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Third Edition

Documentation Basics
for the Physical
Therapist Assistant

Core Texts for PTA Education

Third Edition

Documentation Basics
for the Physical
Therapist Assistant

Core Texts for PTA Education

MIA L. ERICKSON, PT, EDD, CHT, ATC
Midwestern University

Physical Therapy Department
Glendale, AZ

REBECCA MCKNIGHT, PT, MS
Educational Consultant
Reach Consulting, LLC

Forsyth, MO

www.Healio.com/books

Dr. Mia L. Erickson and Rebecca McKnight have no financial or proprietary interest in the materials presented herein.

All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher, except for brief quota-
tions embodied in critical articles and reviews.

The procedures and practices described in this publication should be implemented in a manner consistent with the professional
standards set for the circumstances that apply in each specific situation. Every effort has been made to confirm the accuracy of the
information presented and to correctly relate generally accepted practices. The authors, editors, and publisher cannot accept respon-
sibility for errors or exclusions or for the outcome of the material presented herein. There is no expressed or implied warranty of this
book or information imparted by it. Care has been taken to ensure that drug selection and dosages are in accordance with currently
accepted/recommended practice. Off-label uses of drugs may be discussed. Due to continuing research, changes in government policy
and regulations, and various effects of drug reactions and interactions, it is recommended that the reader carefully review all materials
and literature provided for each drug, especially those that are new or not frequently used. Some drugs or devices in this publication
have clearance for use in a restricted research setting by the Food and Drug and Administration or FDA. Each professional should
determine the FDA status of any drug or device prior to use in their practice.

Any review or mention of specific companies or products is not intended as an endorsement by the author or publisher.

SLACK Incorporated uses a review process to evaluate submitted material. Prior to publication, educators or clinicians provide impor-
tant feedback on the content that we publish. We welcome feedback on this work.

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Instructors: Documentation Basics for the Physical Therapist Assistant, Third Edition Instructors Manual is also available from
SLACK Incorporated. Dont miss this important companion to Documentation Basics for the Physical Therapist Assistant, Third
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CONTENTS
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Chapter 1 Disablement and Physical Therapy Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Mia L. Erickson, PT, EdD, CHT, ATC

Chapter 2 The Physical Therapy Episode of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Rebecca McKnight, PT, MS

Chapter 3 Reasons for Documenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Mia L. Erickson, PT, EdD, CHT, ATC

Chapter 4 Documentation Formats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Mia L. Erickson, PT, EdD, CHT, ATC

Chapter 5 Electronic Medical Record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Mia L. Erickson, PT, EdD, CHT, ATC

Chapter 6 Basic Guidelines for Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Rebecca McKnight, PT, MS and Mia L. Erickson, PT, EdD, CHT, ATC

Chapter 7 Interpreting the Physical Therapist Initial Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Rebecca McKnight, PT, MS

Chapter 8 Writing the Subjective Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Rebecca McKnight, PT, MS

Chapter 9 Writing the Objective Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Rebecca McKnight, PT, MS

Chapter 10 Writing the Assessment and Plan Sections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Rebecca McKnight, PT, MS

Chapter 11 Payment Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Mia L. Erickson, PT, EdD, CHT, ATC

Chapter 12 Legal and Ethical Considerations for Physical Therapy Documentation . . . . . . . . . . . . . . . . 119
Mia L. Erickson, PT, EdD, CHT, ATC

Chapter 13 Documentation Across the Curriculum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Mia L. Erickson, PT, EdD, CHT, ATC

Traumatic Brain Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Tracy Rice, PT, MPH, NCS

Spinal Cord Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Tracy Rice, PT, MPH, NCS

Appendix: Abbreviations and Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155

ABOUT THE AUTHORS
Mia L. Erickson, PT, EdD, CHT, ATC, is a faculty member in the Physical Therapy Department at Midwestern

University in Glendale, AZ. Mia earned a bachelors degree from West Virginia University in secondary education in 1994
and a master of science degree in physical therapy from the University of Indianapolis in 1996. Mia earned a doctoral
degree in education from West Virginia University with an emphasis on curriculum and instruction in 2002. Her clinical
practice is in the area of hand and upper-extremity rehabilitation.

