Patient requires further skilled physical therapy treatment on a daily basis and can be provided, as a practical matter, only on an inpatient basis in a SNF secondary to the patient’s inability to return home safely due to the following reasons:
patient needs 24-hour aide services that cannot be provided in home health care setting due to the intermittent criteria,
patient will return to live alone,
inadequate/ insufficient assistance from caregiver, primary caregiver has ____ limiting the the assistance to be provided to the patient,
caregiver can only provide verbal instruction and unable to provide physical assist,
Patient’s spouse is unable to effectively physically assist the patient because of medically complex condition,
unable to navigate __ stairs in order to enter/exit home safely,
unable to ascend/descend __ stairs to the bedroom and bathroom,
high risk of falling (see standardized test),
sub-acute medical condition related to ____ with high risk of re-hospitalization,
inadequate muscle strength (muscle weakness in BLE rated ) and impaired balance with high risk of re-injury during transfers and gait due to inadequate assistance in the home,
unable to return home safely due to significant/pronounced impairment in the patient's ability to perform bed mobility, transfers and gait,
patient is no longer appropriate to return to previous home (private home) and family is actively looking for an assisted living with 24 hour care assist,
Muscle strength B LE: 3+/5 Bed mobility: supervision Endurance: Fair Transfer: Contact Guard Assist Balance Sit: Good Balance: Stand: G- Stairs: Moderate Assist Pain legs/ft: 5-6/10
JUSTIFICATION FOR DISCHARGE: In the Medicare Benefit Policy Manual Chapter 8 Coverage of Extended Care (SNF) Services Under Hospital Insurance 30.2.2- Principles for Determining Whether a Service is Skilled, the deciding factor is not the patient's potential for recovery , but whether the services needed require the skills of a therapist or whether they can be provided by non-skilled personnel. In this case, the patient has reached a plateau functionally, and the exercises can be safely carried out by a caregiver. Although the patient has not reached the prior level of function, the patient's deterioration in mental status limits further progression in therapy. Patient would be requiring _____assist due to the risk of falling which can be safely provided by a non-medical person and that exercises to maintain the patient's function can be safely and effectively carried out by a caregiver.
the sevices cannot be carried by unskilled personel
reasonable and necessary to the treatment of the patient's illness or injury
potential that the condition of the patient will improve materially in a reasonable and generally predictable period of time. Improvement is evidenced by objective successive measurements. potential that the condition of the patient will improve materially in a reasonable and generally predictable period of time. Improvement is evidenced
Patient does not suffer a transient or easily reversible loss of function which could reasonably be expected to improve spontaneously as the patient gradually resumes normal activities.
The patient requires specialized skills, knowledge, and judgment of a physical therapist due to the complexity of the services provided to the patient requiring frequent treatment progressions and intervention adjustments designed to address the patient’s physical impairment with bed mobility transfers and gait in order to decrease risk of falling and re-injury.
development, course and outcomes of the skilled observations, assessments, treatment and training performed
However, if the criteria in §40.2.1(d)(3) are met, where there is clear documentation that, because of special medical complications (e.g., susceptible to pathological bone fractures),
inherently complex that it can be safely and effectively performed
, the physical therapist should regularly reevaluate the patient’s condition and adjust any exercise program
30.4.1 – (Rev. 1, 10-01-03) A3-3132.3A, SNF-214.3.A 30.4.1.1 Direct Skilled Therapy Services to Patients-Skilled Physical Therapy - General, Example 1, An 80-year old, previously ambulatory, post-surgical patient has been bed-bound for 1 week, and, as a result, had developed muscle atrophy, orthostatic hypotension, joint stiffness and lower extremity edema. To the extent that the patient requires a brief period of daily skilled physical therapy to restore lost functions, those services are reasonable and necessary and must be documented in the medical record (see §30.2.2.1).
This is in reference to Jimmo v. Sebelius case and the Medicare regualtions at 42 CFR 409.32(c), the level of care criteria for SNF coverage specify that the “restoration potential of a patient is not the deciding factor in determining whether skilled services are needed. Even if full recovery or medical improvement is not possible, a patient may need skilled services to prevent further deterioration or preserve current capabilities.”
In the previously-issued Jimmo v. Sebelius Settlement Agreement Fact Sheet, CMS stated that the skills of a therapist are necessary to maintain, prevent, or slow further deterioration of the patient’s functional status, and the services cannot be safely and effectively carried out by the beneficiary personally, or with the assistance of non-therapists, including unskilled caregivers.
In the Jimmo v. Sebelius settlement agreement, Medicare clarified its longstanding policy that when skilled services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration when the beneficiary’s maintenance care needs cannot be addressed safely and effectively through the use of nonskilled personnel.
NU step to promote temporal conjunction of arm and contralateral leg at apex of shoulder and hip excursions during gait
NU step to improve gait with arm-leg-synchrony through contralateral movements of the arms and legs to promote coordinated gait.
Intrinsic standing balance exercises with narrow base of support, semi-tandem position, ankle dorsiflexion, hip abduction and extension.
Ankle Strategy
Hip Strategy
Stepping Strategy Training
Center of Gravity Control
Base of Support Training
SIT TO STAND
STANDING UNSUPPORTED
SITTING UNSUPPORTED
STANDING TO SITTING
TRANSFERS
STANDING WITH EYES CLOSED
STANDING WITH FEET TOGETHER
FORWARD REACH
RETRIEVING OBJECT FROM THE FLOOR
TURNING TO LOOK BEHIND
TURNING 360 DEGREES
PLACING ALTERNATING FEET ON STOOL
TANDEM STANDING
ONE-LEGGED STANDING
STANDING BALANCE EXERCISES
ABDOMINAL STRENGTHENING
movement composition training ( heel to knee to toe technique, foot pointing, and gait) to promote the patient's ability to control movement with several muscle groups acting together with focus on quality of movement, control, speed, and reaction time in order to improve performance transfers and gait.
movement accuracy training to improve the patient's ability to gauge distance and speed of voluntary movement with focus on quality of movement, control, speed, and reaction time in order to facilitate effective transfers and gait.
LE joint stabilization/fixation/postural holding training to improve the patient's ability to hold stationary posture to improve elevating, pushing, and lowering the body necessary for sit<> stand and bed< >chair transfers.
reciprocal movement coordination training to improve the patient's ability to reverse movement (agonist <> antagonist) with emphasis in the quality of movement, control, speed, and reaction time to improve reciprocal gait.
proprioceptive training to improve joint position sense by moving the patient's extremity through a predetermined range of motion to improve patient's equilibrium necessary for transfers and gait.
Kinesthetic training to improve the patient's body awareness during transfers and gait while in motion and to improve perception of body movement to decrease risk of falling.
Skilled interventions provided include teaching, instruction, demonstration, and training incorporating with the use of kinesthetic sense by activating neural receptors in the muscles and joints with the use of sensory reception approach.
Skilled interventions provided include education, instruction, demonstration, and training as it relates to joint protection principles with the use of techniques to protect the joints in performing the activity.
Skilled interventions provided include education, instruction, demonstration, and training as it relates to biomechanical alignment, which involves body alignment position in weight-bearing and non weight-bearing situations.
Skilled interventions provided include education, instruction, demonstration, and training incorporating proprioceptive approaches with the use of sensations from joints, muscles, and connective tissues that lead to body awareness.
Skilled interventions provided include education, instruction, demonstration, and training incorporating perceptual motor integration approaches such as visual-motor integration and adaptation.
Skilled interventions provided include education, instruction, demonstration, and training incorporating osteokinematic alignments with the use of movements occurring between two segments (bones) relative to the three cardinal planes.
Skilled interventions provided include education, instruction, demonstration, and training as it relates to incorporating neuromuscular treatment approach with the use of treatment approaches.
Skilled interventions provided include education, instruction, demonstration, and training incorporating stereognosis with the faculty of perceiving and understanding the form and nature of objects by the sense of touch.
Skilled interventions provided include education, instruction, demonstration, and training incorporating barognosis with the perception of weight by cutaneous and muscle sense.
Skilled interventions provided include education, instruction, demonstration, and training integrating sense approach with the recognition and awareness of the location of external cutaneous stimulus.
Skilled interventions provided include education, instruction, demonstration, and training as integrating with the use of kinesthetic sense by activating neural receptors in the muscles and joints with the use of sensory reception approach.
Skilled interventions provided include education, instruction, demonstration, and training with the use of proprioceptive sense with the sensory input and feedback of joint position.
Skilled interventions provided include education, instruction, demonstration, and training integrating with the use of osteokinematics with the relationship of the bone and its associated joint movements.
Skilled interventions provided include education, instruction, demonstration, and training as it relates to arthrokinematics, with the adjoining joint surfaces move each other during osteokinematic joint movement.
Skilled interventions provided include education, instruction, demonstration, and training as it relates to with the use of adaptation phenomena providing perceptual plasticity and mechanism of visual coding.
Skilled interventions provided include education, instruction, demonstration, and training as it relates to with the use combined cortical integrative approach utilizing visual and verbal feedback.
Tinetti Balance and Gait test was performed to objectively measure balance and gait deficits for significant changes, position changes, and gait maneuvers used during mobility in order to assess patient’s ability to perform specific gait and balance tasks and as predictive measure for falls. .Areas Tested: BALANCE: sitting balance, rises from chair, attempts to rise, immediate standing balance (first 5 seconds), standing balance, nudged, eyes closed, turning 360 degrees, and sitting down; GAIT: initiation of gait, step length and height, foot clearance, step symmetry, step continuity, gait path, trunk sway, and walking time.
Gait Interpretation: Older adults who take longer than 13.5 seconds to complete the TUG have a high risk for falls (Shumway-Cook Measurement) Transfer Interpretation: According to Podsiadlo and Richardson, 1991 Timed Up & Go Test Score less than 20 seconds for Functional Mobility Skill (Community-Dwelling Elderly People with a variety of medical conditions) is indicative of independent for basic transfers. Procedure: The timed “Up and Go” test measures the time taken by the patient to stand up from a standard arm chair, walk a distance of 3 meters (118 inches, approximately 10 feet), turn, walk back to the chair, and sit down. Patient started with back against the chair, arms resting on the armrests, and walking aid at hand. Patient was instructed that, on the word “go” to get up and walk at a comfortable and safe pace to a line on the floor 3 meters away, turn, return to the chair and sit down again.
Performed Five Times Sit to Stand Test to assess functional lower-limb muscle strength, functional change of transitional movements, balance performance, and assess fall risk. Patient Instruction: "I want you to stand up and sit down 5 times as quickly as you can when I say 'Go'." SCORE: Patient's score was ________ seconds and determined to be _____ risk of falling. Interpretation: The normative data by Bohannon et al, 2006 for ages , the cut off indicates below or lower times = better scores) 60-69 y/o = 11.4 sec 70-79 y/o = 12.6 sec 80-89 y/o = 14.8 sec
Pain in ____ rated /10 which occurs at least daily, it is not easily relieved, and affects the patient’s sleep, physical energy, concentration, and ability/ desire to perform physical activity. STANDARDIZED TEST:
Tinetti Performance Oriented Mobility Assessment Total Score for Balance and Gait: ___/28 (Balance: /16 and Gait /12). Risks Indicators: equal or less than 18 is HIGH RISK for fall, 19-23 is MODERATE RISK for fall, equal or greater than 24 is LOW RISK for fall.
Elderly Mobility Scale Score:___/20 Scores under 10 – generally these patients are dependent in mobility manoeuvres; require help with basic ADL, such as transfers, toileting and dressing. Scores between 10 – 13 – generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility manoeuvres. Scores 14 and over – generally these patients are able to perform mobility manoeuvres alone and safely and are independent in basic ADL.
_____________________
Tinetti Performance Oriented Mobility Assessment Total Score for Balance and Gait: ___/28 (Balance: /16 and Gait /12). Risks Indicators: equal or less than 18 is HIGH RISK for fall, 19-23 is MODERATE RISK for fall, equal or greater than 24 is LOW RISK for fall.
Elderly Mobility Scale Score:__/20 Scores under 10 – generally these patients are dependent in mobility manoeuvres; require help with basic ADL, such as transfers, toileting and dressing. Scores between 10 – 13 – generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility manoeuvres. Scores 14 and over – generally these patients are able to perform mobility manoeuvres alone and safely and are independent in basic ADL.
_____________________________
Tinetti Performance Oriented Mobility Assessment Total Score for Balance and Gait: ___/28 (Balance: /16 and Gait /12). Risks Indicators: equal or less than 18 is HIGH RISK for fall, 19-23 is MODERATE RISK for fall, equal or greater than 24 is LOW RISK for fall.
Elderly Mobility Scale Score:__/20 Scores under 10 – generally these patients are dependent in mobility maneuvers; require help with basic ADL, such as transfers, toileting, and dressing. Scores between 10 – 13 – generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility maneuvers. Scores 14 and over – generally these patients are able to perform mobility maneuvers alone and safely and are independent in basic ADL.
Berg Balance Scale Score:___/56. Interpretation: 41-56 = low fall risk, 21-40 = medium fall risk, 0 –20 = high fall risk
_____________________________
Tinetti Performance Oriented Mobility Assessment Total Score for Balance and Gait: ___/28 (Balance: /16 and Gait /12). Risks Indicators: equal or less than 18 is HIGH RISK for fall, 19-23 is MODERATE RISK for fall, equal or greater than 24 is LOW RISK for fall.
Elderly Mobility Scale Score:___/20 Scores under 10 – generally these patients are dependent in mobility manoeuvres; require help with basic ADL, such as transfers, toileting and dressing. Scores between 10 – 13 – generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility manoeuvres. Scores 14 and over – generally these patients are able to perform mobility manoeuvres alone and safely and are independent in basic ADL.
Berg Balance Scale Score:___/56. Interpretation: 41-56 = low fall risk, 21-40 = medium fall risk, 0 –20 = high fall risk
_____________________
Tinetti Performance Oriented Mobility Assessment Total Score for Balance and Gait: ___/28 (Balance: /16 and Gait /12). Risks Indicators: equal or less than 18 is HIGH RISK for fall, 19-23 is MODERATE RISK for fall, equal or greater than 24 is LOW RISK for fall.
Elderly Mobility Scale Score:__/20 Scores under 10 – generally these patients are dependent in mobility manoeuvres; require help with basic ADL, such as transfers, toileting and dressing. Scores between 10 – 13 – generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility manoeuvres. Scores 14 and over – generally these patients are able to perform mobility manoeuvres alone and safely and are independent in basic ADL. Berg Balance Scale Score:___/56. Interpretation: 41-56 = low fall risk, 21-40 = medium fall risk, 0 –20 = high fall risk
_____________________________
Tinetti Performance Oriented Mobility Assessment Total Score for Balance and Gait: ___/28 (Balance: /16 and Gait /12). Risks Indicators: equal or less than 18 is HIGH RISK for fall, 19-23 is MODERATE RISK for fall, equal or greater than 24 is LOW RISK for fall.
Elderly Mobility Scale Score:__/20 Scores under 10 – generally these patients are dependent in mobility maneuvers; require help with basic ADL, such as transfers, toileting, and dressing. Scores between 10 – 13 – generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility maneuvers. Scores 14 and over – generally these patients are able to perform mobility maneuvers alone and safely and are independent in basic ADL.
Berg Balance Scale Score:___/56. Interpretation: 41-56 = low fall risk, 21-40 = medium fall risk, 0 –20 = high fall risk
_____________________________
_____________________
____________________
Patient was previously undergoing subacute rehabilitation but interrupted by the most recent in-patient hospital stay.
Clinical objective problems include gait deficit, muscle weakness affecting mobility, equilibrium or balance deficit, pain interfering with movements, tenderness, muscle spasm, muscle guarding, high fall risks. These clinical problems have resulted in significant functional deterioration, as evidenced by remarkable deficit in activities of daily living, which include but not limited to deterioration in sit <-> stand and bed <-> chair transfer, bed mobility, gait on even and uneven surfaces, [[[[ navigating stairs]]]]], requiring physical assistance.
These clinical problems have resulted in substantial functional decline, as evidenced by marked deficit in activities of daily living with deterioration in sit <-> stand and bed <-> chair transfer, bed mobility, gait on even and uneven surfaces, [[[[ negotiating stairs]]]]], requiring skilled physical therapy.
Furthermore, the services are reasonable and necessary for the treatment consistent with the nature and severity of the patient’s illness or injury, the patient’s particular medical needs, and accepted standards of medical practice due to the following clinical objective problems
Supine<> sit at the edge of the bed training required : _ physical assist, sit<>stand training required _ physical assist, bed< >chair transfer training required: _ physical assist.
Bed Mobility Task: trained the patient in performing arm reach and trunk lift to improve bed mobility; patient was instructed to reach forward and over the side of exit with the opposite arm while lifting the trunk slightly in order to improve elevating and turning the trunk for the initial part of bed rise
Bed Mobility Task: trained the patient in performing lateral leg movement to improve bed rise; patient was instructed to move one leg toward the side of exit and then the other leg to the opposite side to improve moving hips/legs laterally for initial part of bed rise
Bed Mobility Task: trained the patient in performing unilateral heel raise; patient was positioned with one knee and hip flexed and the opposite leg extended (SLR position). Patient was instructed to raise the heel of the straight leg 4-6 inches off the bed and hold for 3 seconds, then repeated on the opposite side to improve elevating the legs in preparation for bed rise
Bed Mobility Task: trained the patient in performing roll to side lying; patient was instructed to roll onto the side by pushing the opposite heel down to improve moving the trunk and pelvis onto the side with foot push in preparation for bed rise
Bed Mobility Task: trained the patient in performing side lying to sit. Patient was positioned in side lying with hips and knees flexed and heels supported on the bed; patient was instructed to push down with the elbow in contact with the bed and the opposite hand and come to sit with legs dangling off the edge of the bed to improve alternate way to rise after rolling onto the side
Bed Mobility Task: trained the patient in performing bed rise with weight on hip and then hold. Patient was positioned in sitting at the edge of the bed with legs dangling and arms folded across the chest. Patient was instructed to place all weight on one hip, lean as far as possible to one side, and hold for 3 seconds, then repeated to the opposite side to improve balancing trunk on one side of the hip necessary for bed mobility
Bed Mobility Task: trained the patient in performing trunk elevation by upper extremity extension with patient's position in supine. Patient was instructed to raise the trunk by extending the arms first then pushing off and extending the elbows to improve elevating the trunk using shoulder and elbow extension
Bed Mobility Task: trained the patient in performing bridging; positioned patient in hook lying with hands at the sides, then patient was instructed to raise buttocks off the bed and hold for 3 seconds to improve elevating the pelvis and utilizing arm support necessary for bed mobility
Bed Mobility Task: trained the patient in performing supine to sit, wherein patient was instructed to slide forward to the edge of the bed, shifting the weight from one hip to the other with the assistance of both arm to improve moving the pelvis forward
Task: trained the patient on how to properly slide forward for sit <> stand. Patient was instructed to slide forward to the edge of the seat, shifting the weight from one hip to the other, wherein both armrests used for assistance to improve moving the pelvis forward on the seat
Task: trained the patient in performing the required trunk flexion for sit <> stand. Patient was instructed to lean forward from the hip joint as far as possible keeping the neck and upper back straight with both armrests used for assistance to improve leaning forward
Task: trained the patient in performing trunk rock and lift. Patient was in seated position at the edge of the chair, then instructed to rock back and forth and lift the buttocks off the seat. Both armrests were used for assistance. Training was conducted to develop sufficient trunk momentum to elevate the buttocks off the seat. Activity was repeated 15 times with corrections
Task: trained the patient in performing pelvic elevation. Patient was seated back in chair with legs extended out in front to minimize leg assistance, patient was then instructed to push down on both armrests and elevate the pelvis off the seat to improve using the arms only to help elevate the pelvis
Task: trained the patient with flexed configuration after lift-off. Patient was instructed to rise from the seat using the armrests and keep the buttocks off the seat without rising to a full standing position with hips and knees remained flexed. This is to improve balancing at the critical moment of lift-off from the seat
Task: trained the patient in performing rising from chair with hands. Patient was instructed to rise from the seat using hands to improve rising from the chair in a comfortable an safe manner
Task: trained the patient in performing rise from chair without hands - patient was then instructed to rise from the seat using safe strategy except for using hands. Training was conducted to improve rising from the chair in a safe manner without using hands
Task: trained the patient in performing hip and knee bends for sit <-> stand. Positioned patient in standing. patient was instructed to bend the hips and knees as far as possible and then raise up again to improve knee and hip extension at the final phase of chair rise
Patient was instructed not to lift, push or pull objects heavier than 5 pounds without further clearance from the physician. Explained to the patient that a half-gallon of milk is about 4 pounds. Educated that the sternum is not fully integrated at this time with good new bone regeneration and lifting heavy weight may separate bones and the sternum wires could work loose.
In order to adhere with the sternal precaution, patient was instructed to use the log roll technique when getting out of bed and to refrain from using the arms and hands to pull self up. Patient was then instructed to rise from bed, use the log roll technique by simply lying on the back, and then roll onto one side and allow the legs to fall slowly off the edge of the bed, and allow the momentum to assist the upper body to rise up, taking care not to push or pull with the arms.
Patient was educated to use the legs to stand up from a chair so as not to disrupt the healing sternal incision. Patient was instructed to slide the heels back so the feet are positioned well under the knees, and place the hands on the thighs. Patient was then instructed to lean forward with the nose over the toes, and rise up, taking care not to push or pull with the arms.
Patient was instructed to roll the shoulders to stretch to decrease stiffness instead of placing both arms overhead in order to adhere with the rules of the sternal precautions post surgery. Instead of reaching overhead to stretch, instructed to the shoulder blades forward and back with the arms by the side to avoid excessive separation of the breastbone and the chest incision.
Patient was instructed to utilize a pillow to splint when coughing. Patient was educated that coughing can be painful after open heart surgery, and coughing forcefully can place stress and strain through the sternum. Instructed to place a pillow over the chest and hug it tightly whenever feeling the need to cough or sneeze.
1) Skilled therapeutic activities require the involvement of a therapist to meet the patient’s needs, promote recovery, and ensure medical safety related to the patient’s illness.
2) The skill of therapist is still needed to manage the appropriateness of the therapeutic activities and hands-on techniques.
3) Therapist is still needed to carry out the skilled therapeutic procedures to improve and achieve the fundamental goals.
4) Patient’s condition continues to materially improve in a reasonable and predictable time, as set in the plan of care.
5) Skilled therapy is concurrent with the patients’ care plan.
6) Treatment of the patient’s illness can only be carried out by the skilled therapist due to hands-on technique and complexity of the plan of care.
7) Service cannot be carried out by non-skilled personnel due to the inherent complexity of the treatment regimen provided.
8) In view of the patient’s overall conditions, skilled management provided by the therapist is due to the inherent level of sophistication.
9) The skill of therapist is still needed due to special medical condition; patient is susceptible to pathological bone fracture due to osteoporosis.
10) Continue restorative physical therapy program for skilled intervention and adjustment of current therapeutic regimen.
11) Continue therapy for the implementation of the therapeutic intervention tailored for the specific needs of the patient.
12) Treatment provided specifically directed to an active written treatment regimen approved by the physician.
13) Patient continues to improve and require therapy based on the clinical findings, extent of loss of function, social considerations, and patient overall function.
14) Assessment on patient’s progress toward set goals established in the plan of care was performed for the patient’s physical impairment.
15) Patient continues to require broad range of skilled rehabilitative techniques to improve movements and physical function.
16) Patient’s treatment activities are directed to improve the restriction of mobility strength, balance or coordination affecting ADL.
17) Current treatment addresses the patient’s specific functional needs for recovery, skilled intervention was upgraded today.
18) Patient necessitates further treatment to achieve optimum rehabilitation potential.
19) Patient has the capacity to learn the instructions given to improve function. New instructions were given to improve ADL.
20) Patient is expected to return to the highest level of function as described in the plan of care.
21) Patient demonstrates improvements toward set goals and requires further treatment to achieve functional mobility
22) Patient is able to participate and continue to benefit from skilled intervention given.
23) Patient continues to improve towards the established goals and makes significant improvement to increase functionality with skilled therapy.
24) Patient treatment has not reached plateau and continues to make functional improvement with skilled therapy.
