OCCT 506: Clinical Reasoning about Occupation
Form #4
Student: Vicky Pringels & Gerilynn Gobuyan
Activity: Making Pizza
Date: September 19, 2012
Activity Analysis for Therapeutic Intervention
Directions: This form is to be completed as a group. It requires detailed analysis of the therapeutic activity you present and teach to
the class. Complete all sections in complete sentences with thorough descriptions and thought.
Provide a brief description of the
activity.
Identify the major steps, including
the time required for each.
Section I
Activity Description
Section II
Therapeutic Qualities
Energy Patterns: Describe the
required energy level in terms of
Making pizza starts with preparing a flat, round bread covered with
tomatoes or a tomato sauce and cheese. Toppings are then added
based on personal preference.
1. Start by gathering necessary ingredients for the pizza from the
kitchen including pre-made dough, pre-cut toppings, sauces, and
cheese. (5 minutes)
2. Then, preheat the oven to specified temperature depending on
your oven (usually 350⁰-400⁰). (1-5 minutes)
3. Next, roll out pre-made dough using a dough roller and form into
a circular shape. (3-5 minutes)
4. Apply sauce evenly to the pizza dough leaving a small margin on
the outer-side of the dough which will allow the crust to rise and
crisp more quickly. (1-3 minutes)
5. Apply shredded cheese evenly to the sauce. (1 minute)
6. Arrange preferred toppings over the layer of cheese. (1-2
minutes)
7. Place prepared pizza in the center of the top oven rack. (30
seconds)
8. Set timer for appropriate cooking time. (10-15 minutes)
9. Remove baked pizza from the oven with caution. (1 minute)
10. Now you are ready to slice the pizza according to your
preference, wait for it to cool down, and enjoy! (1-2 minutes)
This activity is an IADL that includes planning, preparing, serving,
and cleaning up food and utensils. A light level of activity (2-3
(Modified from Hersch, Lamport, & Coffey, 2005)
OCCT 506: Clinical Reasoning about Occupation
Form #4
light, moderate, or heavy work
patterns and provide an explanation
for the level specified (refer to
description of MET levels in W&S).
Activity Patterns: Indicate the
patterns of activity expected for
successful completion of the
activity.
 Structural/Methodical/Orderly
 Repetitive
 Expressive/Creative/Projective
Describe required body structures
METs) is necessary to complete this activity. The oxygen consumed
will be between 7-11 mL/kg/min.

Structural/Methodical/Orderly
o When making pizza it is necessary to follow the
aforementioned steps in order to ensure the pizza is
cooked properly. For example, you must put the sauce on
the dough before you add the cheese.
 Repetitive
o There are repetitive motions when making pizza
including rolling out the dough multiple times to ensure
an even pizza surface and continuously putting selected
toppings on the pizza.
 Expressive/Creative/Projective
o You can be expressive or creative with your pizza by
making various designs with the toppings or
personalizing the pizza to fit your unique style. For
example, you can write a message or note for a friend by
using various types of toppings (e.g., Will you marry
me?)
There are several body structures needed when making a pizza. First,
you will need two hands, all your fingers (including the thumb) and
your wrists to grasp and grip both ends of the roller when rolling out
the dough. Those same structures are also needed when using the
spoon to spread the sauce and when adding the various pizza
toppings to the pizza. Fine motor skills are especially necessary for
the proper placement and grasp of the different size toppings. When
moving the pizza in and out of the oven you will need the other
structures in your upper extremity. While all your upper extremity
muscles are necessary to complete the transfer of pizza into the oven
you will use your supinator muscles and forearm and elbow flexor
(Modified from Hersch, Lamport, & Coffey, 2005)
OCCT 506: Clinical Reasoning about Occupation
Form #4
Describe required body functions
(have justification and why it’s that)
Tactile Components: consider the
following
 Contact with others
 Materials
 Equipment
muscles for the majority of the movements. The other muscles in the
arm and shoulder will help support and stabilize your movements.
Your upper extremity joints and muscles are also needed when
opening and closing the refrigerator, oven, and pantry. Eyes are
important to find where your items are located in the kitchen as well
as where to place the toppings on the pizza. You will use your nose
to help determine when the pizza is ready to take out of the oven or
if it may be burning. Your legs, feet and lower extremity muscles
will be needed when walking throughout the kitchen. Your back
muscles are important stabilizers when standing in the kitchen and
when bending over to place the pizza on the oven rack.
