Click-to-copy therapeutic exercise documentation for OTs and COTAs in skilled nursing. Free, no login.
Patient will increase RUE PROM elbow extension from 90 degrees elbow flexion to 45 degrees.
Patient's modified Barthel Index Score will improve from xx/xxx; xx% impairment/limitation/restriction to xx/xxx; xx% impairment/limitation/restriction.
Patient is a 57 y/o female who was seen for an initial occupational therapy evaluation in which the following deficits were noted: decreased BUE AROM, UE strength, GM coordination/skills, functional activity tolerance, and functional mobility. Patient presents with decreased safety awareness during ADL's. Patient requires increased assistance for ADL participation. The patient would benefit from skilled OT services to target the aforementioned deficits, to assess the need for AE, and increase safe participation with ADLs; increase QOL.
Patient engaged in ther ex to increase strength, coordination, and functional ax tolerance via chest press, lat pull, bicep/tricep curl ex x 12 reps x 3 sets each movement c 12 inch green theraband (100% stretch) and 1lb ther dowel. OT instructed patient in making mind-muscle connection to activate and isolate muscle activation of targeted muscles using proper form and technique, c slow, controlled movement on eccentric portion of movements.
Patient will increase RUE PROM thumb extension (IP joint) from 90 degrees thumb flexion to 45 degrees.
PROM applied to cervical spine via lateral extension static stretch x 15 minutes from 60 degrees lateral flexion to 45 degrees lateral flexion. Manual Tx: joint mobilization techniques, stretching of shortened connective tissue, manipulation techniques, myofascial release and manual traction.
PROM and manual tx applied to RUE utilizing proximal to distal massage in order to decrease edema.
PROM applied to bilateral LEs in order to facilitate proper standing position to decrease risk for falls via static stretch to posterior muscles of bilateral LEs x 15 minutes. Manual Tx: joint mobilization techniques, stretching of shortened connective tissue, manipulation techniques, myofascial release and manual traction.
Patient c increased AROM to ankle joint to place feet flat on floor in standing position (decrease toe-walking, decrease risk for falls). Patient completed sit <-> stand x 10 reps x 3 sets c rest breaks in between sets c min A. OT instructed patient in proper form while standing to engage in dorsiflexion to neutral bilaterally. OT instructed patient in proper sequencing via scooting to edge of wheelchair, leaning forward c nose over knees, and pushing off c UEs and safety precautions when transferring via making sure brakes are locked and using UEs for a controlled movement to guide self when perform stand to sit transfer. Ther Ex: therapeutic resistance exercises, progressive resistance exercises and therapeutic graded exercises.
1. Patient directed in NuStep training to increase biofeedback to BUE, mimic reciprocal pattern and increase overall BUE strength to decrease abnormal movement pattern. Patient completed x 15 minutes with OT facilitating interval training of varying resistance 1-2 minutes. Patient required verbal cues for erect posture to maximize cardiopulmonary function. O2 monitored pre, during and post exercise with O2 levels > 95% to ensure positive response and reduce risk of desaturation. Patient denied shortness of breath and indicated just right challenge.
2. Patient arrived at skilled OT complaining of 5/10 R shoulder pain limiting UE dressing tasks. R shoulder ROM measurements taken as follows: OT assessed and measured R shoulder flexion: 60 degrees, ABD: 58 degrees, EXT: 20 degrees, IR: 20 degrees, ER: 25 degrees. Patient instructed in the following exercises to increase RUE ROM, decrease stiffness and reduce pain level: pulleys 1-2 minutes x 3 trials to increase shoulder flexion with short rest in between trials. Patient reported no increase in pain. OT individualized and instructed patient in AROM exercises to max patient range in pain free zone as follows: IR/ER, abd/add 1x10, extension with 3 second hold. Patient reported "it feels looser." Patient verbalized 3/10 pain post session indicating positive results from directed exercises.
3. OT educated patient in B hand strengthening exercises post estim to improve overall grip/pincer grasps. Patient trained in the following exercises using moderately resistive putty in order to increase gross grasp and various pinches: gross grasp, opposition, abd/add, tip pinch. Patient required vc and visual demo to perform correctly. Post exercise OT assessed and measured gross grasp: 40# L, 42# R, tip pinch 7# bilaterally (an improvement of 2# each hand for gross grasp and 1# improvement bilaterally for tip pinch from last session). Patient denied pain, just complained of overall "weakness." Patient reported functional progress with opening jars in prep for feeding and grooming tasks.
4. Patient instructed in the following exercises to increase L wrist/hand ROM, decrease stiffness, reduce pain in order to utilize L hand in task s/p wrist fx. Patient now cleared to begin ROM exercises per MD documentation. Patient is L hand dominant. Patient instructed in L wrist flex/ext, radial/ulnar deviation, opposition, finger abd/add, MCP flex/ext, PIP flex/ext 2x10 with therapeutic rest as needed. Tactile, verbal and visual cues needed to isolate targeted muscle groups. Patient with difficulty noted for radial/ulnar deviation thus OT stabilized patient at the wrist joint to perform accurately and patient was able to complete with overall less pain.
