Pair Treatment Plan #3

Patient name:
Diagnosis: R CVA
PMH: none reported by patient
Psycho Social/ Family situation: Pt. is currently unemployed since his CVA but formerly
was an IT Specialist. He is 59 years old and lives with his two daughters and one
granddaughter who he cares for occasionally. He lives in a one-story house in a rural
setting with 1 step to enter. He is divorced from wife. Prior to his stroke, he enjoyed
cooking, housework, spending time with his family, working on cars, and television.
Precautions: none
Patient’s stated goals: Pt. expressed boredom and a desire to return to a different line
of work. He also expressed difficulty with bimanual tasks and wishes to regain the ability
to peel a potato and participate in more household tasks. Additionally, he desires to be
able to get down and up off the floor to participate in leisure activities like working on
cars. He expressed difficulty with shopping and managing his money and wishes to not
be as impulsive in this area. He also expressed difficulty with laundry and often leaves
clothing in basket rather than going through trouble of folding and putting away.
Medical Cause/ Description of Diagnosis:

Pt. experienced R CVA of unknown cause in 2013, resulting in limitations of the

left side of his body. He exhibited decreased ROM on left side of body, specifically with
shoulder ROM, elbow extension, wrist extension as well as ulnar and radial deviation.
He exhibited decreased muscle strength with his left shoulder, elbow and hand. He has
difficulty coordinating use of both hands. He showed slight undershooting on each
diagonal target during saccades. He had decreased vision in his left central visual field.

A stroke can be caused by the sudden loss of blood circulation to an area of the
brain, resulting in a loss of neurologic function. A stroke occurring on the right side of
the brain can cause paralysis/paresis on the left side of the body. Individuals can have
difficulty with vision and touch sensation. This can include decreased sensation on the
left side of the body, double vision, left side neglect, and uncontrolled movements of
the eyes (nystagmus). Individuals can also have several problems with left sided
movement, such as coordination, balance, spasticity/flaccidity and paralysis or
weakness of the left side of the body. They will experience difficulties with thinking and
perception, such as attention span, finishing long tasks, judgement, sequencing tasks,
bathing and grooming, impulsiveness. These difficulties can put the individual at a safety
risk and should not be left alone while recovering.

Models or Frame of Reference:

The rehabilitative frame of reference is used to allow an individual to be as
independent as possible despite limitations in functioning. This can include adaption of
tasks, adaption of the environment, providing adaptive devices, and family training. This
approach is used when improvement has leveled off, as is the case in this patient since
he is five years post-stroke. Adaptive devices that may be helpful include a reacher due
to difficulty getting down to the ground, adaptive cooking devices that may help with
meal preparation and an adaptive laundry folder. Adaption of the environment may be
used for the patients decreased ROM in his L UE. This could include raising items off the
ground to make it easier for him to utilize like placing shoes on a shoe rack rather than
on the ground.
Priority Intervention STG LTG
Impairment/ Activity
Limitations/
Problem Areas
Bimanual Tasks 1. Pt will target To demonstrate Pt. will prepare
bimanual increased bimanual homemade mashed
coordination coordination, pt. will potatoes in one-hour
by practicing peel 4 potatoes. He will utilizing both hands to
screwing and hold and stabilize improve bimanual
unscrewing a potato in one hand and coordination.
lightbulb with peel with the other
hand-over- hand.
hand
assistance as
needed.
2. Pt will target
bimanual
coordination
by dealing
cards for "war"
into two piles.
Pt will hold the
deck in one
hand and deal
the cards with
the other hand
until no cards
remain in his
hand.
3. Pt will target
bimanual
coordination
by opening and
closing 4
different-sized
containers
utilizing both
hands.
4. Pt will target
bimanual
coordination
 by buttoning a
front-button
shirt while
wearing it,
decreasing
time as he
improves.
5. Pt will target
bimanual
coordination
by holding a
peeler and
peeling a
cucumber. This
will assist with
peeling
potatoes by
practicing with
a less-slippery
item.
Financial Management 1. Pt will target Pt. will demonstrate Pt. will demonstrate
financial improved financial improved financial
management management by management by
by making a creating a monthly creating grocery list and
weekly budget budget given a pretend complete shopping
given a set monthly job salary with independently without
amount of no more than two exceeding his set
money verbal cues. budget.
monthly.
2. Pt will target
financial
management
by making a
grocery
shopping list
from created
budget that
will not go over
the set
amount.
3. Pt will target
financial
management
by utilizing a
job search
website (I.e.
monster) to
identify a job in
which he is
qualified for,
that he can
complete given
 his limitations,
and that fits his
needed
budget.
L Ulnar/Radial Deviation 1. Pt. will target L Pt will perform 10 Pt. will perform 15
ROM radial and ulnar degrees of active radial degrees of active ulnar
deviation by deviation to increase and radial deviation in
completely independence in his left wrist to increase
wiping down sweeping his kitchen. independence in
kitchen table cleaning his home.
with a wet rag.
He will use his
right hand to
stabilize and
his left hand to
wipe down the
table. This will
promote
independence
in cleaning
routine.
2. Pt. will target L
radial and ulnar
deviation by
sweeping
contents on
kitchen floor
into a pile. This
repetitive
motion will
increase
independence
in his wrist
ROM to clean
his kitchen.
3. Pt will perform
radial and ulnar
deviation
exercises on
left wrist with a
half-filled
water bottle 5
reps x 3 sets in
each direction.
This will target
increase
independence
in L ulnar and
radial deviation
to allow for
 ability to take
care of his
home,
including
sweeping
floors and
wiping
counters.

Home Management 1. Pt. will practice Pt will demonstrate Pt will demonstrate

folding laundry increased home increased home
with adaptive management by management by
shirt folder. He simulating changing oil completing entire
will place the in car by stabilizing laundry routine from
shirt on the funnel with one hand start to finish
board, flip the and pouring with the independently.
left side with other into a bottle with
his left hand, no more than 2 verbal
flip the right cues.
side with his
right hand and
flip the bottom
up with both
hands. This will
promote
increased
independence
with laundry.
2. Pt will practice
dynamic
standing
balance by
bending down
to assist
granddaughter
in picking up
her toys and
placing in
basket. This
will promote
increased
independence
in home
management
tasks like
laundry or
gardening.
3. Pt will practice
filling up bottle
with water by
unscrewing
cap, placing
funnel, filling it
until full, then
screwing cap
back on. This
will promote
independence
in changing the
oil in his car, a
preferred
home
management
skill.