Net Health/Optima SNF

Progress Note

SKILLED INTERVENTIONS & REASON FOR SKILLED SERVICES
During POC, physical therapy has implemented interventions targeting LE and core strengthening, bed mobility, transfer training, static and dynamic balance, ambulation, and gait. 
Targeted interventions have been provided to the patient for a chance of maximal independence with functional tasks. Skilled physical therapy services continue to be indicated for assessment of maximal functional capacity, continued assessment of mechanics with functional tasks, discharge planning, and to reach patient's goals of maximal independence with interventions provided.
REMAINING IMPAIRMENTS
Although patient has made improvements towards goals, patient still requires skilled physical therapy services for improvements in bed mobility, LE and core strength and power, static and dynamic balance, functional transfers, gait, ambulation, and ambulation tolerance to reach maximal functional ability.

TREATMENT NOTE
Pt is agreeable to skilled physical therapy services and willing to participate in assessment of goals. Educated patient regarding progress since SOC and education regarding benefits of therapy. Refer to assessment documentation regarding specific results for each measure assessed. 
Assessment of bed mobility with subsequent repetitions for continued improvements.
Assessment of transfer ability with subsequent repetitions for progression to maximal independence and increasing LE and core strength.  
Assessment of LE strength with 30 sec CST performed. Pt required verbal cues for proper technique and pacing. 
Assessment of sit <> stand and stability with ambulation while maneuvering around object with Timed Up and Go.
Assessment of W/C mobility for maximal independence with mobility through facility.
Assessment of static balance and risk for falls with Berg Balance Scale.

Goals

SEATED BALANCE
Patient will be able to maintain seated balance (back unsupported, without BUE support, feet flat on the floor) for 1 minute with independence indicating improvements in core strength required for balance and transfers.
Patient previously was able to maintain seated balance (back unsupported, without BUE support, feet flat on the floor) for 1 minute with independence.
Patient is able to maintain seated balance (back unsupported, without BUE support, feet flat on the floor) for 20 seconds with CGA indicating reduced core strength and reduced balance. 
Patient is unable to maintain seated balance (back unsupported, without BUE support, feet flat on the floor) for any length of time indicating reduced core strength and reduced balance. 
SIT TO STAND
Patient will be able to perform sit to stands with independence indicating improvements in LE strength and stability with transitional movements.
Patient previously performed sit to stands with independence. 
Patient is able to perform sit to stands with ModA indicating reduced LE and core strength with functional transitional movements.
Patient is unable to perform sit to stands at the time of assessment indicating reduced LE and core strength. 
30 SECOND CST
Patient will be able to perform 8x sit to stands during 30 second CST with BUE for assistance indicating an improvements in LE strength required for functional transfers.
Patient previously was able to perform sit to stands at a functional level.
Patient is able to perform 4x sit to stands in 30 seconds with BUE for assistance indicating reduced LE and core strength for functional transfers.
Patient is unable to perform a sit to stand at this time without assistance. 
TRANSFERS
Patient will be able to perform stand pivot transfer with independence indicating improvements in LE strength and stability for maximal independence. 
Patient previously performed stand pivot transfers with independence.
Patient is unable to perform stand pivot transfer at time of assessment indicating reduced LE and core strength.
Patient performs stand pivot transfer requiring ModA indicating reduced LE and core strength.
AMBULATION
Patient will be able to ambulate 50 feet with independence and LRAD indicating improvements in functional locomotion for maximal independence.
Patient previously ambulated community distances independently and without AD.
Patient is unable to ambulate at time of assessment indicating reduced LE strength and stability.
STANDING TOLERANCE
Patient will be able to stand with/without BUE support on AD for 1 minute indicating improvements in transfer ability. 
Patient previously was able to stand without BUE support on AD for 1 minute.
Patient is unable to stand without physical assistance from therapist at this time indicating reduced LE and core strength.
Patient is able to stand for 10 seconds at time of assessment indicating reduced LE and core strength required for functional transfers. 
FUNCTIONAL REACH
Patient will demonstrate 10 inches on the Functional Reach test for improvements in stability and safety with standing and reaching tasks.
Patient previously was able to perform standing and reaching tasks at a functional level.
Patient demonstrates 4 inches on the Functional Reach test indicating reduced stability with standing tasks and an increased risk for falls.
Patient is unable to stand unsupported at time of assessment.
STAIRS
Patient will be able to negotiate 4 steps with BIL handrail use indicating improvements in LE strength and stability for a safe return to home.
Patient previously negotiated steps independently. 
Patient is unable to negotiate steps at time of assessment indicating reduced LE strength and stability with standing tasks.    

Potential for goal achievability:
Good based on patient's willingness to participate in skilled PT. 

PCC

Type: [X]PT []ST []OT

Order: []Screen [] Eval Only [X]Evaluate & Treat 

PT to treat pt 5-6 times/week for 30 days with therapeutic exercise, therapeutic activity, neuromuscular re-education, W/C management, gait training, and manual therapy provided in group, concurrent and individual setting as applicable.

Interventions with Evaluation

Therapeutic Activity (in conjunction with evaluation) for progression towards reaching goals and patient's stated goals for maximal functional mobility. Education regarding benefits of therapy and importance of each intervention explained to patient. Interventions related to LE strengthening, core strengthening, bed mobility, W/C mobility, transfers, ambulation, and static and dynamic balance were implemented. 

Warm-up and cool-down:
Shoulder flexion, elbow flexion/extension, GH IR and ER while flexed to 90, GH horizontal abduction stretch, wrist flexion/extension, grasping/opening, cervical flexion/extension, cervical lateral rotation, cervical rotation, trunk rotation, trunk lateral flexion with one arm maximally abducted, hamstring stretch, heel/toe rocking

Balloon Volleyball
Group therapy consisting of appropriate warm-up and cool-down pre- and post- intervention for injury prevention. Pt required verbal and visual cues for proper stretching and joint ROM for BIL UE, BIL LE, cervical, and trunk. 
Facilitation of improvements in core strength, improved coordination, improved anticipatory seated reactive balance, non-anticipatory seated reactive balance, UE strengthening, LE strengthening, and activity tolerance. Facilitation of balloon volleyball from therapist <> pt as well as from pt <> pt. To further encourage core strengthening and increased balance reaction, facilitated activity without back supported for added benefit and difficulty. Second half of balloon volleyball, applied 2# weight to dominant UE for improved UE strength. 
Facilitated kicking ball from pt <> pt while pt seated and back unsupported. 
All exercises required supervision for stability. Appropriate rest provided throughout treatment session for proper muscle recovery and for reduction of fatigue. 
Chair Dancing
Group therapy consisting of appropriate warm-up and cool-down pre- and post- intervention for injury prevention. Pt required verbal and visual cues for proper stretching and joint ROM for BIL UE, BIL LE, cervical, and trunk. 
Facilitation of improvements in core strength, improvements in LE and UE strength, improvements in coordination, and improvements in anticipatory seated reactive balance. Facilitation of seated exercises to music addressing all things mentioned. Exercises consisted of UE, LE, concurrent UE and LE, coordination with extremities, and reaching in all directions. Verbal and visual cues provided for each exercise for correct technique. 
All exercises required supervision for stability. Appropriate rest provided throughout treatment session for proper muscle recovery and for reduction of fatigue. 

https://pogoe.org/sites/default/files/FIST%20Training%20Manual%20v1-5.pdf