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	ADD ON TO END OF MANUAL MUSCLE STRETCH NOTE	***chose one Skilled intervention required as pt unable to achieve or maintain end range independently due to cognitive deficits. COTA control required to ensure safety and effective stretch. Non-skilled PROM insufficient due to guarding and inconsistent motor response.
	Arm arc	seated/ standing act to increase balance and UE ROM for dressing tasks. Tactile cues/verbal cues for core activation.
	BUE ROM	act to improve shoulder mobility, core activation, and weight shifting during supported/unsupported sitting. VC to adjust posture, core use, and UE ROM.
	BUE ROM	act and stretches to gain motion to work w/ strength.
	BUE strengthening exercises	elbow flexion, shoulder flexion, hand squeezes, Lat pull downs, shoulder horizontal abduction/adduction, shoulder internal/external rotation, shoulder abduction/adduction, scapular protraction/retraction.
	CARD GAMES CONES RING	engages in act to promote wrist flex/ext, wrist ulnar/radial deviation, forearm supination/pronation w/ use ring and cone.
	Clothespins act	to promote UE ROM, fine motor coordination, sensory perception, and facilitate UB dressing tasks with reaching and coordination.
	Coordination	act w/ use of weak hand to place grasp and release item on target by sequence in numbers.
	Core strength act	to promote balance, fxnl txf, and fxnl mobility.
	Denial proof add on phrase pic 1 or 2	Skilled intervention required to prevent joint injury and manage abnormal tone. PROM necessary due to inability to actively move affected extremity. Manual facilitation required secondary to neuromuscular impairment. Intervention supports prevention of secondary complications related to immobility. Skilled judgment used to modify ROM based on tone and tissue response.
	Education on	slow and controlled pace to decrease fatigue.
	Education on energy conservation	to maximize energy reserves.
	Facilitation in	Self-Range of Motion Exercises for shoulders, arms, wrists, and fingers. Visual demo and verbal instructions for correct body mechanics and pace.
	Facilitation in seated	BUE strengthening and ROM exercises 1 set x15 reps for all shoulder aspects. FA pronation/supination, wrist flexion/extension. Visual demo and instruction for pt to follow along. Tactile cues for slow and steady pace w/ correct body mechanics.
	Facilitation in seated BUE strengthening	with ____ for shoulder flex/ext, horizontal abb/abd, internal/ext rotation elbow flex/ext, FA pronation/supination.
	Facilitation in seated stretches	for back pain.
	Facilitation of ROM	and stretching exercises to increase joint flexibility and mobility to perform personal hygiene and dressing tasks.
	FM block act	to focus on problem solving, sequencing, and eye hand coordination. Pt completes task in ____ mins w/ __ cues.
	Frozen shoulder exercises	w/ forward/backward and up/down shrugs, protract/retract, forward/backward circles, and horizontal abduction. Visual demos and verbal instructions were provided to correct body mechanics.
	Grasp and release act	to enhance grip strength to enable pt to hold and manipulate utensils effectively, ensuring independence in feeding and promoting self-esteem.
	GRIP STRENGTH	Pt participates in wrist exercises to increase grip strength for grooming and feeding tasks. Visual demo and verbal instructions for wrist flexion/extension, wrist rotation, prayer stretch, wrist radial deviation, wrist ulnar deviation, wrist circles, and wrist push-ups.
	Grip strength act	to bear weight on walker, improving mobility and reducing fall risks. *to hold and manipulate utensils and promote independence w/ self-feeding tasks. *to allow pt to hold grab bars securely for safe toilet txf. *to promote participation/ind in grooming task.
	Hand	strengthening exercises to increase overall grip for fxnl tasks.
	Hand exercises	Hand MCP extension/flexion, Hand MCP abduction/adduction, Ball squeeze, Putty squeeze.
	In Hand Manipulation Skill Exercise	by picking up small objects from countertop w/ index finger and thumb and moving to the palm of hand to hold and releasing in target by , moving items from palm of hand to fingers.
	Instrinsic muscle	exercises w/ rubber bands to increase grip strength. Pt instructed to perform finger flex/ext.
