Client #1: Middle aged male, wheelchair bound, I assisted in setting up the FES (Functional Electrical Stimulation) which involved learning how to place electrode pads of the machine on the patient. They undergoing 40min exercise on a FES (Functional Electrical Stimulation) to stimulate blood flow, prevent atrophy, support motor, neural recovery, as well as stimulate mechanical muscle use for the patient, maintain bone density.The AHP further engaged the patient in thinking about the riding of the bike and thinking of the muscles engaged in the exercise. This stimulates the brain to think about the limbs and muscles being used. I completed the use of the FES machine and properly packed away all equipment used.

Client #2: Middle aged male, wheelchair bound, I assisted the AHP with 2 x 12 es seated pallof press exercises, 2 x 15 seated wide grip rows by tracking sets and reps and observing the technique, 3 x 15 es dumbbell chest press with a neutral grip in which I spotted the patient as he lifted the dumbbell from supine position into the air, and provided extra support with my fingertips to help the client reach lift the dumbbell as instructed by the AHP. Finally I provided support in manually assisting the patient and manual assisted treadmill training for four laps at 0.8km/hr. The exercises with the dumbbell and gym equipment stimulate strength building in the muscles of the upper body and core, while the manual assisted treadmill activity promoted aerobic function of the client, as well as leg muscle activation, motor learning and progressive loading.

Client #3: Elderly male suffering hemiplegia from stroke with left hand spasticity, assisted in delivery of 2 x15 Supine Leg Abduction with Resistance Band by holding the band and counting reps and sets, and Gait Training with Parallel Bars to improve stability, balance, strength, endurance, posture and alignment of the patient. Discussion of various topics of travel and sport engaged the client in enthusiastic involvement of the activity.

Client #4: Assisted AHP in removing and packing up of the FES machine. I then completed induction paperwork for the site and reinforced placement goals in areas of lower professional development.

Client #2: Middle aged male, wheelchair bound, I assisted the AHP with 2 x 12 es seated pallof press exercises, 2 x 15 seated wide grip rows by tracking sets and reps and observing the technique, 3 x 15 es dumbbell chest press with a neutral grip in which I spotted the patient as he lifted the dumbbell from supine position into the air, and provided extra support with my fingertips to help the client reach lift the dumbbell as instructed by the AHP. Finally I provided support in manual assisting the treadmill training for four laps at 0.8km/hr. The exercises with the dumbbell and gym equipment stimulate strength building in the muscles of the upper body and core, while the manual assisted treadmill activity promoted aerobic function of the client, as well as leg muscle activation, motor learning and progressive loading.

Client #3: Elderly male suffering hemiplegia from stroke with left hand spasticity, assisted in delivery of 2 x15 Supine Leg Abduction with Resistance Band by holding the band and counting reps and sets, and Gait Training with Parallel Bars to improve stability, balance, strength, endurance, posture and alignment of the patient. Discussion of various topics of travel and sport engaged the client in enthusiastic involvement of the activity.

Client #4: Assisted AHP in removing and packing up of the FES machine. I then completed induction paperwork for the site and reinforced placement goals in areas of lower professional development.

Client #2: Repeat Client an elderly female with MS and Diabetes type 1. I Assisted her by supporting bicep curls, chest presses and sit to stands, which aims to improve her strength ,balance and reduce spasticity. Finally assisted in new treatment of Normatec Boots for ct, which boosted lympathic drainage, stimulating muscles and promoting circulation, by promoting blood flow and oxygen to muscles.

Client #3: Older male MS ct, Assisted in timing and cueing ct in reps for SL lifts R) leg, to promote strength, weight bearing on left leg on vibration plate. This aimed to maximise muscle use for session in the left leg

Client #4: 4: Repeat client from previous week. Assisted in chest press, and bosu ball exercises including spatula lifts, to stretch and improve mobility of clients back that included lifting arms out to the side and pinching the shoulder blades. Assisted cueing client in lateral pull downs for 5 minutes to build upper body strength and promote aerobic activity and independence. Assisted ct in harness for AHP assisted sit to stand, where i operated the machines height per the needs of the pt, and the final treadmill training for 9 minutes in three minute intervals, at 1.0km/hr assisted by two exercise physiologists who help the patient move his legs forward. The treadmill in harness allowed the patient to activate the hips, and legs, improving proprioception awareness. After the session i wrote up SOAP notes for the pt file.

