Leah Rosler

Individual Treatment Plans

Patient name: Ken

Diagnosis: L hemiparesis as a result of a R Hemorrhagic Stroke
PMH: high blood pressure, atrial fib, type II diabetes, on Coumadin, 1990 had surgery to
remove 2 discs in his neck
Psycho Social/ Family situation: Pt lives at home with his wife in the first floor of their
house. There is a shower and bathroom on the first floor of their home. His son,
daughter in law, and 2 grandchildren (ages 4 and 8) live at home with them. They live on
the second floor of the house. Wife is a retired rehabilitation nurse and cares for pt
now.
Precautions: fall risk, previous L subluxed shoulder (from accident)
Patients stated goals: Pt stated that he would like to increase his L UE movement, bring
a cup of coffee up to his mouth, as well as safely return to being able to do
woodworking in his shop in his back yard.

Medical Cause/ Description of Diagnosis: Pt suffered a R hemorrhagic stroke following

an accident where he was hit by a car while on a motorcycle. Hemorrhagic strokes are
caused by a rupture in a blood vessel in the brain. More immediate symptoms include
total or limited loss of consciousness, nausea, vomiting, sudden and severe headache,
weakness or numb feeling the face, leg or arm on one side of the body, seizures,
dizziness, loss of balance, problems with speech or swallowing, confusion or
disorientation. As the result of a R hemorrhagic stroke individuals will likely lose motor
control on the left side of their body, may have trouble remembering, demonstrate
impulsive behavior or mood changes, paralysis or weakness on left side of body, trouble
walking, not knowing how close an object is to your body, lack of awareness of the left
side of your body, or trouble swallowing, speaking, reading, writing, or understanding
language.

Models or Frame of Reference:

Kens treatment plan will primarily be based upon the rehabilitative frame of reference.
The rehabilitative frame of reference is used when aiming at making people as
independent as possible in spite of any residual impairment. It consists of compensatory
strategies, environmental adaptation and combines both physical and psychosocial
aspects. Different rehabilitative methods include changing the task or changing the
context. In Kens situation we will have to adapt his environment to help him become
more successful. The rehabilitative frame of reference is a bridge to independence and
in Kens case, he is looking to eventually get back to doing tasks such as woodworking or
drinking out of a coffee cup. The rehabilitative frame of reference is applicable in
regards to Kens intervention activities because we will be focusing on his whole self.
We will be considering his emotional state, strengthening his body, compensating, using
adaptive equipment, and doing ADL/ IADL directed tasks.

Priority Intervention STG LTG

Impairment/ Activity
Limitations/
Problem Areas
Hand Grasp 1. Pt will perform Pt will Pt will independently
each theraputty independently grasp pants and pull
exercise ( finger grasp and pick up a pants over hips while
scissor, fingertip pair of pants with toileting.
pinch, power grip, his left hand.
flat pinch, finger
spread, finger
extension, finger
spread, full grip) 10
times to increase
independence in
lower body dressing
(see attached
picture).

2. Pt will hold a 2.5

pound dumbbell for
30 seconds X 5 to
increase
independence in
lower body dressing

3. Pt will squeeze
the soft hand grip
tool for 3 sets of 10
reps to increase
independence in
lower body dressing

Dynamic Sitting 1. Pt will perform Pt will maintain Pt will choose a shirt,

Balance dynamic sitting good dynamic get the shirt from a
activities on edge of sitting balance drawer, and doff pull
mat to increase when reaching to over shirt with
independence in pull a shirt out of his moderate assistance
upper body dressing drawer. all while maintaining
good dynamic sitting
 2. Pt will practice balance.
reaching for
clothing items out
of his drawers to
increase
independence in
dressing.

3. Pt will practice
reaching to put his
dirty clothes into
the laundry basket
to increase
independence in UE
and LE dressing.

4. Pt will practice
moving articles of
clothing from one
table in front of him
to a table behind
him to increase
independence in UE
and LE dressing.

Fine Motor Hand 1. Pt will practice Pt will Pt will independently

stacking coins to independently button his button
increase button 1 button on down shirt.
independence in UE a shirt (increase
dressing. independence in UE
dressing)
2. Pt will practice
doing a puzzle to
increase
independence in UE
dressing.

3. Pt will complete
the 9 hole peg
activity to increase
independence in UE
dressing.
Increased ROM L UE Pt will Pt will independently
1. While lying flat independently get a cup from a
on a mat pt will reach a cup to his cupboard, fill the cup
perform 3 sets of 10 mouth. with water, reach the
straight arm cup to his mouth
punches to increase (using his left hand)
shoulder ROM to and take a drink out of
increase it.
independence in
drinking out of a
cup (see attached
for picture)

2.While lying flat on

a mat pt will
perform 3 sets of 10
elbow flexion and
extension stretches
to increase elbow
flexion and
extension to
increase
independence in
drinking out of a
cup (see attached
for picture)

3. While lying flat

on mat pt will
perform 3 sets of 10
shoulder flexion
overhead to
increase shoulder
ROM to increase
independence in
drinking out of a
cup (see attached
for picture)

4. Pt will play move

utensils from one
side of the table to
another to increase
shoulder ROM to
increase
independence in
meal preparation

5. Pt will play the

card game war
with his left hand to
practice flexing his
shoulder and
flexing/ extending
his elbow by
reaching for the
cards to increase
independence in
household
management
activities.

