CONTACTS
SUBJECTS
Physical Therapy Dix-Hallpike Test Head Maneuver Diagnosed Benign Pa
1303 -
1303 - ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS 37 0000. ref SDS 35 0000.
130502 -
130503 -
130504 - [On 160601 1429 received call from Lauren notifying meeting
130505 - scheduled with Neurology on 160603 1430. ref SDS 39 Q66I
130506 -
130507 - [On 160608 0900 Mike advised that despite getting dizzy
130508 - followig Dix-Hallpike maneuver, BPPV has not been
130509 - diagnosed, because patient showed no evidence of eyes
130510 - moving. ref SDS 40 9W6N
130511 -
130512 -
130513 -
130515 - ..
1306 -
1307 -
1308 - Background
1309 -
130901 - Telecon Meeting Primary Care VA Balance and Wound Care
130902 -
130903 - Follow up ref SDS 37 JN3J, ref SDS 35 JN3J.
130904 -
130905 - On 160504, met Lauren Rettberg, NP PA, in Primary Care. Reported loss
130906 - of balance that caused fall on 160501, ref SDS 31 JN3J, shown in case
130907 - study on 140101 0600. ref SDS 4 O85F Lauren performed a neurological
130908 - test, passed this including Romberg's balance test. ref SDS 31 WZ50
130910 - ..
130911 - On 160513 1100 at 1200, Lauren called. She planned to contact
130912 - Neurology for radiology test to evaluate cause of falling on Half Dome
130913 - on 150916, and recently at Castle Rock Park on 160510. ref SDS 34 YK6J
130914 - There was discussion at that time, that Neurology might refer the
130915 - matter to Gait and Balance for Physical Therapy. ref SDS 34 YK68
130917 - ..
130918 - On 160516, on returning from the VA this afternoon, there was a
130919 - telephone message OA 1100 from Ivy in Physical Therapy Department...
130920 - She called to schedule meeting for physical therapy to resolve balance
130921 - issues. Called back, but phone rang 40 times and no one answered.
130922 -
130923 -
130925 - ..
1310 -
1311 -
1312 - Progress
1313 -
131301 - Met with Mike Szotak...
131302 -
131303 - 415 244 8306 ext 2-3157
131305 - ..
131306 - Mike scheduled meeting in Physical Therapy today at 0830, during
131307 - previousl meeting on 160519 0800. ref SDS 37 010U
131309 - ..
131310 - Arrived at 0800. Mike said he is busy and to return at 0830.
131311 - Walked to beach near the Cliff House, and returned, about 2 mile
131312 - hike.
131314 - ..
131315 - Enjoyed working with Mike. He is knowledgable and efficient, and aids
131316 - understanding of complex balance issues with clear, concise
131317 - communication.
131319 - ..
131320 - Mike asked about patient history of regular exercise?
131322 - ..
131323 - Explained hiking 10 - 15 miles per day 6 - 7 times per week, which
131324 - makes about 300 miles per month and totalling about 11,000 miles the
131325 - past 5 years. This is shown on the Internet in a case study showing
131326 - daily exercise, diet, medications, and vitals on 140101. ref SDS 4
131327 - XY4M
131329 - ..
131330 - Mike asked about history of falling cited in referral issued by Lauren
131331 - in Primary Care, shown in the record on 160513 1100. ref SDS 34 R46H
131333 - ..
131334 - Background on patient falling that requires medical care is set out in
131335 - the letter to the medical team on 160505 1715. ref SDS 33 J07Q
131337 - ..
131338 - There have been 4 falls the past year...
131339 -
131340 - 1. Fell hiking Half Dome near nevada Falls - lost balance with no
131341 - awareness of falling, reported on 150916 0535. ref SDS 10 O87H
131343 - ..
