After reading a patient's chart and looking at the eval, I usually have a plan formulated in my head on what I am going to do with that patient. Sometimes it does not go as my well as my meticulously thought-out plan and I feel like running right into some of the rooms screaming, "Leeroy Jenkins!" ("World of Warcraft" players will recognize this).
There will always be those patients who can hide their dementia very well and other patients who claim they can do more than what their body will allow them to. Most of the time, I can accommodate for these things and usher along a patient who thinks all I do is force him out of bed to move his legs.
For joint replacements there are sets of exercises we all do with the patients, then I break protocol and begin their functional descent into "real-life" therapy. Can they carry a grocery bag (or other items) while pushing a walker or using a cane? Are they able to use a flashlight and maneuver around a room in the dark? How about climbing a ladder to change the smoke-alarm battery? These things are very functional for someone who is supposed to go home, but what do I bill it under?
In a home assessment, I usually delve into the bedroom, bathroom and kitchen -- the three rooms most people are likely to go. But what about the laundry room, feeding the animals, gardening and trying to get between the pews at church with an assistive device? I attempt to replicate some of this as best I can at the facility with the patients but sometimes it does not work. And there are times when no matter what I have planned for patients in my head, they will take me in another (better) functional direction. One patient showed me how she picked up flat pieces of paper on the floor with her reacher without breaking her THA precautions. Another patient perfected the log roll from supine to stand in one smooth movement without violating his back precautions.
Even though I have a plan in my head, there are times I have to wing it because the patients have already thought out their difficulty and accommodated for the deficit. By the time I get there, all I can do it go through the monotony of supine, seated and standing LE exercises. It is the patients who haven't formulated their own plans that keep me motivated enough to show different functional ways to move around without feeling helpless.