Samples

Impairments and Functional Limitations
ADL, IADL, productivity and leisure impairment
Impaired functional mobility
Hemiparesis or hemiplegia of the upper and lower extremities
Spasticity
Impaired postural control and balance
Impaired coordination
Limited activity tolerance and endurance
Impaired sensation
Central post-stroke pain
Language disorders (aphasia, dysarthria, dyspraxia)
Dysphasia
Visual and perceptual impairment
Cognitive impairment
Behavioral disorders (depression, lability, low frustration tolerance, impulsivity)
Bladder and bowel dysfunction
Potential secondary complications may include biomechanical shoulder pain (biceps tendonitis, rotator cuff pathology, adhesive capsulitis, complex regional pain syndrome), edema (upper and lower extremity), pressure ulcers, joint contractures, depression, DVT’s, aspiration pneumonia, seizures, fall risk

Assessments
Assessment of Motor and Process Skills
Chedoke-McMaster Stroke Assessment Scale
Modified Ashworth Scale of Spasticity
Stroke Impact Scale

Occupational Therapy Intervention
ADL, IADL, productivity and leisure training

• Safely incorporate affected extremity with all activities.
• Use compensatory techniques (task modification, one-handed techniques, hand-over-hand guiding, task segmentation, backward chaining).
• Recommend and/or provide adaptive equipment. Rocker knife, inner lip plates, holders for books or playing cards, stabilizing devices for activities that traditionally require two-handed performance (cutting vegetables, cleaning dentures), and keyboards adapted for one-handed computer use.
• Instruct in pacing and energy conservation strategies.

Train in safe and efficient functional mobility (sit-to-stand, bed mobility skills, transfers, standing, ambulation, and wheelchair mobility) during ADL and IADL tasks.

Provide functional posture and balance activities.

• Focus on stability, weight shifting, body awareness, trunk rotation & elongation.
• Have patient turn toward affected side when reaching.
• Set up room so the patient must physically move to their affected side.
• Provide reach-grasp-hold-release activities, in standing and sitting, with and without support.

Provide activities and exercises to uninvolved side to prevent loss of ROM and strength.

Restore function of the upper extremity. Use a variety of remedial approaches according to the needs of the patient.

• Provide early mobilization and positioning.
• Incorporate task-oriented/task specific training.
• Provide opportunities to use and move the arm throughout the day (use of mobile arm support, overhead suspension sling, functional splinting such as wrist cock-up, and dynamic finger extension splints).
• Provide modified constraint-induced movement therapy or constraint-induced movement therapy.
• Instruct an arm and hand strengthening exercise program.
• Cyclic NMES during functional movements and activity.
• Instruct in a functional dynamic orthoses (SaeboFlex, SaeboReach).
• Use cognitive strategies (mirror therapy, mental imagery/practice, action observation).
• Provide sensory re-education intervention.
  
  • Avoid increasing spasticity.
  • Encourage use of extremity in functional tasks.
  • Provide weight-bearing activities.
  • Provide sensory stimulation activities.
  • Teach compensatory techniques and safety measures for sensory deficits. Use vision to compensate for sensory loss. Test bath/dish water temperature using the intact extremity or a thermometer. Use a thermal regulation valve to lower water temperature. Avoid using heating pads on impaired extremities. Wear gloves to prevent frostbite. Avoid going barefoot. Wear sunscreen to prevent sunburn. Avoid cuts and burns in kitchen. Use intact hand to handle sharp kitchen utensils. Perform skin checks.
• Prevent or manage hand edema.
  
  • Teach active self-range of motion exercises in elevation.
  • Position hand in elevation
  • Use retrograde massage.
  • Use gentle grade 1-2 mobilizations for the hand and fingers.
  • Provide a compression garment.
• Manage spasticity.
  
  • Prevent contractures.
  • Provide PROM, SROM and stretching exercises.
  • Instruct in positioning in bed, chair and during mobility.
  • Select use of splinting to protect hand/wrist. Resting hand splint for flaccid to mild tone, spasticity splint for moderate to high tone. Reassess frequently and discontinue of there is no benefit.
  • Post-Botox injections, provide strengthening/FES to antagonists, stretching and splinting
• Prevent or manage shoulder pain.
  
