1

Treatment Plan #2: “Bill”

Alicia Colossi

Department of Occupational Therapy, Duquesne University

Dr. Elizabeth Deluliis, & Dr. Michelle McCann

OCCT 520 Neurological Sensorimotor Function II / Lab

February 03, 2023

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Conceptual Models

The compensation approach of the Cognitive Rehabilitation Model (CRM) will be used

to help the occupational therapy student (OTS) develop an intervention plan for this client. Due

to the client’s current cognitive deficits, they would not be able to utilize transfer of learning.

Therefore, the OTS will largely focus on teaching compensatory strategies throughout their

session (Wilson, 2000). According to Wilson (2000), the compensation approach of the CRM

puts a large focus on addressing the disabilities at hand rather than the impairment. Thus, the

OTS will utilize compensatory strategies such as structured environments, external cues, and

habit training to help compensate for the client's cognitive and perceptual deficits rather than to

remediate them. In doing so, the OTS will allow the client to have a greater advantage of success

in their activities which is crucial for their current cognitive status and recovery.

Additionally, the Neuro-Functional Approach (NFA) will be used to guide the OTS’s

therapeutic decisions, as it was designed for individuals who are unlikely to develop self-care or

community independence skills spontaneously following a TBI (Giles, 2010). This client

currently requires maximum assistance for all activities, and without intervention and support

they would most likely be unable to return to their typical functioning. Through the use of NFA,

the OTS will develop real-life situations that provide the client the opportunity to learn by doing

(Giles, 2010). For example, the OTS will utilize real eating utensils when trying to facilitate the

client's learning of how to utilize them properly to self feed. Furthermore, the OTS will follow

the practice of errorless learning that is expressed in this approach. In doing so, the client's

frustration and discouragement will hopefully be decreased and allow for better opportunities to

acquire the desired skill.

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Strengths and Weaknesses

Clients Strengths Include:

1. Client is 22 years old. This is a strength because recovery after a brain injury is much

more limited for an individual that is older (Marquez et al., 2008). Thus, this puts the

client at an advantage for a higher chance of a faster recovery based on their diagnosis.

2. Client has a temporary discharge set-up with their brother.

3. Client’s muscle tone, strength, and range of motion (ROM) are within normal limits.

4. Client’s visual acuity is intact.

5. Client is mobile- they can ambulate without an assistive device.

6. Client can/will participate in gross motor activities.

7. Client has leisure interests such as sports and hanging out with friends.

Clients Weaknesses Include:

1. Client has a lack of effective health insurance. This can continue to cause issues with

receiving the proper care needed to recover due to extreme expenses

2. Client does not have a completed highschool education.

a. Research by Dube (2018), illustrates that, “Not completing [a] high school

education is linked to poor health literacy skills, which are necessary to navigate

the healthcare system” (n.p.). This may put the client at a disadvantage towards

being able to make knowledgeable medical decisions for themselves, especially

since they lack parental support.

3. Client has a lack of parental and significant other support.

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4. Client is currently unemployed which may cause financial setbacks with their

rehabilitation courses of treatment. Especially since the client’s health insurance is not

strong.

5. Client has a TBI- closed head injury, accompanied by minor head laceration

6. Client’s vitals may fluctuate due to their current status.

Neurosensorimotor Problem List

1. Client is currently experiencing the following cognitive deficits.

a. Client has decreased safety and judgment skills.

b. Client is agitated and is showing aggression.

c. Client is confused and not oriented to time or place.

d. Client has a limited attention span: is easily distracted.

e. Client is experiencing post traumatic amnesia.

f. Client has decreased short term memory.

2. Client is currently experiencing the following visual perceptual deficits.

a. Client is experiencing visual agnosia.

i. They are having difficulty recognizing family members in photographs

b. Client is experiencing various forms of apraxia:

i. Ideational apraxia as expressed through difficulty using utensils

properly.

ii. Dressing apraxia as expressed through difficulty dressing in the right

order.

c. Client is experiencing left (L) side hemi-inattention as expressed through

sporadically missing letter cancelation tasks.

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3. Client requires assistance and external cues with all activities.