Client #5: Young Male using FES bike for 40 minutes in wheelchair. Assisted in the set up of the pads in the correct order and place on the patient, and tended to the patients comforts to ensure the exercise was comfortable.

Concluded the day by discussing soap notes for ct #4 and a tidy of the workplace.

Client #2: Repeat Client an elderly female with MS and Diabetes type 1. I Assisted her by supporting bicep curls, chest presses, and delivered active assisted quad stretches supine, finally supporting sit to stands holds by providing support from behind for 5 minute intervals. Finally assisted in second session of Normatec Boots, and discussed the noticeable benefits after boot sessions.

Client #3: Repeat client from previous week. Assisted in chest press, and delivered bosu ball exercises including spatula lifts with arm weights, to stretch and improve mobility of clients back that included lifting arms out to the side and pinching the shoulder blades.Also delivered resistance band lateral pulls laying on bosu ball. Assisted ct in harness biodex movement for AHP as they assisted sit to stand, where i operated the machines height per the needs of the pt. Assisted in moving the biodex machine as ct walked with AHP supporting leg movement.

Practiced SOAP notes for client #3 and attempted client#1 of observed activity.

Client #4: Repeat client. young Male using FES bike for 40 minutes in wheelchair. Assisted in the set up of the pads in the correct order and place on the patient, and tended to the patients comforts to ensure the exercise was comfortable.

Client #2: Repeat Client an elderly female with MS and Diabetes type 1. I Assisted her by supporting bicep curls, chest presses, and delivered active assisted quad stretches supine, finally supporting sit to stands holds by providing support from behind for 5 minute intervals. Finally assisted in third session of Normatec Boots, monitoring patient for duration of the boot cycle. BGL monitored throughout the session and noted to the carer at the end of session.

Client #3: Elderly male, assisted with helping patient raise arms higher during reps of lateral pull downs. Stretching and simulating movement and power for the limbs.

Client #4: Repeat client from previous week. As directed by supervising AHP, delivered same exercises as previous week by assisting and cueing chest press, bosu ball exercises including spatula lifts with arm weights, to stretch and improve mobility of clients back that included lifting arms out to the side and pinching the shoulder blades, as well as delivered resistance band lateral pulls laying on bosu ball. Assisted ct in harness biodex movement for AHP as they assisted sit to stand, where i operated the machines height per the needs of the pt. Assisted in moving the biodex harness machine as ct walked with AHP supporting leg movement. Assisted in a group game session of bocce ball, where multiple clients participated in a competitive game of throwing balls of varying weight difficult. Stimulating social interaction and inclusion, as well as the movement of throwing a ball.

Client #5: Middle aged male who suffered from a spinal injury, wanting to increase mobility and function. Actively assisted client with supervising AHP to enable patient to use legs on the recumbent bike by assisting in lifting the leg up, to allow to client to push down with power. Assisted in maintaining leg alignment on the bike, and supporting food. Additionally assisted in the counting and recording and ball and balloon coordination exercise, while also supplying tools to support the clients comfort and stability for the activity.

Client 2: A 31-year-old female with muscular dystrophy recovering from surgery. I assisted with arm stretches to encourage range of motion and improve circulation. Using the Biodex harness, the client stood and engaged in a BladePod game to promote muscle engagement and cognitive stimulation. The session ended with marching in place.

Client 3: A 77-year-old male with a spinal cord injury. I assisted with arm extensions, resistance exercises, and lateral shoulder pull-downs, followed by deadlifts under AHP supervision. We incorporated standing hip extensions using a railing for support, focusing on hip abductor stretching.

Client 4: Assisted a 58-year-old male with a complete motorbike injury by monitoring treadmill use and facilitating transfer to a wheelchair. Discussed upcoming hydrotherapy sessions with the AHP and agreed to attend the next session to gain experience. Concluded the day by practicing and reviewing SOAP notes with the AHP.

Client 2: Elderly female with MS and type 1 diabetes. Assisted wheelchair-to-plinth transfer, supported bicep curls, chest presses, and AAROM quad stretches. Monitored sit-to-stand holds and BGL, concluding with Normatec Boots therapy and session notes.