Properly functioning wrist, elbow, and shoulder joints are needed to
position the arms for movement. Skin should be free of cuts or
abrasions to avoid contaminating the pizza. Thermal awareness is
important to know when the pizza is too hot to eat. Awareness of
body position and space when putting the pizza in the oven will help
to avoid burns. A sense of smell will alert you when the pizza is
ready or burning in the oven. Visual awareness is important when
placing toppings on pizza. Judgment is used to know when it is time
to take the pizza out. You should have awareness of where the
necessary items are located in the kitchen. You will need cognitive
insight on what the proper steps include when making a pizza.
Hearing is important to know when the cooking timer goes off
alerting you that the pizza is finished cooking or if a smoke detector
goes off when the pizza is burning.
When working with other individuals, communication is necessary
to know each person’s role and placement in the kitchen.
Materials needed:
- Various food products of different shapes and sizes such as
cheese, onions, pepperoni, pineapple, olives, mushrooms,
oregano, garlic, sauce, dough, etc.
Equipment and Tools needed:
(Modified from Hersch, Lamport, & Coffey, 2005)
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-
-
Performance Patterns: consider the
following:
 Habits
 Routines
 Roles
The equipment necessary for this activity is a large, square
oven to cook the pizza and a tall rectangular refrigerator to
keep the ingredients fresh and cool before cooking.
Some tools that are necessary include a large square metal or
wood pizza pan, a circular plastic or electric timer, a
cylindrical dough roller with handles on both ends, a sharp
round pizza cutter, a spoon, and plastic, glass or ceramic
containers for the ingredients.
Roles:
- When making pizza your role is a cook and an artist because
you want the pizza to taste good AND look good.
Habits:
- Some habits when cooking a pizza are setting the timer to a
certain time that works best for your pizza oven. Most people
set the timer for the same amount of time each time they
cook a pizza, checking it occasionally to make sure it is not
burning.
- Another habit people tend to have is picking the same
favorite ingredients to put on the pizza each time. Some
people love Hawaiian pizza and have a habit of making a
Hawaiian pizza every time they make their own pizza,
instead of trying something new.
Routines:
- Following the sequence of steps involved in making a pizza
is a routine that everyone follows. This routine includes the
following steps:
o Rolling the dough
o Putting the sauce on the dough
o Putting the cheese and toppings on top of the sauce
o Placing pre-made pizza in the oven
o Setting timer for appropriate cooking time
o Removing pizza from the oven
(Modified from Hersch, Lamport, & Coffey, 2005)
OCCT 506: Clinical Reasoning about Occupation
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Population: Discuss for whom and
in what way increased occupational
performance can be derived from
use of this activity.
Motor & Praxis Performance Skills
Section III
Therapeutic
Application
Sensory-Perceptual Performance
Skills
o Slicing the pizza
This activity would be an excellent and fun activity for a person who
has weak fingers or difficulty grasping. Because grasping each
individual topping and placing it onto the pizza is very repetitive it
would allow that person to strengthen the fingers, hand and wrist
muscles which will strengthen their over-all fine-motor movements.
This would also be a good therapeutic activity for someone with
sensory issues because each topping will have different textures and
consistencies. Another option for someone with sensory issues is
having the cook use their hands to spread the sauce around the
dough instead of using the spoon.
There are several motor and praxis skills needed to complete this
activity. You will need to use your motor skills to reach for items in
the refrigerator and pantry and your praxis stills to walk with those
items in your hands to your cooking surface. Bending will take place
when opening the oven and you will have to coordinate your body
movements to open the door and place the pizza inside the oven.
When working with others, you will be continuously adjusting your
body posture and positioning to maneuver around people and objects
in the kitchen.
An important sensory skill is positioning the body in a location far
enough so you don’t get burned by the oven, but close enough so
you are stable when transferring the pizza onto the oven rack. You
will use your hearing to listen for the timer to go off. After the timer
goes off, you will need to time the appropriate moment to take the
pizza out of the oven (sometimes the pizza is ready to go once the
timer goes off, sometimes it needs to cook for another minute or
two). Discerning what toppings would be appropriate for your pizza
is part of the art of cooking. For example, you probably do not want
to put cool toppings like banana slices or avocado on your pizza
before you cook it because they do not taste good when they are
warm. You will also need to visually determine the proper size of
(Modified from Hersch, Lamport, & Coffey, 2005)
OCCT 506: Clinical Reasoning about Occupation
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Emotional Regulation Performance
Skills
Cognitive Performance Skills
Communication & Social
Regulation Performance Skills
Identify Precautions and
Contraindications
the pizza pan as well as the storage container for any leftover pizza.