	Intrinsic	muscle exercises w/ rubber bands to increase grip strength. Pt instructed to perform finger flex/ext.
	jd	Pt expressed frustration w/ not being able to do what he used to do before surgery. Discussion w/ pt on progression w/ w/c mobility, bed mobility, change of status w/ txf from Hoyer to sit > stand, dressing tasks. Communication w/ pt on OT session working towards walker level and standing stability to upgrade status. Encouragement for pt to continue working toward goal to be able to perform tasks as much as possible w/ less assistance. Pt agreeable. Postural control training seated in w/c. Physical a on shoulder to promote posture. Provided LUE PROM exercises w/ shoulder flexion, shoulder abd/add, elbow flex/ext, wrist flex/ext, finger flex/ext. Skilled intervention required as pt unable to achieve or maintain end range independently. Discomfort on 5th digit noted. Pt instructed to perform finger ext to 5th digit to control manage comfort level.
	Manual muscle stretching	to end range w/ sustained hold to address soft tissue tightness impacting fxnl movement patterns.
	MANUAL STRETCH DENIAL PROOF CHOOSE ONE	Skilled intervention required as pt unable to achieve or maintain end range independently. Manual stretching required therapist control to ensure safety and effective ROM gains. Non-skilled PROM insufficient due to cognitive deficits and inconsistent motor response.
	MANUAL STRETCHING	Skilled OT provided manual muscle stretching to end range to address impaired ROM and muscle tightness impacting functional positioning and ADL performance.
	MANUAL STRETCHING BODY AREA	1. Manual stretching to end range provided to shoulder flexion/abduction to improve functional reach for grooming. 2. Skilled stretching to end range applied to elbow extension and wrist extension to improve UE positioning for hygiene. 3. Manual stretching to end range performed to hip flexors/hamstrings to improve sitting tolerance and postural alignment for ADLs.
	MANUAL STRETCHING GENERAL STATEMENT	Provided manual muscle stretching to end range to address impaired ROM and muscle tightness impacting functional positioning and ADL performance.
	Manual therapy	Provided manual therapy for joint mobilization w/ dorsal abduction to perform gripping act w/ ADLs. Pt reports __easier. No pain reported.
	Manual therapy techniques	Provided joint mobilization to bilateral CMC for pain and ROM. Practiced UB dressing. Pt responded well to ROM, which allowed pt complete task at __ assist.
	mm	Safety training during transitional movements. Pt donns shoes seated in w/c at min a w/ R shoes due to decreased alertness. Pt ties shoes laces w/ increased time. Washes hands at w/c level SBA. Pt seated in w/c reaching for items upon entrance. Ed on locking w/c brakes when reaching out of BOS to decrease fall risks. Pt reports needing to remember that. Requires prompting when reaching down for shoes. Assessment on tub txf at w/c level at CGA. Suggestion w/ using leg lifter to assist w/ bringing BLE over tub. Pt reports bathroom smaller than therapy bathroom where pt txf from toilet > bathtub. Pt states shower chair broken 6-8 months ago and pt in seated in bathtub for bathing/showers. Continue to work on txf for consistency. Pt txf w/c <> toilet ind. Seated on toilet at end of session. BUE ROM act at parallel bar to improve shoulder mobility, core activation, and weight shifting during supported sitting. 1 set 10 reps and 10 seconds hold. Squat stretch 1 set 10 reps w/ 10 secs hold. Requires tb due to fatigue. Mirror provided for visual feedback. Min cueing for proper body mechanics.
	PART A MANUAL STRETCHING	1. Skilled OT provided manual stretching to end range to B UE to improve positioning for hygiene and dressing; hands-on facilitation required for safety. 2. Manual muscle stretching to end range completed to reduce tone and tightness affecting functional movement; pt unable to follow commands without therapist assistance. 3. Skilled end-range stretching provided due to resistance and poor motor planning, requiring therapist control to prevent injury.
	PART B MANUAL STRETCHING	1. Provided manual stretching to end range to improve ROM needed for functional reach during ADLs. 2. Skilled end-range stretching performed to address ROM limitations impacting grooming and dressing tasks. 3. Manual stretching to end range completed with verbal and tactile cues for relaxation and positioning.
