Ther-Act: Patient received bed mobility rolling training, PNF trunk core recruitment, and functional transfer training of sit to stands for improved ADL.
Ther-Act: Patient is performing compensatory movement strategies addressing basic transfers and all phases of bed mobility.
Ther-Act: Patient received bed mobility rolling training, and gross motor muscle facilitation for functional transfers in sit to stands. Patient also performed PNF core trunk muscles techniques for static sitting balance in w/c.
Ther-Act: Patient received bed mobility rolling training, and gross motor muscle facilitation for functional transfers in sit to stands. Patient also performed PNF core trunk muscles techniques for static sitting balance in w/c.
Ther-Act: Patient received bed mobility rolling training, and gross motor muscle facilitation for functional transfers in sit to stands. Patient also performed PNF core trunk muscles techniques for static sitting balance in w/c.
SIT TO STAND RW + GENERAL AROM + STRETCH In order to improve functional mobility and increase participation to daily activities, patient was coached through sit-to-stands using RW, knee lifts, SAQs, and stretching to B hamstrings and gastroc for improved flexibility, BLE strength, sequencing, dynamic balance, proprioception, and tolerance during functional transfers. Patient required maximal verbal, visual and tactile cueing for correct performance of exercises, enhanced muscle contractions, and improved safety awareness in the handling of RW.
Transfers:
Patient continues to demonstrate with positive responses to improve gross motor muscle facilitation of BLE for transfer preparation as well as the compensatory movement strategies of forward momentum for transfer preparation at TD+ for 75% of sit to stand phase with 70% verbal and tactile cueing.
Patient made pronounced gains in functional transfers of sit to stands as he is now performing the technique at Min Ax1 with facilitation of hip and trunk extensors for improved extension phase with 15% verbal cueing ; and stand pivoting technique Mod-Min Ax1.
Patient had marked progress in functional transfers of stand pivoting technique at Mod-Min Ax1 with improved pivoting from w/c <> bed with 15% verbal cueing and Min Ax1 for sit to stands with facilitation of hip and trunk extensors for improved extension phase sit to stand.
Patient steady progress in functional transfers of sit to stands as he is now performing the technique at Min Ax1 with 15% verbal cueing; stand pivoting from w/c to bed at Mod Ax1.
Remarkable gains in functional transfers were noted as pt is now able to perform stand pivoting technique at Mod-Min Ax1 with improved pivoting from w/c <> bed with 25% verbal cueing for improved safety and is currently performing sit to stands at Min Ax1.
Provided training in pulling feet back under W/C for better positioning for sit-to-stand transfers and Pt is now showing practical improvement in pulling feet back for improved transfer technique of sit to stands as patient now performs the transfer at Mod Ax1. Pt continues to require Max Ax1 for stand pivots secondary to LOB while turning.
BED MOBILITY TRAINING: (Rolling: ----- assistance, Supine <-> Sit: ----- assistance) Patient was instructed on proper rolling technique and required verbal ---- tactile cues to perform. Patient was coached through proper side lying to sit transfer, lead through proper sequencing of LE and UE utilization to assume the seated position. Patient made effort to follow commands, but further training is required.
SIT TO STAND TRAINING: Transfer training: (Sit <->Stand: ---- assistance for --- reps) While performing sit to stand patient was instructed to reposition self further forward with feet firmly planned behind knee on floor and to utilized UE on surface pushing. Patient required verbal ----- and tactile cues during transfer training to ensure proper technique and safety, further training is require for patient to master safe sit to stand transfers.
SPT TRAINING: (Stand Pivot: ---- assistance) Patient was instructed during stand pivot to first come to full erect standing before turn, to take small focused steps until repositioned in front of the ----- touch knees against the edge and utilizing UE to sit slow and controlled. Patient had ---- difficulty performing transfer, although patient attempted to follow commands and proper sequencing further training will be required.
SITTING TOLERANCE: Patient was lead though Edge of bed --- edge of mat table activity; requiring minimal –- moderate --- maximum support. Patient was given verbal --- tactile cues for posture, foot and hand placement, patient tolerance sitting well for --- ~15mins.
SITTING WHEELCHAIR - Patient was instructed though and monitored with wheelchair sitting for alignment and posture.
STANDING TOLERANCE: Patient stood in parallel bars --- with a walker ; requiring minimal –- moderate --- maximum support. Patient was given verbal --- tactile cues for posture, foot and hand placement, patient tolerance sitting well for --- ~15mins..
SLIDING BOARD: Patient instructed on proper safety and technique with sliding board transfer with bed/WC transfers, requiring cuing for hand placement, posture, positioning of board and height of bed.
STANDING FRAME: Patient was placed in standing frame for --- minutes and was observed for any adverse response; patient tolerated treatment well.