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Data Collection

NSM Problem Measure Description/Rationale Results

Vitals Since the client has suffered a TBI, their vitals will be Blood Pressure: 125/79 mmHg
taken at the beginning, middle, and end of the session. It
Blood pressure will be important to note if they are in functional range, Heart Rate at rest: 70 bpm
(BP) and if the client can tolerate the entirety of the session.
Heart Rate The OTS will assess the clients HR via direct observation Blood Oxygen: 99% Sp02
(HR) at their radial artery located on the wrist. The normal
Blood Oxygen range that they will be looking for is between 60-100 All of the client’s vital signs are within normal limits.
(O2) bpm. Next, they will assess the client’s BP via a blood This indicates that the OTS can precede with their
pressure cuff and stethoscope. The normal range the OTS session.
will be looking for is 100-140/60-90. Finally, they will
assess the clients O2 via a pulse oximeter. The normal
Sp02 range they are looking for is 95-100%.

Agitation Agitated Behavior The ABS is a 14-item instrument that is used to measure, __4__1. Short attention span, easy distractibility,
Scale (ABS) “Behavioral aspects of agitation during the acute phase of inability to concentrate.
recovery from acquired brain injury including aspects of __4__2. Impulsive, impatient, low tolerance for pain or
aggression, disinhibition, and lability” (Shirley Ryan frustration.
Ability Lab, 2012). This 30 minute assessment should __3__3. Uncooperative, resistant to care, demanding.
only be completed for clients experiencing symptoms of __3__4. Violent and or threatening violence toward
agitation. If the OTS notices that the client becomes too people or property.
frustrated or agitated during the assessment they will look __3__5. Explosive and/or unpredictable anger.
at an abbreviated amount of the assessment. They can do __1__6. Rocking, rubbing, moaning or other self-
so by assessing questions 1-7 instead of 1-14. The OTS stimulating behavior.
will assess the client on each item and rank them on a __1__7. Pulling at tubes, restraints, etc.
scale from 1-4. Scoring for this assessment is as follows: __4__8. Wandering from treatment areas.
__3__9. Restlessness, pacing, excessive movement.
1= Behavior is not present. __3__10. Repetitive behaviors, motor and/or verbal.
2= Behavior is present but does not prevent others. __3__11. Rapid, loud or excessive talking.
3= Behavior is present and client needs to be redirected. __3__12. Sudden changes of mood.
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4= The individual is not able to engage in __3__13. Easily initiated or excessive crying and/or
appropriate behavior due to the interference of the laughter.
agitated behavior. __1__14. Self-abusiveness, physical and/or verbal.
It is important to assess the client’s agitation levels as it
will influence the treatment approaches used with them. It Total Score: 39- This shows that the client is agitated
will also give the OTS a better understanding of potential and it is affecting their ability to be treated. They need
triggers of their agitation through observation. The to be redirected when this behavior occurs.
minimum score on this assessment is 14 and the
maximum is 56.
(Shirley Ryan Ability Lab, 2012).

Cognition Direct Understanding if a patient is able to make safe judgment The OTS noted that the client did not exhibit safety
observation decisions is important not just for their own safety, but awareness during their session. They requested
Safety and for the safety of everyone else in the outpatient clinic. A supervision of the client during their time at the
Judgement patient that is unable to make safe decisions requires outpatient clinic to ensure that patient remains safe as
supervision to ensure that nothing dangerous will happen. well as to keep other patients safe. Below are some
This client has been noted to have a lack of judgment questions and answers that were discussed between the
skills. For this reason, the OTS will complete a direct OTS and client:
observation of how they respond and act during their
assessment sessions and to questions that they ask. The Q1: What would you do if someone fell down and
OTS will use their clinical knowledge to come to a fainted next to you?
conclusion if they think the client has safety awareness or A1: I would walk away from them.
not. Q2: What would you do if you were in your kitchen and
you started to see smoke but you were not cooking?
A2: I would open the windows and then stay in the
kitchen to make sure my belongings were safe.
Q3: What would you do if you were eating lunch and
you noticed that it smelled sour?
A3: I would keep eating it if I was hungry.