131344 - 2. Fell during routine hike after turning the corner at Oak Grove
131345 - onto Treat Boulevad. Fall was not balance related - caused by
131346 - stepping on slippery fruit or small round pine cones that had
131347 - fallen from an overhanging tree, reported on 151116, reported
131348 - in case study on 140101 of exercise, diet, medications, and
131349 - vitals. ref SDS 4 WXST
131350 -
131351 - [On 160707 0900 meeting with Bethany Wiseman in Audiology
131352 - and Balance Department at VA Medical Center in San
131353 - Frnacisco, presented this list of falls in connection with
131354 - Bethany providing medical services that completely resolved
131355 - balance problems arrising from BPPV condition, using a
131356 - series of about 20 Dix Hallpike and Epley maneuvers.
131357 - ref SDS 43 436F
131359 - ..
131360 - 3. Fell hiking Crystal Rock Park 3 weeks ago on 160501 and shown
131361 - in case study on 140101 0600; like Half Dome there was no
131362 - awareness of falling until near to the ground, ref SDS 4 O85F
131364 - ..
131365 - 4. Fell entering VA Medical Center Building 203 - workman rolled
131366 - carpet up in front of main entry doors, and failed to lock the
131367 - doors nor place warning tape and signs not to enter - not
131368 - balance related, reported on 160519 0527. ref SDS 36 MS5J
131370 - ..
131371 - Falls hiking Half Dome on 150916, and traversing a stream in Crystal
131372 - Rock Park trail were similar because there was no awareness of falling
131373 - until being very near the ground with no time to adjust that normally
131374 - avoids falling, and only time to mitigate injury by twisting slightly.
131375 - These 2 falls seem to reflect difficulty adjusting for "sway", as set
131376 - out in research on 160505 0753. ref SDS 32 VC5J
131378 - ..
131379 - Mike performed Dix-Hallpike head movement maneuver testing for BPPV,
131380 - (Benign paroxysmal positional vertigo), explained in the record on
131381 - 160513 1100. ref SDS 34 4W62
131383 - ..
131384 - This test was performed twice laying on a large table with blue
131385 - covering, about 18" above the ground. The first test was negative,
131386 - indicating there is no balance problem with vestibular condition on
131387 - the right side of the head.
131389 - ..
131390 - Second Dix-Hallpike test was positive, causing severe dizziness, and
131391 - showing this occurs with left vestibular condition.
131393 - ..
131394 - Mike further noted that despite experiencing dizziness, there was no
131395 - rapid movement (i.e., flutting) of eyes back and forth.
131396 -
131397 - [...below on 160523 0830 Progress Notes report finding
131398 - dizziness on left side, but "without nystagmus"; research
131399 - indicates this means the eyes showed no involuntary
131400 - movement. ref SDS 0 PP9M
131402 - ..
131403 - [On 160608 0900 Mike advised that despite getting dizzy
131404 - followig Dix-Hallpike maneuver, BPPV has not been
131405 - diagnosed, because patient showed no evidence of eyes
131406 - moving. ref SDS 40 9W6N
131408 - ..
131409 - [On 160616 1000 Mike advised that rapid eye movement
131410 - observed with severe dizziness after assisting with Epley
131411 - manauver again, establishes diagnosis of BPPV in this case.
131412 - ref SDS 41 JQ4O
131414 - ..
131415 - This aligns with experiencing dizziness from time to time, perhaps 3 -
131416 - 4 times per month, usually very mild laying in bed, occasionally
131417 - getting up from bed - maybe once per month, and further from simply
131418 - bending over, for example to disconnect cables from a computer sitting
131419 - on the floor - last time this happened was on 150804. 150804 1048,
131420 - ref SDS 7 FG46
131422 - ..
131423 - Next, sat on the edge of the low, blue table. Mike held his hand up
131424 - with 2 fingers extended. He moved his hand left and right, up and
131425 - down, and observed the eyes following this movement. This seemed to
131426 - go well.
131428 - ..
131429 - After establishing diagnosis of Benign Paroxysmal Positional Vertigo
131430 - (BPPV) with the Dix-Hallpike test, per above, ref SDS 37 IE6N, we
131431 - reviewed the record in this case of falling that seems unrelated to
131432 - dizziness, explained in the letter to the medical team on 160505 1715.
