DRemediation: Patient of the Day

Throughout the remainder of the semester, I will upload a patient of the day with a piece of exercise
equipment to be used. If you are able to appropriately identify an exercise/activity that will move the
patient to the next level of functioning, then you will be able to use your score on this assignment to add 1
point to your final exam grade.
Task: You will be given a patient scenario &/or be asked to watch a video. You will also be given a
picture(s) of equipment. The equipment MUST BE integral to the task you have chosen to do, keeping in
mind principles of neuroplasticity, overload, FITT, and motor learning strategies. Each exercise you
choose to do should have a physical component and cognitive component - remember if a very
complicated physical task, the cognitive task may be just to perform accurately.
The idea is to be creative so don’t use equipment in a similar manner to a previous patient of the day case.
Be creative, unique & realistic
DO NOT write in paragraph form – use bullets. Do not submit an answer that is >1/2 page.
DUE DATE: 4/11/23
Day 1:
31 y.o. female with TBI to L frontal & temporal lobe.  pt presents with following status:
Bed mobility: min A to initiate motion @ hips & LE’s- pt completes remainder of task with S
Transfers: sit/stand: mod A to maintain hip & knee extension & balance; ambulatory transfers to
commode/w/c bed with max A  due to maintain hip & knee extension & balance
Ambulation: with max A  12 feet from wall; A required to maintain hip & knee extension and slight A
50% of time to advance R LE;pt wearing DF assist with acewrap;
Cognition: A & O x 4:sustained attention; compulsive; processing delays
Motor: + apraxia;
Behavior: completes task with consistent coaxing; pleasant
Insight: Situational Generalized
Reasoning: Is able to generate some different solutions to presented problems, but can’t decide which
one is best

Exercise Equipment:
 Patient Case Day 1

- Physical:
o Begin seated and start with sit to stand.
o Ambulate forward 8 feet to get to color mat.
o PT calls out a specific color and foot (R or L) for her to tap.
- Cognitive:
o Choosing and remembering the correct color to step and which leg to step with so they
keep balance.
- F: 4-5x/week
- I: 40%-80% moderate to high HR from baseline
- T: Timed as baseline for future improvement
- T: Functional, cognitive
- P: Adding multiple colors to tap with both/one leg.
Motor Learning
- Associative stage of learning: Serial order tasks
- Faded feedback: Patient completes tasks with coaxing so we can work on improving ambulation
and transfers consistently.
- Knowledge of performance
Neuroplasticity Principle:
- Use it and Improve It – Serial task order to improve subsequent movement using biomechanical
efficiency
- Use it or Lose It – Continuing to practice transfers and ambulation to improve
- Transference – Increasing independence during ADLs
- Intensity Matters – Measuring by HR
Day 2

Here is the patient for today: Watch the video: https://www.youtube.com/watch?v=LuxuKVKem78

Use the equipment below in your PT session
Assumptions: Functional Status: walking S on indoor tile 300 feet with extremely slow cadence; lack of
hip extension L, decreased L push off, decreased Lknee extension at terminal stance; Transfers: modified
I except floor transfer: inconsistently min/mod A
Dynamic Balance: standing: resistant to reaching out of base of support; chooses wide base of support
when standing

AND
 Patient Case Day 2

- Physical:
o A game/race with parents/aide that involves tug of war using the rope and standing on
one of the tiles from the game.
o Each tile will have a number and the rope laid on the floor reachable from each tile
o Start on the floor and begin with floor transfer to standing. PT min A
o Pick an index card and flip it over to see which number to stand on
o Pick up the rope and begin tug of war with the parent/aide to challenge reaching out of
his base of support and using a narrower BOS
o PT guarding at pelvis and trunk with min-mod A
o Stimulate a race by cueing the patient to hurry and try to win the game because the lava is
getting higher!
- Cognitive: Being able to complete the tasks first without stepping off a tile.
- F: 3-4x/week
- I: Based on HR at the beginning and end of the game
- T: Timed as they finish the game and used as baseline for future game and improvement
- T: Aerobic, functional, dual tasks
- P: Adding a cognitive component by having him name all his favorite TV show characters
Motor Learning
- Associative stage of learning: Serial order of tasks
- Summ
- Knowledge of results
Neuroplasticity Principle:
- Age matters: The patient is 8 years old so training-induced plasticity is able to recover quicker
- Use it and Improve It – Serial task order to improve subsequent movement using biomechanical
efficiency
- Use it or Lose It: Adding cognitive components to challenge patient’s physical abilities
- Salience: Patient is still young so he would be more engaged in a game setting.
Patient # 3
https://www.youtube.com/watch?v=TvfoQ8viiqE watch 5:28-9:00

This patient has meningitis, but sake of the activity – I’m going to say to pretend as if he has Revised
Rancho Level of V
Exercise equipment

