Thursday, April 30, 2015

Constraint Therapy Goals

Thank you notes for Allie's teachers (top) and Andrew's teachers (bottom)

Here are Allie's official writeup and goals for this round of constraint therapy:

Mobility

Current:
- Decreased right forearm supination
- Decreased right elbow extension 
- Decreased right upper extremity weight bearing tolerance 
- Decreased right upper extremity strength
- Right upper extremity hypertonicity 

Functionality: Allie is independent with all bed mobility, including scooting, rolling, and come to sit. She demonstrates weight-bearing through right upper extremity in quadruped positioning and prone prop with hand open, but variable thumb positioning. The patient ambulates community distances with the following gait pattern: foot flat positioning at initial contact on the right. She demonstrates wide base of support throughout ambulation. Decreased arm swing on the right (elbow flexed). Allie is able to ascend and descend a flight of 7" stairs (12) demonstrating a reciprocal stepping pattern using the left railing with distant supervision.

Goals: Achieve maximum physical abilities and a means of mobility
- The patient will demonstrate improved right grasp strength to carry a bucket with 1.5 lbs of weight for 100 ft. 
- The patient will demonstrate improved weight bearing in quadruped position to weight bear on right upper extremity while reaching with left upper extremity for 10 seconds. 
- The patient will demonstrate improved coordination to steer an adaptive tricycle around 4 cones with close supervision while sustaining right grasp on handle bar. 
- The patient will demonstrate improved balance and coordination to complete two footed jump and land with less than 3" difference between right and left foot.
- The patient will demonstrate improved coordination to catch a playground ball with bilateral coordination to catch a playground ball with bilateral upper extremities 4 out of 5 trials. 
- The patient will trial the Bioness L300 to address right foot drop during ambulation. 
- Patient and his family will demonstrate independence in a home therapeutic activity program. 


Fine Motor

Current: Allison has good awareness and use of her affected upper extremity but has overall decreased strength and fine motor coordination/dexterity. 

Goal: Achieve hand/eye coordination commensurate with cognitive/motor recovery. 


Activities of Daily Living

Current: Patient is currently assisting with self care tasks and continues to require assistance for dressing. 

Goals: Achieve the maximal ability for activities of daily living (with/without assistive devices)
- Patient will demonstrate right forearm supination to neutral for improved ability to participate in play and self care activities. 
- Patient will demonstrate controlled right wrist extension and deviation from neutral for improved performance in placing toys precisely in containers/holes/slots 3 out of 4 trials.
- Patient will demonstrate isolated right index finger pointing with ulnar finger inhibition with VC only.
- Patient will demonstrate improved finger coordination for right pincer grasp, three finger grasp and lateral grasp to manipulate small toys and foods 3 out of 4 trials. 
- Patient will demonstrate improved strength for right hand grasp as evidenced by the ability to open/close marker caps, pull apart interlocking toys and open food containers 2 out of 3 trials. 
- Patient will demonstrate age appropriate bimanual skills for throwing and catching a medium-large sized ball 3 out of 4 trials. 
- Patient will return demonstration of a home exercise program to maximize functional abilities.  

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