  • Avoid overaggressive therapy and overhead pulleys.
  • Mobilize and strengthen the scapula.
  • Position arm with cubital fossa facing up, 45º shoulder abduction and comfortable shoulder external rotation.
  • Provide firm support devices such as lap trays and arm troughs.
  • Range of motion exercises should not move the shoulder beyond 90°of flexion and abduction unless there is upward rotation of the scapula and external rotation of the humeral head.li>
  • o Manage acquired orthopedic conditions (biceps tendonitis, impingement syndrome, adhesive capsulitis, rotator cuff pathologies, CRPS).
  • Use functional electrical stimulation (FES) for shoulder subluxation.

Instruct patient and caregivers in care of the affected extremity.

• Prevent and control of edema.
• Teach passive ROM exercises.
• Teach self-ROM exercises.
• Protect and support the affected arm during bed mobility, transfers and ambulation using slings, a pocket, or hand hold and during wheelchair use by using a hemi tray or arm trough.
• Teach proper positioning in bed, chair and wheelchair.
• Instruct in care and use of positioning splints.

Teach compensatory strategies for perceptual deficits.

Provide cognitive retraining and train in the use of compensatory strategies.

Provide education about fall risk and prevention strategies.

Community reintegration

• Complete a comprehensive, performance-based home assessment. Recommend and/or provide modifications, adaptive equipment and/or assistive technology.
• Encourage leisure and social participation.
• Address ability to drive safely. Provide referral to driving rehab specialist and/or explore alternative transportation options.
• Recommend vocational rehabilitation strategies to assist with return to work if appropriate.

Teach strategies to incorporate wellness and health management routines into daily activities.

Educate patient and caregivers about stroke, the availability of community resources. and support groups. Provide educational materials about stress management, coping strategies, and occupational balance.

Patient and Caregiver Education Handouts
Edema (Swelling) Control of the Arm(s)
Edema (Swelling) Control of the Leg(s)
In and Out of Bed - Toward Your Weaker Left Side
In and Out of Bed - Toward Your Weaker Right Side
Position in Bed - Left Side Weakness
Position in Bed - Right Side Weakness
Position Your Arm - Left Side Weakness
Position Your Arm - Right Side Weakness
Protect the Arm - Left Side Weakness
Protect the Arm - Right Side Weakness
Splint/Brace Instructions
Stress Management
Tips to Conserve Energy
Using a Front Wheel Walker (2 wheels)
Wheelchair Safety

Patient and Caregiver Exercise Handouts
Balance Exercises - Sitting and Standing
Fine Motor Strengthening and Coordination Activities
Gross Motor Tasks
Level 1 Activities - Help Your Weaker Arm Move
Level 2 Activities - Use Your Weaker Arm to Passively Hold
Level 3 Activities - Use Your Weaker Arm to Actively Move and Hold
Level 4 Activities - Use Your Weaker Arm with Gross Motor
Level 5 Activities - Use Your Weaker Arm with Fine Motor
Passive Range of Motion - One Side Weakness
Posture Exercises
Putty Exercises
Scapular Mobility and Strength Exercises
Self Range of Motion
Upper Body Active Range of Motion
Upper Body Exercises - Dumbbells
Upper Body Exercises - Holding a Ball
Upper Body Strength Activities
Use Your Arm to Actively Move and Hold
Use Your Arm to Hold Passively
Use Your Arm with Assisted Guiding
Use Your Arm with Gross Motor Activities
Use Your Arm with Self-Guiding
Weight Bearing Exercises

Additional Treatment Guides
Activities of Daily Living
Apraxia
Balance
Cognition
Depression
Fall Risk Assessment and Prevention
Functional Mobility
Handwriting
Health Management
Home Safety and Modification
Therapeutic Exercise
Visual Skills
Wheelchair Seating, Positioning, and Mobility

Osteoarthritis (OA), rheumatoid arthritis (RA), psoriatic arthritis (PsA)

