Do Your Older Patients Jump 

Do you jump with your older adults? Even those in their 80’s and 90’s?

If not, why not??

Do not be nervous to challenge your older adults. Not only is jumping safe for them but it’s very beneficial.

The Research

Jumping has been shown to increase muscle strength and balance more than regular exercise alone!

Here is the link for the article supporting jumping in the elderly: https://www.jstage.jst.go.jp/article/jpts/24/12/24_1345/_pdf

How to Progress

To start off I have my patients hold on to the parallel bars with 2 hands, then 1 hand and then some do it unsupported.

And your patients may at first be hesitant but once they do it they feel proud and accomplished which also helps with compliance!

Do you know other therapists that could use more ideas for patient-centered treatment? Make sure to share this post and follow us and tag them on Instagram www.instagram.com/thenoteninjas

And if you haven't yet, make sure to...

How to Treat Decreased Step Length

Many of my patients present with decreased step length.

I frequently use verbal and visual cues to increase it but after a few steps many of my patients forget that cue and go back to a smaller step length.

So a different technique to use is a theraband around the legs of a rollator.

You would tie the theraband around the rollator and then cue the patient to try to touch their shin to the theraband.

By using the theraband you are helping them increase their step length with extrinsic feedback and it carries over for more than just a few steps!

Full disclosure...I just found this treatment idea in a Facebook group and loved it and have used it with success!!! I totally forget where I found this idea from (I’m so sorry because I would love to give you credit.) 

Also if you have other creative ideas send us an email about them so we can try it and then tag you in the Instagram post!!

Do you know other therapists that could use more ideas...

Wii and Patient Engagement

One of my favorite balance activities to do with my higher level, more advanced patients is the Wii.  Using the Wii provides opportunity to challenge your patient while still having fun. You can even have patients who are wheelchair bound play the Wii to improve coordination, UB strengthening, dynamic sitting balance, etc.

Wii Games for Therapy

My personal favorite games are Wii bowling, tennis and baseball. If you have the Wii balance board, you can have your patient practice stepping balance, yoga and various components of dynamic standing balance.

 Wii Progression

To challenge your presents, here are some ideas:

• decrease UE support
• position them on balance pad (if you do not have a balance board)
• use non dominant hand
• add ankle or wrist weights
• increase time to improve endurance
• upgrade sitting to standing

 What you Need

•  Wii Console
•  Wii Sports
•  Wii U Fit Balance Board
•  Wii Fit Plus

Do you know other therapists...

Use Action Words

When thinking about documenting skilled care it always helps me to include an action word.

This makes me really analyze why I did something.

Words to Include

Some words that are great to use and show skilled care are:

• Progressed
• Modified
• Assessed
• Challenged
• Facilitated
• Monitored
• Updated
• Instructed
• Stabilized

All of those words help strengthen your documentation to showed skilled care!

So next time you write a note ask yourself how you can incorporate one of these words and you will see how much easier it is to show your skill!

And for a more comprehensive list of words as well as more skilled documentation tips click HERE!

Do you know other therapists that could use more ideas for patient-centered treatment? Make sure to share this post and follow us and tag them on Instagram www.instagram.com/thenoteninjas

To view our clinical favorites that you can purchase on Amazon, CLICK HERE

TUG Test

We often use the Timed up and Go (TUG) test as a functional outcome measure with our patients.  We use this activity also during our treatment sessions in order to improve speed and balance with turning and transfers.  

If your patient can perform the TUG within the norms for their age group, you can challenge them by adding in a dual task.

Dual Tasking

A dual task is when you have your patient do two activities simultaneously.  The purpose of dual tasking is to assess the cognitive and executive function of a task while also assessing their falls risk and gait.  Dual tasking is especially useful for community-dwelling seniors as a prediction for falls. Using the TUG with dual task can be especially helpful in patients with neurological diseases such as Parkinson's disease, dementia, MS, and Stroke.

Technique

To facilitate a dual task, I will begin by assessing each activity as a single component. I will measure my patient performing a cognitive task...