Client 3: A 77-year-old male with a spinal cord injury aiming to improve right-arm movement and core engagement. Assisted with recumbent bike exercises, R) arm pendulum movements, and massage gun stimulation. I also cued supine sit-ups and theraband pull-downs, ending with foam step-ups. Completed session documentation under AHP review.

Client 4: A repeat client with complete injury post-motorbike accident resumed hydrotherapy after healing from a leg burn. Assisted with pool transfers and supported supine floating for balance and core strength, ending with assisted sit-to-stands in water.

Client 2: Elderly female with MS and type 1 diabetes. Assisted with wheelchair-to-plinth transfer, cued exercises, and provided AAROM quad stretches and sit-to-stand holds. Achieved a personal best towards her goal of standing at a family event. Monitored BGLs and assisted with Normatec Boots therapy.

Client 3: A 77-year-old male with a spinal cord injury (SCI), aiming to sit independently. Despite stiffness post-botox, I facilitated cycling and thoracic stretching, assisting with AAROM and balance exercises. The session ended with treadmill walking and SOAP notes documentation.

Client 4: A 41-year-old male with complete T8 SCI focused on core and upper limb strength. I observed and supported the session with SOAP note documentation, assisting with thoracic exercises and lower limb stretching.

Client 5: A 23-year-old with Ehlers-Danlos and Marfan syndromes, focusing on core and upper limb strength. Assisted with lunges, core exercises, and upper body movements aimed at improving pushing and throwing abilities for basketball.

I ended the day by cleaning the center, restocking supplies, and completing SOAP notes.

Client #2: Repeat Client an elderly female with MS and Diabetes type 1. I Assisted her by supporting client transfer from wheelchair to plinth, and spotted and cued client for reps of bicep curls, chest presses, and delivered AAROM quad stretches supine, and supporting sit to stands holds by providing support from behind for a 9 minute interval. a new personal best a current goal of being able to stand and take photos at an upcoming family event. Finally assisted in third session of Normatec Boots, monitoring patient for duration of the boot cycle. BGL monitored throughout the session and noted to the carer at the end of session. Additional SOAP notes were written for the session and assisted with transfer to leave session with carer.

Client #3: 77 year old male, suffering spinal cord injury. Client goal is to be able to sit up out of bed independently, and to improve movement of right arm to be able to touch his face, and new set goals of being able to move his neck side to side easier, as well as be able to swim breaststroke. This session aimed to collect outcome measures, and started with the usual warm up walk of about 50m with spotting support. Client was very tired this session and easily fatigued in exercises. I gently stretched the clients right arm in the lateral and frontal directions, taking care to stretch patients arm and fingers without causing pain above around 90 degrees. Measures for Dynamic Gait Index included a series of walking tests with various obstacles and instructions, while I provided close spotting as client is unstable when walking. We moved to seated measuring activities for dexterity like picking up and placing pins into holes, as well as a grip test, to allow the client to rest after exertion via gait measuring. I aided the AHP by recording measures in the clients SOAP notes and spotting STS measures. Clients goals were updated at session conclusion.

General tidying and sanitising of equipment was conducted, after concluding assistance with the last client of the day in the FES bike for 30m of stimulated bike riding.

Client #2: Repeat Client an elderly female with MS and Diabetes type 1. I Assisted her by supporting client transfer from wheelchair to plinth, and spotted and cued client for reps of bicep curls, chest presses. Session was concluded by family members joining to discuss upcoming family events and standing goals for the client at the event. Measured BGL before session.

Client #3: Assisted in cueing 31 year old female with muscular dystrophy in scapula rotation and resistance pull downs.

Client #4: Assisted in exercise of a session with a repeat client, 58 year old male with complete injury from a motorbike accident, by monitoring the treadmill equipment while in use. I assisted in holding clients knee's and providing light assistant for supine squats with resistant band, to enable clients legs were stabilised for the exercise. I again participated in a hydrotherapy session for this client, helping guide patient through exercises in the water, which focused on engaging and building core strength by cueing patient to sway legs side to side and engage core to accomplish the movement. Assisted sit to stands and breaststroke exercises before concluding session.

