Discharge

Throughout POT, focus of tx has been to improve functional independence with all self-care ADLs and functional mobility within the home. Specifically, bilateral UE MS, activity tolerance, and endurance were targeted through use of weights, arm cycle, and resistive push/pull tabletop activities to facilitate ease with sit-to-stand transitions and transfers to/from all household surfaces for improved ADL performance. Dynamic sit/stand balance activities progressed from unilateral reaching within BOS to reaching across midline and outside BOS to facilitate weight shifting for improved safety with performance of all standing ADLs and functional mobility. Functional transfers to/from all household surfaces and functional mobility progressed via increasing physical challenge (lower surface heights, inclusion of car and shower as transfer surfaces, and increased length of standing tolerance activities). Self-care ADLs were targeted through task performance, education (compensatory strategies for LB dressing, functional mobility/transfer training with RW, safety awareness, and energy conservation), and activity simulation to ensure a safe d/c home.

Throughout POT, focus of tx has been to improve functional independence with all self-care ADLs and functional mobility within the home. Specifically, bilateral UE MS, activity tolerance, and endurance were targeted through use of weights, arm cycle, and resistive push/pull tabletop activities to facilitate ease with sit-to-stand transitions and transfers to/from all household surfaces for improved ADL performance. Dynamic sit/stand balance activities progressed from unilateral reaching within BOS to reaching across midline and outside BOS to facilitate weight shifting for improved safety with performance of all standing ADLs and functional mobility. Functional transfers to/from all household surfaces and functional mobility progressed via increasing physical challenge (lower surface heights, inclusion of car and shower as transfer surfaces, and increased length of standing tolerance activities). Self-care ADLs were targeted through task performance, education (compensatory strategies for LB dressing, functional mobility/transfer training with RW, safety awareness, and energy conservation), and activity simulation to ensure a safe d/c home. Complex ADLs (i.e., home management, simple meal prep, item retrieval) were targeted through task performance, with education provided for energy conservation, task simplification, and RW management to promote functional (I) in ADLs consistent with PLOF, with good comprehension of all education evidenced through return demonstration.

Throughout POT, focus of tx has been to improve functional independence with all self-care ADLs and functional mobility within ALF. Specifically, bilateral UE MS, activity tolerance, and endurance were targeted through use of progressive weights and Omnicycle to facilitate ease with sit-to-stand transitions and transfers to/from all household surfaces for improved ADL performance. Dynamic sit/stand balance activities included contralateral reaching with unilateral UE within BOS to facilitate weight shift in prep for improved task performance in seated/standing self-care ADLs. Functional transfers performed to/from all household surfaces including car to improve safety and (I) during all functional mobility within ALF. Self-care ADLs were targeted through task performance with education provided for safety awareness, compensatory strategies (Figure 4), energy conservation, task simplification, and pacing. Throughout POT education has been provided for safety awareness during all functional mobility and self-care ADLs, with poor carryover displayed evidenced through observation of task performance.

Throughout POT, focus of tx has been to improve functional independence with all self-care ADLs and functional mobility within ALF. Specifically, bilateral UE MS, activity tolerance, and endurance were targeted through use of weights and towel slides to facilitate ease with sit-to-stand transitions and transfers to/from all household surfaces for improved ADL performance. Dynamic sit/stand balance activities progressed from unilateral reaching within BOS to reaching across midline and outside BOS to facilitate weight shifting for improved safety with performance of all standing ADLs and functional mobility. Functional transfers to/from all household surfaces and functional mobility progressed via increasing physical challenge (lower surface heights, inclusion of car and shower as transfer surfaces, and increased length of standing tolerance activities). Self-care ADLs were targeted through task performance, education (AE for LB dressing, functional mobility/transfer training with RW, safety awareness, and energy conservation), and activity simulation to ensure a safe d/c to ALF.

Throughout POT, focus of treatment has been to improve functional independence with all self-care ADLs and functional mobility within the home. Specifically, bilateral UE MS was targeted through resistive exercises and R TKR OT program focused on improving ROM/MS to ease functional mobility. Dynamic sit/stand balance activities progressed from unilateral reaching to bilateral reaching across midline (outside BOS) to facilitate weight shifting for improved safety with performance of all standing ADLs and functional mobility. Functional transfers to/from all household surfaces and functional mobility within the home progressed via increasing physical challenge (lower surface heights, inclusion of car as a transfer surface, and increased length of standing tolerance activities) with improved body mechanics (including R knee flexion). Self-care ADLs were targeted through task performance, education (AE, compensatory strategies, safety awareness, energy conservation), and activity simulation to ensure a safe d/c home and return to the community.

Throughout POT, education has been provided for: (1) TKR exercises for improved ROM in R knee, (2) safety awareness with regards to BOS during functional mobility/transfer training, (3) AE for LB dressing (sock aide, reacher, dressing stick) and compensatory strategies (use of foot stool to raise and support R LE) to ease self-care ADLs; and (4) energy conservation during ADLs, specifically for pacing and positioning to optimize performance; and (5) bed mobility for use of proper body mechanics ( i.e., bending opposite knee prior to rolling), use of proper hand placement for pushing trunk up into neutral during supine<->sit, and scooting technique at EOB to ensure positioning of self proper distance from HOB for ease sit<->supine transition.

Throughout POT, focus of tx has been to improve functional independence with all self-care ADLs and functional mobility within the home. Specifically, bilateral UE MS, activity tolerance, and endurance were targeted through use of weights, arm cycle, and resistive push/pull tabletop activities to facilitate ease with sit-to-stand transitions and transfers to/from all household surfaces for improved ADL performance. Dynamic sit/stand balance activities progressed from unilateral reaching within BOS to bilateral reaching across midline and outside BOS to facilitate weight shifting for improved safety with performance of all standing ADLs and functional mobility. Functional transfers to/from all household surfaces and functional mobility progressed via increasing physical challenge (lower surface heights while maintaining THPs, inclusion of car and shower as transfer surfaces, and increased length of standing tolerance activities) with improved body mechanics. Self-care ADLs were targeted through task performance, education (AE for LB dressing to maintain THPs, functional mobility/transfer training with RW, safety awareness, and energy conservation), and activity simulation to ensure a safe d/c home.

Throughout POT, focus of tx has been to improve functional independence with all self-care ADLs and functional mobility within the home. Specifically, dynamic sit/stand balance activities progressed from unilateral reaching within BOS to bilateral reaching across midline and outside BOS to facilitate weight shifting for improved safety with performance of all standing ADLs and functional mobility. Functional transfers to/from all household surfaces and functional mobility progressed via increasing physical challenge (lower surface heights, inclusion of car and shower as transfer surfaces, and increased length of standing tolerance activities) with improved body mechanics. Self-care ADLs were targeted through task performance, education (compensatory strategies to facilitate UB dressing while maintaining sternal precautions, compensatory strategies/AE for LB dressing to decrease physical bending demands to reduce discomfort 2* sternal precautions, functional mobility/transfer training with RW, safety awareness, and energy conservation), and activity simulation to ensure a safe d/c home.

Home safety eval & DME

OT recommends: home OT to include a home safety evaluation and DME (RW, commode, TTB, and hip kit). Family is in agreement with all recommendations and has acquired all non-covered items through outside vendor.

Supervision during bathing & assist for IADLs

OT recommends: home OT to include a home safety evaluation; Supervision during bathing; assist PRN for IADLs (meal prep, homemaking, community mobility); and DME (RW, commode, TTB). Family is in agreement with all recommendations.