25) Patient’s loss of function is not expected to improve over time without skilled physical therapy services.
26) Patient makes great strides with the skilled therapy intervention, but requires further skilled care to achieve prior level of function..
27) Patient is compliant with the treatment plan and continues to respond with skilled therapy.
28) Patient continues to gain functional improvement as a result of the physical therapy treatment.
29) Physical therapy treatment is concurrent with the established plan of treatment.
30) Patient responds with the skilled therapy intervention geared to improve mobility.
31) Patient actively participates in the skilled treatment regimen designed to increase function in connection with the plan of treatment.
32) Patient requires further skilled treatment to attain maximum rehab potential.
33) Skilled rehab training is geared to improve the functional capacity of the patient.
34) Patient actively involves in the treatment provided through skilled therapy interventions.
35) Patient shows functional progress with the treatment, but requires further therapy treatment to reach functional goals.
36) Patient exhibits favorable response with the skilled treatment regimen provided.
37) Patient demonstrates progress in lined with the attainment of the established goals.
39) Patient necessitates further skilled treatment to achieved functional goals as set in the plan of care.
40) Patient exhibits good rapport with the therapist and favorable response with the treatment to improve functional goals.
41) Patient has attained maximum physical rehabilitation potential, as of this visit.
42) Patient has achieved optimum physical rehabilitation potential, as of this visit.
43) Patient has completed treatment and achieved the highest functional rehab potential.
44) Patient has completed comprehensive physical rehabilitation treatment as of this visit.
45) Patient has achieved optimum functional rehabilitation potential as of this visit.
Erector Spinae
Hip Adductor
Abductor
Hip flexor
Hip extensors
Knee Flexors
Knee Extensors
Hamstrings
Quadriceps
Anterior Tibialis
Plantar Flexors
Gastrocnemius/Soleus
ground reaction force vectors (GRFV)
and posterior to hip joint
*facilitation of midstance with ground reaction force with dorsiflexor moment at the ankle joint and eccentric activity in the hip flexors
and hip joint during the preswing for an effective gait pattern
INITIAL SWING 1-Initial swing (Acceleration) Facilitation of the initial swing during swing phase of gait while the hip is in flexion and external rotation
Facilitation of the knee flexors since flexion of the knee is necessary for the swinging limb to clear the ground as it moves forward.
MIDSWING Facilitation of the Mid-swing (the middle third of the swing phase from 73 to 87% of the gait cycle) from the time the swing foot is opposite the stance limb to when the tibia is vertical.
Facilitation of midswing which begins from maximum knee flexion (when the swing limb is under the body) until the swing limb passes the stance limb and the tibia becomes in a vertical position.
TERMINAL SWING Facilitation of the terminal swing (the final third of the swing phase from 78 to 100% of the gait cycle) from the time when the tibia is vertical to initial contact.
3-(terminal swing) Deceleration Gait training with focus to improve rerminal swing/deceleration while the knee is extending in preparation for heel strike, the hip becomes more flexed, the foot in neutral position.
Facilitation of termina lswing as the heel touches the ground, the foot moves into plantar flexion (by the controlling action of the dorsiflexors).
Subphases of Stance Phase
Focus in the Initial Contact of the stance phase of gait to improve the moment when the foot contacts the ground (heel strike) to improve gait pattern.
Facilitation of the Loading response (LR) period to improve when the weight is transferred onto the outstretched limb during the first period of double-limb support (foot flat)
Facilitation of Midstance (MSt) to improve when the body progresses over a single, stable limb
Facilitation of Terminal Stance (TSt) to improve the progression over the stance limb as the body moves ahead of the limb and weight is transferred onto the forefoot.
Facilitation of Pre-Swing (PSw) to improve the unloading of the limb as weight is transferred onto the forefoot (toe-off) to improve gait pattern
Subphases of Swing Phase
Facilitation of Initial swing (ISw) as the thigh begins to advance and as the foot comes up from the floor for an effective gait pattern.
Facilitation of Midswing (MSw) as the thigh continues to advance and the knee begins to extend then the foot clears the ground for an effective gait pattern
Facilitation of Terminal Swing (TSw) as the knee extends and the limb prepares to contact the ground for Initial Contact for an effective gait pattern
Gait Cycle – Functional Tasks
Facilitation of Weight Acceptance (WA) during the period when body weight is rapidly loaded on the outstretched limb so that the impact of the floor-reaction force is absorbed and the body continues in a forward path while stability is maintained during the Initial Contact and Loading Response.
Facilitation of Single Limb Support (SLS) during the period when the body progresses over a single lower extremity then weight is transferred onto the metatarsal heads and the heel comes off the ground during the Mid Stance and Terminal Stance.
Facilitation of Swing Limb Advancement (SLA) during the time when the limb is unloaded and the foot comes off the ground then the limb is moved from behind to in front of the body, reaching to take the next step as transitional movement during Pre-Swing, Initial Swing, Mid Swing and Terminal Swing.
Facilitation of pretibial muscles (anterior tibial, extensor digitorum longus, and extensor hallucis longus) acting prior to and during heel strike with eccentric contraction in order to control the foot while lowering to the ground.
Facilitation of pretibial muscles (anterior tibial, extensor digitorum longus, and extensor hallucis longus) acting prior to and during preswing with concentric contraction in order to improve foot dorsiflexion and clear toes off the ground
• Calf Muscles
– Gastrocs, Soleus (FDL, FHL, Posterior tibial)
– Foot flat
• Eccentric contraction - control of tibia over the foot
– Heel off
• Concentric contraction – ankle plantarflexion
• Quadriceps – Vastus medialis/lateralis/intermedius, RF – Before Heel Strike • Concentric contraction – initiate knee extension – Swing phase • Eccentric contraction – slow down leg (tibia)
• Hamstrings – Biceps, Semitendinosus, Semimembranosus – Heel strike • Eccentric contraction - HS peaks – protects knee from hyperextension – Swing phase • Concentric contraction – knee flexion, hip extension
• Hip Abductors – Gluteus medius, Gluteus minimus, TFL – Stance phase • Concentric contraction - stabilize pelvis • Hip Adductors – Adductor longus/brevis, Gracilis, Adductor magnus (horizontal and vertical heads) – Early and late stance • Concentric contraction –stabilize pelvis
• Facilitation of the gluteus maximus with eccentric contraction to decelerate forward momentum during stance phase of gait to improve control during gait • Facilitation of the gluteus maximus concentric contraction achieved with hip extension which is essential for the pre-swing phase of gait • Facilitation of the Erector Spinae necessary during heel strike through toe-off to improve trunk posture during gait. • Facilitation of the fibularis longus and brevis concentric contraction necessary for the stance phase of gait to improve medial and lateral stability of the foot • Facilitation of the foot Intrinsics concentric contraction which is essential for the stance phase of gait to support plantar fascia 
LE Stretching Progressive muscle lengthening of the psoas major, towards extension and internal rotation at hip joint (action: flexion and external rotation in the hip joint) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of iliacus, which arises from the iliac fossa on the interior side of the hip bone, towards hip extension (action: hip flexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of gluteus maximus muscle the primary for hip extensor, towards flexion and internal rotation of hip(action: external rotation and extension of the hip joint) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the gluteus maximus since it acts upon the pelvis, supporting it and the trunk upon the head of the femur , towards flexion and internal rotation of hip(action: external rotation and extension of the hip joint) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the gluteus maximus, which causes the body to regain the erect position after stooping assisted in this action by the hamstring muscles , towards flexion and internal rotation of hip(action: external rotation and extension of the hip joint) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of gluteus medius, which originates from the pelvis attached to the femur, towards adduction of the hip (action: abduction of the hip; medial rotation of thigh) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of tensor fasciae latae, which serves to stabilize the pelvis upon the head of the femur, towards thigh extension, internal rotation and adduction (action: Thigh - flexion, medial rotation, abduction, and trunk stabilization) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of tensor fasciae latae the oblique direction of its fibers enables it to abduct the thigh and assists with internal rotation and flexion of hip , towards thigh extension, internal rotation and adduction(action: Thigh - flexion, medial rotation, abduction and trunk stabilization) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of quadratus femoris, which is attached to the inferior portion of the pelvis and connected to the femur bone, towards medial rotation (action: lateral rotation of thigh) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of inferior and superior gemellus - together is called gemelli, towards medial rotation of thigh (action: rotates laterally thigh) to improve ADL activities involving the use of the lower extremities. Progressive muscle lengthening of the piriformis muscle, which occupies a central location in the buttocks, towards internal rotation (action: external rotation of thigh) to improve activities of daily living involving with the use of the lower extremities.
Progressive muscle lengthening of the piriformis muscle, which laterally rotates the extended thigh, towards internal rotation (action: external rotation of thigh) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the piriformis muscle, which is an important muscle in walking for shifting the body weight, towards internal rotation. (action: external rotation of thigh) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the sartorius muscle, which assists in flexion, abduction, lateral rotation of hip, and flexion of knee , towards extension of the hip and knee (action: flexion of the hip and knee) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the sartorius muscle the key muscle used when looking at the bottom of the foot, towards extension of the hip and knee (action: flexion of the hip and knee) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the sartorius muscle also known as the “tailor’s muscle”, which assists in flexion, abduction, lateral rotation of hip, and flexion of knee, towards extension of the hip and knee (action: flexion of the hip and knee) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the quadriceps femoris muscle, which is the greatest extensor of the leg, towards hip extension and knee flexion (action: hip flexion and knee extension) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the quadriceps femoris muscle, which consists of four individual muscles, towards hip extension and knee flexion (action: hip flexion and knee extension) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the biceps femoris muscle, which originates from the pelvis and femur, towards hip flexion and knee extension (action: hip extension, knee flexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the semitendinosus muscle, which has a prominent tendon on the back of the knee, towards knee extension and hip flexion (action: flex knee, extend hip joint) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the semimembranosus, which has a deep tendon on the back of the knee that is hard to locate, towards hip flexion and knee extension (action: hip extension and knee flexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the pectineus muscle, which is primarily responsible for hip flexion, towards hip extension (action: hip flexion, adduction and medial rotation) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the obturator externus muscle, which passes behind the pelvis, towards abduction and medial rotation (action: adduct thigh, rotate thigh laterally) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the gracilis, towards hip abduction and hip extension (action: hip adduction, hip flexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the gracilis, towards hip abduction and hip extension (action: hip adduction, hip flexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the adductor a muscle, which consists of 3 individual muscles, towards hip abduction (action: hip adduction) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the adductor magnus a large triangular muscle, situated on the medial side of the thigh, towards hip abduction (action: hip adduction) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the adductor longus muscle, which is located on the medial side of the thigh, towards hip abduction (action: hip adduction) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the adductor brevis, which is located on the medial side of the thigh, towards hip abduction (action: hip adduction) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the tibialis anterior muscle, which acts to keep the leg vertical, towards plantar flexion and eversion of foot at ankle joint (action: dorsiflexion and inversion of ankle) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the triceps surae, which consists of 2 large muscles, towards knee extension and ankle dorsiflexion (action: knee flexion, ankle plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the gastrocnemius muscle, which crosses 2 joints on the lower extremity, towards knee extension and ankle dorsiflexion (action: knee flexion, ankle plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the soleus muscle the deeper of 2 individual muscles, which forms the triceps surae muscle on the leg, towards ankle dorsiflexion (action: ankle plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the soleus muscle, which plays an important role in standing, towards ankle dorsiflexion (action: ankle plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the soleus muscle, which keeps an upright posture, towards ankle dorsiflexion (action: ankle plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the plantaris muscle, towards foot dorsiflexion and knee extension (action: knee flexion, foot plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the plantaris muscle, which may provide biofeedback information to the brain regarding the position of the foot, towards foot dorsiflexion and knee extension (action: knee flexion, foot plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the popliteus muscle, which is also known as the “key muscle” unlocking the femur on the tibia, towards knee flexion (action: lateral rotation of femur on tibia, and flexion of knee) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the peroneus longus muscle, which is also known as the fibularis longus, towards dorsiflexion and inversion of the foot (action: plantarflexion, eversion of foot) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the peroneus brevis muscle, which runs vertically downward on the leg passing behind the lateral malleolus at the side of the foot, towards dorsiflexion and inversion (action: plantarflexion and eversion of foot) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the toe extensors, which consists of two muscles located on top of the foot, towards toe flexion (action: extension of toes) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the flexor digitorum brevis, towards extension of second to fifth toes (action: flexion of second to fifth toes) to improve activities of daily living involving with the use of the lower extremities.
Torso Stretching Progressive Muscle lengthening of splenius capitis muscle, a straplike muscle in the back of the neck and connects the base of the skull to the vertebrae in the neck and upper thorax, towards flexion, rotation and lateral flexion to the opposite side (action: extend, rotate, and laterally flex the head ) to improve ADL activities with the use of the upper extremities.
Progressive muscle lengthening of splenius cervicis muscle, a narrow tendinous band from the spinous processes of the third to the sixth thoracic vertebrae, towards contralateral rotation and lateral bending of the neck to improve activities of daily living involving with the use of the trunk movements. .
Progressive muscle lengthening of erector spinae also known as the sacrospinalis towards flexion of the vertebral column (action: extension of the vertebral column) to improve activities of daily living involving with the use of the trunk movements.
Progressive muscle lengthening of the left external oblique muscle, which is situated on the lateral and anterior parts of the abdomen, towards side bending to the right (action: trunk rotation to the right, trunk flexion, side bending to the left) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the left external oblique muscle, which is situated on the lateral and anterior parts of the abdomen, towards trunk rotation to the left (action: trunk rotation to the right, trunk flexion, side bending to the left) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the left external oblique, which is situated on the lateral and anterior parts of the abdomen, towards trunk extension (action: trunk rotation to the right, trunk flexion, side bending to the left) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the right external oblique muscle, which is situated on the lateral and anterior parts of the abdomen, towards side bending to the left (action: trunk rotation to the left, trunk flexion, side bending to the right) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the right external oblique muscle, which is situated on the lateral and anterior parts of the abdomen, towards trunk rotation to the right (action: trunk rotation to the left, trunk flexion, side bending to the right) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the right external oblique, which is situated on the lateral and anterior parts of the abdomen, towards trunk extension (action: trunk rotation to the left, trunk flexion, side bending to the right) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the right internal oblique muscle also referred to as the same side rotators, towards trunk extension (action: compresses abdomen; rotate trunk to same side, flex the trunk, lateral trunk bending on same side) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the right internal oblique muscle also referred to as the same side rotators , towards trunk side bending to the left (action: compresses abdomen; rotate trunk to same side, flex the trunk, lateral trunk bending on same side) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the right internal oblique muscle also referred to as the same side rotators , towards trunk rotation the left (action: compresses abdomen; rotate trunk to same side, flex the trunk, lateral trunk bending on same side) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the left internal oblique muscle also referred to as the same side rotators , towards trunk extension (action: compresses abdomen; rotate trunk to same side, flex the trunk, lateral trunk bending on same side) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the left internal oblique muscle also referred to as the same side rotators , towards trunk side bending to the right (action: compresses abdomen; rotate trunk to same side, flex the trunk, lateral trunk bending on same side) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the left internal oblique muscle also referred to as the same side rotators , towards trunk rotation the right (action: compresses abdomen; rotate trunk to same side, flex the trunk, lateral trunk bending on same side) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the transverse abdominal muscle, the most important abdominal muscle for spinal stability, towards trunk extension (action: compress the abdominal contents to stabilize the spine) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the transverse abdominal muscle the innermost of the flat muscles of the abdomen, towards trunk extension (action: compress the abdominal contents to stabilize the spine) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the transverse abdominal muscle, which has fibers running horizontally from the side of the trunk to the front of the trunk, towards trunk extension (action: compress the abdominal contents to stabilize the spine) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the transverse abdominal muscle, the most important abdominal muscle for spinal stability, towards trunk extension (action: compresses the ribs and viscera, providing thoracic and pelvic stability) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the transverse abdominal muscle the innermost of the flat muscles of the abdomen, towards trunk extension (action: compresses the ribs and viscera, providing thoracic and pelvic stability) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the transverse abdominal muscle, which has fibers running horizontally from the side of the trunk to the front of the trunk, towards trunk extension (action: compresses the ribs and viscera, providing thoracic and pelvic stability) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the rectus abdominis muscle a paired muscle running vertically on each side of the anterior wall of the human abdomen , towards trunk extension (action: flexion of trunk/lumbar vertebrae) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the rectus abdominis muscle, which helps in keeping the internal organs intact by creating intra-abdominal pressure, towards trunk extension (action: flexion of trunk/lumbar vertebrae) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the rectus abdominis muscle, which is long, flat and extends along the whole length of the front of the abdomen , towards trunk extension (action: flexion of trunk/lumbar vertebrae) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the rectus abdominis muscles, which are two parallel muscles, separated by a midline band of connective tissue called the linea alba (white line), towards trunk extension (action: flexion of trunk/lumbar vertebrae) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the quadratus lumborum muscle, which connects the pelvis to the spine, towards contralateral side flexion of spine (action: unilateral action lateral flexion of vertebral column; acting bilaterally depression of thoracic rib cage) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the quadratus lumborum muscle , which is tight, short, and overused during prolonged sitting spine, towards contralateral side flexion of spine (action: unilateral action lateral flexion of vertebral column; acting bilaterally depression of thoracic rib cage) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the quadratus lumborum muscle towards contralateral side flexion of spine (action: unilateral action lateral flexion of vertebral column; acting bilaterally depression of thoracic rib cage) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the quadratus lumborum muscle, which constantly contracts while seated , towards contralateral side flexion of spine (action: unilateral action lateral flexion of vertebral column; acting bilaterally depression of thoracic rib cage) to improve activities of daily living involving with the use of the trunk movements.
Progressive resistive exercise/ facilitation of the quadriceps, specifically the vastus medialis, which is important in stabilizing the patella and the knee joint during gait for an effective gait pattern.
Progressive resistive exercise/ facilitation of the knee extensors with emphasis of the rectus femurs to improve gait as it swings the leg forward into the ensuing step since it also acts also a flexor of the hip since it's attached to the ilium.
PRE LE
Progressive manual resistive exercise / facilitation of the psoas major towards flexion and external rotation in the hip joint to facilitate trunk balance when sitting and also to maintain the vertebral column upright to improve mobility involving with the use of the lower extremities.
Progressive resistive exercise (PRE)/ facilitation of the iliacus towards hip flexion to assist in lifting the trunk from a lying position and to improve mobility through the use of the lower extremities.
Progressive manual resistive exercise of / facilitation gluteus maximus towards external rotation and extension of the hip joint to help raise the trunk after stooping in unison with the hamstring muscles to improve mobility with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the gluteus maximus the action of which is to cause the body to regain the erect position after stooping assisted in this action by the hamstring muscles to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE)/ facilitation of gluteus medius the main hip abductor preventing the opposite pelvis from dropping when standing on one leg towards hip abduction to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the gluteus minimus a hip internal rotator and abductor primarily important in supporting the body on one leg towards abduction and internal rotation to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the tensor fasciae latae towards thigh flexion, medial rotation and abduction facilitating stability of the pelvis on the head of the femur when standing to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the quadratus femoris towards external rotation and adduction of thigh to stabilize the femoral head of the hip to its articulation with the acetabulum on the pelvis to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) of the inferior gemellus muscle towards external rotation of thigh to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the piriformis towards hip external rotation to shift the body weight to the opposite side of the foot being lifted avoiding falls to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the sartorius towards hip and knee flexion to facilitate donning and doffing of shoes.
Progressive resistive exercise (PRE) / facilitation of the sartorius towards hip and knee flexion to facilitate donning and doffing of socks to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the sartorius towards hip and knee flexion to facilitate foot care and cutting of toe nails to improve activities of daily living involving with the use of the lower extremities. Progressive resistive exercise (PRE) / facilitation of the rectus femoris muscle towards hip flexion and knee extension which is crucial in the swing phase of gait to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the vastus medialis muscle towards knee extension to prevent excessive lateral displacement of the patella to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the vastus lateralis muscle which is the largest of the quadriceps femoris group of muscles towards knee extension to assist in sit to stand mobility and to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the biceps femoris muscle towards hip extension and knee flexion necessary in lifting the buttocks of the bed in performing lower garment dressing while in bed and to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the pectineus muscle towards hip flexion to facilitate ambulation and stair climbing activities to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the pectineus muscle towards hip flexion to facilitate lower garment dressing activities and to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) of the pectineus muscle towards hip flexion to facilitate donning/doffing of shoes and socks to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the obturator externus muscle towards hip adduction and external rotation necessary for dynamic stability while standing and to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the gracilis muscle towards hip flexion and hip adduction to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the adductor longus muscle of the thigh towards hip adduction to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the adductor brevis muscle of the thigh towards hip adduction to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the adductor magnus muscle of the thigh towards hip adduction to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the adductor group of muscles of the thigh towards hip adduction to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the tibialis anterior muscle towards dorsiflexion and inversion of the foot to facilitate heel strike during the contact phase of gait and to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the tibialis anterior muscle towards dorsiflexion and inversion of the foot to keep the leg vertical even when walking on uneven ground and to to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the tibialis anterior muscle towards dorsiflexion and inversion of the foot necessary to allow the toes to clear the walking surface during the swing phase of gait.
Progressive resistive exercise (PRE) / facilitation of the triceps surae muscle towards plantarflexion of foot to facilitate ambulation during the push off phase of gait.
Progressive resistive exercise (PRE) / facilitation of the gastrocnemius muscle towards plantarflexion of the foot to facilitate ambulation during the push off phase of gait.
Progressive resistive exercise (PRE) / facilitation of the soleus muscle towards plantarflexion of the foot to facilitate ambulation during the push off phase of gait.
Progressive resistive exercise (PRE) / facilitation of the plantaris muscle towards knee flexion and plantarflexion of the foot to facilitate ambulation during the push off phase of gait.
Progressive resistive exercise (PRE) / facilitation of the peroneus longus muscle towards plantarflexion and eversion of the foot at the ankle joint to facilitate the loading response of foot during the contact phase of gait.
Progressive resistive exercise (PRE) / facilitation of the peroneus brevis muscle towards plantarflexion and eversion of the foot at the ankle joint to facilitate the loading response of foot during the contact phase of gait.
Progressive resistive exercise (PRE) of the peroneus longus muscle towards plantarflexion and eversion of the foot at the ankle joint to facilitate the foot flat phase during the contact cycle of gait.
Progressive resistive exercise (PRE) / facilitation of the peroneus brevis muscle towards plantarflexion and eversion of the foot at the ankle joint to facilitate the foot flat phase during the contact cycle of gait.
Progressive resistive exercise (PRE) / facilitation of the toe extensors towards toe extension to allow the toes to clear the walking surface during the swing phase of gait.
Progressive resistive exercise (PRE) / facilitation of the extensor hallucis brevis towards toe extension to allow the toes to clear the walking surface during the swing phase of gait.
Progressive resistive exercise (PRE) / facilitation of the extensor digitorum brevis towards toe extension to allow the toes to clear the walking surface during the swing phase of gait.
Progressive resistive exercise (PRE) / facilitation of the flexor digitorum brevis towards flexion of second to fifth toes to facilitate easier donning of shoe.
Progressive resistive exercise (PRE) / facilitation of the toe flexor muscles located on the plantar surface of the foot towards toe flexion to facilitate donning of shoes/footwear.
Progressive Resistive Exercise (PRE) / facilitation of the splenius capitis towards cervical extension, rotation, and laterally flexion which is essential in cervical motions to improve activities of daily living involving with the use of the neck.
Progressive Resistive Exercise (PRE) / facilitation of the splenius cervices towards ipsilateral rotation and lateral flexion of the neck to improve pull of the head posteriorly to improve activities of daily living involving with the use of the neck.
Progressive resistive exercise (PRE) / facilitation of the left external oblique towards trunk flexion and rotation to the right to facilitate dynamic and static balance
Progressive resistive exercise (PRE) / facilitation of the right external oblique towards trunk rotation to the left to facilitate dynamic and static balance.
Progressive resistive exercise (PRE) / facilitation of the left internal oblique towards trunk flexion and rotation to the left to improve dynamic and static balance to improve activities of daily living involving with the use of the trunk flexion and rotation.