131433 - ref SDS 33 J077
131434 -
131435 - [On 160601 1429 received call from Lauren notifying meeting
131436 - scheduled with Neurology on 160603 1430. ref SDS 39 Q66I
131438 - ..
131439 - Mike commented that these falls unrelated to dizziness, could result
131440 - from a condition diagnosed as...
131442 - ..
131443 - Vestibular Hypofunction
131444 -
131445 - Post-meeting research found...
131446 -
131447 - Vestibular System
131448 -
131449 - https://en.wikipedia.org/wiki/Vestibular_system
131450 -
131451 - https://en.wikipedia.org/wiki/Vestibular_system#Structure
131452 -
131454 - ..
131455 - Vestibular Disorders Association
131457 - ..
131458 - Bilateral Vestibular Hypofunction
131459 -
131460 - https://vestibular.org/BVH
131462 - ..
131463 - Reduction or loss of vestibular function bilaterally results
131464 - in difficulty maintaining balance, especially when walking in
131465 - the dark or on uneven surfaces, and in a decrease in the
131466 - patient?s ability to see clearly during head movements. In
131467 - addition, patients with bilateral vestibular hypofunction or
131468 - loss (BVH or BVL) also complain of intense feelings of being
131469 - off-balance and of strange but disturbing sensations in their
131470 - heads with head movement. Because of these problems, patients
131471 - with BVH may restrict their activities and can become socially
131472 - isolated.
131474 - ..
131475 - Condition may be progressive.
131477 - ..
131478 - Medication side effects may cause vestibular hypofunction
131479 -
131481 - ..
131482 - Today, Romberg's test was performed, with favorable results, similar
131483 - to working with Lauren in Primary Care on 160504 1030. ref SDS 31 HU74
131484 - This was done in several ways. Testing was with eyes open and then
131485 - with eyes shut. Initially simply standing on a linoleum concrete
131486 - floor, i.e., very stable surface. This was successful. Also stood on
131487 - just one leg at a time. Then stood between 2 rails and on a plyable
131488 - surface. This was more difficult, but think this test was passed.
131490 - ..
131491 - Heal-toe walking test was initially more problematic. Fell off-line
131492 - after only a few steps, similar to same test during meeting with
131493 - Doctor Abrams in Neurology on 130227 0930. ref SDS 2 IP5L Tried this
131494 - 3 or 4 times. Failed 2nd test as well. On third test walked about 6
131495 - steps heal to toe, and on the 4th test, went maybe 20 steps heal-toe,
131496 - so got better.
131497 -
131498 - [On 160601 1429 received call from Lauren notifying meeting
131499 - scheduled with Neurology on 160603 1430. ref SDS 39 Q66I
131501 - ..
131502 - Walking gait was examined. Walked up and down the hall about 100
131503 - feet or so. Another test was walking the same distance and turning
131504 - the head 90 degrees left and right about every 4th step. This seemed
131505 - to go well.
131507 - ..
131508 - Last test was done in a machine, with computer system monitoring
131509 - balance results.
131511 - ..
131512 - Feet on separate metal, moveable plates about 12" apart. Patient
131513 - faces a semicircle, moveable casing, sort of like being in an
131514 - earthquake.
131516 - ..
131517 - Initiall test, the feet plates move very little, and the sidewall
131518 - casings are stable. Subsequent test, the feet plate movement
131519 - increases. Seemed to pass these tests. On the final test, the feet
131520 - plates move faster, and the sidewall casing spins left and right.
131521 - Failed this test. Mike ran it again, possibly twice more, and failed
131522 - all 3 tests. Mike caught me to prevent falling.
131524 - ..
131525 - Mike scheduled additional care in Physical Therapy...
131526 -
131527 - 160608 0900
131528 - 160616 1000
131529 - 160705 1100 same day meet Doctor Stewart at 1300
131530 - 160720 0900
131532 - ..