Direct During conversation with the client, the OTS will want to Below are the client’s verbal and physical reactions
Observation/ ensure to assess the client's level of orientation, attention, to the OTS’s questions:
Screening and short term memory. Due to the client's current level
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Orientation, of agitation and frustration, it would not be feasible for 1) Can you tell me your name and date of birth?
attention, and the OTS to do a standardized assessment at this time to ● Bill Smith, January 01, 1994.
short term assess these areas. However, it is important for the OTS 2) Can you tell me where you are?
memory (STM) to get an understanding of where the client is in these ● My grandma's house. When will she be back?
areas as it will impact their ability to participate in their Are you her friend?
daily activities. 3) Can you tell me the date?
● No.
Questions that the OTS can ask the client to assess these 4) Can you tell me the time?
areas include: ● I don’t know.
Orientation: 5) What is my name?
1) Can you tell me your name and date of birth? ● I don’t remember. You don’t know your own
2) Can you tell me where you are? name?
3) Can you tell me the date? 6) What did you have for breakfast this morning?
4) Can you tell me the time? ● Lasagna. My mom made it for me.
7) Attention
Short term memory: ● The client did not maintain eye contact with the
1) At the beginning of the session the OTS will tell OTS. They needed to be redirected 3 times to
the client their name. About 5 minutes in they will become re-attentive.
ask the client if they remember what their name is.
2) What did you have for breakfast this morning? Upon conversation with the client, the OTS noted that
they are only oriented to self and not to place or time.
Attention: They have poor short term memory and became
1) The OTS will pay attention to the distractibility of frustrated when prompted to try and answer the
the client when they are talking to them and see if question again. They appeared disoriented when asked
they maintain eye contact or are looking around what they ate for breakfast, naming a typical dinner
the room and unfocused. food that was prepared by their mom. However, they
have not spoken to their mom in a while. Client was
easily distracted and did not maintain eye contact with
the OTS.

Ranchos Los The RLA measures a client’s level of awareness and The OTS has determined that the client is a level 4 on
Amigos Scale cognitive functioning (Lin & Wroten, 2022). It is the RLA. This means that they are confused/agitated,
(RLA) important to use this assessment for a patient s/p TBI due are hyperactive with bizarre and non-purposeful
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Cognitive & to the possible impairments they may be exhibiting. behavior, and require maximal assistance for activities
Behavior Depending on the level of this scale a patient is placed on, of daily living (Lin & Wroten, 2022).
Patterns their intervention sessions may use different treatment
techniques. Through direct observation, client’s are The OTS will use this information to guide their
ranked on one of the following levels: (only levels 1-5 are intervention sessions, further understanding both the
shown but there are 10 levels on this scale that the client assistance the client will require, and their current
can move up through. They do not have to hit all levels behavioral status.
through their recovery as all patients are unique).

Level 1: No response to external stimuli, total assistance

Level 2: General response, total assistance. Responds
inconsistently and non-purposefully to external stimuli.
Level 3: Localized response, total assistance. Responds
inconsistently and specifically to external stimuli
Level 4: Confused/agitated, maximal assistance.
Hyperactive with bizarre and non-purposeful behavior.
Level 5: Confused and non-agitated, maximal assistance.
Shows increase in consistency with following and
responding to simple commands.
(Lin & Wroten, 2022, pp.4-9).

Visual Visual Perceptual Prior to administering any standardized assessments for Below are some questions and answers that were
Perception Screening VP deficits, the OTS will conduct a VP screen to see if discussed between the OTS and client:
(VP) Through Direct there are any areas of need and what they are. In doing so,
Observation the OTS will shorten the amount of time that assessments 1) Has anyone ever told you that you should wear
are being conducted, which will benefit the client due to glasses or contacts?
their current level of distractibility and agitation. ● No
Questions/screenings that the OTS can ask the client to 2) Do you experience any blurriness in your vision?
assess these areas include: ● No
3) 3) Do you experience headaches frequently?
1) “Has anyone ever told you that you should wear ● No
glasses or contacts?” 4) Client appears to struggle with letter cancellation
2) “Do you experience any blurriness in your vision?” tasks, getting dressed in the right order, and using
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3) “Do you experience headaches frequently?” utensils appropriately.

