RIGHT ESTIM Strength E-stim applied R elbow and R shouder in order to facilitate neuromuscular reeducation and enhance muscle strength,power and functional activity tolerance and intensity levels/settings at Neuro Re-ed Triphasic PENS RUE biceps and triceps at 41mA x15 minutes. Skin integrity intact pre and post estim application.
LEFT ESTIM Strength E-stim applied L elbow and L shouder in order to facilitate neuromuscular reeducation and enhance muscle strength,power and functional activity tolerance and intensity levels/settings at Neuro Re-ed Triphasic PENS LUE biceps and triceps at 41mA x15 minutes. Skin integrity intact pre and post estim application.
RIGHT ESTIM Shoulder FLEXION Estim applied to R wrist,R elbow and R shoulder for purpose (s) of increasing ROM and intensity/levels at Neuro Re-ed Triphasic PENS RUE mid biceps/triceps,across the thenar and hypothenar eminence and upper 1/3 extesnor carpi ulnaris,extensor carpi radialis and extensor digitorum at 23mA x15 minutes. Skin integrity intact pre and post estim application.
LEFT ESTIM Shoulder FLEXION Estim applied to L wrist,L elbow and L shoulder for purpose (s) of increasing ROM and intensity/levels at Neuro Re-ed Triphasic PENS LUE mid biceps/triceps,across the thenar and hypothenar eminence and upper 1/3 extesnor carpi ulnaris,extensor carpi radialis and extensor digitorum at 23mA x15 minutes. Skin integrity intact pre and post estim application.
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.
SIT TO STANDS Therapist provided verbal/tactile cues to improve body mechanics/positioning and facilitate LE WB during training in sit to stand/stand to sit mobility with UE support utilizing parallel bars in order to enhance safety and increase I with LB dsg and transfers.
BALL CATCH for UB dressing Therapist provided visual/verbal cues during functional reaching task to retrieve needed item from various planes with BUE in BIL/uni lateral patterns in order to improve GMC,deltoids strength,crossing midline,BIL coordination and VMI skills needed for ADLs such as UB dressing.
Socks over Cones for LB dsg
Therapist provided v/v/t during therapeutic activity to pull socks over various size cones in order to improve GMC,BIL coordination,deltoids strength and VMI skills needed for LB dsg utilizing AE.
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.
EOM/B dynamic sit for FIST
Therapist provided verbal/tactile cues to facilitate abdominal muscle activation to increase trunk control during static balance activities including anterior/lateral/posterior pertubations and functional reaching tasks while sitting EOB unsupported to improve core strength,dynamic sitting balance and righting reactions needed to increase score on the Function in Sitting Test.
Omni Stand
Pt participated with variable dynamic standing adjunct to reaching for objects in various heights/planes through use of Omnistand in order to increase standing balance/tolerance needed for ADLs.
Transfers
Standard commode stand pivot transfers with UE support at Min A including verbal/tactile cues to improve body mechanics/positioning,facilitate LE WB and proper anterior/posterior stepping to facilitate pivot.
Ball Tennis for BATHING
Therapist provided v/v/t during therapeutic activity to hit moving targeting from various planes utilizing racket held with RUE in order to improve GMC,crossing midline,deloids strength,tool manipulation and VMI skills needed for ADLs such as bathing utilizng AE.
SELF (breaks) Rest periods given throughout skilled OT session to promote energy conservation.
RNP
6xweek 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.
Painting for G/H and Self-feeding
Therapist provided v/v/t for increased strategy during therapeutic activity to paint picture within borders utilizing provided paintbrush in order to increase FMC,eye-hand coordination,tool manipulation and VMI skills needed for ADLs such as self-feeding.
Fold Towels for UB Dressing
Therapist provided v/v/t during therapeutic activity to fold various size towels over elevated table in order to improve GMC,BIL coordination,deltoids strength,crossing midline and VMI skills needed for UB dsg.
Clothes Pins
Pt grasped and manipulated object with Min resistance (clothes pin) with BUE in unilateral pattern and attached to requested target in various planes all to improve FMC,intrinsic hand muscles strength,wrist extension and VMI skills needed for ADLs.
Drawing Shapes
Therapist provided Min verbal/tactile cues for increased strategy during therapeutic activity over elevated table top utilizing writing tool held with RUE to complete simple shapes (circle,square) on paper all to improve FMC,eye-hand coordination,tool manipulation,shoulder flexion and VMI skills needed for G/H tasks.