131533 - Requested meetings at 0830, to avoid traffic problems coming from
131534 - Concord.
131536 - ..
131537 - Ivy the Physical Therapy Admin rep, explained Mike normally meets
131538 - patients the earliest at 0900, so he was kind to make an exception
131539 - today. On the other 2 days, his 0900 slots are already filled.
131541 - ..
131542 - [On 160527 0834 called Neurology, talked to Gary who said
131543 - he can schedule meeting with Doctor Abrams in August;
131544 - discussed background understanding Lauren talked to Doctor
131545 - Abrams and she understoon the doctor wanted a meeting
131546 - immediately. Gary will send the Doctor an email, asking
131547 - about this case; he will send a copy to Lauren and to me.
131548 - ref SDS 38 545I Called Medical Practice and talked to
131549 - Katasha - she will notify Lauren on status of the case, so
131550 - that Lauren can take proactive action if required.
131551 - ref SDS 38 E39M
131552 -
131553 -
131554 -
131555 -
131556 -
1316 -
SUBJECTS
Default Null Subject Account for Blank Record
1403 -
140401 - ..
140402 - Medical Chart Progress Notes for Physical Therapy 160523
140403 - Progress Notes Physical Therapy Meeting 160523 Mike Szotak
140404 - Mike Szotak Progress Notes Physical Therapy Meeting 160523
140405 -
140406 -
140407 - VA Progress Notes for meeting with health care providers are
140408 - available at...
140409 -
140410 - https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=mhvHome
140411 -
140422 -
140423 - F:\05\00003\SM\CC\AGMJ\20160523-075006\mhv_WELCH_20160523_075006.txt
140425 - ..
140426 - This is a test
140427 -
140428 - 1. Note Title: PHYSICAL THERAPY OUTPT CLINIC EVALUATION
140429 - Location: San Francisco CA VAMC
140430 - Signed By: SZOTAK,MICHAEL
140431 - Co-signed By: SZOTAK,MICHAEL
140432 - Date/Time Signed: 23 May 2016 @ 1015
140434 - ..
140435 - 2. LOCAL TITLE: PHYSICAL THERAPY OUTPT CLINIC EVALUATION
140436 - STANDARD TITLE: PHYSICAL THERAPY OUTPATIENT E & M NOTE
140437 - DATE OF NOTE: MAY 23, 2016@07:49 ENTRY DATE: MAY 23, 2016@07:50:06
140438 - AUTHOR: SZOTAK,MICHAEL EXP COSIGNER: OBRIEN,LYNN M
140439 - URGENCY: STATUS: COMPLETED
140441 - ..
140442 - 3. GAIT AND BALANCE EVALUATION
140444 - ..
140445 - 4. DATE OF INITIAL EVALUATION:5/23/16
140447 - ..
140448 - 5. REFERRING CLINIC: MP
140450 - ..
140451 - 6. REFERRING CLINICIAN: Lynn Obrien-Attending NP Lauren
140452 - Rettberg-Resident NP
140454 - ..
140455 - 7. Provisional Diagnosis: Fall on same Level from Slipping,
140456 - Tripping and Stumbling without Subsequent Striking Against
140457 - Object, Sequela(ICD-10-CM W01.0XXS)
140458 -
140460 - ..
140461 - 8. Reason for Physical Therapy Referral (YOU MUST provide
140462 - supporting documentation in CPRS related to this request):
140464 - ..
140465 - Gait and balance evaluation, pt has had two recent falls on
140466 - flat ground. Would appreciate eval for sway
140468 - ..
140469 - This aligns with request during the meeting, per above. ref SDS 0 EL8G
140471 - ..
140472 - Progress Notes on 160523 continue...
140473 -
140474 - 9. Treatment Precautions (ie. weightbearing status, cardiac
140475 - parameters, etc): none
140477 - ..
140478 - 10. Other Pertinent PMH (date of surgery, fracture, or incident
140479 - connected to this referral): CAD s/p CABG 2009, h/o peripheral
140480 - neuropahty no resolved
140482 - ..
