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Mr. John wishes to return to and resume his PLOF. One of his impairments is poor sitting and standing balance. This impairment affects things like bed mobility. To improve Mr. John’s static sitting balance I would do an activity of playing a game of cards. I would put some cards further away and have him reach them. Filling up his laundry basket with laundry, and possibly carrying it to the laundry room might be the next step. This would work on his dynamic standing balance. Laundry can work on other things like strength and coordination as well.

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Due to Mr John's CVA, he is unable to perform many previously attained motor activities, including ADLs, IADLs, and leisure activities like card playing and spending time with family. As he states that he would like to return to his prior level of functioning, I would work on some home maintenance skills that he used to perform, to make him feel confident and helpful, not a hindrance. The task oriented approach would allow Mr John to practice his left handed motor coordination, dynamic sitting balance, and left visual field inattention through the simple task of dividing up laundry and folding fresh laundry. This will boost his self efficacy and allow him to assist his wife in some small way.

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Mr. John's goal is to resume life as it was before his stroke. He particularly enjoys playing cards and hosting his grandchildren. A task-oriented approach to treatment would include playing cards with his grandchildren while sitting. In doing this he can work on improving sitting balance, L inattention and self awareness while participating an activites he enjoys

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Mr. John would love to engage in the activities he would do before his stroke. He particularly misses playing cards with his wife and friends. However, this is now difficult for him due to his impaired sitting balance. I would use a task-oriented approach and play a card game by placing the cards further and further away from him to increase his balance. He can even practice this with his grandchildren when they come over on the weekend.

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Mr. John's goal is to be able to complete the daily activities he used to do before his stroke. Prior to the stroke, Mr. John was independent in his ADL's and IADL's. He used to help around the house like doing the laundry and shopping. We will use doing laundry as a task oriented approach. Mr. John will practice picking up clean laundry by reaching to one bin, folding the laundry then piling it up on the table.

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One of Mr Johns social hobbies with his wife and friends is playing cards. As an OT I would work on motor learning while playing cards with, specifically with his left hand. I would ask Mr John to keep his L UE on the table and deal a game of his choice to 2 people. We will focus on regaining  movement patterns needed for certain cards games, grading up with faster or slower games/ reaction times. ROM will be incorporated so that Mr John will be able to reach needed distances for a successful game of cards with friends. 

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One of Mr Johns social hobbies with his wife and friends is playing cards. As an OT I would work on motor learning while playing cards with, specifically with his left hand. I would ask Mr John to keep his L UE on the table and deal a game of his choice to 2 people. We will focus on regaining  movement patterns needed for certain cards games, grading up with faster or slower games/ reaction times. ROM will be incorporated so that Mr John will be able to reach needed distances for a successful game of cards with friends. 

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Before Mr. John`s stroke he was independent in all his ADLS. His desired goal is to go back to his PLOF. As an OT I would work on laundry with Mr. John as he did before his CVA.This is a task oriented approach. Mr. John will retrieve  the laundry from the machine using his right hand. He will then learning to bring it to the table to sit and start folding. Once Mr. John regains Motor control in his left hand it can get more involved in the activity. With practice everyday Mr. John can work on strength and endurance to help him get back tohis  PLOF.

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Prior to Mr. John’s stroke, he was able to preform all ADL’s and IADL’s independently. His goal now is to be able to do all the things he used to such as playing cards with his wife and friends. Due to his VFD and L inattention this has become difficult for him. I would use a client centered approach and help him with this goal. I would implement different scanning techniques such as spreading out cards and placing the cards on his left side to help improve his visual inattention. Additionally, I would have Mr. John stand and use his L arm to reach for cards while playing the game to improve his L UE ROM and dynamic and static standing balance.

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Before Mr. John had a stroke he was independent in all ADLs, IADLs, and leisure. Currently the main goal he voices  is to get back to all the things he was doing before the stroke. When creating a treatment plan for him I would begin with enabling him to preform his ADLs independently. One of his goals includes modified independently donning a tee shirt with a one handed technique. I would use a task oriented approach and have Mr. John practice putting on one of his own tee shirt with the correct technique  every morning. Mr John should be sitting when he performs this task as he has difficulty with balance. In addition I would teach Mr. John the proper way to don a tee shirt with one hand. He would first put his affected arm into the sleave and his unaffected will follow. Mr. John should perform this task consistently every morning.

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Mr. John would like to return to his PLOF and be independent in all ADL’s. As an OT, I would work on meal prep, as Mr. John prepared his lunch every day prior to his CVA. I would use a task oriented approach in order to promote motor recovery. John will use his L hand to hold and stabilize a jar of jelly while using his R hand to open it and apply it to the bread. As John regains motor control in his L hand, he can use it more actively in the activity. Mr. John will practice making a sandwich every day in order to increase the effectiveness of therapy.