Impairments and Functional Limitations
ADL, IADL, work and leisure impairment
Functional mobility impairment
Limited activity tolerance and endurance
Limited ROM
Impaired hand function
Impaired strength
Joint pain, swelling, and stiffness
Joint deformity and instability
Postural changes
Impaired balance
Sleep problems
Co-occurring conditions may include RA - joint deformities (swan neck, boutonniere, hitchhikers thumb, ulnar drift), nerve compression, surgery (joint replacement, joint fusion, synovectomy, tendon repair), cardiovascular disease, lung fibrosis, osteoporosis. OA - CMC arthritis, joint replacement. PsA - psoriasis, diabetes, cardiovascular disease.

Outcome Measure
Rheumatoid Arthritis Disease Activity Index (RADAI-5)
Arthritis Hand Function Test (AHFT)

Occupational Therapy Intervention
ADL, IADL, productivity and leisure training

• Train in the use of joint protection and adaptive equipment to improve grasp (built-ups), improve ease of performance (electric can opener), compensate for ROM loss (dress stick), compensate for weak/absent muscle (universal cuff, jar opener), prevent stress on joints (lever door handle), prevent prolonged grasp (book holder, Dycem), prevent accidents (bath seat, nonskid rugs).
• Instruct in body mechanics and good posture.

Train in safe and efficient functional mobility (sit-to-stand, bed mobility skills, transfers, standing, ambulation, and wheelchair mobility) during ADL and IADL tasks.

• Adaptive mobility equipment - hospital beds, lift chairs, standard/electric wheelchairs, transfer boards, hydraulic patient lifts, leg lifter, bed rails.

Provide orthotics to maintain/correct joint alignment, improve function, correct or minimize deformities/contractures, and support weak or painful joints. Examples for RA include resting hand splint, wrist cock-up splint, ulnar drift splint, anti-swan neck deformity splints (oval 8), anti-boutonniere splint. Examples for OA include CMC orthosis, thumb spica splint, DIP/PIP orthosis.

Teach strategies to self-manage fatigue and conserve energy.

• Assess using the Modified Fatigue Impact Scale.
• Teach pacing and energy conservation strategies.
• Instruct in balancing self-care, productivity, play, and rest.
• Instruct in good sleep habits.
• Encourage use of a fatigue journal.
• Problem-solve ways to self-manage fatigue.

Provide an individualized exercise program that includes low-impact, low-intensity endurance, strengthening, flexibility, and balance activities. Modify exercises (use yoga blocks, wrap foam around weights, weight lifting gloves to improve grip).

• Acute flare-ups - instruct in performing gentle passive or active ROM exercises 3-4 times daily followed by icing for 15 minutes.
• Non-acute joints - instruct in the use of superficial heat, passive or active ROM and isometric strengthening in pain free range.
• Encourage participation in community programs. (Tai Chi, Active Living Every Day, Arthritis Foundation Aquatic Program, Arthritis Foundation Exercise Program, Enhance Fitness, Fit and Strong, Walk with Ease).

Provide pain management.

• Modalities (heat, cold, ultrasound, fluidotherapy, paraffin).
• Manual therapy techniques (massage, soft tissue mobilization).

Instruct in pain self-management strategies.

• Coordinate medication peak with exercise and activity.
• Superficial heat, cool/cold water, contrast baths.
• Self-massage techniques (foam rollers, tennis ball, rolling massage stick).
• Breathing techniques, mindful meditation or other relaxation methods.
• Positioning devices (seat cushions, back supports, pillows, splints).
• Encourage use of a pain journal.
• Problem-solve ways to self-manage pain.

Complete a comprehensive, performance-based home and/or work assessment. Recommend and/or provide modifications, accommodations, adaptive equipment, and/or assistive technology.

Provide education about fall risk and prevention strategies.

Teach strategies to incorporate wellness and health management routines into daily activities.

Educate patient and caregivers about arthritis, the availability of community resources and support groups.

