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PT Re-evaluation (to be done very 3-4 months)
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Time (frequency and # of months) participating in Able Bionics program
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SUBJECTIVE Intake
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Important updates/ Events since last evaluation
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Any physical changes noticed by client or caregivers
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Pain
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Falls since last evaluation
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Current Home Exercise Program
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Medication changes since last evaluation
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Other current therapies
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Cannabis/ CBD Use?
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Other
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OBJECTIVE
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Spine: (ROM, scoliosis)
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Core strength
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Balance
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Other
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Transfers
|
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Client Survey Response
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ABC Scale
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Quality of Life Scale
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UE spasticity
|
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Elbow flex - L
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Elbow flex - R
|
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Elbow ext - L
|
Elbow ext - R
|
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Wrist flex - L
|
Wrist flex - R
|
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Wrist ext - L
|
Wrist ext - R
|
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Other - L
|
Other - R
|
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UE Spasticity Comments
|
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Shoulder AROM/PROM
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AROM/PROM
• • •
|
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Flexion - L
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Flexion - R
|
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Extension - L
|
Extension - R
|
|
External Rotation - L
|
External Rotation - R
|
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Internal Rotation - L
|
Internal Rotation - R
|
|
Abduction - L
|
Abduction - R
|
|
Elbow AROM/PROM
|
AROM/PROM
• • •
|
|
Flexion - L
|
Flexion - R
|
|
Extension - L
|
Extension - R
|
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Supination - L
|
Supination - R
|
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Pronation - L
|
Pronation - R
|
|
Wrist AROM/PROM
|
AROM/PROM
• • •
|
|
Flexion - L
|
Flexion - R
|
|
Extension - L
|
Extension - R
|
|
Shoulder Strength
|
|
|
Flexion - L
|
Flexion - R
|
|
Extension - L
|
Extension - R
|
|
External Rotation - L
|
External Rotation - R
|
|
Internal Rotation - L
|
Internal Rotation - R
|
|
Abduction - L
|
Abduction - R
|
|
Elbow Strength
|
|
|
Flexion - L
|
Flexion - R
|
|
Extension - L
|
Extension - R
|
|
Supination - L
|
Supination - R
|
|
Pronation - L
|
Pronation - R
|
|
Wrist Strength
|
|
|
Flexion - L
|
Flexion - R
|
|
Extension - L
|
Extension - R
|
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Upper extremity comments
|
|
|
LE Spacticity
|
|
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Hip flex - L
|
Hip flex - R
|
|
Hip ext - L
|
Hip ext - R
|
|
Hip add - L
|
Hip add - R
|
|
Knee flex - L
|
Knee flex - R
|
|
Knee ext - L
|
Knee ext - R
|
|
Plantar flex - L
|
Plantar flex - R
|
|
Dorse Flex - L
|
Dorse Flex - R
|
|
Hip AROM/PROM
|
AROM/PROM
• • •
|
|
Flexion - L
|
Flexion - R
|
|
Extension - L
|
Extension - R
|
|
Internal Rotation - L
|
Internal Rotation - R
|
|
External Rotation - L
|
External Rotation - R
|
|
Abduction - L
|
Abduction - R
|
|
Adduction - L
|
Adduction - R
|
|
Knee/Ankle AROM/PROM
|
AROM/PROM
• • •
|
|
Extension - L
|
Extension - R
|
|
Flexion - L
|
Flexion - R
|
|
Ankle Dorsi - L
|
Ankle Dorsi - R
|
|
Ankle Plantar - L
|
Ankle Plantar - R
|
|
Ankle Inversion - L
|
Ankle Inversion - R
|
|
Ankle Eversion - L
|
Ankle Eversion - R
|
|
Hip Strength
|
|
|
Flexion - L
|
Flexion - R
|
|
Extension - L
|
Extension - R
|
|
Internal Rotation - L
|
Internal Rotation - R
|
|
External Rotation - L
|
External Rotation - R
|
|
Abd - L
|
Abd - R
|
|
Add - L
|
Add - R
|
|
Knee/Ankle Strength
|
|
|
Extension - L
|
Extension - R
|
|
Flexion - L
|
Flexion - R
|
|
Ankle Dorsi - L
|
Ankle Dorsi - R
|
|
Ankle Plantar - L
|
Ankle Plantar - R
|
|
Ankle Inversion - L
|
Ankle Inversion - R
|
|
Ankle Eversion - L
|
Ankle Eversion - R
|
|
Lower Extremity Comments
|
|
|
Balance
|
|
|
Berg Balance Scale
|
Tinetti Test (Gait and Balance)
|
|
TUG
|
Sitting balance
|
|
Mini- Best
|
|
|
Gait
|
|
|
6 min walk test
|
Description of Gait quality
|
|
10 MWT
|
Comments
|
|
PT ASSESSMENT
|
|
|
Assessment
|
|
|
PT PLAN
|
|
|
Plan
|
|
|
Goals
|
Goals
|
|
Goals
|
Goals
|
|
Goals
|
Goals
|