	Physical assistance	to thread UE through sleeve.
	Physical assistance for	proper body mechanics.
	Posterior card flip	to enhance trunk rotation, shoulder ROM, LE strength, balance, and coordination.
	PROM	exercises seated in w/c/EOB/ supine in bed w/ shoulders, arms, wrists, and fingers to prevent worsening contracture in LUE/RUE.
	PROM bed level	1. Skilled PROM performed to affected UE/LE with manual facilitation to manage abnormal tone and protect joint integrity post-CVA. ***Pt tolerated PROM without pain; COTA modified range based on tone response and resistance.
	PROM BUE	Provided BUE PROM exercises w/ shoulder flexion, shoulder abd/add, elbow flex/ext, wrist flex/ext, finger flex/ext.
	PROM with spasticity present	1. PROM administered with slow rhythmic pacing and prolonged end-range holds to inhibit spasticity and prevent further contracture. 2. Decreased resistance noted following skilled handling; no adverse response observed.
	Provided	manual muscle stretching to end range to B shoulders to address ROM limitations impacting dressing, requiring hands-on facilitation for safety.
	Pt participates in	table top act to promote shoulder endurance w/ prolonged reaching and pinch strengthening to increase participation in fxnl tasks.
	Putty act	to promote hand/grip strength, digit/wrist ROM for grooming/hand washing.
	Putty rolling	to promote hand/grip strength, digit/wrist ROM for grooming/hand washing
	Putty shaping	to promote hand/grip strength, digit/wrist ROM and dexterity for grooming/hand washing.
	Reaching and Grasping	Pt participates in forward reaching during sitting/standing and grasp and release to increase wrist and finger ROM.
	ROM	Facilitation in Self-Range of Motion Exercises for shoulders, arms, wrists, and fingers. Visual demo and verbal instructions for correct body mechanics and pace.
	ROM FOR SPLINT	Pt participates in PROM to LUE wrist and digits into extension and wrist into flexion w/ prolong gentle stretchingch. Focus on preparing for RHS/LHS. Pt ed on self-stretching techniques to prevent worsening contracture and reduce pain to Lhand/Rhand. Pt requires min to mod- cueing for appropriate self-stretching.
	SAFE MMS TEMPLATE	Skilled OT provided manual muscle stretching to end range to B shoulders to address ROM limitations impacting dressing, requiring hands-on facilitation for safety.
	Seated	table top act w/ use to noodle to promote core strength, BUE ROM, coordination, stability, reaction time, and act tolerance.
	Seated BUE ROM and strengthening	with use of ergometer at load 1. Pt completes x mins at x distance with TB breaks.
	Seated BUE strengthening with	tband 1 set 10 reps for all shoulder aspects, FA pronation/supination, wrist flexion/ext.
	Seated BUE strengthening with dumbbell	1 set 10 reps for all shoulder aspects, FA pronation/supination, wrist flexion/ext.
	Seated FM act	w/ clothes pins and rod to promote functional reach, BUE ROM, and hand/wrist ROM and dexterity strength for fxnl task.
	Seated Upper Extremity Preparatory Exercises for	UB dressing. 1 set reps of External shoulder rotation, scapular reach/advanced external rotation, shoulder horizontal adduction/shoulder taps, internal shoulder rotation, and back scratch stretch. Provided visual demo and verbal instructions for pt to observe and follow along. Physical assist at elbow and shoulder to increase range of motion. Cues for facilitating AAROM to increase ROM of affected UE. Tactile facilitation at scapula to increase proprioception and increase ROM. Use of towel during back scratch stretch to increase joint mobility. Increased back scratch stretch from -10in to -7in
	Shoulder	PROM exercises w/ pendulum swings, flexion and abduction w/ a stick.
	Shoulder AROM	Pg. 700-702 Shoulder and Hand Active Exercises 703 Shoulder blade exercise 724-725 Shoulder, Elbow, and Hand Active Exercises 726
	Shoulder internal and external rotation	to promote UE ROM to wash hair and body.
