Phys Health FINAL: Intervention study

purposeful or adjunct, contrived and simulated activities to assist the goal. (not actually doing the goal itself)

Sternal Precautions (CABG/Open Heart Surgery)

No PUSH, No PULL, No LIFT, No TWIST

• No lifting >5 lbs

• No pushing/pulling with arms in bed mobility

  • can push off with elbows

• No shoulder movement >90°

• Do not strain or hold your breath during the activity. Use pursed lip breathing during the activity.

• Pace yourself and take frequent rest breaks before you become fatigued.

• No crossing midline, twisting, or deep bending

• Brace chest when coughing/sneezing

• Rest after meals, avoid extreme temperatures

• No driving or sexual activity until cleared

  -

Hip (THR/THA – Posterior & Anterior) Precautions

No Flex >90°, No Turn In, No Cross

• Posterior: No hip flexion >90°, no internal rotation, no adduction

No Step Back, No Turn-Out, No Cross

• Anterior: No hip extension >45°, no external rotation, no adduction

Both: Follow weight-bearing precautions, use adaptive equipment

Common Diagnoses:

• Total Hip Arthroplasty (THA)

• Hip Osteoarthritis

• Post-surgical recovery following THR

Back Precautions (Spinal Surgery/Instability)

No BLTs (Bend, Lift, Twist) No bending, lifting (>5 lbs), or twisting (BLTs)

• Use log rolling for bed mobility

• No pushing/pulling with arms in bed mobility

  • can push off with elbows

• No shoulder movement >90°

• Do not strain or hold your breath during the activity. Use pursed lip breathing during the activity.

• Pace yourself and take frequent rest breaks before you become fatigued.

• Keep a balanced, aligned position of comfort at all times. When lying on your side, place a pillow between your knees and at your back.

• Wear brace as prescribed

• Keep spine aligned and rest lying down when possible

Total Knee Replacement (TKR/TKA) Precautions

Move (stay mobilized), No Kneel, No Twist

• Avoid immobility, use CPM (Continuous Passive Motion) ordered

• No kneeling or rotation on the affected leg

• Adhere to weight-bearing precautions

Total Shoulder Replacement Precautions

Sling On, No Weight, Small Moves

• Wear immobilizer as prescribed

• Avoid certain shoulder movements per MD orders

• Perform elbow, wrist, and hand AROM daily

• Do Codman’s/Pendulum exercises as ordered

What are the 6 key areas to hit in an OT intervention session? (from rubric)

1. Appropriate intervention

2. Diagnosis + precautions

3. Grading/modification

4. AE/DME use (if applicable)

5. Patient education + HEP

6. Safety + professionalism

Post-Cardiac Surgery with Sternal Precautions

1. Modified Grooming Techniques

   • Description: Use of adaptive equipment and techniques to perform grooming tasks within movement restrictions.

   • Clinical Reasoning: Supports self-care independence while protecting the healing sternum.​Verywell Health

2. Energy Conservation Strategies

   • Description: Educate on pacing, rest breaks, and prioritizing tasks to manage fatigue.

   • Clinical Reasoning: Enhances endurance and safety during daily activities, promoting recovery.​

3. Chest Splinting Education

   • Description: Teach the use of a pillow to support the chest during coughing or sneezing.

   • Clinical Reasoning: Reduces discomfort and protects the sternum during activities that increase intrathoracic pressure

Spinal Fusion (L4-S1)

Performed for herniated disc or instability

• follow back precautions

Rotator Cuff Repair

• Limited overhead movement

• PROM → AAROM → AROM protocol

• Sleep with sling, no lifting early on

Precautions:

• No shoulder abduction or flexion above 90° if specified

• Avoid IR/ER if specified

• Watch for shoulder hiking/shrugging

Knee Replacement (TKA)

Common Diagnoses:

• Total Knee Arthroplasty (TKA)

• Knee Osteoarthritis

• Post-surgical recovery following TKR​

  Precautions:

• Follow WB status

• Encourage ROM and avoid prolonged flexed positions

• Support for transfers and toileting initially

• Pain and stiffness in the knee

• Initial weight-bearing may be restricted

Shoulder Subluxation (common post-stroke)

