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Occupational Therapy ToolkitEducational Handouts - Section 3OtherTips to Prevent Upper Body LymphedemaOrthopedicArthritic Joint Changes and Deformities - Therapist ResourceBody MechanicsDaily Tasks after Back (Lumbar) SurgeryDaily Tasks after Neck (Cervical) SurgeryDaily Tasks after Shoulder SurgeryDesensitizationEdema (Swelling) Control of the Arm(s)Edema (Swelling) Control of the Leg(s)Good PostureHip Dislocation Precautions - Posterior ApproachJoint Protection and Energy Conservation for Wheelchair UsersJoint Protection for ArthritisScar MassageSpinal Surgery PrecautionsSplint/Brace InstructionsSuperficial ColdSuperficial HeatSafetyDon’t Let a Fall Get You Down - BookletDon’t Let a Fall Get You Down - Post-Fall SurveyFall Triggers and Tips to Prevent Falls - Therapist ResourceFoot Care and Foot SafetyHome Safety and Performance Assessment - Therapist ResourceUsing a Front Wheel Walker (2 wheels)Using a Rollator (3 or 4 wheels)Using a Standard Walker (no wheels)Using a Wheelchair 2018 Cheryl Hall www.ottoolkit.com

Occupational Therapy ToolkitTherapeutic Exercise Handouts - Section 4BalanceBalance Exercise GuidelinesBalance Exercises - SittingBalance Exercises - StandingCore Exercise GuidelinesCore Exercises - Back MusclesCore Exercises - Pelvic MusclesCore Exercises - Stomach MusclesExercise Ball GuidelinesExercise Ball - Back MusclesExercise Ball - Pelvic MusclesExercise Ball - Stomach MusclesCondition SpecificBurn Injury Stretches - GuidelinesBurn Injury Stretches - FaceBurn Injury Stretches - NeckBurn Injury Stretches - TrunkBurn Injury Stretches - ShoulderBurn Injury Stretches - Elbow, Forearm, WristBurn Injury Stretches - Left HandBurn Injury Stretches - Right HandBurn Injury Stretches - Hip and KneeBurn Injury Stretches - Ankle and ToesElbow Stretches for Below Elbow AmputationExercise Tips for Amyotrophic Lateral SclerosisExercise Tips for ArthritisExercise Tips for DiabetesExercise Tips for Guillain-Barré SyndromeExercise Tips for Multiple SclerosisExercise Tips for Myasthenia GravisExercise Tips for Orthopedic ConditionsExercise Tips for Post-Poliomyelitis SyndromeExercise Tips for Renal ConditionsMastectomy ExercisesOsteoporosis Extension ExercisesParkinson’s Disease ExercisesPulmonary ExercisesElbow, Forearm, WristElbow, Forearm and Wrist Active Range of MotionElbow, Forearm and Wrist Strength ExercisesElbow, Forearm and Wrist StretchesElbow, Wrist and Hand Active Exercises 2018 Cheryl Hall www.ottoolkit.com

Occupational Therapy ToolkitTherapeutic Exercise Handouts - Section 4Elbow, Forearm, WristForearm and Wrist Active Range of MotionForearm and Wrist Strength ExercisesForearm and Wrist StretchesHandFine Motor ActivitiesFinger and Thumb Strength Exercises - LeftFinger and Thumb Strength Exercises - RightFinger and Thumb Stretches and Active Range of Motion - LeftFinger and Thumb Stretches and Active Range of Motion - RightFlexor Tendon GlidesMedian Nerve GlidesPutty ExercisesLower BodyAnkle and Foot Active Range of MotionAnkle and Foot Isometric ExercisesAnkle and Foot Strength ExercisesAnkle and Foot StretchesHip and Knee Exercises - LyingHip and Knee Exercises - SeatedHip and Knee Exercises - StandingLow Back StretchesStretch Band Exercises - LegsThigh StretchesMiscellaneousFace and Neck Active Range of MotionGeneral Exercise TipsPassive Range of MotionPelvic Floor (Kegel) ExercisePhysical Activity PlanWalking GuidelinesNeckNeck Active Range of MotionNeck Isometric ExercisesNeck Strength ExercisesNeck StretchesShoulderDowel Exercises - SupineDowel Exercises - UprightPendulum Exercises - LeftPendulum Exercises - RightShoulder Active Range of Motion 2018 Cheryl Hall www.ottoolkit.com