Patient and Caregiver Handouts
Body Mechanics - Good Posture
Exercise Tips for Arthritis
Finger and Thumb Stretches and Active Range of Motion
Forearm and Wrist Active Range of Motion
Forearm and Wrist Stretches
Joint Protection for Arthritis
Pain Journal
Putty Exercises
Shoulder Isometric Exercises - Seated
Splint/Brace Instructions
Stress Management
Tendon Glides
Tips to Conserve Energy
Upper Body Active Range of Motion
Using Cold for Pain Relief
Using Heat for Pain Relief

Additional Treatment Guides
Ankylosing Spondylitis
Carpal Tunnel Syndrome
Cubital Tunnel Syndrome
Health Management
Joint Contractures
Lupus (Systemic Lupus Erythematosus)
Rest and Sleep
Scleroderma (Systemic Sclerosis)
Sexual Expression and Activity
Total Hip Replacement (Arthoplasty)
Total Knee Replacement (Arthoplasty)
Total Shoulder Arthroplasty and Hemiarthroplasty
Work and Industry

Impairments and Functional Limitations
ADL, IADL, productivity and leisure impairment
Impaired ROM and strength of trunk and upper extremity
Post-op pain and edema
Potential secondary complications may include nerve damage, lymphedema

Assessments
Disabilities of the Arm, Shoulder, and Hand Questionnaire
Functional Assessment of Cancer Therapy - Breast

Occupational Therapy Preoperative Intervention

• Baseline measurements (ROM, strength, sensation, and limb volume measurements, functional outcome measure such as DASH))
• Provide education about postoperative activity limitations, precautions and exercise.
• Instruct in good posture during activities.
• Educate about lymphedema prevention or risk factor reduction.
• Teach strategies to incorporate wellness and health management routines into daily activities.
• Educate about breast cancer and the availability of community resources. Encourage participation in support groups.

Occupational Therapy Postoperative Intervention
ADL, IADL, productivity and leisure training

• Treat underlying limitations to safety and independence.
• Recommend and/or provide adaptive equipment as needed. Train in lower body ADL equipment following reconstructive surgery involving abdominal muscles.
• Instruct in good posture during activities.
• Instruct to elevate arm several times a day to self-manage postoperative edema.
• Instruct in protective use of affected arm for the first 2 weeks. Unless otherwise instructed by surgeon.
  • Avoid overuse.
  • Avoid sleeping on the same side as the surgery.
  • Avoid lifting more than 5 lbs./2.25 kg.
  • Keep tasks below 90° of shoulder motion.

Train in safe and efficient functional mobility (sit to stand, bed mobility skills, transfers, ambulation and wheelchair mobility) during ADL and IADL tasks.

Pain self-management

• Coordinate medication peak with exercise and activity.
• Teach stress management and relaxation techniques.
• Use pillows to help the arm and shoulder relax while sitting and lying down.
• Instruct in good posture during activities.

Provide graded UE activities and exercises. Follow the referring surgeon’s specific guidelines for ROM and progression of exercises.

• AROM exercises within restricted ranges according to surgical intervention. Progress exercises until full ROM restored. Begin strengthening 4-6 weeks after surgery.
• Instruct in deep (diaphragmatic) breathing exercises and lateral expansion.
• Instruct in a walking program.

Provide surgical scar management. Treat axillary web syndrome if present.

Educate about lymphedema prevention or risk factor reduction. Manage lymphedema using Complete Decongestive Therapy (CDT) (performed by a certified lymphedema therapist).

Patient and Caregiver Handouts
Arm Measurement
Body Mechanics - Good Posture
Deep (Diaphragmatic) Breathing
Edema (Swelling) Control of the Arm(s)
Mastectomy Exercises
Median Nerve Glides
Radial Nerve Glides
Scar Massage
Tips to Prevent Upper Body Lymphedema
Ulnar Nerve Glides
Walking Guidelines

Additional Treatment Guides
Cancer
Health Management
Lymphedema

Dressing includes selecting appropriate clothing for the time of day, weather, and occasion. Obtaining clothing from closets and drawers. Dressing and undressing using open-front garments (shirt/blouse, robe, sweater, jacket, winter coat), pullover garments (sweatshirt, t-shirt, sweater), bra, pants, skirts, suspenders, necktie, scarf, gloves, underwear, socks, pantyhose, nylons, shoes, boots, slippers, support and anti-embolism stockings. Opening and closing fasteners, (snaps, buttons, hooks, zippers, Velcro). Managing personal medical devices (hearing aids, eyeglasses, contacts, AFO, hand splint, back brace, slings, and prosthetics).

