Step, Tap, Align Group | Occupational Therapy Intervention

Group Therapy Intervention

Occupational Therapy Intervention : Group Therapy

Documentation and Activity Rationale

The patient engaged in a dual-tasking activity with an emphasis on visual memory and recall. The task required the patient to receive a 3-part image at point A, ambulate 20 ft while clearing obstacles of various sizes and heights, and recall and draw the image received at Pt A. This activity is purposed to improve the relationship between perceptual processing and encoding, storage, and retrieval of the resulting neural representations after approximately 10 seconds of time-lapse. The patient demonstrated no evidence of LOB or instability. She required between 2-3 repetitions per image with 2-3 verbal cues. 3 step directions are moderately difficult for the patient.

Grading Strategies

Grading Up:

more narrow BOS
increase the frequency of stepping
integrate dual-tasking (e.g. counting by 2’s)

Grading Down:

increase BOS
decrease stepping outside of BOS (e.g. “tap your foot to the side every 5 steps)

Appropriate Diagnoses / Deficits

Balance deficits
Memory Changes
CVA
TBI

One Leg Stance and Cross Midline Tap Group | Occupational Therapy Intervention

OT Practitioners

Group Therapy Intervention – Balance

Occupational Therapy Intervention : Group Therapy Intervention

Documentation and Activity Rationale

The patient engaged in LE dynamic balance activity designed to promote neuronal excitation, brain plasticity, interhemispheric communication, balance, agility, visualization, and stability. Alternating toe taps were completed invoking crossing midline using a visual target to ensure maximum range and visual perceptual skills, BUE cross midline, internal rotation, adduction > outside BOS. 15 reps were completed per LE.

Grading Strategies

Grading Up:

integrate dual-tasking
utilize directional component (e.g. “tap you left foot 3 times and your right foot 2 times)

Grading Down:

allow for one-handed support (e.g. a chair/non-wheeled walker)

Appropriate Diagnoses / Deficits

Balance deficits
Memory Changes
CVA
TBI

Tandem Walking Group | Occupational Therapy Intervention

OT Practitioners

Group Therapy Intervention

Occupational Therapy Intervention : Tandem Walking – Group

Documentation and Activity Rationale

The patient engaged in tandem gait pattern to reduce trunk-tilt, center of mass displacement, medial-lateral feet distance, and frequency of stepping error as well as increase lateral support strengthening, trunk/core support, movement intention, and eye-foot coordination in order to improve community mobility. Walking in tandem has been proven to promote increased strength, gait stability, neural excitation for greater plasticity, and increased carryover into other functional movements. The patient walked approximately 30-40 ft CGA without the use of an ambulation device with moderate difficulty and verbal cues throughout entire task to slow down and focus on stable movements. The patient was not able to exemplify complete tandem pattern and was off by approximately 50%.

Grading Strategies

Grading Up:

place tandem line in “Z” formation
integrate dual-tasking

Grading Down:

begin with wider BOS that is challenging but achievable and grade from there

Appropriate Diagnoses / Deficits

Balance deficits
Memory Changes
CVA
TBI

Side Step to Elevated Surface | Occupational Therapy Intervention

OT Practitioners

Lower Extremity Strengthening – Step Ups

Occupational Therapy Intervention : Lower Extremity Strengthening

Documentation and Activity Rationale

The patient engaged in LE strengthening exercise in which she was tasked with single-leg balance, gait clearance and maintaining postural alignment in order to decrease balance deficits and increase hip flexors and peripheral musculature of the LE’s.

Grading Strategies

Grading Up:

increase speed
increase repetitions

Grading Down:

lower aerobic stepper
provide study support for balance and safety (e.g. chair, non-wheeled walker)

Appropriate Diagnoses / Deficits

Generalized weakness
Balance deficits
Muscle imbalances
CVA
TBI

Agility Ladder Forward Cross Midline Group | Occupational Therapy Interventions

OT Practitioners

Agility Ladder with Midline Crossing – Group

Occupational Therapy Intervention : Group Intervention

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 a forward midline crossing pattern which required him to challenge his single leg balance by moving his LLE to the other side of his RLE and vise versal. 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

Wrist Flexion and Extension| Occupational Therapy Intervention

OT Practitioners

Wrist Flexion and Extention:

Forearm Strengthening

Occupational Therapy Intervention : Wrist Flexion and Extension

Documentation and Activity Rationale

The patient engaged in a wrist AROM against resistance provided by a 2lb weighted ball. The exercise sequence elicited wrist flexion and extension in order to increase extrinsic forearm musculature. The patient was instructed to perform each movement slowly, methodically, and with complete control. No pain or discomfort verbalized by the patient, though the patient affirmed muscle fatigue at the end of the sequence. Therapeutic rest given after task.

Grading Strategies

Grading Up:

include radial and ulnar deviation, circumduction, pronation and supination in the AROM sequence

Grading Down:

begin with less weight
fewer repetitions

Appropriate Diagnoses / Deficits

generalized weakness
atrophy s/p hand and/or wrist surgery
CVA
TBI

An occupational therapy practitioner would work on wrist flexion and extension using various shaped and weighted items, such as bars for cylindrical grasp, balls for spherical grasp, and books for specific grasp types, to achieve several therapeutic goals:

Strengthening Muscles: Different shapes and weights challenge the wrist flexor and extensor muscles, promoting muscle strengthening and endurance. This is crucial for improving overall wrist stability and function.

Enhancing Grip Variety: Practicing with various objects helps to enhance different types of grips such as cylindrical, spherical, and pinch grasps. This diversity in training ensures that patients can perform a wide range of everyday activities.

Improving Dexterity and Coordination: Using objects of different shapes and sizes requires fine motor skills and coordination. This helps to improve hand-eye coordination and dexterity, which are essential for precise movements.

Functional Application: Activities that involve gripping and manipulating different objects are directly related to daily tasks such as opening jars, picking up objects, and using tools. Training with these objects simulates real-life scenarios, making the therapy functional and relevant to the patient’s daily life.

Promoting Motor Control: Varying the resistance and shape of objects helps in refining motor control and proprioception, which are important for smooth and controlled movements of the wrist and hand.

Addressing Specific Deficits: Different objects target specific muscle groups and movement patterns. For example, using cylindrical objects primarily targets wrist flexion and extension, while spherical objects challenge the intrinsic muscles of the hand.

Encouraging Neural Adaptation: Engaging in diverse and challenging tasks promotes neuroplasticity, which is the brain’s ability to reorganize itself by forming new neural connections. This is especially important for patients recovering from neurological injuries.

Here’s an example of how specific objects can be used:

Cylindrical Grasp: Bars or tubes to improve wrist flexion and extension strength.

Spherical Grasp: Balls to enhance overall grip strength and coordination.

Lateral Pinch: Books or flat objects to practice the lateral pinch grasp, improving precision grip used in activities like holding cards or sheets of paper.