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Mr. John wishes to get back to all the things he was doing before the stroke. Client was I with all ADl’s,IADl’s,leisure activities , and assisted wife with household chores and the shopping. I would use the motor control and task oriented approach with Mr. John and work on personal hygiene. The activity would be brushing teeth - I would do this in the morning, and encourage Mr.J to complement the whole task and to use his left arm to hold the toothpaste and stabilize the toothbrush when squeezing the paste on it,   (Motor learning approach). I would start off with Mr. John sitting in a chair , and then eventually have him brush his teeth standing to work on static /dynamic standing .  It is task oriented because client is focused on completing his task yet at the same time he is strengthening overall sitting /standing balance , as well as a bit of coordination and strength in L UE.

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One of Mr. John's interests is playing cards with his friends, which he would like to return to doing. One of Mr. Johns impairments is L visual field deficit and inattention. Using the task oriented approach, I would create a treatment plan that includes playing a card game that requires scanning and provide strategies to help with his L visual field deficit. The card game would also work on his static and dynamic sitting balance, and his L UE strength (putting the cards closer or further to increase AROM.) This is a task oriented approach since playing card games is using an relevant motor task to promote improvements.

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Before Mr. John had his stroke he was independent In all areas and he states that his goal is to do all the things he used to be doing. One of his leisure activities was playing cards with friends. Currently he has a left visual field deficit and left inattention. Therefore, I would use a client centered approach and begin by addressing his goals. First I would work on different scanning techniques and placing items on the left side which will help improve his skills. For example, I would play a card game and place the cards closer on the left side so that he will begin turning his head. After implementing this skill  with card games I would begin using it with other activities, such as grooming.

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When asking Mr. John what his main goal is, he says he wants to be able to do everything he used to before his stroke. One of the things Mr. John enjoys doing is playing card games on a weekly basis. But his dynamic and static standing balance is poor - and his dynamic sitting is fair -. For my treatment plan I would use the client centered approach and do an activity that he enjoys doing. I would work on his balance by playing cards with him with dynamic sitting balance and slowly have him work on his static and dynamic standing balance by playing his favorite card games. Eventually this will help his balance improve and will help him become independent.

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The focus of Mr. John’s treatment is to work forward obtaining his goal of returning to his prior level of functioning which was independence in all occupations. As his goal is to resume independence in occupations, as an OT, I would take a task oriented approach so Mr. John can see active progress throughout treatment and begin participating in the desired occupations as he goes through the therapeutic process. One technique I would employ is to  work on Mr. John’s standing balance as he performs ADL self care activities. I would work with Mr. John grooming at the bathroom sink, as he learns how to stabilize on the sink with his left arm while his right arm performs the activity. Once Mr. John has learned the method, i would give him a HEP to employ this method during all standing self care activities including shaving, brushing teeth and washing up. Being able to start taking care of himself will help him gain confidence and encourage him to work on other areas of occupation.

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Prior to Mr. John’s stroke, he looked forward to seeing his grandchildren on a regular basis. Mr. John has articualted that he wishes to return to his PLOF. Additionally, Mr. John enjoys playing cards, but because of his L UE weakness and L inatttention it is hard to play cards. As a treatment plan, both his grandchildren and playing cards can be incooperated. Mr. John can play cards games with his grandchildren using only his left hand to deal the cards and pick up the cards that are needed.

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Mr. John would like to get back to "the things I did before the stroke" which includes helping his wife with the shopping.  Mr John can use items on shelves in his house and bags full of food in a tasks oriented approach to practice reaching items from shelves and holding shopping bags of food.

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Mr. John would like to return to his PLOF, which includes his leisure activity of playing weekly card games. As Mr. John’s OT, I would use mental practice to help Mr. John play a card game. We would record the steps so Mr. John can listen to them and practice the task several times per day. The steps would include the details of picking up a card, putting it in his hand, and putting the card out. Mr. John would imagine performing the activity over and over without actually doing it with the goal of improving his motor performance.

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Mr. John states that he would like to go back to doing everything he was doing before his stroke. He used to perform all his ADLs independently and so he would like to perform his personal hygiene independently, specifically brushing his teeth. I would use the task oriented approach to practice this skill. I would have Mr. John sit in front of a sink and hold the toothbrush with his L hand while putting the toothpaste on with his right. I would then have Mr. John practice bringing the toothbrush to his mouth and move it along his teeth to brush them. I would then set a schedule with Mr. John that he would use this technique every morning and evening to practice brushing his teeth.

