Date

Client’s Initials and Age: KD, 54 y/0 Time allotted for session: 20 minutes
implemented:9/19/18
Diagnosis and any Precautions: Left CVA, fall risk

Goal/s being addressed: (1) Right side weakness, decreased cognitive ability, decreased right hand coordination
Activity Demands (setting,
Specific Objectives for this Modifications (provided during the
Intervention Activities materials, and social
activity (list 2-3) activity and planned for next
(5) requirements)
(5) session) (5)
(5)
- Setting and materials: Pt in -When we arrived the pt was not fully
hospital room with hospital bed in alert, this led to increased cognitive
flat position. challenges and a need for one-step
-Social demands: Pt must be commands and verbal cues. The patient
Pt will perform bed mobility from
able to follow commands and had some verbal impairment making it
supine to sitting EOB to increase
-Pt will follow 3-step commands. assist OT in bed mobility. difficult to communicate during the
independence in bed mobility
-Pt will sit EOB with Supervision. -Grading: To grade down the OT session. Due to this we utilized yes or no
and prepare for coordination
may provide min A during bed questions and responses. For better
task. (5 minutes)
mobility for further assistance or performance in the next session, I would
provide 1-step commands. To consider the cognitive aspect of the task
grade up, the pt may complete and be prepared to give extra verbal
bed mobility independently. cues.
- Setting and materials: Pt in
hospital room with hospital bed in
OT will educate patient on active flat position. Bedside table will be - As previously stated, the pt did have
hand exercises and stretches. lowered to patient level and some difficulty following 3-step
Patient will perform 5 exercises within reach. Active hand commands and communicating complex
including: MCP flexion with DIP worksheet will be on table facing thoughts. This led to some confusion
-Pt will complete each exercise
extension, MCP flexion with DIP the patient for education. regarding pt’s ability and understanding
with supervision for verbal cues.
flexion, extending and abducting -Social demands: Pt must be of exercises. In the future, I would
- Pt will follow 3 step commands.
fingers from a fist, thumb able to follow commands and prepare fewer exercises to spend more
-Pt will be able to complete 10
abduction and adduction, finger model OT and images on the time ensuring the pt understood
reps of each exercise.
and thumb abduction and worksheet. instructions fully. Furthermore, the pt
-Pt will perform dynamic sitting
adduction with palm flat on -Grading: To grade down, OT could not fully adduct her thumb. I would
with supervision.
bedside table. All exercises will may provide 1 step commands consider this when selecting exercises,
be demonstrated by therapist and extra verbal cues. They may as well. The pt was able to complete 10
and visually represented on also educate the patient on fewer repetitions of each exercise, this seemed
worksheet. (5 minutes) exercises this session. To grade to be an appropriate duration.
up, the OT may increase number
of reps to 15 per exercise.
 OT will educate patient on
strengthening and coordination
hand exercises with yellow
theraputty. Patient will perform 3
exercises including: gross grasp
of putty, key grasp of putty and
pincer grasp with putty. All
exercises will be demonstrated
by therapist as the patient
practices. (5 minutes)
- Setting and materials: Pt in
hospital room with hospital bed in
flat position. Bedside table will be
- Again, we spent extra time
lowered to patient level and
communicating with the patient and
within reach. Theraputty will be
providing primarily 1-step commands, as
on table for strengthening task.
her cognition was not as advanced as we
- Pt will complete each theraputty -Social demands: Pt must be
predicted. The pt also had difficulty with
exercise with verbal cues. able to follow commands and use
thumb adduction during these exercises.
- Pt will follow 3 step commands. putty appropriately to repeat
I would accommodate for this in the
-Pt will perform dynamic sitting exercises.
future by creating an exercise focusing
with supervision. -Grading: To grade down the OT
on adduction. In the future, I would also
may provide 1-step verbal cues
further discuss which ADLs require
or use less resistant theraputty
which kind of grasp to make the
(tan). To grade up, the OT may
exercises more functional for the pt.
increase duration or use more
resistant theraputty (red or
green).

Pt will perform transfer from - Setting and materials: Pt in

sitting EOB to sitting in chair to
increase independence in
functional mobility (5 minutes)
S/OT name: Sydney Gately
-Pt will perform stand pivot
transfer with min A.
-Pt will be able to perform static
sitting independently.
hospital room with hospital bed in
flat position. Chair is positioned
at 90 degrees from the bed.
Table has been cleared from
area to prepare room for transfer.
OT will use gait belt for safety.
-Social demands: Pt must be
able to follow commands and
assist OT during transfer.
-Grading: To grade down the OT
may provide mod A for further
assistance during transfer. To
grade up, the OT may provide
supervision only during transfer.
-During this transfer, the patient was
more independent than we expected.
She was able to transfer from the edge
of the bed to sitting in a chair with
supervision only. In future sessions, I
would focus more on cognition and
hand coordination, and less on mobility,
as she was more independent than
anticipated when performing functional
mobility tasks.

Add rows for more activities if needed, please erase the red instructions when filling it out.

Find one peer-reviewed article that supports the intervention you planned/provided. At the bottom of your plan, paste the abstract and
citation and then in your own words describe how this supports your intervention plan. (5)
Seo, N. J., Rymer, W. Z., & Kamper, D. G. (2009). Delays in grip initiation and termination in persons with stroke: effects of arm support and active
muscle stretch exercise. Journal of neurophysiology, 101(6), 3108-3115.

Abstract: Stroke survivors' difficulty in releasing grasped objects may be attributable not only to impaired finger extension but also to delays in
terminating activity in the gripping flexor muscles. This study was undertaken 1) to quantify the time needed to initiate and terminate grip muscular
activity following stroke and 2) to examine effects of arm support, grip location, and active muscle stretch on the delays recorded in the paretic
hand. Delays in initiation and termination of finger flexor muscle activity in response to an auditory stimulus were measured for both paretic and
nonparetic hands of ten stroke survivors with chronic hemiparesis and the dominant hand of five neurologically intact subjects. Additionally, the
delays for the paretic hand were recorded while an external arm support was used and after 30 min of active muscle stretch. We found that delays
in grip initiation and termination were greatest for the paretic hand (1.9 and 5.0 s), followed by the nonparetic hand (0.5 and 1.6 s), and least for the
control hand (0.2 and 0.4 s). Arm support reduced delay in grip termination 37% for the paretic hand. Repeated active muscle stretch resulted in
24% reduced delay in grip initiation and 32% increased delay in grip termination for the paretic hand. Therapies and interventions reducing these
delays may improve the ability to grasp and release objects and thus increase functional independence for stroke survivors.

Many stroke survivors experience increased difficulty with activities requiring hand function and coordination. This is often related to one-sided
weakness post-stroke and the effects can lead to difficulty in many functional activities. According to the article cited above, hand and finger
stretches or exercises can be very beneficial to these patients to improve finger flexion and extension for grip and fine motor coordination. The
patient that this intervention is planned for is having difficulty completing full range of motion of her right hand post-CVA. She also has limited
coordination and strength in her right hand. To improve patient function through increased finger flexion and extension, patient was educated on a
variety of active stretches or exercises designed to improve patient grasp and fine motor activity during ADLs. This increase in grip ability and
general coordination ability associated with hand stretch, has shown increased functional independence in stroke patients, like KD.

Total: 27 points