HOYER: Patient and caregiver educated on proper technique and safety when transferring this specific patient. Caregiver able to giver understanding back.
W/C POSTURE: Patient positioned properly in wheelchair and give verbal and tactile cues on proper positioning.
CAR TRANSFER – Patient was instructed on the proper car transfer technique and safety hazards; to facilitate safety during out of facility ---- home trip. Focus given on hand and foot placement as well as trunk movement. Patient was reminded that all vehicles are different and that the environment should be surveyed for dimensions and hand holds and that the pace of transfer should be slow to maintain balance and coordination.
Patient was coached through sit-to-stands and ambulation x 10 ft at parallel bars using BUE support to increase tolerance to tasks for improved sequencing and performance of functional activities. Patient required min A and maximal verbal and visual cues to come to edge of seat and position feet in preparation for standing. Patient required CGA during extension phase of standing and throughout ambulation with moderate verbal cueing to take larger steps and advance hands forward.
In order to improve bed mobility and hygiene, patient was instructed through bridging and rolling to R and L exercises in supine for improved sequencing and tolerance to activities. Patient required min A and maximal verbal and tactile cueing for correct performance of tasks. Patient was coached through gait exercise x 100 feet using R/w to increase tolerance to activity for improved functional mobility. Patient required min A to come to standing and CGA during ambulation with assistance with guiding walker around curves. Patient’s BP was 110/73 mmHg and HR was 56 bpm in sitting before ambulation. After ambulation exercise, patient’s BP was 102/62 mmHg and HR was 62 bpm.
In order to improve functional mobility and increase safety awareness, patient was instructed through supine to/from sit and stand-pivot transfers bed to/from WC for improved sequencing and tolerance to activities. Patient required maximal verbal, visual and tactile facilitation for safe and correct performance of exercises.
Patient was coached through sit-to-stands for improved proprioception via WB, hypertrophy of B glutes and quads, and sequencing of activity in order to improve functional mobility. Patient required mod A in coming to edge of seat and min A to come to standing position. Patient required maximal tactile, verbal, and visual cueing for correct and safe performance of task. Patient demonstrates better performance of sit-to-stands using parallel bars than with RW.
In order to improve participation in daily activities, patient was coached through supine-to-sit, bed to/from chair via stand-pivots, sit-to-stands, and static standing activities for improved bed mobility, transfers, and tolerance to ADLs. Patient required SBA with maximal visual and verbal cueing for safe and correct performance of all tasks. Patient was able to tolerate standing position for 1 minute before becoming tired and needing a rest break. Patient would benefit from continued PT for increased tolerance to functional WB activities and improved safety awareness.
Patient was lead through sit-to-stands and stand-pivot transfers chair to/from chair and bed in order to improve sequencing and tolerance to activities for improved independence in functional mobility. Patient required min A and maximal verbal and visual cueing for safe and accurate performance of activities.
In order to improve functional mobility, patient was lead through bridging, rolling, supine to/from sit, and stand-pivot transfers for improved sequencing, tolerance to tasks, and dynamic postural control. Patient required maximal verbal/visual facilitation for improved safety awareness and correct performance of activities.
Patient was coached through sit to stands and static standing at parallel bars in order to improve tolerance to activity and balance for improved functional mobility in transfers, toileting, and dressing. Patient demonstrates improved sequencing in coming to edge of seat and extension phase of standing; however, continues to require verbal and tactile cueing for proper positioning of feet and hands. Patient required min A to come to edge of seat and CGA to come to standing.
In order to improve functional mobility, patient was coached through supine-to-sit, stand-pivot transfers, sit-to-stands, and sitting and standing reaching activities for improved sequencing of activities and static and dynamic balance. Patient required min A to CGA and moderate verbal and visual cueing for correct and safe performance of activities. Patient presents with improved static balance in standing with single UE support and improved dynamic balance in sitting without UE support.
Patient was lead through stand-pivot transfer from bed to WC and sit-to-stands at parallel bars in order to improve sequencing and tolerance to functional activities in bed mobility and transfers. Patient required mod A and max verbal cueing with one-step instructions in order to complete tasks safely and correctly.
Patient was educated on and instructed through safe and proper sequencing of supine to/from sit and bed to/from WC transfers for improved safety awareness, body mechanics, and tolerance to functional everyday transfers. Patient required supervision A and moderate verbal and visual cueing for correct performance of activities.
Patient was instructed through supine-to-sit, sit-to-stands, and stand-pivot transfers in order to improve BLE strength, sequencing of activities, and dynamic postural control for improved transitioning of postions and functional transfers. Patient required moderate verbal and tactile facilitation to B knees and BUEs in order to push off from bed and come to sitting position and continues to require reminders to use B armrests for improved sit to/from stands. Patient is demonstrating improvement with functional activities as evidenced by task completion with quicker pace.