140483 - 11. EXAMINATION
140484 -
140485 - CURRENT HISTORY: This is an active 71 yo man who reports 45
140486 - falls over the last yr.Says that he hikes a few miles/day over
140487 - paved pathways and has has a few mechanical falls due to
140488 - slipping/tripping.He also reports a sense of dizziness at times
140489 - without obvious spinning sensations and more of a "foating"
140490 - type of lightheadedness.Says he would like to know how to
140491 - improve his balance and avoid falls.
140493 - ..
140494 - Patient has fallen 4 times in the past year, per report during the
140495 - meeting, shown above. ref SDS 0 EL7G
140497 - ..
140498 - Patient reported during the meeting today hiking 11 - 15 miles per day
140499 - 7 days per week, and about 300 miles per month, 11,000 miles the past
140500 - 5 years, per above. ref SDS 0 YF6N
140502 - ..
140503 - Progress Notes on 160523 continue...
140504 -
140505 - 12. CONTRIBUTING PAST MEDICAL HISTORY:
140506 -
140507 - 1. History of coronary artery bypass grafting,
140508 - Onset 10/00/2009
140509 -
140510 - 10/14/2015
140512 - ..
140513 - Mike may be listing medical history from Doctor Simpson's Progress
140514 - Notes for the meeting on 151014. 151014 0900, ref SDS 23 NP6O
140515 -
140516 - 2. Hyperlipidemia 10/14/2015
140517 - 3. Body mass index 30+ - obesity 10/14/2015
140518 - 4. Chronic ischemic heart disease 10/14/2015
140519 - 5. Esophageal Achalasia * (ICD-9-CM 530.0) 12/08/2009
140521 - ..
140522 - 13. PSH:
140523 -
140524 - 1. CABG 2009
140525 - 2. Laparoscopic Heller myotomy
140527 - ..
140528 - 14. SOCIAL SITUATION: Lives alone in Concord,Ca
140530 - ..
140531 - 15. PAIN? not affecting functional mobility.
140533 - ..
140534 - 16. PRIOR LEVEL OF FUNCTION:
140536 - ..
140537 - 17. FALL HISTORY:
140538 -
140539 - 1. How many falls? 4 over the last yr
140540 -
140541 - 2. When was most recent fall?
140542 -
140543 - 3/19/16-tripped over rolled up carpet her at the VA
140544 -
140546 - ..
140547 - 18. CURRENT ACTIVITY LEVEL: high-walks a few miles/day
140549 - ..
140550 - 19. PRIOR ADAPTIVE EQUIPMENT: none
140552 - ..
140553 - 20. Communication: Pt able to clearly communicate his needs/goals.
140555 - ..
140556 - 21. Cognition: Pt able to learn new tasks and follow all instructions.
140558 - ..
140559 - 22. Motivation: Pt appears very motivated to work with therapy toward goals.
140561 - ..
140562 - 23. Patient has fallen two or more times during past year?..... yes
140563 - PT observes balance/gait deviations?.................. yes-mild
140564 - Patient Reports Balance or gait deviations?........... yes-mild
140565 -
140566 - *Any "yes" will trigger potential interventions reduce fall risk.
140568 - ..
140569 - Recommended fall risk intervention:
140571 - ..
140572 - 24. LEARNING NEEDS: Barriers to and influences on learning
140573 - (consider cognition, language, sensory, attention, cultural,
140574 - spiritual, emotional, pain, motivation and environmental)->
140576 - ..
140577 - no learning barriers noted
140578 -
140580 - ..
140581 - 25. TESTS AND MEASURES
140582 -
140583 - 1. POSTURE: grossly good alighnment
140585 - ..
140586 - 2. RANGE OF MOTION: WFL throughout
140588 - ..
140589 - 3. MUSCLE STRENGTH: 5/5 throughout
140591 - ..
140592 - 4. PROPRIOCEPTION: grossly intact
140594 - ..