Sometimes pizzas get cooked too long and burn, so it is important to
use proper emotional regulation skills to recover from hurt or
disappointment if your pizza burns. One should also display
appropriate emotions when dealing with others in the kitchen. For
example, a polite “excuse me” is better than yelling at someone to
get out of your way.
Judging the appropriate amount of toppings to add to your pizza is
important so the toppings do not weigh down the dough and
everything cooks evenly. Selecting tools and supplies needed to
cook the pizza as well as cleaning up the space after cooking the
pizza are also cognitive skills that will be used. One will need to
sequence the tasks needed to make the pizza (i.e. Determine which
step should come first and which steps goes last). It is helpful to
organize the ingredients before making the pizza so you know you
are not missing anything. You can also save time by multi-tasking.
For example, you can start cleaning the cooking area once the pizza
has been put in the oven.
When completing this tasks with others in the kitchen or when
making a pizza that you are going to share with someone else,
communication is important. You may gesture to others to alert
someone if you need help. You will need to maintain acceptable
physical space when working with others in the kitchen. Taking
turns with the steps is important so that one person does not end up
doing all the work. Acknowledging others input when deciding what
toppings to put on the pizza will insure everyone’s wants and needs
are taken into consideration.
Precautions
- When cooking, open wounds on the hands or surfaces of skin
that come into contact with the food are unacceptable and
should be avoided or covered. If someone has an open would
they will need to put gloves on to insure there is no
(Modified from Hersch, Lamport, & Coffey, 2005)
OCCT 506: Clinical Reasoning about Occupation
Form #4
Grading: Activity sequence,
duration, and/or activity procedures
contamination.
- For someone with a spinal injury, bending, lifting, and
twisting are all precautions and one should discuss proper
ways to bend, lift, and twist to insure there is no re-injury to
the spine.
- If someone has low-vision it is important for them to be
aware of their surroundings and the location of necessary
materials. For example, you do not want them to accidently
touch the oven when it is open or hot.
Contraindications
- Open wounds on face or severe burns to areas of the upper
extremities are red flags. Those individuals should not
perform this task until the severe wounds have healed.
Grading Up
There are several ways to make this activity more difficult
including having the cooks make the dough and sauce from
scratch. This will require more time and steps when mixing
the ingredients for the sauce and dough. Shredding the
cheese instead of using already shredded cheese, chopping
fresh vegetables, cutting the meat into individual pepperoni
slices or roll each sausage crumble by hand will also make
this activity longer. Lastly, not giving the cooks instructions
on how to prepare the pizza, the temperature settings, and the
amount of time the pizza should stay in the oven will make it
more difficult and therefore you will have to account for
more time and probably more steps as they problem solve the
best way to complete the pizza.
Grading Down
- Making your own pizza seems like a pretty simple task, but
there are ways to make it even easier. First having pre-made
dough eliminates the lengthy and strenuous task of kneading
the dough. Buying shredded cheese, pre-cut vegetables, and
(Modified from Hersch, Lamport, & Coffey, 2005)
OCCT 506: Clinical Reasoning about Occupation
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Grading: Working position of the
individual
pre-cut meat options will also save a few steps and will
eliminate using a sharp object for cutting. Also having fewer
ingredient options and larger ingredient options would make
applying the toppings to the pizza easier. To make it
REALLY simple you could buy a pre-made pizza and then
the steps to cooking would be cut down tremendously. The
steps for a pre-made pizza would include pre-heating the
oven, removing the pizza from the packaging, placing the
pizza on the oven rack, setting a timer, and removing the
pizza from the oven when it is finished.
Grading Up
- Adding more individuals to a smaller kitchen would make
this activity more challenging as each person would have to
be more cautious of their body movements in relation to the
other people in the kitchen. There would be more obstacles
in the way making it more difficult to maneuver. Having the
pizza sauce station on one side of the kitchen, the cheese
station on another side of the kitchen, the toping station in
the dinning room, and finally having the oven located further
away from the preparation areas would make this activity
more difficult as more motor and praxis skills would be
needed to get from “A” to “B.”
