Mr. Jones experienced a stroke that resulted in impairments requiring occupational therapy intervention. An occupational therapist used the PEOP model to evaluate Mr. Jones' personal factors, occupations, performance abilities, and home/farm environment. Adaptations were made such as grab bars, mobility aids, and home modifications. The OT addressed challenges with driving, chores, and gardening to preserve Mr. Jones' meaningful roles and independence within his abilities. Community support supplemented areas he could no longer independently perform safety. The holistic PEOP approach focused on maximizing occupational participation through environmental adaptations.

1. MR. JONES: A CASE STUDY
USING THE PEOP MODEL.
BY MOIRA SMALL, GINA STANGO, KARI VITORIA,
AND JENN PHILLIPS

2. WHO IS MR. JONES?
..

3. A FAMILY MAN

4. FISHERMAN

5. FARMER

6. CHURCH MEMBER

7. LIKES ANIMALS

8. GARDNER

9. LOVES TO DRIVE HIS
TRACTOR

10. LOVES TO COOK

11. MR. JONES EXPERIENCED A RIGHT CEREBROVASCULAR
ACCIDENT , RESULTING IN:
SOME CHANGES TO HIS HOME AND FARM

12. PERSON ENVIRONMENT OCCUPATIONAL
PERFORMANCE MODEL (PEOP)
“a client-centered model organized to
improve the everyday performance of
necessary and valued occupations of
individuals, organizations and populations,
and their meaningful participation in the
world around them.”
(Smith, Hudson, 2012)

13. 4 MAJOR COMPONENTS
• Occupations- self directed activities that occupy ones
time(Smith, Hudson, 2012)
• Performance-The ability to preform needed skills of
occupation and the occupation itself (Occupational-Based
Hand Therapy!-PEOP Model, 2012).
• Top- down approach- the components that make an individual
• Personal- Intrinsic factors that make a person, an individual
• Psychological/emotional, physiological, cognitive, spiritual and
neurobehavioral. (Occupational-Based Hand Therapy!-PEOP Model,
2012).
• Environment- Environmental factors are what allows or
hinders the individual in completing their Occupations
• Social support, societal stigmas and attitudes, cultural, values
that can support or enable, community support, built
environments, economics, technology and natural
environments (Smith, Hudson 2012)

15. PERSON
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72 year old male
Prefers to wear bib overalls
Prefers to dress up for church
Prefers to soak in the tub
Mr. Jones likes family photos, collectables and vintage rugs
Prefers to watch tv in his “favorite” chair
Likes raising hay, cows, pigs, fish and chickens
Likes to ride tractor
Likes fresh eggs, catfish, milk, and vegetables (especially tomatoes)
Likes to can peaches
Likes dogs
Tolerates entertaining in the home (wife’s quilting bee)
Religious
Loves to maintain a spectacular yard
Right hand dominant

16. OCCUPATIONS
• Husband
• Father
• Farmer
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Grows hay for
Raises cows, pigs, and chickens
Milks the cow
Maintains and operates a tractor to care for the land
Fisherman
Gardner and lawn keeper
Cook
Care taker of animals
Driver for himself and his wife
Attends church

17. PERFORMANCE
The tasks and subtasks to Mr. Jones Occupations.
For example:
• Cooking
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Cognition to follow directions
Bilateral Upper Extremity movement and strength
Safety awareness
Dynamic standing balance.
(just to name a few subtasks)

18. ENVIRONMENT
• Strong community ties (lived in the same town his
whole life)
• Son and neighbors help care for the land and bail the hay
• Loving family
• Wife-he lives with
• Two sons and daughter that work full time
• Has land that he raises cows, chickens, pigs, catfish
and grows hay
• Large garden
• Fruit trees
• Landscaped yard

19. ENVIRONMENT
(CONTINUED)
• House
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Older style
One story farm house
4 concrete steps to enter with no railings
3 bedroom
2 ½ bathrooms with a claw foot tub
Lots of vintage rugs
Lots of collectables in the home
Chair that is low to the ground

20. OCCUPATIONS THAT ARE
IMPORTANT
TO ME:

21. PEOP MODEL
Identify occupational
strengths and problems
In occupational performance
Assess performance
components
Assess occupation,
activities, tasks
Assess
environmental
conditions