Common Diagnoses:

• Rotator Cuff Tear

• Shoulder Impingement Syndrome

• Post-surgical recovery following rotator cuff repair

  Precautions:

• Avoid pulling on the arm

• Support the shoulder with a sling or positioning

• Use guided movement only (no passive arm lifts)

• Humerus slips slightly out of the socket

  Weakness from a stroke causes poor support

Humerus Fracture (non-dominant hand)

• Pain, limited ROM

• Often in sling or cast

Precautions:

• No lifting or WB until cleared

• Promote ADLs with dominant hand

• Encourage safe compensatory strategies

Osteoarthritis

• Joint stiffness and pain (esp. in morning)

• Can impact hands, knees, hips

Precautions:

• Avoid joint overuse

• Respect pain

• Use built-up handles and joint protection techniques

Distal Radius Fracture

• Wrist fracture common from FOOSH (fall on outstretched hand)

  Precautions:

• No weight-bearing on affected wrist

• Edema management (elevation, compression)

• Joint stiffness → encourage safe AROM early

Spinal Cord Injury (SCI) 11. C6 SCI (Tetraplegia)

• No trunk control

• Wrist extension preserved

• Uses tenodesis grasp (important for function)

Precautions:

• Skin integrity checks

  • they can’t feel pressure on areas like the butt, back, or feet.

  • Pressure relief every 30 mins

• Monitor for autonomic dysreflexia

  • Something like a full bladder or tight clothing can trigger a dangerous spike in blood pressure.

T6 SCI (Paraplegia)

• Full UE function

• May be independent with AE

• Loss of abdominal/trunk control

Precautions:

• Orthostatic hypotension

  • Blood pressure drops when sitting up too fast because the body can't adjust well without the trunk muscles.

• Skin checks

  • can’t feel pressure or pain in areas below the injury, so sores can form easily.

• Use a transfer board or sliding techniques

  • they have no core control

Stroke (CVA) Intervention

• Dressing: One-handed technique, AE (reacher, sock aid), seated for safety

• Grooming: Mirror on affected side, encourage bilateral use if possible

• Feeding: Built-up utensils, plate guard, non-slip mat

• Mobility: Sit-to-stand with walker, transfer training

• Perception: Scanning tasks for neglect (sorting cards, placing pegs)

• Cognition: Visual schedule, simple commands, sequencing cards

THR Interventions

• Dressing: LB dressing with AE (reacher, sock aid, dressing stick)

• Toileting: Raised toilet seat, grab bars

• Transfers: Sit-to-stand with walker; cue precautions

• Grooming: Seated at sink with items in reach

1. Seated Lower Body Dressing with Hip Kit

   • Description: Utilize tools like reachers and dressing sticks to assist with dressing while maintaining hip precautions.

   • Clinical Reasoning: Enables safe dressing without violating movement restrictions, promoting autonomy.​

2. Toileting with Raised Toilet Seat

   • Description: Install elevated toilet seats to prevent excessive hip flexion during transfers.

   • Clinical Reasoning: Facilitates safe toileting practices, reducing the risk of dislocation.​

3. Functional Mobility Training

   • Description: Practice safe techniques for bed mobility and transfers using assistive devices.

   • Clinical Reasoning: Enhances mobility and confidence while adhering to hip precautions.​Verywell Health

Spinal Fusion Intervetions

• Bed Mobility: Log roll training

• Dressing: Long-handled equipment to avoid bending

• Transfers: Slide board or max A depending on level

• Laundry: Use reacher to get clothes from basket

1. Log-Rolling Training for Bed Mobility

   • Description: Teach and practice log-rolling techniques to maintain spinal alignment during bed mobility.

   • Clinical Reasoning: Prevents undue stress on the surgical site, promoting healing and safety.​Sydney Local Health District+1Brigham and Women's Hospital+1

2. Use of Long-Handled Equipment for ADLs

   • Description: Incorporate tools like reachers and long-handled sponges to minimize bending during daily tasks.

   • Clinical Reasoning: Facilitates independence in self-care while adhering to movement restrictions.​

3. Education on Proper Body Mechanics

   • Description: Instruct on techniques like the golfer's lift for safe object retrieval.