Client #2: Older male, with multiple sclerosis, aiming to improve mobility. Following on from last weeks session I observed the AHP administer bicep curl stretching of clients right arm which aimed to achieve proprioception neuro facilitation to improve stretch capability of the right arm which is stiff on that side of the body. I then assisted with gently supporting the client by pushing the chair for knee extension exercises to strengthen hamstrings. Client then moved to the Biodex harness to support leg exercises for balance and strength by doing tandem stance arabesque squats & SL squats. I assisted client by holding a band around the ankle in knee extension in a 90 degree angle and cued the patient for 3 x15 reps of fire-hydrants in this position on the R) leg.

Client #3: Repeat Client an elderly female with MS and Diabetes type 1. I Assisted her by supporting client transfer from wheelchair to plinth, and spotted and cued client for reps of bicep curls, chest presses, and delivered AAROM quad stretches supine before implementing some UL strength exercises. This included 3 x 15 supine lateral pull-downs using resistance band which i held in place behind my back and the client pulled down. 2 x 15 of resistance band pull aparts were conducted while i counted and cued for the client. Session concluded with usual 30min duration of Normatec Boots which i supervised for the session and checking BGL before and after the session.

Client #4: 77 year old male, suffering spinal cord injury. Had a chance to speak to client who was visibly happier and vibrant for this session compared to the previous 2 weeks, and he expressed he had recently moved back into his private home, providing more holistic comfort to his overall well being, and even began dancing in his walking warm up exercise with AHP. Clients carer was present to document exercises conducted in the session to continue at home. Assisted with the client on the recumbent bike for 5 minutes, and recorded distance for SOAP notes. After this, we moved the client to a plynth for LL and UL stretching and I delivered resistant exercises for the LL to properly warm up the client before moving to jumping, hopping and jogging on the horizontal leg press machine. This allowed them to use their legs and strength and the client excelled with great power in the jumping exercises. I spotted step ups before the session concluded.

After client 4 was finished I had a chance to update the soap notes for client 3 & 4, while also showing another AHA the client session schedule and soap note writing system, as well as my own personal note taking habits over placement to support understanding of the therapy sessions and SOAP note writing.

Finally I assisted with some spotting of a client I had previously had a session with, and assisted my senior AHA with setting up the FES bike (functional electrical stimulation) for the last client of the day for their 30 minute bike session. After this I tidied and wiped down the equipment, emptied bins, and finished packing up and sanitising the FES bike equipment.

Client #2: Older male, utilised FAC to support walking. As instructed by my AHP, I cued and counted the client in hip abduction and extensions exercises with theraband around their ankles, followed my squats, and support by me holding a chair behind the client as they are prone to falls, sets for all of these exercises were 2 x 15 reps. Session finished with some walking and golf ball hitting exercises which boost to saliency for the client, where AHP and i took turns doing push ups dictated by clients ability to land balls in the provided net.

Client #3: Assisted in exercise of a session with a repeat client, 58 year old male with complete injury from a motorbike accident. I helped cue the client do 3 x 15 chest press with 10kg dumbbells, as well as observe clinical planning with the client prior to session commencement, as well as exercises to target motor patterning with alternating limbs. Then i assisted in 4 point kneeling exercises and kneeling STS while i held a support box in place for the client while completing their exercises. The session concluded with assisted walking by AHP in a harness on the Biodex machine, in which i directed the machine around the rehab facility in tune to the steps the client was taking with the help of the AHP from behind.

Client #4: I finally helped another AHP and AHA set up the FES bike machine with the pads and comfort before their exercises session.

There was multiple AHA's on site today and i was able to converse with them and also teach a new AHA how the SOAP note writing system operated, as well as complete manual duties of sweeping, sanitising and bin emptying.

Ct #1: Working with middle aged male with complete spinal injury and wheelchair bound. Today it was heavily raining so i helped the client complete a transfer from the car and held umbrella to prevent the client was getting too wet, especially on their legs with can trigger spasms, as expressed by the client.

