Client’s Initials and Age: TK age 57 Time allotted for session: 25-30 min Date implemented: 9/25

Diagnosis and any Precautions: (1) Acute L cerebellar stroke; Fall risk
Goal/s being addressed: (1) Pt will complete LB dressing with Supervision, Pt will demonstrate sufficient standing balance to complete
functional activities with CGA
OT goals: Pt will complete toileting with SBA, Pt will complete toilet transfer with CGA
Activity Demands (setting,
Specific Objectives for this Modifications (provided during the
Intervention Activities materials, and social
activity (list 2-3) activity and planned for next
(5) requirements)
(5) session) (5)
(5)
The patient I ended up performing a
Put on socks at EOB. 5-7
treatment on was a female of similar age
minutes
with a bilateral total knee replacement
1. TK will transfer from
(TKR). She also had difficulties with
supine  sit with SBA
balance. For this activity, I educated her
from OT
Setting: Pt room on how to use the sock aid and had her
2. Pt will sit at EOB and
Materials: chair, gait belt, non- return demonstration. Overall, it went
retrieve socks from the
Pt will successfully don socks slip socks well however I failed to mirror how she
table (to the left of pt, in
without LOB. Social requirements: pt will was moving and what she could/couldn’t
front of OT). OT will sit
Pt will reach outside of base of interact with therapist do. I found myself bending my knee past
beside pt with CGA for
support for socks with R UE the point which she could and was
LOB
placement on bed. Grade up: pt will retrieve socks reminded by myself and FWE to show
3. TK will don sock on L foot
Pt will use figure four technique from ground, outside of his base how it would actually be. Also, the patient
using figure four
to don socks. of support. was seated in the chair as opposed to
technique
Grade down: pt will be handed EOB since this was the last activity we
4. TK will don sock on R foot
socks by OT inside of his base of did. For next time, I will make sure I am
using figure four
support. mirroring the patient with the correct
technique
diagnosis and precautions. I will also
Chosen to address LB dressing
make sure to have them seated at the
goal and decreased dynamic
EOB with either myself next to them or
sitting balance. Pt prone to lose
an assistant. This will allow me to see
balance during activity.
their dynamic sitting balance.
Moving gowns to cabinets. 10 After going over the plan with my FWE I
Pt will use L UE to pick up and Setting: Pt room
minutes realized there was an easier, more
place gowns inside the cabinet, Materials: extra gowns, bedside
1. Pt will stand at cabinet in functional task that I could use to
using the R hand for support on table, w/w, gait belt.
room with bedside table challenge balance and coordination. My
w/w. Social requirements: pt will
to the right of pt and w/w FEW brought up tying shoes while
Pt will cross midline with L UE. interact with therapist
in front of pt for stability seated as an activity that will challenge
Pt will not lose balance when
prn the pts bilateral coordination and sitting
reaching outside of base of Grade up: pt will grab and place
2. Pt will open overhead balance. This activity is more functional
support. gown with both hands
cabinet than the activity I had planned as part of
 3. Pt will rotate trunk to the
right and pick up folded
gown with L hand and R
hand placed on w/w for
stability
4. TK will place gown into
overhead cabinet
5. Repeat steps 3-4 until
gowns have been placed
into cabinet. OT will
provide assistance for
balance
Chosen to address goal of
increased dynamic standing
balance to increase I in self-care
tasks. This activity focuses on
the patients dynamic standing
balance in addition to bilateral
coordination. Both of these are
needed to be independent in self-
care tasks such as grooming, LB
dressing, transfers, etc.
Wash face. 10 minutes
1. TK will ambulate to the
sink with Min A for
dynamic standing
balance
2. Pt will grab washcloth
with L UE and turn on
sink
3. TK will wet washcloth
under the faucet
4. TK will wipe face with
wet washcloth using the
L hand to wipe and R
hand placed on w/w to
steady self
5. Pt will reach for and
apply facewash to
washcloth or hand
(whatever is preferred)
Pt will use L hand to wash face
and place R hand on w/w for
stability.
Pt will perform activity with CGA
for dynamic standing balance.
Pt will perform activity with min
verbal cues for use of L hand.
Grade down: pt will grab gown the intervention. If I had gotten the
with L hand and place next to him opportunity to implement this, I would
instead of in overhead cabinet
Setting: Pt room
Materials: washcloth, facewash,
water, mirror
Social requirements: pt will
interact with therapist
Grade up: Pt will retrieve
materials from the bathroom and
ambulate to sink to perform task.
Grade down: materials set-up at
sink.
have changed this activity to shoe tying.
Functional, repetitive activities have
been proven to show greater outcomes
for individuals with strokes.
I did not get to implement this activity
with the patient I did perform a treatment
on because she was fatigued and in
severe pain due to bilateral TKR. Also, I
performed the functional activities first.
This was the first activity I did with my
patient. For this activity, one thing I
modified is that I had her sit in the chair
and perform this activity after
ambulating to the sink. Since she was a
bilateral TKR, she was WBAT for both
LE. She required min-mod assist of 2 to
ambulate to the sink. Once she got
there, she was already very fatigued,
leading to the decision to sit in the chair.
Her dynamic sitting balance was still
challenged by reaching for the materials
at the sink. For next time, I would have
the patient stand for at least 2-4 steps
of the activity to assess their dynamic
standing balance and activity
endurance.
 6. Pt will wash face with L
hand and R hand placed
on w/w for stability
7. TK will turn on faucet
and run washcloth
underneath, removing
excess soap
8. Pt will squeeze out
excess water in
washcloth with both
hands
9. Pt will wipe off facewash
with washcloth using the
L hand to wipe and R
hand placed on w/w to
stabilize self
10. TK will place wet
washcloth in sink and
reach (with L hand) to
grab dry wash on R side
of the sink. TK will keep
R hand on w/w for
stabilization
11. Pt will dry off face with
washcloth using the L
hand and R hand placed
on w/w for stability
12. TK will place washcloth
on the R side of the
countertop using the L
hand while the R hand is
on the w/w.
This activity was chosen to
address goal of increased
dynamic standing balance for
increased I in self-care tasks.
This activity challenges the
clients L UE coordination as well
as dynamic standing balance.
S/OT name: Rachel Wegener

Add rows for more activities if needed, please erase the red instructions when filling it out.
Find one peer-reviewed article that supports the intervention you planned/provided. At the bottom of your plan, paste the abstract and
citation and then in your own words describe how this supports your intervention plan. (5)

Total: 27 points