140595 - 1. VIBRATION: intact throughout
140597 - ..
140598 - 2. SENSATION: grossly intact throughout
140600 - ..
140601 - 3. COORDINATION: mildly ataxic toe taps
140603 - ..
140604 - 4. VISION: grossly intact with normal tracking.
140606 - ..
140607 - 5. Dix-Hallpike - nomral without nystagmus, but did report
140608 - some briefness when testing on nthe left.
140610 - ..
140611 - Does "briefness" mean the same as dizziness, which was significant on
140612 - left side, during the test, reported for meeting this morning, per
140613 - above. ref SDS 0 I769
140614 -
140615 - [On 160616 1000 Mike advised that rapid eye movement
140616 - observed with severe dizziness after assisting with Epley
140617 - manauver again, establishes diagnosis of BPPV in this case.
140618 - ref SDS 41 JQ4O
140620 - ..
140621 - Research on Internet found...
140622 -
140623 - Wikipedia
140624 -
140625 - Nystagmus
140626 -
140627 - https://en.wikipedia.org/wiki/Nystagmus
140629 - ..
140630 - Nystagmus (ni staegmes) is a condition of involuntary (or
140631 - voluntary, in rare cases)[1] eye movement, acquired in infancy
140632 - or later in life, that may result in reduced or limited
140633 - vision.[2] Due to the involuntary movement of the eye, it is
140634 - often called "dancing eyes".[3][a]
140636 - ..
140637 - In a normal condition, while the head rotates about any axis,
140638 - distant visual images are sustained by rotating eyes in the
140639 - opposite direction on the respective axis.[4] The semicircular
140640 - canals in the vestibule sense angular acceleration. These send
140641 - signals to the nuclei for eye movement in the brain. From
140642 - here, a signal is relayed to the extraocular muscles to allow
140643 - one?s gaze to fixate on one object as the head moves.
140644 - Nystagmus occurs when the semicircular canals are being
140645 - stimulated while the head is not in motion. The direction of
140646 - ocular movement is related to the semicircular canal that is
140647 - being stimulated.[5]
140649 - ..
140650 - [On 160608 0900 Mike advised that despite getting dizzy
140651 - followig Dix-Hallpike maneuver, BPPV has not been
140652 - diagnosed, because patient showed no evidence of eyes
140653 - fluttering. ref SDS 40 9W6N
140655 - ..
140656 - [On 160616 1000 Mike advised that rapid eye movement
140657 - observed with severe dizziness after assisting with Epley
140658 - manauver again, establishes diagnosis of BPPV in this case.
140659 - ref SDS 41 JQ4O
140661 - ..
140662 - Progress Notes continue...
140663 -
140664 - 6. COMPUTERIZED POSTUROGRAPHY: Performed Sensory OrGANIZATION
140665 - TEST on the Smart BalanceMaster today,which revealed normal
140666 - subscores for visual and somatosensory integration, but his
140667 - subscore for vestibular integration was zero, which is c/w
140668 - bilateral vestibular hypofunction.
140670 - ..
140671 - During the meeting today, Mike described cause of falling during Half
140672 - Dome hike last year on 150916, and again a few weeks ago on 160501,
140673 - which were not associated with dizziness and for which patient was
140674 - unaware of falling until too close to the ground to recover as
140675 - vestibular hypofunction, per above. ref SDS 0 IG5K
140677 - ..
140678 - Progress Notes continue...
140679 -
140680 - 7. GAIT DESCRIPTION: He ambulates independently without an
140681 - assistive device and without any significant gait
140682 - deviations.
140684 - ..
140685 - 8. Gait speed: normal-at least 160 feet/min
140687 - ..
140688 - 9. FUNCTIONAL MOBILITY: BED MOBILITY-independent
140690 - ..
140691 - 10. TRANSFERS - independent
140692 -
140694 - ..
