Kelsi Doerrer

Individual Treatment Plan

Patient name: L.V.

Diagnosis: Left-sided stroke

PMH: Type II Diabetes, obesity, hypertension

Psycho Social/ Family situation: Pt is XX-year-old female who lives in a 1-story 55+ community
apartment, is retired and does not work currently and is on disability. The pt is widowed and has both a
middle-aged daughter and son, with the daughter providing frequent transportation for the pt. She
enjoys playing Bingo, watching TV and movies, socializing with people, attending community events,
doing hair and nails, and cooking 1 pot meals.

Precautions: Fall risk, no PROM of R shoulder past 90 deg (shoulder flexion/abduction)

Patient’s stated goals: Patient reports wanting to increase movement and function on the R side with an
increase ROM in the R UE and R LE and increase R hand dexterity. The pt also reports having a desire to
increase social participation and communication, hoping to host a girl’s night in the near future.

Medical Cause/ Description of Diagnosis: The pt experienced a stroke over 10 years ago, which has
affected her in several areas including decreased function on the R side. The pt reports having no pain,
has normal static sitting and good dynamic sitting balance, good static and fair dynamic standing
balance, the R scapula is abducted and depressed, the pt had fatigue ½ way through saccadic exam, has
left visual field difficulty, has normal ROM on the left UE and has R UE ROM of 35° R shoulder flexion
with scapular substitution, 65° R shoulder abduction with scapular substitution, 15° R shoulder external
rotation, 45° R shoulder internal rotation, 65° R elbow flexion, -35° R elbow extension, 90° R supination,
0° R pronation, 35° R wrist flexion, -45° R wrist extension, and is 2-/5 MMT with shoulder flexion and
abduction, elbow flexion, and elbow extension, 2+/5 MMT with shoulder internal rotation, 1/5 MMT
with shoulder external rotation, wrist flexion, wrist extension, and hand, 0/5 MMT with supination and
pronation, and a 4/5 MMT with shoulder internal rotation and hand, and 5/5 MMT with the rest of L UE
MMT. Additionally, the pt is A&O x4, follows multi step directions, and good LTM and STM with a FIM
score of 7 for both, and demonstrates good routine problem solving with a 7 FIM score and a 6 FIM
score for complex problem solving. A stroke is a “brain attack” and can happen to anyone. It occurs
when blood flow is cut off to the brain, depriving the brain cells of oxygen. Left hemisphere strokes
occur on the left side of the brain which controls the right side of the body. The left side of the brain also
helps with speech and language abilities. The prognosis following a stroke depends on where the stroke
occurred in the brain and how large the damage was. Over ⅔ of stroke survivors will live with disability
following the stroke, but some may completely recover. Strokes are the fifth leading cause of death and
are the leading cause of adult disability in the United States. Risk factors for strokes include becoming
overweight, diabetes, heart disease, and developing high blood pressure and cholesterol.

Models or Frame of Reference: The frame of reference that will be used is the biomechanical FOR due
to most of the patients’ difficulties involving physical ROM and strength. This frame of reference will
guide therapy through participating in purposeful activities to remediate loss patient’s loss of range of
motion, endurance, and/or strength. The expected outcomes for this patient are reduction in
limitations, learning new skills, slowing declines, maintaining quality of life, and consistency with
performance. Intervention activities with a basis in the biomechanical FOR will aid in the maintenance
and improvement of function.
Priority Impairment/ Intervention Activity STG LTG
Limitations/ Problem
Areas

Decreased R Shoulder Pt will work on left Pt will demonstrate Pt will demonstrate

ROM shoulder flexion AROM 60 degree of active 100 degree of active
by using her right hand
to lift a cup of water
R shoulder flexion R shoulder flexion
and bring it to her to increase to increase
mouth and drink. This independence with independence with
will be in preparation reaching for cooking putting on
for independence with items in shelves sweatshirts
self-feeding.
during meal prep. overhead for UE
Pt will perform dressing.
shoulder flexion
exercise 4 x 4 each with
yellow theraband to
increase R shoulder
flexion AROM for
reaching for cooking
supplies during meal
prep. To grade up, the
pt will use red and
green therabands of
increased resistance or
use a weight.

Pt will target R shoulder

flexion AROM by
hanging hangers up
with R hand. This can be
graded up by hanging
clothes on the hangers
or increasing the height
at which the hangers
are hung.

Pt will work on L
shoulder abduction,
flexion, and external
rotation AROM by
combing through hair.
Decreased FMC Pt. will increase FMC in Pt will demonstrate Pt. will demonstrate
right hand by picking up increased FMC by increased FMC
poker chips with the
right hand and placing
opening three through buttoning
them in a horizontal, wrappers with pants
diagonal, or vertical line pincer grip during independently.
on a bingo board. This simple meal prep.
activity will be in
 preparation for the
opposition of thumb
and digit FMC needed
to handle clothing
fasteners including
buttons and zippers
during UE dressing.

Pt will increase FMC by

manipulating the
buttons on the TV
remote with the R hand.
This will increase her
independence when
flipping through TV
stations with the
remote. The remote can
be placed on the table
at first but be graded up
by holding the remote
in the L hand while
pressing the buttons
with the R or holding in
the R hand.

Pt will increase FMC by

manipulating a can
opener with the left
hand to increase FMC
needed for meal prep.

Pt will target FMC by

painting construction
paper with nail polish to
increase independence
in doing her own nails.

Decreased Pt will improve her Pt will demonstrate Pt. will demonstrate

independence in meal independence in meal increased increased
prep prep by pouring
ingredients with the R
independence in independence in
hand into a measuring meal preparation meal preparation
cup and then pouring through pouring through preparing a
into a large bowl. salt, pepper, and complex one pot
water into a bowl meal of pot roast
Pt will improve
with supervision. with min A.
independence in meal
prep by constructing a
one pot meal. She will
need to gather all the
supplies from the
 cabinets, mix the
ingredients in the pot,
turn on the stove, and
set a timer.

Pt. will practice sitting

and cutting theraputty
with a plastic knife to
increase independence
in cutting vegetables
during meal prep. The
pt will begin by
stabilizing the
theraputty with the
R hand while cutting
with the L hand and
then grade up by
stabilizing the
theraputty with the L
hand while cutting with
the R hand.

Decreased R elbow Pt will perform elbow Pt will demonstrate Pt will demonstrate

ROM flexion exercise 3 x 4 100 degree of active R 125 degree of active R
each with yellow elbow flexion to elbow flexion to
theraband to increase R increase increase
elbow AROM for
independence with independence with
holding and carrying
cooking supplies during
folding clothes during bathing.
meal prep. To grade up, laundry for home
a red or green maintenance.
theraband can be used
to increase resistance.

Pt will target elbow

extension and flexion by
using a sponge to brush
beads on the counter
toward her and into a
bin. This will be in
preparation for cleaning
up following meals.

Pt will practice placing

boxes on various height
shelves using B hands to
improve elbow
extension needed for
tidying around the
house during home
maintenance. To grade
up, the pt can stand
farther away from the
shelf to increase the
amount of elbow
extension.