5. Patient instructed in UE bike to maximize UE ROM and strength for improved overall function in tasks. OT graded the task based on patient's response to exercise. Patient instructed in 5 minutes of level 1 resistance then graded to level 2 resistance for 5 minutes and finally level 3 resistance for the remainder of task. Patient denied SOB or pain, but reported "that was a good workout." O2 monitored pre, during, and post exercise with readings > 94%. Verbal cues were provided to improve postural alignment and engage in pursed lipped breathing to maximize functional tolerance. Increased time needed for proper positioning prior to exercise to ensure optimal execution of task.
8. Patient arrived at OT for engagement in incontinence management including PME's to reduce urinary urgency. Patient reporting 3 episodes of nocturia increasing risks of falls. OT developed program and patient was instructed in variety of exercises to increase pelvic musculature, reduce urgency and bladder control for overall reduced falls. Patient instructed in glute squeeze, Kegels, hip abd, hip add with pelvic floor activation holding 5 seconds each 3x10. Patient required initial visual demo for ability to isolate targeted muscles and increase carry over. After intervention, was then able to carry out with intermittent cues for pacing and staying on task. By end of session, patient stated, "I have noticed I am able to hold it in longer."
9. Patient arrived at therapy 6 weeks post R humeral fracture. New orders from MD for patient to begin ROM per protocol. Patient educated on purpose and instructed in Codman's exercise x 1-minute x 5 RUE clockwise, then counter clockwise. OT provided stabilization at the shoulder to ensure proper form and to prevent injury. Max vc to execute properly. Patient required standing rest breaks in between each set and 2 seated rest breaks overall. Patient was limited by pain and fatigue, but with encouragement and stabilization, improvement and tolerance noted.
11. Patient is at risk for increased back pain without training to stabilize core muscles. OT instructed patient in variety of core strengthening exercises to decrease complaints of back pain. In supine, patient positioned properly to train in posterior pelvic tilts, abdominal crunches 2x 15. Verbal and tactile cues provided to isolate targeted muscle groups and reduce substitution methods. OT graded task to perform in standing side crunches with 5# weight x 10 each side with CGA at times for balance. Patient then instructed in 30 second planks x 3 with rest breaks in between planks to maximize tolerance. Progress to minimal 40 second planks next session but encourage patient to complete to point of fatigue.
14. Patient directed in functional standing task incorporating functional reach outside base of support/all planes to increase ability to reach for items in closet while reducing risk of falls. OT provided pelvic stabilization as well as minimal verbal cues to decrease substitution methods and promote safety awareness. Task graded to incorporate standing tasks on uneven surface. On uneven surface, patient with loss of balance requiring mod A for proper weight shifting, all 4 trials. Will continue to require dynamic standing/reaching interventions to reduce fall risks and maximize balance recovery strategies.
15. Patient instructed in multiple squatting activities in attempt to improve functional mobility and safety, ability to retrieve items from floor level, reduce falls, and improve independence at home. OT facilitated mobility tasks without use of assistive device to retrieve multiple items from floor level. Patient required CGA and mod verbal cues to get closer to object, hold object closer to the body to reduce lumbar strain as well as cues for posture, and technique to facilitate quad contraction. Patient educated on the need to reduce excessive lumbar flexion during task to reduce injury and promote proper lifting techniques.
17. Patient instructed in table top task incorporating L wrist flexion/extension, radial/ulnar deviation, finger flex/extension, opposition movements to increase ROM, decrease stiffness, reduce pain to utilize L hand in functional tasks s/p wrist fx. Patient is L hand dominant. Patient instructed in familiar household tasks (lifting coffee cup, transporting small, light objects from one location to another). Tasks incorporated the need for patient to stabilize wrist against gravity, engage in L wrist flex/ext, radial/ulnar deviation, opposition movements with therapeutic rest as needed. Min tactile, verbal, and visual cues needed to isolate targeted muscle groups. Patient with difficulty noted for radial/ulnar deviation, thus, OT stabilized patient at the wrist joint to perform accurately and patient was able to complete with overall less pain.
26. OT instructed patient in ther ex to increase strength, coordination, and functional ax tolerance via chest press, lat pull, bicep/tricep curl ex x 12 reps x 3 sets each movement c 12 inch green theraband (100% stretch) and 1lb ther dowel. OT instructed patient in making mind-muscle connection to activate and isolate muscle activation of targeted muscles using proper form and technique, c slow, controlled movement on eccentric portion of movements.