	Shoulder mobility	Seated act w/ use of pool noodle and tband to promote shoulder mobility, wrist mobility, grip strength, coordination, and BUE ROM for fxnl tasks.
	Shoulder mobility exercises	Pendulum Swings to loosen tight shoulder muscles. Wall slides to target shoulder flexors/extensors. Cross body arm stretch w/15-second holds to stretch posterior shoulder muscles, improve flexibility, and reduce muscle tension.
	Splint application	to LUE/RUE. Pt verbalizes comfort upon application. COTA departs and returns following 30 min, 60 min, 1:30 and 2 hours of wearing time. Splint removal and skin inspection upon each entrance. No skin issues noted. No identation and no pain reported.
	STRENGTH	Facilitation in seated HEP for BUE strengthening and ROM exercises w/ light band 2 sets x15 reps for all shoulder aspects. FA pronation/supination, wrist flexion/extension. Visual demo and instruction for proper body mechanics. Pt demos good steady pace. TB due to fatigue.
	Stretching	Seated in chair forward flexion w/ BUE over knees and straighten back. Hand and wrist stretches w/ 5 second holds. Place weaker hand on table. Apply pressure placing strong hand over weak.
	Tactile cue	to facilitate proper muscle activation. for postural alignment. on the diaphragm to promote breathing techniques. to increase awareness of one side. to reach outside BOS.
	tband	Facilitation in seated BUE ROM and strengthening w/ light resistance for all shoulder aspects within ROM. VC for breathing during exercise. Demos slow and controlled pace. VC and visual demo for proper body mechanics. One TB due to fatigue.
	Theraband row	to simulate the motion of donning socks and lower body clothing while enhancing UE strength and ROM.
	TONE INHIBITING STRETCH	*DEMENTIA/NEURO/GUARDING 1. Provided slow, sustained tone-inhibiting stretch to end range to reduce resistance and facilitate controlled, functional movement. 2. Skilled pacing and positioning used to reduce abnormal tone and guarding during functional tasks.
	Towel glides	w/ shoulder flexion/extension, shoulder abduction/adduction, and shoulder internal/external rotation to help improve/maintain shoulder range of motion, strengthen shoulder muscles, and increase overall mobility. Upgrade act w/ weighted cuffs.
	Towel slides	act to promote shoulder and elbow extension and trunk mobility. 1 set 10 reps for anterior and lateral slides alternating UE.
	Trunk rotation act	to promote reaching across midline, UE ROM and coordination, grasp for item retrieval, core strength, motor control, and sitting balance.
	UB stretching	in shoulders, wrists, and fingers to reduce tightness and spasticity.
	UE PROM	Shoulder flexion/extension: Therapist moves the patient’s arm overhead and back down. Shoulder abduction/adduction: Therapist moves the arm out to the side and back in. Shoulder external/internal rotation: Therapist rotates the arm at the elbow while keeping the shoulder stabilized. Elbow flexion/extension: Therapist bends and straightens the elbow. Forearm supination/pronation: Therapist rotates the forearm palm-up to palm-down. Wrist flexion/extension: Therapist bends the wrist forward and backward. Wrist radial/ulnar deviation: Therapist moves the wrist side to side. Finger flexion/extension: Therapist curls and straightens fingers individually or as a group.
	V	c for pacing to prevent fatigue.
	Visual cues	for correct positioning. to increase ROM. for proper form/technique. mirror for proper hand/foot placement.
	Visual demo and	and verbal instructions provided. Requires tactile cue for correct body mechanics.
	Weight	-bearing on a walker to improve grip strength to enable pt to bear weight confidently.
	Weight bearing	on walker to enhance mobility and decrease risk of falls.
	Wrist exercises	1 set 10 reps for flexion/extension, rotation, prayer stretch, radial deviation, ulnar deviation, and circles.

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Facilitation in seated HEP for BUE strengthening and ROM exercises w/ light band 2 sets x15 reps for all shoulder aspects. FA pronation/supination, wrist flexion/extension. Visual demo and instruction for proper body mechanics. Pt demos good steady pace. TB due to fatigue.

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