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.