Clinician provided passive stretches to B glenohumeral joint sagittal, frontal, and horizontal plane, elbows in sagittal plane and wrist in sagittal and frontal planes with prolong stretch at end range to decrease risk of contractures and increase ROM. Clinician provided passive stretches to B elbows to increase ROM and facilitate participation with daily activities.
Clinician provided passive stretches to R glenohumeral joint sagittal, frontal, and horizontal plane, elbows in sagittal plane and wrist in sagittal and frontal planes with prolong stretch at end range with joint compression to decrease risk of contractures, normalize tone and increase ROM.
Clinician provided passive stretches to B shoulder in all planes with prolong stretch at end range to decrease risk of contractures and increase ROM in order to facilitate participation with daily activities. Pt required HOH to complete task this date.
Clinician provided passive stretches to B shoulder in all planes, elbows and wrist with prolong stretch at end range to decrease risk of contractures and increase ROM.
Clinician provided joint mobilization of B MCP, DIP, PIP, and wrist to normalize tone and increase ROM in order to tolerate B hand carrot splint and assist with self-care task. Pt tolerance session with no signs of pain or discomfort.
Pt educated on safety precautions during transitional movements to increase independence with UB dressing and promote safety. Pt training in UB dressing technique via visual/verbal/tactile cues to promote ADL independence. Pt required Max A to thread BUE through sleeve and pull garment overhead to complete task.
Bilateral Upper Extremity therapeutic exercise, including shoulder extension, shoulder flexion, hand MCP flexion, elbow flexion, elbow extension and shoulder external rotation seated unsupported to enhance muscle strength in order to enable increased participation in self care tasks.
Pt progressed through manual passive range of motion exercises to RUE glenohumeral joint in sagittal, frontal, and horizontal plane to increase ROM to facilitate independence with UB dressing. Therapeutic exercises for shoulders, elbows and wrist and deltoids, biceps, triceps targeted facilitating strength, coordination and tolerance for UB dressing and toilet commode transfers.
RUE resistive exercises via shoulder flexion, elbow flexion/extension and manual passive range of motion exercises to LUE glenohumeral joint in sagittal, frontal, and horizontal plane to increase ROM to facilitate independence with UB dressing and functional transfers. Therapeutic exercises targeting deltoids, biceps, triceps to facilitating strength, coordination and tolerance for UB dressing and toilet commode transfers.
Pt progressed through manual passive range of motion exercises to BUE glenohumeral joint in sagittal, frontal, and horizontal plane, elbows in sagittal plane and wrist in sagittal and frontal planes with prolong stretch at end range to decrease risk of contractures and increase tolerance of BUE carrot splint
Pt completed reciprocal resistive exercises to increase UB dressing independence and increase R AROM needed for ADLs. Clinician provided verbal and visual cues for upright posture during session to maximize muscles contraction and facilitate muscle strength of deltoids, biceps and triceps.
Pt completed reciprocal resistive exercises to increase oral hygiene independence and increase L AROM, strength and coordination needed for ADLs. Clinician provided Mod verbal, tactile and visual cues for upright posture during session to maximize muscles contraction and facilitate muscle strength of deltoids, biceps and triceps. Family/caregiver (wife) educated on therapeutic exercises with using of thera-band with verbal understanding.
Clinician instructed patient in BUE resistive and aerobic exercises via shoulder flexion and elbow flexion/extension. Therapeutic exercises targeted deltoids, biceps and triceps to increase muscles strength, coordination of BUE and tolerance.
Pt complete BUE resistive and aerobic exercises via shoulder flexion, elbow flexion/extension targeting deltoids, biceps and triceps with grip flexion to increase intrinsic/extrinsic muscles of the B hands to safely dress UB and LB and assist with toilet commode transfers. Pt required Min rest breaks during session this date.
BUE resistive exercises including shoulder flexion, elbow flexion/extension, wrist flexion/extension and MCP flexion. Therapeutic exercises targeting deltoids, biceps, triceps and intrinsic/extrinsic muscles of the hands to facilitate independence with LB dressing and toilet commode transfers.
Clinician provided BUE resistive exercises via manual resistance in flexion/extension of shoulder, elbow, wrist and digits to promote deltoid, bicep, triceps and intrinsic/extrinsic muscles strength, coordination, and activity tolerance required for UB/LB dressing functional transfers and bathing task.
Clinician provided BUE aerobic exercises targeting deltoids, biceps, and triceps via thera-band in order to facilitate muscle strength, coordination, ROM and activity tolerance in order to increase independence with ADLs. Pt required Mod rest breaks between reps due to fatigue. Pt's o2 during session at 95%.
Skilled interventions focused on crossing midline to facilitate independence in functional skill performance, dynamic balance activities during sitting and strengthening activities to increase functional task performance.
