Many occupational therapists work with children with developmental delays from birth to 3 years of age in Early Intervention (EI) settings. The goals of intervention in this setting is to support families as they promote their child's physical, cognitive, communication, social, and/or adaptive development. This is the story of Bobby, and 18 month old child who was referred for EI services due to his delayed physical and communicative development.

Occupational Profile: Bobby is happy and easy going. He loves to snuggle with his mother and father and his four year old sister and enjoys having books read to him but he does not look at the pictures. His home is filled with toys of which he shows interest once they are placed near him. Bobby will sit independently and manipulate objects near him, but will not move to retrieve them nor does he gesture to have others get them for him. He is not yet crawling or standing and has not developed any discernable words though he will babbly some sounds. He does not attempt to feed himself. His parents want Bobby to learn to craw and stand and say a few words.

Evaluation and Treatment: The occupational therapist, as part of the team involving Bobby's parents and other EI professionals, collect data on Bobby's development and collaboratively devise goals for his EI involvement. The occupational therapist focuses on helping Bobby's parents find ways to support his physical (e.g., crawling, standing, taking steps, and manipulating toys), his adaptive (e.g., holding a spoon and cup), and his communication (e.g., saying mama and dada) development. Over the next six months, the family learns important strategies to support Bobby's self feeding, his play, and his mobility skills and begin to incorporate his sister in play with him. He begins to scoot across the floor to get a favorite toy and to be able to stand against the side of the sofa. He can hold a sippy cup and bring it to his mouth.

Questions to ponder:

• What do you think are Bobby's and his family's strengths?

• How might the occupational therapist in this case used theses strengths to support Bobby's developmental needs?

• What might the occupational therapist focus on next in her work with the family?

Children with Down Syndrome are frequently seen by occupational therapists in both school and outpatient clinic settings. The goals of intervention in these settings are to improve the child's participation in the roles and routines, improve performance of necessary skills, and promote independence. Sam is an 8 year old, second grader who receives occupational therapy services at school and after school at an occupational therapy clinic two times per week.

Occupational Profile: Sam is the only child of a single parent. He attends his neighborhood school and is placed in a classmate with his agemate peers. He enjoys interacting and playing with his peers and he is well liked. He needs the help of his teacher to stay attentive to the activities presented in class and to persist to complete assigned tasks. He is easily frustrated by tasks the he imagines will be hard for him. He is learning to write letters and form shapes, attempt to solve and manage challenging problems, and develop independent work habits.

Evaluation and Treatment: The occupational therapists in each setting collaborate with one another, Sam's parent, and the school team to identify and prioritize his needs. They develop interventions to support his task skills (e.g., attention, persistence, problem solving), motor control (e.g., handwriting), and his social and emotional development (e.g., managing frustration). They work with his teachers to modify instruction and assignments and with his mother to promote his engagement in play and chores at home.

Questions to ponder:

• What are Sam's strengths and how do these strengths compare to the demands of his home, school, and community role expectations?

• What factors might Sam's team (e.g., his parent, the occupational therapists, and his teachers and other school providers) consider to prioritize his instruction and intervention?

• What kinds of modifications do you think might best support Sam's participation in activities at home and school?

Occupational therapists work with individuals who have orthopedics injuries and surgeries in acute care, rehabilitation and skilled nursing, outpatient, and home and community settings. The goals of therapy intervention are to reduce the potential for additional injury, decrease pain and increase mobility and strength, and improve use of the body part for functional activity and participation in valuable occupation. Suzanne is a 72 year old woman who underwent a total hip replacement surgery after a fall resulting in hip fracture.

Occupational Profile: Suzanne lives in a two story home with her husband. There are four steps to enter the house and her bedroom and bathing facilities are on the second floor. She has a toilet and basin on the first floor. Suzanne is a retired teacher who enjoys gardening, cooking, and playing card games with her friends.

Evaluation and Treatment: Suzanne is first seen approximately 12 hours post surgery on the orthopedic post-surgical unit of the hospital. In collaboration with the physical therapist, Suzanne is instructed in bed mobility and is helped to sitting bedside. Over the next day, the occupational therapist teaches the patient how to protect the hip through positioning and the use of adaptive equipment for self care. The occupational therapist discusses a home health care referral for Suzanne upon discharge from the hospital. Suzanne is discharged to home two days after her surgery.

Questions to ponder:

• What barriers might Suzanne and her care teams at the hospital and home be considering following her hip surgery?

• What factors might support and/or hinder her recovery and her occupational performance?

• What areas of occupation might you prioritize for her home care?

The Centers for Disease Control estimates that more than 795,000 people experience a cerebral vascular accident, or stroke, every year. Symptoms vary considerably depending upon the location in the brain affected by the stroke. Following acute care stabilization, people suffering from stroke often receive rehabilitation in either an inpatient rehabilitation unit or a skilled nursing facility to help with movement, speech, strength and daily living skills. Eleanor is a 78 year old went to the emergency department with an acute infarct to the left middle cerebral artery. Read this case study describing the interprofessional rehabilitation treatment plan for her care.

Questions to Ponder:

• What is the value of an interprofessional team and how did is change the healthcare considerations for Elenore?

• What key competencies would members of Eleanor's healthcare team require in order to improve her health outcomes?

• What role did Eleanor's family members play in her care decisions?