Occupational Therapy ToolkitTherapeutic Exercise Handouts - Section 4ShoulderShoulder and Hand Active ExercisesShoulder and Rotator Cuff Active Exercises - LeftShoulder and Rotator Cuff Active Exercises - RightShoulder and Rotator Cuff Exercises Free Weight - LeftShoulder and Rotator Cuff Exercises Free Weight - RightShoulder and Rotator Cuff Exercises Stretch Band - LeftShoulder and Rotator Cuff Exercises Stretch Band - RightShoulder Blade ExercisesShoulder, Elbow, and Hand Active ExercisesShoulder Isometric Left - SeatedShoulder Isometric Left - StandingShoulder Isometric Right - SeatedShoulder Isometric Right - StandingShoulder Passive and Active-Assisted Range of Motion - LeftShoulder Passive and Active-Assisted Range of Motion - RightShoulder Pulley Exercises - LeftShoulder Pulley Exercises - RightShoulder Stretches - LeftShoulder Stretches - RightStrokeLevel 1 Activities - Help Your Weaker Arm MoveLevel 2 Activities - Use Your Weaker Arm to Passively HoldLevel 3 Activities - Use Your Weaker Arm to Actively Move & HoldLevel 4 Activities - Use Your Weaker Arm with Gross MotorLevel 5 Activities - Use Your Weaker Arm with Fine MotorPassive Range of Motion - Left Side WeaknessPassive Range of Motion - Right Side WeaknessScapular Mobility and Strength Exercises - Left Side WeaknessScapular Mobility and Strength Exercises - Right Side WeaknessSelf Range of Motion - Left Side WeaknessSelf Range of Motion - Right Side WeaknessUse Your Left Arm to Actively Move and HoldUse Your Left Arm to Passively HoldUse Your Left Arm with Assisted GuidingUse Your Left Arm with Gross Motor ActivitiesUse Your Left Arm with Self-GuidingUse Your Right Arm to Actively Move and HoldUse Your Right Arm to Passively HoldUse Your Right Arm with Assisted GuidingUse Your Right Arm with Gross Motor ActivitiesUse Your Right Arm with Self-Guiding 2018 Cheryl Hall www.ottoolkit.com

Occupational Therapy ToolkitTherapeutic Exercise Handouts - Section 4StrokeWeight Bearing Exercises - Left Side WeaknessWeight Bearing Exercises - Right Side WeaknessUpper BodyArm CycleCool-Down StretchesGross Motor TasksNerve Flossing - MedianNerve Flossing - RadialNerve Flossing - UlnarPosture ExercisesStretch Band Exercises - ArmsUpper Body Active Range of MotionUpper Body Exercises - Hand WeightsUpper Body Exercises - Using a BallUpper Body Strength ActivitiesWarm-Up Exercises 2018 Cheryl Hall www.ottoolkit.com

Occupational Therapy ToolkitBreast Cancer - Pre and Postoperative ManagementSurgical procedures include radical, modified or simple mastectomies, lymph nodedissection, and breast reconstruction.Impairments and Functional Limitations:ADL, IADL, productivity and leisure impairmentImpaired ROM and strength of trunk and upper extremityPost-op pain and edemaPotential secondary complications - nerve damage, lymphedemaOccupational Therapy Preoperative Intervention: Baseline measurements (ROM, strength, sensation, and limb measurements) Provide education about post-operative activity limitations, precautions andexercise. Instruct in good posture during activities. Educate about lymphedema prevention or risk factor reduction. Teach strategies to incorporate wellness and health management routines intodaily activities. Educate about breast cancer and the availability of community resources.Encourage participation in support groups.Occupational Therapy Postoperative Intervention:ADL, IADL, productivity and leisure training Treat underlying limitations to safety and independence. Recommend and/or provide adaptive equipment as needed. Train in lower bodyADL equipment following reconstructive surgery involving abdominal muscles. Instruct in good posture during activities. Instruct in protective use of affected arm for the first 2 weeks. Avoid overuse,avoid sleeping on the same side as the surgery, avoid lifting more than 5 pounds,keep tasks below 90-degrees of shoulder motion. Instruct to elevate arm severaltimes a day to manage post-op edema. Unless otherwise instructed by surgeon.Train in safe and efficient functional mobility (sit to stand, bed mobility skills, transfers,ambulation and wheelchair mobility) during ADL and IADL tasks.Pain self-management Coordinate medication peak with exercise and activity. Teach stress management and relaxation techniques. Use pillows to help arm and shoulder relax in sitting and lying down. Instruct in good posture during activities. 2018 Cheryl Hall www.ottoolkit.com

Occupational Therapy ToolkitBreast Cancer - Pre and Postoperative ManagementOccupational Therapy Postoperative Intervention:Provide graded UE activities and exercises. Follow the referring surgeon’s specificguidelines for ROM and progression of exercises. AROM exercises starting 2-3 days after surgery. Progress exercises until full ROMrestored. Begin strengthening 4-6 weeks after surgery. Instruct in deep (diaphragmatic) breathing exercises and lateral expansion. Instruct in a walking program.Provide surgical scar management at 3-4 weeks post surgery (mobilization, massage,desensitization, stretching exercises).Provide education about lymphedema prevention and risk factor reduction.Patient and Caregiver Handouts:Arm MeasurementDeep (Diaphragmatic) BreathingEdema (Swelling) Control of the Arm(s)Good PostureMastectomy ExercisesScar MassageTips to Prevent Lower Body LymphedemaWalking GuidelinesAdditional Treatment Guides:CancerHealth Management 2018 Cheryl Hall www.ottoolkit.com

Occupational Therapy ToolkitDressingDressing includes selecting appropriate clothing for the time of day, weather, andoccasion. Obtain clothing from closets and drawers. Dress and undress using open-frontgarments (shirt/blouse, robe, sweater, jacket, winter coat), pullover garments(sweatshirt, t-shirt, sweater), bra, pants, skirts, suspenders, necktie, scarf, gloves,underwear, socks, pantyhose, nylons, shoes, boots, slippers, support and anti-embolismstockings. Open and close fasteners, (snaps, buttons, hooks, zippers, Velcro). Managingpersonal devices (hearing aids, eyeglasses, contacts, AFO, hand splint, back brace,slings, and prosthetics).Impairments and Functional Limitations:Impaired shoulder strength and/or ROMImpaired hand strength, ROM, sensation and/or coordinationImpaired LE functionLimited activity tolerance and enduranceImpaired sitting balanceImpaired standing balancePainVisual perceptual impairmentCognitive impairmentOccupational Therapy Intervention:Apply different approaches for solving difficulties with dressing. Remediate underlying limitations to safety and independence. Physicalimpairments (muscle weakness, impaired hand function, limited ROM, paralysis,incoordination, impaired balance, fatigue, dyspnea, abnormal tone, tremor),sensory impairment (impaired sensation, low vision, hard of hearing, vestibular,pain), behavioral, cognition, perception. Train in compensatory techniques (safety techniques, one-handed techniques,pacing, energy conservation, joint protection, body mechanics, breathingtechniques, low vision techniques, cognitive/perceptual compensation, step-bystep instructions, task segmentation, task sequencing, backward chaining, verbaland physical cueing, hand-over-hand guiding). Train in the use of adaptive equipment and assistive devices (buttonhook, Velcroclosures on shoes, elastic shoelaces, long handled shoehorn, dressing stick,reacher, sock aid, zipper pull, loops on pants, loops on socks, labeling system foridentifying clothes, and specialized clothing). Provide environmental modifications and adaptations (avoid storing items on thefloor, lower closet poles, organize clothes within easy reach, and label drawersusing picture or words). 2018 Cheryl Hall www.ottoolkit.com

