OT TREATMENT SEGMENTS

The treatment segments include:

1. Patient Self-Management

2. Reach/Grasp Related Tasks/Activities (HIRT)

3. UE Open and Closed Chain (HIRT)

4. LE Open and Closed Chain (HIRT)

5. Mobility Related Tasks/Activities

6. Gait Speed Training

7. Dynamic Standing Balance

8. Other Preparatory Tasks

9. Teaching/Training Skills, Habits, and Behaviors

10. Medication Management Routine

11. Adaptive/Compensatory Strategies

12. Prevention & Maintenance Strategies

Patient Self-Management Parameters

Duration:

• 10–30 minutes combined

Patient:

• Selects goal at beginning

• Links effort to goals throughout

• Uses one tool appropriately

• Rates participation at end

Purpose:

• Engage patient in directing care

• Reflect on behavior associated with activation

Why is Patient Self-Management Important?

Promotes:

• Active engagement

• Self-reflection

• Ownership of goals

• Carryover outside therapy

• Increased motivation and activation

Mobility Related Tasks Parameters

• Performed in moderate/vigorous HR training zone

• Goal: build to 15 minutes

• Targets functional mobility in real-world contexts

Purpose:
Resistance or activity training of the LE in the context of a task or activity.

Mobility Tasks May Target Which Physiologic System?

Mobility tasks may target:

• Heart rate training

• Cardiovascular endurance

• Functional mobility

• LE function

Document note:
Tasks may use lower loads with a target of heart rate rather than biomechanical failure.

Mobility Related Task Examples

• Rolling with weighted vest/limbs

• Sit-to/from supine with weighted vest/limbs

• Scooting with weighted vest/limbs

• Surface-to-surface transfers with weighted vest/limbs

• Unilateral/bilateral carrying weighted objects

• Reach or lunge to floor with weighted objects

• Push weighted cart

• Floor-to-stand transfers with weighted trunk if needed

Dynamic Standing Balance Parameters

Back:

• Intensity: RPE 15–17

• Duration: 10–15 minutes

Purpose:
Balance training using tasks sufficiently challenging to produce errors or loss of balance.

Why are bilateral UE support tasks often insufficient?

The document notes:

Most tasks allowing bilateral UE support do not:

• Encourage protective balance responses

• Provide sufficient challenge

Dynamic Standing Balance Activities

Recommended tasks:

• Step-up

• Step-over

• Stair climbing with reduced UE support

• Surface changes

• Changing direction while maintaining speed

• Head turning

• Secondary cognitive task

• Sustained speed with turns

• Gait training with least restrictive device

Teaching/Training Areas

Training to establish or restore skills in:

• Self-care

• Self-management

• Home management

• Community or work integration

• ADL training

• IADL training

• Low vision training

• Functional cognitive training

Purpose of Teaching/Training

• Functional independence

• Participation

• Habit formation

• Daily routines

• Cognitive performance

Medication Management

Training to establish or restore patient's abilities with managing medications independently.

May include:

• Medication education

• Family/caregiver education

• Use of tools/reminders

Improve:

• Medication adherence

• Safety

• Independence

• Understanding of medication purpose

• Understanding of side effects

ADAPTIVE/COMPENSATORY STRATEGIES

Includes strategies to improve functional independence by compensating for impairments impacting function.

May include:

• Adaptive devices

• Equipment

• Environmental modifications

Activities are:

• Individually tailored

• Often delivered at light or very light intensity

• Designed to encourage skill acquisition

Adaptive/Compensatory Strategies May Be:

• Short-term strategies

• Long-term strategies

Some patients use these briefly, while others use them permanently.

PREVENTION & MAINTENANCE STRATEGIES

Required to:

• Maintain joint mobility

• Support function

• Prevent decline

• Manage pain

• Promote stability of chronic conditions

• Support independence with activity and participation

Prevention & Maintenance Examples

May include:

• ROM

• Positioning

• Positioning devices

• Bed positioning

• Wheelchair management

• Time management

• Symptom management

• Disease self-management

• Respiratory health

• Caregiver training

• Other disability prevention measures

• Other health promotion measures