Progressive resistive exercise (PRE) of the right internal oblique towards trunk flexion and rotation to the right to improve dynamic and static balance and to improve activities of daily living involving with the use of the trunk flexion and rotation
Progressive resistive exercise (PRE) / facilitation of the transverse abdominal muscle towards abdominal compression by drawing the belly button towards the spine (vacuum exercise) to improve the stability of the vertebral column to improve activities of daily living involving with the use of the trunk movements.
Progressive resistive exercise (PRE) / facilitation of the transverse abdominal muscle towards abdominal compression by drawing the belly button towards the spine (drawing in maneuver) to improve the stability of the vertebral column to improve activities of daily living involving with the use of the trunk movements.
Progressive resistive exercise (PRE) / facilitation of the rectus abdominis muscle towards trunk flexion to improve posture column to improve activities of daily living involving with the use of the trunk movements.
Progressive resistive exercise (PRE) / facilitation of the quadratus lumborum muscle towards lateral flexion of vertebral column (hip hiking) to reduce the risk of unilateral low back pain and column to improve activities of daily living involving with the use of the trunk movements.
Progressive resistive exercise (PRE) of the levator ani muscles to address urinary incontinence. Progressive resistive exercise (PRE) of the pubococcygeus muscle by making it contract similar to stopping the flow of urine when emptying bladder (Kegel exercises - to be performed when bladder is empty) Progressive resistive exercise (PRE) of the pubococcygenus muscle by performing the Kegel exercises to address urinary incontinence. Progressive resistive exercise (PRE) of the puborectalis muscle by performing pelvic floor muscular contractions similar to when inhibiting defecation crucial to addressing bowel incontinence. Progressive resistive exercise (PRE) of puborectalis muscle by performing pelvic floor muscular contractions similar to when controlling defecation crucial to addressing bowel incontinence. Progressive resistive exercise (PRE) of the coccygeus muscle by performing pelvic floor muscular contractions similar to when inhibiting defecation crucial to addressing bowel incontinence. Progressive resistive exercise (PRE) of coccygeus muscle by performing pelvic floor muscular contractions similar to when controlling defecation crucial to addressing bowel incontinence.
STM LE
Soft tissue mobilization performed with focus on the psoas major area approximately from the transverse processes, bodies and discs of T12-L5 towards the lesser trochanter of the femur to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the iliacus approximately from the iliac fossa towards the lesser trochanter of femur to improve activities of daily living involving with the use of the lower extremities.
Soft tissue mobilization performed with focus on the gluteus maximus from the gluteal surface of ilium, lumbar fascia, sacrum, sacrotuberous ligament towards the the gluteal tuberosity of the femur and iliotibial tract to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the gluteus medius approximately from the gluteal surface of ilium, under gluteus maximus towards the greater trochanter of the femur to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the tensor fasciae latae approximately from the iliac crest towards the iliotibial tract. Soft tissue mobilization performed with focus on the quadratus femoris from the area on top of the Ischial tuberosity towards the intertrochanteric crest to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the superior gemellus approximately from the spine of the ischium towards the obturator internus tendon to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the inferior gemellus approximately from the ischial tuberosity towards the obturator internus tendon to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the piriformis approximately from the sacrum towards the greater trochanter of the femur to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the sartorius approximately from the anterior superior iliac spine a bony prominence in the pelvis towards the pes anserinus on the anteromedial aspect of the tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the rectus femoris muscle approximately from the area surrounding the ilium on the pelvis towards the tibial tuberosity of the tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the quadriceps femoris muscle approximately from the ilium and shaft of the femur towards the tibial tuberosity on the tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the biceps femoris muscle approximately from the ischial tuberosity of the pelvis towards the head of the fibula and lateral tibial condyle to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the semitendinosus muscle approximately from the ischial tuberosity of the pelvis towards the pes anserinus on the tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the pectineus muscle approximately from the superior pubic ramus towards the lesser trochanter and linea aspera of the femur to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the obturator externus muscle approximately from the obturator foramen and obturatory membrane towards the greater trochanter of the femur to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the gracilis muscle approximately from the ischiopubic ramus towards the pes anserinus on the tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the adductor magnus approximately from the pubis of the pelvis towards the femur and tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the adductor longus approximately from the pubis of the pelvis towards the femur and tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the adductor brevis approximately from the pubis of the pelvis towards the femur and tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the tibialis anterior muscles approximately from the body of the tibia towards the medial cuneiform and first metatarsal bones of the foot to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the triceps surae muscle approximately from the end of the femur and upper part of the tibia posteriorly towards the calcaneus of the foot via the Achilles tendon. Soft tissue mobilization performed with focus on the gastrocnemius muscle approximately from the medial and lateral condyle of the femur posteriorly towards the calcaneus of the foot via the Achilles tendon to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the soleus muscle approximately at the upper part of the tibia posteriorly towards the calcaneus of the foot via the Achilles tendon to improve activities of daily living involving with the use of the lower extremities.
Soft tissue mobilization performed with focus on the plantaris muscle approximately from the top of the lateral supracondylar ridge of femur above the lateral head of gastrocnemius towards the tendo calcaneus (medial side, deep to gastrocnemius tendon) on the foot to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the popliteus muscle approximately from the lateral femoral condyle towards the posterior tibia under the tibial condyles to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the peroneus longus muscle approximately from the side of the fibula towards the first metatarsal, medial cuneiform on the foot to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the toe extensors towards approximately from the top of the calcaneus towards the phalanx of the great toe and proximal dorsal region of middle phalanges 2, 3 & 4 to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the flexor digitorum brevis approximately from the calcaneus at the bottom side of the foot towards the phalanges of toes 2 to 5 to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the flexor hallucis brevis approximately from the bottom of the foot on the cuboid bone towards the medial and lateral sesamoid bones of first metatarsal of the foot to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the muscles of the plantar surface of the foot from their origin approximately from the heel and tarsals towards the phalanges of the toes to improve activities of daily living involving with the use of the lower extremities.
STM Torso
Soft tissue mobilization performed to the splenius capitis approximately from the ligamentum nuchae and spinous process of C7-T6 towards its insertion: mastoid process of temporal and occipital bone to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed to the splenius cervices approximately from the spinous processes of vertebrae T3 or T4 to T6 intervening supraspinous ligaments towards the posterior tubercles on the transverse processes of cervical vertebrae C1 to C3 or C4 to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the left external oblique approximately from the top of the left lower eight ribs towards the iliac crest and inguinal ligament to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the right external oblique approximately from the top of the right lower eight ribs towards the iliac crest and inguinal ligament to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the left internal oblique approximately from the thoracolumbar fascia, anterior two-thirds of the iliac crest, and lateral half of the inguinal ligament towards the inferior border of the 10-12th ribs, linea alba, and the pubis via the conjoint tendon to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the right internal oblique approximately from the thoracolumbar fascia, anterior two-thirds of the iliac crest, and lateral half of the inguinal ligament towards the inferior border of the 10-12th ribs, linea alba, and the pubis via the conjoint tendon to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the transverse abdominal muscle approximately from the iliac crest, inguinal ligament, lumbar fascia, and cartilages of inferior six ribs towards the xiphiod process, linea alba, and pubis (pelvis) to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the rectus abdominis muscle approximately from the pubis a part of the pelvis towards the costal cartilage of ribs 5 to 7, and xiphoid process of sternum to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the quadratus lumborum muscle approximately from the top on the iliac crest and iliolumbar ligament towards the last rib and transverse processes of lumbar vertebrae to improve activities of daily living involving with the use of the trunk musculature.
thoracic
§ Progressed home exercise program to dynamic breathing exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - cervical / thoracic exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic manual range of motion - Spine Progressed home exercise program to extension exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic manual range of motion - spine extension exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic lengthening - extension / pectoral lengthening exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic manual range of motion - side lengthening exercise x 6 seconds hold x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic manual range of motion - rotation exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic lengthening exercise x 7secs hold, 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic manual range of motion - side bends exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic lengthening - supine extension exercise x 7 secs. Hold x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic lengthening - vertebral exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic muscle strengthening - latissimus (tubing row) exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic muscle strengthening- triceps / latissimus (tubing pull for extension) exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic muscle lengthening - lateral shoulder exercise x 5-10 repetitions for 2 sets, 2-3 times daily § thoracic Care Tips Muscle o back § Progressed home exercise program to muscle lengthening / flexion - gluteals / low back exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening / flexion - gluteals / low back exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abdominals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abdominals / gluteals exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abdominals / shoulder (lumbar stabilization) exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abdominals / shoulder (flexion) exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abdominals / thigh muscles (Lower extremity - flexion) exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - Mobilization - low back extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to extension - prone relaxation exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion / muscle lengthening - back extension exercise x 7 secs hold x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening / strengthening - back extension manual range of motion - low back extension exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening- low back extension exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - lumbar / hip exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - Sacroiliac exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - Sidelying lumbar exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - piriformis exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily
o knee § Progressed home exercise program to knee extension / muscle strengthening - quadriceps exercise x hold 8 repetitions for 2 sets, 2 times daily § Progressed home exercise program to knee flexion / muscle strengthening - quadriceps exercise x 5-10 repetitions for 2 sets, 2 times daily § Progressed home exercise program to knee manual range of motion - knee muscle lengthening exercise x 10 repetitions for 2 sets, 3 times daily § Progressed home exercise program to knee manual range of motion - prone knee muscle lengthening exercise x 10 repetitions for 2 sets, 3 times daily § Progressed home exercise program to knee muscle strengthening - hamstrings (prone heel-to-Buttocks lengthening) exercise x 8 repetitions for 2 sets, 2 times daily § Progressed home exercise program to knee muscle strengthening- hip flexion / quadriceps exercise x 8 repetitions for 2 sets 2 times daily § Progressed home exercise program to knee muscle strengthening - quadriceps exercise x 10 repetitions for 2 sets 2 times daily § Progressed home exercise program to knee muscle strengthening - hip adduction (isometric) exercise x 5-10 repetitions for 2 sets, daily § Progressed home exercise program to knee muscle strengthening - quadriceps exercise x 7secs. hold 7 repetitions for 2 sets, 2 times daily § Progressed home exercise program to knee muscle lengthening - quadriceps exercise x 7secs. hold 6 repetitions for 2 sets, 2 times daily § Progressed home exercise program to knee muscle lengthening - hamstring exercise x 7secs. hold 6 repetitions for 2 sets, 3 times daily § Progressed home exercise program to knee muscle strengthening - hamstring exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to knee partial squat vastus medialis oblique (VMO) muscle exercise x 12repetitions for 2 sets, 3 times daily § Progressed home exercise program to knee pillow squeeze on vastus medialis Oblique (VMO) exercise x 7secs. hold 5repetitions for 1 set, 3 times daily § Progressed home exercise program to knee manual range of motion - heel prop exercise x 10 repetitions for 2 sets, 2 times daily § knee Care Tips o Total knee § Progressed home exercise program to manual range of motion - ankle § Progressed home exercise program to knee muscle strengthening - quadriceps (isometric) exercise § Progressed home exercise program to knee muscle strengthening - hamstrings (isometric) exercise § Progressed home exercise program to Progressed home exercise program to knee muscle strengthening - quadriceps with hip flexion exercise § Progressed home exercise program to knee muscle strengthening - quadriceps with hip flexion exercise § Progressed home exercise program to manual range of motion - knee exercise § Progressed home exercise program to knee muscle lengthening - hamstrings exercise § Progressed home exercise program to manual range of motion - knee flexion exercise § Progressed home exercise program to knee muscle strengthening - hamstrings with knee flexion exercise § Progressed home exercise program to knee strengthening - hamstrings / gluteals with hip / knee flexion exercise § Progressed home exercise program to knee muscle strengthening - quadriceps with hip flexion exercise § Progressed home exercise program to muscle strengthening - hip abduction exercise § Progressed home exercise program to strengthening- hip adduction exercise § Progressed home exercise program to knee muscle strengthening - quadriceps exercise § Progressed home exercise program to Range of Motion exercise § Progressed home exercise program to knee manual range of motion - sitting knee flexion exercise § Progressed home exercise program to knee manual range of motion - sitting knee flexion exercise § Progressed home exercise program to knee manual range of motion - sitting knee flexion exercise o hip § Progressed home exercise program to hip muscle lengthening - gluteals / low back exercise x 7secs. hold 6 repetitions for 1 sets, 2-3 times daily § Progressed home exercise program to hip muscle lengthening - piriformis / hip external rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle lengthening - hip adduction exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip manual range of motion - hip Internal / external rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle lengthening / manual range of motion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip manual range of motion / muscle lengthening - trunk rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion / muscle lengthening - hip exercise § Progressed home exercise program to hip muscle strengthening - gluteals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle strengthening - hip abduction exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle strengthening - hip Progressed home exercise program to flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle lengthening - hip flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle strengthening - gastrocnemius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip Long Axis Distraction (Passive) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle lengthening - Iliotibial Band exercise (supine) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle lengthening - Iliotibial Band standing exercise § Progressed home exercise program to hip/pelvic bridging level 1 (Pelvic lifts)exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 2 Pelvic Lifts with hold) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 3 (Pelvic Lifts with sway) exercise pelvic bridging x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 4 (Pelvic lifts with Bobath tech at 180 deg) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 5 (more decreased angle of knees) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 6 (Stronger LE in FABER position on top of weaker side) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 7 (Stronger LE crossed on top of the weaker side) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 8 exercise Stronger LE in SLR position x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § hip Care Tips o Total hip § Progressed home exercise program to muscle strengthening - quadriceps exercise § Progressed home exercise program to muscle strengthening - gluteals exercise § Progressed home exercise program to strengthening - quadriceps exercise § Progressed home exercise program to manual range of motion - ankle exercise § Progressed home exercise program to Range of Motion exercise § Progressed home exercise program to Progressed home exercise program to muscle lengthening / manual range of motion exercise § Progressed home exercise program to muscle strengthening - abduction exercise § Progressed home exercise program to muscle strengthening - Internal / external rotation exercise § Progressed home exercise program to manual range of motion - shoulder exercise § Progressed home exercise program to muscle strengthening - biceps / triceps exercise § Progressed home exercise program to muscle strengthening - finger flexion exercise § Progressed home exercise program to muscle strengthening - triceps / quadriceps exercise § Progressed home exercise program to muscle strengthening - abduction exercise § Progressed home exercise program to muscle strengthening - gluteals exercise § Progressed home exercise program to muscle strengthening - hamstrings with knee flexion exercise § Progressed home exercise program to muscle strengthening - hip flexion exercise § Progressed home exercise program to Progressed home exercise program to muscle strengthening- hip abduction exercise § Progressed home exercise program to muscle strengthening - gluteals exercise o ankle / foot § Progressed home exercise program to Amanual range of motion - Toe flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Amanual range of motion - Interossei exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Pmanual range of motion (lengthening) - Toe flexion / extension (Passive) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Amanual range of motion - ankle dorsi / plantar flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Amanual range of motion - ankle Inversion / Eversion (Side Bends) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Amanual range of motion - ankle Inversion / Eversion & dorsi / plantar flexion (Circumduction) exercise § Progressed home exercise program to muscle strengthening - ankle plantar / dorsiflexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Intrinsics (muscles of Arch) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - ankle Inversion / Eversion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - plantar Fascia exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - Soleus exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - gastrocnemius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - dorsiflexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Eversion (isometric) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Eversion (Resistive) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Inversion (Resistive) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - plantar flexion (Resistive) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - dorsiflexion (Resistive) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - inversion (isometric) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § · Mobility o sitting § Progressed home exercise program to muscle strengthening - hamstrings / quadriceps exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - gluteals / Adductors exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - triceps / gluteals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - lateral trunk exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - quadriceps exercise § Progressed home exercise program to muscle strengthening - hip flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - lumbar extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - Suboccipital (Axial extension) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - upper trapezius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion - Shoulders exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - dorsi / plantar flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily
o sitting to standing § breathing exercise § Progressed home exercise program to manual range of motion - trunk exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - hip extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - triceps exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - quadriceps exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Toe extension / manual range of motion - plantar flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion - trunk exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - shoulder x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily o o Gait § Progressed home exercise program to muscle strengthening - ankle dorsi / plantar flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - gastrocnemius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - hip flexion / extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - hip abduction exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - hip extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion - hip flexion / extension & abduction / adduction exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion / lengthening - hip Internal / external rotation & low back rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - ankle dorsi / plantar flexion exercise § Progressed home exercise program to proprioception/ kinesthetic activities exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception / Kinesthetic Activities/ coordination exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Big Stepping without swaying exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - hip adduction & innternal rotation exercise § Progressed home exercise program to proprioception/ kinesthetic activities - trunk Weight Shift exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Arm Swings exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to knee straighteners exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily
o balance § Progressed home exercise program to manual range of motion / lengthening - low back / gluteals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to abductionominals / back extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - ankle dorsi / plantar flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § muscle lengthening - gastrocnemius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/Kinesthetic Activities - One-Legged Stands exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - One-Legged Stands Eyes Closed exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/Kinesthetic Activities- Toe Stands exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - heel Stands exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - Head Tilts exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - Head Tilts Up and Down x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - Two-Legged standing rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - Head Motion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - Eye Motion exercise § Progressed home exercise program to proprioception/ kinesthetic activities - Grapevine exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - High Stepping exercise § Progressed home exercise program to Walking Head Turns exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Walking Figure Eights exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Semi Tandem standing exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Tandem standing exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to balance / proprioception / kinesthetic activities exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - thigh / leg musculature exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - low back / abductionominals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § o Flexibility § Progressed home exercise program to muscle lengthening - cervical extension / flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - cervical Side Bends / flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § M Progressed home exercise program to muscle lengthening - trapezius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - levator shoulder x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - shoulder flexion / extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - trunk Side Bends exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - thoracic rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - cervical / thoracic extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - hamstring / low back extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - gluteals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - thoracic / lumbar exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - hamstring / low back extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - hip flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - gastrocnemius x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - shoulder extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Amanual range of motion / lengthening - ankle muscles exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - low back / thoracic / cervical exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - hip / low back rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - Full Body exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - hamstring exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - piriformis / gluteals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily
o Posture § Progressed home exercise program to muscle lengthening - cervical exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion - cervical exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion - cervical exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - upper trapezius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Scapular protraction / retraction exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Scapular protraction / retraction exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - rhomboid exercise progressed home exercise program to muscle lengthening - trunk exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abdominals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - lumbar exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - gluteals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion - shoulder exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception / strengthening- plantar flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - back extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Scapular retractionor exercise
