
General:
Occupational therapy practitioner CAN treat the lower body! In fact, in many ways, an occupational therapy practitioner is the BEST practitioner to take lead on lower body rehabilitation and restorative therapy. Despite what you may have learned…or maybe never learned in school…an occupational therapy practitioner should know just as much, if not more about the lower body as they do about the upper body! Occupational therapy practitioners treat the entire body! If your patient wants to do any of the activities found within the 8 domains of occupational therapy, they will need their occupational therapy practitioner to address mobility including restoring function, restoring structures, enhancing performance skills, and maximizing independence. This is a continuum!
So what are some things an occupational therapy practitioner can do for the lower body?
Assign & Train
Assigning and training an Adaptive Equipment and Duable Medical Equipment
Increase safety and efficiency of gain or standing
Prevent deformity or impairment
Determine wheelchair and seating needs
Determine walker, care, mobility aid
ASSESS
Assessing gait, posture, and body mechanics to restore musculoskeletal and neuromuscular function
Gait– manner a person walks
Ambulation – process of moving from place to place
[Necessary] for interdisciplinary or multidisciplinary apprach to rehabilitation
REMEDIATION [Balance]
Remediation of balance and integration of effective weight shifting bilaterally
Achieving equilibrium without acceleration
Increasing standing tolerance in varying degrees of COG displacement
Stability during dynamic weight shift required BUE AROM
Stability during any activity meaningful to your patient
REMEDIATION [Transitional]
Remediation/Restoring Transitional Movements
Moving from one position to another with varying degrees of extraneous cognitive load and contextual factors
Examples:
- Sit to stand
- Stand to sit
- supine to sit to stand
- stand to sit to supine
- sit to stand – pivot [parallel or perpendicular- stand to sit
Showcase : Lower Extremity Treatment Ideas

Assessments to use in Evaluation and Progress Notes:
- BERG Balance Assessment
- Timed Up and Go
- 5 Times Sit to Stand
- 10ft Tandem Line
- Modified Falls Efficacy Scale
- Lower Extremity Functional Scale (LEFS)
- Brief Pain Inventory
- ABC Balance Scale
- Tinnetti Gait and Balance
- Gait analysis Checklist
Common Problems in the Lower Extremity
Foot Drop
- Difficulty or inability for dorsiflexion
- Reduced knee function, hip flexion, and ankle dorsiflexion all may affect clearing during foot swing
- If untreated, client can develop a nonfunctional gait pattern, be at risk for falls. And further functional decline.
- Can cause hip circumduction
- What muscle is affected?
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- Common peroneal nerve, common fibular nerve
- Branches off the sciatic nerve, lumbosacral plexus, and the L5 nerve root proximally
- Innervates anterior tibialis muscle
- What can cause this diagnosis?
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- Neurological damage in CNS / PNS
- Diabetes mellitus
- Tumors
- Motor neuron disease
- MS
- Adverse reactions to drugs and alcohol
- Treatment
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- Surgical Intervention
- Modalities
- Strengthening and movement therapy
- Motor re-learning strategies
- AFO management
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Circumduction
- During hip swing the pelvis hikes while the hip abducts on the unsupported side
- The leg advances in a circular motion out to the side
- Decreases safety, increases energy expenditure, decreases movement options for the development of more functional gait patterns
Hemiplegic Gait
**New Research suggests that reciprocal arm swing has very little effect on gait efficiency**
- Foot drop
- Synergy pattern: hip adduction, hip extension, hip medial rotation, knee extension, ankle plantar flexion, and ankle inversion
- Slow speed, short stance phase, poorly coordinated movements, and decreased weight bearing on the affected extremity
- The trunk muscles may by hypertonic restricting normal pelvic forward rotation during gait
Helpful Printables in the Occupational Therapy Store

How should you approach the lower body in Occupational Therapy?
Explanation: Don’t be afraid to do some manual therapy! Use therapeutic touch for modalities is evidence-based and research supported. Knowing how to palpate trigger points. see muscle malalignments causing joint instability and atypical force vectors during occupational performance is all occupational therapy! This is why we take so many classes in the Biomechanical, medical, and science field and must achieve a measure of proficiency during practicals. Remember that your professor may have never been a practitioner in a setting requiring an occupational therapy practitioner to be strong in physical medicine of the lower body, but this DOES NOT MEAN you should not be strong in these skills. This is why there are so many continuing education classes available for you to take!
What are some clinical considerations for addressing lower body dysfunction?
- Identify occupations affected by their diagnosis and how the activity is affected by their diagnosis/comorbidity implications
- Use activity analysis to break down the identified activity into its parts related to the lower body (with careFULL consideration that your body is a kinematic chain. You cannot segment the body!
- Build a plan of care and treatment continuum of care based on the elements you need to improve in order to help your client perform their valued activity (running, playing sports, walking their dog, standing for their job, playing with their children).
- Use evidence-based and research-supported interventions to improve and maximize performance in all performance skills PRIOR to having them perform the identified occupation.
- Remember that body mechanics, strength, stability, and perceived pain must decrease before efficient mobility can be achieved.

Occupational Therapy Treatment and Documentation Examples
Treatment Video Links
Traumatic Brain Injury Rehabilitation
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Dementia Diagnosis
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Joint Replacement Rehabilitation
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Buffalo Rehab
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Outpatient Occupational Therapy
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Stroke Rehabilitation
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Traumatic Brain Injury Rehabilitation
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Lewy Body Dementia and Rehabilitation
Lewy Body Dementia and Rehabilitation Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.What is Lewy Body Dementia?Lewy Body Dementia (LBD) is the second most prevalent progressive neurodegenerative diagnosis causing dementia. It is second to Alzheimer's disease...
Multiple Sclerosis and Rehabilitation
Multiple Sclerosis and Rehabilitation Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.Common Symptoms of Multiple SclerosisMultiple sclerosis (MS) is a neurodegenerative disease affecting the central nervous system (brain and spinal cord). During the progression...
Parkinson’s Disease
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Early Memory Loss and Confusion
Early Memory Loss and Confusion Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.Symptoms of Early Memory Loss and Confusion You Should Take SeriouslyIf you are experiencing signs and symptoms of early memory loss, it is important to take them seriously. Although...
Dementia Diagnosis
Dementia Diagnosis Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.What do I do if I just received a dementia diagnosis?'Dementia' is a general term for memory deficits or memory changes. It is important to note that 'dementia' is not a synonym for any other...
Joint Replacement Rehabilitation
Joint Replacement Rehabilitation Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.What is the role of outpatient occupational therapy for a joint replacement?Outpatient occupational therapy, like every other outpatient rehabilitation, is a specialized area of...
Buffalo Rehab
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Outpatient Occupational Therapy
Outpatient Occupational Therapy Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.What is the role of outpatient occupational therapy? Outpatient occupational therapy, like every other outpatient rehabilitation, is a specialized area of rehab that makes the ability...
Stroke Rehabilitation
Stroke Rehabilitation Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.In search of an outpatient neurological stroke rehab program in Buffalo, NY?When should you have stroke rehabilitation?Depending on how big your stroke was and the area of the brain your stroke...