TheraPUTTY Activity
Therapist provided v/v/t during therapeutic activity utilizing BUE to pull/twist/pinch theraputty with Mod resistance to make pliable in order to retrieve needed items all to improve BIL coordination,intrinsic/extrinsic hand muscles strength,FMC and VMI skills needed for ADLs such as LB dsg.
Fall Prevention Protocol
Balance Fall prevention protocol implementation: clinician instructed pt on dynamic sitting activities reaching to frontal plane for objects for increased postural control,core activation and and righting reactions for reduced risk of falls.
Strength Fall prevention intervention protocol with emphasis on BUE strength of biceps,triceps,deltoids and wrist extensor muscles with facilitation of BUE shoudler,elbow and wrist flexion/extension as well as shoulder protaction and retraction to reduce risk of falls.
WC Sitting Tolerance
Tolerated sitting in wc x1 hour continuous without slipping and no signs of pain/discomfort in order to increase socialization oppurtunities and to reduce risk of pressure sores.
SPLINT adjustments with required skilled positioning for affective application.
V/T to increase Participation
Therapist provided Max verbal/tactile cues to facilitate participation including redirection as needed secondary to decreased volition and arousal/alertness.
COVID Hall Patients
Pt positive for COVID-19;clinician implemented all infection control practices including use of PPE for droplet precautions during treatment session in room.
Caregiver EDU (SPLINT)
Therapist educated caregivers (…..CNA,….CNA) on proper don/doff BIL carrot splint with emphasis on skin checks pre and post application with Good return verbal feed back and demonstration.
Caregiver EDU (ORAL CARE)
Therapist educated caregivers (…..CNA,…..CNA) on safe and efficient pt oral hygiene techniques with Good return verbal feed back and demonstration.
Caregiver EDU (WC SIT)
Therapist educated caregivers (…CNA,……CAN) on safe positioning strategies in wc to reduce risk of pressure sores with Good return verbal feed back and demonstration.
CARRYOVER Tx NOTE doc from ADVHC
Neuromuscular SITTING
forward reach, lateral reach, weight shift anterior and weight shift lateral in sitting, supported, 10 repetitions reps, 3 sets without resistance and fading verbal instruction and fading tactile cues / facilitation given due to compromised technique in order to facilitate motor control, facilitate patterned movements and provide corrective assistance for loss of balance.
Neuromuscular SITTING (TD)
forward reach, anticipatory reaction anterior challenge, anticipatory reaction lateral challenge and weight shift anterior , in sitting, supported, 10 repetitions reps, 2 sets without resistance and consistent / 100% verbal instruction and consistent / 100% tactile cues / facilitation and consistent / 100% physical assistance given due to compromised attention, coordination, range of motion, strength, technique and muscle tone in order to facilitate motor control and facilitate patterned movements.
Neuromuscular STANDING
forward reach, perturbation anterior, perturbation lateral, perturbation posterior, weight shift multi-directional, step forward, tandem stance and overhead reach , in standing, supported, 10 repetitions reps, 3 sets without resistance and fading verbal instruction and fading tactile cues / facilitation given due to compromised coordination and technique in order to facilitate motor control, facilitate patterned movements and provide corrective assistance for loss of balance.
Neuromuscular POSITIONING
facilitation of position in space and facilitation of postural control , in sitting, unsupported, 10 repetitions reps, 3 sets in order to facilitate motor control, facilitate patterned movements and provide corrective assistance for loss of balance .
Neuromuscular NEUROMUSCULAR REED
gross motor coordination techniques and postural control in order to facilitate motor control, facilitate patterned movements and provide corrective assistance for loss of balance.
DRESSING
Skilled interventions focused on patient's ability to perform Dressing tasks included
analysis of movement during dressing
task segmentation during LB dressing
safety training during transitional movements
TOILETING
Skilled interventions to facilitate safety and independence with Toileting tasks focused on safety training during functional mobility during toileting, safety training during transitional movements and facilitation of safe maneuvering in small spaces.
CONCURRENT
Patient participated in concurrent therapy with 1 other patient to successfully progress towards individual treatment plan/goals by addressing patient's gross motor coordination deficits, strength impairments, postural alignment/control and balance deficits ; skilled interventions included .
RESPONSE TO SERVICES
actively participates with skilled interventions.
compliant with skilled interventions and compliant with trained techniques.