RIGHT ESTIM shoulder flexion E-Stim applied to right wrist, right elbow and right shoulder for purpose(s) of increasing ROM and intensity level/settings at Neuro Re-ed Triphasic PENS RUE mid biceps/triceps strength,across the thenar and hypothenar eminence and upper 1/3 extensor carpi ulnaris,extensor carpi radialis and extensor digitorum at 29mA x15 minutes. Skin integrity intact pre and post estim application.
LEFT ESTIM shoulder flexion E-Stim applied to left wrist, left elbow and left shoulder for purpose(s) of increasing ROM and intensity level/settings at Neuro Re-ed Triphasic PENS LUE mid biceps/triceps strength,across the thenar and hypothenar eminence and upper 1/3 extensor carpi ulnaris,extensor carpi radialis and extensor digitorum at 29mA x15 minutes. Skin integrity intact pre and post estim application.
RIGHT ESTIM strength E-Stim applied to right elbow and right shoulder in order to facilitate neuromuscular reeducation and enhance muscle strength,power and functional activity tolerance and intensity level/settings at Neuro Re-ed Triphasic PENS RUE biceps and triceps at 40mA x15 minutes. Skin integrity intact pre and post estim application.
LEFT ESTIM strength E-Stim applied to left elbow and left shoulder in order to facilitate neuromuscular reeducation and enhance muscle strength,power and functional activity tolerance and intensity level/settings at Neuro Re-ed Triphasic PENS LUE biceps and triceps at 40mA x15 minutes. Skin integrity intact pre and post estim application.
Estim Duane
Pt demonstrates decrease R deltoid strength limiting shoulder flexion affecting self-feeding. E-Stim applied to right shoulder for purpose(s) of increasing ROM and muscle contraction and intensity level/settings at Muscle Disuse Atrophy LVPC Medium muscle Symmetrical Biphasic R anterior deltoid and bicep to increase deltoid strength to facilitate shoulder flexion : Stimulation pulse duration 250 microsecond;Stimulation frequency 50 Hz;Channel timing 2:15 at 33mA x15 minutes. Skin integrity intact pre and post estim application.
Diathermy (NM)
Diathermy applied to right elbow for 15 minutes in order to increase range of motion with intensity level/settings at RUE (elbow) 2 Delta T to decrease joint stiffness and contracture x15 minutes with required skilled positioning for affective application.
Skin integrity intact pre and post diathermy application.
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.
Sit to Stands Training Therapist provided verbal/tactile cues to improve body mechanics/positioning and to 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 transfers and LB dressing.
Transfers
Stand pivot transfers with UE support in 3/3 trials with Min A including verbal/tactile cues to improve body mechanics/positioning,facilitate LE WB and proper anterior/posterior stepping to facilitate pivot.
Wc<>standard commode stand pivot transfers with UE support utilizing grab bars at Sup/T in 1/3 trials;verbal/visual cues to lock wc brakes and to facilitate proper wc positioning to increase efficiency, energy conservation and to reduce risk of falls.
Stand Pivot transfer Tactile cues for step
Stand pivot transfers with UE support at Max/Substantial A including verbal/tactile cues to facilitate upright head/neck and trunk posture and with tactile cues needed during stand pivot to facilitate initiation of RLE lateral side step.
EOM activities for TOILETING Therapist provided verbal/tactile cues to facilitate abdominal muscle activation to increase trunk control during functional reaching tasks including to retrieve object from behind (object at midline,hands breadth posterior) while sitting EOM to improve core strength,dynamic sitting balance and righting reactions needed for toileting tasks.
EOM including STATIC balance Therapist provided verbal/tactile cues to facilitate abdominal muscle activation to increase trunk control during static balance activities including anterior/posterior/lateral pertubations and functional reaching tasks while sitting EOM to improve core strength,dynamic sitting balance and righting reactions needed to increase score on the Function in Sitting Test.
Ther Act BALL CATCH Therapist provided visual/verbal cues during functional reaching task to retrieve needed item from various planes with BUE in uni/BIL patterns in order to improve GMC,BIL coordination,deltoids strength,crossing midline and VMI skills needed for ADLs such as dressing.
Ther Act BALLOON TENNIS Therapist provided visual/verbal cues during therapeutic activity to hit moving target utilizing racket held with BUE in unilateral patterns in order to improve GMC,crossing midline,tool manipulation,deltoids strength,tool manipulation and VMI skills needed for ADLs such as bathing using AE.