Grading Down
- Having an assistant around to help when needed would make
this task easier. For example, having the assistant open the
oven door while the cook puts the pizza in the oven would
make it less difficult for the cook. Also, allowing the cook to
use a stool or chair when preparing the pizza for the oven
would be helpful for someone with weakness in the lower
extremities. Having all the ingredients set up in a work
station that is close to the oven would make this activity
easier as there would be less maneuvering throughout the
(Modified from Hersch, Lamport, & Coffey, 2005)
OCCT 506: Clinical Reasoning about Occupation
Form #4
Grading: Tools (nothing should be
blank) – things you can use over and
over again
 Position
 Size
 Shape
 Weight
 Texture
Grading: Materials – things that are
used up
 Position
 Size
 Shape
 Weight
 Texture
kitchen.
Grading Up
- To make this more challenging you can use a dough roller
with smaller handles. You could use a smaller size knife or a
duller knife to make cutting the pizza ingredients more
difficult. Having the ingredients in small bowls as opposed to
larger containers would make picking up the ingredients
harder. Using a knife to cut the final slices instead of a round
pizza slicer would be more challenging. Having the cook use
a long tong to pick up the small ingredients and place them
on the pizza would really work on their fine motor and
grasping skills. You could also test their cognitive and
sensory skills by not allowing the cooks to use a timer and
instead relying on them to check the pizza every few minutes
and use their best personal judgment on when it is ready to
come out of the oven.
Grading Down
- To make this activity easier you can use a dough roller with
larger handles. You can use large, labeled containers to make
discerning the toppings simpler. Using a weighted spoon to
spread the sauce on the dough could also be helpful for some
people. Using a thin metal pan rather than a thick wood pizza
pan would make getting the pizza in and out of the oven
easier. Using a pizza slicer would make cutting the pizza
slices quicker.
Grading Up
- You could make different shaped pizzas instead of the
traditional circular pizza. You could add more toppings to the
pizza or make it bigger and heavier which would make it
harder to pick up and place in the oven.
Grading Down
- Using fewer ingredients will make the pizza lighter and
(Modified from Hersch, Lamport, & Coffey, 2005)
OCCT 506: Clinical Reasoning about Occupation
Form #4
Grading: Nature/degree of
interpersonal contact
Grading: Extent of tactile, verbal, or
visual cues provided by practitioner
during activity
Grading: Teaching-learning
environment
Therapeutic Adaptation: Indicate
ways in which this activity can be
changed to increase occupational
performance and state your
reasoning. Consider: (don’t leave
anything blank)
- Orthotic devices
easier to place in the oven. Of the ingredients that you
choose, having larger diameters would make picking up the
toppings easier.
Grading Up
- Having more people in the kitchen would increase the
number of distractions while cooking.
Grading Down
- Having another person present when making the pizza will
allow for the steps to go faster and allow you to have help if
needed.
Grading Up
- Giving no instruction would allow the client to problem
solve on their own.
Grading Down
- The practitioner showing the client how to perform each step
would ensure they are doing the activity correctly.
Grading Up
- Following a video on a computer instead of having an
instructor in the room with you would make learning the
steps more difficult. Providing a paper with directions but not
giving feedback on how to do those steps will create a more
challenging environment.
Grading Down
- One-on-one instruction would make this activity less
stressful.
- Orthotic devices
Using a back brace would help stabilize individuals with back
and lower extremity deficits. This would allow them to be more
mobile in the kitchen and stand for longer periods of time. Using
a long-handled reacher for retrieving items from high shelves
can avoid the need to climb on a ladder or step stool.
- Prosthetic devices
An artificial arm, known as the “myoelectric” arm, can be used
to provide the user with fine control of the limb. This artificial
(Modified from Hersch, Lamport, & Coffey, 2005)
OCCT 506: Clinical Reasoning about Occupation
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-
Prosthetic devices
Assistive technology
Adaptive devices
Architectural modifications
Environmental modifications
Wheelchair modifications
-
-
arm is battery powered and places small electrodes on the skin at
the site of amputation and uses the muscle signals from the
remaining arm muscles to help move the prosthetic arm.
Assistive technology
Using an enlarged print digital timer is useful for people with
limited vision.
Adaptive devices
Other useful items include an electric can opener to open the
sauce can and a rubber cover that can be slipped over the oven
door handle and the refrigerator door handle to provide a better
grip. A high stool with a backrest will provide comfort while
working on a countertop. A rolling cart can be utilized to
transport heavy objects and decrease the number of trips between
the kitchen and dining table. Heavy containers can be replaced
with lighter plastic ones that do not break.
