B Y M O I R A S M A L L , G I N A S T A N G O , K A R I V I T O R I A , A N D J E N N P H I L L I P S

MR. JONES: A CASE STUDY USING THE PEOP MODEL.

. .

WHO IS MR. JONES?

A FAMILY MAN

FISHERMAN

FARMER

CHURCH MEMBER

LIKES ANIMALS

GARDNER

LOVES TO DRIVE HIS TRACTOR

LOVES TO COOK

MR. JONES EXPERIENCED A RIGHT CEREBROVASCULAR ACCIDENT , RESULTING IN:

S O M E C H A N G E S T O H I S H O M E A N D FA R M

PERSON ENVIRONMENT OCCUPATIONAL PERFORMANCE MODEL (PEOP)

“a client-centered model organized to improve the everyday performance of necessary and valued occupations of individuals, organizations and populations, and their meaningful participation in the world around them.”

(Smith, Hudson, 2012)

4 MAJOR COMPONENTS• Occupations- self directed activities that occupy ones

time(Smith, Hudson, 2012)

• Performance-The ability to preform needed skills of occupation and the occupation itself (Occupational-Based Hand Therapy!-PEOP Model, 2012).

• Top- down approach- the components that make an individual

• Personal- Intrinsic factors that make a person, an individual• Psychological/emotional, physiological, cognitive, spiritual

and neurobehavioral. (Occupational-Based Hand Therapy!-PEOP Model, 2012).

• Environment- Environmental factors are what allows or hinders the individual in completing their Occupations• Social support, societal stigmas and attitudes, cultural,

values that can support or enable, community support, built environments, economics, technology and natural environments (Smith, Hudson 2012)

PERSON

• 72 year old male• Prefers to wear bib overalls• Prefers to dress up for church• Prefers to soak in the tub• Mr. Jones likes family photos, collectables and vintage rugs• Prefers to watch tv in his “favorite” chair• Likes raising hay, cows, pigs, fish and chickens• Likes to ride tractor• Likes fresh eggs, catfish, milk, and vegetables (especially tomatoes)• Likes to can peaches• Likes dogs• Tolerates entertaining in the home (wife’s quilting bee)• Religious• Loves to maintain a spectacular yard• Right hand dominant

OCCUPATIONS

• Husband• Father• Farmer

• Grows hay for • Raises cows, pigs, and chickens• Milks the cow• Maintains and operates a tractor to care for the land

• Fisherman• Gardner and lawn keeper• Cook• Care taker of animals• Driver for himself and his wife• Attends church

PERFORMANCE

The tasks and subtasks to Mr. Jones Occupations.For example:• Cooking

• Cognition to follow directions• Bilateral Upper Extremity movement and strength• Safety awareness• Dynamic standing balance.

(just to name a few subtasks)

ENVIRONMENT

• Strong community ties (lived in the same town his whole life)• Son and neighbors help care for the land and bail the hay

• Loving family• Wife-he lives with• Two sons and daughter that work full time

• Has land that he raises cows, chickens, pigs, catfish and grows hay

• Large garden• Fruit trees• Landscaped yard

ENVIRONMENT(CONTINUED)

• House• Older style• One story farm house • 4 concrete steps to enter with no railings• 3 bedroom • 2 ½ bathrooms with a claw foot tub• Lots of vintage rugs• Lots of collectables in the home• Chair that is low to the ground

OCCUPATIONS THAT ARE IMPORTANT

TO ME:

PEOP MODEL

Identify occupational strengths and problems

In occupational performance

Assess performancecomponents

Assess occupation,activities, tasks

Assess environmental

conditions

• Smith-Fess Vocational Rehabilitation Act

• Focus: clinical impairments and management

PEOP MODEL

PEOP MODEL

• Environment is the problem!