Ther Act (theraputty) Therapist provided v/v/t during therapeutic activity utilizing BUE to twist/pull/pinch theraputty with Mod resistance to make pliable in order to retrieve needed items within theraputty all to improve B coordination,GMC,FMC,intrinsic/extrinsic hand muscle strength and VMI skills needed for ADLs.
PAINTING for G/H and Eating Therapist provided verbal/tactile cues for increased strategy during therapeutic craft activity to paint picture within borders utilizing provided paint brush in order to improve FMC,eye-hand coordination,tool manipulation and VMI skills needed for eating and G/H tasks.
PAINTING for VMI Demonstrated ability to color designated sections of picture within borders utilizing matching/corresponding colors all to improve FMC,eye-hand coordination,tool manipulation and VMI skills needed for self-care skills such as eating tasks.
BOLTs and SCREWS activity Therapist provided FM activity to facilitate BIL hand dexterity and in-hnad manipulation skills to increase ability to perform functional grasp/release of daily living items.
Reacher for LB dressing Therapist instructed pt with use of AE (reacher) for LB dsg to compensate for pt decreased sitting balance and improve safey and I with dsg. Therapist provided v/v/t during therapeutic activity to retrieve needed item from floor utilizing reacher,while sitting in wc, in order to increase GMC,eye-hand coordination,tool manipulation and VMI skills to enhance safety and facilitate I with LB dressing.
Socks Over Cone (LB dsg sim) Therapist instructed pt with use of AE (sock-aide) for LB dsg to compensate for pt decreased sitting balance and improve safey and I with dsg. Therapist provided visual/verbal cues during therapeutic activity to pull socks over various size cones in order to improve GMC,BIL coordination,motor planning/coordination and VMI skills needed for LB dressing utilizing AE.
FOLD TOWELS for UB dsg 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/manipulated item 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.
Omnistand Ball Catch 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 and righting reactions needed for community ADLs.
Standing Frame Tolerated supported standing utilizing standing frame x8 minutes continuous with coaching for trunk righting and posture to reduce knee pain
DRESSING
Skilled interventions focusing on pts ability to perform dsg tasks included
analysis of movement during dsg
task segmentation during LB dsg
safety training during transitional movements
TOILETING Skilled interventions to facilitate safety and I with toileting tasks focused on safety training during functional mobility during toileting,safety training during transitional movement and facilitation of safe maneuvering in small spaces.
NeuroMuscular SITTING wc 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 and facilitate patterned movements.
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, ROM, 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 provided corrective assistance for LOB.
NeuroMuscular STANDING 2 Static standing balance training initiated for weight shifting for COG over BOS for improved balance to decrease fall risk with initiation of standing. Therapist facilitated bringing hips forward and increased trunk extension for upright upper body posture. Pt initially required Max A for correction with implementation of use of mirror to enable self-correction. Pt able to reduce level of assistance needed for Mod A with this visual feedback.
NeuroMuscular Positioning EOM 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 LOB.
CONCURRENT Pt participated in concurrent therapy with 1 other pt to successfully progress towards individual treatment plan/goals by addressing pts GMC deficits, strength impairments, postural alignment/control and balance deficits; pt worked on
RESPONSE TO SERVICES
Actively participates with skilled interventions. O2 saturation levels maintained at during today’s session
Compliant with skilled interventions and compliant with trained techniques.
Compliant with skilled interventions however with verbal/tactile redirection as needed secondary to aversion to non-preferred tasks.
V/T to Increase Participation Therapist provided Max verbal/tactile cues to facilitate participation with redirection as needed secondary to decreased volition and arousal/alertness. O2 saturation levels maintained at
ISO Tx Session Completed Pt implemented all infection control practices including use of PPE for droplet precautions during treatment session in room.
Grasp/Release for DSG and bed mob Therapist instructed pt in grasp/release therapeutic activities with R/L hand to increase I with dsg tasks and bed mobility. Facilitation provided using hand over hand assistance due to muscle weakness. Tx initiated with large items requiring full hand for grasp/release which pt demonstrated improved performance with but gradual decline with strength noted as size of items decreased. Unable to demonstrate performance of…………. at this treatment.