Occupational Therapy Intervention
Apply different approaches for solving difficulties with dressing.

• Remediate underlying limitations to safety and independence. Physical (e.g. muscle weakness, limited ROM, fatigue), sensory (e.g. impaired sensation, low vision, pain), behavioral (e.g. anxiety, depression, impulsivity), cognitive (e.g. impaired attention, memory, language and communication, or executive functions), perceptual (e.g. unilateral neglect, impaired figure ground).
• Train in compensatory techniques (safety techniques, one-handed techniques, pacing, energy conservation, joint protection, body mechanics, breathing techniques, low vision techniques, cognitive/perceptual compensation, step-by-step instructions, task segmentation, task sequencing, backward chaining, verbal and physical cueing, hand-over-hand guiding).
• Train in the use of adaptive equipment and assistive devices (buttonhook, Velcro closures on shoes, elastic shoelaces, long handled shoehorn, dressing stick, reacher, sock aid, zipper pull, loops on pants, loops on socks, labeling system for identifying clothes, and specialized clothing).
• Provide environmental modifications and adaptations (avoid storing items on the floor, lower closet poles, organize clothes within easy reach, and label drawers using picture or words).
• Instruct in activity modification.
  
  • Change the task (place the weaker extremity into the garment first, dress in a supine position).
  • Eliminate part or all of the task (choose garments that are easy to put on and remove such as: elastic waist pants, loose fitting tops, pullover tops, suspenders instead of a belt, Velcro shoes, slip on shoes, front hook bra, sports bra, camisole).
  • Have someone else do part or the entire task.

Train in safe and efficient functional mobility (sit to stand, bed mobility skills, transfers, standing, ambulation, and wheelchair mobility) during dressing tasks.

Provide caregiver/family education and training.

Patient and Caregiver Handouts

Dressing Techniques - One Handed

Dressing Techniques - Upper Body

Impairments and Functional Limitations
ADL, IADL, productivity and leisure impairment
Functional mobility impairment
Slow walking speed
Muscle weakness
Limited activity tolerance and endurance
Impaired balance
Impaired vision and hearing
Chronic pain
At high risk for major adverse health outcomes including institutionalization, disability, falls, hospitalization, and mortality
Co-occurring conditions may include functional decline, falls, fear of falling, delirium, dementia, dizziness, depression, incontinence, sleep disorders, malnutrition, dehydration, pressure ulcers, sarcopenia, hypothermia, hyperthermia

Assessments
Edmonton Frail Scale
FRAIL (Fatigue, Resistance, Aerobic capacity, Illnesses, Loss of weight) Scale
Groningen Frailty Index
Johns Hopkins Frailty Assessment Calculator
SHARE-FI (Survey of Health, Ageing and Retirement in Europe Frailty Index)

Occupational Therapy Intervention ADL, IADL, productivity and leisure training

• Treat underlying limitations to safety and independence - physical (strength, hand function, ROM, coordination, balance, endurance, abnormal tone), sensory (tactile, vision, hearing, vestibular, pain), behavioral, cognition and/or perceptual.
• Address nutrition - oral health, ability to feed self, ability to shop, access kitchen, prepare nutritious meals and get adequate hydration. Encourage to eat with others.
• Address ability to drive safely. Provide referral to driving rehab specialist and/or explore alternative transportation options.

Train in safe and efficient functional mobility (sit to stand, bed mobility skills, transfers, standing, ambulation and wheelchair mobility) during ADL and IADL tasks.

• Train in the safe and correct use of assistive devices and adaptive equipment (walkers, canes, sliding boards, bed transfer handles, leg lifters, wheelchairs) as appropriate.

Provide an individualized exercise program that includes progressive endurance, strengthening and flexibility activities.

Provide functional balance activities to increase balance confidence with ADL tasks.