Rebecca McKnight, PT, MS, received her bachelor of science degree in physical therapy from St. Louis University in 1992
and her postprofessional master of science degree from Rocky Mountain University of Health Professions in 1999. She
taught at Ozarks Technical Community College for 14 years, serving as Program Director for 9 of those years. Rebecca is
an active member of the American Physical Therapy Association and is a former chair of the Physical Therapist Assistant
Educators Special Interest Group of the education section. Rebecca has spoken at many national meetings on physical
therapist assistant curriculum design and programmatic assessment. She is the 2009 recipient of the F.A. Davis Award for
Outstanding Physical Therapist Assistant Educator. Rebecca has been providing educational consultation in the areas of
curriculum design, development, and assessment for physical therapist assistant programs nationwide since 2007.

PREFACE
We would like to thank you for choosing the Third Edition of Documentation Basics for the Physical Therapist Assistant.

We think that you will find some substantial changes that make this edition more modern, reflecting contemporary prin-
ciples in documentation. Two of the biggest changes are incorporation of the International Classification of Functioning,
Disability and Health (ICF) disablement model (vs other models that have been discussed in previous editions) and further
integration of the electronic medical record. The ICF serves as the framework for several important aspects of this text.
Throughout, we encourage readers to really think about disablement and disablement concepts when writing notes. This
includes documenting impairments in body structure and function in addition to activity limitations and participation
restriction. We also encourage the reader to frequently note improvements in impairments, activity limitations, and par-
ticipation restrictions brought on by the intervention provided in objective terms so that others reading the documentation
can see the improvement.

This edition has been updated in its discussion of the electronic medical record. In addition to describing the differ-
ences in documentation methods using a computer vs a paper chart, this edition features a stand-alone chapter on the
electronic medical record. It walks the reader through differences in the electronic health and medical records and dis-
cusses the rationale for change to electronic record keeping. The book also incorporates some evidence tied to benefits
and challenges of computerized documentation. We were fortunate enough to have WebPT (Phoenix, AZ) allow us to
integrate screen shots from its computerized documentation system. This enables the reader to see what a screen would
look like in various parts of the medical record.

We continue to incorporate concepts related to documenting the rationale for treatment and note how the unique skills
of the physical therapist assistant were used in patient management. Examples, or how-tos, are also provided. We feel
like these changes are unique to our text and can help readers to understand these important aspects of documentation
in todays payer system.

While we continue our instruction in writing a note using the SOAP (subjective, objective, assessment, and plan) struc-
ture, we recognize and point out its flaws. We still believe that understanding parts of notes using the SOAP acronym can
help students to learn the fundamentals and then, when they get to the clinical site, they can integrate their knowledge
into the software or charting system used at that site.

Again, we are happy to provide you with this updated version of our book, and we hope that you enjoy it, whether you
are using it as a physical therapist assistant student, a physical therapist assistant educator, or a clinician.

Mia L. Erickson, PT, EdD, CHT, ATC

Erickson ML, McKnight R. Documentation Basics
for the Physical Therapist Assistant, Third Edition (pp. 1-7)

2018 SLACK Incorporated
1

Disablement and Physical
Therapy Documentation

Chapter 1

After reading this chapter, the reader will be able to do
the following:
1. Define disablement.
2. Define terminology used in the International

Classification of Functioning, Disability and Health
(ICF).

3. Differentiate between impairment, activity limitation,
and participation restriction.

4. Define documentation.
5. Describe the need for common language in physical

therapy documentation.
6. Describe how disablement concepts can be integrated

into physical therapy documentation.
A traditional approach to defining a persons health

comes from the biomedical model in which health means
free or absent from disease.1 The biomedical model implies
that accurate diagnosis and identification of the patients
biological defects can directly lead to selection of interven-
tions that will maximize health outcomes.1 In this model,
however, there is little emphasis on how the disease affects

the persons ability to function or participate within society
on a daily basis. Over the last few decades, many reha-
bilitation professionals have shifted their focus away from
managing the disease or pathology and have moved toward
managing the consequences of the disease or condition. It
has become more common to focus on these consequences
as they pertain to the individuals ability to carry out tasks
and function within society. Assessing functional perfor-
mance and describing functional status are now primary
components of the physical therapists examination of the
patient. Verbrugge and Jette2 described the consequences
that chronic and acute conditions have on specific body
system function and on a persons ability to act in neces-
sary, usual, expected, and personally desired ways in his
or her society as disablement. These authors explained that
disablement is a process, indicating that it is dynamic, or
a trajectory of functional consequences over time. A more
contemporary approach to physical therapy patient man-
agement is to incorporate disablement and disablement
concepts.

Individuals and groups throughout the world have
developed disablement frameworks. Disablement frame-
works are useful for providing a common language for
health care providers, and they can serve as a basic archi-

CHAPTER OBJECTIVES

KEY ABBREVIATIONS APTA | ICD-10 | ICF | PT | WHO

Chapter 12

tecture for research, policy, and clinical care.2 In addi-
tion to providing infrastructure, disablement frameworks
define health in terms that go beyond the patients medical
diagnosis or disease, acknowledging the importance of
societal, psychological, and physical functioning. Rather
than placing the measure of health on the disease process
itself, these models have helped providers to shift toward
understanding an individuals ability to carry out neces-
sary life tasks and to function within society. Disablement
frameworks have attempted to delineate a pathway from
pathology to functional outcome while recognizing the
social, psychological, and environmental factors that can
facilitate or interfere with the pathway.2 The purpose of
this chapter is to introduce you to the disablement frame-
work used in physical therapy practice and to introduce the
purpose of using disablement and disablement concepts in
clinical documentation.

INTERNATIONAL CLASSIFICATION OF
FUNCTIONING, DISABILITY AND HEALTH

The ICF, originally known as the International
Classification of Impairments, Disabilities, and Handicaps,
was endorsed by the 54th World Health Assembly and
released in 2001. The ICF provides a uniform, standard
language for describing an individuals health and health-
related state that moves beyond his or her diagnosis.3 In
2008, the American Physical Therapy Association (APTA)
House of Delegates voted to endorse the ICF and, as a result,
APTA publications, documents, and communications have
been updated to incorporate the ICF language (Example
1-1).4 Therefore, the ICF serves to provide a common lan-
guage for physical therapists to communicate.

Example 1-1
The following definitions have been endorsed by the
World Health Organization as part of the ICF3:

Functioning is an umbrella term that includes all body functions, activities, and participation.
Disability serves as an umbrella term for dysfunction at any one or more of the following levels:
impairment, activity limitation, and participation restriction.

Body functions are physiological functions of the body (including psychological function).
Body structures are anatomical bodily structures, such as organs and limbs.
Impairments are problems with body functions (physiological, psychological) or structures,
such as a deviation or loss.

Activity is the execution of a task or activity by an individual.
Activity limitations are difficulties that might be encountered by an individual who is
attempting to complete a task or carry out an activity.

Participation is involvement in a life situation, such as work or school.
Participation restrictions are problems an individual might face while involved in life
situations.

Contextual factors are the complete factors that make up a persons life and living,
including his or her background.

Environmental factors are the physical, social, and attitudinal environmental in which
people live and carry out their lives. These include things immediate to the individual, such
as his or her home or workplace, and the larger social context, such as government
agencies designed to assist people with disabilities.

Personal factors are factors specific to the individual and his or her background.
These include things such as age, gender, social habits, health habits, upbringing, and coping
strategies.

Disablement and Physical Therapy Documentation 3

In the ICF, the individuals health or health-related state
is described in terms of function and disability. What the
individual can do is known as functioning, or the positive
aspects of health. What the individual cannot do is known
as disability, or the negative aspects of health (Figure 1-1).3
Function and disability comprise Part 1 of the ICF. Part
1 is further divided into the following 2 components: (1)
body functions (physiological function) and body struc-
tures (anatomical structures) and (2) activities and partici-
pation (Figure 1-2).3 In categorizing an individuals health
according to the ICF, a health care provider would describe
body structures and functions that are intact and those
that are not intact. Any deviation(s) from normal body
structure and/or function are known as impairments. For
the activities and participation component, the exam-
iner identifies functional tasks that the individual can do
(known as activities) and those that he or she cannot do
(known as activity limitations). The examiner also identi-

fies life roles that the individual can carry out (known as
participation) and those that he or she cannot carry out
(known as participation restrictions; see Figure 1-1).3

The ICF also accounts for contextual factors that might
facilitate or impede the patients function. These appear in
Part 2, which also includes environmental and personal
factors that affect the individuals functioning and dis-
ability. Environmental factors are external factors that
are either within the individuals immediate environment
or part of a larger social structure and that affect the
individuals ability to participate in society. These might
be facilitators, which enhance participation, or barriers,
which deter participation. Environmental factors include
things such as physical structures (eg, ramps, stairs,
curbs). Personal factors are those that are unique to the
individual, such as attitude, mood, or family support (see
Figure 1-2).3

Figure 1-1. Overview of the International
Classification of Functioning, Disability and
Health.3 The string of boxes on the left repre-
sents the positive aspects of the health state or
condition. The string of boxes on the right rep-
resents deviations from normal, or the negative
aspects of health.

