While some clients are agreeable to trying any intervention you suggest, knowing its purpose is to achieve their goals and desired outcome, others may be resistant to interventions that they don’t find meaningful. In this case, your interventions may be much better received if you implement occupation based interventions suggested or identified by your client. But implementing an intervention chosen by your client does not mean that you forfeit your authority as the treating therapist or somehow decrease the effectiveness of your interventions. Instead, use an activity analysis to control and modify the activity, or a related activity, to achieve your desired outcome.

For example, as a new OT I once had a client in a SNF who repeatedly refused to participate in OT services. When I inquired as to what occupations were meaningful to him and what activities he would be agreeable to participating in, he insisted that the only intervention that he would consider was building a full sized airplane inside the facility’s gym space. Now realistically, there was no way we had the budget, space, or materials to achieve this, nor would he have had the physical or cognitive ability to complete the task even if we could provide it. But what I could do instead was identify the component parts of the task he was seeking and provide activities that included both those component tasks as well as the skills he needed to work on in rehab.

This is where an activity analysis is particularly helpful. On the surface level, it would seem as though a nuts-and-bolts activity would be appealing to this client, but in reality it was repulsive. To me, it seemed relevant to the task of building airplanes and definitely achieved the goal of addressing fine motor deficits and problem solving skills, but to the client it was insulting and childish. It didn’t matter that, for him, this was actually a difficult task. What mattered was that it was meaningless, served no obvious purpose, and held no value for him.

So instead, with the help of my more experienced manger, I searched for an alternate activity, evaluating each potential activity through the lens of an activity analysis. My requirements were that the activity include problem solving and fine motor components at the appropriate level of difficulty for each, while my client’s requirements were that it appear adult-like and challenging and had an engineering component. The solution? Our clinic had several white storage cabinets that had served as temporary bedroom wardrobes during a facility renovation. Once permanent wardrobes had been installed, we had inherited these storage cabinets as replacements for our older cabinets that were now in disrepair. In order to make room for the new cabinets, we needed to disassemble the older cabinets and transport them to the garbage area. This task required both problem solving (we no longer had the assembly instructions for the old cabinets) as well as fine motor skills (they were all assembled and repaired with screws that now needed to be removed), and was definitely an adult task with an engineering component. So I asked my client to “assist” me with the disassembly of the old cabinets. I graded the task by turning the cabinets on their side to be more accessible from wheelchair level, and I used the technique of backwards chaining to remove the lower, less accessible screws before we began. In this way he was able to experience the success of completing the task with the least amount of assistance.

While I won’t go so far as to say my client loved the activity, he did at least agree to participate, and this was a big step in the right direction. For me, this experience reinforced the importance of choosing occupation based interventions and what an invaluable resource an activity analysis can be in achieving this goal.

To view a sample activity analysis, click here.