What are your patient’s goals?

• • If most of your goals are ADL focused (depending on the setting), think about what parts of the goal is difficult for the patient by doing a thorough activity analysis
  • Example: 
    • Pt will demonstrate completing toileting task with SBA while utilizing grab bars for safety within 2 weeks.

Activity analysis time!

• • Really break down each set of the ADL/activity and think about:
    • “What are the body functions/components that they are specifically having trouble with during this task?”
  • Example: 
    • Difficulty with – dynamic balance, endurance, sequencing more than 3 step directions, internal rotation to pull up pants in the back

What other body functions, purposeful or occupation based interventions can address these barriers to their goals?

• • After identifying the performance components that are difficult, what other treatment ideas can you use/grade to work on these same components?
  • Be client centered!
    • Integrate activities are occupation based or meaningful to them into your treatment sessions or directly address the underlying deficit.
  • Example:
    • Working on endurance activities because they cannot stand the 2 minutes it takes to pull up their pants?
      • Time them to see how long they participate in the task to document our skilled intervention and progress the patient, increasing activity time or timing them for how long they can participate before needing a rest break:
        • Cornhole game
        • Facility scavenger hunts
        • Folding laundry (standing or sitting depending on challenge leve)
        • Cooking tasks
        • Standing at parallel bars and playing a game

• • • Working on dynamic balance activities because they cannot reach outside their base of support to reach the toilet paper? 
      • Work on progressive dynamic balance exercise during activities such as:
        • Putting dishes away from the dishwasher to the cabinets above (occupation based)
        • Complete a putting green activity to simulate the weight shift and dynamic balance of golfing or even add a balance pad to grade it more difficult (purposeful activity)
        • Start with standing shoulder width apart, and reaching, progress to rhomberg stance with reach, etc (body functions)

Documentation

• Document the specific body function/component that you are working on so you can directly link it to the occupation and goal that the patient is working on.
  • Example SOAP Note Documentation:
    • Therapist instructed in dynamic sitting balance activity, requiring the patient to pick up objects from floor level 10x with 1, 30 second rest break to progress toward lower body dressing.
      • You could have completed any meaningful activity to work on dynamic balance in this scenario:
        • Picking up socks out of a laundry basket
        • Playing Jenga with set up of the blocks on the floor
• You do not have to document the specific activity (as in you do not have to document that the patient is playing Jenga) unless it is directly related to the goal.

Additional Micro-Videos:

Balance Progression

Occupation Based Treatment Ideas

Resources:

Development of the Dynamic Model of Occupation-Based Practice

Home- and occupation-based interventions in stroke rehabilitation: a scoping review