Skilled interventions focused on crossing midline to facilitate independence in functional skill performance, balance activities during sitting and strengthening activities to increase functional task performance
Skilled interventions focused on crossing midline to facilitate independence in functional skill performance, and strengthening activities by reaching for object away from to increase functional reach and static sitting balance to promote increase participation with task.
Pt progress through AAROM stretches to B shoulders glenohumeral joint in sagittal, frontal, and horizontal plane, elbows in sagittal plane and wrist in sagittal and frontal planes with prolong stretch at end range during e-stim to R anterior deltoid and bicep setting at LVPC Medium muscle disuse atrophy x 15 minutes 15.8 mA with skin integrity intact pre and post session.
Patient participated in concurrent therapy with 1 other patient to successfully progress towards individual treatment goals by addressing patient's balance deficits, decreased ROM, gross motor coordination deficits and safety awareness deficits; skilled interventions included static and dynamic sitting balance activities to increase trunk strength, therapeutic and aerobic exercises, and education on safety precautions to decrease fall risk and promote independence with toilet commode transfers. Pt tolerance session with min rest breaks during session.
Patient participated in group therapy with 2 other patients to successfully progress towards individual treatment plan/goals by addressing patient's balance deficits, decreased ROM, gross motor coordination deficits and safety awareness deficits; skilled interventions included static/dynamic sitting balance, aerobic exercises and education on safety precautions to decrease risk of falls and promote independence with ADLs. Pt able to tolerate session well this date.
Clinician provided B exercises targeting deltoids, biceps, and triceps in order to facilitate muscle strength, coordination, ROM and activity tolerance in order to increase independence in order to ADLs.
Skilled interventions focused on training in log rolling technique to increase independence in bed mobility tasks. Pt required Total A to roll from side to side to decrease risk of skin break down. Maximum improvement is yet to be attained. Pt demonstrated increase L and R PROM shoulder flexion of 5 degrees this reporting period. Pt demonstrated 0/100 on Modified Barthel Index and 0/56 on FIST score this reporting period. Pt <30 seconds on activity tolerance.
Pt demonstrated increase L and R PROM shoulder flexion of 10 degrees this reporting period.
5 x a week x 12 weeks 15 minutes or as tolerated. Pt. benefits from S/U of meals, and orientation; benefits from verbal cueing to initiate self feeding.
Fall Risk, confusion, behavior risk. Monitor vitals. Benefits from monitored aerobic and resistive exercises.
Pt fall risk, diabetic and cardiac precautions, and monitor respiratory. Pt benefits from monitored and resistive BUE exercises.
Clinician provided BUE resistive and aerobic exercises via shoulder flexion, elbow flexion/extension, and grip strength 3 sets of 10 targeting deltoids, biceps, triceps and intrinsic/extrinsic muscles of the hand to facilitate muscle strength, power, coordination and cardio to increase participation with daily activities such as UB dressing and toilet commode transfers. Pt demonstrated increase R hand grip strength of 14.3 kg and 10.1 kg of L hand grip strength.
Skilled interventions focused on crossing midline to facilitate independence in functional skill performance, dynamic balance activities during sitting and strengthening activities to increase functional task performance. Pt demonstrated increase activity tolerance of 10 minutes during task.
decreased problem solving and decreased awareness. balance deficits, safety awareness deficits, decreased static balance and decreased ROM.
Clinician provided BUE resistive and aerobic exercises via shoulder flexion, elbow flexion/extension, and grip strength via restorator with min resistance, 1 lb dowel and thera-band targeting deltoids, biceps, triceps and intrinsic/extrinsic muscles of the hand to facilitate muscle strength, power, coordination and cardio to increase participation with daily activities such as UB dressing and toilet commode transfers.
Skilled interventions focused on crossing midline to facilitate independence in functional skill performance, dynamic balance activities during sitting and strengthening activities to increase functional task performance.
Pt fall risk, hx of CVA, dysphagia, severe dementia, aphasia, wound to sacrum wound to R and L hip, a fib, and pacemaker. Pt benefits from ROM of BUE and sitting up in w/c.
Clinician instructed patient in BUE resistive and aerobic exercises including shoulder flexion and elbow flexion/extension. Therapeutic exercises targeted deltoids, biceps and triceps to increase muscles strength, coordination of BUE needed for UB dressing and toilet commode transfers.
BUE resistive exercises including shoulder flexion, elbow flexion and extension to facilitate muscle contracture, tolerance and coordination. Therapeutic exercises targeting deltoids, biceps, triceps in order to increase independence with ADLs. Pt required min verbal cues to initiate task. Pt required Min rest breaks.
HTN, blindness, diabetic precautions, allergic to morphine, NWB to RLE, displace R femoral neck fx, S/P TMA, fall risk, O2 AT 2L/min via NC PRN. Pt benefits from sitting upright in chair for meals to decrease aspiration and increase social participation. Pt benefits from aerobic and monitored BUE exercises. Pt benefits from divided plate for meals.