6. Pt will take
objects from table
and move them into
a laundry basket on
the floor to increase
independence in
household
management
activities.

7. Pt will place
sticky notes on a
board in front and
slightly higher than
him to increase
independence in
reaching for items
out of a cupboard.

8. Pt will practice
touching his chin to
increase
independence in
drinking out of a
cup.
 9. Pt will perform 3
sets of 10 towel
hand slides on a
table (pt places
both hands on
towel and bilaterally
slides hands
forward to flex
shoulder) to
increase
independence in
reaching for items.

10. Pt will complete

box and block
activity to increase
independence in
self feeding.

Increased Strength L 1. Pt will utilize Pt will achieve a Pt will independently

UE dowel rod to score of a MMT 3- pick up a coffee mug
bilaterally flex on shoulder flexion from the table in front
shoulders 3 sets of to demonstrate of him and bring it to
10 reps to increase increased strength his mouth, and lower
independence in in his L UE in order it back down to the
household to increase table with his left
management independence in hand
activities. drinking out of a
coffee mug.
2. Pt will move bean
bags across his
midline to one side
of the table to
another to increase
independence in
self feeding.

3. Pt will lift bean

bags up to be able
to put them on the
surface above and
in front of him to
increase
independence in
household
management.
Straight Arm Punches Elbow Flexion and Extension

Shoulder Flexion Overhead Theraputty Exercises

Group Peer Feedback

Reviewing Group Member Name: Kerri Metzel

1. What did you like about your group members completed assignment?
As usual I really liked your explanation for your chosen FoR. It was well thought out and
well explained. I like the number of interventions you have for each problem area. I also
liked that you included pictures of some of your exercises to help further describe them.

2. What did you learn or something you can use from you group members assignment?
You had a large variety of interventions that were both exercise based and activity
based. When addressing ROM and strength I will definitely try to be more creative with
my interventions and include activities that are not so exercise based. I will also try to
include more interventions to demonstrate range and depth.

3. What do you recommended your group member would change about their
completed assignment?
Your LTGs are pretty specific and I think would be seen as more STGs. Make the LTGs
broader, for example your hand grasping LTG could be Pt will demonstrate increased
hand grasp to perform lower body dressing independently. You could also use MMT
measures for strength related problem areas. Also, be sure that your interventions
relate back to your problem area. For example, with dynamic sitting balance you could
say pt will perform (insert exercise) to increase dynamic sitting balance in order to
increase independence in dressing.
Reviewing Group Member Name: Meredith Schulz

1. What did you like about your group members completed assignment?
I really liked that you noted that his wife was a rehab nurse because that gives a lot of
context for her capabilities to help the pt carry out take-home exercises etc. I also like
that you provided structured theraputty exercises, which I havent seen before. Ive
always just seen therapists ask pts to play with it or remove items from it. You had a ton
of really good ideas for UE ROM interventions!
2. What did you learn or something you can use from you group members assignment?
I really liked the idea of including pictures of exercises in the treatment plan and think
that would be really helpful. I also liked the idea of using 9 hole peg and box and block
as therapeutic exercise. Make sure you specify that those are for exercises and not for
assessments though.
3. What do you recommended your group member would change about their
completed assignment?
With your dynamic sitting balance goals, I think that reaching over to pull something out
of a drawer might challenge dynamic sitting balance more than taking off a shirt. At the
very least, they seem like they are of equal difficulty. Id say maybe revise these goals to
something of varying difficulty. As for the goals for fine motor, I had similar goals in the
last ITP and had a note that said instead of a button strip, just have your patient
practice buttoning on an actual shirt. So you could have your STG be one button and
your LTG all the buttons.

Grading rubric for individual treatment plan

Excellent Good Fair Poor Incomplete

35-32 31-28 27-25 24-21 20-17
Short Short Short Short No description
paragraph paragraph paragraph paragraph of medical
description of description of description of a description of a cause of
medical cause medical cause medical medical patients
of patients of patients diagnosis diagnosis diagnosis
primary secondary
diagnosis diagnosis
Short Short Short Short No description
paragraph paragraph paragraph paragraph of approach
description of description of description of description of and principle to
appropriate inappropriate appropriate an appropriate an be used in
approach and approach and approach and approach and intervention
principle to be principle to be principle principle
used in used in
intervention intervention
Identify at least Identify 3 Identify 2 Identify 1 Identify no
4 priority and impairments impairments impairments impairments
appropriate priority and priority and priority and
impairments appropriate appropriate appropriate
impairments impairments impairments
Provide at least Provide at least Provide at least Provides no Does not
3 appropriate 2 appropriate 1 appropriate appropriate provide any
treatment treatment treatment treatment treatment
activities for activities for activities for activities for activities for
each each each each each
impairment impairment impairment impairment impairment
Provide an Provide an Provide an Provide an Does not
appropriate appropriate inappropriate inappropriate provide a short
short term and short term or short term or short term and term and long
long term goal long term goal long term goal long term goal term goal for
for each for each for each for each each
impairment impairment impairment impairment impairment
Your score: