Dynamic Standing Balance and UB Coordination

Dynamic Stepping with Functional Reach and Controlled Movement

Occupational Therapy Intervention : Dynamic Stepping

Documentation and Activity Rationale

The patient engaged in dynamic standing activity on unstable surface using a foam pad requiring balance on one foot with unilateral upper extremity support and volitional catch-release of weighted 16oz ball using opposite UE. The multimodal occupation-centered activity is purposed to improve weight-shift, elicit righting reaction, establish COG, increased multi-cognitive-kinetic-tasking, increased postural alignment, and improve perceived balance confidence for increased safe, independent participation in work and leisure occupatioins requiring these functions and skills.

Grading Strategies

Grading Up:

Use ankle or wrist weights
Increase Weighted ball
Alternate arm/leg used for activity
Speed / Time (how many successful throws in x amount of minutes)

Grading Down:

Untimed
Decrease or eliminate weighted ball
Stand with both feet on the balance pad, or remove the pad entirely

Appropriate Diagnoses / Deficits

Generalized Weakness
SCI
CVA
TBI
Balance deficits

Stroop and Hurdles | Occupational Therapy Interventions

OT Practitioners

Cognitive Dual Tasking – Stroop and Hurdles

Occupational Therapy Intervention : Cognitive Dual Tasking

Documentation and Activity Rationale

The patient engaged in a dual-tasking activity requiring the ability to recruit executive functioning components while alternating between movement-based performance. This task utilized the stroop color and word test (SCWT) to maximize the ability to inhibit cognitive interference when the processing of a specific stimulus feature impedes the simultaneous processing of a second stimulus attribute. The movement-based component required the ability for the patient to clear 5/5 hurdles approximately 8″ in height to improve reaction time, visual-perceptual functions, reaction time, eye-foot coordination, neuromuscular communication, and the ability to process sensory-motor stimuli s/p executive-function based activity in order to elicit neuronal excitation and maintain cognitive reserve.

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Grading Strategies

Grading Up:

more complex stroop
more hurdles

Grading Down:

begin with larger stroop with less words
decrease amount of hurdles
start with just the stroop

Appropriate Diagnoses / Deficits

Alzheimer’s
Dementias
Memory Changes
Attention deficits [alternating/divided]
CVA
TBI

Volitional Functional Reach | Occupational Therapy Interventions

OT Practitioners

Volitional Functional Grasp

Occupational Therapy Intervention : Cylindrical Grasp

Documentation and Activity Rationale

The patient engaged in a grasp and release activity in today’s session emphasizing principles of interhemispheric communication by way of continuous midline crossing in order to promote neural excitation, UE strength, ROM, motor initiation, motor termination, and calibration of UE movements. The patient was set up in a high-back chair and was tasked with reaching and grasping an object with a cynlindrical grasp. The patient completed 3×12 repetitions in today’s session.

Grading Strategies

Grading Up:

complete standing/ dynamically
challenge pt with numerous items (e.g. bean bags, cones…)

Grading Down:

start with smaller objects that the patient is able to form the whole hand around
move the object to facilitate complete grasp (turning the object so that the patient can complete the grasp)

Appropriate Diagnoses / Deficits

CVA
TBI
Alzheimer’s (cognitive deficits that result in difficulty of grasp and release/ movement initiation)

Agility Ladder + Side Step Group | Occupational Therapy Intervention

OT Practitioners

Group Therapy Intervention – Agility Ladder

Occupational Therapy Intervention : Group – Agility Ladder

Documentation and Activity Rationale

The patient participated in agility-centered activity using a high contrast agility ladder to invoke the vestibular, neuromuscular, muscular, and visual perceptual body systems in order to increase balance, gross coordination, visual perception, agility, invoke involuntary postural correction, attention to task, motor planning, movement intention, and neuromuscular communication. The patient demonstrated difficulty in performing a forward linear pattern which required him to alternate between a narrow BOS and wide BOS x6 step sequence. CGA with x4 errors requiring verbal and visual cues.

Grading Strategies

Grading Up:

complete with metronome
complete more complex pattern
integrate dual-tasking (e.g. have patient count by 2’s)

Grading Down:

begin with a more simple pattern, challenging the patient to still not touch the yellow or black lines

Appropriate Diagnoses / Deficits

Memory Changes
Attention deficits [alternating/divided]
CVA
TBI
Balance deficits

Dynamic Agility Ladder Step Pattern Group | Occupational Therapy Intervention

OT Practitioners

Dynamic Agility Ladder – Group

Occupational Therapy Intervention : Agility Ladder – Group

Documentation and Activity Rationale

Patient participated in agility-centered activity using a high contrast agility ladder to invoke the vestibular, neuromuscular, muscular, and visual perceptual body systems in order to increase balance, gross coordination, visual perception, agility, invoke involuntary postural correction, attention to task, motor planning, movement intention, and neuromuscular communication. The patient demonstrated difficulty in performing pattern which required him to use speed while side-stepping in a diagonal pattern. CGA with x4 errors requiring verbal and visual cues.

Grading Strategies

complete with metronome
complete more complex pattern
integrate dual-tasking (e.g. have patient count by 2’s)

Grading Down:

begin with a more simple pattern, challenging the patient to still not touch the yellow or black lines

Appropriate Diagnoses / Deficits

Memory Changes
Attention deficits [alternating/divided]
CVA
TBI
Balance deficits

Seated Hula Hoop Group | Occupational Therapy Intervention

OT Practitioners

Seated Hula Hoop Group Intervention

Occupational Therapy Intervention : Group Intervention

Documentation and Activity Rationale

The patient engaged in a BUE AROM, mm Elongation, and generalized strengthening activity requiring them to hold the hula hoop at various points to elicit gross shoulder flexion, pronation/supination, internal/external rotation, scapular protraction/retraction. The patient perform 2×15 each movement pattern with noted fatigue at the end of sequence. Therapeutic rest offered.

Grading Strategies

Grading Up:

complete standing as a dynamic balance activity
complete with a weighted hula hoop

Grading Down:

offer rest breaks between each set

Appropriate Diagnoses / Deficits

Generalized weakness
Balance deficits (when graded to a stand)
Memory Changes
Attention deficits [alternating/divided]
CVA
TBI