Provide pain management.

Provide a fall prevention program that includes balance, coordination, and agility training, and education about fall risk and prevention strategies. Provide functional balance activities to increase balance confidence with ADL tasks.

Complete a comprehensive, performance-based home assessment. Recommend and/or provide modifications, adaptive equipment and/or assistive technology.

Educate about the negative effects of prolonged sitting and bed rest. Educate regarding hypothermia and hyperthermia prevention.

Patient and Caregiver Handouts
Balance Exercise
Hip and Knee Exercises - Seated
Putty Exercises
Resistance Band Exercises - Arms
Resistance Band Exercises - Legs
Upper Body Exercises - Dumbells
Walking Guidelines

Additional Treatment Guides
Balance
Chronic Pain Syndrome
Fall Risk Assessment and Prevention
Functional Mobility
Health Management
Home Safety and Modification
Pressure Ulcers
Rest and Sleep
Urinary Incontinence

Impairments and Functional Limitations
ADL, IADL, productivity and leisure impairment
Impaired functional mobility
Hemiparesis or hemiplegia of the upper and lower extremities
Spasticity
Impaired postural control and balance
Impaired coordination
Limited activity tolerance and endurance
Impaired sensation
Central post-stroke pain
Language disorders (aphasia, dysarthria, dyspraxia)
Dysphasia
Visual and perceptual impairment
Cognitive impairment
Behavioral disorders (depression, lability, low frustration tolerance, impulsivity)
Bladder and bowel dysfunction
Potential secondary complications may include biomechanical shoulder pain (biceps tendonitis, rotator cuff pathology, adhesive capsulitis, complex regional pain syndrome), edema (upper and lower extremity), pressure ulcers, joint contractures, depression, DVT’s, aspiration pneumonia, seizures, fall risk

Assessments
Assessment of Motor and Process Skills
Chedoke-McMaster Stroke Assessment Scale
Modified Ashworth Scale of Spasticity
Stroke Impact Scale

Occupational Therapy Intervention
ADL, IADL, productivity and leisure training

• Safely incorporate affected extremity with all activities.
• Use compensatory techniques (task modification, one-handed techniques, hand-over-hand guiding, task segmentation, backward chaining).
• Recommend and/or provide adaptive equipment. Rocker knife, inner lip plates, holders for books or playing cards, stabilizing devices for activities that traditionally require two-handed performance (cutting vegetables, cleaning dentures), and keyboards adapted for one-handed computer use.
• Instruct in pacing and energy conservation strategies.

Train in safe and efficient functional mobility (sit-to-stand, bed mobility skills, transfers, standing, ambulation, and wheelchair mobility) during ADL and IADL tasks.

Provide functional posture and balance activities.

• Focus on stability, weight shifting, body awareness, trunk rotation & elongation.
• Have patient turn toward affected side when reaching.
• Set up room so the patient must physically move to their affected side.
• Provide reach-grasp-hold-release activities, in standing and sitting, with and without support.

Provide activities and exercises to uninvolved side to prevent loss of ROM and strength.

Restore function of the upper extremity. Use a variety of remedial approaches according to the needs of the patient.

• Provide early mobilization and positioning.
• Incorporate task-oriented/task specific training.
• Provide opportunities to use and move the arm throughout the day (use of mobile arm support, overhead suspension sling, functional splinting such as wrist cock-up, and dynamic finger extension splints).
• Provide modified constraint-induced movement therapy or constraint-induced movement therapy.
• Instruct an arm and hand strengthening exercise program.
• Cyclic NMES during functional movements and activity.
• Instruct in a functional dynamic orthoses (SaeboFlex, SaeboReach).
• Use cognitive strategies (mirror therapy, mental imagery/practice, action observation).
• Provide sensory re-education intervention.
  
