User talk:Deo Grace

Therapeutic Ex
Completed progressive muscle strengthening exercises on BLE using 2# and facilitated bilateral hip flexors, hip abductors, quadriceps, HS, TA and gastroc-soleus to develop muscle strength, control and for increased safety and improve level of independence with functional mobility.

Patient performed muscle strengthening ex on RLE using 2# and AAROME on LLE with facilitation technique to improve muscular contractions and to increase LE muscle strength. Completed core and pelvic muscle strengthening and stabilization exercises on the mat to improve motor control and proximal body muscle strength for increase ability to perform functional transfers and standing tasks. PNF technique applied to LLE to facilitate co-contractions at proximal joint and develop tone and strength to hip, knee and ankle.

Balance
Sitting static and dynamic balance training with patient sitting on the mat with back unsupported and BUE on her lap in order to improve ability to self correct LOB and improve postural awareness. Sitting Static graded as F/ F- and dynamic as P+. Functional forward and side reaching to the L with facilitation for balance recovery and maintaining F static balance and increase L side awareness.

Patient performed anterior and posterior postural sway to enhance ankle strategy. Facilitation of Tibialis anterior when leaning back to decrease risk of falling backward and Concentric Triceps surae to decrease risk of falling forward.

Without PT
Without PT, the patient will be at high risk for falls with potential injury, further decline in function, will be unable to return to previous walking abilities, will be unable to recover in a reasonable amount of time to return to prior level of ambulation, will not recover from underlying impairments to return home and live at modified level of living with spouse.

Therapy is necessary for improving muscle strength & coordination B LE; increase dynamic standing / ambulatory balance, ambulatory capacity, activity performance, and to increase in the level of independence with bed mobility, transfers and gait. Without therapy, the patient is at risk for decline in his functional mobility, ambulation, risk for re-injury to the surgical repair, and complications of immobility like contracture formation, decline in skin integrity, and increased fall risk.

loading response
Gait training with use of RW ~ 100 ft x 2 with CGA. Facilitated ankle dorsiflexors to eccentrically contract to decrease slapping of the foot on the floor and hold ankle joint for heel to toe gait pattern. Facilitated quadriceps to act eccentrically to control knee flexion during loading of LE. Activated erector spinalis to stabilize the trunk during weight shift transfer and prevent forward trunk flexion during initial contact of LE and produce trunk and pelvic rotation.

MIDSTANCE
Facilitated quadriceps to act concetrically to initiate and allow full knee extension for increased stability at sungle limb stance for safe and effective gait.

TERMINAL STANCE
Facilitated ankle plantar flexors during midstance to allow heel to rise from the flooor with continued forward momentum of the upper body, Facilitated hip abductors to elevate the pelvis in preparation for swing.

INITIAL SWING
Facilitated the hip flexors and knee extensors (primarily rectus femoris) to initiate swing phase of gait and dorsiflexors to permit the forefoot to clear the ground. Activated hip adductors to assist hip flexion during preswing and initial swing phase of gait.

TERMINAL SWING
Faciliated hamstrings (primarily the medial group) act eccentrically to decelerate the swinging extremity, while the dorsiflexors hold the ankle in position for initial contact.

BED MOBILITY
Bed Mobility Tasks:

Patient instructed on sequencing of body movement to improve performance and safety with supine to sit. Facilitation of UE instead of neck flexion to initiate movement followed by using trunk lateral flexion and rotation and elbow to broaden base of support to be able to elevate self to sitting position with less assistance and to increase level of independence.

TRANSFERS
Functional transfer training provided with demonstration of phases of rising from a w/c or bed/mat. Instructions provided to allow forward trunk flexion and lift buttocks from the seat and facilitated ankle dorsiflexors to bring the center of body mass forward and over the feet. Performed Quadriceps activation which is very critical for seat off in order to stand completely with concentric knee extension and concentric hip extension. Once full standing achieved, hip stabilization and ankle stabilization needed for balance stability.

PT EVAL NOTE
PT Evaluation completed. Plan of care developed and skilled treatment recommended for bed mobility training, transfer training, gait training, stair management, balance re-training, patient education and d/c planning. Discussed patient's goals and d/c plan. Patient verbalized desire to return home alone and indepenedently without caregiver. She agreed to POC established in order to return home safe and Independently.

Patient performed active range of motion of LLE AP 2 x10 reps; active assistive ROME R LE due to decreased mobility and muscle strength. R knee flexion tested in sitting and measured as -5 to 90 degrees with complaints of pain with movement. Instructed patient on avoiding pillow under knee when in bed to decrease or avert knee flexion deformity.

Patient's gait assessed and instructions provided during gait training to correct pattern to improve gait safety and level of independence. Patient ambulated 60 ft x 2 with RW and CGA and demonstrates decreased step length, NBOS, R foot inward step and inadequate foot clearance. Patient instructed on safety and tech with ambulation and appropriate WB.

Patient requires CGA with bed mobility. She needs CGA with functional transfers with VI for hand and LE placement for increased knee joint protection and increased safety. Standing S: Fair and dynamic; F-, MMT of RLE - 3-/5 and LLE 3+/5. Patient demonstrated with good understanding regarding educational interventions for R TKA precautions and safety.