o breathing § Quick Test § Deep Effective Breaths exercise § lengthening - shoulder Girdle Intercostals exercise § shoulder protraction / retraction exercise § Heavyweight breathing exercise § Posture Awareness § Pursed Lip breathing exercise § breathing Tips o strengthening Regimen § Progressed home exercise program to muscle strengthening - biceps brachii exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - triceps brachii exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - anterior deltoids / biceps exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - finger flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - pectorals / triceps exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abductionominals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - quadriceps exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - quadriceps/gluteals x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - gastrocnemius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abductionominals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening- Pubococcygeus muscle exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening Training Tips · Special Conditions o Osteoporosis § Progressed home exercise program to muscle strengthening - thoracic / lumbar extension exercise § Progressed home exercise program to muscle strengthening - rhomboid exercise § Progressed home exercise program to muscle lengthening - Suboccipital (Axial extension) exercise § M Progressed home exercise program to uscle lengthening - shoulder retraction exercise § Progressed home exercise program to muscle lengthening - shoulder flexion exercise § muscle lengthening - thoracic / lumbar extension exercise § Progressed home exercise program to muscle strengthening - gluteals (isometric) exercise § Progressed home exercise program to muscle strengthening - quadriceps exercise § Progressed home exercise program to muscle strengthening – gastrocnemius exercise § Progressed home exercise program to muscle lengthening - Gastrocnemius-Soleus exercise § Progressed home exercise program to muscle strengthening - triceps exercise § Progressed home exercise program to muscle lengthening - Corner exercise § Progressed home exercise program to muscle lengthening - Body Extender (Arms Down) exercise § Progressed home exercise program to muscle strengthening - trunk / lateral shoulder muscles & pectorals exercise § Progressed home exercise program to muscle strengthening - trunk /forearm / shoulder muscles exercise o Arthritis § Deep breathing § Amanual range of motion - Suboccipital muscles (Axial extension) exercise § Amanual range of motion - cervical muscles exercise § Amanual range of motion - upper trapezius / rhomboid / levator / scapulae / mid trapezius exercise § Amanual range of motion - finger flexion & extension exercise § Amanual range of motion - wrist flexion & extension exercise § Amanual range of motion - forearm supination & pronation exercise § Amanual range of motion - biceps (elbow flexion) exercise § Amanual range of motion - shoulder flexion (deltoids & biceps) exercise § Amanual range of motion - shoulder Horizontal abductionuctors / retractionors exercise § Amanual range of motion - spinal Side Bender muscles exercise § Amanual range of motion - spinal rotation exercise § Amanual range of motion - spinal extension exercise § Amanual range of motion / strengthening - quadriceps exercise § manual range of motion / strengthening - hip abduction / adduction exercise § muscle strengthening - gluteals exercise § Amanual range of motion - ankle dorsi / plantar flexion exercise § Amanual range of motion - Toe flexion exercise o Lower extremity Amputee § Amanual range of motion - trunk extension exercise § Amanual range of motion - quadriceps extension exercise § hip flexion (Active / Resistant) exercise § trunk extension (isometric) § muscle strengthening - abductionominals (isometric) exercise § muscle strengthening - hip extension (isometric) exercise § muscle strengthening - hip adduction (isometric) exercise § muscle strengthening - hip adduction (isometric) exercise § muscle strengthening - gluteals (isometric) exercise § muscle lengthening / strengthening - Full Body (isometric) exercise § muscle strengthening - gluteals exercise § muscle strengthening - gluteals / abductionominals exercise § manual range of motion - hip abduction exercise § muscle lengthening - hip flexion exercise o Parkinson § Deep breathing § muscle lengthening - suboccipital (Axial extension) exercise § manual range of motion - knee / ankle / foot exercise § muscle lengthening - lumbar / hip exercise § manual range of motion - hip / knee / ankle exercise § muscle strengthening - hip flexion § muscle strengthening- dorsiflexion § balance / proprioception - The Grapevine exercise § standing Rocks exercise § standing Side Rocks exercise § manual range of motion - trunk exercise § manual range of motion - hand / wrist exercise § manual range of motion - finger opposition § manual range of motion - cervical exercise § strengthening- upper trapezius exercise § Face exercises § anterior Pelvic Tilt (supine) § strengthening- gluteals / quads / trunk / triceps § Postural strengthening § manual range of motion - trunk (supine) o Stroke § muscle strengthening - hip / knee flexion exercise § muscle strengthening - rhomboid / pectorals exercise § muscle strengthening - lateral cervical flexion exercise § balance / proprioception exercise § muscle strengthening- quadriceps exercise § manual range of motion - ankle exercise § muscle strengthening - gluteals (isometric) exercise § muscle strengthening - quadriceps exercise § manual range of motion - hip adduction exercise § sitting Weight Shift exercise § muscle strengthening - quadriceps exercise § muscle strengthening - quadriceps / gluteals exercise § muscle strengthening - hip abduction exercise § manual range of motion - upper extremity Reach exercise § manual range of motion - supine Reach exercise § manual range of motion - supine Reach (Advanced) exercise § manual range of motion - Scapulo-Humeral (standing) exercise § Weight Bearing hand Sit exercise § muscle strengthening - Scapular Stabilateralizer exercise § muscle strengthening - Scapular Stabilateralizer (Advanced) exercise § muscle strengthening - wrist extension exercise § Muscular (Movement) coordination exercise § muscle strengthening- forearm supination / pronation exercise § Arm Movements (Supported) exercise § Weight Shift - Involved Side exercise § Weight Shift - Forward upper Body: scapulae exercise § Weight Shift - Forward upper Body exercise § Weight Shift - Forward upper Body(Advanced) exercise § Muscular (Movement) coordination - Lower extremity exercise
§ Geriatrics exercises § 1. AAmanual range of motion elbow flexion w/cane (cane assist biceps curl) § 2. AAmanual range of motion hip hike unilateral stand w/elastic (Elastic assist hip hike) § 3. AAmanual range of motion hip/knee flexion (heel slides) w/person (Caregiver heel slides) § 4. AAmanual range of motion shoulder ER bilateral supine w/cane abduction (cane assist overhead twist) § 5. AAmanual range of motion shoulder ER bilateral supine w/cane neutral (cane assist arm out) § 6. AAmanual range of motion shoulder IR w/cane (cane assist behind back lift) § 7. Amanual range of motion alt arms supine hooklying (Hooklying alternating front raises) § 8. Amanual range of motion ankle DF bilateral stand (Toe raise) § 9. Amanual range of motion ankle DF/PF (not elevationated) (ankle pump) § 10. Amanual range of motion ankle PF bilateral stand (Double heel raise) § 11. Amanual range of motion cervical retraction (chin tuck) supine (supine chin tuck) § 12. Amanual range of motion cervical rot supine (supine neck turn) § 13. Amanual range of motion cervical sidebending supine (supine neck sidebend) § 14. Amanual range of motion elbow ext stand (triceps kickbacks) (standing triceps kickback) § 15. Amanual range of motion elbow flexion/ext (biceps curl) § 16. Amanual range of motion elbow flexion/ext (arms abduction) in Pool (Pool scarecrow) § 17. Amanual range of motion Face cheek elevation (Cheek squeeze) § 18. Amanual range of motion Face forehead elevation (Eyebrow raise) § 19. Amanual range of motion Face grimace (Grimace) § 20. Amanual range of motion Face mouth/lip compression (Purse lip) § 21. Amanual range of motion Face neck depression (Platysma) (Platysma drill) § 22. Amanual range of motion finger walk (finger walk) § 23. Amanual range of motion gait crossovers (Crossovers) § 24. Amanual range of motion gait toe to toe walk (heel toe walk) § 25. Amanual range of motion gait walking (Walking) § 26. Amanual range of motion hand cane balance (cane balance) § 27. Amanual range of motion hip abduction bilateral supine (Leg angels) § 28. Amanual range of motion hip abduction unilateral sidelying w/person (eccentrics) (Leg raise eccentrics) § 29. Amanual range of motion hip abduction unilateral stand (Side leg kickout) § 30. Amanual range of motion hip abduction unilateral supine (supine side leg) § 31. Amanual range of motion hip ER sit (sitting leg in) § 32. Amanual range of motion hip ER/IR supine bilateral (supine double hip rotations) § 33. Amanual range of motion hip ext prone knee bent (Bent knee kickback) § 34. Amanual range of motion hip ext prone straight leg (prone leg raise) § 35. Amanual range of motion hip ext stand knee straight (Straight leg mule kick) § 36. Amanual range of motion hip flexion (sitting SLR) (sitting SLR) § 37. Amanual range of motion hip flexion (SLR) supine knee bent (Straight leg raise) § 38. Amanual range of motion hip flexion alt on Ball (Ball marching) § 39. Amanual range of motion hip flexion alt sit (Seated march) § 40. Amanual range of motion hip flexion sit (Seated knee lift) § 41. Amanual range of motion hip flexion stand bent knee (Chair march) § 42. Amanual range of motion hip hike supine (supine hip hike) § 43. Amanual range of motion hip hike unilateral stand (hip hike) § 44. Amanual range of motion hip marching (Seated marching) § 45. Amanual range of motion hip marching on Ball (Marching on ball) § 46. Amanual range of motion hip marching w/ alt arms (Seated leg/arm marching) § 47. Amanual range of motion hip marching w/alt arms on Ball (Marching arm salute on ball) § 48. Amanual range of motion hip/knee flexion (heel slides) (heel slides) § 49. Amanual range of motion hip/knee stance unilateral (clock reach) (Clock reach) § 50. Amanual range of motion knee ext (long arc quads) sit (Long arc) § 51. Amanual range of motion knee ext (short arc quads) sit (short arc) § 52. Amanual range of motion knee flexion prone (prone ham curl) § 53. Amanual range of motion knee flexion sit to stand (Sit to stand) § 54. Amanual range of motion knee marching (standing high step) § 55. Amanual range of motion knee partial lunge (short lunge) § 56. Amanual range of motion knee wall slide bilateral partial (Partial wall slide) § 57. Amanual range of motion kneel, half kneel, stand (kneel to half kneel to stand) § 58. Amanual range of motion lumbar alt leg/arm (bird dog) (Bird dog) § 59. Amanual range of motion lumbar bridging bilateral (bridging) § 60. Amanual range of motion lumbar bridging unilateral (Single leg bridge) § 61. Amanual range of motion lumbar ext prone (elbow press ups) (prone elbow press up) § 62. Amanual range of motion lumbar ext prone low level (prone back extend) § 63. Amanual range of motion lumbar ext quadruped (cat) (Cat) § 64. Amanual range of motion lumbar ext standing (standing back extension) § 65. Amanual range of motion lumbar flexion bilateral knee to chest (Double knee to chest (DKC)) § 66. Amanual range of motion lumbar flexion bilateral knee to chest hooklying (Single knee to chest hooklying) § 67. Amanual range of motion lumbar flexion quadruped (camel) (kneeling camel) § 68. Amanual range of motion lumbar flexion unilateral knee to chest (Single knee to chest (SKC)) § 69. Amanual range of motion lumbar lying prone arms up (prone prop up on pillow) § 70. Amanual range of motion lumbar rotation sit (sitting trunk twist) § 71. Amanual range of motion lumbar rotation supine (supine knee side to side) § 72. Amanual range of motion lumbar side to side sit on Ball (sitting side tilt on ball) § 73. Amanual range of motion lumbar side bend pushup (Side bend push up) § 74. Amanual range of motion shoulder abduction (finger walking) at wall (shoulder finger side walk up) § 75. Amanual range of motion shoulder abduction/adduction (cradle rock) (Cradle rock) § 76. Amanual range of motion shoulder abduction/adduction overhead w/cane (Overhead cane side to side) § 77. Amanual range of motion shoulder circles (choo-choo) (Choo choo) § 78. Amanual range of motion shoulder circles supine w/cane (cane circles) § 79. Amanual range of motion shoulder circum bilateral (Arm circles) § 80. Amanual range of motion shoulder elevation/retraction bilateral (shoulder rolls) (shoulder rollbacks) § 81. Amanual range of motion shoulder flexion (finger walking) at wall (Forward arm wall walk) § 82. Amanual range of motion shoulder flexion bilateral w/cane (cane double front arm raise) § 83. Amanual range of motion shoulder flexion bilateral w/cane (shoulder press) (cane overhead press) § 84. Amanual range of motion shoulder horizontal abduction/adduction stand w/cane (Front cane side reach) § 85. Amanual range of motion shoulder horizontal abduction/adduction supine w/cane (cane dance) § 86. Amanual range of motion shoulder IR w/cane (Behind back cane lift) § 87. Amanual range of motion shoulder ladductioner (shoulder ladductioner) § 88. Amanual range of motion shoulder overhead press bilateral (Double overhead press) § 89. Amanual range of motion shoulder pendulum (shoulder pendulum) § 90. Amanual range of motion shoulder press up bilateral w/cane (cane press up) § 91. Amanual range of motion shoulder retraction bilateral stand hands at neck (Open fly stretch) § 92. Amanual range of motion shoulder retraction/thoracic ext - Sun Salute (Sun salute) § 93. Amanual range of motion shoulder retraction ion w/cane (cane backward lift) § 94. Amanual range of motion shoulder touches (shoulder touches) § 95. Amanual range of motion shoulder/wrist rotation bilateral stand w/cane (cane shoulder twist) § 96. Amanual range of motion shoulder/wrist rotation bilateral supine w/cane (cane twister) § 97. Amanual range of motion thoracic breathing overhead arms supine (Overhead arm breath) § 98. Amanual range of motion thoracic diaphragm breathing (Reclined diaphragm breathing) § 99. Amanual range of motion thoracic ext supine (mid back arch) § 100. Amanual range of motion thoracic mid chest expansion (mid chest breathing) § 101. Amanual range of motion thoracic rotation diag (Seated trunk diagonal) § 102. Amanual range of motion thoracic rotation w/cane (sitting trunk twist with dowel) § 103. Amanual range of motion thoracic sidebend (sitting side bend) § 104. Amanual range of motion thoracic upper chest expansion (upper chest breathing) § 105. Amanual range of motion thumb CMC circum (thumb circles) § 106. Amanual range of motion thumb/finger opposition (thumb to finger touch) § 107. Amanual range of motion toe intrinsics (Toe intrinsics) § 108. Amanual range of motion trunk flexion supine w/ball (Static abdominal crunch w/ball) § 109. Amanual range of motion vestib standing balance (dynamic) (Feet together standing balance) § 110. Amanual range of motion vestib standing balance w/stride (standing stride balance) § 111. Amanual range of motion wrist circles (wrist circles) § 112. Amanual range of motion wrist sup/pron (wrist twist) § 113. Grav- shoulder protract/retraction (Seated shoulder punch) § 114. Grav- wrist flexion/ext (wrist side to side) § 115. Iso ankle DF (isometric supine foot lift) § 116. Iso cervical flexion (isometric forward neck push) § 117. Iso cervical rotation (isometric neck twist push) § 118. Iso cervical sidebend (isometric side neck push) § 119. Iso hip abduction sit w/belt (isometric hip out) § 120. Iso hip adduction sit w/pillow (Seated leg squeeze) § 121. Iso hip gluteal sets (prone glut set) § 122. Iso hip gluteal sets supine (supine glut sets) § 123. Mob thoracic ext (Wall angel) § 124. Mob thoracic sidebend/rot/ext sit (sitting thoracic extend and twist) § 125. Pmanual range of motion ankle circum w/person (Caregiver ankle circles) § 126. Pmanual range of motion ankle inv/ever w/person (Caregiver passive ankle side to side) § 127. Pmanual range of motion hip IR/ER w/flexed leg w/person (Caregiver flexed hip rotations) § 128. Pmanual range of motion hip IR/ER w/straight leg w/person (Caregiver hip rotations) § 129. Pmanual range of motion hip/knee flexion (heel slides) w/person (Caregiver passive heel slides) § 130. Pmanual range of motion shoulder abduction w/person (Caregiver passive side arm lift) § 131. Pmanual range of motion shoulder adduction w/person (Caregiver passive arm across) § 132. Pmanual range of motion shoulder ext w/person (Caregiver passive arm pull back) § 133. Pmanual range of motion shoulder flexion w/person (Caregiver passive arm lift) § 134. Pmanual range of motion shoulder horizontal adduction w/person (Caregiver passive arm crossover) § 135. Pmanual range of motion shoulder IR/ER w/person (Caregiver arm rotation) § 136. Resist ankle DF w/elastic (Elastic ankle pull up) § 137. Resist ankle ever bilateral w/elastic (Elastic double ankle pull out) § 138. Resist ankle inv w/elastic (Elastic ankle pull in) § 139. Resist ankle PF unilateral w/ elastic (Tubing gas pedal) § 140. Resist Diaphragmatic breathing w/wt. (Weighted abdominal lift) § 141. Resist finger flexion grip w/putty (Putty finger squeeze) § 142. Resist finger flexion intrinsics w/putty (Putty fingertip squeeze) § 143. Resist finger intrinsics w/putty (Putty taffy pull) § 144. Resist hand gross opposition w/putty (Putty finger grab) § 145. Resist hand key pinch w/putty (Putty key pinch) § 146. Resist hand three jaw chuck pinch w/putty (Putty three jaw chuck) § 147. Resist hip flexion (sitting SLR) w/wt (Weight seated SLR) § 148. Resist hip flexion sit w/elastic (Elastic march) § 149. Resist hip/knee flexion (heel slides) supine w/elastic (Elastic supine heel slide) § 150. Resist knee bike upright (Upright bike) § 151. Resist knee press w/elastic (Elastic seated leg press) § 152. Resist knee w/Recumbent Stepper (Recumbent stepper) § 153. Resist lumbar ext sit w/elastic (Elastic sitting lean back) § 154. Resist lumbar ext stand w/elastic (Elastic back pull back) § 155. Resist lumbar flexion sit w/elastic (Elastic sitting crunch) § 156. Resist lumbar rotation supine w/elastic (supine elastic back twist) § 157. Resist lumbar sidebend w/elastic (Elastic trunk sidebend) § 158. Resist lumbar sidebend w/wt (DB trunk sidebend) § 159. Resist shoulder diagonal D1 ext w/elastic (Elastic shoulder diagonal down and out) § 160. Resist shoulder diagonal D1 flexion w/elastic (Elastic shoulder inward crossover) § 161. Resist shoulder diagonal D2 ext w/elastic (Elastic shoulder diagonal down and in) § 162. Resist shoulder diagonal D2 flexion w/elastic (Elastic diagonal up and out) § 163. Resist shoulder elevation/retraction bilateral w/elastic (shoulder rolls) (Elstic shoulder shrugs) § 164. Resist shoulder ER bilateral w/elastic (Tubing double outward arm) § 165. Resist shoulder flexion bilateral w/elastic (Elastic double front arm raise) § 166. Resist shoulder horizontal abduction bilateral w/elastic (Elastic reverse flies) § 167. Resist shoulder overhead press bilateral w/wt (DB double overhead press) § 168. Resist stance heel/toe w/crosspull w/elastic (heel toe elastic pull) § 169. Resist stance unilateral w/crosspull w/elastic (One leg balance with elastic) § 170. lengthening finger flexors (finger table stretch) § 171. lengthening Gastroc sit w/person (Caregiver calf stretch) § 172. lengthening Gastroc sit w/towel (sitting Gastroc towel stretch) § 173. lengthening Gastroc unilateral standing (Runner stretch) § 174. lengthening hamstring sit w/person (Caregiver hamstring stretch) § 175. lengthening hamstrings supine active (Kick up hamstring stretch) § 176. lengthening hamstrings supine w/towel (Towel hamstring stretch) § 177. lengthening hip adductionuctor stand w/chair (Inside leg chair stretch) § 178. lengthening hip flexors leg abduction supine (Off table hip stretch) § 179. lengthening lumbar rotation supine w/person (Caregiver trunk twist) § 180. lengthening Pectoral standing bilateral at door (Pectoral door stretch) § 181. lengthening Pectoral standing unilateral (Side Pectoral stretch) § 182. lengthening quads sit (sitting Quad stretch) § 183. lengthening quads standing (standing Quad stretch) § 184. lengthening rhomboids/trapezius (sitting rhomboid stretch) § 185. lengthening shoulder blade pinch supine (anterior chest stretch) § 186. lengthening shoulder flexion at wall (Arm up shoulder wall stretch)
Allen's Cognitive Levels
Level I (Automatic Actions) Conscious to the external environmental is minimal. characterized by automatic motor responses and changes in the autonoic nervous system.
Level II (Postural Actions) PROP cues. Poor imitation of posture. unable to imitate the running stitch, three stitches.
Level III (Manual Actions) Repetitive Training. Recognize family & friends. Able to complete basic self-care tasks if VERBAL reminders are provided. Sanding. Follow simple directions: "Squeeze my hands" or "Look at me." Able to imitate the running stitch, three stitches.
Level IV (Goal-Directed Actions) VISUAL cues. Can carry out established routines but cannot cope w/ unexpected events. Matching colors of clothing, step by step illustrated directions, engage in simple activities (self-feeding and dressings), learn new skills by imitating a model or demonstration. Provide project samples for clients to dublicate. Able to imitate the whipstitch, three stitches.
Level V (Exploratory Actions) Understand cause and effect. New learning occurs. Overt trial and error problem solving. Can performa a task involving 3 familiar steps and a new one, plan a 3 course meal. Able to imitate the single cordovan using overt trial and error methods, three stitches.
Level VI (Planned Actions) SYMBOLIC cues. Can do mental trial and error problem solving. 30 mins of attention spane, aware of month, time, & year, ADL with min A, ability to recognize errors, written directions for the clients to follow. Able to imitate the single cordovan stich using covert trial and error methods, three stitches.
>approach the chair with firm steps, at good pace; • make a wide turn in front of the chair and stop straight in front of the chair: you must have the feeling that you walk around something (first, practice this, for example, with a cone in front of the chair, later without the cone); if necessary, turn at the rhythm of the cue you already used when you were approaching the chair; • place your calf or back of the knee against the seat; • bend slightly forward and bend through the knees, keep your weight well above your feet; • move with your hands towards the arms of the chair or the seat, seek for support with your arms; • lower yourself in a controlled manner; sit down well, at the back of the chair.
• place your hands on the arms or the side of the seat; • move your feet towards the chair (just in front of the chair legs, two fists apart); • shift your hips to the edge of the chair; • bend your trunk (not too far, nose above the knees); • rise gently, from your legs, let your hands lean on the arms of the chair, the seat or your thighs, and then extend your trunk completely (if necessary, make use of a visual cue). In case of starting problems rock back and forth a few times and rise at the third count.
Rest after the fall • turn from lying, through side-sit (pushing up the trunk with hetero-lateral arm and homo-lateral elbow support), to the position on hands and knees; • crawl to an object to pull yourself up (for example chair, bed); • bend the strongest leg and place the opposite arm on the object (rifleman’s position); • push yourself up with legs and arms.
It is advisable to slide the covers to the foot of the bed first (like an accordion); the top of the cover points in the direction of the head of the bed, so it can be pulled easily over the patient. For aids and other provisions (for instance, a bed adjustable in height) the working group refers to an occupa- tional therapist. 84 V-19/2004 KNGF Guidelines for physical therapy in patients with Parkinson’s disease
• approach the bed with firm steps, possibly with the use of a rhythmical cue , and make a wide turn in front of the bed (not over one leg), and walk at a good pace until you feel the bedside with your calf or back of your knee; • sit down on the edge of the bed (be sure there is enough distance to the pillow); • lower the upper part of the body in the direction of the pillow, and place the weight on the elbow; • lift the legs one by one into the bed so that you are lying on your side; • grab the covers with your free arm; • lower the upper part of the body onto the mattress and try to lie comfortably by moving your backside; • pull the covers over the body.
• approach the bed forwards with firm steps, if necessary make use of a rhythmical cue; • bend forward, lean with your hands on the mattress and crawl onto it in such a way that you are positioned on your knees, lengthwise, at the middle of the mattress; • lie down on your side (be sure there is enough distance to your pillow); • grab the covers with your free arm and pull them over your body.
• approach the bed forwards with firm steps, if necessary make use of a rhythmical cue, make a wide turn in front of the bed (not over one leg), and walk at good pace until you feel the bedside with your calf or back of your knee; • sit down on the bed, with sufficient distance and in diagonal direction to the pillow, with the arms as back- ward support; • place your legs, one by one, on the mattress, turn until you are lengthwise on the mattress; • grab the covers at the end of the bed, slide your feet under the covers; • lower yourself quietly until you are lying on your back, hold on to the covers and pull them over your body.
Smooth sheets (satin) or satin pyjamas make sliding or turning easier. Socks can give more grip on the sheets and, with that, make turning easier.
• move the cover to the side opposite to the one you want to turn to; • lift the cover with your arms and pull up your knees while you are lying on your back, put your feet flat on the bed; • move your body to the side, alternating with your feet, your pelvis, and your head and shoulders, in the opposite direction of the turn; • place your arm which is on the side you want to turn to next to your head, then turn your head and shoul- ders, use your free arm for the direction; • then lower your knees in the direction of the turn, if possible make some room under the covers with your free arm; • lie down comfortably.
• move the cover to the side opposite to the one you want to turn to; • lift the cover with your arms and pull up your knees while you are lying on your back, put your feet flat on the bed; • move yourself to the edge of the bed (alternating with your feet, pelvis, head and shoulders), in the opposite direction of the turn; • place your arm which is on the side you want to turn to next to your head; • pull up your knees as far as you can (in the direction of your chest, your feet on the mattress) and ‘drop’ in the direction of the turn (if necessary lift the cover with your free arm), roll over with your pelvis; • head and shoulders follow the free arm; • lie down comfortably.
• lift the cover and pull up your knees, while you are lying on your back, and put your feet flat on the bed; • move yourself to the edge of the bed (alternating with your feet, pelvis, head and shoulders), in the opposite direction of the turn; • outstretch one or two arms vertically; • bend your knees or keep your legs straight, whatever you prefer; • make a rolling movement with your total body, using an arm swing; • lie down comfortably.
N.B. For all three strategies it is important that the patient does not roll off the bed and lies in the middle of the mattress.
Getting out of bed: from lying on the back to sitting on the edge of the bed
The following tips might make it easier to get out of bed:
• at night a nightlight is on to make visual feedback possible.
• on the bed are no light covers or smooth sheets.
• the patient wears smooth (satin) pyjamas and socks for more grip.
• the bed is not too low.
• handy aids are: elevator to lift a patient, sliding board, handles on the sides of the bed (occupational thera-
pist).
• move your body a bit from the middle to the edge of the bed. • roll over on your side (see turning in bed); • pull your knees further to your chest; • open the cover; • place your top arm next to your bottom shoulder; • bring your feet over the edge of the bed and, at the same time push yourself up with both arms (if help- ful, support sitting up with your bottom arm straight and the hand of your other arm placed nearby your elbow).
• bend your knees, put your feet flat on the bed; • move yourself to the edge of the bed (alternating with your pelvis, shoulders and feet), in the opposite direc- tion of the turn; • lift the covers; • shift your feet over the edge of the bed and, at the same time roll over to your side; • place the hand your top arm on the bed near the elbow of your other arm; • bring your feet over the edge of the bed and, at the same time push yourself up with both arms (if helpful, support coming to sit with your bottom arm straight and the hand of your other arm placed nearby your elbow). From sitting on the edge of the bed to standing
• sit upright on your buttocks; • lean on your arms, place your fists a bit behind your body; • shift your buttocks to the edge of the bed; • lean with your arms on the edge of the bed; • place your feet right in front of the bed, approximately 20 cm apart; • bend forward (with your nose above your knees); • stand up from your legs, if necessary rock first.