  • Avoid increasing spasticity.
  • Encourage use of extremity in functional tasks.
  • Provide weight-bearing activities.
  • Provide sensory stimulation activities.
  • Teach compensatory techniques and safety measures for sensory deficits. Use vision to compensate for sensory loss. Test bath/dish water temperature using the intact extremity or a thermometer. Use a thermal regulation valve to lower water temperature. Avoid using heating pads on impaired extremities. Wear gloves to prevent frostbite. Avoid going barefoot. Wear sunscreen to prevent sunburn. Avoid cuts and burns in kitchen. Use intact hand to handle sharp kitchen utensils. Perform skin checks.
• Prevent or manage hand edema.
  
  • Teach active self-range of motion exercises in elevation.
  • Position hand in elevation
  • Use retrograde massage.
  • Use gentle grade 1-2 mobilizations for the hand and fingers.
  • Provide a compression garment.
• Manage spasticity.
  
  • Prevent contractures.
  • Provide PROM, SROM and stretching exercises.
  • Instruct in positioning in bed, chair and during mobility.
  • Select use of splinting to protect hand/wrist. Resting hand splint for flaccid to mild tone, spasticity splint for moderate to high tone. Reassess frequently and discontinue of there is no benefit.
  • Post-Botox injections, provide strengthening/FES to antagonists, stretching and splinting
• Prevent or manage shoulder pain.
  
  • Avoid overaggressive therapy and overhead pulleys.
  • Mobilize and strengthen the scapula.
  • Position arm with cubital fossa facing up, 45º shoulder abduction and comfortable shoulder external rotation.
  • Provide firm support devices such as lap trays and arm troughs.
  • Range of motion exercises should not move the shoulder beyond 90°of flexion and abduction unless there is upward rotation of the scapula and external rotation of the humeral head.li>
  • o Manage acquired orthopedic conditions (biceps tendonitis, impingement syndrome, adhesive capsulitis, rotator cuff pathologies, CRPS).
  • Use functional electrical stimulation (FES) for shoulder subluxation.

Instruct patient and caregivers in care of the affected extremity.

• Prevent and control of edema.
• Teach passive ROM exercises.
• Teach self-ROM exercises.
• Protect and support the affected arm during bed mobility, transfers and ambulation using slings, a pocket, or hand hold and during wheelchair use by using a hemi tray or arm trough.
• Teach proper positioning in bed, chair and wheelchair.
• Instruct in care and use of positioning splints.

Teach compensatory strategies for perceptual deficits.

Provide cognitive retraining and train in the use of compensatory strategies.

Provide education about fall risk and prevention strategies.

Community reintegration

• Complete a comprehensive, performance-based home assessment. Recommend and/or provide modifications, adaptive equipment and/or assistive technology.
• Encourage leisure and social participation.
• Address ability to drive safely. Provide referral to driving rehab specialist and/or explore alternative transportation options.
• Recommend vocational rehabilitation strategies to assist with return to work if appropriate.

Teach strategies to incorporate wellness and health management routines into daily activities.

Educate patient and caregivers about stroke, the availability of community resources. and support groups. Provide educational materials about stress management, coping strategies, and occupational balance.

Patient and Caregiver Education Handouts
Edema (Swelling) Control of the Arm(s)
Edema (Swelling) Control of the Leg(s)
In and Out of Bed - Toward Your Weaker Left Side
In and Out of Bed - Toward Your Weaker Right Side
Position in Bed - Left Side Weakness
Position in Bed - Right Side Weakness
Position Your Arm - Left Side Weakness
Position Your Arm - Right Side Weakness
Protect the Arm - Left Side Weakness
Protect the Arm - Right Side Weakness
Splint/Brace Instructions
Stress Management
Tips to Conserve Energy
Using a Front Wheel Walker (2 wheels)
Wheelchair Safety

Patient and Caregiver Exercise Handouts
Balance Exercises - Sitting and Standing
Fine Motor Strengthening and Coordination Activities
Gross Motor Tasks
Level 1 Activities - Help Your Weaker Arm Move
Level 2 Activities - Use Your Weaker Arm to Passively Hold
Level 3 Activities - Use Your Weaker Arm to Actively Move and Hold
Level 4 Activities - Use Your Weaker Arm with Gross Motor
Level 5 Activities - Use Your Weaker Arm with Fine Motor
Passive Range of Motion - One Side Weakness
Posture Exercises
Putty Exercises
Scapular Mobility and Strength Exercises
Self Range of Motion
Upper Body Active Range of Motion
Upper Body Exercises - Dumbbells
Upper Body Exercises - Holding a Ball
Upper Body Strength Activities
Use Your Arm to Actively Move and Hold
Use Your Arm to Hold Passively
Use Your Arm with Assisted Guiding
Use Your Arm with Gross Motor Activities
Use Your Arm with Self-Guiding
Weight Bearing Exercises