Fall risk, foley cath placement, and HTN. Pt benefits from sitting upright during meals to decrease risk of aspiration.
Bilateral Upper Extremity therapeutic exercise, including shoulder extension, shoulder flexion, hand MCP flexion, elbow flexion, elbow extension and shoulder external rotation seated unsupported to enhance core muscle strength in order to enable increased participation in self care tasks and assist with transitional movements.
Clinician provided BUE resistive and aerobic exercises via shoulder flexion, elbow flexion/extension, and grip strength 3 sets of 10 targeting deltoids, biceps, triceps and intrinsic/extrinsic muscles of the hand to facilitate muscle strength, power, coordination and cardio to increase participation with daily activities such as UB dressing, LB dressing, and bathing. Pt required Supervised A to dress UB due to increase AROM of R shoulder of 65 degrees. Pt was able to tolerance session of 20 minutes before taking rest break. Pt demonstrated 18/56 on FIST score this reporting period. Pt required Mod A to stand x 1 min in order to assist with toilet commode transfers.
Patient participated in group therapy with 1 other patient to successfully progress towards individual treatment plan/goals by addressing patient's balance deficits, decreased ROM, gross motor coordination deficits and safety awareness deficits; skilled interventions included static/dynamic sitting balance, aerobic exercises and education on safety precautions to decrease risk of falls and promote independence with ADLs. Pt able to tolerate session well this date.
NWB to LLE, stroke with left sided weakness, fall risk. Pt benefits from monitored BUE aerobic and resistive exercises.
Patient participated in concurrent therapy with 1 other patient to successfully progress towards individual treatment goals by addressing patient's balance deficits, decreased ROM, gross motor coordination deficits and safety awareness deficits; skilled interventions included static and dynamic sitting balance activities to increase trunk strength, therapeutic and aerobic exercises, and education on safety precautions to decrease fall risk and promote independence with toilet commode transfers.
Manual Tx: joint mobilization techniques and stretching of shortened connective tissue to L elbow, shoulder and wrist to decrease risk of contracture and promote ROM.
RUE resistive exercises including shoulder flexion, elbow flexion, extension and grip flexion. Therapeutic exercises targeting deltoids, biceps, triceps and intrinsic/extrinsic muscles of the hand to promote independence with ADLs. Pt tolerated session well this date. Pt educated on application of L shoulder brace to decrease risk of subluxation with good return demonstration. Pt educated in safety during sit to stand during transfers to decrease fall risk and promote independence with LB dressing. Pt required Max A to thread BLE through slacks and pull to waist to complete task.
Passive stretches to L wrist in sagittal and frontal planes with prolong stretch at end range with no joint compression due to pain to L thumb during session. Charged nurse Roxanne was notified. BUE resistive exercises via shoulder flexion, elbow flexion/extension and grip flexion. Therapeutic exercises targeting deltoids, biceps, triceps and intrinsic/extrinsic muscles of the hands to facilitate independence with oral hygiene, UB dressing and functional transfers. Pt required Mod verbal cues throughout session to initiate task.
Fall risk, fall precautions, low bed padded floor mats, monitor vitals, stage 2 coccyx. Pt benefits from monitor BUE aerobic and resistive exercises.
Skilled interventions focused on safety during transitional movements in order to decrease fall risk and promote independence with self-care task. Pt educated on UB dressing techniques with Partial A to thread BUE through sleeves and pull garment overhead to complete task.
4. Patient is a 57 y/o female who was seen for an initial occupational therapy evaluation in which the following deficits were noted: decreased BUE AROM, UE strength, GM coordination/skills, functional activity tolerance, and functional mobility. Patient presents with decreased safety awareness during ADL's. Patient requires increased assistance for ADL participation. The patient would benefit from skilled OT services to target the aforementioned deficits, to assess the need for AE, and increase safe participation with ADLs; increase QOL.
8. Patient will increase RUE PROM elbow extension from 90 degrees elbow flexion to 45 degrees.
11. Patient's modified Barthel Index Score will improve from xx/xxx; xx% impairment/limitation/restriction to xx/xxx; xx% impairment/limitation/restriction.
19. Patient will increase RUE PROM thumb extension (IP joint) from 90 degrees thumb flexion to 45 degrees.
24. Patient will tolerate PROM/manual techniques to BUE 50% or more of the time with min to no pain in order to decrease risk of contractures, increase joint mobility, and preserve skin/joint integrity.
Ther Ex
1. OT instructed patient in ther ex to increase strength, coordination, and functional ax tolerance via chest press, lat pull, bicep/tricep curl ex x 12 reps x 3 sets each movement c 12 inch green theraband (100% stretch) and 1lb ther dowel. OT instructed patient in making mind-muscle connection to activate and isolate muscle activation of targeted muscles using proper form and technique, c slow, controlled movement on eccentric portion of movements.
