Initiated grooming activities while seated in w/c at sink, including hand/face washing, brushing teeth, and combing hair. Seated position determine to be safer option at this time, as opposed to standing, due to reduced standing balance/tolerance. Education provided for energy conservation techniques, including having commonly used items set up on vanity within easy reach to decrease activity demands and maintain safety.
Initiated grooming while standing at sink, with RW for unilateral UE support while reaching. Verbal cues provided for safe RW management and positioning in relation to sink.
Pt performed UB dressing, while seated in w/c, with set-up assist.
Initiated education for UB dressing using hemi-techniques including threading weaker/affected UE first and education provided for techniques using various shirt styles (i.e., pullover vs. button down shirt) via visual demonstration.
Initiated education for UB dressing using compensatory strategies, including threading head first via cervical forward flexion and using elbow flexion, to promote adherence to sternal precautions to increase functional independence in BADL while maintaining safety.
THPs with A.E.
Education provided for R THPs and visual demonstration/verbal cues provided for LB dressing with AE. Patient engaged in LB dressing with dressing stick, sock aide, reacher, and long-handled shoe horn. At this time, further education is warranted to improve carryover and functional independence during task performance.
Spinal precautions
Education provided for spinal precautions and visual demonstration/verbal cues provided for LB dressing with AE to maintain precautions and safety during ADL. After education, patient engaged in LB dressing with dressing stick, sock aide, reacher, and long-handled shoe horn.
Initiated LB dressing activity while seated in w/c. Education provided for impact of spinal precautions on LB dressing activity. Visual demonstration provided for Figure-4 compensatory strategy, as pt is unable to sustain forward trunk flexion 2* spinal precautions and declined use of AE at this time
Energy Conservation - Foot stool
Initiated LB dressing activity, while seated in w/c, with visual demonstration and education provided for use of footstool to support bilateral LEs and decrease activity demands.
Compensatory Strategies (i.e., weaker leg first)
Initiated LB dressing activity while seated in w/c, with education provided for AE and compensatory strategies (i.e., long-handle reacher to thread legs, donning weaker LE first) to don/doff pants via visual/verbal demonstration.
Initiated toileting activity with verbal/tactile cues required for positioning self in relation to toilet, sequencing pivot and clothing management, and proper hand placement on grab bar during clothing mgmt and on arm rails of commode prior to sitting.
Initiated functional transfer training with education provided for proper hand placement during sit <-> stand transitions, proper body mechanics for safe walker management with emphasis on turns, and maintaining appropriate BOS to improve safety during all functional mobility within the home.
Progressed
Progressed functional transfer training using RW to include car and shower, in addition to previous training on commode transfer. Initiated education for use of proper body mechanics during car and shower transfer.
Continued functional mobility training with progression of transfer surfaces to include shower, car, and various heights (w/c and armchair); training progressed from RW to rollator to include negotiation of various obstacles in prep for improved safety during functional mobility within the home and community. Education provided for proper use of rollator brakes ( i.e., locking brakes prior to sit <-> stand transition) and maintaining an appropriate BOS to improve safety and independence with ADLs and functional mobility.
Shower transfer
Initiated shower transfer training with grab bars and shower chair via dry simulation of side-stepping over 2” block while maintaining bilateral UE support on grab bar to simulate pt’s PH. Visual demonstration provided for side stepping technique, maintaining BOS, and safe hand placement on GBs to educate pt on safe technique prior to task performance.
Tub transfer with TTB
Initiated tub transfer training with TTB (SPT w/c <-> TTB utilizing grab bar) with education provided for proper hand placement during sit <-> stand transition and safe body mechanics (i.e., positioning self on seat and lifting bilateral LEs over threshold).
TKR - All transfer surfaces
Initiated functional transfer training to/from all household surfaces (including car) with education provided for proper body mechanics with RW, importance of R knee flexion during sit transition, and maintaining proper body alignment when standing to promote equal weight bearing through bilateral LEs.
THPs - higher surface
Initiated functional transfer training to/from all household surfaces with education provided for proper body mechanics with RW to maintain THPs (especially with regard to turns and pivots), maintaining proper body alignment when standing to promote equal weight bearing through bilateral LEs, benefit of higher surface heights to maintain THPs and minimum seat height that will maintain hip flexion < 90*, and techniques including leaning back to reduce angle of hip flexion when elevated surface is not available (i.e., in prep for safe car transfer).
Initiated functional mobility via L<>R rolling with education provided for proper hand placement and body mechanics to increase functional independence.
Initiated functional bed mobility education via visual/verbal demonstration for proper body mechanics to ease sit <-> supine transition for improved independence and safety in prep for EOB ADLs.
Initiated bed mobility with education provided for use of log rolling technique to maintain spinal precautions, enhance safety, and decrease pain.
Initiated simple meal prep simulation with education provided for task simplification and energy conservation techniques (i.e., safe zones for reaching into cabinets, re-organizing kitchen for ease of access to frequently used items, sliding items on counter, using simple appliances rather than oven) with min verbal cueing provided to maintain safety and proper body mechanics to ensure a safe d/c home.
Initiated home management kitchen activities focusing on standing tolerance at counter top, with education provided for task simplification, energy conservation, safe RW management, side-stepping technique, maintaining unilateral UE support on stable surface, and reaching within BOS to improve safety during standing ADLs and household tasks.
Initiated item retrieval activity utilizing a RW with a wire basket to simulate clothing retrieval. Education provided for unilateral reaching, while maintaining opposite UE support on RW, and use of RW/basket to transport clothing items within the home to improve functional (I) in self-care ADLs.