Patient was seen by skilled PT services, to progress towards goals established in POC.
Active Exercise
GENERAL BLE EXERCISE: Patient performed therapeutic resistance exercises, isotonic resistive exercises to hips and knees in all planes, and theraband resistive exercises for improved mobility task.
GENERAL AROM + TRANSFERS - Patient was coached through PROM and stretching to B hips, knees, ankles for improved flexibility and joint integrity. Patient was lead through AROM exercises via hip flex/ext/ABD/ADD, knee flex/ext, and ankle PF/DF in order to improve increase strength to BLE for increased independence in transfers. Patient was able to perform stand-pivot transfers bed to/from chair with max A.
GENERAL AROM - Patient was coached through AROM and isometric exercises to BLE hips, knees, and ankles to increase strength and improve motor control for improved functional mobility. Patient responded well to verbal and visual cueing and tapping technique to agonist musculature in order to initiate and enhance contractions in exercises.
GENERAL AROM KNEES LIMITED EX -Patient was lead through B AROM knee ext exercises and stretching to B hamstrings in order to increase B knee ext ROM and strengthen quads musculature for improved functional mobility in standing. Patient presented with increased tolerance to exercises; however continues with B knee ext ROM limitations that impair upright standing posture.
ISOMETRICS – Patient was coached through BLE strengthening exercises via isometric exercises to hips, knees, and ankles in all planes in order to improve strength, kinesthetic position sense, counteract muscle atrophy and joint health for improved functional mobility.
GENERAL BLE ISOMETRIC - Patient was coached through BLE strengthening exercises via AAROM and isometric exercises to hips, knees, and ankles in all planes in order to improve strength, kinesthetic position sense, and joint health for improved functional mobility. Patient required verbal and visual cueing with tapping technique to agonist musculature for enhanced contractions. Patient continues to present with decreased strength and motor control to BLE with more involvement to RLE with c/o numbness from the knee down.
GENERAL ISO + AROM - Patient was instructed through BLE strengthening exercises via isometric exercises and AROM to B hips, knees, and ankles in order to improve tolerance for functional mobility and counteract muscle atrophy. Patient tolerated treatment well with frequent rest breaks and required maximal verbal cueing to maintain attention to tasks.
GENERAL 3 EXERCISE + NUSTEP - Patient was lead through seated BLE strengthening exercises via marching, kicking, and ankle pumps in order to address muscle atrophy associated with immobility and increase tolerance to WB functional activities in ambulation, bed mobility, and transfers. Patient was coached through endurance exercise on NuStep in order to perform BLE reciprocal loading, increase tolerance to ADLs, and improve kinesthetic awareness. Patient required minimal verbal cueing for correct performance of exercises.
KNEE – TO – CHEST Patient was coached through supine ther ex. to B hip, knee, and ankle musculature for improved strength and tolerance to ADLs in bed mobility, transfers, and toileting. Patient was able to tolerate exercises well today and required min A with knee-to-chest exercises; all other exercises were performed with moderate verbal cueing for improved attention and performance of ex’s and without need for manual A.
4-WAY EX - In order to improve functional mobility, patient was coached through BLE strengthening to glutes, iliopsoas, quads, hams, ant. tib, and gastroc/soleus via standing 4-way exercises and leg curls and sitting LAQs, knee bends, ankle DF/PF with manual resistance. Treatment focused on increasing BLE strength, BLE AROM, and functional activity tolerance. Patient required moderate verbal/visual/tactile cueing for safe and correct performance of exercises.
PRE-GAIT BLE: In order to progress tolerance to ambulation, patient was instructed through ther ex to BLE in elevated sitting via LAQs and knee lifts
HAMSTRING STRETCH: Patient received slow static stretching to BLE knee flexors for increased Knee extension ROM.
SIT-STAND Patient performed therapeutic exercises that were progressed to closed chain exercises, therapeutic exercises progressed from sitting to standing.
SUPINE - Patient progress through bilateral LE AROM of hip, knee and ankle, to improve the strength, coordination and tolerance to activity in LE allowing for improved performance of functional activities and gait.
SUPINE - In order to increase patient participation in daily activities, patient was coached through the following: supine exercises via SAQs and ankle pumps;
SEATED - Patient was progressed through seated bilateral LE AROM of hips, knee and ankles; to improve strength, tolerance to activity and coordination; allowing for improved performance of functional mobility and ADLs.
STANDING – Patient coached through therapeutic exercises for LE to facilitate independence in mobility tasks in standing. Patient given verbal --- tactile cues for proper form, posture and count. Patient tolerated standing exercises ---- requiring --- therapeutic rest breaks.
Mod STANDING - modified standing exercises on high mat via weight shifting f/b and side-to-side; and standing exercises via mini-squats.