Daily Treatment Notes

Let’s go back to the basics here.  Every time we work with a patient, we open a daily treatment note.  Whether you have been practicing as an OT or PT for several years or you are just getting started, it is important to review the basics of writing a daily treatment notes.

It’s easy to get in the habit of checking or clicking the same activities each session. However, this is not skilled and it is not best practice.

Show Your Skill

To support skilled care in your daily treatment note you need to document:

• assist level
• cues
• comments
• support your billing by showing there is an appropriate volume of interventions
• include time or set/reps of each activity to support billing

Dig Deeper

• connect your activity to your goals
• link education to a functional goal
• monitor vital signs
• record subjective comments
• keep your treatment client-centered

I hope you can all use this refresher to improve your documentation.  Let us know your...

Do You Use Tai Chi With Your Patients?

I recently began adding more Tai Chi to my patients treatment programs because once I started researching more I found so many great resources documenting the benefits.

Benefits of Tai Chi Are:

• Increases flexibility and muscle strength
• Improves balance
• Improves gait
• Improves posture
• Improves body awareness and proprioception
• Improves health and fitness
• Decreases stress
• Improves existing medical conditions
• Improves mental health

That's a lot of benefits!

And there are so many options of Tai Chi exercises to chose from you can always change up the exercises and your treatment sessions will remain skilled!

Do you know other therapists that could use more ideas for client-centered treatment? Make sure to share this post and follow us and tag them on Instagram www.instagram.com/thenoteninjas

And if you haven't yet, make sure to download our FREE PDF with skilled care documentation tips HERE!

To view our clinical favorites that you can...

Ambulation for Extended Periods of Time

A goal I have with almost every patient I treat is ambulation.

But this is not a quick and easy goal to accomplish with most of my patients.

Most have a lot of gait deviations as well as a lot of hindrances such as fear of falling and/or cognitive decline.

How to Justify

So how do I justify ambulation training for an extended period of time?

I focus on different parts of the activity on different days. I provide different levels of assist. I document different cues and exactly what I had to cue the patient on that day.

So for my patient today she had decreased step height.

So we did gait with verbal cues to increase step height and tactile cues at hip flexors to further increase height. I documented how she has a fear of falling (which is her hindrance and a reason for continued treatment.) And then what I did to address her fear which was fall prevention tips.

I then did a few activities focusing on step height such as stepping over a...

How to Improve Step Length and Lower Extremity Coordination

We are always looking for creative ways to improve step length and LE coordination while continuing to provide skilled care.  

I am working on improving this patient’s balance with emphasis on LE coordination. She has difficulty with executive functioning so using different colors to step towards and adding the step height incorporates dual tasking into the activity.

Technique

For this activity, I will call out a color for the patient to tap with LE, one side at a time. This activity can be modified to document skill and show progression. You can easily upgrade the activity by decreasing UE support or calling out both side and color simultaneously.  Ex. “Right blue, Left green, Left pink, Right green”

This is a good treatment technique for patients who have festinating gait or foot drop. It is also useful for implementing safety strategies for patients with impaired cognition.

Showing Your Skill...

Education Has to Be Documented Frequently and Needs to Be Skilled and Linked to a Functional Goal

One of the things I educate on a lot is strengthening, stretching and range of motion for a home exercise program.

I will educate my patient on safety such as where to perform the exercises and proper technique.

I will educate the caregiver on these same safety techniques to help with carryover and compliance.

What Test Are You Using

I  VERY rarely do manual muscle testing (MMT.) I find it very difficult to do with my population especially since many have dementia. Or even if they don’t I just don’t feel it is reliable.

Instead I do 5 times sit to stand (5x STS.) And I MUST do this to provide a HEP and education on it.

I need a test like 5x STS to test and measure lower extremity (LE) strength and then I must make a goal to relate strength to function.

Example

So a lot of the time my goal will be something like:

• Pt will perform 5x STS in 14 seconds or less to...