STARES: 4th entry: intervention

Situation:
93 year old female adm 20/8/09 with L sided weakness post multiple R CVA’s. L UL has improved since adm to close to baseline fx, residual L LL weakness/AROM. Currently supported sitting, poor independent balance, non ambulant. Pt lives with daughter who cares for pt, needs to be able to t/f with min A to return home. Pt is non English speaking daughter translates.

Task:
Aim is to get pt to t/f independently/minimal A. short term goal is improve sitting balance to eventuate to standing balnce/amb/t/f practice. The task was sitting balance ex’s.

Action:
Sitting balance ex’s: improve sitting posture, static sitting balance, reaching out of BOS.
With sitting posture we introduced a mirror so the pt could self correct.
Reaching out of BOS: used cones for pt to reach for, plus reaching for therapist’s shoulders. As the pt has limited English all instructions were short, simple and concise and when possible had the daughter there to translate.

Result:
Through the past week of seeing this pt her sitting balance has improved greatly. She can now sit independently and now moving to improve her exercise tolerance and progress towards mid term goals.

Evaluation:
I think my actions were quite effective in reaching independent sitting balance. At first there were too many distractions in the room which made the pt a bit confused with what she was being asked. Once I realized this I removed most of the distractions and made sure one person was talking at a time, talked directly in the pt’s eye line and used simple hand gestures to show what I wanted her to do.

Strategies:
Removing all distractions possible
Used simple, clear instructions
Used non verbal forms of communication