140695 - 26. EVALUATION
140696 -
140697 - ASSESSMENT: This is an active 71 yo man who reports 45 falls
140698 - over the last yr. Says that he hikes a few miles/day over
140699 - paved pathways and has has a few mechanical falls due to
140700 - slipping/tripping.He also reports a sense of dizziness at times
140701 - without obvious spinning sensations and more of a "foating"
140702 - type of lightheadedness.Says he would like to know how to
140703 - improve his balance and avoid falls.
140705 - ..
140706 - Reporting 45 falls conflicts with the record also in Progress Notes
140707 - reporting 4 falls in past year, only 2 are significant that warrant
140708 - review for recovery.
140710 - ..
140711 - Patient reported during the meeting today hiking 11 - 15 miles per day
140712 - 7 days per week, and about 300 miles per month, 11,000 miles the past
140713 - 5 years, per above. ref SDS 0 YF6N
140715 - ..
140716 - Progress Notes continue...
140717 -
140718 - 27. Today's PT tersting is c/w impaired dynamic standing balance
140719 - due to bilateral vestibular hypofunction. HE would benfit from
140720 - a few f/u PT sessions for pt education in fall prevention and
140721 - development of a daily home balance exercise program. He is
140722 - extremely motivated.
140723 -
140725 - ..
140726 - 28. REHAB POTENTIAL: Pt is receptive and would benefit from PT
140727 - intervention at this time. Prognosis:good for below goals
140729 - ..
140730 - 29. TREATMENT TODAY: Eval and Theraputic exercise-75 mins
140731 -
140733 - ..
140734 - 30. EQUIPMENT ISSUED:none
140736 - ..
140737 - 31. EDUCATION TODAY: Discussion of home safety tips regarding fall
140738 - prevention with emphasis upon use of visual reference points
140739 - and my assessment of his balance disorder
140741 - ..
140742 - 32. Written HEP provided to patient with pictures and recommended
140743 - frequency and duration-braiding dytnamic standing balance
140744 - exercise with use of visual reference points.
140746 - ..
140747 - 33. Also discussed my assessment and proposed plan of care.
140749 - ..
140750 - 34. RESPONSE TO EDUCATION: Pt. verbalized understanding of above
140751 - education. He displays the ability to perform the above
140752 - exercise safely and effectively.
140754 - ..
140755 - 35. Understands and agrees with plan of care/treatment goals.
140757 - ..
140758 - 36. PLAN
140760 - ..
140761 - 37. Patient agrees to the following treatment plan and goals.
140763 - ..
140764 - 38. GOALS:
140766 - ..
140767 - 39. The following long-term goals (LTGs) to be achieved in 12 weeks
140768 -
140769 - 1. Pt (I) with execution of and progression of a basic HEP
140770 - 2. no falls
140771 -
140773 - ..
140774 - 40. The following short-term goals(STGs) to be achieved in 4 weeks.
140775 -
140776 - 1. Pt able to (I)'ly demonstrate and adhere to an advanced HEP
140777 - 2. no falls
140778 -
140780 - ..
140781 - 41. INTERVENTION: Pt to be seen for gait and balance training with
140782 - emphasis on fall prevention, for fall recovery training, and
140783 - for instruction in and progression of home program. Assess for
140784 - equipment needs to decrease fall risk.
140786 - ..
140787 - 42. TREATMENT FREQUENCY/DURATION:4-6 sessions over 12 weeks
140788 -
140789 -
140790 - 43. /es/ Michael Szotak ,PT (NPI# 152808347)
140791 - Physical Therapist
140792 - Signed: 05/23/2016 10:15
140793 -
140794 - 44. /es/ Lynn M OBrien, APRN
140795 - Infectious Disease Clinic, VA2451, NPI#:1114996980
140796 - Cosigned: 05/23/2016 10:17
140797 -
140798 -
140799 -
140800 -
140801 -
140802 -
140803 -
140804 -
140805 -
140806 -
140807 -
140808 -
140809 -
140810 -
140811 -
140812 -
140813 -
140814 -
140815 -