Occupational Analysis of My Community Partner and Author Peg Kehret's Autobiography Small Steps: The Year I Got Polio

The basis of this paper is to execute a full occupational analysis of my community partner and Peg Kehret who is the author and subject of a disability autobiography titled, "Small Steps: The Year I Got Polio." In my analysis I use the Model of Human Occupation(MOHO), a theory in which occupation is motivated, patterned, and performed (www.moho.uic.edu), and Occupational Adaptation(OA) which is a framework therapist can use to guide their intervention planning and implementation (Janette King Schkade). In addition to the analysis I will compare and contrast the occupational issues that affect each person which will identify the similarities and differences in their adaptation to internal and external challenges, as well as resulting occupational performance and social participation.

The Model of Human Occupation: Jon. The information in this case study was obtained from face to face interviews and weekly interactions with Jon from January, 2011-April, 2011.

Narrative. Jon is a 29year old male Naval Dental Laboratory Technician/Fleet Marine Force corpsman, husband, and father of two. On September 9, 2009, Jon and his family were involved in a horrific car accident that killed his wife and left him with a fractured left hip, open fractured right humerus, closed fracture right wrist, broken right hand, a shook brain, two broken ribs, lost of permanent maxillary lateral incisor, and an emergency appendectomy. Jon was also later diagnosed with migraines, hallucinations, and insomnia. The injuries that Jon obtained from the accident affected his occupations. Jon's restricted range of motion in his dominant hand for example, permitted him from doing job related task such as making dental bridges and crowns, as well as activities of daily living. Jon lives at home with his two children and cousin who has moved in to assist Jon with instrumental activities of daily living such as child rearing.

Personal causation
Personal causation is the sense of one's personal capacity and self-efficacy (Kielhofner, 2007 pg.35). Since Jon's accident, his recognition of his decreased ability to grip, pinch, stretch, sleep, walk, and stand have greatly affect his independence with daily living skills and work tasks. Due to Jon’s accident and the resulting disabilities, he was unable to work as a DLT/FMF corpsman or participate in the weekly family baseball games with his children. He had difficulty managing daily tasks required for work and play such as gripping dental pliers and catching a baseball. Although Jon desired to play baseball with his children as well as meet the demands of the Navy, he realized that he was not physically capable of engaging in such task at that time. With his faithfulness to God, Jon knew he would be blessed to meet his personal desire and the demand of the Navy by reassuming his fulfilling role as catcher in the families weekly baseball game and DLT/FMF corpsman of the Navy.

Values are personal convictions and the sense of obligation that goes with them (Kielhofner, 2007). Since the car accident and the death of his wife, Jon has started to value his family, friends, and health more. Jon makes it a point to tell his immediate and extended members that he loves and appreciates them whenever possible. Jon no longer goes into work two hours early nor stays two hours later, he dedicates the extra time to his children. Jon also values the memory of his late wife that keeps him focused on what is needed to be done as a parent.

Jon says that he is an "American Man" who interest includes fishing, hunting, camping, barbecuing, sports, and working on cars. Jon views all of his interest as therapy to his soul. He says that each one of his leisurely task are more meaningful, now that he includes his children in each of them as much as possible.

Roles and Habits. Jon's occupational environment and occupational role as a father and sailor have changed since the accident. As a widowed father, Jon has become the primary caregiver. Jon is more attentive to the needs and well being of his children. He now assumes the role as both mother and father. As a sailor, Jon appreciates his job, but realizes it is no longer priority number one in his life. He spoke with a few of his superior officers at his place of employment about transferring some of his managerial responsibilities to other sailors so that he can dedicate more time to his family matters. With the approval of his superiors to leave work 3:30pm daily Jon has setup a routine of picking his children up from school, assisting them with homework, cooking dinner, giving baths, play a nightly board game, reading a bed time story, and sitting down to watch sports center before retiring to bed. Since the death of his wife Jon needed to be, and desired to a great figure that his children could look up to. Pressed with the challenge to be a strong foundation for his children, Jon's current response has exceeded the expectations he put on himself as well as the expectations of the his social environment.

Performance Capacity
Performance Capacity is the underlying mental and physical abilities and how they are use and experienced in performance (Kielhofner, Forsyth, Kramer, Melton, & Dobson, 2009 pg 449). The disabilities that Jon obtained from the accident have affected his performance capacity a great deal. Although Jon is able to walk and play catcher in his family baseball games, he constantly gets migraine headaches that force him to sleep the rest of the day, has hallucinations, and does not display a full smile due to his insecurities from his missing permanent maxillary lateral incisor. All the continues disabilities listed above limit Jon's engagement occupational task he once did with no complexities.

Jon lives in a three bed room 2000 sqft single story home with his two children, two dogs, and a cousin that stays at the home two days out of the week to assist Jon. In Jon's work space he is surrounded by supportive co-workers, both military members and civilians who often cook meals for him and his family so Jon can have some extra free time to relax.