STANDING TOLERANCE + ENDURANCE EX- Patient was coached through standing activity using RW for B UE A in order to increase tolerance to functional standing activities. Patient was able to tolerate standing position for 30 seconds before reporting symptoms of dizziness. Patient was coached through endurance exercise using Omnicycle in order to increase BLE strength and tolerance to ADLs. Patient required moderate verbal and tactile cueing to B quads in order to equalize loading of LEs. Patient was lead through balance exercise in sitting on an elevated mat for modified WB in order to improve dynamic postural control and progress tolerance to standing position. Patient performed a dual motor task while on elevated mat and was able to hold position without UE support on mat. Patient tolerated treatment well and would benefit from continued PT for improved tolerance to functional activities.
DYNAMIC STANDING ACITIVITES + TRANSFERS-In order to improve balance, strength, and tolerance to ADLs, patient was instructed through sit-to-stands, reaching activities in sitting and standing, kicking ball in sitting with 3 lb ankle weights, marching in place, and resisted hip ABD using yellow T-band. Patient required one-step instructions and maximal visual cueing via mimicking desired movements in order to improve sequencing and attention to activites. Patient is demonstrating improved supine-to-sit and stand-pivot transfers with decreased need for manual A.
STATIC STANDING static standing for increased BLE strength, tolerance to standing position, and proprioception via WB positions.
AAAROM
AAROM BLE EXERCISE Patient performed AAROM to knee, hips, and ankles in all planes for increased gross motor muscle facilitation. Patient also performed Isometric s resistance to hip flexors and abductors.
GENERAL AAROM – HYGIENE - In order to improve bed mobility and hygiene, patient was instructed through isometric and AAROM to B hip, knee, and ankle musculature for improved BLE strength and motor control. Patient required moderate verbal and visual cueing with tapping to agonist musculature in order to initiate and enhance contractions. Patients continues to present with BLE weakness and impaired motor control with more involvement to RLE.
GENERAL AAROM BLE - Patient was lead through resisted ankle pumps and AAROM to B hips, knees, and ankles via knee-to-chest, alt. hip ABD/ADD, SAQs, and heel slides in order to increase BLE strength and improve neuromuscular activity for improved functional mobility. Patient required moderate verbal and tactile cueing for enhanced contractions and performance of activities. More A is needed to L LE due to unilateral neglect; however, patient is demonstrating improved volitional contractions to L hip, knee, and ankle musculature.
GENERAL PROM -AAROM - Patient was progressed through PROM and AAROM to B hips, B knees, and L ankle to increase flexibility with emphasis on increasing B hip and knee ext ROM and L ankle DF and Ever. ROM for improved functional mobility and anatomical alignment. Patient responded well to maximal verbal cueing with calm tone and sustained pressure to antagonist musculature.
GENERAL AAROM + NEGLECT In order to gain functional strength needed for ADLs, patient was coached through AAROM exercises to B hip, knee, ankle joints for improved BLE strength and tolerance to activities. Patient required maximal facilitation with redirecting, tapping to agonsit musculature, and demonstration of task for improved motor control. Significant neglect and weakness was noted to right side.
AAROM FOR HYGIENE GROOMING DRESSING - In order to increase independence in ADLs for hygiene, grooming, and dressing, patient was coached through AAROM exercises to B hip, knee, and ankle joints for improved strength to anti-gravity musculature and tolerance to functional activities. Patient required frequent rest breaks and maximal verbal one-step instructions, demonstration of tasks, and tapping to agonist musculature for improved motor control and strength of contractions. Patient required close monitoring of exertion and vital signs for safe performance of exercises.
TRUNK PNF
GENERAL PNF - Patient was progressed through PROM via PNF D1 flex/ext to B hips, knees, and ankles and static stretching to B ankles in order to improve joint health and B ankle DF ROM for improved functional mobility. Effective handling techniques were monitored for the development of RNP and contracture management program. Patient responded well to sustained pressure over antagonist musculature and maximal contact to plantar surface with slow progression in ROM in order to decrease tone and not exacerbate hyperreflexia and spasticity.
MOD LEVEL PNF - Patient was lead through ther ex to strengthen BLE anti-gravity musculature and trunk via bridging, lower trunk rotation via dynamic reversals PNF technique, resisted LAQs, and resisted heel-raises in sitting for improved trunk stabilization and tolerance to functional upright activities. Patient required maximal verbal cueing and moderate tactile facilitation for enhanced muscular contractions and correct performance of exercises.
OMNI - Patient was monitored while performing 15-minute skilled motorized assistive cycle therapeutic exercise. Patient was provided with verbal and tactile cuing for maintaining upright posture during activity
OMNI ENDURANCE- In order to increase participation to dailty activities, patient was lead through endurance exercise on Omnicycle for improved kinesthetic awareness via closed-chain exercise, increased BLE strength, and increased tolerance to functional activities. Patient required moderate verbal cueing to equalize loading of LEs and monitoring of vitals.