Global Deterioration Scale (GDS) – Stage 1: Normal cognition – Stage 2: Age-associated memory impairment – Stage 3: Mild cognitive impairment – Stage 4: Mild dementia—caregiver does 25% – Stage 5: Moderate dementia—caregiver does 50%, Can no longer survive without assistance – Stage 6: Moderately severe dementia—caregiver does 75% – Stage 7: Severe dementia—caregiver does 100
- Preclinical: changes in the brain begin years before a person shows any signs of the disease. This time period is called preclinical Alzheimer's disease and it can last for years. - Mild, Early Stage: symptoms at this stage include mild forgetfulness but person may still live independently at this stage, but increased trouble with remembering a name, recalling recent events, remembering where he or she put a valuable object, making plans, staying organized, managing money. - Moderate, Middle Stage: at this stage, symptoms include increasing trouble remembering events, problems learning new things, trouble with planning complicated events (like a dinner), trouble remembering their own name and personal history, problems with reading, writing, and working with numbers, now that some people are familiar but not remember their names, lose track of time and place, need help choosing the right clothing and getting dressed, become moody or withdrawn, Be restless, agitated, anxious, or tearful, Physical changes may occur as well, Choosing the right clothing for the weather - Severe, Late Stage: lose many physical abilities, may lose bowel and bladder control, may be able to say some words or phrases, needs help with all activities, is unaware of recent experiences and of his or her surroundings, is more likely to get infections
Behavioral Strategies:
Interventions include: empathy approach with active listening, compassionate presence, affirmation, encouragement and reassurance with patient
DISCHARGE PLANNING & CASE MANAGEMENT
Patient requires further skilled physical therapy treatment on a daily basis and can be provided, as a practical matter, only on an inpatient basis in a SNF secondary to the patient’s inability to return home safely due to the following reasons:
patient needs 24-hour aide services that cannot be provided in home health care setting due to the intermittent criteria,
patient will return to live alone,
inadequate/ insufficient assistance from caregiver, primary caregiver has ____ limiting the the assistance to be provided to the patient,
caregiver can only provide verbal instruction and unable to provide physical assist,
Patient’s spouse is unable to effectively physically assist the patient because of medically complex condition,
unable to navigate __ stairs in order to enter/exit home safely,
unable to ascend/descend __ stairs to the bedroom and bathroom,
high risk of falling (see standardized test),
sub-acute medical condition related to ____ with high risk of re-hospitalization,
inadequate muscle strength (muscle weakness in BLE rated ) and impaired balance with high risk of re-injury during transfers and gait due to inadequate assistance in the home,
unable to return home safely due to significant/pronounced impairment in the patient's ability to perform bed mobility, transfers and gait,
patient is no longer appropriate to return to previous home (private home) and family is actively looking for an assisted living with 24 hour care assist,
Muscle strength B LE: 3+/5 Bed mobility: supervision Endurance: Fair Transfer: Contact Guard Assist Balance Sit: Good Balance: Stand: G- Stairs: Moderate Assist Pain legs/ft: 5-6/10
JUSTIFICATION FOR DISCHARGE: In the Medicare Benefit Policy Manual Chapter 8 Coverage of Extended Care (SNF) Services Under Hospital Insurance 30.2.2- Principles for Determining Whether a Service is Skilled, the deciding factor is not the patient's potential for recovery , but whether the services needed require the skills of a therapist or whether they can be provided by non-skilled personnel. In this case, the patient has reached a plateau functionally, and the exercises can be safely carried out by a caregiver. Although the patient has not reached the prior level of function, the patient's deterioration in mental status limits further progression in therapy. Patient would be requiring _____assist due to the risk of falling which can be safely provided by a non-medical person and that exercises to maintain the patient's function can be safely and effectively carried out by a caregiver.
the sevices cannot be carried by unskilled personel
reasonable and necessary to the treatment of the patient's illness or injury
potential that the condition of the patient will improve materially in a reasonable and generally predictable period of time. Improvement is evidenced by objective successive measurements. potential that the condition of the patient will improve materially in a reasonable and generally predictable period of time. Improvement is evidenced
Patient does not suffer a transient or easily reversible loss of function which could reasonably be expected to improve spontaneously as the patient gradually resumes normal activities.
The patient requires specialized skills, knowledge, and judgment of a physical therapist due to the complexity of the services provided to the patient requiring frequent treatment progressions and intervention adjustments designed to address the patient’s physical impairment with bed mobility transfers and gait in order to decrease risk of falling and re-injury.
development, course and outcomes of the skilled observations, assessments, treatment and training performed
However, if the criteria in §40.2.1(d)(3) are met, where there is clear documentation that, because of special medical complications (e.g., susceptible to pathological bone fractures),
inherently complex that it can be safely and effectively performed
, the physical therapist should regularly reevaluate the patient’s condition and adjust any exercise program
30.4.1 – (Rev. 1, 10-01-03) A3-3132.3A, SNF-214.3.A 30.4.1.1 Direct Skilled Therapy Services to Patients-Skilled Physical Therapy - General, Example 1, An 80-year old, previously ambulatory, post-surgical patient has been bed-bound for 1 week, and, as a result, had developed muscle atrophy, orthostatic hypotension, joint stiffness and lower extremity edema. To the extent that the patient requires a brief period of daily skilled physical therapy to restore lost functions, those services are reasonable and necessary and must be documented in the medical record (see §30.2.2.1).
This is in reference to Jimmo v. Sebelius case and the Medicare regualtions at 42 CFR 409.32(c), the level of care criteria for SNF coverage specify that the “restoration potential of a patient is not the deciding factor in determining whether skilled services are needed. Even if full recovery or medical improvement is not possible, a patient may need skilled services to prevent further deterioration or preserve current capabilities.”
In the previously-issued Jimmo v. Sebelius Settlement Agreement Fact Sheet, CMS stated that the skills of a therapist are necessary to maintain, prevent, or slow further deterioration of the patient’s functional status, and the services cannot be safely and effectively carried out by the beneficiary personally, or with the assistance of non-therapists, including unskilled caregivers.
In the Jimmo v. Sebelius settlement agreement, Medicare clarified its longstanding policy that when skilled services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration when the beneficiary’s maintenance care needs cannot be addressed safely and effectively through the use of nonskilled personnel.
NU step to promote temporal conjunction of arm and contralateral leg at apex of shoulder and hip excursions during gait
NU step to improve gait with arm-leg-synchrony through contralateral movements of the arms and legs to promote coordinated gait.
Intrinsic standing balance exercises with narrow base of support, semi-tandem position, ankle dorsiflexion, hip abduction and extension.
Ankle Strategy
Hip Strategy
Stepping Strategy Training
Center of Gravity Control
Base of Support Training
SIT TO STAND
STANDING UNSUPPORTED
SITTING UNSUPPORTED
STANDING TO SITTING
TRANSFERS
STANDING WITH EYES CLOSED
STANDING WITH FEET TOGETHER
FORWARD REACH
RETRIEVING OBJECT FROM THE FLOOR
TURNING TO LOOK BEHIND
TURNING 360 DEGREES
PLACING ALTERNATING FEET ON STOOL
TANDEM STANDING
ONE-LEGGED STANDING
STANDING BALANCE EXERCISES
ABDOMINAL STRENGTHENING
movement composition training ( heel to knee to toe technique, foot pointing, and gait) to promote the patient's ability to control movement with several muscle groups acting together with focus on quality of movement, control, speed, and reaction time in order to improve performance transfers and gait.
movement accuracy training to improve the patient's ability to gauge distance and speed of voluntary movement with focus on quality of movement, control, speed, and reaction time in order to facilitate effective transfers and gait.
LE joint stabilization/fixation/postural holding training to improve the patient's ability to hold stationary posture to improve elevating, pushing, and lowering the body necessary for sit<> stand and bed< >chair transfers.
reciprocal movement coordination training to improve the patient's ability to reverse movement (agonist <> antagonist) with emphasis in the quality of movement, control, speed, and reaction time to improve reciprocal gait.
proprioceptive training to improve joint position sense by moving the patient's extremity through a predetermined range of motion to improve patient's equilibrium necessary for transfers and gait.
Kinesthetic training to improve the patient's body awareness during transfers and gait while in motion and to improve perception of body movement to decrease risk of falling.
Skilled interventions provided include teaching, instruction, demonstration, and training incorporating with the use of kinesthetic sense by activating neural receptors in the muscles and joints with the use of sensory reception approach.
Skilled interventions provided include education, instruction, demonstration, and training as it relates to joint protection principles with the use of techniques to protect the joints in performing the activity.
Skilled interventions provided include education, instruction, demonstration, and training as it relates to biomechanical alignment, which involves body alignment position in weight-bearing and non weight-bearing situations.
Skilled interventions provided include education, instruction, demonstration, and training incorporating proprioceptive approaches with the use of sensations from joints, muscles, and connective tissues that lead to body awareness.
Skilled interventions provided include education, instruction, demonstration, and training incorporating perceptual motor integration approaches such as visual-motor integration and adaptation.
Skilled interventions provided include education, instruction, demonstration, and training incorporating osteokinematic alignments with the use of movements occurring between two segments (bones) relative to the three cardinal planes.
Skilled interventions provided include education, instruction, demonstration, and training as it relates to incorporating neuromuscular treatment approach with the use of treatment approaches.
Skilled interventions provided include education, instruction, demonstration, and training incorporating stereognosis with the faculty of perceiving and understanding the form and nature of objects by the sense of touch.
Skilled interventions provided include education, instruction, demonstration, and training incorporating barognosis with the perception of weight by cutaneous and muscle sense.
Skilled interventions provided include education, instruction, demonstration, and training integrating sense approach with the recognition and awareness of the location of external cutaneous stimulus.
Skilled interventions provided include education, instruction, demonstration, and training as integrating with the use of kinesthetic sense by activating neural receptors in the muscles and joints with the use of sensory reception approach.
Skilled interventions provided include education, instruction, demonstration, and training with the use of proprioceptive sense with the sensory input and feedback of joint position.
Skilled interventions provided include education, instruction, demonstration, and training integrating with the use of osteokinematics with the relationship of the bone and its associated joint movements.
Skilled interventions provided include education, instruction, demonstration, and training as it relates to arthrokinematics, with the adjoining joint surfaces move each other during osteokinematic joint movement.
Skilled interventions provided include education, instruction, demonstration, and training as it relates to with the use of adaptation phenomena providing perceptual plasticity and mechanism of visual coding.
Skilled interventions provided include education, instruction, demonstration, and training as it relates to with the use combined cortical integrative approach utilizing visual and verbal feedback.
Tinetti Balance and Gait test was performed to objectively measure balance and gait deficits for significant changes, position changes, and gait maneuvers used during mobility in order to assess patient’s ability to perform specific gait and balance tasks and as predictive measure for falls. .Areas Tested: BALANCE: sitting balance, rises from chair, attempts to rise, immediate standing balance (first 5 seconds), standing balance, nudged, eyes closed, turning 360 degrees, and sitting down; GAIT: initiation of gait, step length and height, foot clearance, step symmetry, step continuity, gait path, trunk sway, and walking time.
Gait Interpretation: Older adults who take longer than 13.5 seconds to complete the TUG have a high risk for falls (Shumway-Cook Measurement) Transfer Interpretation: According to Podsiadlo and Richardson, 1991 Timed Up & Go Test Score less than 20 seconds for Functional Mobility Skill (Community-Dwelling Elderly People with a variety of medical conditions) is indicative of independent for basic transfers. Procedure: The timed “Up and Go” test measures the time taken by the patient to stand up from a standard arm chair, walk a distance of 3 meters (118 inches, approximately 10 feet), turn, walk back to the chair, and sit down. Patient started with back against the chair, arms resting on the armrests, and walking aid at hand. Patient was instructed that, on the word “go” to get up and walk at a comfortable and safe pace to a line on the floor 3 meters away, turn, return to the chair and sit down again.
Performed Five Times Sit to Stand Test to assess functional lower-limb muscle strength, functional change of transitional movements, balance performance, and assess fall risk. Patient Instruction: "I want you to stand up and sit down 5 times as quickly as you can when I say 'Go'." SCORE: Patient's score was ________ seconds and determined to be _____ risk of falling. Interpretation: The normative data by Bohannon et al, 2006 for ages , the cut off indicates below or lower times = better scores) 60-69 y/o = 11.4 sec 70-79 y/o = 12.6 sec 80-89 y/o = 14.8 sec
Pain in ____ rated /10 which occurs at least daily, it is not easily relieved, and affects the patient’s sleep, physical energy, concentration, and ability/ desire to perform physical activity. STANDARDIZED TEST:
Tinetti Performance Oriented Mobility Assessment Total Score for Balance and Gait: ___/28 (Balance: /16 and Gait /12). Risks Indicators: equal or less than 18 is HIGH RISK for fall, 19-23 is MODERATE RISK for fall, equal or greater than 24 is LOW RISK for fall.
Elderly Mobility Scale Score:___/20 Scores under 10 – generally these patients are dependent in mobility manoeuvres; require help with basic ADL, such as transfers, toileting and dressing. Scores between 10 – 13 – generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility manoeuvres. Scores 14 and over – generally these patients are able to perform mobility manoeuvres alone and safely and are independent in basic ADL.
_____________________
Tinetti Performance Oriented Mobility Assessment Total Score for Balance and Gait: ___/28 (Balance: /16 and Gait /12). Risks Indicators: equal or less than 18 is HIGH RISK for fall, 19-23 is MODERATE RISK for fall, equal or greater than 24 is LOW RISK for fall.
Elderly Mobility Scale Score:__/20 Scores under 10 – generally these patients are dependent in mobility manoeuvres; require help with basic ADL, such as transfers, toileting and dressing. Scores between 10 – 13 – generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility manoeuvres. Scores 14 and over – generally these patients are able to perform mobility manoeuvres alone and safely and are independent in basic ADL.
_____________________________
Tinetti Performance Oriented Mobility Assessment Total Score for Balance and Gait: ___/28 (Balance: /16 and Gait /12). Risks Indicators: equal or less than 18 is HIGH RISK for fall, 19-23 is MODERATE RISK for fall, equal or greater than 24 is LOW RISK for fall.
Elderly Mobility Scale Score:__/20 Scores under 10 – generally these patients are dependent in mobility maneuvers; require help with basic ADL, such as transfers, toileting, and dressing. Scores between 10 – 13 – generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility maneuvers. Scores 14 and over – generally these patients are able to perform mobility maneuvers alone and safely and are independent in basic ADL.
Berg Balance Scale Score:___/56. Interpretation: 41-56 = low fall risk, 21-40 = medium fall risk, 0 –20 = high fall risk
_____________________________
Tinetti Performance Oriented Mobility Assessment Total Score for Balance and Gait: ___/28 (Balance: /16 and Gait /12). Risks Indicators: equal or less than 18 is HIGH RISK for fall, 19-23 is MODERATE RISK for fall, equal or greater than 24 is LOW RISK for fall.
Elderly Mobility Scale Score:___/20 Scores under 10 – generally these patients are dependent in mobility manoeuvres; require help with basic ADL, such as transfers, toileting and dressing. Scores between 10 – 13 – generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility manoeuvres. Scores 14 and over – generally these patients are able to perform mobility manoeuvres alone and safely and are independent in basic ADL.
Berg Balance Scale Score:___/56. Interpretation: 41-56 = low fall risk, 21-40 = medium fall risk, 0 –20 = high fall risk
_____________________
Tinetti Performance Oriented Mobility Assessment Total Score for Balance and Gait: ___/28 (Balance: /16 and Gait /12). Risks Indicators: equal or less than 18 is HIGH RISK for fall, 19-23 is MODERATE RISK for fall, equal or greater than 24 is LOW RISK for fall.
Elderly Mobility Scale Score:__/20 Scores under 10 – generally these patients are dependent in mobility manoeuvres; require help with basic ADL, such as transfers, toileting and dressing. Scores between 10 – 13 – generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility manoeuvres. Scores 14 and over – generally these patients are able to perform mobility manoeuvres alone and safely and are independent in basic ADL. Berg Balance Scale Score:___/56. Interpretation: 41-56 = low fall risk, 21-40 = medium fall risk, 0 –20 = high fall risk
_____________________________
Tinetti Performance Oriented Mobility Assessment Total Score for Balance and Gait: ___/28 (Balance: /16 and Gait /12). Risks Indicators: equal or less than 18 is HIGH RISK for fall, 19-23 is MODERATE RISK for fall, equal or greater than 24 is LOW RISK for fall.
Elderly Mobility Scale Score:__/20 Scores under 10 – generally these patients are dependent in mobility maneuvers; require help with basic ADL, such as transfers, toileting, and dressing. Scores between 10 – 13 – generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility maneuvers. Scores 14 and over – generally these patients are able to perform mobility maneuvers alone and safely and are independent in basic ADL.
Berg Balance Scale Score:___/56. Interpretation: 41-56 = low fall risk, 21-40 = medium fall risk, 0 –20 = high fall risk
_____________________________
_____________________
____________________
Patient was previously undergoing subacute rehabilitation but interrupted by the most recent in-patient hospital stay.
Clinical objective problems include gait deficit, muscle weakness affecting mobility, equilibrium or balance deficit, pain interfering with movements, tenderness, muscle spasm, muscle guarding, high fall risks. These clinical problems have resulted in significant functional deterioration, as evidenced by remarkable deficit in activities of daily living, which include but not limited to deterioration in sit <-> stand and bed <-> chair transfer, bed mobility, gait on even and uneven surfaces, [[[[ navigating stairs]]]]], requiring physical assistance.
These clinical problems have resulted in substantial functional decline, as evidenced by marked deficit in activities of daily living with deterioration in sit <-> stand and bed <-> chair transfer, bed mobility, gait on even and uneven surfaces, [[[[ negotiating stairs]]]]], requiring skilled physical therapy.
Furthermore, the services are reasonable and necessary for the treatment consistent with the nature and severity of the patient’s illness or injury, the patient’s particular medical needs, and accepted standards of medical practice due to the following clinical objective problems
Supine<> sit at the edge of the bed training required : _ physical assist, sit<>stand training required _ physical assist, bed< >chair transfer training required: _ physical assist.
Bed Mobility Task: trained the patient in performing arm reach and trunk lift to improve bed mobility; patient was instructed to reach forward and over the side of exit with the opposite arm while lifting the trunk slightly in order to improve elevating and turning the trunk for the initial part of bed rise
Bed Mobility Task: trained the patient in performing lateral leg movement to improve bed rise; patient was instructed to move one leg toward the side of exit and then the other leg to the opposite side to improve moving hips/legs laterally for initial part of bed rise
Bed Mobility Task: trained the patient in performing unilateral heel raise; patient was positioned with one knee and hip flexed and the opposite leg extended (SLR position). Patient was instructed to raise the heel of the straight leg 4-6 inches off the bed and hold for 3 seconds, then repeated on the opposite side to improve elevating the legs in preparation for bed rise
Bed Mobility Task: trained the patient in performing roll to side lying; patient was instructed to roll onto the side by pushing the opposite heel down to improve moving the trunk and pelvis onto the side with foot push in preparation for bed rise
Bed Mobility Task: trained the patient in performing side lying to sit. Patient was positioned in side lying with hips and knees flexed and heels supported on the bed; patient was instructed to push down with the elbow in contact with the bed and the opposite hand and come to sit with legs dangling off the edge of the bed to improve alternate way to rise after rolling onto the side
Bed Mobility Task: trained the patient in performing bed rise with weight on hip and then hold. Patient was positioned in sitting at the edge of the bed with legs dangling and arms folded across the chest. Patient was instructed to place all weight on one hip, lean as far as possible to one side, and hold for 3 seconds, then repeated to the opposite side to improve balancing trunk on one side of the hip necessary for bed mobility
Bed Mobility Task: trained the patient in performing trunk elevation by upper extremity extension with patient's position in supine. Patient was instructed to raise the trunk by extending the arms first then pushing off and extending the elbows to improve elevating the trunk using shoulder and elbow extension
Bed Mobility Task: trained the patient in performing bridging; positioned patient in hook lying with hands at the sides, then patient was instructed to raise buttocks off the bed and hold for 3 seconds to improve elevating the pelvis and utilizing arm support necessary for bed mobility
Bed Mobility Task: trained the patient in performing supine to sit, wherein patient was instructed to slide forward to the edge of the bed, shifting the weight from one hip to the other with the assistance of both arm to improve moving the pelvis forward
Task: trained the patient on how to properly slide forward for sit <> stand. Patient was instructed to slide forward to the edge of the seat, shifting the weight from one hip to the other, wherein both armrests used for assistance to improve moving the pelvis forward on the seat
Task: trained the patient in performing the required trunk flexion for sit <> stand. Patient was instructed to lean forward from the hip joint as far as possible keeping the neck and upper back straight with both armrests used for assistance to improve leaning forward
Task: trained the patient in performing trunk rock and lift. Patient was in seated position at the edge of the chair, then instructed to rock back and forth and lift the buttocks off the seat. Both armrests were used for assistance. Training was conducted to develop sufficient trunk momentum to elevate the buttocks off the seat. Activity was repeated 15 times with corrections
Task: trained the patient in performing pelvic elevation. Patient was seated back in chair with legs extended out in front to minimize leg assistance, patient was then instructed to push down on both armrests and elevate the pelvis off the seat to improve using the arms only to help elevate the pelvis
Task: trained the patient with flexed configuration after lift-off. Patient was instructed to rise from the seat using the armrests and keep the buttocks off the seat without rising to a full standing position with hips and knees remained flexed. This is to improve balancing at the critical moment of lift-off from the seat
Task: trained the patient in performing rising from chair with hands. Patient was instructed to rise from the seat using hands to improve rising from the chair in a comfortable an safe manner
Task: trained the patient in performing rise from chair without hands - patient was then instructed to rise from the seat using safe strategy except for using hands. Training was conducted to improve rising from the chair in a safe manner without using hands
Task: trained the patient in performing hip and knee bends for sit <-> stand. Positioned patient in standing. patient was instructed to bend the hips and knees as far as possible and then raise up again to improve knee and hip extension at the final phase of chair rise
Patient was instructed not to lift, push or pull objects heavier than 5 pounds without further clearance from the physician. Explained to the patient that a half-gallon of milk is about 4 pounds. Educated that the sternum is not fully integrated at this time with good new bone regeneration and lifting heavy weight may separate bones and the sternum wires could work loose.
In order to adhere with the sternal precaution, patient was instructed to use the log roll technique when getting out of bed and to refrain from using the arms and hands to pull self up. Patient was then instructed to rise from bed, use the log roll technique by simply lying on the back, and then roll onto one side and allow the legs to fall slowly off the edge of the bed, and allow the momentum to assist the upper body to rise up, taking care not to push or pull with the arms.
Patient was educated to use the legs to stand up from a chair so as not to disrupt the healing sternal incision. Patient was instructed to slide the heels back so the feet are positioned well under the knees, and place the hands on the thighs. Patient was then instructed to lean forward with the nose over the toes, and rise up, taking care not to push or pull with the arms.
Patient was instructed to roll the shoulders to stretch to decrease stiffness instead of placing both arms overhead in order to adhere with the rules of the sternal precautions post surgery. Instead of reaching overhead to stretch, instructed to the shoulder blades forward and back with the arms by the side to avoid excessive separation of the breastbone and the chest incision.
Patient was instructed to utilize a pillow to splint when coughing. Patient was educated that coughing can be painful after open heart surgery, and coughing forcefully can place stress and strain through the sternum. Instructed to place a pillow over the chest and hug it tightly whenever feeling the need to cough or sneeze.
1) Skilled therapeutic activities require the involvement of a therapist to meet the patient’s needs, promote recovery, and ensure medical safety related to the patient’s illness.
2) The skill of therapist is still needed to manage the appropriateness of the therapeutic activities and hands-on techniques.
3) Therapist is still needed to carry out the skilled therapeutic procedures to improve and achieve the fundamental goals.
4) Patient’s condition continues to materially improve in a reasonable and predictable time, as set in the plan of care.
5) Skilled therapy is concurrent with the patients’ care plan.
6) Treatment of the patient’s illness can only be carried out by the skilled therapist due to hands-on technique and complexity of the plan of care.
7) Service cannot be carried out by non-skilled personnel due to the inherent complexity of the treatment regimen provided.
8) In view of the patient’s overall conditions, skilled management provided by the therapist is due to the inherent level of sophistication.
9) The skill of therapist is still needed due to special medical condition; patient is susceptible to pathological bone fracture due to osteoporosis.
10) Continue restorative physical therapy program for skilled intervention and adjustment of current therapeutic regimen.
11) Continue therapy for the implementation of the therapeutic intervention tailored for the specific needs of the patient.
12) Treatment provided specifically directed to an active written treatment regimen approved by the physician.
13) Patient continues to improve and require therapy based on the clinical findings, extent of loss of function, social considerations, and patient overall function.
14) Assessment on patient’s progress toward set goals established in the plan of care was performed for the patient’s physical impairment.
15) Patient continues to require broad range of skilled rehabilitative techniques to improve movements and physical function.
16) Patient’s treatment activities are directed to improve the restriction of mobility strength, balance or coordination affecting ADL.
17) Current treatment addresses the patient’s specific functional needs for recovery, skilled intervention was upgraded today.
18) Patient necessitates further treatment to achieve optimum rehabilitation potential.
19) Patient has the capacity to learn the instructions given to improve function. New instructions were given to improve ADL.
20) Patient is expected to return to the highest level of function as described in the plan of care.
21) Patient demonstrates improvements toward set goals and requires further treatment to achieve functional mobility
22) Patient is able to participate and continue to benefit from skilled intervention given.
23) Patient continues to improve towards the established goals and makes significant improvement to increase functionality with skilled therapy.
24) Patient treatment has not reached plateau and continues to make functional improvement with skilled therapy.
25) Patient’s loss of function is not expected to improve over time without skilled physical therapy services.
26) Patient makes great strides with the skilled therapy intervention, but requires further skilled care to achieve prior level of function..
27) Patient is compliant with the treatment plan and continues to respond with skilled therapy.
28) Patient continues to gain functional improvement as a result of the physical therapy treatment.