4) OT will observe client during basic activities and pay 5) Client named all colors correctly- does not appear to
attention to their vision and where their eyes go. have color discrimination issues.
5) OTS will hold up a piece of paper with colored squares 6) All functional and typical.
on it and ask the client to identify colors. 7) Got correct.
6) OTS will use a pen light to track saccades and ocular 8) Got correct.
alignment 9) Could not identify family members.
7) “Can you read my name tag?” 10) Could not identify correct use of utensils.
8) “Can you tell me what that sign says on the other side 11) Could not identify the correct dressing order.
of the room?
9) “Can you tell me who is in this picture? Client’s vision is functional and intact. Client has some
10) Hold up 3 utensils. “Can you tell me what the purpose visual perceptual deficits noted that should be further
of each of these are?” examined. These include agnosia, apraxia, and hemi-
11) Hold up underwear and pants. “Which of these should inattention.
you put on first?”

Occupational The OT-APST is used to “Test for the presence of Agnosia Subtest Apraxia Subtest
Therapy Adult impairment in visual perception across each of the major 1) Name six colors in an 1) Smile command and
Perceptual constructs of visual perception and praxis” (Zeltzer, array (6) copy (2)
Screening Test 2008). There are 35 items on this test that are categorized ● “Blue, pink, red, ● Completed
(OT-APST) into 7 subtest areas. Due to the client’s limited attention orange, yellow, … I 2) Wave right hand
Agnosia and span and agitated nature, the OTS will give the client an don't know.” command and copy (2)
apraxia abbreviated version of this assessment. The subtests that 2) Name this object and ● Completed
the OTS will perform include agnosia and apraxia as its purpose (ruler) (1) 3) Wave left hand
these have been the observed area that the client struggles ● Named object but command and copy (2)
the most with. During the Agnosia subtest, the OTS will could not name ● Completed
assess the client on color, object, figure-ground, shape purpose. 4) Stapler hold
constancy, and reading agnosia via sets of questions and 3) Recognize 5 items in command and copy (2)
prompts. During the apraxia subtest, the OTS will assess the photo with the busy ● Could not
the client on different command and copying tasks. This background (5) complete.
should take about 10 minutes to complete (Zeltzer, 2008). ● Client spotted 2 of 5)Pen use for writing (1)
If the client can tolerate the entire assessment, which the 5 images. ● Could not
takes about 30 minutes, it would be preferred for the OTS 4) Can you find all the complete without
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to administer the other subtests to note any other possible squares on this piece of commands.
areas of deficits. The client will be scored on each task. paper? (10) 6) Writing (1)
The lower the score received, the greater the visual ● Client sporadically ● Could not
perceptual deficit (Zeltzer, 2008). missed 4 of the 10 complete without
squares commands.
5) Can you read this
paragraph? (4)
● Client became
agitated and lost
attention- could not
finish reading.

Total score 21/36

Score interpretation: Client is experiencing deficits in
both agnosia and apraxia. Therefore, OTS should
develop interventions focused on addressing these VP
deficits.

Strength and Functional When working with a new client it is best practice to The client’s UE ROM and strength are within
Range of Observation assess their ROM and strength to gather a baseline and to functional limits. The client appeared disoriented and
Motion Passive range of note if they have any potential deficits (Rowe & Zeiner, agitated to prompts from the OTS.
(ROM) motion (PROM ) 2021). Therefore, the OTS will complete a functional
Goniometry observation of the client during their daily routine. If they
Manual muscle notice any limitations in ROM or strength, the OTS will
testing (MMT) first do a PROM screening. Then they will complete
goniometry and/or MMT to see if/where the deficits are.

Activities of Barthel Index (BI) The Barthel Index assessment is important to use with 1) Bowels: 4) Feeding
Daily Living this client because it will assess their current level of 0=incontinent (needs 0=unable
ability to care for themselves (Shirley Ryan Ability Lab, enemata) 1=needs help cutting,
2020). Due to the client’s current level of agitation and 1= occasional accident spreading butter, etc.
distractibility, the OTS will use an abbreviated version of (once/week) 2=independent (food
the BI. There are 10 items that make up the BI and the 2=continent provided within reach)
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OTS will use the 5 most applicable to the client’s current Score= 2 Score= 1
status. The 5 areas that the OTS will focus on are bowels, 2) Bladder: 5) Dressing
bladder, grooming, feeding, and dressing. The lower the 0= incontinent, or 0=dependent
score the client receives on each item, the higher their catheterized and unable to 1=needs help but can do it
disability level (Shirley Ryan Ability Lab, 2020). The manage half unaided
OTS will use the client’s scores on this assessment to 1=occasional accident 2=independent (including
identify appropriate goal areas to work on them with. (max once per 24 hours) buttons, zips, laces, etc.)
2= continent (for over 7 Score= 1
days)
Score= 2 Total Score on ½ of
3) Grooming: questions: 6/10
0=needs help with personal Score interpretation:
care Scores on this assessment
1=occasional accident show that the client
(max once per 24 hours) requires assistance for
2=continent (for over 7 ADLs and that is an
days) appropriate goal area for
Score= 1 the OTS to work with the
client on.

