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Exercises

In sitting: bilateral knee extension, hip flexion, ankle pumps, hip abduction  with verbal cues and couching to acquire end range movement, perform slowly and controlled to optimize muscle activation, and to optimize movement pattern to perform safest as possible to avoid injury.

Sustained standing

Patient and family educated in importance of sustained standing exercise with appropriate guarding for safety in order to reduce pressure sore risk and ton increase strength and functional capacity for transfers and walking.

Sit to stand

Repeated sit to stands with emphasis on slow and controlled movements and correct use of upper extremities for safety.

Teaching

Diaphragmatic breathing

Instruction in Diaphragmatic breathing today with emphasis on breathing in through the nose and out through the mouth, pushing stomach out when breathing in when experiencing symptoms of shortness of breath.

Depression

Instructed patient to pay close attention to symptoms of any depression and to follow MD recommendations in regards to any medication dosing and to call MD if needed if symptoms become unmanageable.

HEP

WB restrictions

Instructed patient in importance of home exercise program to be performed daily as tolerated with appropriate rest breaks between exercises. Emphasized  patient to perform ambulation with correct weight bearing status on right LE at least once every 2 hours with assistance from family member. Other HEP exercises include, but not limited to : bilateral knee extension, hip flexion, ankle pumps, hip abduction  10 reps 2-3x/day.

Standard:

Instructed patient in importance of home exercise program to be performed daily as tolerated with appropriate rest breaks between exercises. Emphasized  patient to perform ambulation with correct posture and use of walker at least once every 2 hours with assistance from family member. Other HEP exercises include, but not limited to : bilateral knee extension, hip flexion, ankle pumps, hip abduction  10 reps 2-3x/day.

Instructed patient in importance of home exercise program to be performed daily as tolerated with appropriate rest breaks between exercises. Emphasized  patient to perform ambulation with correct posture and correct speed and motion of exercises as not to cause injury.

Teaching on expectations for soreness, need to increase walking distance and endurance with
multiple intervals spread over the day in addition to supine, sitting and/or standing HEP.
Moderate muscle or joint soreness that resolves within 24 hours should be expected at times.

Diabetic foot care

Instructed patient on effective safe cleaning of feet when showering and making sure now skin break down is observed.

Medication

Instructed patient to pay close attention to MD instructions regarding all medications and to take as prescribed and on time, monitoring for any side effects or adverse reactions and to appropriately report those to agency or MD as appropriate.

Ambulation:

Instructed patient and family in daily ambulation with emphasis on safe posture and safe movement, keeping pathways clear and well illuminated, in addition to adequate pacing of activity with rests breaks as needed.

verbal cues and couching for correct posture and safety with turns and correct walker management

WB restrictions ambulation teaching

Instructed patient and family in daily ambulation, following appropriate weight bearing precautions of 20% on right LE with emphasis on safe posture and safe movement during turns with correct use of walker, in addition to adequate pacing of activity with rests breaks as needed.

Instructed patient and family in daily ambulation with emphasis on safe posture and safe movement during turns with correct use of walker, in addition to adequate pacing of activity with rests breaks as needed.

Transfers

Instructed patient and family in safe transfers performance for sit to stand transfers and chair to bed transfers with emphasis on patient correctly using upper extremities to safely push off from chair to then transition to walker and when coming to sit, to be sure to feel chair behind legs and then reach back for surface with upper extremities to allow safest transfer possible.

Instructed and performed with patient safe transfers performance for sit to stand transfers with emphasis on patient correctly using upper extremities to safely push off from chair to then transition to walker and when coming to sit, to be sure to feel chair behind legs and then reach back for surface with upper extremities to allow safest transfer possible.

Home bound

Patient is truly homebound s/p right LE fracture with limited weight beating due to severe fall.  Patient is unable to ambulate without extensive assistance and is unable to stand without significant help. Patient is a high falls risk related to strength deficits and balance deficits. It is very difficult and taxing for patient to leave home, requiring the use of wheelchair and one or more persons to be able to leave home.

Patient is truly with diagnosis of MS and presents with limited functional mobility.  Patient is unable to ambulate without risk for falling. Patient is a falls risk related to strength deficits and balance deficits. It is very difficult and taxing for patient to leave home, requiring the use of wheelchair and one or more persons to be able to leave home.

Patient is truly homebound presenting with limited functional mobility.  Patient is unable to ambulate without risk for falling. Patient is a falls risk related to strength deficits and balance deficits. It is very difficult and taxing for patient to leave home, requiring the use of cane and one or more persons to be able to leave home.

Assessment

Severe falls risk

Patient presents as a severe falls risk, having had multiple falls in recent history, requiring EMS to pick patient up off ground. Pt has deficits in strength, posture, gait, safety, balance, transfers, and activity tolerance. Patient will benefit from physical therapy to restore functional independence, by instructing in a daily home exercise program, progressing the program based on patient’s response each visit and performing functional balance activities, all in an effort to reduce falls risk and re-hospitalization risk.

Progressing:

Patient making progress overall with significant gains in ambulation, safety, posture, and endurance. Patient expected to continue to progress with further PT intervention to reduce falls and risk for re-hospitalization.

Homebound

Patient has a low activity tolerance. Standing, walking and requirements for leaving the apartment can be daunting due to pain, fatigue and increasing fall risk with symptoms. Patient is very limited functionally and requires the use of a (assisted device) in addition to one or more persons to assist in leaving the home. Patient is truly homebound because of the degree of how taxing and difficult it is for the patient to move around, let alone, leave the home.

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