Applied sensorimotor, cognitive, and perceptual intervention techniques in a clinical situation.
Rationale: Cutaneous facilitation technique to elicit reaction from motor neurons (increasing muscle tone) during movement through ROM and in functional activities.
Intervention Goal: Patient will increase muscle tone in RUE for functional assist in ADL's.
Description: Rapid brushing of three second bursts on the agonist m. during concentric motion of joint ROM. For elbow flexion, apply rapid brushing on the biceps brachii muscle body while moving forearm through flexion. Stop brushing once full ROM is reached and put elbow back into extension. Examples of functional activities: Brushing teeth, combing hair, donning hat, etc.
Rationale: Inhibitory technique used to reduce spasticity in muscles surrounding the glenohumeral joint to reduce pain and stiffness. Used before functional activities.
Intervention Goal: Patient will decrease pain to 0-1/10 on a 10 point scale in Right Glenohumeral Joint.
Description: Patient elbow flexed at 900 and shoulder abducted 35-450. Therapist stabilizes shoulder and applies compression force through the longitudinal axis of the humerus. Once muscles of the shoulder girdle start to relax, therapist can begin to circumduct the humerus. Therapist could incorporate drawing into this therapuetic intervention as a functional activity.
Stage Four--Hand Behind Back
Rationale: As spasticity begins to decrease, movement patterns tend to be less dependent on limb synergies as patient moves through stages of Brunnstrom. Stage four "hand behind back" combines synergies of the UE; also described as conditioning of the synergies that are used during functional activities.
Intervention Goal: Patient will use thier RUE as a functional assist in ADL's.
Description: Combines shoulder abduction (flexor synergy) with elbow extension, and forearm pronation (extensor synergy). Dorsum of hand should stroke the patient's back for sensory feedback. Application: scrubbing back for bathing/showering, removing wallet from back pocket, or feeding belt through rear belt loop.
Functional Bimanual Task
Rationale: In adult patients with hemiplegia, use of the involved side allows for neuroplasticity on the affected side of the brain, reduces non-use behavior, and increases motor learning with practice. Clasping hands together encourages use of involved side during functional activities. Beach-ball toss allows patients to utilize this technique in a play participation activity.
Intervention Goal: Patient will demonstrate increased use of involved UE 90% of the time with verbal cues in ADL's.
Description: Patient interlocks fingers and places thumb of affected UE on top. Therapist tosses ball to patient and patient uses a combination of their affected and unaffected side with thier hands clasped to the hit beach ball back to therapist.
Rationale: Weight-bearing by leaning on affected UE during functional activity decreases tone.
Intervention Goal: Patient will decrease tone as exhibited by increased AROM in RUE.
Description: Have patient sit and weight-bear on affected UE by leaning towards thier affected side while performing a functional task with thier unaffected UE across mid-line. Encourage anterior pelvic tilt. Example: have patient reach across mid-line for small rubber balls and place them in a bucket next to thier non-affected side.
UE D1 Extension
Rationale: Opening a car door utilizes a D1 extension pattern. Unilateral diagonal patterns possess functional significance in ADL's and thier use is encouraged to increase independence during funcitonal activities.
Intervention Goal: Patient will demonstrate car transfers with independence in order to increase community mobilization.
Description: In regards to car mobility/transfer (as pictured), D1 extension leads with hand opening toward ulnar side (on level car handles), elbow extended, scapular depression, and shoulder in extension-abduction-internal rotation. Have client enter and exit their primary vehicle emphasizing use of affected UE.
UE D2 Extension
Lower Body Dressing
Rationale: Putting on shoes utilizes a D2 extension pattern and bilateral diagonal patterns possess functional significance in ADL's and thier use is encouraged to increase independence during functional activities.
Intervention Goal: Patient will dress lower body with verbal cues with safe technque.
Description: In regards to the functional activity pictured, D2 extension contains scapular depression-rotation; shoulder extension, adduction, and internal rotation; Elbow in slight flexion; forearm pronated; finger flexion and adduction; thumb opposition. Have patient don/doff thier own shoes.
Rationale: Depth perception (Stereopsis) is used to locate objects in the visual environment, to have accurate hand movements under visual guidance, and to function safely with purposeful tasks. This self-feeding task evaluates if the patient is able to effectively locate and pour their beverage into a glass.
Intervention Goal: Patient will drive with independence.
Description: Have patient pour beverage into glass and observe if client completes task correctly without hesitation. Utilize a restorative approach by providing tactile-kinesthetic guiding during activities by having patient grasp the glass before/during pouring thier beverage.
Rationale: IADL of sweeping was chosen to assess the patients ability to perform all three stages of problem-solving: problem analysis, generating possible solutions, and evaluation of solutions generated. All three stages are needed for appropriate completion of activity.
Intervention Goal: Patient will appropriately initiate, perform, and terminate IADL's with verbal cues.
Description of Assessment/Assessment: Provide an unstructured tasks (i.e. sweeping floor). Observe if patient goes through three stages of problem-solving. In this case; recognizing floor is dirty, selecting and using the appropriate tool, and termination of sweeping at appropriate time. Methods to address this deficit would be to encourage patient to ask for help when he/she is unable to solve a given problem and if need be, break task down into subgoals and ask questions related to steps that could or need to be taken.
Rationale: Ironing clothes can be used to address deficits in motor, visual-perceptual, and cognitive performance skills. PNF will be utilized with a D2 extension pattern, visual-perceptual skills are required to identify proper placement of clothes and iron, and problem-solving is used to initiate, conduct, and terminate the intervention.
Intervention Goal: Patient will complete IADL of home management independently by ironing five different articles of clothing utilizing appropriate safety precautions.
Description: Plug-in iron and allow time for warm-up to necessary temperature. Instruct patient in safety precautions. Place five different articles of clothing (button-up shirt, long denim pants, t-shirt, polo, and cargo shorts) in a clothing basket. Have patient remove items at random and iron as appropriate. Assist with verbal cues and hand-over-hand as needed.