   • Clinical Reasoning: Promotes safe engagement in daily activities, reducing the risk of re-injury.​Saint Luke's Health System Kansas City

Distal Radius Fracture Interventions

• Grooming: Adaptive handles, sponge gloves

• Dressing: Use unaffected arm for pull-over clothes

• ROM: AROM exercises per MD order

• Home management: Cooking with jar openers, lightweight pans

Shoulder Surgery Interventions

• Feeding: Use non-affected arm

• Dressing: Overhead movements avoided early on

• HEP: Pendulum exercises, PROM as prescribed

• Transfers: Stand-pivot or step with walker if needed

• Hand, Wrist, and Elbow Active Range of Motion (AROM) Exercises

  • Description: Engage in movements of the distal joints while keeping the shoulder immobilized.

  • Clinical Reasoning: Maintains mobility and circulation in the unaffected joints without compromising shoulder healing.​

• Scapular Mobility Exercises

  • Description: Perform gentle scapular movements within a pain-free range.

  • Clinical Reasoning: Supports shoulder girdle function and prevents stiffness, aiding in overall shoulder rehabilitation.​

• Adaptive Self-Care Techniques

  • Description: Use of long-handled tools for grooming and dressing to minimize shoulder movement.

  • Clinical Reasoning: Promotes independence in activities of daily living while adhering to movement restrictions.

Total Knee Replacement (TKA) Interventions

• Dressing: Seated LB dressing with reacher/sock aid

• Toileting: Raised toilet seat; manage clothing from seated position

• Transfers: Sit-to-stand with walker, cue for knee alignment

• Grooming: Standing or seated at sink; rest breaks for fatigue

• ROM: AROM for knee extension/flexion with towel slides

• Home Management: Seated kitchen tasks, walker basket for carrying

1. Seated Lower Body Dressing with Adaptive Equipment

   • Description: Use of long-handled reachers and sock aids to assist with dressing while seated.

   • Clinical Reasoning: Facilitates independence in dressing without requiring knee flexion beyond comfort, adhering to movement precautions.​

2. Functional Transfer Training

   • Description: Practice safe techniques for moving from sitting to standing using armrests and assistive devices.

   • Clinical Reasoning: Enhances mobility while preventing undue stress on the knee joint during transitions.​Healthline

3. Energy Conservation Education

   • Description: Teach pacing strategies and the importance of rest breaks during activities.

   • Clinical Reasoning: Helps manage fatigue and reduces the risk of overexertion, promoting safe participation in daily tasks.

Shoulder Subluxation (Post-Stroke) Interventions

• Dressing: Assisted dressing with support to prevent traction

• Toileting: Sit-to-stand with caregiver cueing; AE for safety

• Transfers: Watch for leaning/pushing on weak arm

• Grooming: Table-top grooming with mirror and AE; support involved arm

• ROM: Supported scapular mobilization and PROM (no overhead reach)

• Home Management: Light sorting/folding tasks on table with affected UE support

Humerus Fracture (non-dominant) Interventions

• Dressing: Over-the-head or one-arm dressing with dominant arm

• Toileting: AE for hygiene; reacher for clothing

• Transfers: Usually unaffected, but monitor for guarding

• Grooming: One-handed tasks or setup assistance

• ROM: AROM as cleared by physician

• Home Management: One-handed meal prep or folding laundry seated

Osteoarthritis Interventions

• Dressing: Joint protection techniques, AE (button hook, shoehorn)

• Toileting: Use of grab bars; padded toilet seat for comfort

• Transfers: Pacing strategies, avoid twisting joints

• Grooming: Built-up handles for easier grip

• ROM: Gentle morning AROM/stretching

• Home Management: Use of rolling carts, reachers, and ergonomic tools

AE/DME Cheat Cheat

• Reacher → For retrieving items, dressing

• Sock aid → Donning socks w/o bending

• Dressing stick → Pushing/pulling clothing

• Long-handled sponge → Bathing lower body

• Leg lifter → For bed mobility

• Shower chair → Sitting support during bathing

• Grab bars → Bathroom safety

• Walker → Gait and safety post-surgery

• Bedside commode → Used near bed if toilet access is hard

• Gait belt → Used for safe transfers

• Wedge cushion → Post-THR to prevent adduction

• Universal cuff → Grasping tools/utensils with weak grip

• Plate guard → Prevents food from spilling during feeding

Grading Strategies (Up/Down)