Note: Client does not appear to have active family members present at their therapy sessions. Client has a temporary discharge set-up
with their brother. Try and contact the brother to come to future therapy sessions to be able to complete family interviews and client
care education with them. Involving family members in a TBI client’s recovery can increase their positive outcomes (Rasmussen et al.,
2021).
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Goals

Long Term Goal

1. Client will complete the task of self-feeding with supervision via the use of cue cards,

with no more than 2 verbal cues in 2 weeks.

Short Term Goals

1. Client will demonstrate appropriate use of fork and spoon, 3/4 times during a self-

feeding activity, with supervision, and no more than 1 verbal and 1 tactile cue in 7 days.

2. Client will verbally identify 2/3 feeding utensils in order to engage in a self-feeding

activity, with supervision and no more than 3 verbal cues in 5 days.

Occupational Therapy Intervention

Prior to meeting with the client, the OTS will complete an extensive chart review and talk

with the interdisciplinary team to see if therapy can be tolerated. All team members agree that

the client can participate in therapy, and the chart does not indicate the client is NPO. The OTS

will ensure to find a quiet area of the clinic’s gym or request a private room for this session, as a

normalized environment will assist the client in their success due to their known distractibility

and agitation. At the start of the session, the OTS will confirm the patient's name and date of

birth. They will then verbally introduce themselves, and give a quick explanation of the purpose

of occupational therapy. Then, the OTS will take the clients HR, BP, and blood oxygen levels.

Therapy should not be conducted if the client’s vitals are not within functional limits.

Occupational therapy intervention will begin by providing the client with a visual

plan/schedule of the activities/goals of the session. The OTS will verbally describe this plan to

the client and respond to any presented agitation or confusion in relation to the activities. The
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OTS will be utilizing a compensatory approach to guide this session via various external cues;

therefore, providing the client with both photos and words on the activity plan will allow them to

make connections that they otherwise might not be able to.

As another intervention to support occupation, the OTS will focus on orienting the client

to different feeding equipment to help support their short term goal of being able to verbally

identify them. Currently, the client has lost the ability to utilize feeding utensils appropriately.

Since the client is experiencing a lack of orientation and awareness, the OTS will begin their

session by individually presenting the client with real-life feeding utensils/objects (ie: Fork,

spoon, knife, and cup) to allow them to build these perceptual connections. The OTS will use

real life-objects rather than photos to start because it will allow for a greater opportunity for

naming accuracy and recognition since the client has visual agnosia (Holler et al., 2019). During

this activity, the client will be seated erect in a chair directly across from the OTS. The OTS will

first hold up a fork, identify the name of the utensil, what types of food it can be used for (ie:

solids not liquids), and then demonstrate how to use it. During this activity, food will not be

included and the OTS will roleplay the use of the utensils. After the fork, the OTS will repeat

with the spoon, then the fork and knife together, and then the cup. With each item, the OTS will

make sure to provide verbal and gestural cues to the client about the name, purpose, and

mechanisms to each object. If any family members are present during this session, the OTS will

provide them with a handout on important things to include when trying to describe objects and

their ideational purposes to clients.

The OTS will then move on to a purposeful activity that involves the client having to

gather feeding utensils around the room. This will allow the OTS to work with the client on their

object recognition skills, while also incorporating the client’s interest in gross motor activities. A
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literature review by Zhang et al., (2022) discusses the effectiveness of movement on the

improvement of patients s/p brain injury. They found that, “Exercise, as a non-pharmacological

tool, contributes to outcome improvement after TBI, including improvement of injury-induced

cognitive and mood disorders” (Zhang et al., 2022, n.p.). Thus, the OTS will utilize these

findings to guide their decision to incorporate movement throughout the session in hopes of

decreasing the client's frustration and agitation, while also helping them to achieve their goals.

