Individual Treatment Plan

Patient name: John

Diagnosis: L-side ischemic stroke
PMH: 2 L knee replacement surgeries, L Carotid cleaned up, 2 heart
stints, 1 kidney stint, and high cholesterol
Psycho Social/ Family situation: John lives alone with two dogs in a two-
story house that has three steps to enter. His bedroom and bathroom
are on the first floor and he has a ramp to avoid the entry steps; he
owns a cane, shoe horn, shower chair, and bed-side urinal and also
uses grab bars in the bathroom and a hand-held shower head. His
daughter lives within five miles and his son lives within 15 miles; his
wife passed away within the last year.
Precautions: Fall risk and Hemiplegic shoulder PROM limitations
Patients stated goals: John would like to improve the FMC and strength
of his R hand and increase the ROM of his R UE. He would like to be
able to walk better and would also like to write letters.

Medical Cause/ Description of Diagnosis:

John is a 69-year-old male with a left-side ischemic stroke. Ischemic
strokes occur as a result of a blockage, or infarct, in a blood vessel
supplying blood to the brain. The underlying condition for this type of
obstruction is the development of fatty deposits lining the vessel walls.
These fatty deposits can cause two types of obstructions, cerebral
thrombosis and cerebral embolism. When the infarct is on the left side
of the brain, the patient will experience deficits to the right side of the
body, and vice versa. John is now more than seven-years post-stroke
and has regained most of his independence.

Models or Frame of Reference:

Occupational therapy with John will primarily involve a biomechanical
approach. The focus will be on improving range of motion, strength,
and endurance, which will help improve his daily functioning. His
interventions will have a high emphasis on exercises of the right upper
extremity. His progress will be quantified using range of motion
assessments; as his measurements improve, new functional goals will
be set.

Priority Intervention STG LTG

Impairment/ Activity
Limitations/
Problem
Areas
R hand 1. Practice John will John will
handwriting copying simple demonstrate demonstrate
 sentences using improvement in improvement in
the R hand R hand R hand
2. Practice handwriting by handwriting by
writing with addressing an writing five
sidewalk chalk envelope for sentences in a
and gradually the mail to letter for a
use skinnier increase social friend to
instruments to participation increase social
improve R hand participation
handwriting
endurance
3. Educate and
practice using a
built-up pencil
grip to improve
pencil grasp
4. Perform
squeezing/relea
sing Thera-
putty exercises
with R hand to
increase
strength for
handwriting
(increase from
soft-hard for
increased
difficulty)
5. Practice
using a hole-
punch with the
R hand to
increase
strength for
handwriting
endurance
(punch thicker
papers for
increased
difficulty)

R wrist ROM 1. Do 2 sets John will John will

10 reps of wall demonstrate achieve 25
pushes to increased R degrees of
strengthen R wrist ROM by active R wrist
wrist extensors drawing three extension to
 for improved smiley faces increase
grooming with his R hand independence
2. Practice on the vertical with grooming
stretching R white board to
wrist extensors increase
by leaning on R independence
hand while in self-care
sitting on a mat tasks
to increase
independence
in self-care
tasks
3. Practice
drawing on a
vertical surface
using R hand to
increase wrist
extension for
self-care tasks
4. Practice
digging with
gardening
spade for
increased
leisure
participation

R shoulder ROM 1. Practice John will John will

reaching up demonstrate achieve 100
with R hand increased R degrees of
and removing shoulder ROM active R
objects placed by reaching the shoulder ROM
in the upper plates in the to increase
cabinets for upper cabinets independence
increased ROM 3/5 times with with household
for household his R hand to management
management increase tasks
tasks independence
2. Practice wall with meal
climb exercises preparation
for 2 sets 5
reps, hold in
maximum
shoulder flexion
for 15 seconds
to increase
AROM against
gravity
3. Lay on L side
on mat and use
gravity-
minimized
AROM to do 2
sets 10 reps
of R shoulder
flexion
exercises for
increased ROM
for dressing
4. Practice
hanging
laundry to
increase
participation in
household
management
tasks (increase
height to hang
or weight of
clothes for
increased
difficulty)
5. Stand side-
ways next to
the refrigerator
and use R
shoulder
abduction to
place magnets
as high as
possible to
increase ROM
for household
management
tasks
6. Sit side-ways
next to a raised
table and
practice
reaching for
single playing
cards with R
 hand for
increased
leisure
participation
(raise table
height for
increased
difficulty)

R hand FMC 1. Practice John will John will

picking-up demonstrate demonstrate
jigsaw puzzle increased FMC increased FMC
pieces from the by buttoning in his R hand
table with R 3/5 buttons by dealing a
hand and with his R hand full deck of
manipulating to increase cards
them in-hand to independence independently
participate in in dressing to increase
leisure participation in
activities leisure
2. Practice activities
dealing playing
cards with R
hand for social
participation
3. Practice
digging small
objects out of
Thera-putty
using R hand to
improve FMC
for grooming
(increase from
soft-hard putty
for increased
difficulty)
4. Practice
buttoning with
R hand for
improved FMC
in dressing
5. Practice
playing
computer
solitaire with R
hand for leisure
participation