Additional Treatment Guides
Activities of Daily Living
Apraxia
Balance
Cognition
Depression
Fall Risk Assessment and Prevention
Functional Mobility
Handwriting
Health Management
Home Safety and Modification
Therapeutic Exercise
Visual Skills
Wheelchair Seating, Positioning, and Mobility

Do the checked exercises _____ times per day, _____ days a week

Shape the putty into a ball. Squeeze the putty with all your fingers.

Do _____ sets of _____.

Shape the putty into a ball. Hold the putty in your hand. Press your thumb into the putty.

Do _____ sets of _____.

Shape the putty into a ball. Pinch the putty between your thumb and the side of your index finger.

Do _____ sets of _____.

Shape the putty into a ball. Hold your fingers straight and your knuckles bent. Squeeze the putty between your fingers and thumb.

Do _____ sets of _____.

Flatten the putty into a pancake. Place your fingers into the center of the putty and spread the putty outward.

Do _____ sets of _____.

Flatten the putty into a pancake. Spread the putty apart using two fingers at a time.

Do _____ sets of _____.

Shape the putty into a sausage. Squeeze the putty between your fingers.

Do _____ sets of _____.

Shape the putty into a sausage. Pinch the putty between your thumb and each finger.

Do _____ sets of _____.

Pace yourself, rest often, and use pursed lip breathing.

Use your left arm as much as you can during the day. Here are a few ideas.

Use your left hand to hold your plate while eating.

Hold a sheet of paper with your left hand while writing with your right hand.

Hold a wash cloth with your left hand and apply soap with your right hand.

Hold your toothbrush with your left hand and apply toothpaste with your right hand.

Haga los ejercicios marcados _____ veces al día, _____ días a la semana.

Flexión de los Dedos

Moldee la masilla en forma de pelota. Apriete la masilla con su mano completa.

Complete _____ series de _____.

Flexión del Pulgar

Moldee la masilla en forma de pelota. Agarre la masilla con la mano. Presione con el pulgar hacia el interior de la masilla.

Complete _____ series de _____.

Pinza Lateral

Es la que emplearía para usar una llave. Moldee la masilla en forma de pelota. Pellizque la masilla entre el pulgar y el lateral del dedo índice.

Complete _____ series de _____.

Pinza Lumbrical

Moldee la masilla en forma de pelota.Estire los dedos y doble los nudillos. Apriete la masilla entre sus dedos y pulgar.

Complete _____ series de _____.

Extensión de los Dedos

Aplane la masilla en forma de tortita. Coloque la punta de los dedos juntos en la masilla, y expanda la masilla hacia fuera.

Complete _____ series de _____.

Abducción de los Dedos

Aplane la masilla en forma de tortita. Expanda la masilla usando dos dedos a la vez.

Complete _____ series de _____.

Aducción de los Dedos

Moldee la masilla en forma de salchicha. Apriete la masilla entre los dedos.

Complete _____ series de _____.

Pinza por Oposición Terminal
(punta con punta)

Moldee la masilla en forma de salchicha. Pellizque la masilla entre el pulgar y cada uno de los dedos individualmente.

Complete _____ series de _____.

 

Es muy importante que utilice el brazo afectado todo lo posible durante las actividades diarias. Aquí hay algunos ejemplos sobre cómo puede hacerlo.

Use la mano izquierda para estabilizar el plato mientras come.

Estabilice una hoja de papel con la mano izquierda mientras escribe con la derecha.

Estabilice el paño con la mano izquierda mientras aplica jabón con la mano derecha.

Estabilice el cepillo de dientes con la mano izquierda mientras usa la derecha para aplicar pasta de dientes.