29) Physical therapy treatment is concurrent with the established plan of treatment.
30) Patient responds with the skilled therapy intervention geared to improve mobility.
31) Patient actively participates in the skilled treatment regimen designed to increase function in connection with the plan of treatment.
32) Patient requires further skilled treatment to attain maximum rehab potential.
33) Skilled rehab training is geared to improve the functional capacity of the patient.
34) Patient actively involves in the treatment provided through skilled therapy interventions.
35) Patient shows functional progress with the treatment, but requires further therapy treatment to reach functional goals.
36) Patient exhibits favorable response with the skilled treatment regimen provided.
37) Patient demonstrates progress in lined with the attainment of the established goals.
39) Patient necessitates further skilled treatment to achieved functional goals as set in the plan of care.
40) Patient exhibits good rapport with the therapist and favorable response with the treatment to improve functional goals.
41) Patient has attained maximum physical rehabilitation potential, as of this visit.
42) Patient has achieved optimum physical rehabilitation potential, as of this visit.
43) Patient has completed treatment and achieved the highest functional rehab potential.
44) Patient has completed comprehensive physical rehabilitation treatment as of this visit.
45) Patient has achieved optimum functional rehabilitation potential as of this visit.
Erector Spinae
Hip Adductor
Abductor
Hip flexor
Hip extensors
Knee Flexors
Knee Extensors
Hamstrings
Quadriceps
Anterior Tibialis
Plantar Flexors
Gastrocnemius/Soleus
ground reaction force vectors (GRFV)
and posterior to hip joint
*facilitation of midstance with ground reaction force with dorsiflexor moment at the ankle joint and eccentric activity in the hip flexors
and hip joint during the preswing for an effective gait pattern
INITIAL SWING 1-Initial swing (Acceleration) Facilitation of the initial swing during swing phase of gait while the hip is in flexion and external rotation
Facilitation of the knee flexors since flexion of the knee is necessary for the swinging limb to clear the ground as it moves forward.
MIDSWING Facilitation of the Mid-swing (the middle third of the swing phase from 73 to 87% of the gait cycle) from the time the swing foot is opposite the stance limb to when the tibia is vertical.
Facilitation of midswing which begins from maximum knee flexion (when the swing limb is under the body) until the swing limb passes the stance limb and the tibia becomes in a vertical position.
TERMINAL SWING Facilitation of the terminal swing (the final third of the swing phase from 78 to 100% of the gait cycle) from the time when the tibia is vertical to initial contact.
3-(terminal swing) Deceleration Gait training with focus to improve rerminal swing/deceleration while the knee is extending in preparation for heel strike, the hip becomes more flexed, the foot in neutral position.
Facilitation of termina lswing as the heel touches the ground, the foot moves into plantar flexion (by the controlling action of the dorsiflexors).
Subphases of Stance Phase
Focus in the Initial Contact of the stance phase of gait to improve the moment when the foot contacts the ground (heel strike) to improve gait pattern.
Facilitation of the Loading response (LR) period to improve when the weight is transferred onto the outstretched limb during the first period of double-limb support (foot flat)
Facilitation of Midstance (MSt) to improve when the body progresses over a single, stable limb
Facilitation of Terminal Stance (TSt) to improve the progression over the stance limb as the body moves ahead of the limb and weight is transferred onto the forefoot.
Facilitation of Pre-Swing (PSw) to improve the unloading of the limb as weight is transferred onto the forefoot (toe-off) to improve gait pattern
Subphases of Swing Phase
Facilitation of Initial swing (ISw) as the thigh begins to advance and as the foot comes up from the floor for an effective gait pattern.
Facilitation of Midswing (MSw) as the thigh continues to advance and the knee begins to extend then the foot clears the ground for an effective gait pattern
Facilitation of Terminal Swing (TSw) as the knee extends and the limb prepares to contact the ground for Initial Contact for an effective gait pattern
Gait Cycle – Functional Tasks
Facilitation of Weight Acceptance (WA) during the period when body weight is rapidly loaded on the outstretched limb so that the impact of the floor-reaction force is absorbed and the body continues in a forward path while stability is maintained during the Initial Contact and Loading Response.
Facilitation of Single Limb Support (SLS) during the period when the body progresses over a single lower extremity then weight is transferred onto the metatarsal heads and the heel comes off the ground during the Mid Stance and Terminal Stance.
Facilitation of Swing Limb Advancement (SLA) during the time when the limb is unloaded and the foot comes off the ground then the limb is moved from behind to in front of the body, reaching to take the next step as transitional movement during Pre-Swing, Initial Swing, Mid Swing and Terminal Swing.
Facilitation of pretibial muscles (anterior tibial, extensor digitorum longus, and extensor hallucis longus) acting prior to and during heel strike with eccentric contraction in order to control the foot while lowering to the ground.
Facilitation of pretibial muscles (anterior tibial, extensor digitorum longus, and extensor hallucis longus) acting prior to and during preswing with concentric contraction in order to improve foot dorsiflexion and clear toes off the ground
• Calf Muscles
– Gastrocs, Soleus (FDL, FHL, Posterior tibial)
– Foot flat
• Eccentric contraction - control of tibia over the foot
– Heel off
• Concentric contraction – ankle plantarflexion
• Quadriceps – Vastus medialis/lateralis/intermedius, RF – Before Heel Strike • Concentric contraction – initiate knee extension – Swing phase • Eccentric contraction – slow down leg (tibia)
• Hamstrings – Biceps, Semitendinosus, Semimembranosus – Heel strike • Eccentric contraction - HS peaks – protects knee from hyperextension – Swing phase • Concentric contraction – knee flexion, hip extension
• Hip Abductors – Gluteus medius, Gluteus minimus, TFL – Stance phase • Concentric contraction - stabilize pelvis • Hip Adductors – Adductor longus/brevis, Gracilis, Adductor magnus (horizontal and vertical heads) – Early and late stance • Concentric contraction –stabilize pelvis
• Facilitation of the gluteus maximus with eccentric contraction to decelerate forward momentum during stance phase of gait to improve control during gait • Facilitation of the gluteus maximus concentric contraction achieved with hip extension which is essential for the pre-swing phase of gait • Facilitation of the Erector Spinae necessary during heel strike through toe-off to improve trunk posture during gait. • Facilitation of the fibularis longus and brevis concentric contraction necessary for the stance phase of gait to improve medial and lateral stability of the foot • Facilitation of the foot Intrinsics concentric contraction which is essential for the stance phase of gait to support plantar fascia 
LE Stretching Progressive muscle lengthening of the psoas major, towards extension and internal rotation at hip joint (action: flexion and external rotation in the hip joint) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of iliacus, which arises from the iliac fossa on the interior side of the hip bone, towards hip extension (action: hip flexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of gluteus maximus muscle the primary for hip extensor, towards flexion and internal rotation of hip(action: external rotation and extension of the hip joint) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the gluteus maximus since it acts upon the pelvis, supporting it and the trunk upon the head of the femur , towards flexion and internal rotation of hip(action: external rotation and extension of the hip joint) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the gluteus maximus, which causes the body to regain the erect position after stooping assisted in this action by the hamstring muscles , towards flexion and internal rotation of hip(action: external rotation and extension of the hip joint) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of gluteus medius, which originates from the pelvis attached to the femur, towards adduction of the hip (action: abduction of the hip; medial rotation of thigh) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of tensor fasciae latae, which serves to stabilize the pelvis upon the head of the femur, towards thigh extension, internal rotation and adduction (action: Thigh - flexion, medial rotation, abduction, and trunk stabilization) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of tensor fasciae latae the oblique direction of its fibers enables it to abduct the thigh and assists with internal rotation and flexion of hip , towards thigh extension, internal rotation and adduction(action: Thigh - flexion, medial rotation, abduction and trunk stabilization) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of quadratus femoris, which is attached to the inferior portion of the pelvis and connected to the femur bone, towards medial rotation (action: lateral rotation of thigh) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of inferior and superior gemellus - together is called gemelli, towards medial rotation of thigh (action: rotates laterally thigh) to improve ADL activities involving the use of the lower extremities. Progressive muscle lengthening of the piriformis muscle, which occupies a central location in the buttocks, towards internal rotation (action: external rotation of thigh) to improve activities of daily living involving with the use of the lower extremities.
Progressive muscle lengthening of the piriformis muscle, which laterally rotates the extended thigh, towards internal rotation (action: external rotation of thigh) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the piriformis muscle, which is an important muscle in walking for shifting the body weight, towards internal rotation. (action: external rotation of thigh) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the sartorius muscle, which assists in flexion, abduction, lateral rotation of hip, and flexion of knee , towards extension of the hip and knee (action: flexion of the hip and knee) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the sartorius muscle the key muscle used when looking at the bottom of the foot, towards extension of the hip and knee (action: flexion of the hip and knee) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the sartorius muscle also known as the “tailor’s muscle”, which assists in flexion, abduction, lateral rotation of hip, and flexion of knee, towards extension of the hip and knee (action: flexion of the hip and knee) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the quadriceps femoris muscle, which is the greatest extensor of the leg, towards hip extension and knee flexion (action: hip flexion and knee extension) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the quadriceps femoris muscle, which consists of four individual muscles, towards hip extension and knee flexion (action: hip flexion and knee extension) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the biceps femoris muscle, which originates from the pelvis and femur, towards hip flexion and knee extension (action: hip extension, knee flexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the semitendinosus muscle, which has a prominent tendon on the back of the knee, towards knee extension and hip flexion (action: flex knee, extend hip joint) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the semimembranosus, which has a deep tendon on the back of the knee that is hard to locate, towards hip flexion and knee extension (action: hip extension and knee flexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the pectineus muscle, which is primarily responsible for hip flexion, towards hip extension (action: hip flexion, adduction and medial rotation) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the obturator externus muscle, which passes behind the pelvis, towards abduction and medial rotation (action: adduct thigh, rotate thigh laterally) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the gracilis, towards hip abduction and hip extension (action: hip adduction, hip flexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the gracilis, towards hip abduction and hip extension (action: hip adduction, hip flexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the adductor a muscle, which consists of 3 individual muscles, towards hip abduction (action: hip adduction) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the adductor magnus a large triangular muscle, situated on the medial side of the thigh, towards hip abduction (action: hip adduction) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the adductor longus muscle, which is located on the medial side of the thigh, towards hip abduction (action: hip adduction) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the adductor brevis, which is located on the medial side of the thigh, towards hip abduction (action: hip adduction) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the tibialis anterior muscle, which acts to keep the leg vertical, towards plantar flexion and eversion of foot at ankle joint (action: dorsiflexion and inversion of ankle) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the triceps surae, which consists of 2 large muscles, towards knee extension and ankle dorsiflexion (action: knee flexion, ankle plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the gastrocnemius muscle, which crosses 2 joints on the lower extremity, towards knee extension and ankle dorsiflexion (action: knee flexion, ankle plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the soleus muscle the deeper of 2 individual muscles, which forms the triceps surae muscle on the leg, towards ankle dorsiflexion (action: ankle plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the soleus muscle, which plays an important role in standing, towards ankle dorsiflexion (action: ankle plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the soleus muscle, which keeps an upright posture, towards ankle dorsiflexion (action: ankle plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the plantaris muscle, towards foot dorsiflexion and knee extension (action: knee flexion, foot plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the plantaris muscle, which may provide biofeedback information to the brain regarding the position of the foot, towards foot dorsiflexion and knee extension (action: knee flexion, foot plantarflexion) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the popliteus muscle, which is also known as the “key muscle” unlocking the femur on the tibia, towards knee flexion (action: lateral rotation of femur on tibia, and flexion of knee) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the peroneus longus muscle, which is also known as the fibularis longus, towards dorsiflexion and inversion of the foot (action: plantarflexion, eversion of foot) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the peroneus brevis muscle, which runs vertically downward on the leg passing behind the lateral malleolus at the side of the foot, towards dorsiflexion and inversion (action: plantarflexion and eversion of foot) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the toe extensors, which consists of two muscles located on top of the foot, towards toe flexion (action: extension of toes) to improve activities of daily living involving with the use of the lower extremities. Progressive muscle lengthening of the flexor digitorum brevis, towards extension of second to fifth toes (action: flexion of second to fifth toes) to improve activities of daily living involving with the use of the lower extremities.
Torso Stretching Progressive Muscle lengthening of splenius capitis muscle, a straplike muscle in the back of the neck and connects the base of the skull to the vertebrae in the neck and upper thorax, towards flexion, rotation and lateral flexion to the opposite side (action: extend, rotate, and laterally flex the head ) to improve ADL activities with the use of the upper extremities.
Progressive muscle lengthening of splenius cervicis muscle, a narrow tendinous band from the spinous processes of the third to the sixth thoracic vertebrae, towards contralateral rotation and lateral bending of the neck to improve activities of daily living involving with the use of the trunk movements. .
Progressive muscle lengthening of erector spinae also known as the sacrospinalis towards flexion of the vertebral column (action: extension of the vertebral column) to improve activities of daily living involving with the use of the trunk movements.
Progressive muscle lengthening of the left external oblique muscle, which is situated on the lateral and anterior parts of the abdomen, towards side bending to the right (action: trunk rotation to the right, trunk flexion, side bending to the left) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the left external oblique muscle, which is situated on the lateral and anterior parts of the abdomen, towards trunk rotation to the left (action: trunk rotation to the right, trunk flexion, side bending to the left) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the left external oblique, which is situated on the lateral and anterior parts of the abdomen, towards trunk extension (action: trunk rotation to the right, trunk flexion, side bending to the left) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the right external oblique muscle, which is situated on the lateral and anterior parts of the abdomen, towards side bending to the left (action: trunk rotation to the left, trunk flexion, side bending to the right) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the right external oblique muscle, which is situated on the lateral and anterior parts of the abdomen, towards trunk rotation to the right (action: trunk rotation to the left, trunk flexion, side bending to the right) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the right external oblique, which is situated on the lateral and anterior parts of the abdomen, towards trunk extension (action: trunk rotation to the left, trunk flexion, side bending to the right) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the right internal oblique muscle also referred to as the same side rotators, towards trunk extension (action: compresses abdomen; rotate trunk to same side, flex the trunk, lateral trunk bending on same side) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the right internal oblique muscle also referred to as the same side rotators , towards trunk side bending to the left (action: compresses abdomen; rotate trunk to same side, flex the trunk, lateral trunk bending on same side) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the right internal oblique muscle also referred to as the same side rotators , towards trunk rotation the left (action: compresses abdomen; rotate trunk to same side, flex the trunk, lateral trunk bending on same side) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the left internal oblique muscle also referred to as the same side rotators , towards trunk extension (action: compresses abdomen; rotate trunk to same side, flex the trunk, lateral trunk bending on same side) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the left internal oblique muscle also referred to as the same side rotators , towards trunk side bending to the right (action: compresses abdomen; rotate trunk to same side, flex the trunk, lateral trunk bending on same side) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the left internal oblique muscle also referred to as the same side rotators , towards trunk rotation the right (action: compresses abdomen; rotate trunk to same side, flex the trunk, lateral trunk bending on same side) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the transverse abdominal muscle, the most important abdominal muscle for spinal stability, towards trunk extension (action: compress the abdominal contents to stabilize the spine) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the transverse abdominal muscle the innermost of the flat muscles of the abdomen, towards trunk extension (action: compress the abdominal contents to stabilize the spine) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the transverse abdominal muscle, which has fibers running horizontally from the side of the trunk to the front of the trunk, towards trunk extension (action: compress the abdominal contents to stabilize the spine) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the transverse abdominal muscle, the most important abdominal muscle for spinal stability, towards trunk extension (action: compresses the ribs and viscera, providing thoracic and pelvic stability) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the transverse abdominal muscle the innermost of the flat muscles of the abdomen, towards trunk extension (action: compresses the ribs and viscera, providing thoracic and pelvic stability) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the transverse abdominal muscle, which has fibers running horizontally from the side of the trunk to the front of the trunk, towards trunk extension (action: compresses the ribs and viscera, providing thoracic and pelvic stability) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the rectus abdominis muscle a paired muscle running vertically on each side of the anterior wall of the human abdomen , towards trunk extension (action: flexion of trunk/lumbar vertebrae) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the rectus abdominis muscle, which helps in keeping the internal organs intact by creating intra-abdominal pressure, towards trunk extension (action: flexion of trunk/lumbar vertebrae) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the rectus abdominis muscle, which is long, flat and extends along the whole length of the front of the abdomen , towards trunk extension (action: flexion of trunk/lumbar vertebrae) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the rectus abdominis muscles, which are two parallel muscles, separated by a midline band of connective tissue called the linea alba (white line), towards trunk extension (action: flexion of trunk/lumbar vertebrae) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the quadratus lumborum muscle, which connects the pelvis to the spine, towards contralateral side flexion of spine (action: unilateral action lateral flexion of vertebral column; acting bilaterally depression of thoracic rib cage) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the quadratus lumborum muscle , which is tight, short, and overused during prolonged sitting spine, towards contralateral side flexion of spine (action: unilateral action lateral flexion of vertebral column; acting bilaterally depression of thoracic rib cage) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the quadratus lumborum muscle towards contralateral side flexion of spine (action: unilateral action lateral flexion of vertebral column; acting bilaterally depression of thoracic rib cage) to improve activities of daily living involving with the use of the trunk movements. Progressive muscle lengthening of the quadratus lumborum muscle, which constantly contracts while seated , towards contralateral side flexion of spine (action: unilateral action lateral flexion of vertebral column; acting bilaterally depression of thoracic rib cage) to improve activities of daily living involving with the use of the trunk movements.
Progressive resistive exercise/ facilitation of the quadriceps, specifically the vastus medialis, which is important in stabilizing the patella and the knee joint during gait for an effective gait pattern.
Progressive resistive exercise/ facilitation of the knee extensors with emphasis of the rectus femurs to improve gait as it swings the leg forward into the ensuing step since it also acts also a flexor of the hip since it's attached to the ilium.
PRE LE
Progressive manual resistive exercise / facilitation of the psoas major towards flexion and external rotation in the hip joint to facilitate trunk balance when sitting and also to maintain the vertebral column upright to improve mobility involving with the use of the lower extremities.
Progressive resistive exercise (PRE)/ facilitation of the iliacus towards hip flexion to assist in lifting the trunk from a lying position and to improve mobility through the use of the lower extremities.
Progressive manual resistive exercise of / facilitation gluteus maximus towards external rotation and extension of the hip joint to help raise the trunk after stooping in unison with the hamstring muscles to improve mobility with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the gluteus maximus the action of which is to cause the body to regain the erect position after stooping assisted in this action by the hamstring muscles to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE)/ facilitation of gluteus medius the main hip abductor preventing the opposite pelvis from dropping when standing on one leg towards hip abduction to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the gluteus minimus a hip internal rotator and abductor primarily important in supporting the body on one leg towards abduction and internal rotation to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the tensor fasciae latae towards thigh flexion, medial rotation and abduction facilitating stability of the pelvis on the head of the femur when standing to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the quadratus femoris towards external rotation and adduction of thigh to stabilize the femoral head of the hip to its articulation with the acetabulum on the pelvis to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) of the inferior gemellus muscle towards external rotation of thigh to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the piriformis towards hip external rotation to shift the body weight to the opposite side of the foot being lifted avoiding falls to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the sartorius towards hip and knee flexion to facilitate donning and doffing of shoes.
Progressive resistive exercise (PRE) / facilitation of the sartorius towards hip and knee flexion to facilitate donning and doffing of socks to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the sartorius towards hip and knee flexion to facilitate foot care and cutting of toe nails to improve activities of daily living involving with the use of the lower extremities. Progressive resistive exercise (PRE) / facilitation of the rectus femoris muscle towards hip flexion and knee extension which is crucial in the swing phase of gait to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the vastus medialis muscle towards knee extension to prevent excessive lateral displacement of the patella to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the vastus lateralis muscle which is the largest of the quadriceps femoris group of muscles towards knee extension to assist in sit to stand mobility and to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the biceps femoris muscle towards hip extension and knee flexion necessary in lifting the buttocks of the bed in performing lower garment dressing while in bed and to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the pectineus muscle towards hip flexion to facilitate ambulation and stair climbing activities to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the pectineus muscle towards hip flexion to facilitate lower garment dressing activities and to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) of the pectineus muscle towards hip flexion to facilitate donning/doffing of shoes and socks to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the obturator externus muscle towards hip adduction and external rotation necessary for dynamic stability while standing and to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the gracilis muscle towards hip flexion and hip adduction to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the adductor longus muscle of the thigh towards hip adduction to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the adductor brevis muscle of the thigh towards hip adduction to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the adductor magnus muscle of the thigh towards hip adduction to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the adductor group of muscles of the thigh towards hip adduction to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the tibialis anterior muscle towards dorsiflexion and inversion of the foot to facilitate heel strike during the contact phase of gait and to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the tibialis anterior muscle towards dorsiflexion and inversion of the foot to keep the leg vertical even when walking on uneven ground and to to improve activities of daily living involving with the use of the lower extremities.
Progressive resistive exercise (PRE) / facilitation of the tibialis anterior muscle towards dorsiflexion and inversion of the foot necessary to allow the toes to clear the walking surface during the swing phase of gait.
Progressive resistive exercise (PRE) / facilitation of the triceps surae muscle towards plantarflexion of foot to facilitate ambulation during the push off phase of gait.
Progressive resistive exercise (PRE) / facilitation of the gastrocnemius muscle towards plantarflexion of the foot to facilitate ambulation during the push off phase of gait.
Progressive resistive exercise (PRE) / facilitation of the soleus muscle towards plantarflexion of the foot to facilitate ambulation during the push off phase of gait.
Progressive resistive exercise (PRE) / facilitation of the plantaris muscle towards knee flexion and plantarflexion of the foot to facilitate ambulation during the push off phase of gait.
Progressive resistive exercise (PRE) / facilitation of the peroneus longus muscle towards plantarflexion and eversion of the foot at the ankle joint to facilitate the loading response of foot during the contact phase of gait.
Progressive resistive exercise (PRE) / facilitation of the peroneus brevis muscle towards plantarflexion and eversion of the foot at the ankle joint to facilitate the loading response of foot during the contact phase of gait.
Progressive resistive exercise (PRE) of the peroneus longus muscle towards plantarflexion and eversion of the foot at the ankle joint to facilitate the foot flat phase during the contact cycle of gait.
Progressive resistive exercise (PRE) / facilitation of the peroneus brevis muscle towards plantarflexion and eversion of the foot at the ankle joint to facilitate the foot flat phase during the contact cycle of gait.
Progressive resistive exercise (PRE) / facilitation of the toe extensors towards toe extension to allow the toes to clear the walking surface during the swing phase of gait.
Progressive resistive exercise (PRE) / facilitation of the extensor hallucis brevis towards toe extension to allow the toes to clear the walking surface during the swing phase of gait.
Progressive resistive exercise (PRE) / facilitation of the extensor digitorum brevis towards toe extension to allow the toes to clear the walking surface during the swing phase of gait.
Progressive resistive exercise (PRE) / facilitation of the flexor digitorum brevis towards flexion of second to fifth toes to facilitate easier donning of shoe.
Progressive resistive exercise (PRE) / facilitation of the toe flexor muscles located on the plantar surface of the foot towards toe flexion to facilitate donning of shoes/footwear.
Progressive Resistive Exercise (PRE) / facilitation of the splenius capitis towards cervical extension, rotation, and laterally flexion which is essential in cervical motions to improve activities of daily living involving with the use of the neck.
Progressive Resistive Exercise (PRE) / facilitation of the splenius cervices towards ipsilateral rotation and lateral flexion of the neck to improve pull of the head posteriorly to improve activities of daily living involving with the use of the neck.
Progressive resistive exercise (PRE) / facilitation of the left external oblique towards trunk flexion and rotation to the right to facilitate dynamic and static balance
Progressive resistive exercise (PRE) / facilitation of the right external oblique towards trunk rotation to the left to facilitate dynamic and static balance.
Progressive resistive exercise (PRE) / facilitation of the left internal oblique towards trunk flexion and rotation to the left to improve dynamic and static balance to improve activities of daily living involving with the use of the trunk flexion and rotation.