• A.N.S.I.• Buildings

accessible to and usable

• Unemployment• Architectural

Barriers Act

PEOP MODEL

• Education• Transportation• Education for all

Handicapped Children Act

• Uniform Federal Accessibility Standards

• Air Carriers Act

AMERICANS WITH DISABILITIES

ACT

1990

STRENGTHS

• Social Support• Fulfilling/Active Life• Intact Value System• Community Involvement• Stimulating Natural Environment• Meaningful Activities• Loving Partner

CHALLENGES

• Children: Full Time Jobs• Wife: Glaucoma/Arthritis• Particular • Large Property/Upkeep

DIAGNOSTIC STRENGTHS

Alert and Oriented x Person and place

LTM Intact Verbal Expression

Attend to Task 30min.Occasional re-direct

Good Sitting Balance

Right HandDominant

Follows Most Commands

Motivated Strong PLOF

DIAGNOSTIC CHALLENGES

Not Oriented to Time STM Impaired Mildly

LeftInattention

Left Upper ExtremityImpaired

Pattern MovementPresent

Poor Gross and Fine MotorCoordination

Impulsive/PoorSafety Awareness

Light TouchSuperficial PainStereognosis

Prefers His Way of Doing Things

OCCUPATIONAL PERFORMANCE

• Creating function from a place of dysfunction utilizing this flexible model to adapt all 3 variables.

MOTIVATION AND CHANGE

•

MotivationIntrinsic and

extrinsic

ChangePhysical changes

More support of family/friends

Opportunities to develop new

interests

INTERVENTION APPROACHINTERVENTION APPROACH

• Home Modifications

• Patient Education

• Home Safety checklist

INTERVENTION STRATEGIES

PERSON

Recommend methods of assessment to acknowledge Mr. Jones’ preferences in daily occupational tasks.

Wear life alert necklace

Give client a cell phone or have phones in most rooms in case of emergency.

Educate client/family/friends for support system

Medication management

Stroke support group

ENVIRONMENT

Make environmental adaptations to the kitchen and yard to assist in ADLs, and IADLs.

Provide social supports

Adequate lighting in all rooms.

Add railing to front steps.

Take up all the “rag” rugs.

Provide sturdy chair in kitchen, outside near chicken coop

Move chicken coop closer to house

Clear counters of collectibles

Add cushions to his existing favorite chair.

OCCUPATION

No driving, set up rides to church, etc.

IADLS ADLS

Feeding chickens Baking biscuits Dressing, Fasteners

Fishing, Gardening Operating tractor Bathing

PERFORMANCE

Home health to maximize performance potential

Adaptive equipment for dressing

Utilize non-skid mats in kitchen and bathroom

Utilize a different bathroom for bathing, unless sons are able to lower him in to the claw foot bathtub.

Mirror for when shaving

Provide cut up foods or finger foods or utilize rocker knife

Durable medical equipment to assist with ADLs.

SPECIFIC CHALLENGES FACED BY MR. JONES AND HOW THEY WERE ADDRESSED IN TREATMENT UNDER THE PEOP MODEL.

QUALITY OF LIFE AND CONTINUED OCCUPATION, FIRST AND FOREMOST.

• Mr. Jones significant responsibilities in caring for the farm presented a challenge in terms of safety, energy conservation, and pain management.

• However, as the PEOP model distinguishes itself from other models, by looking at occupation and performance as way of fitting the person to the environment. Within this model, the environment (his home and farm) and what needs to change to enhance performance, not necessarily Mr. Jones as PEOP draws heavily from the disability rights movement and utilizes a top down approach when working towards enhancing client participation. (Baum and Christiansen, 2005)

ADAPTATIONS

• Although Mr. Jones was not yet ready for driving, to increase visual and sensory inattention on the left side, the O.T practitioner was looking in to ways to adapt the tractor. In the meantime, drawing on community support from the church, Mrs. Jones created a volunteer system for a young man from the church to drive the tractor while Mr. Jones rode in order to continue his role as the breadwinner. The rehab team felt that as there was no risk of traffic while operating the tractor, that being able to drive the tractor independently given adaptations would be possible. However, for now the extra community help would continue his participation.