In order to increase participation to daily activities in bed mobility, transfers, and toileting, patient was instructed through supine to/from sit, sit to/from stands, and transfers bed to/from WC for improved tolerance, sequencing, and dynamic balance during activities. Patient required part-to-whole technique for sit-to-stands for gradual progression to activity due to h/o dizziness during standing. Patient required maximal verbal cueing for improved safety awareness and correct performance of activities.
Patient was coached through stand-pivot transfers bed to/from WC and WC to/from chair with mod A in order to improve sequencing of transfers and increase BLE strength for improved functional mobility. Patient required maximal verbal cueing for improved safety awareness and tactile facilitation to trunk and B feet for correct performance of task.
In order to improve bed mobility and upright functional mobility, patient was lead through supine-to-sit with mod A, stand-pivot transfers with mod A, and sit-to-stands with min A for improved sequencing of tasks, BLE functional strength, and dynamic postural control. Patient required maximal verbal, visual, and tactile cueing for correct and safe performance of tasks.
In order to improve functional mobility in getting in and out of bed and moving in bed, patient was coached through stand-pivot transfers, supine to/from sit, moving up and side-to-side in bed. Patient required moderate verbal cueing and maximal tactile facilitation for correct and safe performance of tasks.
In order to improve participation in ADLs, patient was coached through bed exercises with mod A via bridging, moving side-to-side and up/down in bed, rolling to L/R using siderails, and supine to/from sit for improved initiation and sequencing of tasks. Additional goals for tx were to increase BLE strength, coordination, and functional activity tolerance. Patient required maximal verbal/tactile facilitation in order to initiate tasks and perform tasks safely. Patient was coached through stand-pivot transfers bed to/from chair with armrests with max A in order to improve functional mobility and decrease need for caregiver assistance. Patient required maximal verbal prompting, visual cueing, and tactile facilitation to enhance strength contraction to anti-gravity musculature and improve sequencing of activity. While in sitting on bedside chair, patient was lead through strengthening to B quads and ant. tib via AROM for improved functional strength against gravity. Patient demonstrated improved upright posture in sitting at edge of bed and in sitting in chair with back rests with improved back/neck extension and increased use of BUE for support.
In order to improve participation in dressing and hygiene, patient was coached through bed exercises with mod A via bridging, moving side-to-side and up/down in bed, rolling to L using siderail, and supine to/from sit for improved initiation sequencing of tasks. Additional goals for tx were to increase BLE strength, coordination, and functional activity tolerance. Patient required moderate verbal/tactile facilitation in order to perform tasks correctly and safely. Patient was coached through stand-pivot transfers bed to/from chair with armrests with max A in order to improve functional mobility and decrease need for caregiver assistance. Patient required careful monitoring to L shoulder due to previous injury and subluxation and moderate cueing for correct and safe performance of tasks.
In order to increase participation in ADLs with dressing, hygiene, grooming and feeding, patient was coached through bed exercises with max A via rolling to L/R using siderails and supine to/from sit for improved sequencing and independence of tasks. Patient was progressed through sitting tolerance at edge of bed in order to assess and improve static and dynamic balance via sitting with/without use of BUE, sitting eyes closed, reaching of objects in all directions, scooting forward/backwards/sideways, and marching. Additional goals for tx were to increase BLE strength, coordination, postural awareness, and functional activity tolerance. Patient required maximal verbal/tactile facilitation in order to initiate tasks and perform tasks correctly. Patient was coached through stand-pivot transfers bed to/from WC with max A in order to improve functional mobility and decrease need for caregiver assistance. Patient required maximal verbal prompting, visual cueing, and tactile facilitation to enhance strength contraction to anti-gravity musculature and improve sequencing of activity. While in sitting in WC, patient was lead through strengthening to B hips, quads, and ant. tib. via AROM for improved functional strength against gravity.
In order to increase participation in hygiene, grooming, dressing and feeding, patient was lead through the following functional activities: bridging, rolling to L/R, supine to/from sit, and sit-to-stands. Focus of treatment was to improve BLE strength, coordination, static/dynamic balance, and sequencing of activities. Patient required maximal verbal/tactile/visual facilitation for correct and safe performance of all exercises.
In order to improve independence in ADLs, patient was facilitated through functional activies in bed mobility via rolling , bridging, supine-to-sit, reaching to floor for donning of socks and shoes, and weight-shifting in all directions at edge of bed. Patient required SBA and minimial verbal/tactile/visual cueing for correct and safe performance of exercises. Patient was able to perform transfers WC to/from low and compliant surface (bed, sofa) safely and independently today.