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Prior to his CVA, Mr. John led a totally independent lifestyle. He engaged in all ADL, IADL, and leisure activities without any assistance. He was a successful business owner and helped around the house with maintenance, shopping and laundry. Now as he is slowly recovering from his CVA, his wish is that he can return back to his prior level of functioning. Specifically he wants to go back to church, socialize with his friends and play card games with his grandchildren. One area which is holding him back from engaging in these activities is his impaired balance. As Mr. John’s OT I would take a client centered approach and would incorporate the activities he enjoys doing into his treatment. We would begin by working on static sitting balance and move on to dynamic sitting balance ie: playing cards when sitting. As time passes we would progress to standing static/dynamic balance so that Mr. John can once again go to church and socialize with his friends. Additionally, I would practice trunk strengthening exercises to help Mr. John reach his goal faster.

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Mr. John would like to get back to his PLOF. His L hemiparesis impairs his L UE strength and tone. Therefore, Mr. John is unable to complete dressing and grooming activities independently, as he did before the CVA. As an OT, we can use the NDT model, by facilitating normal movement in Mr. Johns L UE. Mr. John can weight bear on his affected side to help stregthen his muscles. Additionally the weight bearing would allow for muscle activity activation from the weaker side. During an OT session this can be incoorpated when Mr. John his playing card (his favorite:)), the OT can set up a table on Mr. Johns left side, so that he would need to weight bear on his left side to keep him balanced. In addition, the OT can practice this technique when Mr. John practices dressing techniques, Mr. John can use his left arm to weight bear and as a stabilizer.

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Mr. John’s goal is to return to his prior level of functioning and to do all the things he was doing before his stroke. Since one of the goals determined by the OT is for him to groom while self-sitting in the wheelchair by the sink and to be able to play card games with friends, I would work with Mr. John on his visual scanning ability. As a result of his left VFD/ left inattention and decreased dynamic sitting balance, both of these tasks are hard for him because he does not scan for items to located on his left side. Therefore, using the motor control approach, I would bring him to the sink and position grooming items in front of him, mostly away from midline. I would focus his attention on looking for grooming items within his left visual field and provide him with a strategy for turning his head from the left to the right side, scanning for the items. He will first identify all of the items in front of him and then reach for the items required for the grooming task (ex: shaving) with his Left UE by telling him to use the edge of the sink to slide his arm along onto in order to obtain the items. As he improves, I would provide him with less VCs for looking to the left. Furthermore, since Mr. John will be performing this task from his wheelchair, it will also work on his dynamic sitting balance when reaching for the grooming items out of his BoS. This activity will hopefully allow him to reach his goal of self-care and his goal of card playing by working on both his left visual inattention and dynamic sitting balance.

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Mr. John’s main goal is to return to his PLOF.  Prior to his right CVA, Mr. John used to play UNO with his grandchildren. Mr. John was a champion UNO player and enjoyed playing while interacting with his grandkids. Due to his fair dynamic sitting balance and 1/2 AROM in his L UE, Mr. John can no longer play UNO as he did in the past. I would therefore use the task oriented approach and incorporate Mr. John’s goal of playing with his grandchildren by having Mr. John engage in a game of cards during the therapy session. Playing cards will help increase his dynamic sitting balance, as Mr. John will have to reach to place the cards on the table. Additionally, by requiring him to use his L UE to maneuver the cards, Mr. John will strengthen his UE and eventually be able to once again compete against his grandchildren in a game of UNO.

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Some of Mr. John goals are to get back to all the things he was doing before this stroke, resume to normal life with his wife and return to his weekly card games with his friends. Mr John has limited AROM in his L UE w/increased muscle tone and need more movement. Additionally, he has deficits in left inattention and self awareness. Since one of his assets is that he likes engaging in leisure activities, I would do an activity with cards to help with his deficits. I would have reach for cards with his left hand in order to increase his ROM. Before I do the activity, I would ask him how he think he will do in the activity. Additionally, I would have him pick specific cards on the left side to help with left visual inattention. At the end of the activity I would ask him what he thought about the activity in order to increase his self awareness.

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Mr. John’s goal is to get back to all the things he was doing before the stroke. Two of these activities include weekly card games and visiting with grandkids. Two impairments which will make playing cards and playing with the grandchildren difficult are his L VFD, L inattention, and sitting balance. I would work on both of these by having Mr. John play a card game with his grandchildren in a treatment session. His grandchildren can be spaced out across from him from left to right, which will require him to direct his attention towards the left. The activity can be graded based on where his kids are seated (more centrally or more towards the left), which hand he holds the cards in, how far he has to reach, and how fast paced the game is. Working on balance and visual attention utilizing an activity of interest will hopefully increase motivation.

