, LE joint replacement. [PowerPoint]. (2013). Retrieved
from https://bbtun.touro.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_3_1&url=%2Fwebapps%
2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_741578_1%26u
rl%3D