Occupational Performance
When engaging in occupations as a father or sailor, fine motor skills can be problematic for Jon. For instance, Jon constantly experiences sharp pains in his dominant hand while working, which easily upset him when is trying to cast a porcelain or gold tooth for a dentist. When stricken with the sharp pain, Jon must grit and bare the pain because he is unable to put down his working utensils to stretch his hand for that needed moment. This is an issue Jon hopes will subside sooner than later, or he will have to come up with some type of adaptation to decrease his discomfort.

Jon's strong desire to regain function and strength to play baseball with his children, as well as meet the demands of the Navy, gave him the incentive to work hard and persevere through a challenging time in his life. Jon met the challenges and exceeded the expectations quicker than anyone could have imagined. Jon mastered the press between work demands and personal desires by regaining function and strength in numerous locations of his body in less than eight months.

As long as Jon continues to understand his volition, habituation, and performance capacity, as well as maintains a strong support system. He will continuously grow in his occupational identity as a father and sailor. Because he values the motivational memories of his wife, Jon will constantly strive to be a better man and father for his children. Furthermore, Jon's engagement in interest such as fishing and camping will give him the therapeutic relief that he needs when times are rough. Although troubled by migraines, hallucinations, and insecurities the reinforcement Jon receives from his support system helps him engage in his desired occupations.

The Model of Human Occupation: Peg Kehret. The information in this case study was obtained from the disability autobiography titled, "Small Steps: The Year I Got Polio."

Peg Kehret is a women from rural Minnesota who at age twelve was stricken with the polio virus that left her with a 102 temperature that lasted a week, difficulty swallowing, and paralysis from the neck down. Unable to perform any occupations without the assistants from others, Peg was determined to overcome her disabilities. With the support from her family, doctors, therapist, and roommates who shared her experience of being diagnosed with polio, Peg got well enough to go home. Unfortunately forty years later, Peg was diagnosed with post-polio syndrome which are symptoms and unexpected problems related to fatigue and muscle weakness (Gordon & Feldman, 2002). Armed with the weapon of determination, she says "The battle continues" as she continues to live out her life (book).

Personal Causation
Peg recognizes her inability to do any occupations of daily living due to the infection of the polio virus to her spine and brain, which stripped her of all sensory feelings and motor functions(www.dhpe.org/infect/polio.html).Feeling vulnerable and exposed, Peg made a mental note to try her hardest to overcome the disability without self-pity.

Peg values the relationship that she shares with her friends, parents, doctors and therapist. She looks to her parents for comfort, which they show during the weekly visits; her doctor and therapist for motivation that is displayed during daily medical sessions; and her friends for joy, that is displayed when they sing and laugh.

Peg interest include listening to Lone Ranger, reading, and singing. She enjoyed in engaging in occupations that brought a smile to her and her roommates, while taking their minds off of their disabling conditions.

Habituation: Roles and Habits
Peg normal roles consisted of being a daughter, sister, friend, and student, but for seven months her main occupational environment and role changed. Peg was a patient recovering from polio in a colorful room with four other girls who also were recovering from polio. Pegs daily routine consisted of visits from doctors, nurses, physical therapist, and occupational therapist. The visits were usually composed of medication, hot baths, stretches, crafts, and exercise that were designed to stretch and strengthen her damaged muscles.

Performance Capacity
Peg's initial encounter with polio was grave. She had difficulties swallowing before the intervention of a chocolate milkshake that was given to her by her mother against the doctor's orders; A constant temperature of 102 degrees that lasted for a week; and a lack of all sensory feeling and motor functions. Over time Peg was able to overcome all of the disabilities that prevented her from engaging in occupations that she desired such as singing and walking.

While at her stay at Sheltering Arms hospital, Peg resided in a colorful room, with curtains, pictures, a book shelf, and striped blankets. She occupied that room with four other girls whom became her lifelong friends. In addition to her friends there were nurses, therapist, and doctors who frequently visited her room to check on her well-being. Dr. Bevis, Pegs favorite doctor encouraged her to try things when she wanted to give up and motivated to learn how to walk again so that she could show him.

Occupational Performance
Immediately following her paralysis, Peg lacked all nueromusculoseketal and movement functions that permitted her from engaging in any occupations she desired. Overtime, Peg regained enough strength throughout her body to perform activities of daily living such as eating and personal hygiene. With adequate strength and muscle tone, Peg started to walk and was able to go home and to school. While at school Peg was embraced by her peers, and performed equally or better than her classmates when it came to education.

Peg's desire to regain her sensory functions and motor functions so that she can go home to be with her family gave her the incentive to work hard and defeat disabilities. Peg mastered the press of her desire to defeat polio, and the demand of the medical staff to regain her motor functions with the support of her family, friends, doctors, and therapists.

As long as Peg continues to understand her personal causation, and maintains her desire to "continue the battle" against polio (book). She will put up a good fight against the disease, and may persevere once again.