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Monday, May 23

  1. page TE edited TE {photo.JPG} TE Physical Therapy Plan: Tanner is seen 30 minutes twice per week for direc…

    TE{photo.JPG} TE
    Physical Therapy Plan: Tanner is seen 30 minutes twice per week for direct intervention at Delbrook Preschool with 15 minutes 4 times per month Support to Program Personnel.
    Physical Therapy Goal: In individual and group settings, Tanner will demonstrate improvement in functional mobility by 1) moving sit to stand without support, 2) independently walk 20 feet using a forward facing rolling walker following a straight path, 3) independently cruise along furniture in his preschool classroom, 4) independently move floor to sit on a chair, 5) independently move floor to stand at a walker by moving through a ½ kneel.
    (view changes)
    9:12 pm
  2. file photo.JPG uploaded
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  5. page TE edited ... Therapy ball sit and bounce with therapist providing minimal joint compression through knees t…
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    Therapy ball sit and bounce with therapist providing minimal joint compression through knees to maintain foot contact to floor and use of feet to stabilize body while sitting on the ball. Tanner bounce on the ball working for motivator of a small ball to throw.
    Attempted bouncing on the trampoline and it was difficult for Tanner to grade small amplitude movements at the knee, he used large movements with a delay in switching direction to create a bounce. He was unable to do this motion while standing on the floor
    ...
    Transition Movements:
    Sit to stand from Turt-L-shell with assist ½ way through the motion. Tanner is spontaneously using a forward lean then transfer to weight bearing push to stand with improved balance.
    Scooting backward up a step, then lower back to the floor
    ...
    1/2 kneel to stand at walker
    Bear stance: hands and feet flat on floor, short distance with intermittent prompts and cues to look
    {TESittoStandFall15.wlmp}
    {TE Sit to Stand Spring16.wlmp}
    {TE Step to floor.wlmp}
    {TE Tall Kneel.wlmp}
    {TEBearWalking.wlmp}

    Standing balance:
    Standing at support for play without trunk in contact with support surface (maintaining his trunk a few inches from the support surface)
    ...
    {TEGaitSpring16.wlmp}
    {TE RearFacing Walker Spring16.wlmp}
    {TE Cruising.wlmp}
    Wheelchair mobility: Tanner tends to use both arms simultaneously. With prompts, Tanner can use 1 arm independently, but this takes a slight delay in processing.
    Suggestions for working on wheelchair mobility at home:
    (view changes)
    9:00 pm
  6. page TE edited ... Physical Therapy Goal: In individual and group settings, Tanner will demonstrate improvement i…
    ...
    Physical Therapy Goal: In individual and group settings, Tanner will demonstrate improvement in functional mobility by 1) moving sit to stand without support, 2) independently walk 20 feet using a forward facing rolling walker following a straight path, 3) independently cruise along furniture in his preschool classroom, 4) independently move floor to sit on a chair, 5) independently move floor to stand at a walker by moving through a ½ kneel.
    The following descriptions with pictures and videos depict activities Tanner is working on in his Physical Therapy sessions:
    Tall kneeling: able to achieve with wider base, therapist facilitated a narrow base, once achieved, maintained for a couple seconds, but unable to maintain postural control in this position when throwing a ball.
    ½ kneeling: needed assistance to achieve and maintain positioning. Used one arm to a chair and minimal therapist assistance to lead leg and trunk.
    Bear walking: a few steps (short distance)
    Therapy ball sit and bounce (able to initiate bounce and maintain postural control with feet fixed and therapist support at his knees): working on mid-range knee strength and control as well as trunk control.
    Cruising along furniture and taking a step with a reach to transfer between surfaces.
    Scooting backward up step, then lower back to the floor
    Floor to stand at walker
    1 hand to support with other hand throwing a ball to a target
    Wheelchair mobility: tends to use both arms simultaneously. With prompts, Tanner can use 1 arm independently it takes a slight delay in processing. Assessed foot position without calf strap: feet slid backward on the footplate so that the foot had less contact with the flootplate, contacting only at the toes. This limits Tanners ability to stabilize his feet on the footplate to assist with postural control and decrease energy expenditure.
    Suggestions for working on this skill at home:
    Open space self exploration of wheelchair movement. Just letting him have the opportunity of exploring the movement of the wheelchair without direction.
    Giving him large targets that motivate him (here it was a ball and the basketball hoop, outside), let him problem solve trying to move to the object, then provide prompts/assistance as needed so he can learn and be successful.
    He’s got the forward movement down! Uses both hands together with good strength and range of motion!
    Prompts to reach further forward on the wheel to give him more range for greater movement and better efficiency when going backward. A positive note: he has nice strength moving from the mid-wheel to behind the seat with his arms.
    Turning: prompts to keep one arm holding the wheel still while the other one turns by pushing forward.
    I wouldn’t worry about backward turns yet, just try to get the idea of how to use his arms each doing a different motion to achieve a forward turn.
    Transfers: floor to wheelchair with contact guarding and intermittent prompts to motor plan. He was able to mostly transfer the skill he learned from floor to chair to use with the wheelchair. Sit to stand from Turt-L-shell with minimal assist ½ way through the motion. Sit to stand from bench seat and from Turt-L-shell: Tanner is spontaneously using a forward lean then transfer to weight bearing push to stand with improved balance.
    Standing balance:
    Standing at support for play without trunk in contact with support surface (maintaining his trunk a few inches from the support surface)
    Side stepping along a support surface to the left and the right, prompts to keep trunk a few inches away from the support surface
    Transition from one surface to another 12” away by side stepping. Needs minimal physical prompts to the right and moderate physical prompt/minimal assist to the left.
    Stand and throw a bean bag to a target with one hand holding a support surface without trunk contact: able with the left arm throwing. Added a dynamic cushion under his left foot, Tanner was able to throw using the left arm with contact guard supervision. Throwing with the right arm to a target, Tanner required intermittent minimal assist for balance, but achieved 2/3 throws with only contact guard supervision. No dynamic cushion used under his right foot.

    Mid-range knee flexion motion:
    Therapy ball sit and bounce with therapist providing minimal joint compression through knees to maintain foot contact to floor and use of feet to stabilize body while sitting on the ball. Tanner bounce on the ball working for motivator of a small ball to throw.
    ...
    it was difficultydifficult for Tanner
    ...
    the floor
    Transfers and Transition Movements:
    Sit to stand from Turt-L-shell with assist ½ way through the motion. Tanner is spontaneously using a forward lean then transfer to weight bearing push to stand with improved balance.
    Scooting backward up a step, then lower back to the floor
    Tall kneeling: Tanner is able to achieve a tall kneel when using a wide base (knees apart). With the therapist facilitating a narrow base, Tanner is able to maintain for a couple of seconds, but is unable to maintain while throwing a ball.
    1/2 kneel to stand at walker

    Bear stance:
    ...
    on floor, attempted walkingshort distance with intermittent prompts and cues to look
    Standing balance:
    Standing at support for play without trunk in contact with support surface (maintaining his trunk a few inches from the support surface)
    Stand and throw a bean bag to a target with one hand holding a support surface without trunk contact: able with the left arm throwing.
    Gait Activities:
    Side stepping along a support surface to the left and the right, prompts to keep trunk a few inches away from the support surface
    Transition from one surface to another 12” away by side stepping.
    {TEGait10-15.wlmp}
    {TEGait Winter.wlmp}
    {TEGaitSpring16.wlmp}
    {TE RearFacing Walker Spring16.wlmp}
    Wheelchair mobility: Tanner tends to use both arms simultaneously. With prompts, Tanner can use 1 arm independently, but this takes a slight delay in processing.
    Suggestions for working on wheelchair mobility at home:
    Open space self exploration of wheelchair movement. Just letting him have the opportunity of exploring the movement of the wheelchair without adult direction.
    Giving him large targets that motivate him (i.e. ball, basketball hoop), let him problem solve trying to move to the object, then provide prompts/assistance as needed so he can learn and be successful.
    Prompts to reach further
    forward on handsthe wheel to give him more range for a larger movement and feetbetter efficiency when going backward. A positive note: he has nice strength moving from the mid-wheel to behind the seat with minimalhis arms.
    Turning: prompts
    to moderate therapist assist.keep one arm holding the wheel still while the other one turns by pushing forward.
    Exploration of turning wheelchair with only one hand, using an object held in his other hand to decrease his tendency to use both hands together.
    I wouldn’t worry about backward turns yet, just try to get the idea of how to use his arms each doing a different motion to achieve a forward turn.

    Ideas for activities at home:
    Limiting trunk contact with a support surface while standing and playing, and cruising.
    ...
    Bear stance and beginning to walk: builds trunk control, hip and leg strength, and arm strength, as well as coordination.
    Play in deep squat for a length of time to work on balance and strength in this position.
    Exploration of turning wheelchair with only one hand, using an object held in his other hand to decrease his tendency to use both hands together.
    (view changes)
    8:54 pm
  7. file TE Cruising.wlmp uploaded
    8:32 pm
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  10. file TEGait10-15.wlmp uploaded
    8:31 pm

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