Occupational Therapy ToolkitDressingOccupational Therapy Intervention:Apply different approaches for solving difficulties with dressing (continued). Instruct in activity modification.o Change the task (place the weaker extremity into the garment first, dressin a supine position).o Eliminate part or all of the task (choose garments that are easy to put onand remove such as: elastic waist pants, loose fitting tops, pullovertops, suspenders instead of a belt, Velcro shoes, slip on shoes, front hookbra, sports bra, camisole).o Have someone else do part or the entire task.Train in safe and efficient functional mobility (sit to stand, bed mobility skills, transfers,standing, ambulation, and wheelchair mobility) during dressing tasks.Provide caregiver/family education and training.Patient and Caregiver Handouts:Adaptive Equipment for DressingDressing TipsTips to Conserve Energy with Self Care TasksDressing Techniques - Lower BodyPut On and Take Off an Ankle-Foot Brace - Method 1 - Left LegPut On and Take Off an Ankle-Foot Brace - Method 1 - Right LegPut On and Take Off an Ankle-Foot Brace - Method 2 - Left LegPut On and Take Off an Ankle-Foot Brace - Method 2 - Right LegPut On and Take Off Pants - Method 1Put On and Take Off Pants - Method 2Put On and Take Off Pants, Socks, and Shoes Lying DownPut On and Take Off Pants, Socks, and Shoes Using a StoolPut On and Take Off Pants Using a Dressing Stick or ReacherPut On and Take Off Socks and Shoes Using Dressing ToolsPut On and Take Off Support StockingsDressing Techniques - One HandedPut On a T-shirt with One Hand - Left Side WeaknessPut On a T-shirt with One Hand - Right Side WeaknessPut On an Open Front Shirt with One Hand - Left Side WeaknessPut On an Open Front Shirt with One Hand - Right Side WeaknessPut On and Take Off a Bra with One Hand - Left Side WeaknessPut On and Take Off a Bra with One Hand - Right Side WeaknessPut On Pants with One Hand - Left Side WeaknessPut On Pants with One Hand - Right Side WeaknessPut On Socks and Shoes with One Hand - Left Side Weakness 2018 Cheryl Hall www.ottoolkit.com

Occupational Therapy ToolkitDressingPatient and Caregiver Handouts:Dressing Techniques - One HandedPut On Socks and Shoes with One Hand - Right Side WeaknessTake Off a T-shirt with One Hand - Left Side WeaknessTake Off a T-shirt with One Hand - Right Side WeaknessTake Off an Open Front Shirt One Hand - Left Side WeaknessTake Off an Open Front Shirt One Hand - Right Side WeaknessTake Off Pants with One Hand - Left Side WeaknessTake Off Pants with One Hand - Right Side WeaknessTie Shoes with One Hand - Left Side WeaknessTie Shoes with One Hand - Right Side WeaknessDressing Techniques - Upper BodyPut On and Take Off a T-shirt - Arm-Head-ArmPut On and Take Off a T-shirt - Head-Arm-ArmPut On and Take Off a T-shirt Using a Dressing StickPut On and Take Off an Open Front Shirt - One Shoulder DrapePut On and Take Off an Open Front Shirt - Two Shoulder DrapePut On and Take Off an Open Front Shirt Using a Dressing StickUsing a Buttonhook 2018 Cheryl Hall www.ottoolkit.com