Grading Up (More Challenging)

• Increase # of steps or complexity

• Reduce cues/prompts

• Remove AE

• Add time or balance demands

• Use real-life materials

• Add dual-task elements (e.g., talking while dressing)

Grading Down (Easier)

• Break task into smaller steps

• Use AE/DME

• Provide hand-over-hand assistance

• Use visual or verbal cues

• Modify the environment (seated vs. standing)

• Reduce distractions

• Pre-set materials

Tabletop Ball Roll

Pt. places both hands on a lightweight ball (like a therapy ball or small inflatable) resting on a table in front of them. While seated, pt. gently rolls the ball forward and back, or side to side.

• Promotes gentle shoulder and scapular mobility

• Encourages bilateral UE movement without lifting or pulling

• Stays below 90° shoulder flexion—safe for sternal or shoulder precautions

• Helps with the functional range of motion needed for tasks like reaching for clothing or grooming items

• Controlled motion avoids pain or overexertion

• Gives the therapist an easy way to monitor fatigue and posture
  
  🔻 Grade down: Use a towel instead of a ball for smoother, easier motion

  🔺 Grade up: Increase the number of repetitions or add small directional changes (diagonal or circular)

AD use:

• Use a non-slip mat under the ball or towel to increase control and safety
  

Reach and Retrieve Task

Place soft, lightweight items (socks, towels, foam objects) in front of the client on a table—within arm’s length and below shoulder height. The client reaches one arm at a time to retrieve each item and bring it to the midline or a central basket.

• Simulates gathering clothes or grooming supplies, like when dressing or preparing for a shower

• Trains functional reaching while reinforcing safe range and posture

• Encourages pacing and energy conservation (client can rest between reaches)

• Avoids pushing, pulling, twisting, or crossing midline—precaution-safe

Clinical Application:

This task supports sequencing, upper body movement, and visual scanning while directly reinforcing the steps needed for real ADLs like dressing or organizing clothing.

🔻 Grade down: Place items closer to midline and reduce number of objects

🔺 Grade up: Slightly increase reaching distance (still within safe ROM) or add a simple sorting task after retrieval (e.g., match socks)

Simulated toilet hygiene

• Using a raised toilet seat and a long-handled toilet paper aid. Seated with upright posture and instructed in how to use the tool to simulate wiping, avoiding bending or twisting. The therapist observes and provides cueing.

Diagnosis + Precautions:

• L2-L5 lumbar fusion, no bending, lifting, twisting (BLT). Encourage neutral spine and log rolling. Or can be fit for sternal precautions as well.

Grading/Modification:

• Grade Down: Practice wiping motion only.

• Grade Up: Add full sequence, including toilet paper setup/disposal.

AE/DME Use:

• Raised toilet seat.

• Long-handled toilet hygiene tool.

Patient Education + HEP:

• Review/post spinal precautions near toilet.

• Practice simulated hygiene technique 1–2x/day with cues.

Safety + Professionalism:

• Maintain spinal alignment during all tasks.

• Provide education in calm, supportive tone.

• Respect privacy and encourage pacing.

Modified Grooming Practice Seated at Sink:

• Practice seated grooming with adaptive equipment (long-handled brush or electric razor). Provide frequent rest breaks and allow clients to alternate arms for pacing.

Grading/Modification:

• Grade Down: Reduce repetitions; perform grooming with more rest and additional verbal cueing.

• Grade Up: Add more challenging reach angles within safe limits, increase grooming item use (combing, face washing), and decrease rest breaks.

