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