New Stroke Patient ARU/IRF Checklist for Occupational Therapy

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Equipment & Supplies

  • Wheelchair with necessary pieces (including anti-tippers)
  • W/C arm trough
  • Hemi-arm sling
  • Drop-arm Commode
  • Fall risk armband
  • Grippy socks
  • Eye-patching for diplopia
  • Shower set-up and DME
  • Sara Stedy
  • Hoyer lift
  • Splints
  • Built-up utensils
  • Theraputty
  • Earplugs
  • Diary (pain, sleep, symptoms)

Environment

  • Signage for safety and recommendations, e.g. arm sling during transfers.
  • Wheelchair and bed positioning for hemi-inattention/neglect.
  • Call bell and phone on dominant side.
  • Other items on non-dominant side.
  • Commode and wheelchair out of reach prevent self-transfers (if unsafe).
  • Sufficient task lighting
  • Reducing clutter
  • Reducing noise

Recommended Transfer Sequence

  • Signage for interdisciplinary team
  • Bed mobility, bed <> wheelchair, bed <> chair, bed <> commode, wheelchair <> commode.
  • Type of transfer (squat, stand-pivot, sara stedy, cane, hand-hold, mechanical lift, 2 person).
  • Level of assist needed – I, Min, Mod, Max, 2P, CGA/SBA.
  • Blocking if needed.
  • Cue patient before/during transfer.
  • Collaborate with nursing toileting recommendations.

Evaluation Scores

CARE Tool, Outcome measure (e.g., Barthel Index)

BADLs:

  • Feeding/eating
  • Grooming
  • Toileting
  • UB dressing
  • LB dressing
  • Bathing

Hemiparesis:

  • Modified Ashworth scale

Cognition (if no SLP):

  • Attention
  • Memory (e.g., BIMS)
  • Problem Solving
  • Planning
  • Safety

Strength

Sensation and proprioception

ROM

Vision

Handed-ness

Grip strength

Coordination

Balance

Collaboration

  • Family/Caregivers – training, environmental modifications, support
  • Doctor/Specialists – request for orders (e.g., splint), following orders
  • Nursing – transfers, toileting, shower; findings (e.g., skin breakdown)
  • PT – transfers, ambulation, ambulatory aides, co-treat
  • SLP – communication, swallow/dysphagia, cognition, safety
  • Psych – intervention, Rx, referral
  • Neuroopthalmologist – referral for vision
  • Spiritual care – adjustment to disability, faith, psychosocial
  • Vendors/Rehab aide – D/C DME that will be needed
  • Social worker – anticipated needs, caregiver training, communication with family, rehab progress
  • Dietician – dysphagia, intake

OP Referrals

  • Continue neuropsych (in-person, telehealth) for adjustment, depression, anxiety.
  • Center for neuro skills (CNS) if appropriate
  • Skilled nursing facility (lack of progress to D/C home)
  • Home health vs. Outpatient therapies
  • Transportation
  • Vendors for special equipment and installations
  • Handyman – e.g., installation of W/C ramp
  • Support groups
Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, culture, sociology, philosophy, and more.