AE/DME Use:

• Long-handled grooming tools

• Electric razor or adaptive brush

• Padded loops or towel rolls for grip support

Patient Education + HEP:

• Educate on joint protection techniques (avoiding tight grips, using large joints when possible)

• Encourage use of moist heat before sessions (if cleared) to reduce stiffness

• Recommend gentle shoulder mobility exercises within pain-free range 1–2x/day

Safety + Professionalism:

• Observe for pain signs and joint strain

• Encourage slow movements and frequent check-ins

• Provide supportive feedback to boost confidence with self-care routines

Simulated Seated Lower Body Dressing using TheraBand

Practice threading a TheraBand over the feet and pulling it toward the knees while seated. Use hands directly if possible (bending forward is permitted in the anterior hip approach) while keeping legs in a neutral, shoulder-width position.

• The TheraBand mimics the waistband of pants. After practice, the activity can progress to real pants to simulate full dressing.

• Therapist consistently repeats precautions throughout the session due to his memory issues.

Precautions:

If there is cognitive impairment, there is an increased risk of forgetting precautions; therefore, verbal cueing must be consistent and clear.

Grade Down:

• Use adaptive equipment like a dressing stick or sock aid.

• Provide hand-over-hand guidance for the motion.

  Grade Up:

• Replace TheraBand with real pants

• Allow the client to initiate more steps independently while the therapist observes

• Slight reduction in verbal cueing near the end of the session if safe

AE/DME Use:

• Dressing stick (optional)

• Front-wheeled walker for the standing portion

• Chair with armrests for seated safety during dressing

Patient Education + HEP:

• Provide a printed list of anterior hip precautions with visuals

• Encourage supervised dressing practice at home with spouse or caregiver nearby

• Reinforce verbal repetition of precautions before each dressing attempt

• Recommend HEP of seated dressing 1x/day with supervision, using a mirror or checklist

  Safety + Professionalism:

• Maintain neutral leg positioning throughout (no crossing midline)

• Monitor closely during the stand phase for balance and alignment

• Use calm, supportive cueing; verify understanding through teach-back (“What do we avoid again before standing?”)

• Be alert to signs of fatigue or unsafe movements due to memory lapses

Mirror-Guided Seated Dressing Practice

• Use a floor mirror positioned to the side so pt. can visually monitor their lower body positioning while donning pants. While seated pt. is instructed to keep knees neutral (shoulder-width apart) and avoid hip extension beyond 45° (anterior) or hip flexion moe than 90* (posterior) while pulling fabric over each leg. Therapist uses frequent cueing and teaches pt. to look in the mirror and self-check posture and precautions.

Rationale: Reinforces visual learning for a client with mild cognitive impairment and builds awareness of body alignment during dressing.

Grading:

• Grade Down: Provide hand-over-hand guidance and break the task into single steps with cueing.

• Grade Up: Ask Elias to independently verbalize his precautions and identify if he is following them using the mirror.

AE/DME Use:

• Mirror

• Reacher or dressing stick (optional if shoulder mobility is limited)

• Front-wheeled walker for safety when standing

Education:

• Encourage pt. to use a mirror or a checklist at home when dressing

• Provide written anterior hip precautions, emphasizing "no hip extension past 45°"

Safety:

• Therapist monitors posture and ensures the mirror setup is stable and safe

• Provide verbal feedback and stop task if pt. forgets a precaution

Footwear Organization & Sequencing Task

• Provide pt. with a set of labeled shoes (slippers, walking shoes, sandals). Ask him to organize them by activity (“What shoes would you wear after therapy?”) and simulate donning each using a long-handled shoehorn. Pt. remains seated and is encouraged to monitor knee positioning during the activity.

Rationale: Promotes flexibility, dressing readiness, sequencing, and safe reach without excessive knee flexion.

Grading:

• Grade Down: Practice with one shoe type at a time with full setup support.

• Grade Up: Ask pt/ to retrieve shoes from under a bench (within reach), simulate donning, and explain the reasoning behind each choice.

AE/DME Use:

• Long-handled shoehorn

• Shoe-removal aid, if available

Education:

• Reinforce proper seated posture and leg alignment

• Discuss shoe choice for safety, gai,t and joint support

Safety:

• Ensure items are within safe reach

• Monitor for signs of pain or overuse during repetition

Seated Arm Raises (Up to 90°)

This is a low-impact movement that focuses on controlled arm raises to shoulder height, which is safe within sternal precautions. The goal is to maintain gentle shoulder mobility and prevent stiffness, but with a controlled range of motion that avoids exceeding the 90° limit for shoulder flexion.

