OT Treatment Ideas: General

• Perform tasks across positions (in bed, EOB, standing) using positioning aids or adaptive equipment as needed
• It's okay to repeat activities across sessions — patients brush their teeth and wash their face every day
  • Build up grooming items or utensils; be creative
  • Upper body bathing in supported sitting or long sitting
  • Grooming at EOB (brushing teeth, combing hair, folding towels) — targets UE function, balance, endurance, posture, and coordination
  • Pre-feeding and self-feeding: adapt utensils, practice hand-to-mouth pattern, select meal items from the menu
  • Encourage participation in typical grooming: shaving, applying makeup, nail care
• Grade the task by changing the patient's position: supported long sitting → supported chair sitting → unsupported EOB → standing at the sink
• Consider position to maximize participation
  • Elevate the UE to reduce the movement distance required
  • If the patient can't transfer to a chair, elevate the HOB to approximate an upright seated position
• Use meaningful occupations and activities
  • Sit at EOB for the length of the patient's favorite song
  • Modify a favorite activity to allow as much participation as possible
• Encourage functional UE use; train in adaptive and durable medical equipment to improve coordination and motor planning
• Progress positioning: bed → EOB → bedside chair/commode → standing → in-room mobility with appropriate assistive device

Neglect & Inattention

• Position items on the neglected side and cue the patient to attend to it during functional tasks
• Use scanning strategies during ADL (meal tray, grooming setup, environmental objects)

Tracking & Scanning

• Have the patient track a penlight, a familiar object, or photos of family members
• Progress from fixation to smooth pursuit to scanning across midline
• Incorporate tracking into functional tasks (following a utensil to the mouth, locating grooming items)

Cognitive Skills

• Target orientation, attention, concentration, executive function, memory, and visual-perceptual ability
• Reorient the patient throughout the session
• Grade the challenge: consider initiation, sequencing, and task termination separately

Delirium Prevention & Management

• Speak clearly using simple words and phrases; repeat cues as needed
• Orient the patient and have them verbalize correct orientation
• Talk about familiar topics, family members, and friends
• Encourage family to bring in familiar items and photos
• Reinforce sleep protocols and daytime activity routines
• Teach and practice coping strategies

Activity Ideas

• Folding laundry or towels — targets sequencing and sustained attention
• Meal ordering — can the patient pick items from the menu? Targets command following, initiation, attention, and memory
• Whiteboard with Velcro — laminate small cards for the patient to sequence (steps of an activity, order of daily tasks)
• Laminated cognitive tasks
  • Analog clock: what time is shown?
  • Coin identification: quarter and nickel — how much total?
  • Photo of a familiar person: who is this?
  • Connect-the-dot drawing: finish the image

• Optimize normal sensory input — ensure appropriate lighting, noise management, and provision of visual and hearing aids
• Polysensory stimulation — provide multimodal input to increase arousal and environmental awareness

• Address ROM deficits, positioning needs, and contracture management
• Use prefabricated (soft or orthoplast) or custom-fabricated splints as appropriate
• Position hands in intrinsic plus when possible to prevent deformity
• Document wear schedule and monitor skin integrity at each session
• Train family and caregivers on splint application, removal, and skin inspection

Stretching & Exercise

• Head, neck, UE, and trunk stretches to facilitate movement against gravity with neuromuscular reeducation as needed
• Exercises: movement against gravity, isometrics, weight-bearing, core and trunk stabilization — to prepare the patient for ADL and IADL participation
• Train family and caregivers to assist with the exercise program

Positioning

• Position to increase tolerance for upright posture and promote effective respiration
• Use positioning aids to maintain alignment and reduce skin breakdown risk

• Educate patient and family on the benefits of therapy and the consequences of prolonged immobility and bed rest
• Train caregivers in exercise programs, positioning techniques, and ADL assistance
• Explain OT's role and the plan of care at each stage of recovery
• Prepare family for discharge planning: home safety, adaptive equipment needs, and follow-up rehabilitation