• We used Activity Card Sort to find out more about his interests.
• We found he has big appetite and love for seafood.
• We suggested a cooking session to motivate James to stand up and walk by engaging in the activity that he likes.
• He was willing to stand up in the kitchen and cook with us.
• Peter decided what ingredients will go into the pasta, and we went grocery shopping together which helped him to warm up for the cooking session.
• Peter managed to stand up in the kitchen for more than 5 minutes. He helped us prepping ingredients and cooking the pasta.
• In the end, he decided to use a walker to put his dish into the sink.
• Even though he last his interest in his previous occupation, bowling, after the accident, we helped him to find the new occupation that was meaningful for him, and the new occupation motivated him to stand up and walk again.

Client: Jimmy

Jimmy was an older adult who had hypoxia while he was in the surgery. He had a lot of years of driving experience and worked as a truck and trailer driver. He had not driven since the surgery. He had to depend on his wife in transportation, and she had been supportive. But, since she worked full-time and their house was located in a mountain side, Jimmy had to stay home by himself when she was off to work.

During the on-road evaluation, Jimmy had difficulty on divided attention, which affected his ability to spot traffic signals and lights. He especially had hard time noticing stop signs at the wide and large intersections. Since Jimmy had knowledge and experience in driving, the OT focused on areas that required divided attention during the session, for example, bike and stop signs on the road, Botts' dots, emerging lane signs, etc. Since he learned how to drive more than 30 years ago and lives in a rural area, he had never seen some of the traffic signs and had a hard time figuring out some of the new signs on the road. Also, he made a wide left turn. The OT and I thought it was his habit from driving a trailer and a truck. As an OT, to plan a session, I learned that we need to consider client's environment and person factors, for example, which area and what kind of neighborhood client lives, and what driving knowledge does client have. Also, I learned that it is important to create an occupational profile to find out and consider all these client factors that might affect client's driving behavior and knowledge on the road.

After the session, I decided to capture some of road pictures that Jimmy had difficulty spotting traffic signs for the next session to help him visually detect where he had trouble. I sent these pictures to the OT, and she decided to go over series of pictures that could help Jimmy to pick up critical information on the road while he drives for the next session.

Client: Jinny

During the fieldwork, I was able to observe the OT helping the client, Jinny, to use adaptive driving equipment. Jinny had THA on her R LE, and after the surgery, she was not able to dorsiflex her R foot because of nerve damage. She had to wear AFO which limited her driving. The OT did a full evaluation and tried left foot accelerator (LFA) with the client. Since she was capable to drive LFA, the OT decided to go for LFA instead of other option (hand accelerator).

During the session, the OT explained about car modification that needs to be done on the client's car and provided information on vendors that install LFA in the car. The OT also provided precautions on LFA. I only thought that the OT's job is helping the client to drive by using the left foot accelerator. I didn't think of other follow-ups that OTs had to do. I learned that OT's job was not only limited to educating the client on how to use LFA but contacting a 3rd party for car modification, provide a list of vendors who sell LFA, emailing and calling the clients for follow up, explaining the pros and cons of products, evaluating if the client is suitable to use LFA, etc.

The OT always had eyes on the client's left foot and asked me to have my eyes on the foot. After I observed her L foot, I noticed that she moved her whole leg from the accelerator to break, which might fatigue her leg faster. After the session, the OT asked the client how the practice went, and the client stated that because of AFO, she had to buy a bigger size of the shoes which made her uncomfortable switching her left foot sideways. I learned that having a good observation on the clients' behaviors/acts is important as an OT to catch what is going on with them.

At the end of the session, the OT gave homework to the client, so she could practice while her husband drives her around. The homework was that the client had to imaginarily drive by using her left foot while others drive her around. It was to help the client to do mental practice using LFA. It was to help her brain to re-register new pattern. I learned that participating in the session is important but educating and explaining for the client on the importance and purpose of homework is also important. By emphasizing the importance, the client could more commit to the homework and speed up the progress.

Also, throughout the sessions with Jinny, I learned that grading up and down the driving task for the client was important. The OT always started the session from residential areas, shopping center, freeway, and downtown. Also, by providing goal directed task, I learned that the OT can assess client's divided attention, problem solving skills, and process speed.