• Grading/Modification:

  • Grade up: Add resistance bands to the movement for more strength-building once shoulder flexibility improves.

  • Grade down: Reduce the number of repetitions or use the opposite arm for support to maintain posture and prevent straining.

• AE/DME Use (if applicable):

  • Optional: Resistance bands for added challenge (if appropriate).

• Patient Education + HEP:

  • Patient Education: Instruct the patient to perform the arm raises slowly and to stop if they feel any pulling or discomfort in their chest or shoulders. Make sure they are only raising their arms to shoulder height.

  • HEP:

    • Frequency: 3-4 times a week

    • Sets/Reps: 2-3 sets of 10 reps per arm

    • Instructions: Perform seated, raising the arms gently to shoulder height without bending the elbows. Avoid any twisting or leaning during the movement.

Seated Shoulder Flexion and Extension (Using a Stick)

Using a stick (e.g., a cane or broomstick) helps the patient maintain a safe range of shoulder motion without exceeding the 90° threshold. By gently pushing the stick forward (flexion) and backward (extension) in front of the body, the patient can engage in controlled, low-impact movement that improves shoulder range of motion while preventing any strain on the sternum.

• Grading/Modification:

  • Grade up: Increase the range of motion (moving stick further) or increase repetitions.

  • Grade down: Limit movement to small, gentle flexions and extensions or reduce the amount of time spent on the exercise.

• AE/DME Use (if applicable):

  • Use a cane or broomstick for the exercise.

• Patient Education + HEP:

  • Patient Education: Instruct the patient to keep the shoulders relaxed and avoid lifting the arms overhead. Emphasize controlled and slow movements, ensuring the back remains straight and stable.

  • HEP:

    • Frequency: 3-5 times per week

    • Sets/Reps: 2 sets of 10-12 repetitions, holding each position for 3-5 seconds.

    • Instructions: Sitting upright, gently raise the stick in front to shoulder height (flexion) and extend it back behind, ensuring no shoulder movement exceeds 90°.

Wall Push-Ups (Modified)

• Clinical Reasoning:
  Wall push-ups can help strengthen the arms, shoulders, and chest muscles without putting excessive strain on the sternum. By performing the push-ups at the wall, the patient can control the depth of the movement and prevent excessive pressure on the chest. This allows for functional strength-building while adhering to sternal precautions.

• Grading/Modification:

  • Grade up: Increase the number of repetitions, or lower the body slightly closer to the wall to increase the intensity.

  • Grade down: Perform the wall push-ups at a higher angle to reduce strain.

• AE/DME Use (if applicable):

  • No AE/DME required. Performed against a wall.

• Patient Education + HEP:

  • Patient Education: Teach the patient to maintain a neutral spine, avoid twisting, and control the depth of the push-up. Instruct them not to lean forward into the movement but to keep the chest at a safe distance from the wall.

  • HEP:

    • Frequency: 3-4 times per week

    • Sets/Reps: Start with 2 sets of 5-8 reps and increase as tolerated.

    • Instructions: Stand at arm's length from the wall, placing palms on the wall. Lower the body toward the wall, keeping elbows close to the sides, and then push back up slowly.

Seated Hip Abduction (with or without resistance)

• Hip abduction helps strengthen the hip abductors (gluteus medius, minimus) and promotes the stability of the hip joint while staying within the prescribed range of motion. This exercise can be performed with or without resistance bands to match the patient’s current abilities.

• Grading/Modification:

  • Grade up: Increase the range of motion or use a resistance band to increase the difficulty.

  • Grade down: Perform without resistance or limit the range of motion to avoid straining the hip.

• AE/DME Use:

  • Use a resistance band for added challenge, if appropriate.

• Patient Education + HEP:

  • Patient Education: Ensure the patient avoids crossing the legs or rotating the hip during the exercise.

  • HEP:

    • Frequency: 2-3 times per week

    • Sets/Reps: 2-3 sets of 10-12 reps

    • Instructions: Sit upright with legs straight, slowly move one leg outward to the side and back in, keeping the foot flat on the floor.

