1. Topic-
HEP education
2. Content-
Exercise instruction, patient learning responsibility, incorporating caregiver into plan
3. Goals: Aims/Outcomes-
1.After being instructed by demonstration and in writing, patient will complete cane exercises in flexion, abduction and internal rotation without any cueing, for three consecutive visits.
2.Once caregiver and patient have been educated by OT on exercises (including frequency and duration), patient will complete a home exercise program progress chart, demonstrating compliance with home exercise program at least two times per day, five days per week.
3. After speaking with patient's caregiver on the phone, caregiver to attend at least one therapy visit per week and meet with therapist to be updated on patient's progress and get new home exercises.
4. Objectives-
1.Psychomotor Domain
2.Cognitive Domain
3.Affective Domain
5. Materials and Aids-
Exercise computer program, paper, mat table, cane, paper & pencil
6. Procedures/Methods-

A. Introduction-

1.Explain to patient the purpose of the cane exercises is to increase motion at the shoulder and avoid tendons getting shorter from not moving.
2. Explain to patient the importance of regular HEP completion for increasing use of her arm.
3. Explain to caregiver that the success of therapy is dependent on the HEP compliance.

B. Development-

1. Instruct patient to lay supine, give her the cane and verbal instructions for each exercise.
2. Educate the patient that her exercises are to be completed 30 times, 2-3 times per day & show her where the frequency of her exercises is written on the exercise sheet.
3. Explain the HEP to caregiver and ask if she has any questions about therapy.

C. Practice-

1.While the patient is completing the exercises, use hand over hand to correct her technique as needed.
2. Demonstrate filling out the exercise log that the therapist will be providing to the patient.
3. Request caregiver attempt to monitor patient's compliance with HEP.

D. Independent Practice-

1. Once patient demonstrates understanding of the exercise with hand over hand, the therapist will step back and allow her to complete 20 reps without additional instruction.
2. Request patient fill in a column to demonstrate understanding.
3. Request caregiver attend at least one therapy session per week to ask questions & get updated HEP instruction

E. Accommodations (Differentiated Instruction)-

1 & 2. Use verbal cueing as needed throughout the process.
3. Set up a phone conference if caregiver is unable to attend therapy.

F. Checking for understanding-

1. At the end of the session, review each exercise along with the handout to ensure patient understands it.
2. Ask patient to repeat the entire HEP back
3. Ask caregiver what day she can come next week and set up an "appointment"

G. Closure-

1. Show patient the phone number of the clinic on the handout should she have urgent questions. Encourage her to write down all other questions to be answered at the next treatment session.
2. Remind patient to fill in her exercise log as she is leaving.
3. Thank her for her time
7. Evaluation-
1.There are three cane exercises so I could give the patient a percentage of 33.3%, 66.6% or 100% depending on how many she could do without cueing, with the goal being 100% 3 times in a row.
2.I would issue this chart to patient with the days of the week along the vertical axis (separated into 2 rows each, see below) & the exercises along the horizontal axis. The patient would then just need to mark an "X"� in the column if she does complete the exercise. I would probably also have the caregiver initial each to ensure the patient is not just marking the chart without completing the program.
3. I would document this meeting including any questions the caregiver raised and how they were answered. I would include in the chart any handouts issued along with a description of the type of education provided along with it (verbal, demonstration, hand over hand assist, etc.).

This Lesson Plan is available at (www.teacherjet.com)