Session was delivered by a new AHP to the center, and i observed some briefing questions between AHP and client, as well as rapport building and communication techniques. I helped AHP set up and spot 2 point kneeling exercise support by a high box in front of the client, to lean on to support the exercise. I helped spot the client as they were instructed to lift their body into an upright position while placing one hand on a soft Pilates ball to provide an unstable environment to allow the client to practice stability and balance during this exercise. I also participated in conversations around the clients breathing as well as at home exercises and health concerns such as bone density. While in the 2 point position with feet supported by cushion and foam mat, the client passed a ball between their arms which were outstretched, in a alternating shoulder abduction with Pilates ball, while i spotted them as they were struggling to maintain balance. This focused on upper strength and shoulders, to promote max intensity and stimulate neuro control and eventually change.

Ct #2: Assisted in exercise of a session with a repeat client, 58 year old male with complete injury from a motorbike accident. Observed and discussed with AHP the importance of LL stretching at the start of sessions, and spotted + lightly assisted the client in 3 x 12 chest press with kettle bell. I then helped transfer the client to the bosu ball, and helped cue and count the client in scapula retractions, which were aimed to align with clients goels and strengthen the upper and lower back for ADL's.

For the rest of the day I floated to where I was needed, spotting kettle bell exercises, counting bosu ball exercises and spotting behind a walking client with a PUF.

Additionally i had the opportunity to apply some skills learned, by helping a new AHP to learn how to set up and monitor the use of the Normatec Boots during a session, as well as speak to a fellow AHA about their experience so far. I performed house keeping duties as well by sanitising the equipment, tidying and putting everything away where it belongs.

This morning i helped a male client in his mid thirties be hooked up to the FES bike with new patches, and observed an AHP discussing health concerns with the client, and kept the client included in a conversation while they were exercising on the bike.

Client #1: Repeat Client an elderly female with MS and Diabetes type 1. I Assisted her by supporting client transfer from wheelchair to plinth, and spotted and cued client for reps of bicep curls, chest presses, before implementing some UL strength exercises. This included 3 x 10 supine lateral pull-downs using resistance band which i held in place behind my back and the client pulled down upon my cues while providing feedback. Lastly i provided support for the sit to stand holds exercise with AHP by providing support from behind so the client could rest between standing intervals.

Client #2: A new client, a 50 year old male, with his wife, carer, doing a goal reassessment as his usual AHP has gone on holiday. I took notes on all goals expressed by the patient, relevant to healthcare framework parameters and implemented them into updated SOAP notes. We then set up the FES bike for the clients UL exercise, and monitored for pain in the R) shoulder.

After completing various SOAP notes I did housekeeping duties of tidying and sanitising before setting up equipment for the group session class I was leading that afternoon.

I structured the group session around a yoga class, focusing on beginner stretches and a flowing style of exercises to gradually support the next exercises to allow for seamless transition and ease for the group. This focused on core, back and leg stretching, with multiple back twists. I conclude the session with a 2 minute lay down and supports nervous system rest, and reduce tension in the body, as well as mental relaxation and transition back into life after the yoga session.

Client #2: Repeat Client an elderly female with MS and Diabetes type 1. I Assisted her by supporting client transfer from wheelchair to plinth, and spotted and cued client for reps of bicep curls, chest presses, before implementing some UL strength exercises. This included 3 x 10 supine lateral pull-downs using resistance band which i held in place behind my back and the client pulled down upon my cues while providing feedback. Lastly i provided support for the sit to stand holds exercise with AHP by providing support from behind so the client could rest between standing intervals, followed by a Normatec boots session for 30 minutes which involved liasing with the clients carer to ensure BGL were within safe ranges for the session.

Client #3: Elderly 77yr old male ive been building a relationship with over the last few months came in after missing a month of sessions due to an ear infection. Worked with my AHP in consulting the client about how they were feeling for the session and considerations to plan around. I took SOAP notes and assisted in limb stretching and spotting walking exercises as client was tired and stiff from a month of recovery without exercise sessions.

Client #4: Middle aged male with complete injury completing hydrotherapy, where I assisted in helping the client do squats in water by holding his legs in place during the exercise, and other various assistive equipment provided by the pool such a noodles. To conclude the session I helped the client transfer out of the pool and into fresh clothing and into their wheelchair.

This concluded my time at the Next Step Spinal Cord Injury Recovery and I was sad to say by to clients and staff alike.