Establish: A daily schedule and routine so the patient may have order and a predictable schedule daily. This may include a feeding schedule, bathroom schedule, and hygiene schedule. A visual schedule may be posted in his room to facilitate order.

Prevent: Bed sores and skin break down by implementing positioning techniques to keep client comfortable and skin integrity intact

PEOP Model - The interaction between the client's abilities, the environmental and the demands of different occupations influences the performance outcome. This can apply to occupation/ADL of feeding. This can help the therapist with the treatment session in a holistic way (Cole & Tufano, 2008).

Biomechanical FOR - The biomechanical model focuses on ROM, strength, and endurance of his upper and lower extremities. This FOR applies to this case because ROM will be vital to keeping his extremities from contractures. Both strength and endurance will be needed as his condition improves (Cole & Tufano, 2008).

Modified Ashworth Scale: Measuring the level of spasticity present in his limbs will help to measure progress towards gains in the range of motion. It can measure muscle tone or resistance to passive movement (Radomski & Latham, 2014).

Restore: Sensory stimulation by educating caregiver to sit patient upright in bed or in wheel chair. Playing his favorite music in his room to restore auditory stimulation (Chuakarn & Jitpanya, 2017).

Glascow Coma Scale- will measure assess the impairment of conscious level in response to defined stimuli; it takes into consideration the depth of the coma based on its severity (Radomski & Latham, 2014).

Educate: Wife on caregiver techniques such as feeding, dressing, bed mobility, grooming, support groups and resources within the community. Educate the daugther with proper body mechanics to help mother with transfers, and bed mobility (Erfin Firmawati et al., 2015).

Functional Independence Measure: FIM will evaluate Homer's occupational performance and track his ADLs and functional status. It will measure the severity of disability based on the burden of care rather than Homer's impairments. The scale rates Homer's performance taking into consideration, his need for assistance from another person or the need for an assistive device ( Radomski & Latham, 2014) .

Long Term Goal 1 : Within 6 weeks, Homer will respond to visual stimuli consistently on 3 out of 4 opportunities, for 3 consecutive weeks, with min A, and no more than 2 verbal cues, to facilitate executive functioning.

Long Term Goal 2: Within 6 weeks, Homer's caregiver will independently demonstrate how to complete transfers, bed mobility, grooming, feeding, and hygiene for Homer as witnessed by the occupational therapist, to facilitate completion of ADLs.

Long Term Goal 3: Within 6 weeks, Homer will demonstrate decreased tone in his lower and upper extremities as shown with a decrease in the Modified Ashworth Scale, in order to prevent skin breakdown and maintain skin integrity for functional mobility.

Maintain Passive range of motion in upper extremities and lower extremities and through use of orthotics/ splinting

Coma Recovery Scale - Revised : Measuring the patient's response to visual, tactile, auditory, etc. stimuli will enable the therapist to determine the client's progress and current level of functioning (Parten, 2018).

Cole, M. and Tufano, R. (2008). Applied theories in occupational therapy. Thorofare: SLACK.

Occupational Therapy Practice Framework: Domain and Process (OTPF) (3rd Edition). (2014). American Journal of Occupational Therapy, 68(Supplement_1), pp.S1-S48.

Chuaykarn, U., & Jitpanya, C. (2017). Effects of Two Sensory Stimulation Models on Recovery in Adults with Severe Traumatic Brain Injury. International Journal of Medical Research and Health Sciences, Vol 6, Iss 8, Pp 69-74 (2017), (8), 69. Retrieved from http://prx-usa.lirn.net/login?url=http://search.ebscohost.com/login.aspxdirect=true&db=edsdoj&AN=edsdoj.771e07d9d7472997a98349dbb31589&site=eds-live

Wheeler, S. (2018). Occupational Therapy Practice Guidelines for Adults with Traumatic Brain Injury. BrainLine. Retrieved from https://www.brainline.org/article/occupational-therapy-practice-guidelines-adults-traumatic-brain-injury

Wheeler, S., Acord-Vira, A., Arbesman, M., Lieberman, D. (2017). Occupational Therapy Interventions for Adults With Traumatic Brain Injury. American Journal of Occupational Therapy 71(3):7103395010p1-7103395010p3. doi: 10.5014/ajot.2017.713005.

Radomski, M., & Latham, C. (2014). Occupational therapy for physical dysfunction (7th ed., pp. 1-1426). Lippincott Williams & Wilkins, a Wolters Kluwer business.

Parten, C. (2018). Coma Recovery Scale - Revised Assessment of Patients with Brain Injury [Powerpoint slides] Retrieved from https://class.usa.edu/bbcswebdav/pid-5327756-dt-content-rid-41923648_1/xid-41923648_1

Firmawati, E., Songwathana, K. & Kitrungrote, L. (2015). Effect of Self-Efficacy Enhancing Education Program on Family Caregivers’ Competencies in Caring for Patients with mild Traumatic Brain Injury in Yogyakarta, Indonesia. Nurse Media: Journal of Nursing, Vol 4, Iss 2, Pp 767-783 (2015), (2), 767. https://doi.org/10.14710/nmjn.v4i2.8385

Gutman, S. A., & Schonfeld, A. B. (2009). Screening adult neurologic populations: A step-by-step instruction manual. Bethesda, MD: AOTA Press.

Rancho Los Amigos - Revised. (n.d.). Retrieved November 27, 2018, from https://www.neuroskills.com/resources/rancho-los-amigos-revised.php

"Demonstrates generalized reflex response to painful stimuli" ("Rancho Los Amigos - Revised", 2018, pg.1).

Responses may be significantly delayed ("Rancho Los Amigos - Revised", 2018, pg.1).

"Responses noted above may be same regardless of type and location of stimulation" ("Rancho Los Amigos - Revised", 2018, pg.1).

"Responds to external stimuli with physiological changes generalized, gross body movement and/or not purposeful vocalization" ("Rancho Los Amigos - Revised", 2018, pg.1).

"Responds to repeated auditory stimuli with increased or decreased activity" ("Rancho Los Amigos - Revised", 2018, pg.1).

Educate: Caregiver and family about over stimulation. Provide recommendations that only 1-3 people visit him at a time and that environment not be too over stimulating (Erfin Firmawati et al., 2015)