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Mr. Jonh’s main goal is to return to his previous level of functioning. Before his CVA ,Mr. John used to attend church weekly where he socialized with his friends and engaged in leisure activities. However, now walking has become difficult due to his poor dynamic standing balance. Therefore, I would work on improving his poor dynamic standing balance so that he should be able to walk to attend church to socialize with his friends and to engage in a card game. For treatment, I would engage in balance training activities with Mr. John. For example, I would first work on static sitting balance then I would move on to dynamic sitting balance and engage in a card game. I would slowly work our way up until Mr. John is ready to work on dynamic standing balance.

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One of Mr. John’s goals is to resume all that he was doing prior to the stroke, especially his weekly card games. However, his L VFD and L inattention may be impacting his ability to do so. Therefore, I would gear a treatment towards improving his visual scanning skills so that he will be able to turn his head/gaze toward the left and see the full picture throughout his games and other daily tasks. Without this skill, it would be very difficult for him to be successful when playing these card games. I would do so through utilizing a gross motor treatment activity first, such as a visual scanning board/path. I would initially provide him with verbal and tactile cues to attend towards the left, but slowly decrease them once his abilities improve. I would then make the treatment even more client-centered by implementing visual scanning activities using the cards themselves, since he enjoys playing cards. I would also play the specific card games that he plays at home with him.  Eventually, he can transfer the skills that he has learned into his weekly games, thereby becoming increasing his independence and working towards his goal.

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Prior to his stroke, Mr John was independent with his ADL's. Now, Mr John would like to regain his abilities and return to his PLOF. His current standing static balance is poor +. Therefore, I would use a client centered approach and incorporate his personal goal of getting back to all of the things he used to do, for example playing cards, into his treatment . I would work on improving his balance by initially playing cards with Mr John while he is standing at a table with contact guard assist and progressively move towards supervision, ultimately achieving independence.

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Mr. John wishes to return to his PLOF. His L UE is causing some difficulty in the attainment of this goal. One of Mr. John’s favorite activities is playing with his grandchildren. His grandchildren love to play board games with their grandfather. I would recommend Mr. John play Monopoly (or other games) only using his left hand to roll the dice and move the game pieces.

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Mr. John stated that his goal is to get back to doing everything he was doing before he had a stroke. Therefore one of the goals determined by the OT is for Mr. John to be able to dress his upper body using an adapted technique or extra time. Based on the Motor Learning approach, I would have Mr. John practice putting on a shirt using a one handed dressing technique. The OT would first demonstrate to Mr. John how to the technique works and then have him practice it in the OT room. Then Mr. John would practice this technique in his room in the rehab center, and eventually the he would be able to dress his upper body in his home environment.

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Mr. John hopes to return to his PLOF and to be able to watch and play his grandchild like he was able to prior to his stroke. In order to increase Mr. John’s balance and ROM in the L UE, I would encourage Mr. John to continue to play games with his grandchild. One beneficial activity Mr. John can do is to play catch with his grandchild which can increase his balance and ROM while being engaged with his grandchildren.  This acitivity can be played while Mr. John is sitting and while he is standing. In addition, playing catch can increase Mr. John’s abilities to I do other tasks including his ADLs and IADLs.

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Prior to Mr. John’s stroke he was independent with all ADL’s. He hopes to get back to his PLOF. I would therefore help try to regain his independence by working on dynamic sitting since he currently has a fair rating for dynamic and static sitting. Since Mr. John loves to play cards I would do a therapy session on which we worked on balance, teaching him the best way to align his posture so that he would have the best control while playing his games. We would play the card game that he enjoys while focusing on keeping our posture correct. As Mr. John regains his truncal strength we will start doing other various activities such as food prep in the kitchen that he can do while sitting, in order to help his wife.

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Mr. John helps his wife with tasks around the home and his goal is to resume whatever he was doing prior to experiencing a stroke. Therefore, I would utilize a task oriented approach to help him fold laundry (towels that they have in the clinic). He can use his LUE to stabilize the towel while using his RUE to do the folding. As he regains more motor control he can use his LUE to do some of the folding with his LUE by starting with 1 fold and then increasing the amount he uses his affected extremity.

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Sample post: He likes to watch sport on TV, so we could use the remote control in a task oriented approach. He could practice picking up the remote and aiming it at the TV. Julie Kardachi

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Sample post: He likes to watch sport on TV, so we could use the remote control in a task oriented approach. He could practice picking up the remote and aiming it at the TV. Julie Kardachi

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He likes to play cards. However, he has sensory challenges with his left hand, along with LVFD. I would suggest, that Mr. John work on sensory re-education with his left hand. Also, the OT and Mr. John should work on strategy’s to compensate for his LVFD so he can play cards.