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