Reason for Services
What is Sam’s current Rancho level?
Level V: Confused–Inappropriate.
What job did Sam have before his TBI?
Auto mechanic.
Who remains Sam’s primary caregiver during rehab?
His wife, Ingrid.
How does Sam’s memory function at Level V?
Severely impaired short-term memory; relies on external cues.
What cognitive goal should Sam work toward?
Attend to a simple task for 5 minutes with minimal verbal cues.
What is a hallmark behavior at Level V?
Inappropriate responses to stimuli and poor memory without external structure.
What are two meaningful occupations from Sam’s past?
Cooking meals with his wife and attending church.
What environmental strategy can help Sam succeed now?
A calm, predictable setting with minimal distractions.
What attention challenges does Sam still show?
Poor sustained attention and distractibility
What ADL goal is appropriate now?
Complete simple grooming tasks with maximal assistance and cuing.
What remains a major OT focus at this stage?
Improving attention, orientation, and appropriate behavioral responses.
How might Sam’s leisure interests help in therapy at this stage?
Use simple, familiar tasks like preparing snacks or taking a walk.
How does Sam’s social circle potentially influence rehab?
Positive support from family and friends encourages participation.
How might Sam behave socially at Level V?
May make inappropriate comments or behaviors.
What safety goal should be introduced?
Demonstrate safe behavior during simple mobility tasks with supervision.
How much assistance does Sam need for ADLs at Level V?
Maximal assistance.
What aspect of Sam’s past routines could support rehab?
Use of religious or family-centered activities to build orientation and participation.
What home feature will still require safety considerations post-rehab?
Home layout for supervision and safety (open floor plan).
What motor skills does Sam likely retain?
Basic mobility and gross motor abilities (assuming no orthopedic limitations).
How can therapy address Sam’s confusion?
Use orientation activities (calendar training, familiar object recognition).
Why is consistency in environment and routine important now?
It minimizes confusion and supports emerging attention skills.
Why is recognizing Sam’s PLOF important now?
To maintain hope and connect therapy to his personal identity.
How does Ingrid’s engagement in therapy sessions help Sam?
Reinforces skills and routines outside of formal therapy.
What technique helps improve Sam’s learning at this stage?
Repetition and visual/verbal cuing.
What long-term goal remains a major focus?
Gradual increase in participation in structured, meaningful activities.