Concentration Card
AND Game
 Patient Case Day 3

- Physical:
o Patient laying prone on the wedge
o PT A depending on patient needs to keep head upright for 5 minutes
- Cognitive: PT has 2 of the concentration cards on either the L/R or up/down. PT calls out one of
the cards the patient has to “mark”. Patient can look at the cards and “marks” it by looking at the
right one and blinking quickly twice.
- F: 6-7x/week
- I: mod-high intensity, 50%-80% of HR max
- T: 5 minutes
- T: Functional, strength, cognitive
- P: Increasing the time to hold position and then decreasing amount of assistance
Motor Learning
- Cognitive stage of learning: blocked practice
- Faded feedback
- Knowledge of results
Neuroplasticity Principle:
- Use it and Improve It – Repeated sets of holding the position and
- Use it or Lose It – Continuing to practice transfers and ambulation to improve
- Transference – Increasing independence during bed mobility
- Intensity Matters – Measuring by HR
- Age matters: Patient is still young and has a higher capacity to improve neuroplasticity
Patient of the Day/ Exercise of the Day
Patient #4:
https://www.youtube.com/watch?v=npkaNY_3SAs watch from beginning to 2:33

Equipment:
 Patient Case Day 4

- Physical:
o Begin seated on the edge of mat and the different balls will be spread around the room
either on the tables/counter or above him.
o Sit to stand and then PT will call out a specific ball to walk to and pick up. (ex. Pick up
the soccer ball)
- Cognitive:
o After picking up the correct ball, he will be asked to demonstrate using it in the right
manner. (ex. He would have to kick the ball)
- F: 4-5x/week
- I: 60%-80% HR max
- T: 10 minutes
- T: Cognitive, functional, dual task
- P: Introduce a cognitive portion while he finds and picks up the right ball. Either counting
backwards or naming fruit.
Motor Learning
- Associative stage of learning: serial order
- Bandwidth feedback to ensure he identifies the correct ball
Neuroplasticity Principle:
- Use it and Improve It –
- Use it or Lose It – Continuing to practice ambulation and dynamic balance
- Transference – Improving ability to walk and grab items during ADLs
- Intensity Matters – Measuring by HR
- Repetition Matters: Repeated task during blocked practice
Patient of the Day/ Exercise of the Day
Patient #5

https://www.youtube.com/watch?v=Hg3zcaRSPJQ watch 18:33 to 19:00

Equipment:

AND
 Patient Case Day 5

- Physical:
o Start standing and complete forward latter drills by alternating steps in and out of the
ladder.
o Complete a weighted ball toss onto the trampoline
o Walk backwards next to the ladder to return to start (no drills or pattern)
- Cognitive: Completing the tasks correctly with the right stepping patterns
- F: 3x/week
- I: 50%-80% of HR max
- T: 15 minutes
- T: Functional, strength
- P: Change positioning and complete the drills laterally instead of forward
Motor Learning
- Associative stage of learning: Serial task order
- Summary feedback
- Knowledge of performance
Neuroplasticity Principle:
- Age matters: Patient is young and benefits from training-induced plasticity
- Transference: Walking in different directions/spots to transfer to community ambulation
Patient of the Day/ Exercise of the Day
Patient #6
https://www.youtube.com/watch?v=dWKSB3btKEM (start @ 5:23)

AND
Patient Case Day 6

- Physical:
o Begin standing in Romberg BOS on BOSU ball 5 inches away from the box of tools
o Reach forward to grab a tool and then put it in a box either to his left or right side
o PT will tell which box to place in
- Cognitive:
o Naming each tool that he picks up and what it is used for
- F: 5x/week
- I: 60%-80% HR max
- T: 5 minutes (or until he picks up all of the tools)
- T: Static balance, cognitive, coordination
- P: Change to tandem stance
Motor Learning
- Associative stage of learning: serial task order
Neuroplasticity Principle:
- Use it and Improve It – Having to challenge balance and reach out his BOS while on an uneven
surface
- Use it or Lose It – Improving balance by challenging it
- Intensity Matters – Measuring by HR
Patient of the Day/ Exercise of the Day
Patient #7
https://www.youtube.com/watch?v=8yGmV5s5YYE (watch 2:50-3:20)

Equipment

AND
 Patient Case Day 7

- Physical:
o Set up: Mini hurdles are lined up (various distances from each other) in front of him and
there are targets at different heights at the end
o PT calls a specific-colored hurdle to get to (forward alternating feet/steps) while cradling
a ball in the lacrosse stick
o 10 ball flips in R hand while he’s standing
o Throw the ball at specified target
- Cognitive:
o Completing the task correctly since there are many steps to the physical task
- F: 5x/week
- I: 60%-80% HR max
- T: 15 minute bouts
- T: Functional, coordination, dual task, balance
- P: Increase intensity by adding a timed component  still random but have to complete each task
at least 5 times within 15 minutes
Motor Learning
- Autonomous stage of learning: Random order
- Summary feedback
- Knowledge of performance
Neuroplasticity Principle:
- Use it and Improve It – Random order to improve autonomy of each activity
- Salience- Patient enjoys lacrosse so it’s an activity he will actually be interested in
- Age Matters: Patient is still young and can benefit from training induced plasticity
- Intensity Matters – Measuring by HR