Heel and Toe Raises

• Heel and toe raises help strengthen the gastrocnemius and soleus muscles, which support knee stability. These exercises help improve overall lower leg strength and mobility after knee replacement surgery.

• Grading/Modification:

  • Grade up: Perform the exercise standing or increase repetitions for added difficulty.

  • Grade down: Perform seated with assistance to help with balance and support.

• AE/DME Use:

  • No AE/DME required unless balance is a concern (e.g., use a walker for support).

• Patient Education + HEP:

  • Patient Education: Encourage slow, controlled movements to engage the muscles safely.

  • HEP:

    • Frequency: 3-4 times per week

    • Sets/Reps: 2-3 sets of 10-15 reps

    • Instructions: Stand or sit with feet flat. Slowly lift heels to stand on toes, then lower. Repeat for a set of 10-15 reps.

Functional Mobility Training: Sit-to-Stand with Support

Sit-to-stand transitions are essential for improving functional mobility post-TKA. Using a raised chair or firm support helps the patient perform this task with minimal strain on the knee. It’s a great way to promote independence and encourage safe movement patterns.

• Grading/Modification:

  • Grade up: Increase the standing time or add weight-bearing progression to build strength.

  • Grade down: Use a higher chair or assist the patient by guiding their movements.

• AE/DME Use:

  • Raised chair, walking aids (if needed for balance), or grab bars for additional support.

• Patient Education + HEP:

  • Patient Education: Instruct the patient to use the arms for support, ensuring they don’t overuse the knee joint for standing.

  • HEP:

    • Frequency: 3-4 times per day

    • Sets/Reps: 2-3 sets of 10-15 sit-to-stand repetitions

    • Instructions: Sit upright, and then push from the armrests or legs to rise slowly, ensuring proper knee alignment and no twisting.

Hip Precautions (Posterior and Anterior Approaches) 1. Adaptive Bathing Techniques

Bathing can be difficult post-hip replacement, especially with posterior hip precautions that restrict hip flexion and rotation. Long-handled sponges or bath brushes help the patient wash without bending or twisting the hip joint. Using a bath bench or shower chair allows for safe sitting during the activity.

• Grading/Modification:

  • Grade up: Increase the time the patient spends standing or transferring with minimal support.

  • Grade down: Perform the activity with a fully supportive chair or tub bench.

• AE/DME Use:

  • Bath bench, long-handled sponge, grab bars, or shower chair.

• Patient Education + HEP:

  • Patient Education: Explain the importance of not bending the hip past the prescribed limit and how to use adaptive equipment for safer bathing.

  • HEP:

    • Frequency: Daily

    • Sets/Reps: 1-2 bath sessions per day

    • Instructions: Use long-handled sponges and a tub bench for seated bathing. Avoid crossing the legs or reaching beyond 90° flexion for posterior precautions.

Functional Transfer Training (From Bed to Chair)

This intervention focuses on improving the patient’s ability to safely transfer from a sitting to standing position (or vice versa) while respecting the hip precautions. For posterior hip precautions, emphasis is placed on avoiding excessive flexion and rotation of the hip during transfers.

• Grading/Modification:

  • Grade up: Perform the transfer with less assistance or from a lower chair.

  • Grade down: Provide more assistance, and use a higher chair for initial practice.

• AE/DME Use:

  • Transfer boards, raised chairs, or grab bars for additional support.

• Patient Education + HEP:

  • Patient Education: Teach the patient to avoid excessive bending or twisting while standing and sitting, and to keep the operated leg aligned.

  • HEP:

    • Frequency: Daily

    • Sets/Reps: 3-5 transfers per day

    • Instructions: Ensure the patient keeps the operated leg forward when standing and that they don’t twist during transfers.

Standing Knee Flexion with Assistance

Standing knee flexion exercises help to regain knee mobility and prevent stiffness, which is common post-surgery. Using a therapist-assisted approach helps ensure that the knee flexion does not exceed the prescribed limit, while the patient gradually regains strength.

• Grading/Modification:

  • Grade up: Increase the amount of knee flexion as tolerated, or use a resistance band to assist with the movement.

  • Grade down: Perform the flexion in a seated position if standing is too challenging.

• AE/DME Use:

  • Therapist assistance, resistance bands (optional).