Caregiver EDU (Splint) Therapist educated caregivers (…..CNA,…..CNA) on proper don/doff ( splint type) 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 utilizing dental swab with Good return verbal feed back and demonstration. .
Caregiver EDU (wc sit) Therapist educated caregivers (….CNA,….CNA) on safe positioning strategies in wc to reduce risk of pressure sores with Good return verbal feed back and demonstration.
Caregiver Splint Edu Therapist educated caregivers (Adrianna,CNA;Susanna,CNA) on proper carrot splint don/doff procedures with emphasis on skin checks before/after splint application with Good return verbal feed back and demonstration.
RNP
RNP established with patient present to maintain current level of mobility and functional I level and to reduce risk of decline/complications.
Duration 6xweek x8 weeks x15 minutes
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.
AROM BUE Therex Patient would benefit from monitored aerobic and resistive exercises utilizing weights,weighted dowels,UE restorator and therabands;AAROM/AROM to BUE.
BED MOBILITY for RNP Pt benefits from repositioning every 2 hours or as needed, to decrease risk of pressure sores.
SPLINT Tolerate splint *** hours daily or as tolerated with skin checks before/after splint application.
FALL PREVENTION PROTOCOL VERBAGE
STRENGTH Fall prevention intervention protocol with emphasis on BUE STR of biceps, triceps, deltoids and wrist extensor muscles with facilitation of BUE shoulder, elbow and wrist flexion/extension as well as shoulder protraction and retraction to reduce risk of falls.
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 righting reactions for reduced risk of fall.
Fall Prevention Strategies
Call Light Therapist educated patient on fall prevention strategies to correctly identify call light and implement usage by correctly answering yes/no questions in …..
Fall prevention (call light) Therapist educated patient on fall prevention strategies to correctly identify call light and implement usage by correctly answering yes/no questions with …….. at …….. with noted deficits with attention and emotion regulation (crying) impacting progress secondary to presence of dementia.
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 flexability of quadratus lumborum muslces activation and strengthening of hamstrings with mod tactile cueing to improve patients capicity 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.
Carrot tolerance
Pt. benefits from LUE Carrot x----; however, pt. benefits from interval assessment of carrot placement secondary to RUE pronation/ spontaneous movement.
Patient tolerated LUE carrot splint x3 hours however with 1 hour interval assessment of carrot placement secondary to spontaneous LUE movement including pronation.
FIST form STG set up
Patient will decrease risk of falls as evidence from increase in score to /56 on the Function in Sitting Test
Pt. benefits from ___ cueing/assist ....
Just modify reps/ assistance accordingly
ADL Life Story
Therapist gathered information from patient and caregivers to complete ADL Life Story in order to increase patient socialization within the facility.
IADLs Light Maintenance Goal
Pt. will demonstrate increased independence with light home maintainence tasks to ______ without LOB, good safety awareness and WNL vitals to increased independence with IADLs.
W/C positioning and tolerance
therapist reclined w/c to increase anatomical alignment secondary to observed kyphotic posture with R lateral trunk flexion.
Required reposition A secondary to excessive weight lateral shifting to the Right.
Goal progression hindered by ISO
patient recently in isolation x14 days hindering patient progress with POC; however, patient contat precautions have been discharged and patient demonstrates good potential to return to PLOF
as observed by emerging skills: ......... ( fill in the blank with any good skills).
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.
Diathermy (NM)
Diathermy applied to LUE digits for 15 minutes in order to decrease pain with intensity level/settings at 1 Delta T to relieve pain x15 minutes with required skilled positioning for affective application.
Skin integrity intact pre and post diathermy application.
E Clin ESTIM to decrease pain
Post Traumatic-Post Surgical Pain Sensory Nerve Block to LUE (biceps,triceps,most proximal forearm extensor/flexor muscles) at 21mA x15 minutes in order to reduce pain. Skin integrity intact pre and post estim application.
Reported 4/10 pain rating to LUE pre estim application;2/10 post estim application.
ESTIM to decrease pain (forearm BELL)
E-Stim applied to left wrist and left elbow for purpose(s) of decreasing chronic pain and intensity level/settings at IFC PREMOD motor L forearm anterior flexor muscles (flexor carpi radialis,pronator teres,palmaris longus) at 33mA x15 minutes to reduce pain. Skin integrity intact pre and post estim application.
Reported 9/10 pain rating pre estim application;8/10 post estim application.