Seeking professional support for natural setting current mobility, even small doses, but track and expand.

I have struggled to find support for my skills in adding small changes in current settings that lead to natural improvement in mobility, when so much care is organized about snapshot impressions and assessments and exercises imagined for younger or healthier people.

Professional training and culture both look to medical professionals as experts - and in the case of repairing injury they are experts - but there is a difference between in hospital resources for shorter term care - and long term care in skilled facilities or homes.

Working over 40 years in adaptive care for small numbers of people but specific attention to them as they used their resources in communities where they live, I learned to notice what movement someone can do on their own and if none, what level of training will help them safely get started, so they can gain strength - outside offices of therapists.

"Use of Community for Occupational Therapy for fragile".

Hard to explain, but working to keep my developmentally and sensory disabled brother safely mobile in community, after I realized that I could not help him completely by myself, and the educated people in his world usually examined goals too far off and brought solutions too complex and removed from the life he could access,

I put him in a rural village, with setup for disability van pickup to take him to a professionally designed day program and back home at day's end to a family led boarding home. I then stayed in touch regularly by phone and 4-5 times a year visits for at least 5 -7 days, where I would examine and assess his progress, for I kept track of his changes.

This process over 40 years, led me to learn a lot about family care and professional settings, to find resources at my brother's level and try to support locals in helping him. A huge issue centered around his impatience and passive complaining - for which I added teaching, coaching responsiveness and found a therapist for him - WHILE also noting that his negative attitude disappeared if we could find the right level of project that he could manage and improve on his own. He blossomed when we stumbled on him using a machine that applied embossed names in gold ink onto to colored leather strips: his unpredictable coordination issues were handled by management of simple, repetitive machine.

He could not negotiate but as he worked this machine, his ability to produce increased. When his paycheck varied from week to week, he got depressed and asked his boss the reason, and boss explained that pay was based on production, and his varied by his moods. This was understandable to my brother, but it was when the boss helped him follow his own work by posting his production numbers each day on the wall - my brother began to focus, aim to match prior numbers, and within a month he beat his own numbers, was highest producer.

I saw the lesson's potential: sharing his results in repetitive way helped him focus, not stay lost in confusion and doubts over his up and down swings. It was exhilarating for him to produce reliably and be paid. His confidence glowed.

But the boss left the job, next supervisor read records and saw him as a likely problem, treated him warily, did not see how to help him. After a blowup, he was fired.

Several different components can impact progress in a complicated natural world, and it takes someone alert to progress and trial of various pieces, to set up a tweakable plan that adds practical help in enough places to sustain success. Instead, only one piece is added and clients fail, and what we track is their failures, outbursts or illnesses.