• Patient Education + HEP:

  • Patient Education: Emphasize proper posture while standing and ensuring the knee does not bend too much. Avoid overexertion.

  • HEP:

    • Frequency: 3-4 times per week

    • Sets/Reps: 2-3 sets of 10-15 reps

    • Instructions: Stand tall with support if needed and gently bend the knee back (without pushing beyond safe limits). Perform 10-15 repetitions.

Hip Precautions (Posterior and Anterior Approaches) Adaptive Toilet Transfers

For patients recovering from hip replacement surgery, especially with posterior hip precautions, toilet transfers need to be modified to prevent hip flexion greater than 90° and hip adduction. Using a raised toilet seat and practicing the transfer with controlled movements can improve safety and independence.

• Grading/Modification:

  • Grade up: Gradually decrease the use of a raised toilet seat and perform transfers independently.

  • Grade down: Increase support by using a transfer board or additional caregiver assistance.

• AE/DME Use:

  • Raised toilet seat, transfer board, grab bars.

• Patient Education + HEP:

  • Patient Education: Emphasize keeping the knees apart during transfers and not leaning forward past 90°.

  • HEP:

    • Frequency: 3-4 times per day

    • Sets/Reps: 5-10 transfers per day

    • Instructions: Use the transfer board for safe entry and exit from the toilet, maintaining proper posture.

Back Precautions Log Rolling for Bed Mobility

Log rolling is essential for patients with back precautions, as it allows the patient to get in and out of bed without twisting or straining the spine. This intervention promotes safe mobility while maintaining spinal alignment.

• Grading/Modification:

  • Grade up: Gradually increase the frequency and duration of bed mobility activities.

  • Grade down: Use additional assistance or a higher bed to make the movement easier initially.

• AE/DME Use:

  • None required, although a bed rail or grab bar can assist with rolling.

• Patient Education + HEP:

  • Patient Education: Instruct the patient to avoid twisting and to move their entire body together when rolling.

  • HEP:

    • Frequency: 2-3 times per day

    • Sets/Reps: 5-10 log rolls per day

    • Instructions: Lie on your back, then slowly roll over by moving your body together, using your arms and legs to help.

Standing Heel-to-Toe Walking

Strengthens the lower back and promotes good posture. It helps improve balance and functional mobility while encouraging proper walking mechanics without bending or twisting the back.

• Grading/Modification:

  • Grade up: Increase the walking duration or incorporate it into functional tasks (e.g., walking to the bathroom).

  • Grade down: Shorten the walking distance and provide balance assistance.

• AE/DME Use:

  • Walking aids (e.g., cane or walker) for balance.

• Patient Education + HEP:

  • Patient Education: Encourage the patient to keep the spine neutral and take slow, controlled steps.

  • HEP:

    • Frequency: 2-3 times per day

    • Sets/Reps: 5-10 minutes per session

    • Instructions: Walk in a straight line, placing the heel of one foot directly in front of the toes of the other foot (heel-to-toe).

Functional Task Training: Adaptive Grocery Bagging

This intervention focuses on functional tasks such as grocery bagging or packing that are common household activities. By adapting the process to minimize bending, lifting, or twisting, the patient can continue participating in meaningful activities while adhering to back precautions. This activity helps improve both motor and cognitive skills while encouraging self-sufficiency.

• Grading/Modification:

  • Grade up: Gradually increase the complexity of tasks (e.g., using heavier bags or adding more items).

  • Grade down: Start with lighter, pre-arranged bags or assist the patient in the task as needed.

• AE/DME Use:

  • Reacher, long-handled tongs, or bag hook for lifting and placing items in bags without bending or twisting.

• Patient Education + HEP:

  • Patient Education: Educate the patient on energy conservation techniques and how to keep the spine neutral during functional tasks like grocery bagging.

  • HEP:

    • Frequency: As needed, during regular grocery shopping

    • Sets/Reps: 1-2 sessions per day, based on energy levels and tolerance

    • Instructions: Sit or stand at a comfortable height while using a long-handled reacher or bag hook to place items in a grocery bag. Keep the spine straight and avoid bending forward. Encourage the use of adaptive equipment to prevent strain on the back.