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...and now, function:
GOAL: Patient will: (pick your functional activities below)..
Back to my blog home page: http://travelingotr.blogspot.com
I received an email from John who wrote,
"Can you provide me with some specific goals for Contractures that are Functional, measurable and objective that you've used?"
best way to measure contractures
Thanks, John, for the nudge...
Allow me to sound off from my soapbox about contractures. We can really write good functional goals if we catch the contractures before they become moderate to severe.
Do notwait until a patient or resident cannot stand up or transfer due to 45 degree knee flexion contractures! Catch them when they are just starting to bend at the knee as they stand. Do not wait until the hand is so tight that the fingernails have broken the skin on the palm.
You can screen everyone in the dining room
at one sitting
by asking the residents
to open and close their fingers
or straighten their legs or elbows.
It's really that simple.
You get the idea...
OK. Goal writing, along with step-by-step instructions for Splinting Tre-style...
Caveat: This is not a complete listing of goals. Think about your residents/clients and what functional tasks are important to them. This information may or may not jive with your ideas about splinting and documentation. I have never experienced denials on my documentation or the review process through CMS/intermediaries, and I have been involved in reviewing documentation/managing ADRs as a DOR and an RVP.
Caveat: This is not a complete listing of goals. Think about your residents/clients and what functional tasks are important to them. This information may or may not jive with your ideas about splinting and documentation. I have never experienced denials on my documentation or the review process through CMS/intermediaries, and I have been involved in reviewing documentation/managing ADRs as a DOR and an RVP.
got to have them!
When documenting treatment of contractures with orthotics, you want to document two things:
1) the progression through the splinting process, and
2) the functional response to the application of orthotics.
1) PROGRESSION THROUGH THE SPLINTING PROCESS
You've already determined the person has a Joint contracture.
You can't just write one goal for splinting. The process sequences in the following order:
A) Pick the splint. Measure for it. Order it.
Splinting is complex!
If you have questions about how to choose a splint,
email me at [email protected]
GOAL: Client/resident will participate in identification, measurement and ordering of appropriate orthotic to address joint integrity deficits of (contracted joint) by (date). (written at evaluation)
B) Splint arrives. Fit it. Modify it.
GOAL: Client/resident will participate in fitting and modifications of (ordered orthotic) to (contracted joint) by (date) to increase (contracted joint) AA/PROM for promotion of functional independence or reduction of CG assistance. (written at the first progress note)
...be patient...function is next...
By the way...at fitting and donning, check fit to ensure that two of your fingers fit under the straps; otherwise, you're going to find strap marks on the person when you go to doff the splint.
Two fingers should fit under each strap to prevent pressure...
C)Start wear time at 15 minutes on day one.Increase 15 minutes daily until your long-term goal of 3-6 hours. Stay with the patient through the whole wear period the first three treatments of wear.
Don't slap a splint on for 2 or 3 hours on day 1!
You'll lose any hope of compliance if you do
because your patient/client/resident will be
in pain.
Note: not every resident is capable of tolerating 6 hours of daily splint wear. Over the years, I have seen 2-3 hours/daily work just fine if the orthotics are applied consistently. The key is staff education and consistency.
GOAL: Patient will increase wear time of (orthotic) to (time daily, i.e. 3 hours) for promotion of low-load passive stretch to (affected joint).
GOAL: Patient will increase wear time of (orthotic) to (time daily, i.e. 3 hours) for promotion of low-load passive stretch to (affected joint).
2) THE FUNCTIONAL RESPONSE TO THE APPLICATION OF ORTHOTICS
As you increase wear time and improve joint integrity/AA/PROM, you will progress toward development of more functional goals. I have also used photography of the affected joints with resident and family approval to provide a visual aid to document improvement in joint integrity.
...and now, function:
GOAL: Patient will: (pick your functional activities below)..
Joint | Action | Functional Gain (LOA = level of assistance) | Area of Improvement |
Hand Fingers |
|
|
|
Elbow |
|
|
|
Shoulder |
|
|
|
Knee (contracture goals can also be written for hips, though you obviously won’t splint hips) |
|
|
|
This post first appeared on Insights From A (Former) Traveling Occupational Therapist, please read the originial post: here