Progressive resistive exercise (PRE) of the right internal oblique towards trunk flexion and rotation to the right to improve dynamic and static balance and to improve activities of daily living involving with the use of the trunk flexion and rotation
Progressive resistive exercise (PRE) / facilitation of the transverse abdominal muscle towards abdominal compression by drawing the belly button towards the spine (vacuum exercise) to improve the stability of the vertebral column to improve activities of daily living involving with the use of the trunk movements.
Progressive resistive exercise (PRE) / facilitation of the transverse abdominal muscle towards abdominal compression by drawing the belly button towards the spine (drawing in maneuver) to improve the stability of the vertebral column to improve activities of daily living involving with the use of the trunk movements.
Progressive resistive exercise (PRE) / facilitation of the rectus abdominis muscle towards trunk flexion to improve posture column to improve activities of daily living involving with the use of the trunk movements.
Progressive resistive exercise (PRE) / facilitation of the quadratus lumborum muscle towards lateral flexion of vertebral column (hip hiking) to reduce the risk of unilateral low back pain and column to improve activities of daily living involving with the use of the trunk movements.
Progressive resistive exercise (PRE) of the levator ani muscles to address urinary incontinence. Progressive resistive exercise (PRE) of the pubococcygeus muscle by making it contract similar to stopping the flow of urine when emptying bladder (Kegel exercises - to be performed when bladder is empty) Progressive resistive exercise (PRE) of the pubococcygenus muscle by performing the Kegel exercises to address urinary incontinence. Progressive resistive exercise (PRE) of the puborectalis muscle by performing pelvic floor muscular contractions similar to when inhibiting defecation crucial to addressing bowel incontinence. Progressive resistive exercise (PRE) of puborectalis muscle by performing pelvic floor muscular contractions similar to when controlling defecation crucial to addressing bowel incontinence. Progressive resistive exercise (PRE) of the coccygeus muscle by performing pelvic floor muscular contractions similar to when inhibiting defecation crucial to addressing bowel incontinence. Progressive resistive exercise (PRE) of coccygeus muscle by performing pelvic floor muscular contractions similar to when controlling defecation crucial to addressing bowel incontinence.
STM LE
Soft tissue mobilization performed with focus on the psoas major area approximately from the transverse processes, bodies and discs of T12-L5 towards the lesser trochanter of the femur to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the iliacus approximately from the iliac fossa towards the lesser trochanter of femur to improve activities of daily living involving with the use of the lower extremities.
Soft tissue mobilization performed with focus on the gluteus maximus from the gluteal surface of ilium, lumbar fascia, sacrum, sacrotuberous ligament towards the the gluteal tuberosity of the femur and iliotibial tract to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the gluteus medius approximately from the gluteal surface of ilium, under gluteus maximus towards the greater trochanter of the femur to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the tensor fasciae latae approximately from the iliac crest towards the iliotibial tract. Soft tissue mobilization performed with focus on the quadratus femoris from the area on top of the Ischial tuberosity towards the intertrochanteric crest to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the superior gemellus approximately from the spine of the ischium towards the obturator internus tendon to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the inferior gemellus approximately from the ischial tuberosity towards the obturator internus tendon to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the piriformis approximately from the sacrum towards the greater trochanter of the femur to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the sartorius approximately from the anterior superior iliac spine a bony prominence in the pelvis towards the pes anserinus on the anteromedial aspect of the tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the rectus femoris muscle approximately from the area surrounding the ilium on the pelvis towards the tibial tuberosity of the tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the quadriceps femoris muscle approximately from the ilium and shaft of the femur towards the tibial tuberosity on the tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the biceps femoris muscle approximately from the ischial tuberosity of the pelvis towards the head of the fibula and lateral tibial condyle to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the semitendinosus muscle approximately from the ischial tuberosity of the pelvis towards the pes anserinus on the tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the pectineus muscle approximately from the superior pubic ramus towards the lesser trochanter and linea aspera of the femur to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the obturator externus muscle approximately from the obturator foramen and obturatory membrane towards the greater trochanter of the femur to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the gracilis muscle approximately from the ischiopubic ramus towards the pes anserinus on the tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the adductor magnus approximately from the pubis of the pelvis towards the femur and tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the adductor longus approximately from the pubis of the pelvis towards the femur and tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the adductor brevis approximately from the pubis of the pelvis towards the femur and tibia to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the tibialis anterior muscles approximately from the body of the tibia towards the medial cuneiform and first metatarsal bones of the foot to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the triceps surae muscle approximately from the end of the femur and upper part of the tibia posteriorly towards the calcaneus of the foot via the Achilles tendon. Soft tissue mobilization performed with focus on the gastrocnemius muscle approximately from the medial and lateral condyle of the femur posteriorly towards the calcaneus of the foot via the Achilles tendon to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the soleus muscle approximately at the upper part of the tibia posteriorly towards the calcaneus of the foot via the Achilles tendon to improve activities of daily living involving with the use of the lower extremities.
Soft tissue mobilization performed with focus on the plantaris muscle approximately from the top of the lateral supracondylar ridge of femur above the lateral head of gastrocnemius towards the tendo calcaneus (medial side, deep to gastrocnemius tendon) on the foot to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the popliteus muscle approximately from the lateral femoral condyle towards the posterior tibia under the tibial condyles to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the peroneus longus muscle approximately from the side of the fibula towards the first metatarsal, medial cuneiform on the foot to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the toe extensors towards approximately from the top of the calcaneus towards the phalanx of the great toe and proximal dorsal region of middle phalanges 2, 3 & 4 to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the flexor digitorum brevis approximately from the calcaneus at the bottom side of the foot towards the phalanges of toes 2 to 5 to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the flexor hallucis brevis approximately from the bottom of the foot on the cuboid bone towards the medial and lateral sesamoid bones of first metatarsal of the foot to improve activities of daily living involving with the use of the lower extremities. Soft tissue mobilization performed with focus on the muscles of the plantar surface of the foot from their origin approximately from the heel and tarsals towards the phalanges of the toes to improve activities of daily living involving with the use of the lower extremities.
STM Torso
Soft tissue mobilization performed to the splenius capitis approximately from the ligamentum nuchae and spinous process of C7-T6 towards its insertion: mastoid process of temporal and occipital bone to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed to the splenius cervices approximately from the spinous processes of vertebrae T3 or T4 to T6 intervening supraspinous ligaments towards the posterior tubercles on the transverse processes of cervical vertebrae C1 to C3 or C4 to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the left external oblique approximately from the top of the left lower eight ribs towards the iliac crest and inguinal ligament to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the right external oblique approximately from the top of the right lower eight ribs towards the iliac crest and inguinal ligament to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the left internal oblique approximately from the thoracolumbar fascia, anterior two-thirds of the iliac crest, and lateral half of the inguinal ligament towards the inferior border of the 10-12th ribs, linea alba, and the pubis via the conjoint tendon to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the right internal oblique approximately from the thoracolumbar fascia, anterior two-thirds of the iliac crest, and lateral half of the inguinal ligament towards the inferior border of the 10-12th ribs, linea alba, and the pubis via the conjoint tendon to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the transverse abdominal muscle approximately from the iliac crest, inguinal ligament, lumbar fascia, and cartilages of inferior six ribs towards the xiphiod process, linea alba, and pubis (pelvis) to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the rectus abdominis muscle approximately from the pubis a part of the pelvis towards the costal cartilage of ribs 5 to 7, and xiphoid process of sternum to improve activities of daily living involving with the use of the trunk musculature.
Soft tissue mobilization performed with focus on the quadratus lumborum muscle approximately from the top on the iliac crest and iliolumbar ligament towards the last rib and transverse processes of lumbar vertebrae to improve activities of daily living involving with the use of the trunk musculature.
thoracic
§ Progressed home exercise program to dynamic breathing exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - cervical / thoracic exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic manual range of motion - Spine Progressed home exercise program to extension exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic manual range of motion - spine extension exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic lengthening - extension / pectoral lengthening exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic manual range of motion - side lengthening exercise x 6 seconds hold x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic manual range of motion - rotation exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic lengthening exercise x 7secs hold, 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic manual range of motion - side bends exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic lengthening - supine extension exercise x 7 secs. Hold x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic lengthening - vertebral exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic muscle strengthening - latissimus (tubing row) exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic muscle strengthening- triceps / latissimus (tubing pull for extension) exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to thoracic muscle lengthening - lateral shoulder exercise x 5-10 repetitions for 2 sets, 2-3 times daily § thoracic Care Tips Muscle o back § Progressed home exercise program to muscle lengthening / flexion - gluteals / low back exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening / flexion - gluteals / low back exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abdominals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abdominals / gluteals exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abdominals / shoulder (lumbar stabilization) exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abdominals / shoulder (flexion) exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abdominals / thigh muscles (Lower extremity - flexion) exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - Mobilization - low back extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to extension - prone relaxation exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion / muscle lengthening - back extension exercise x 7 secs hold x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening / strengthening - back extension manual range of motion - low back extension exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening- low back extension exercise x 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - lumbar / hip exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - Sacroiliac exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - Sidelying lumbar exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - piriformis exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily
o knee § Progressed home exercise program to knee extension / muscle strengthening - quadriceps exercise x hold 8 repetitions for 2 sets, 2 times daily § Progressed home exercise program to knee flexion / muscle strengthening - quadriceps exercise x 5-10 repetitions for 2 sets, 2 times daily § Progressed home exercise program to knee manual range of motion - knee muscle lengthening exercise x 10 repetitions for 2 sets, 3 times daily § Progressed home exercise program to knee manual range of motion - prone knee muscle lengthening exercise x 10 repetitions for 2 sets, 3 times daily § Progressed home exercise program to knee muscle strengthening - hamstrings (prone heel-to-Buttocks lengthening) exercise x 8 repetitions for 2 sets, 2 times daily § Progressed home exercise program to knee muscle strengthening- hip flexion / quadriceps exercise x 8 repetitions for 2 sets 2 times daily § Progressed home exercise program to knee muscle strengthening - quadriceps exercise x 10 repetitions for 2 sets 2 times daily § Progressed home exercise program to knee muscle strengthening - hip adduction (isometric) exercise x 5-10 repetitions for 2 sets, daily § Progressed home exercise program to knee muscle strengthening - quadriceps exercise x 7secs. hold 7 repetitions for 2 sets, 2 times daily § Progressed home exercise program to knee muscle lengthening - quadriceps exercise x 7secs. hold 6 repetitions for 2 sets, 2 times daily § Progressed home exercise program to knee muscle lengthening - hamstring exercise x 7secs. hold 6 repetitions for 2 sets, 3 times daily § Progressed home exercise program to knee muscle strengthening - hamstring exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to knee partial squat vastus medialis oblique (VMO) muscle exercise x 12repetitions for 2 sets, 3 times daily § Progressed home exercise program to knee pillow squeeze on vastus medialis Oblique (VMO) exercise x 7secs. hold 5repetitions for 1 set, 3 times daily § Progressed home exercise program to knee manual range of motion - heel prop exercise x 10 repetitions for 2 sets, 2 times daily § knee Care Tips o Total knee § Progressed home exercise program to manual range of motion - ankle § Progressed home exercise program to knee muscle strengthening - quadriceps (isometric) exercise § Progressed home exercise program to knee muscle strengthening - hamstrings (isometric) exercise § Progressed home exercise program to Progressed home exercise program to knee muscle strengthening - quadriceps with hip flexion exercise § Progressed home exercise program to knee muscle strengthening - quadriceps with hip flexion exercise § Progressed home exercise program to manual range of motion - knee exercise § Progressed home exercise program to knee muscle lengthening - hamstrings exercise § Progressed home exercise program to manual range of motion - knee flexion exercise § Progressed home exercise program to knee muscle strengthening - hamstrings with knee flexion exercise § Progressed home exercise program to knee strengthening - hamstrings / gluteals with hip / knee flexion exercise § Progressed home exercise program to knee muscle strengthening - quadriceps with hip flexion exercise § Progressed home exercise program to muscle strengthening - hip abduction exercise § Progressed home exercise program to strengthening- hip adduction exercise § Progressed home exercise program to knee muscle strengthening - quadriceps exercise § Progressed home exercise program to Range of Motion exercise § Progressed home exercise program to knee manual range of motion - sitting knee flexion exercise § Progressed home exercise program to knee manual range of motion - sitting knee flexion exercise § Progressed home exercise program to knee manual range of motion - sitting knee flexion exercise o hip § Progressed home exercise program to hip muscle lengthening - gluteals / low back exercise x 7secs. hold 6 repetitions for 1 sets, 2-3 times daily § Progressed home exercise program to hip muscle lengthening - piriformis / hip external rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle lengthening - hip adduction exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip manual range of motion - hip Internal / external rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle lengthening / manual range of motion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip manual range of motion / muscle lengthening - trunk rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion / muscle lengthening - hip exercise § Progressed home exercise program to hip muscle strengthening - gluteals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle strengthening - hip abduction exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle strengthening - hip Progressed home exercise program to flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle lengthening - hip flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle strengthening - gastrocnemius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip Long Axis Distraction (Passive) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle lengthening - Iliotibial Band exercise (supine) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip muscle lengthening - Iliotibial Band standing exercise § Progressed home exercise program to hip/pelvic bridging level 1 (Pelvic lifts)exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 2 Pelvic Lifts with hold) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 3 (Pelvic Lifts with sway) exercise pelvic bridging x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 4 (Pelvic lifts with Bobath tech at 180 deg) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 5 (more decreased angle of knees) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 6 (Stronger LE in FABER position on top of weaker side) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 7 (Stronger LE crossed on top of the weaker side) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to hip/pelvic bridging level 8 exercise Stronger LE in SLR position x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § hip Care Tips o Total hip § Progressed home exercise program to muscle strengthening - quadriceps exercise § Progressed home exercise program to muscle strengthening - gluteals exercise § Progressed home exercise program to strengthening - quadriceps exercise § Progressed home exercise program to manual range of motion - ankle exercise § Progressed home exercise program to Range of Motion exercise § Progressed home exercise program to Progressed home exercise program to muscle lengthening / manual range of motion exercise § Progressed home exercise program to muscle strengthening - abduction exercise § Progressed home exercise program to muscle strengthening - Internal / external rotation exercise § Progressed home exercise program to manual range of motion - shoulder exercise § Progressed home exercise program to muscle strengthening - biceps / triceps exercise § Progressed home exercise program to muscle strengthening - finger flexion exercise § Progressed home exercise program to muscle strengthening - triceps / quadriceps exercise § Progressed home exercise program to muscle strengthening - abduction exercise § Progressed home exercise program to muscle strengthening - gluteals exercise § Progressed home exercise program to muscle strengthening - hamstrings with knee flexion exercise § Progressed home exercise program to muscle strengthening - hip flexion exercise § Progressed home exercise program to Progressed home exercise program to muscle strengthening- hip abduction exercise § Progressed home exercise program to muscle strengthening - gluteals exercise o ankle / foot § Progressed home exercise program to Amanual range of motion - Toe flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Amanual range of motion - Interossei exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Pmanual range of motion (lengthening) - Toe flexion / extension (Passive) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Amanual range of motion - ankle dorsi / plantar flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Amanual range of motion - ankle Inversion / Eversion (Side Bends) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Amanual range of motion - ankle Inversion / Eversion & dorsi / plantar flexion (Circumduction) exercise § Progressed home exercise program to muscle strengthening - ankle plantar / dorsiflexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Intrinsics (muscles of Arch) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - ankle Inversion / Eversion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - plantar Fascia exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - Soleus exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - gastrocnemius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - dorsiflexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Eversion (isometric) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Eversion (Resistive) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Inversion (Resistive) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - plantar flexion (Resistive) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - dorsiflexion (Resistive) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - inversion (isometric) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § · Mobility o sitting § Progressed home exercise program to muscle strengthening - hamstrings / quadriceps exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - gluteals / Adductors exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - triceps / gluteals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - lateral trunk exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - quadriceps exercise § Progressed home exercise program to muscle strengthening - hip flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - lumbar extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - Suboccipital (Axial extension) exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - upper trapezius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion - Shoulders exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - dorsi / plantar flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily
o sitting to standing § breathing exercise § Progressed home exercise program to manual range of motion - trunk exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - hip extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - triceps exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - quadriceps exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Toe extension / manual range of motion - plantar flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion - trunk exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - shoulder x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily o o Gait § Progressed home exercise program to muscle strengthening - ankle dorsi / plantar flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - gastrocnemius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - hip flexion / extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - hip abduction exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - hip extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion - hip flexion / extension & abduction / adduction exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion / lengthening - hip Internal / external rotation & low back rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - ankle dorsi / plantar flexion exercise § Progressed home exercise program to proprioception/ kinesthetic activities exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception / Kinesthetic Activities/ coordination exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Big Stepping without swaying exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - hip adduction & innternal rotation exercise § Progressed home exercise program to proprioception/ kinesthetic activities - trunk Weight Shift exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Arm Swings exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to knee straighteners exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily
o balance § Progressed home exercise program to manual range of motion / lengthening - low back / gluteals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to abductionominals / back extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - ankle dorsi / plantar flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § muscle lengthening - gastrocnemius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/Kinesthetic Activities - One-Legged Stands exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - One-Legged Stands Eyes Closed exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/Kinesthetic Activities- Toe Stands exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - heel Stands exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - Head Tilts exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - Head Tilts Up and Down x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - Two-Legged standing rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - Head Motion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - Eye Motion exercise § Progressed home exercise program to proprioception/ kinesthetic activities - Grapevine exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception/ kinesthetic activities - High Stepping exercise § Progressed home exercise program to Walking Head Turns exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Walking Figure Eights exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Semi Tandem standing exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Tandem standing exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to balance / proprioception / kinesthetic activities exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - thigh / leg musculature exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - low back / abductionominals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § o Flexibility § Progressed home exercise program to muscle lengthening - cervical extension / flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - cervical Side Bends / flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § M Progressed home exercise program to muscle lengthening - trapezius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - levator shoulder x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - shoulder flexion / extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - trunk Side Bends exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - thoracic rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - cervical / thoracic extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - hamstring / low back extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - gluteals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - thoracic / lumbar exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - hamstring / low back extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - hip flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - gastrocnemius x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - shoulder extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to Amanual range of motion / lengthening - ankle muscles exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - low back / thoracic / cervical exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - hip / low back rotation exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - Full Body exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - hamstring exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - piriformis / gluteals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily
o Posture § Progressed home exercise program to muscle lengthening - cervical exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion - cervical exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion - cervical exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - upper trapezius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Scapular protraction / retraction exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Scapular protraction / retraction exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - rhomboid exercise progressed home exercise program to muscle lengthening - trunk exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abdominals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle lengthening - lumbar exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - gluteals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to manual range of motion - shoulder exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to proprioception / strengthening- plantar flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - back extension exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - Scapular retractionor exercise