2. Patient directed in NuStep training to increase biofeedback to BUE, mimic reciprocal pattern and increase overall BUE strength to decrease abnormal movement pattern. Patient completed x 15 minutes with OT facilitating interval training of varying resistance 1-2 minutes. Patient required verbal cues for erect posture to maximize cardiopulmonary function. O2 monitored pre, during and post exercise with O2 levels > 95% to ensure positive response and reduce risk of desaturation. Patient denied shortness of breath and indicated just right challenge.
3. Patient arrived at skilled OT complaining of 5/10 R shoulder pain limiting UE dressing tasks. R shoulder ROM measurements taken as follows: OT assessed and measured R shoulder flexion: 60 degrees, ABD: 58 degrees, EXT: 20 degrees, IR: 20 degrees, ER: 25 degrees. Patient instructed in the following exercises to increase RUE ROM, decrease stiffness and reduce pain level: pulleys 1-2 minutes x 3 trials to increase shoulder flexion with short rest in between trials. Patient reported no increase in pain. OT individualized and instructed patient in AROM exercises to max patient range in pain free zone as follows: IR/ER, abd/add 1x10, extension with 3 second hold. Patient reported "it feels looser." Patient verbalized 3/10 pain post session indicating positive results from directed exercises.
4. Patient instructed in the following exercises to increase L wrist/hand ROM, decrease stiffness, reduce pain in order to utilize L hand in task s/p wrist fx. Patient now cleared to begin ROM exercises per MD documentation. Patient is L hand dominant. Patient instructed in L wrist flex/ext, radial/ulnar deviation, opposition, finger abd/add, MCP flex/ext, PIP flex/ext 2x10 with therapeutic rest as needed. Tactile, verbal and visual cues needed to isolate targeted muscle groups. Patient with difficulty noted for radial/ulnar deviation thus OT stabilized patient at the wrist joint to perform accurately and patient was able to complete with overall less pain.
5. Patient instructed in UE bike to maximize UE ROM and strength for improved overall function in tasks. OT graded the task based on patient's response to exercise. Patient instructed in 5 minutes of level 1 resistance then graded to level 2 resistance for 5 minutes and finally level 3 resistance for the remainder of task. Patient denied SOB or pain, but reported "that was a good workout." O2 monitored pre, during, and post exercise with readings > 94%. Verbal cues were provided to improve postural alignment and engage in pursed lipped breathing to maximize functional tolerance. Increased time needed for proper positioning prior to exercise to ensure optimal execution of task.
8. Patient arrived at OT for engagement in incontinence management including PME's to reduce urinary urgency. Patient reporting 3 episodes of nocturia increasing risks of falls. OT developed program and patient was instructed in variety of exercises to increase pelvic musculature, reduce urgency and bladder control for overall reduced falls. Patient instructed in glute squeeze, Kegels, hip abd, hip add with pelvic floor activation holding 5 seconds each 3x10. Patient required initial visual demo for ability to isolate targeted muscles and increase carry over. After intervention, was then able to carry out with intermittent cues for pacing and staying on task. By end of session, patient stated, "I have noticed I am able to hold it in longer."
9. Patient arrived at therapy 6 weeks post R humeral fracture. New orders from MD for patient to begin ROM per protocol. Patient educated on purpose and instructed in Codman's exercise x 1-minute x 5 RUE clockwise, then counter clockwise. OT provided stabilization at the shoulder to ensure proper form and to prevent injury. Max vc to execute properly. Patient required standing rest breaks in between each set and 2 seated rest breaks overall. Patient was limited by pain and fatigue, but with encouragement and stabilization, improvement and tolerance noted.
10. Patient is at risk for increased back pain without training to stabilize core muscles. OT instructed patient in variety of core strengthening exercises to decrease complaints of back pain. In supine, patient positioned properly to train in posterior pelvic tilts, abdominal crunches 2x 15. Verbal and tactile cues provided to isolate targeted muscle groups and reduce substitution methods. OT graded task to perform in standing side crunches with 5# weight x 10 each side with CGA at times for balance. Patient then instructed in 30 second planks x 3 with rest breaks in between planks to maximize tolerance. Progress to minimal 40 second planks next session but encourage patient to complete to point of fatigue.
6. Patient c increased AROM to ankle joint to place feet flat on floor in standing position (decrease toe-walking, decrease risk for falls). Patient completed sit <-> stand x 10 reps x 3 sets c rest breaks in between sets c min A. OT instructed patient in proper form while standing to engage in dorsiflexion to neutral bilaterally. OT instructed patient in proper sequencing via scooting to edge of wheelchair, leaning forward c nose over knees, and pushing off c UEs and safety precautions when transferring via making sure brakes are locked and using UEs for a controlled movement to guide self when perform stand to sit transfer. Ther Ex: therapeutic resistance exercises, progressive resistance exercises and therapeutic graded exercises.
10. Patient directed in functional standing task incorporating functional reach outside base of support/all planes to increase ability to reach for items in closet while reducing risk of falls. OT provided pelvic stabilization as well as minimal verbal cues to decrease substitution methods and promote safety awareness. Task graded to incorporate standing tasks on uneven surface. On uneven surface, patient with loss of balance requiring mod A for proper weight shifting, all 4 trials. Will continue to require dynamic standing/reaching interventions to reduce fall risks and maximize balance recovery strategies.
11. Patient instructed in multiple squatting activities in attempt to improve functional mobility and safety, ability to retrieve items from floor level, reduce falls, and improve independence at home. OT facilitated mobility tasks without use of assistive device to retrieve multiple items from floor level. Patient required CGA and mod verbal cues to get closer to object, hold object closer to the body to reduce lumbar strain as well as cues for posture, and technique to facilitate quad contraction. Patient educated on the need to reduce excessive lumbar flexion during task to reduce injury and promote proper lifting techniques.
13. Patient instructed in table top task incorporating L wrist flexion/extension, radial/ulnar deviation, finger flex/extension, opposition movements to increase ROM, decrease stiffness, reduce pain to utilize L hand in functional tasks s/p wrist fx. Patient is L hand dominant. Patient instructed in familiar household tasks (lifting coffee cup, transporting small, light objects from one location to another). Tasks incorporated the need for patient to stabilize wrist against gravity, engage in L wrist flex/ext, radial/ulnar deviation, opposition movements with therapeutic rest as needed. Min tactile, verbal, and visual cues needed to isolate targeted muscle groups. Patient with difficulty noted for radial/ulnar deviation, thus, OT stabilized patient at the wrist joint to perform accurately and patient was able to complete with overall less pain.
22. OT educated patient in B hand strengthening exercises post estim to improve overall grip/pincer grasps. Patient trained in the following exercises using moderately resistive putty in order to increase gross grasp and various pinches: gross grasp, opposition, abd/add, tip pinch. Patient required vc and visual demo to perform correctly. Post exercise OT assessed and measured gross grasp: 40# L, 42# R, tip pinch 7# bilaterally (an improvement of 2# each hand for gross grasp and 1# improvement bilaterally for tip pinch from last session). Patient denied pain, just complained of overall "weakness." Patient reported functional progress with opening jars in prep for feeding and grooming tasks.
3. OT instructed patient to position shirt face down on lap. Therapist instructed patient to utilize strong arm and thread weaker arm through the correct sleeve. Min A w/verbal cues provided for patient to lean forward in order for weak arm to swing out and free from torso...
2. OT provided moderate tactile and verbal cues to enable patient to perform open-chain shoulder exercises w/closed eyes in order to facilitate proper scapulohumeral rhythm and position sense to increase proper overhead IADL tasks...
1. PROM applied to cervical spine via lateral extension static stretch x 15 minutes from 60 degrees lateral flexion to 45 degrees lateral flexion. Manual Tx: joint mobilization techniques, stretching of shortened connective tissue, manipulation techniques, myofascial release and manual traction.
2. PROM and manual tx applied to RUE utilizing proximal to distal massage in order to decrease edema.
3. PROM applied to bilateral LEs in order to facilitate proper standing position to decrease risk for falls via static stretch to posterior muscles of bilateral LEs x 15 minutes. Manual Tx: joint mobilization techniques, stretching of shortened connective tissue, manipulation techniques, myofascial release and manual traction.
5. Clinician provided passive stretches to B glenohumeral joint sagittal, frontal, and horizontal plane, elbows in sagittal plane and wrist in sagittal and frontal planes with prolong stretch at end range to decrease risk of contractures and increase ROM. Clinician provided passive stretches to B elbows to increase ROM and facilitate participation with daily activities.
6. Clinician provided passive stretches to R glenohumeral joint sagittal, frontal, and horizontal plane, elbows in sagittal plane and wrist in sagittal and frontal planes with prolong stretch at end range with joint compression to decrease risk of contractures, normalize tone and increase ROM.
7. Clinician provided passive stretches to B shoulder in all planes with prolong stretch at end range to decrease risk of contractures and increase ROM in order to facilitate participation with daily activities. Pt required HOH to complete task this date.
8. Clinician provided passive stretches to B shoulder in all planes, elbows and wrist with prolong stretch at end range to decrease risk of contractures and increase ROM.
9. Clinician provided joint mobilization of B MCP, DIP, PIP, and wrist to normalize tone and increase ROM in order to tolerate B hand carrot splint and assist with self-care task. Pt tolerance session with no signs of pain or discomfort.
10. Clinician provided patellar mobilizations to improve knee extension and flexion motions, reduced ROM limitation in order to improve functional transfers...
UE Restorator - Closed kinetic chain resistive exercises targeting biceps and triceps with verbal/tactile cues to increase pt capacity for shoulder flexion and elbow flexion/extension all to improve BIL shoulder flexion, GMC, BIL coordination and endurance/stamina needed for ADLs.
NUSTEP - Ther ex with resistance for BUE targeting biceps/triceps and deltoids to increase UB strength with verbal/tactile cues to improve pt capacity for shoulder flexion and elbow flexion/extension needed for ADLs; ther ex with resistance for BLE targeting quadriceps and gastrocnemius for mobility tasks.
MANUAL Stretch - Therapist provided verbal/tactile cues during PROM/AAROM BUE (shoulder, elbow, wrist) in various planes with prolonged stretch at end range to increase/facilitate ROM needed for ADLs.
TheraBar for GRIP - Open kinetic chain resistive exercises targeting intrinsic/extrinsic hand muscles to increase UB/grip strength needed for daily functional tasks.
Therex DELTOIDS - Open kinetic chain weighted exercises targeting deltoids to increase UB strength needed for ADLs functional mobility during ADLs.
Reacher for LB dsg - Therapist provided v/v/t during therapeutic activity to retrieve needed item from floor utilizing reacher, while sitting in wc, in order to improve GMC, eye-hand coordination, tool manipulation and VMI skills needed for LB dsg.
SELF (breaks) - Rest periods given throughout skilled OT session to promote energy conservation.
RNP - 6x week x8 weeks x15 minutes. Pt would benefit from monitored aerobic and resistive exercises utilizing weights, weighted dowels, UE restorator, and therabands; AAROM/AROM to BUE. RNP established with pt present to maintain current level of mobility and functional I level and to reduce risk of decline/complications.
UE Restorator - Closed kinetic chain resistive exercises to increase BIL shoulder flexion, biceps/triceps strength, BIL coordination, GMC and endurance/stamina with verbal/tactile cues to correct form and technique and to improve patients capacity for shoulder flexion and elbow flexion/extension needed to maximize performance and facilitate I with ADLs.
Nustep - Ther ex with resistance for BUE targeting biceps/triceps and deltoids to increase UB strength with verbal/tactile cues to correct form and technique and to improve patients capacity for shoulder flexion and elbow flexion/extension needed to maximize performance and facilitate I with ADLs; ther ex with resistance for BLE targeting quadriceps and gastrocnemius with verbal/tactile cues to facilitate proper upright posture and correct technique to maximize performance for improved self-positioning and mobility tasks.
TheraBAR for GRIP - Open chain kinetic resistive exercises targeting intrinsic/extrinsic hand muscles to increase UB/grip strength needed for daily functional tasks.
Ther ex DELTOIDS - Open kinetic chain weighted exercises targeting deltoids with verbal/tactile cues to facilitate shoulder flexion to increase UB strength needed for functional mobility during ADLs.
Manual PROM - Therapist provided verbal/tactile cues during PROM BUE (shoulder, elbow, wrist) in various planes with prolonged stretch at end range to increase/facilitate ROM needed for ADLs.
Manual PROM/AAROM - Therapist provided verbal/tactile cues during PROM/AAROM BUE (shoulder, elbow, wrist) in all planes with prolonged stretch at end range to increase/facilitate ROM and motor planning/coordination needed for ADLs.
RNP Sitting up for feeding/social - Pt would benefit from sitting upright during all meals to decrease risk of aspiration and daily up in w/c for social interactions.
RNP AROM BUE Therex - Patient would benefit from monitored aerobic and resistive exercises utilizing weights, weighted dowels, UE restorator and therabands; AAROM/AROM to BUE.
Ther ex Cues to avoid Audit - the cueing for postural alignment, vitals with education on deep breathing, etc while doing the exercises that makes that specific exercises skilled. Has to be different from restorative putting a patient to do exercises. Therapist targeted flexibility of quadratus lumborum muscles activation and strengthening of hamstrings with mod tactile cueing to improve patients capacity for dynamic standing. (Followed by patient reaction)
Splint Added - Therapist provided initial fitting and pt educated for application and positioning of L hand resting splint to decrease risk for contracture formation and maintaining functional ROM. Skin checks provided pre and post treatment with no significant changes in skin texture or color following a 2 hour wear time. Plan to increase wearing time and additional 2 hours every 2 days for tolerance of 8 hours.
ADL Life Story - Therapist gathered information from patient and caregivers to complete ADL Life Story in order to increase patient socialization within the facility.
Gait Training - Therapist provided v/t during pre gait training through marching in place activity with UE support to promote stepping strategies needed for gait during community ADLs.
Insurance Functional Prog - Demonstrates functional progress with commode transfers from Mod to Min as observed by increase in motor planning/coordination, UB STR and sequencing.