...adding to our toolbox

Let me begin by telling you a bit about the facility I work in. It is a sub-acute facility; sometimes we see patients typical for a SNF (skilled nursing facility) however we are fortunately enough to have LTAC (long-term acute care) the floor above us, so occasionally those individuals will transfer down to our floor making us sub-acute. In any case, our facility is made of two large buildings, the building attached to our rehab housing LTC (long-term care) residents as well as the facilities' gift shop, synagogue/chapel, laundry machines, our beloved ramp. :) The distance from the rehab to the gift shop, etc. would be "community mobility" ie- 150' x4. I feel that we are VERY LUCKY in how creative we can get with activities, especially those for "higher-level" patients, however we always can be motivated by new ideas. 

Our huddle a couple weeks ago discussed a variety of standing activities to use that are more "grown up" - rather than putting a brightly colored ring arch in front of them. (don't get me wrong I do love my ring arch). Here is what we discussed...

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• "Laundry task": Walking, or taking a w/c, to the laundry machines to perform dynamic reaching for clothing items in/out of the washer/dryer. Patient's can utilize a long-handled reacher/grabber for this task as well. 
• "Library task": (pictured above) reorganizing bookshelves - if a patient can only tolerate a shelf at waist height than only "mess-up" that particular shelf. Another good idea would be taking some books and moving them across the room so your patient would have to "retrieve and transport" their item to the bookshelf to restock. Be mindful some books are heavy and patient's may be under lifting precautions. 
• "Shopping task": For higher-level patients, one's with a basket on their walker or on a cane, etc., this would be a great activity. Typically we empty a "go green" bag on our unit, carry it with them to the bookshelves either on our unit, or further away, "shop for" items in need, and carry it back the distance at which they initially traveled. Unfortunately we do not have a "play" grocery store so this is where we have to get creative. Good activity for endurance though! 
• "Gardening": We are lucky enough to have a fantastic Recreational Therapist on our unit who provides simple plants, pots, and soil for our patients to use. Frequently during the summer season we have patients participate in a simple gardening task standing at the table looking at static standing balance, activity tolerance, sequencing, and fine motor coordination. Some really enjoy this activity. 
• "Gift shop": On our unit we use the gift shop A LOT! It can be used as a location for community mobility, dynamic or static reaching tasks, money management, etc. Sometimes it can be used to look into a patient's memory (I thank my level II fieldwork supervisor for this!). At the start of our functional mobility to the gift shop, provide the patient with 3 items you want them to retrieve; since the gift shop is a good distance away it really tests them to remember. Recommend picking 3 items that are at various heights to look at dynamic standing balance too. 

I hope everyone has enjoyed a look into our sub-acute unit. I would love to hear about standing activities you do with your patients in your setting! 

Functionally yours,

m