The OTS will put 1 fork, 1 spoon, 1 knife, and 1 cup on various multi-level surfaces

around the room. They will also put objects such as pens, paper, a book, and a phone charger on

these surfaces as well. The items that are not required for the self-feeding activity will have a

piece of red tape on them to assist in decreasing the client’s errors during this activity. The OTS

will instruct the client to walk around the room and pick up the 4 items that can be used for self-

feeding. For a client of this level, errorless learning (EL) is crucial to sequentially decrease

frustration and agitation while also increasing success. Barman et al., (2016) describe that

errorless learning is a huge part of a multidisciplinary approach in therapy for individuals s/p

TBI. It is a, “Useful strategy for teaching specific information or procedures” (Barman et al.,

2016, p.14). Therefore, the OTS will ensure to utilize this approach with this client during this

stage of their recovery via various verbal cues and prompts. As the client is walking around the

room the OTS will walk next to them to be able to see what they are going to pick up. If it

appears that the client is going to gather an item that is not meant for self-feeding, the OTS will

say something such as, “Is this something that you need to be able to eat?” If one verbal prompt

does not assist the client, the OTS will further prompt the client to help them understand that is

not an object they need to gather. If the client appears to be ignoring items that are on their L

side, the OTS will provide tactile cues to increase awareness to that side of their body as well as
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items that may be located on that side. Once all of the self-feeding items have been gathered, the

OTS will instruct the client to place them in a labeled bin on top of a table. Once this happens,

the OTS will allow the client to take a 5 minute mental and attention break. If family is present at

this time, the OTS can answer any questions they or the client might have. If this activity needed

to be graded down, the OTS could give the client a list of items that they needed to gather

accompanied by pictures so they could check them off after they gathered them. If it needed to

be graded up, the OTS could have placed colored photos around the room for the client to collect

rather than the real-life item.

Next, the OTS will introduce an occupation-based activity that includes the client

participating in self-feeding. According to AOTA (2020), self-feeding is defined as, “Setting up,

arranging, and bringing food or fluid from the vessel to the mouth” (p.47). Therefore the OTS

will encourage the client to build on the skills from the previous parts of the session as well as

use compensatory strategies to complete this occupation. The client will be sitting upright in a

chair in front of a table for this portion of the session. Prior to starting the activity, the OTS will

squeeze the client’s left and right hands to increase awareness and proprioceptive input. Then,

the OTS will put a bowl of oatmeal in front of the client, as they discussed this is their favorite

food. The OTS will place the 4 feeding utensils on the table in front of the client. Underneath

each utensil will be a cue card with the name of the utensil and a photo of it being used. The OTS

will ask the client to eat the oatmeal, paying attention to which utensil they chose, if they hold it

correctly, and if they are able to get the oatmeal from the bowl and into their mouth. If the client

does not appear to be reaching for the spoon, the OTS will use verbal cues to redirect them. If

time permits and the patient is still hungry, the OTS will provide the client with a plate of eggs.

This activity will then be repeated with the fork. If it appears the client is able to complete these
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components with ease, the OTS can grade it up by giving the client food that requires a fork and

knife. This would require the client to correctly utilize and remember the purpose of two utensils

rather than just one. On the other hand, if the OTS notices the client is experiencing errors in

their participation, they can grade the activity down by increasing their gestural cues. At this

point, the OTS might want to demonstrate how to use the utensils again, then show the client a

photo of someone using them, and then allow the client to try and utilize them properly again.

Backward chaining may also be applied to increase the client’s successfulness in this activity,

thus decreasing their frustration levels.

The treatment session will end with the client’s vitals being taken. This will allow the

OTS to see how well the client tolerated the therapy session. The OTS will verbally thank the

client for their time and for participating in the session. The OTS will then document the session

in their chart and talk to any other members of the interdisciplinary team if necessary.

References and Database Table

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American Occupational Therapy Association (2020). Occupational Therapy Practice

Framework: Domain and process fourth edition. American Journal of Occupational

Therapy, 74 (Suppl. 2),7412410010p1–7412410010p87.

This source was used to define self-feeding.

