Mandaluyong C.A.R.E.S.

(Center for Alternative Rehabilitation and Educational Services)

2nd Floor Lingap Karunungan Center, P. Martinez St.,
Welfareville Compound, Brgy. Addition Hills, Mandaluyong City
Tel. # 710 7190

PHYSICAL THERAPY
Activity Plan
(Inclusive Dates: From the first session to the estimated last session with client)
Name: Kirby Ramos
Age & Sex:
Date of Birth:
Medical Diagnosis:

Referring Doctor:
PT-intern-in-charge: John Ryan H. Paris
CREW-in-charge:

1. Long Term Goal (LTG) 1

Kirby will be able to walk & go up & down the stairs s any difficulty & signs of
imbalance p 6 months of PT sessions.
Short Term Goal (STG) 1
- Pt will be able to do step ups on lap board x10 reps x 1 set on B LE indep p 2 mos
of PT sessions.
- Pt will be able to do single leg stance on B LE x6SH x10reps c contact guard
assist to improve balance p 2 mos of PT sessions.
2. Treatment Plan
- Strategies: Improve LE strength
STS exercise on lapboard x10 reps x1 set c verbal cues given
Step-ups lapboard while reaching toy x10reps x1set on B LE
Playing toy car c B ankle weights x5 rounds around treatment area
- Strategies: Improve Balance
Single leg stance on blue cushion x6SH x10 reps c min assist on
hands
Tandem walking c min +1 assist on hand x5 rounds
OTHER REMINDERS:
- Kirby is very quiet during treatment but follows commands. Always be sure to
repeat all instructions.

Prepared by:
Noted by:
Paris, John Ryan H.
UST PT INTERN 2015
PT Intern-in-Charge

PT Clinical Supervisor

Lifted from the Activity Plan Guide (2008) by John Paul Mallari, OTRP for CTS-Pedia, UP-CAMP