OMNI – GAIT – TOLERANCE - Patient was lead through endurance exercise using Omnicycle to increase tolerance to activities and encourage LE proprioception and reciprocal motion for improved gait cycle. Patient required verbal and tactile cues to equalize LE loading and maintain upright posture.
NUSTEP – Patient prompted through reciprocal LE and UE pattern, engaging bilateral hip, knee and ankle in coordinated rhyme and activity tolerance with --- therapeutic rest breaks. Patient monitor for negative response to exertion. Patient tolerated --- .
NUSTEP - Patient was lead through endurance exercise on NuStep in order to promote reciprocal movement, improve kinesthetic awareness via closed-chain exercise and increase BLE strength for improved tolerance and performance during ambulation.
OMNI - Patient was lead through endurance activity on Omnicycle while performing dual cognitive task in order to increase strength to BLEs, provide proprioceptive input with closed chain exercise, and promote reciprocal LE movement for improved performance gait performance.
OMNI - In order to improve functional mobility, patient was coached through closed-chain functional exercise on Omnicycle for improved BLE strength, reciprocal movement, BLE ROM, kinesthetic sense, and tolerance to activity. Patient required ongoing monitoring of VS and exertion and moderate verbal/visual cueing for increased attention to task and enhancement of strength of muscular contractions.
OMNI - In order to improve functional mobilty, patient was coached through closed-chain functional exercise on Omnicycle and strengthening to BLE via manual resisted exercises to R and AAROM exercises to L. Patient required minimal verbal/visual/tactile cueing to agonist musculature with emphasis to LLE for improved motor control.
iN2L SEATED – Patient coached thought interactive seated task with iN2L engaging cervical and lumbar stabilization while reaching outside base of support; to improve posture control, seated balance and tolerance to tasks.
iN2L STANDING – Patient lead thought interactive standing task with iN2L engaging lumbar stabilization to improve posture control, standing balance and tolerance to standing tasks.
CUEING
TAPPING - Patient required verbal, tactile and visual cueing with tapping technique to agonist musculature for enhanced contractions.
TECHNIQUE/COUNT - Patient required verbal ----- and tactile cues with tasks to ensure proper technique and count.
ORIENTING TO TASK - Patient is easily distracted from task and requires frequent redirection and orientation to task.
CUEING - Patient required moderate verbal cueing and tactile facilitation for correct and safe performance of exercises.
TACTILE -Patient required tactile facilitation to B quads to promote equalized loading to R and L LEs.
FOCUS - Focus of exercises were to increase strength to LE anti-gravity muscles, improve dynamic postural control in standing, increase proprioception and kinesthetic awareness, and increase tolerance to standing position.
TOLERANCE - Patient is demonstrating improved tolerance to activity as evidenced by more active participation and ability to focus on secondary cognitive task simultaneously.
Passive/Stretching
HAMSTRING – PF STRETCH: Patient was progressed through stretching to B hamstrings and gastroc/soleus to increase Bilateral knee extension and Dorsiflexion ROM for improved foot clearance during gait cycle and upright anatomical alignment in standing.
HAM - PF STRETCH WITH LAQIn order to improve upright posture and functional mobility in standing, patient was progressed through stretching exercises to B hamstrings and gastroc/soleus and resisted LAQs for increasead B knee ext and B ankle DF ROM and increased BLE strength. Patient required moderate verbal cueing and tactile facilitation to B quads for enhanced muscular contractions.
HAMSTRING STRETCH + AW EXERICSE - Patient was lead through stretching exercises to B hams in order to increase B knee ext. ROM and LAQs with -----1lb ankle weights to BLE in order to increase quads strength for improved standing posture and gait pattern. Patient performed sit-to-stands and timed standing in order to improve functional strength to BLE extensor musculature for improved balance and tolerance to standing activities. Patient required verbal cueing for correct sequencing of task and upright posture and min A to come to come to standing position.
FALL RISK – STRETCHING – TBAND EXERCISE - In order to improve foot clearance during ambulation and for management of fall risk, patient was progressed through stretching exercises to increase B DF ROM.In order to improve dynamic balance and tolerance to standing functional activities and gait, patient was lead through B resisted DF using yellow T-band, mat to/from WC stand-and-pivot transfers, and side-to-side stepping with BUE support using R/w. Patient required CGA during standing activities and moderate verbal cues for correct and safe performance of tasks.
SCIATIC NERVE GLIDES - In order to improve functional mobility, patient was progressed through sitting sciatic nerve glides and stretching to B glutes, hams, and gastroc/soleus in order decrease risk of scarring, increase soft tissue extensibility, and promote proper collagen alignment. Patient required careful monitoring of pain levels with increased pain noted to LLE and was provided with patient education for correct and safe performance of exercises.