Architectural modifications
For people with money concerns something as simple as adding
“U” shaped handles to the cabinets to avoid grasping the more
difficult knob handles can be a cost effective solution. For
people who are permanently in a wheelchair we could discuss
lowering the counter tops to be at the wheelchair level as well as
re-designing the sink so that a wheelchair can slide under it.
Also, redesigning the cabinets like the picture below will make
reaching for items easier.
(Modified from Hersch, Lamport, & Coffey, 2005)
OCCT 506: Clinical Reasoning about Occupation
Form #4
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Energy conservation techniques or
methods
Work simplification techniques or
methods
Joint protection techniques or
methods
Body mechanics – consider
 Proper body mechanics
 Avoiding static or deforming
postures
 Avoiding excessive weightbearing positions
Wheelchair modifications
Placing a wooden cutting board on the cooks lap will provide
protection of the legs from hot spatters and serves as an insulated
table to put hot items on the lap to prevent burns. It also frees up
the person’s hands so they can maneuver their wheelchair in the
kitchen.
- Environmental modifications
Generally kitchen floors are tile and can be slippery, so adding a
non-slip surface would help reduce the risk of falls in the kitchen
environment.
For people in a wheelchair the aforementioned wheelchair
modification (i.e. wooden cutting) will help conserve energy when
moving about the kitchen. Using a container with multiple
compartments will allow you to have all the ingredients in one
container and decrease the amount of containers thus making cleanup easier.
Using a pizza slicer will make dividing the pizza simpler. Having
fewer toppings available will make choosing the toppings easier and
the actual act of making the pizza quicker.
Listening and respecting any signs of pain are important. Pain is an
indicator of joint destruction, and therefore activities should be
stopped immediately when a person begins to feel pain. Using two
hands to carry objects, lightening the load that the person is carrying,
or building up the handle on the objects (with a towel or foam) to
help distribute the weight of the object across joints will help protect
the joints. Push or pull all objects across the counter instead of
carrying them can also preserve the joints.
Before lifting, reaching, pushing, pulling or carrying objects have
the cook remove any objects that are in their way. Next make sure
their base of support is wide enough to evenly distribute the body
weight. Make sure the cooks are aware of their personal abilities and
limits. For example, when objects are too large, bulky or heavy they
may obtain assistance. When bending make sure the cooks are
(Modified from Hersch, Lamport, & Coffey, 2005)
OCCT 506: Clinical Reasoning about Occupation
Form #4
How does this activity enhance
occupational performance areas?
How does this activity enhance the
satisfaction of the client and/or
caregivers?
How does this activity enhance
quality of life?
Describe in detail each member’s
specific duties during the
presentation and completion of this
form (just the members of the
group). How did your view of
occupation change throughout this
process?
Synopsis
keeping their back straight and are using their legs to lift them back
up rather than their backs.
The steps involved in cooking a pizza are similar to the steps needed
to cook other foods and thus will enhance the client’s ability to
prepare meals independently. Some of these tasks (i.e. grasping
toppings) will build up fine motor strength and will help with other
everyday tasks.
Making a pizza allows a person to personalize their meals and will
make eating more satisfying. If they learn how to adapt the steps to
do this activity independently they will not have to rely on others for
assistance and, in turn, will improve their spirits.
Cooking can be therapeutic and considered a form of art. Some find
that cooking relieves stress and can actually be very fun. Meal
preparation is important in being an independently functioning
person and can provide the fine motor skills necessary in other
household activities.
Gerilynn typed up the outline for our form while Vicky modified it
into complete sentences and made sure it flowed. Both members
researched different modifications and adaptations for this activity.
Both members went shopping for the ingredients and provided tools
to complete the activity. Both members participated in setting up the
work-space prior to engaging in the activity. Vicky’s view on the
occupation of making pizza has changed in that she didn’t realize
how many kitchen modifiers are available for people with various
disabilities. While cooking may still be difficult, these devices really
help make people more independent. Gerilynn’s view of occupation
changed in terms of realizing how much modification and adaptation
must be done in order for a person with disabilities to perform an
activity that is often taken for granted (i.e. cooking). Both Gerilynn
and Vicky feel that making pizza is a simple task and found it hard
to find ways of making it simpler besides using assistive kitchen
devices. Coming up with ways to make this task more challenging
(Modified from Hersch, Lamport, & Coffey, 2005)
OCCT 506: Clinical Reasoning about Occupation
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was much easier for us.
(Modified from Hersch, Lamport, & Coffey, 2005)