Individual Treatment Plans

Patient name: K.T.

Diagnosis: L Hemiplegia d/t R Hemorrhagic stroke from MVA (09/20--)
PMH: HTN, Type 2 DM, R knee surgery, disk removal surgery (19--),
Atrial fib, Coumadin Rx
Psycho Social/ Family situation: Pt is retired railroad engineer, living
with wife, a retired nurse, who acts as caretaker. Pt lives on first floor of
home with bedroom and bathroom. Pts son, daughter-in-law, and 2
grandchildren live on second floor of pts home. Pts daughter-in law is
a nurse and assists in pt care as well.
Precautions: Fall risk, L subluxed shoulder in accident
Patients stated goals: Back to safely woodworking, increase
movement in L UE

Medical Cause/ Description of Diagnosis:

A hemorrhagic stroke occurs when an artery ruptures, leading to
bleeding in areas of the brain, and depriving areas beyond the location
of the rupture of blood and oxygen. The effects of a stroke of the R
hemisphere present in the L side of the body. As with ischemic strokes,
hemorrhagic strokes can cause hemiplegia and hemiparesis. Due to
the functions controlled in the R hemisphere, a person who has
experienced a R hemisphere stroke may have difficulty with memory,
attention, judgment, or vision. Speech difficulties are rare from this
hemisphere stroke, but could potentially present as difficulty speaking
out loud, missing words in sentences, improper word selection, or
overall deficits in speaking and understanding language.

Models or Frame of Reference:

K.Ts stated goals focus around participation in leisure activities. As
such, therapy will focus on the Model of Human Occupation (MOHO).
MOHO frames interventions as examining how K.T. can become a more
active participation in the occupations that are the most important to
him. Treatment interventions will aim to increase his ability to
participate, rather than modifying the context or environment. By
focusing on meaningful occupations of woodworking and scenic trains,
as well as important ADL of UE dressing, as well as roles as
woodworker, retired train engineer, and husband, a MOHO approach
will examine how intervention can allow Ken can meaningfully and
actively participate in his occupations.
Priority Intervention STG LTG
Impairment/ Activity
Limitations/
Problem Areas
Shoulder flexion 1. Pick up books (1- Pt will demonstrate Pt will demonstrate
3lbs) from mat and shoulder flexion shoulder flexion of
place on table to strength endurance 2+/5 MMT to
increase shoulder needing for moving increase ability to
flexion strength L UE away from move L UE safely
needed for woodworking out of way while
participation in UE hobby equipment performing leisure
dressing. by transferring 5 activity of
2. Pt will use books. woodworking.
medium-resistance
theraband to
perform 3 reps of 5
concentric shoulder
flexion exercises
(until 90 degrees)
to increase flexion
strength needed to
move L UE safely
out of the way of
machines during
leisure activity of
woodworking.
3. Pt will practice
folding clothing in
air (while holding)
to increase
shoulder flexion
needed for
participation in UE
and LE dressing.
Supination 1. Turn screw with Pt will demonstrate Pt will have
screwdriver (to L increased supination AROM of
side) out of wood supination by 60 degrees to
block to increase turning flush 1-1/2 increase ability to
ROM and strength screw out of wood perform
in supination block to allow for woodworking
needed for leisure increased leisure activity.
activity of participation in
woodworking. woodworking
2. Turn pages in hobby.
train book (to L
side) to increase
ROM of L UE
supination needed
in participation of
 leisure activity of
enjoying scenic
trains.
3. Use piece of
paper to sweep
small items off of
table (away from
body to mimic
brushing wood
shavings from
work, increasing
supination ROM
needed during
leisure activity of
woodworking.
UE dressing 1. With L hand, Pt will be able to Pt will perf UE
practice placing perf UE dressing dressing with mod
and removing task of managing 8 A.
sleeve of button up buttons on shirt Ily.
shirt from R arm.
2. Use L hand to zip
up coat, while R
hand stabilizes
clothing item.
3. Practice FMC
needed for UE
dressing by
managing buttons
on shirt.
Shoulder internal 1. Using Pt will demonstrate Pt will demonstrate
rotation sandpaper, practice increased shoulder shoulder internal
sanding a piece of internal rotation by rotation AROM of
wood to increase Ily joining belt past 40 degrees to
internal rotation midline (to R side) increase ability to
ROM needed for to increase perform necessary
leisure activity of independent while tasks during leisure
woodworking. travelling for or on activity of
2. Using a ruler and leisure activity of woodworking.
pencil, practice scenic trains.
using a straight
edge to make lines
on a wood block
(going L to R) to
increase internal
rotation ROM
needed for leisure
activity of
woodworking.
3. Pt will use belt to
practice taking
item from L hip to R
hip, crossing
midline, to increase
shoulder internal
rotation ROM
needed to mimic
the action of
buckling a seatbelt
in car or during
leisure activity of
scenic trains.