STRETCH PF + BRIDGING + PREGAIT HIP ABD - In order to improve functional mobility, patient was lead through B stretching to gastroc/soleus to increase ankle DF ROM and through BLE strengthening exercises via bridging, SAQs, and AROM hip ABD to improve foot clearance during gait. Patient was able to complete all exercises correctly and well; however, presented with decreased tolerance to R SAQs due to --- knee pain.
PROM
HAMSTRING & HIP PROM: Patient received slow static stretching to BLE knee flexors and PROM to hips and knees in all planes.
PROM – ALIGNMENT – AAROM - Patient was progressed through PROM and stretching exercises to BLE in all planes with emphasis on increasing B knee ext ROM and R hip IR ROM for improved anatomical alignment and joint health. Effective handling techniques were identified for the development RNP and contracture management program as follows: calming, on-going verbal instructions and sustained pressure to antagonist musculature. Patient was lead through B knee ext/flex AAROM and repositioning in supine for improved self-repositioning and redistribution of pressure points in order to protect skin integrity.
PROGRESSED TO PROM - Patient was progressed through BLE PROM to B hips, knees, and ankles in all planes and B AAROM hip and knee extension and flexion in order to increase BLE ROM, improve joint health, and assist in the development of RNP with effective handling techniques. Techniques utilized in order to reduce tone and improve performance of exercises were calming verbal instructions and slow advancing in movement in order to not exacerbate spasticity.
PROGRESS TO PROM – HYPERTONICITY - In order to improve functional mobility, patient was progressed through PROM and stretching exercises to BLE to increase hip and knee ext. ROM and improve joint health. Effective handling techniques were monitored for the development of RNP and contracture management programs. Patient required soothing verbal instructions and gentle, rocking motion in order to facilitate gains in ROM, manage hypertonicity, and decrease guarding due to pain to ---.
PROM + STRETCH – STANDING – CGA TRANSFER – GAIT FT -Patient was progressed through PROM and stretching to B knees in order to increase knee ext ROM for improved standing posture and balance during stance phase of gait. Patient was coached through sit-to-stands in order to improve sequencing of activity and strengthen BLE extensor musculature for improved performance of functional transfers. Patient required CGA for transfer and tactile facilitation to B glutes and hamstrings in order to come to edge of seat and maximal verbal cueing for proper positioning of feet, trunk, and UEs in preparation for extension phase of sit-to-stand. Patient is demonstrating improvement during transfers with less need for manual A. Patient was able to ambulate x ----- feet with maximal tactile facilitation to ----- hamstrings for increased knee flexion in order to improve foot clearance and step length.
PROM KNEES - Patient was lead through PROM and stretching exercises to B knees in order to increase B knee ext ROM to improve upright standing posture and gait pattern. Patient responded well to exercises and demonstrates increased tolerance to exercises and motivation to increase knee ext ROM for improved standing and ambulation.
GENERAL PROM FOR RNP - Patient was progressed through BLE PROM and stretching exercises to hips, knees, and ankles in order to increase ROM with emphasis in making gains in R hip IR, R knee ext, and L knee ext ROM. Effective handling techniques were monitored for the development of RNP and for contracture management program. Patient responded well to on-going verbal instructions of exercises and slow, steady gains in ROM with maximal limb support.
VITALS
VITALS - Patient required constant monitoring of vitals and exertion levels.
VITALS – REST BREAK -Patient required careful monitoring of vitals and frequent rest breaks due to feelings of significant weakness.
DIZZINESS -Patient required careful monitoring of vitals and signs of dizziness for safe performance of exercises
TALK TEST RESPONSE - Patient tolerated treatment well as evidenced by Talk Test. Patient was able to hold a conversation during all exercises. Patient required careful monitoring of vitals and frequent rest breaks due to feelings of significant weakness.
RNP
RNP ROM - In order to improve functional mobility, patient was progressed through stretching exercises, PROM, and AAROM to B hip and knees and L ankle with emphasis on increasing B hip ABD, B knee ext, and L ankle ever. and DF ROM.
RNP HANDLING - Effective handling techniques were monitored for the development of RNP and contracture management program.
RNP - Patient progress through bilateral LE PROM of hip, knee and ankle, to improve the flexibility and assess response to handling for development of updated RNP. Patient tolerated treatment fair, demonstrates discomfort at end range of -------- . Discused with CNA their handling approach with bathing and hygiene tasks and the patient response.
RNP FOCUS - Effective techniques for the development of RNP were monitored for improved contracture management program.
RNP RESPONSE - Patient responded well to maximal verbal cueing and slow progression into movements in order to minimize spasticity and improve patient cooperation.
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