22. PEOP MODEL
• Smith-Fess
Vocational
Rehabilitation Act
• Focus: clinical
impairments and
management

23. PEOP MODEL
• Environment is the
problem!
• A.N.S.I.
• Buildings accessible
to and usable
• Unemployment
• Architectural
Barriers Act

24. PEOP MODEL
• Education
• Transportation
• Education for all
Handicapped
Children Act
• Uniform Federal
Accessibility
Standards
• Air Carriers Act

25. AMERICANS WITH
DISABILITIES
ACT
1990

26. STRENGTHS
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Social Support
Fulfilling/Active Life
Intact Value System
Community Involvement
Stimulating Natural Environment
Meaningful Activities
Loving Partner

27. CHALLENGES
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Children: Full Time Jobs
Wife: Glaucoma/Arthritis
Particular
Large Property/Upkeep

28. DIAGNOSTIC STRENGTHS
Alert and Oriented x
Person and place
LTM Intact
Verbal Expression
Attend to Task 30min.
Occasional re-direct
Good
Sitting Balance
Right Hand
Dominant
Follows Most
Commands
Motivated
Strong PLOF

29. DIAGNOSTIC CHALLENGES
Not Oriented to Time
STM Impaired
Mildly
Left
Inattention
Left Upper
Extremity
Impaired
Pattern Movement
Present
Poor Gross and Fine
Motor
Coordination
Impulsive/Poor
Safety Awareness
Light Touch
Superficial Pain
Stereognosis
Prefers His Way of
Doing Things

30. OCCUPATIONAL
PERFORMANCE
• Creating function
from a place of
dysfunction utilizing
this flexible model
to adapt all 3
variables.

31. MOTIVATION AND CHANGE
Motivation
Intrinsic and
extrinsic
Change
Physical
changes
More support of
family/friends
Opportunities to
develop new
interests

32. INTERVENTION APPROACH
• Home Modifications
• Patient Education
• Home Safety checklist

33. INTERVENTION STRATEGIES

34. PERSON
Recommend methods
of assessment to
acknowledge Mr.
Jones’ preferences in
daily occupational
tasks.
Wear life alert
necklace
Educate
Medication
client/family/friends for management
support system
Give client a cell
phone or have phones
in most rooms in case
of emergency.
Stroke support group

35. ENVIRONMENT
Make environmental
adaptations to the
kitchen and yard to
assist in ADLs, and
IADLs.
Provide social supports Adequate lighting in
all rooms.
Add railing to front
steps.
Take up all the “rag”
rugs.
Provide sturdy chair in
kitchen, outside near
chicken coop
Move chicken coop
closer to house
Clear counters of
collectibles
Add cushions to his
existing favorite chair.

36. OCCUPATION
No driving, set up rides
to church, etc.
IADLS
ADLS
Feeding chickens
Baking biscuits
Dressing, Fasteners
Fishing, Gardening
Operating tractor
Bathing

37. PERFORMANCE
Home health to
maximize
performance potential
Adaptive equipment
for dressing
Utilize a different
bathroom for bathing,
unless sons are able to
lower him in to the
claw foot bathtub.
Mirror for when shaving Provide cut up foods
or finger foods or utilize
rocker knife
Durable medical
equipment to assist
with ADLs.
Utilize non-skid mats in
kitchen and bathroom

38. SPECIFIC CHALLENGES FACED BY MR. JONES AND HOW THEY
WERE ADDRESSED IN TREATMENT UNDER THE PEOP MODEL.

39. QUALITY OF LIFE AND CONTINUED
OCCUPATION, FIRST AND FOREMOST.
• Mr. Jones significant responsibilities in caring for the farm
presented a challenge in terms of safety, energy
conservation, and pain management.
• However, as the PEOP model distinguishes itself from
other models, by looking at occupation and
performance as way of fitting the person to the
environment. Within this model, the environment (his
home and farm) and what needs to change to
enhance performance, not necessarily Mr. Jones as
PEOP draws heavily from the disability rights movement
and utilizes a top down approach when working
towards enhancing client participation. (Baum and
Christiansen, 2005)

40. ADAPTATIONS
• Although Mr. Jones was not yet ready for driving, to
increase visual and sensory inattention on the left
side, the O.T practitioner was looking in to ways to
adapt the tractor. In the meantime, drawing on
community support from the church, Mrs. Jones
created a volunteer system for a young man from
the church to drive the tractor while Mr. Jones rode
in order to continue his role as the breadwinner. The
rehab team felt that as there was no risk of traffic
while operating the tractor, that being able to drive
the tractor independently given adaptations would
be possible. However, for now the extra community
help would continue his participation.