o breathing § Quick Test § Deep Effective Breaths exercise § lengthening - shoulder Girdle Intercostals exercise § shoulder protraction / retraction exercise § Heavyweight breathing exercise § Posture Awareness § Pursed Lip breathing exercise § breathing Tips o strengthening Regimen § Progressed home exercise program to muscle strengthening - biceps brachii exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - triceps brachii exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - anterior deltoids / biceps exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - finger flexion exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - pectorals / triceps exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abductionominals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - quadriceps exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - quadriceps/gluteals x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - gastrocnemius exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening - abductionominals exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening- Pubococcygeus muscle exercise x 7secs. hold 5-10 repetitions for 2 sets, 2-3 times daily § Progressed home exercise program to muscle strengthening Training Tips · Special Conditions o Osteoporosis § Progressed home exercise program to muscle strengthening - thoracic / lumbar extension exercise § Progressed home exercise program to muscle strengthening - rhomboid exercise § Progressed home exercise program to muscle lengthening - Suboccipital (Axial extension) exercise § M Progressed home exercise program to uscle lengthening - shoulder retraction exercise § Progressed home exercise program to muscle lengthening - shoulder flexion exercise § muscle lengthening - thoracic / lumbar extension exercise § Progressed home exercise program to muscle strengthening - gluteals (isometric) exercise § Progressed home exercise program to muscle strengthening - quadriceps exercise § Progressed home exercise program to muscle strengthening – gastrocnemius exercise § Progressed home exercise program to muscle lengthening - Gastrocnemius-Soleus exercise § Progressed home exercise program to muscle strengthening - triceps exercise § Progressed home exercise program to muscle lengthening - Corner exercise § Progressed home exercise program to muscle lengthening - Body Extender (Arms Down) exercise § Progressed home exercise program to muscle strengthening - trunk / lateral shoulder muscles & pectorals exercise § Progressed home exercise program to muscle strengthening - trunk /forearm / shoulder muscles exercise o Arthritis § Deep breathing § Amanual range of motion - Suboccipital muscles (Axial extension) exercise § Amanual range of motion - cervical muscles exercise § Amanual range of motion - upper trapezius / rhomboid / levator / scapulae / mid trapezius exercise § Amanual range of motion - finger flexion & extension exercise § Amanual range of motion - wrist flexion & extension exercise § Amanual range of motion - forearm supination & pronation exercise § Amanual range of motion - biceps (elbow flexion) exercise § Amanual range of motion - shoulder flexion (deltoids & biceps) exercise § Amanual range of motion - shoulder Horizontal abductionuctors / retractionors exercise § Amanual range of motion - spinal Side Bender muscles exercise § Amanual range of motion - spinal rotation exercise § Amanual range of motion - spinal extension exercise § Amanual range of motion / strengthening - quadriceps exercise § manual range of motion / strengthening - hip abduction / adduction exercise § muscle strengthening - gluteals exercise § Amanual range of motion - ankle dorsi / plantar flexion exercise § Amanual range of motion - Toe flexion exercise o Lower extremity Amputee § Amanual range of motion - trunk extension exercise § Amanual range of motion - quadriceps extension exercise § hip flexion (Active / Resistant) exercise § trunk extension (isometric) § muscle strengthening - abductionominals (isometric) exercise § muscle strengthening - hip extension (isometric) exercise § muscle strengthening - hip adduction (isometric) exercise § muscle strengthening - hip adduction (isometric) exercise § muscle strengthening - gluteals (isometric) exercise § muscle lengthening / strengthening - Full Body (isometric) exercise § muscle strengthening - gluteals exercise § muscle strengthening - gluteals / abductionominals exercise § manual range of motion - hip abduction exercise § muscle lengthening - hip flexion exercise o Parkinson § Deep breathing § muscle lengthening - suboccipital (Axial extension) exercise § manual range of motion - knee / ankle / foot exercise § muscle lengthening - lumbar / hip exercise § manual range of motion - hip / knee / ankle exercise § muscle strengthening - hip flexion § muscle strengthening- dorsiflexion § balance / proprioception - The Grapevine exercise § standing Rocks exercise § standing Side Rocks exercise § manual range of motion - trunk exercise § manual range of motion - hand / wrist exercise § manual range of motion - finger opposition § manual range of motion - cervical exercise § strengthening- upper trapezius exercise § Face exercises § anterior Pelvic Tilt (supine) § strengthening- gluteals / quads / trunk / triceps § Postural strengthening § manual range of motion - trunk (supine) o Stroke § muscle strengthening - hip / knee flexion exercise § muscle strengthening - rhomboid / pectorals exercise § muscle strengthening - lateral cervical flexion exercise § balance / proprioception exercise § muscle strengthening- quadriceps exercise § manual range of motion - ankle exercise § muscle strengthening - gluteals (isometric) exercise § muscle strengthening - quadriceps exercise § manual range of motion - hip adduction exercise § sitting Weight Shift exercise § muscle strengthening - quadriceps exercise § muscle strengthening - quadriceps / gluteals exercise § muscle strengthening - hip abduction exercise § manual range of motion - upper extremity Reach exercise § manual range of motion - supine Reach exercise § manual range of motion - supine Reach (Advanced) exercise § manual range of motion - Scapulo-Humeral (standing) exercise § Weight Bearing hand Sit exercise § muscle strengthening - Scapular Stabilateralizer exercise § muscle strengthening - Scapular Stabilateralizer (Advanced) exercise § muscle strengthening - wrist extension exercise § Muscular (Movement) coordination exercise § muscle strengthening- forearm supination / pronation exercise § Arm Movements (Supported) exercise § Weight Shift - Involved Side exercise § Weight Shift - Forward upper Body: scapulae exercise § Weight Shift - Forward upper Body exercise § Weight Shift - Forward upper Body(Advanced) exercise § Muscular (Movement) coordination - Lower extremity exercise
§ Geriatrics exercises § 1. AAmanual range of motion elbow flexion w/cane (cane assist biceps curl) § 2. AAmanual range of motion hip hike unilateral stand w/elastic (Elastic assist hip hike) § 3. AAmanual range of motion hip/knee flexion (heel slides) w/person (Caregiver heel slides) § 4. AAmanual range of motion shoulder ER bilateral supine w/cane abduction (cane assist overhead twist) § 5. AAmanual range of motion shoulder ER bilateral supine w/cane neutral (cane assist arm out) § 6. AAmanual range of motion shoulder IR w/cane (cane assist behind back lift) § 7. Amanual range of motion alt arms supine hooklying (Hooklying alternating front raises) § 8. Amanual range of motion ankle DF bilateral stand (Toe raise) § 9. Amanual range of motion ankle DF/PF (not elevationated) (ankle pump) § 10. Amanual range of motion ankle PF bilateral stand (Double heel raise) § 11. Amanual range of motion cervical retraction (chin tuck) supine (supine chin tuck) § 12. Amanual range of motion cervical rot supine (supine neck turn) § 13. Amanual range of motion cervical sidebending supine (supine neck sidebend) § 14. Amanual range of motion elbow ext stand (triceps kickbacks) (standing triceps kickback) § 15. Amanual range of motion elbow flexion/ext (biceps curl) § 16. Amanual range of motion elbow flexion/ext (arms abduction) in Pool (Pool scarecrow) § 17. Amanual range of motion Face cheek elevation (Cheek squeeze) § 18. Amanual range of motion Face forehead elevation (Eyebrow raise) § 19. Amanual range of motion Face grimace (Grimace) § 20. Amanual range of motion Face mouth/lip compression (Purse lip) § 21. Amanual range of motion Face neck depression (Platysma) (Platysma drill) § 22. Amanual range of motion finger walk (finger walk) § 23. Amanual range of motion gait crossovers (Crossovers) § 24. Amanual range of motion gait toe to toe walk (heel toe walk) § 25. Amanual range of motion gait walking (Walking) § 26. Amanual range of motion hand cane balance (cane balance) § 27. Amanual range of motion hip abduction bilateral supine (Leg angels) § 28. Amanual range of motion hip abduction unilateral sidelying w/person (eccentrics) (Leg raise eccentrics) § 29. Amanual range of motion hip abduction unilateral stand (Side leg kickout) § 30. Amanual range of motion hip abduction unilateral supine (supine side leg) § 31. Amanual range of motion hip ER sit (sitting leg in) § 32. Amanual range of motion hip ER/IR supine bilateral (supine double hip rotations) § 33. Amanual range of motion hip ext prone knee bent (Bent knee kickback) § 34. Amanual range of motion hip ext prone straight leg (prone leg raise) § 35. Amanual range of motion hip ext stand knee straight (Straight leg mule kick) § 36. Amanual range of motion hip flexion (sitting SLR) (sitting SLR) § 37. Amanual range of motion hip flexion (SLR) supine knee bent (Straight leg raise) § 38. Amanual range of motion hip flexion alt on Ball (Ball marching) § 39. Amanual range of motion hip flexion alt sit (Seated march) § 40. Amanual range of motion hip flexion sit (Seated knee lift) § 41. Amanual range of motion hip flexion stand bent knee (Chair march) § 42. Amanual range of motion hip hike supine (supine hip hike) § 43. Amanual range of motion hip hike unilateral stand (hip hike) § 44. Amanual range of motion hip marching (Seated marching) § 45. Amanual range of motion hip marching on Ball (Marching on ball) § 46. Amanual range of motion hip marching w/ alt arms (Seated leg/arm marching) § 47. Amanual range of motion hip marching w/alt arms on Ball (Marching arm salute on ball) § 48. Amanual range of motion hip/knee flexion (heel slides) (heel slides) § 49. Amanual range of motion hip/knee stance unilateral (clock reach) (Clock reach) § 50. Amanual range of motion knee ext (long arc quads) sit (Long arc) § 51. Amanual range of motion knee ext (short arc quads) sit (short arc) § 52. Amanual range of motion knee flexion prone (prone ham curl) § 53. Amanual range of motion knee flexion sit to stand (Sit to stand) § 54. Amanual range of motion knee marching (standing high step) § 55. Amanual range of motion knee partial lunge (short lunge) § 56. Amanual range of motion knee wall slide bilateral partial (Partial wall slide) § 57. Amanual range of motion kneel, half kneel, stand (kneel to half kneel to stand) § 58. Amanual range of motion lumbar alt leg/arm (bird dog) (Bird dog) § 59. Amanual range of motion lumbar bridging bilateral (bridging) § 60. Amanual range of motion lumbar bridging unilateral (Single leg bridge) § 61. Amanual range of motion lumbar ext prone (elbow press ups) (prone elbow press up) § 62. Amanual range of motion lumbar ext prone low level (prone back extend) § 63. Amanual range of motion lumbar ext quadruped (cat) (Cat) § 64. Amanual range of motion lumbar ext standing (standing back extension) § 65. Amanual range of motion lumbar flexion bilateral knee to chest (Double knee to chest (DKC)) § 66. Amanual range of motion lumbar flexion bilateral knee to chest hooklying (Single knee to chest hooklying) § 67. Amanual range of motion lumbar flexion quadruped (camel) (kneeling camel) § 68. Amanual range of motion lumbar flexion unilateral knee to chest (Single knee to chest (SKC)) § 69. Amanual range of motion lumbar lying prone arms up (prone prop up on pillow) § 70. Amanual range of motion lumbar rotation sit (sitting trunk twist) § 71. Amanual range of motion lumbar rotation supine (supine knee side to side) § 72. Amanual range of motion lumbar side to side sit on Ball (sitting side tilt on ball) § 73. Amanual range of motion lumbar side bend pushup (Side bend push up) § 74. Amanual range of motion shoulder abduction (finger walking) at wall (shoulder finger side walk up) § 75. Amanual range of motion shoulder abduction/adduction (cradle rock) (Cradle rock) § 76. Amanual range of motion shoulder abduction/adduction overhead w/cane (Overhead cane side to side) § 77. Amanual range of motion shoulder circles (choo-choo) (Choo choo) § 78. Amanual range of motion shoulder circles supine w/cane (cane circles) § 79. Amanual range of motion shoulder circum bilateral (Arm circles) § 80. Amanual range of motion shoulder elevation/retraction bilateral (shoulder rolls) (shoulder rollbacks) § 81. Amanual range of motion shoulder flexion (finger walking) at wall (Forward arm wall walk) § 82. Amanual range of motion shoulder flexion bilateral w/cane (cane double front arm raise) § 83. Amanual range of motion shoulder flexion bilateral w/cane (shoulder press) (cane overhead press) § 84. Amanual range of motion shoulder horizontal abduction/adduction stand w/cane (Front cane side reach) § 85. Amanual range of motion shoulder horizontal abduction/adduction supine w/cane (cane dance) § 86. Amanual range of motion shoulder IR w/cane (Behind back cane lift) § 87. Amanual range of motion shoulder ladductioner (shoulder ladductioner) § 88. Amanual range of motion shoulder overhead press bilateral (Double overhead press) § 89. Amanual range of motion shoulder pendulum (shoulder pendulum) § 90. Amanual range of motion shoulder press up bilateral w/cane (cane press up) § 91. Amanual range of motion shoulder retraction bilateral stand hands at neck (Open fly stretch) § 92. Amanual range of motion shoulder retraction/thoracic ext - Sun Salute (Sun salute) § 93. Amanual range of motion shoulder retraction ion w/cane (cane backward lift) § 94. Amanual range of motion shoulder touches (shoulder touches) § 95. Amanual range of motion shoulder/wrist rotation bilateral stand w/cane (cane shoulder twist) § 96. Amanual range of motion shoulder/wrist rotation bilateral supine w/cane (cane twister) § 97. Amanual range of motion thoracic breathing overhead arms supine (Overhead arm breath) § 98. Amanual range of motion thoracic diaphragm breathing (Reclined diaphragm breathing) § 99. Amanual range of motion thoracic ext supine (mid back arch) § 100. Amanual range of motion thoracic mid chest expansion (mid chest breathing) § 101. Amanual range of motion thoracic rotation diag (Seated trunk diagonal) § 102. Amanual range of motion thoracic rotation w/cane (sitting trunk twist with dowel) § 103. Amanual range of motion thoracic sidebend (sitting side bend) § 104. Amanual range of motion thoracic upper chest expansion (upper chest breathing) § 105. Amanual range of motion thumb CMC circum (thumb circles) § 106. Amanual range of motion thumb/finger opposition (thumb to finger touch) § 107. Amanual range of motion toe intrinsics (Toe intrinsics) § 108. Amanual range of motion trunk flexion supine w/ball (Static abdominal crunch w/ball) § 109. Amanual range of motion vestib standing balance (dynamic) (Feet together standing balance) § 110. Amanual range of motion vestib standing balance w/stride (standing stride balance) § 111. Amanual range of motion wrist circles (wrist circles) § 112. Amanual range of motion wrist sup/pron (wrist twist) § 113. Grav- shoulder protract/retraction (Seated shoulder punch) § 114. Grav- wrist flexion/ext (wrist side to side) § 115. Iso ankle DF (isometric supine foot lift) § 116. Iso cervical flexion (isometric forward neck push) § 117. Iso cervical rotation (isometric neck twist push) § 118. Iso cervical sidebend (isometric side neck push) § 119. Iso hip abduction sit w/belt (isometric hip out) § 120. Iso hip adduction sit w/pillow (Seated leg squeeze) § 121. Iso hip gluteal sets (prone glut set) § 122. Iso hip gluteal sets supine (supine glut sets) § 123. Mob thoracic ext (Wall angel) § 124. Mob thoracic sidebend/rot/ext sit (sitting thoracic extend and twist) § 125. Pmanual range of motion ankle circum w/person (Caregiver ankle circles) § 126. Pmanual range of motion ankle inv/ever w/person (Caregiver passive ankle side to side) § 127. Pmanual range of motion hip IR/ER w/flexed leg w/person (Caregiver flexed hip rotations) § 128. Pmanual range of motion hip IR/ER w/straight leg w/person (Caregiver hip rotations) § 129. Pmanual range of motion hip/knee flexion (heel slides) w/person (Caregiver passive heel slides) § 130. Pmanual range of motion shoulder abduction w/person (Caregiver passive side arm lift) § 131. Pmanual range of motion shoulder adduction w/person (Caregiver passive arm across) § 132. Pmanual range of motion shoulder ext w/person (Caregiver passive arm pull back) § 133. Pmanual range of motion shoulder flexion w/person (Caregiver passive arm lift) § 134. Pmanual range of motion shoulder horizontal adduction w/person (Caregiver passive arm crossover) § 135. Pmanual range of motion shoulder IR/ER w/person (Caregiver arm rotation) § 136. Resist ankle DF w/elastic (Elastic ankle pull up) § 137. Resist ankle ever bilateral w/elastic (Elastic double ankle pull out) § 138. Resist ankle inv w/elastic (Elastic ankle pull in) § 139. Resist ankle PF unilateral w/ elastic (Tubing gas pedal) § 140. Resist Diaphragmatic breathing w/wt. (Weighted abdominal lift) § 141. Resist finger flexion grip w/putty (Putty finger squeeze) § 142. Resist finger flexion intrinsics w/putty (Putty fingertip squeeze) § 143. Resist finger intrinsics w/putty (Putty taffy pull) § 144. Resist hand gross opposition w/putty (Putty finger grab) § 145. Resist hand key pinch w/putty (Putty key pinch) § 146. Resist hand three jaw chuck pinch w/putty (Putty three jaw chuck) § 147. Resist hip flexion (sitting SLR) w/wt (Weight seated SLR) § 148. Resist hip flexion sit w/elastic (Elastic march) § 149. Resist hip/knee flexion (heel slides) supine w/elastic (Elastic supine heel slide) § 150. Resist knee bike upright (Upright bike) § 151. Resist knee press w/elastic (Elastic seated leg press) § 152. Resist knee w/Recumbent Stepper (Recumbent stepper) § 153. Resist lumbar ext sit w/elastic (Elastic sitting lean back) § 154. Resist lumbar ext stand w/elastic (Elastic back pull back) § 155. Resist lumbar flexion sit w/elastic (Elastic sitting crunch) § 156. Resist lumbar rotation supine w/elastic (supine elastic back twist) § 157. Resist lumbar sidebend w/elastic (Elastic trunk sidebend) § 158. Resist lumbar sidebend w/wt (DB trunk sidebend) § 159. Resist shoulder diagonal D1 ext w/elastic (Elastic shoulder diagonal down and out) § 160. Resist shoulder diagonal D1 flexion w/elastic (Elastic shoulder inward crossover) § 161. Resist shoulder diagonal D2 ext w/elastic (Elastic shoulder diagonal down and in) § 162. Resist shoulder diagonal D2 flexion w/elastic (Elastic diagonal up and out) § 163. Resist shoulder elevation/retraction bilateral w/elastic (shoulder rolls) (Elstic shoulder shrugs) § 164. Resist shoulder ER bilateral w/elastic (Tubing double outward arm) § 165. Resist shoulder flexion bilateral w/elastic (Elastic double front arm raise) § 166. Resist shoulder horizontal abduction bilateral w/elastic (Elastic reverse flies) § 167. Resist shoulder overhead press bilateral w/wt (DB double overhead press) § 168. Resist stance heel/toe w/crosspull w/elastic (heel toe elastic pull) § 169. Resist stance unilateral w/crosspull w/elastic (One leg balance with elastic) § 170. lengthening finger flexors (finger table stretch) § 171. lengthening Gastroc sit w/person (Caregiver calf stretch) § 172. lengthening Gastroc sit w/towel (sitting Gastroc towel stretch) § 173. lengthening Gastroc unilateral standing (Runner stretch) § 174. lengthening hamstring sit w/person (Caregiver hamstring stretch) § 175. lengthening hamstrings supine active (Kick up hamstring stretch) § 176. lengthening hamstrings supine w/towel (Towel hamstring stretch) § 177. lengthening hip adductionuctor stand w/chair (Inside leg chair stretch) § 178. lengthening hip flexors leg abduction supine (Off table hip stretch) § 179. lengthening lumbar rotation supine w/person (Caregiver trunk twist) § 180. lengthening Pectoral standing bilateral at door (Pectoral door stretch) § 181. lengthening Pectoral standing unilateral (Side Pectoral stretch) § 182. lengthening quads sit (sitting Quad stretch) § 183. lengthening quads standing (standing Quad stretch) § 184. lengthening rhomboids/trapezius (sitting rhomboid stretch) § 185. lengthening shoulder blade pinch supine (anterior chest stretch) § 186. lengthening shoulder flexion at wall (Arm up shoulder wall stretch)
Allen's Cognitive Levels
Level I (Automatic Actions) Conscious to the external environmental is minimal. characterized by automatic motor responses and changes in the autonoic nervous system.
Level II (Postural Actions) PROP cues. Poor imitation of posture. unable to imitate the running stitch, three stitches.
Level III (Manual Actions) Repetitive Training. Recognize family & friends. Able to complete basic self-care tasks if VERBAL reminders are provided. Sanding. Follow simple directions: "Squeeze my hands" or "Look at me." Able to imitate the running stitch, three stitches.
Level IV (Goal-Directed Actions) VISUAL cues. Can carry out established routines but cannot cope w/ unexpected events. Matching colors of clothing, step by step illustrated directions, engage in simple activities (self-feeding and dressings), learn new skills by imitating a model or demonstration. Provide project samples for clients to dublicate. Able to imitate the whipstitch, three stitches.
Level V (Exploratory Actions) Understand cause and effect. New learning occurs. Overt trial and error problem solving. Can performa a task involving 3 familiar steps and a new one, plan a 3 course meal. Able to imitate the single cordovan using overt trial and error methods, three stitches.
Level VI (Planned Actions) SYMBOLIC cues. Can do mental trial and error problem solving. 30 mins of attention spane, aware of month, time, & year, ADL with min A, ability to recognize errors, written directions for the clients to follow. Able to imitate the single cordovan stich using covert trial and error methods, three stitches.
>approach the chair with firm steps, at good pace; • make a wide turn in front of the chair and stop straight in front of the chair: you must have the feeling that you walk around something (first, practice this, for example, with a cone in front of the chair, later without the cone); if necessary, turn at the rhythm of the cue you already used when you were approaching the chair; • place your calf or back of the knee against the seat; • bend slightly forward and bend through the knees, keep your weight well above your feet; • move with your hands towards the arms of the chair or the seat, seek for support with your arms; • lower yourself in a controlled manner; sit down well, at the back of the chair.
• place your hands on the arms or the side of the seat; • move your feet towards the chair (just in front of the chair legs, two fists apart); • shift your hips to the edge of the chair; • bend your trunk (not too far, nose above the knees); • rise gently, from your legs, let your hands lean on the arms of the chair, the seat or your thighs, and then extend your trunk completely (if necessary, make use of a visual cue). In case of starting problems rock back and forth a few times and rise at the third count.
Rest after the fall • turn from lying, through side-sit (pushing up the trunk with hetero-lateral arm and homo-lateral elbow support), to the position on hands and knees; • crawl to an object to pull yourself up (for example chair, bed); • bend the strongest leg and place the opposite arm on the object (rifleman’s position); • push yourself up with legs and arms.
It is advisable to slide the covers to the foot of the bed first (like an accordion); the top of the cover points in the direction of the head of the bed, so it can be pulled easily over the patient. For aids and other provisions (for instance, a bed adjustable in height) the working group refers to an occupa- tional therapist. 84 V-19/2004 KNGF Guidelines for physical therapy in patients with Parkinson’s disease
• approach the bed with firm steps, possibly with the use of a rhythmical cue , and make a wide turn in front of the bed (not over one leg), and walk at a good pace until you feel the bedside with your calf or back of your knee; • sit down on the edge of the bed (be sure there is enough distance to the pillow); • lower the upper part of the body in the direction of the pillow, and place the weight on the elbow; • lift the legs one by one into the bed so that you are lying on your side; • grab the covers with your free arm; • lower the upper part of the body onto the mattress and try to lie comfortably by moving your backside; • pull the covers over the body.
• approach the bed forwards with firm steps, if necessary make use of a rhythmical cue; • bend forward, lean with your hands on the mattress and crawl onto it in such a way that you are positioned on your knees, lengthwise, at the middle of the mattress; • lie down on your side (be sure there is enough distance to your pillow); • grab the covers with your free arm and pull them over your body.
• approach the bed forwards with firm steps, if necessary make use of a rhythmical cue, make a wide turn in front of the bed (not over one leg), and walk at good pace until you feel the bedside with your calf or back of your knee; • sit down on the bed, with sufficient distance and in diagonal direction to the pillow, with the arms as back- ward support; • place your legs, one by one, on the mattress, turn until you are lengthwise on the mattress; • grab the covers at the end of the bed, slide your feet under the covers; • lower yourself quietly until you are lying on your back, hold on to the covers and pull them over your body.
Smooth sheets (satin) or satin pyjamas make sliding or turning easier. Socks can give more grip on the sheets and, with that, make turning easier.
• move the cover to the side opposite to the one you want to turn to; • lift the cover with your arms and pull up your knees while you are lying on your back, put your feet flat on the bed; • move your body to the side, alternating with your feet, your pelvis, and your head and shoulders, in the opposite direction of the turn; • place your arm which is on the side you want to turn to next to your head, then turn your head and shoul- ders, use your free arm for the direction; • then lower your knees in the direction of the turn, if possible make some room under the covers with your free arm; • lie down comfortably.
• move the cover to the side opposite to the one you want to turn to; • lift the cover with your arms and pull up your knees while you are lying on your back, put your feet flat on the bed; • move yourself to the edge of the bed (alternating with your feet, pelvis, head and shoulders), in the opposite direction of the turn; • place your arm which is on the side you want to turn to next to your head; • pull up your knees as far as you can (in the direction of your chest, your feet on the mattress) and ‘drop’ in the direction of the turn (if necessary lift the cover with your free arm), roll over with your pelvis; • head and shoulders follow the free arm; • lie down comfortably.
• lift the cover and pull up your knees, while you are lying on your back, and put your feet flat on the bed; • move yourself to the edge of the bed (alternating with your feet, pelvis, head and shoulders), in the opposite direction of the turn; • outstretch one or two arms vertically; • bend your knees or keep your legs straight, whatever you prefer; • make a rolling movement with your total body, using an arm swing; • lie down comfortably.
N.B. For all three strategies it is important that the patient does not roll off the bed and lies in the middle of the mattress.
Getting out of bed: from lying on the back to sitting on the edge of the bed
The following tips might make it easier to get out of bed:
• at night a nightlight is on to make visual feedback possible.
• on the bed are no light covers or smooth sheets.
• the patient wears smooth (satin) pyjamas and socks for more grip.
• the bed is not too low.
• handy aids are: elevator to lift a patient, sliding board, handles on the sides of the bed (occupational thera-
pist).
• move your body a bit from the middle to the edge of the bed. • roll over on your side (see turning in bed); • pull your knees further to your chest; • open the cover; • place your top arm next to your bottom shoulder; • bring your feet over the edge of the bed and, at the same time push yourself up with both arms (if help- ful, support sitting up with your bottom arm straight and the hand of your other arm placed nearby your elbow).
• bend your knees, put your feet flat on the bed; • move yourself to the edge of the bed (alternating with your pelvis, shoulders and feet), in the opposite direc- tion of the turn; • lift the covers; • shift your feet over the edge of the bed and, at the same time roll over to your side; • place the hand your top arm on the bed near the elbow of your other arm; • bring your feet over the edge of the bed and, at the same time push yourself up with both arms (if helpful, support coming to sit with your bottom arm straight and the hand of your other arm placed nearby your elbow). From sitting on the edge of the bed to standing
• sit upright on your buttocks; • lean on your arms, place your fists a bit behind your body; • shift your buttocks to the edge of the bed; • lean with your arms on the edge of the bed; • place your feet right in front of the bed, approximately 20 cm apart; • bend forward (with your nose above your knees); • stand up from your legs, if necessary rock first.
Global Deterioration Scale (GDS) – Stage 1: Normal cognition – Stage 2: Age-associated memory impairment – Stage 3: Mild cognitive impairment – Stage 4: Mild dementia—caregiver does 25% – Stage 5: Moderate dementia—caregiver does 50%, Can no longer survive without assistance – Stage 6: Moderately severe dementia—caregiver does 75% – Stage 7: Severe dementia—caregiver does 100
- Preclinical: changes in the brain begin years before a person shows any signs of the disease. This time period is called preclinical Alzheimer's disease and it can last for years. - Mild, Early Stage: symptoms at this stage include mild forgetfulness but person may still live independently at this stage, but increased trouble with remembering a name, recalling recent events, remembering where he or she put a valuable object, making plans, staying organized, managing money. - Moderate, Middle Stage: at this stage, symptoms include increasing trouble remembering events, problems learning new things, trouble with planning complicated events (like a dinner), trouble remembering their own name and personal history, problems with reading, writing, and working with numbers, now that some people are familiar but not remember their names, lose track of time and place, need help choosing the right clothing and getting dressed, become moody or withdrawn, Be restless, agitated, anxious, or tearful, Physical changes may occur as well, Choosing the right clothing for the weather - Severe, Late Stage: lose many physical abilities, may lose bowel and bladder control, may be able to say some words or phrases, needs help with all activities, is unaware of recent experiences and of his or her surroundings, is more likely to get infections
Behavioral Strategies:
Interventions include: empathy approach with active listening, compassionate presence, affirmation, encouragement and reassurance with patient
DISCHARGE PLANNING & CASE MANAGEMENT