Barman, A., Chatterjee, A., & Bhide, R. (2016). Cognitive impairment and rehabilitation

strategies after traumatic brain injury. Indian Journal of Psychological Medicine, 38(3),

172-181. doi: 10.4103/0253-7176.183086.

This source was used for evidence to support errorless learning as effective with this client.

Dube, S.R. (2018). The data is in: Americans who don’t finish high school are less healthy than

the rest of the US. Georgia State University.

https://news.gsu.edu/2018/09/27/the-data-is-in-americans-who-dont-finish-high-school-

are-less-healthy-than-the-rest-of-the-us/.

This source was used to determine how education level can affect health literacy.

Giles, G.M. (2010). Cognitive versus functional approaches to rehabilitation after traumatic brain

injury: Commentary on a randomized controlled trial. American Journal of Occupational

Therapy, 64(1), 182-185. doi: 10.5014/ajot.64.1.182.

This source was used to gain information on the neuro-functional approach.

Lin, K. & Wroten, M. (2022). Ranchos los amigos. StatPearls.

https://www.ncbi.nlm.nih.gov/books/NBK448151/#_NBK448151_pubdet_.

This source was used to learn more about the Ranchos Los Amigos scale.

Marquez de la Plata, C.D., Hart, T., Hammond, F.M., Frol, A.B., Hudak, A. Harper, C.R.,

O’neil-Pirozzi, T.M., Whyte, J., Carlile, M. & Diaz-Arrastia, R. (2008). Impact of age on

long-term recovery from traumatic brain injury. Archives of Physical Medicine

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and Rehabilitation, 89(5), 896-903. doi: 10.1016/j.apmr.2007.12.030.

This source was used to gain information on how age can impact recovery after a TBI.

Rasmussen, M.S., Andelic, N., Pripp, A.H., Nordenmark, T.H., & Soberg, H.L. (2021). The

effectiveness of a family-centered intervention after a traumatic brain injury: A pragmatic

randomized controlled trial. Clinical Rehabilitation, 35(10), 1428-1441.

https://orcid.org/0000-0003-2794-4768.

This source was used to support the desire for the client’s family to participate in therapy.

Rowe, V. T., & Zeiner, T. L. (2021). Chapter 13. Motor function assessment: Range of motion,

strength, and endurance. In D. P. Dirette & S. A. Gutman (Eds.), Occupational therapy

for physical dysfunction (8th ed., pp. 197–263). Wolters Kluwer.

The chapter of this textbook was used to gain information on strength and ROM.

Shirley Ryan Activity Lab. (2012, November 30). Agitated behavior scale. Ability Lab.

https://www.sralab.org/rehabilitation-measures/agitated-behavior-scale.

This source was used to learn more about the Agitated Behavior Scale.

Shirley Ryan Activity Lab (2022, May 21). Barthel index. Ability Lab.

https://www.sralab.org/rehabilitation-measures/barthel-index.

This website was used to get information on the Barthel Index.

Wilson, B.A. (2000). Compensating for cognitive deficits following brain injury.

Neuropsychology Review, 10(4), 233-243. https://doi.org/10.1023/A:1026464827874.

This source was used to gain information on the compensation cognitive rehabilitation

model approach to utilize as a guide for this client.

Zeltzer, L. (2008). Occupational therapy adult perceptual screening test (OTAPST). Stroke
 20

Engine. https://strokengine.ca/en/assessments/occupational-therapy-adult-perceptual-

screening-test-ot-apst/.

This source was used to gain information on the OT-APST.

Zhang, Y., Huang, Z., Xia, H., Xionf, J., Ma, X., Liu, C. (2022). The benefits of exercise for

outcome improvement following traumatic brain injury: Evidence, pitfalls, and future

perspectives. Experimental Neurology, 349.

https://doi.org/10.1016/j.expneurol.2021.113958.

This source was used to guide the OTS’s decision in including gross motor movement.

Database Search Terms Limits Total # of Hits # Selected

Searched

PubMed (Cognitive N/A 1719 1

rehabilitation) AND
(Clinical practice)

PubMed ((Real world objects) Within 10 years 1 1

AND (Agnosia)) AND
(Intervention)

PubMed (Errorless learning) N/A 3 1

AND (TBI)

Google Scholar (Exercise) AND Within 5 years 17, 100 1

(Traumatic brain injury)
AND (Outcome
improvement)