Occupational Therapy ToolkitFrailty and DebilityImpairments and Functional Limitations:ADL, IADL, productivity and leisure impairmentFunctional mobility impairmentSlow walking speedMuscle weaknessLimited activity tolerance and enduranceImpaired balanceImpaired vision and hearingChronic painAdvanced age, 80 Co-occurring conditions - functional decline, falls, fear of falling, delirium, dementia,dizziness, depression, incontinence, sleep disorders, malnutrition, dehydration,pressure ulcers, sarcopenia, hypothermia, and hyperthermiaAssessments:6 Minute Walk Test (Enright et al., 1998)Berg Balance Scale (Berg 1989)Geriatric Depression Scale (Parmelee & Katz 1990)Mini Mental State Exam MMSE (Folstein 1975)Nutrition Screening Initiative (White et al., 1992)Physical Performance Test (Lusardi et al., 2004)Timed 10-Meter Walk Test (Bohannon et al., 1996)Occupational Therapy Intervention:ADL, IADL, productivity and leisure training Treat underlying limitations to safety and independence - physical (strength,hand function, ROM, coordination, balance, endurance, abnormal tone), sensory(tactile, vision, hearing, vestibular, pain), behavioral, cognition and/orperceptual. Address nutritional health - oral health, ability to feed self, ability to shop, accesskitchen, prepare nutritious meals and get adequate hydration. Encourage to eatwith others. Address ability to drive safely. Provide referral to driving rehab specialist and/orexplore alternative transportation options.Train in safe and efficient functional mobility (sit to stand, bed mobility skills, transfers,standing, ambulation and wheelchair mobility) during ADL and IADL tasks. Train in the safe and correct use of assistive devices and adaptive equipment(walkers, canes, sliding boards, bed transfer handles, leg lifters, wheelchairs) asappropriate. 2018 Cheryl Hall www.ottoolkit.com

Occupational Therapy ToolkitFrailty and DebilityOccupational Therapy Intervention:Provide an individualized exercise program that includes progressive endurance,strengthening and flexibility activities.Recommend the use of an activity tracker.Instruct patient and caregiver in a written home exercise program.Provide functional balance activities to increase balance confidence with ADL tasks.Provide pain management.Provide a fall prevention program that includes balance, coordination and agilitytraining and education about fall risk and prevention strategies.Complete a comprehensive, performance-based home assessment. Recommend and/orprovide modifications, adaptive equipment and/or assistive technology.Educate about the negative effects of prolonged sitting and bed rest. Educate regardinghypothermia and hyperthermia prevention.Patient and Caregiver Handouts:Balance Exercise GuidelinesBalance Exercises - SittingBalance Exercises - StandingHip and Knee Exercises - SeatedPutty ExercisesStretch Band Exercises - ArmsUpper Body Exercises - Hand WeightsWalking GuidelinesAdditional Treatment Guides:Activities of Daily LivingBalanceChronic/Persistent Pain SyndromeFall Risk Assessment and PreventionFunctional MobilityHome Safety and ModificationPressure UlcersRest and SleepTherapeutic ExerciseUrinary Incontinence 2018 Cheryl Hall www.ottoolkit.com

Occupational Therapy ToolkitOsteoarthritis - Conservative ManagementImpairments and Functional Limitations:ADL, IADL, productivity and leisure impairmentFunctional mobility impairmentLimited UE and LE ROMImpaired hand functionMuscle weaknessLimited activity tolerance and enduranceJoint pain, stiffness and inflammation that increase with activityPostural changesImpaired balanceCo-occurring conditions - joint replacements, joint contractures, fall riskAssessments:Manual Ability Measure (MAM) (Chen & Bode 2010)Occupational Therapy Intervention:ADL, IADL, productivity and leisure training Train in the use of adaptive equipment to improve grasp (built-ups), improveease of performance (electric can opener), compensate for range of motion loss(dress stick), compensate for weak/absent muscle (universal cuff, jar opener),prevent stress on joints (lever door

Tips for Making and Keeping Health Care Visits Meal Prep and Clean Up Manage Kitchen Tasks with a Walker Manage Kitchen Tasks with a Wheelchair . Down Steps with a Rail Using a Cane Down Steps with a Rail Using a Closed Walker Down Steps with a Rail Using an Open Walker Down Steps without