41. SPECIFIC O.T. INTERVENTIONS TO ADDRESS
DRIVING AND COMMUNITY MOBILITY
• To address the person, Mr. Jones practiced using a visual scanning
board in his home based therapy sessions as well as a computerized
driving simulator.
• To address the driving occupation, Increased mirrors were planned to
be adapted, as well as a tractor shorter to the ground with extra
padding and postural supports were added.
• In order to continue occupational participation in his valued role as
a church and community member, the OT practitioner worked with
the family to arrange rides to and from church, and arranged the
weekly men’s bible study group to be held in the Jones’s home.
• The practitioner also provided the Jones’s with the Area Agency on
Aging (AAA) to provide transportation alternatives if any of their
transportation fell through.

42. CONTINUED INTERVENTION TO ADDRESS
THE CHALLENGE OF THE FARM AND
GARDEN
• The PEOP based practitioner places emphasis on quality of life
and participation, so provided continued adaptation to the
garden, which included low tech solutions such as placing
boards along the path to the garden, as well as to the
chicken coop and barn to ensure that Mr. Jones would not fall
while ambulating with his cane.
• Because he was very particular about his garden, it was
decided that large sections of the garden would be
replanted within raised beds. This way he could retain
participation, while the practitioner was able to continue to
provide a NDT and sensory motor based treatment. Mr. Jones
was able to use trunk rotation and incorporate his left
extremity into gardening tasks following scapular protraction
and elevation facilitated from the practitioner.

43. Although Mrs. Jones was not on
the caseload, the practitioner
knew that in order to maintain
their quality of life, which for
them meant staying
independent on the farm for as
long as possible she
recommended that Mrs. Jones:
• As her hobby was canning
peaches, a wall mount can
opener was recommended
and she was taught
techniques to prevent further
ulnar drift. She was also
advised to seek a referral from
her doctor for O.T to address
low vision modifications if the
time should come secondary
to her glaucoma. Many of the
modifications made for Mr.
Jones would help the couple
retain their quality of life.

44. CONCLUSION
“The PEOP (model) reflects the philosophy of
occupational therapy in its consideration of the
interactive nature of the person, environment, and of
the complexity of the tasks and ability to perform
these tasks necessary for the occupation of
managing health.”
(Smith, Hudson, 2012)

45. REFERENCES
• Brown, C.(2009). Ecological Models in Occupational Therapy. In Willard &
Spackman's occupational therapy. E.B. Crepeau, E.S. Cohn, and B.A Boyt-Schell)s.
(Eds )11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins,
2009. Print.
• Buam, C, and Christiansen, C. (2005) Person-environment-occupationperformance: An occupation based framework for Practice. (In Christiansen, C.,
Baum, C, and Bass-Haugen, J (Eds.) Occupational Therapy: Performance,
participation, and well-being. 3rd. Ed. Thorofare: NJ: Slack.
• Howlett, Fiona. (2012). Citing website. In Person Environment Occupational
Performance Model. Retrieved Oct. 1, 2012, from www.yorksj.ac.uk.
•
• Letts, L., Law, M., Rigby, P., Cooper, B., Stewart, D., & Strong, S. (1994). Personenvironment assessments in occupational therapy. American Journal of
Occupational Therapy, 48(7), 608-618. “
• Occupation-Based Hand Therapy! - PEOP Model." Occupation-Based Hand
Therapy! - Home. N.p., n.d. Web. 12 Oct. 2012.
<http://handtherapycanbefun.weebly.com/peop-model.html>.
• Smith, D., & Hudson, S. (2012). Using the Person-Environment-Occupational
Performance conceptual model as an analyzing framework for health literacy.
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doi:10.1179/1753807611Y.0000000021
• Welch, Polly. (2012). Citing website. A Brief History of Disability Rights Legislation in
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www.udeducation.org/resources/61.html.