SPECIFIC O.T. INTERVENTIONS TO ADDRESS DRIVING AND COMMUNITY MOBILITY

• To address the person, Mr. Jones practiced using a visual scanning board in his home based therapy sessions as well as a computerized driving simulator.

• To address the driving occupation, Increased mirrors were planned to be adapted, as well as a tractor shorter to the ground with extra padding and postural supports were added.

• In order to continue occupational participation in his valued role as a church and community member, the OT practitioner worked with the family to arrange rides to and from church, and arranged the weekly men’s bible study group to be held in the Jones’s home.

• The practitioner also provided the Jones’s with the Area Agency on Aging (AAA) to provide transportation alternatives if any of their transportation fell through.

CONTINUED INTERVENTION TO ADDRESS THE CHALLENGE OF THE FARM AND GARDEN

• The PEOP based practitioner places emphasis on quality of life and participation, so provided continued adaptation to the garden, which included low tech solutions such as placing boards along the path to the garden, as well as to the chicken coop and barn to ensure that Mr. Jones would not fall while ambulating with his cane.

• Because he was very particular about his garden, it was decided that large sections of the garden would be replanted within raised beds. This way he could retain participation, while the practitioner was able to continue to provide a NDT and sensory motor based treatment. Mr. Jones was able to use trunk rotation and incorporate his left extremity into gardening tasks following scapular protraction and elevation facilitated from the practitioner.

Although Mrs. Jones was not on the caseload, the practitioner knew that in order to maintain their quality of life, which for them meant staying independent on the farm for as long as possible she recommended that Mrs. Jones:

• As her hobby was canning peaches, a wall mount can opener was recommended and she was taught techniques to prevent further ulnar drift. She was also advised to seek a referral from her doctor for O.T to address low vision modifications if the time should come secondary to her glaucoma. Many of the modifications made for Mr. Jones would help the couple retain their quality of life.

CONCLUSION

“The PEOP (model) reflects the philosophy of occupational therapy in its consideration of the interactive nature of the person, environment, and of the complexity of the tasks and ability to perform these tasks necessary for the occupation of managing health.”

(Smith, Hudson, 2012)

REFERENCES• Brown, C.(2009). Ecological Models in Occupational Therapy. In Willard & Spackman's

occupational therapy. E.B. Crepeau, E.S. Cohn, and B.A Boyt-Schell)s. (Eds )11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009. Print.

• Buam, C, and Christiansen, C. (2005) Person-environment-occupation-performance: An occupation based framework for Practice. (In Christiansen, C., Baum, C, and Bass-Haugen, J (Eds.) Occupational Therapy: Performance, participation, and well-being. 3rd. Ed. Thorofare: NJ: Slack.

• Howlett, Fiona. (2012). Citing website. In Person Environment Occupational Performance Model. Retrieved Oct. 1, 2012, from www.yorksj.ac.uk.

• • Letts, L., Law, M., Rigby, P., Cooper, B., Stewart, D., & Strong, S. (1994). Person-

environment assessments in occupational therapy. American Journal of Occupational Therapy, 48(7), 608-618. “

• Occupation-Based Hand Therapy! - PEOP Model." Occupation-Based Hand Therapy! - Home. N.p., n.d. Web. 12 Oct. 2012. <http://handtherapycanbefun.weebly.com/peop-model.html>.

• Smith, D., & Hudson, S. (2012). Using the Person-Environment-Occupational Performance conceptual model as an analyzing framework for health literacy. Journal Of Communication In Healthcare, 5(1), 3-11. doi:10.1179/1753807611Y.0000000021

• Welch, Polly. (2012). Citing website. A Brief History of Disability Rights Legislation in the United States. Retrieved Oct. 25, 2012, from www.udeducation.org/resources/61.html.