• Common Deficits

    • Hemiparesis or one-sided weakness

    • Decreased fine motor coordination

    • Cognitive/executive dysfunction

    • Reduced independence in ADLs/IADLs

    Standardized Assessments

    • Fugl-Meyer Assessment (UE section) – motor recovery

    • Box and Blocks Test / Nine-Hole Peg Test – fine motor coordination

    • MoCA or SLUMS – cognition

    • Barthel Index / Modified Rankin Scale – functional independence

    • Stroke Impact Scale (SIS) – participation and quality of life

    Treatment Ideas

    • Task-specific training (buttoning shirt, cooking task, grooming)

    • CIMT (constraint-induced movement therapy)

    • Mirror therapy for affected UE

    • Goal-Plan-Do-Review for executive function

    • Adaptive equipment training (one-handed techniques, reachers)

    • Bilateral integration activities (folding laundry, drumming)

    SMART Goal Example

    In 6 weeks, patient will use affected R hand to grasp and release grooming items (comb, toothbrush) 5x in 2 minutes with minimal verbal cues to increase independence in morning ADL routine.

  • Common Deficits

    • Pain with wrist extension or weight-bearing

    • Decreased ROM and grip strength

    • Difficulty with weight-bearing tasks (yoga, lifting, typing)

    Standardized Assessments

    • QuickDASH – functional upper extremity use

    • Numeric Pain Rating Scale (NPRS)

    • Grip and Pinch Strength (Dynamometer / Pinch Gauge)

    • Goniometry – wrist flexion/extension, radial/ulnar deviation

    • Patient-Specific Functional Scale (PSFS)

    Treatment Ideas

    • Soft tissue mobilization and gentle AROM

    • Wrist stabilization and proprioceptive exercises (wrist maze, ball on wall)

    • Gradual weight-bearing retraining

    • Eccentric strengthening (Theraband or FlexBar)

    • Ergonomic education for workstation setup

    SMART Goal Example

    Within 4 weeks, patient will increase R wrist extension from 40° to 65° with pain <3/10 to improve tolerance for meaningful occupations.

  • Common Deficits

    • Paresthesia in thumb, index, and middle fingers

    • Decreased grip strength and dexterity

    • Nocturnal pain or numbness

    Standardized Assessments

    • Boston Carpal Tunnel Questionnaire (BCTQ)

    • Semmes-Weinstein Monofilament Test – sensation

    • Dynamometer / Pinch Gauge – strength

    • Phalen’s / Tinel’s Tests – provocative tests

    • QuickDASH

    Treatment Ideas

    • Median nerve glides

    • Ergonomic modifications for keyboard or tool use

    • Night splinting in neutral wrist position

    • Activity modification education (avoid prolonged wrist flexion)

    • Gentle strengthening once symptoms decrease

    SMART Goal Example

    In 5 weeks, patient will report ability to type for 30 minutes without numbness or tingling in R hand using ergonomic modifications and neutral wrist positioning.

  • Common Deficits

    • Numbness/tingling in ring and small fingers

    • Weak grip and pinch strength

    • Pain with prolonged elbow flexion

    Standardized Assessments

    • QuickDASH

    • Semmes-Weinstein Monofilament Test

    • Grip and Pinch Strength

    • Provocative Tests: Elbow flexion test, Tinel’s at elbow

    • Patient-Specific Functional Scale (PSFS)

    Treatment Ideas

    • Ulnar nerve glides

    • Education on positioning (avoid prolonged elbow flexion, leaning on elbows)

    • Use of elbow extension night orthosis

    • Strengthening of intrinsic hand muscles

    • Ergonomic task modification

    SMART Goal Example

    Within 6 weeks, patient will demonstrate ability to complete 20-minute writing task with elbow in <45° flexion and report pain <2/10 to support work-related activities.

  • Common Deficits

    • Fatigue, weakness, endurance deficits

    • Difficulty performing ADLs/IADLs

    • Decreased balance and activity tolerance

    Standardized Assessments

    • 6-Minute Walk Test / 2-Minute Step Test – endurance

    • Grip Strength – functional strength

    • Modified Barthel Index – ADL independence

    • Functional Reach / TUG – balance

    • Fatigue Severity Scale (FSS)

    Treatment Ideas

    • Graded endurance training (household tasks, standing tolerance)

    • Energy conservation techniques

    • ADL retraining (showering, cooking, dressing)

    • Functional strengthening (sit-to-stand, lifting tasks)

    • Education on pacing and home exercise carryover

    SMART Goal Example

    In 8 weeks, patient will complete full morning ADL routine standing with 1 seated rest break or less to improve independence and energy management for daily routine.