Body-level

Individual-
level

Societal-
level

ICF

Health and Health-
Related States

Function: What
the individual

CAN do
(Positive Aspects of

Health)

Disability: What
the individual

CANNOT do
(Negative Aspects

of Health)

Body tissues and/
or structures that

are intact and
functioning

(Normal)

Body tissues and/
or structures that
are not intact or

functioning
(Impairments)

Tasks an individual
CAN carry out

(Activities)

Tasks an individual
CANNOT carry out

(Activity Limitations)

Roles in which an
individual CAN

participate
(Participation)

Roles in which an
individual CANNOT

participate
(Participation
Restrictions)

Chapter 14

The ICF is part of a family of classifications created
by the World Health Organization (WHO) known as the
WHO Family of International Classifications.5 This family
also includes the International Classification of Diseases,
Tenth Revision (ICD-10), a classification system for medical
diagnoses and diseases. The ICD-10 is the diagnostic clas-
sification standard for all clinical and research purposes.
It defines the universe of disease, disorders, injuries, and
other related health conditions, listed in a comprehensive
format.6 The ICF and ICD-10 are meant to complement
each other in that the ICD-10 provides a catalog of medical
diagnoses, diseases, disorders, and health conditions and
the ICF provides corresponding information on function
and disability. Used together, they provide a broader picture
of an individuals health.7

PHYSICAL THERAPY AND DISABLEMENT
The ICF provides clinicians with standardized termi-

nology and a framework to aid in exploring the impact of
disease or injury on an individuals daily life. More spe-
cifically, physical therapy providers can use the ICF to help
understand the consequences of the disease or condition on
the body systems and the impact on the individuals activ-
ity level and participation within society. Consideration

of disablement when working with patients helps physical
therapy providers to realize more complex functional and
social issues that patients face.

Individuals in need of physical therapy services often
have a disease or injury with resulting impairments in
body structure(s) and/or function(s), activity limitations,
and participation restrictions that are identified during
the physical therapists examination. Impairments can be
limitations in range of motion, strength, endurance, or
balance, to name a few. But to see how the patients abil-
ity to participate in society has been compromised, the
examination must go beyond the impairment level. It is our
responsibility to understand how impairments affect the
patients day-to-day activities and participation in a variety
of settings and situations; therefore, the physical therapists
examination of patient function includes assessment of
the following: (1) activities such as bed mobility, transfers,
hygiene, self-care, and home management (eg, yardwork,
household cleaning); and (2) participation such as the abil-
ity to work, go to school, play, and participate in commu-
nity activities (eg, going to the grocery store or bank). By
understanding an individuals impairments and his or her
activity limitations and participation restrictions, we can
better understand the degree of disability associated with
the pathology for the individual patient.

Figure 1-2. The International
Classification of Functioning,
Disability and Health3 from the
WHO. (Reprinted with permis-
sion from the WHO.)

Disablement and Physical Therapy Documentation 5

DOCUMENTATION AND DISABLEMENT
Documentation, otherwise known as medical record

keeping, has been defined as any entry into the individu-
als health record, such as a(n) consultation reports, initial
examination reports, progress notes, flow sheets, checklists,
re-examination reports, or summations of care, that identi-
fies the care or services and the individuals response to
intervention.8 Complete documentation also includes the
physician prescription(s) and certification(s), communica-
tion with other care providers, copies of exercise programs
or patient instructions, and any other disciplines notes or
comments that support the interventions.9

As you will read in subsequent chapters, documenta-
tion will serve many purposes, but, regardless of the pur-
pose, your documentation should reflect disablement. One
reason for integrating disablement concepts in physical
therapy documentation is to achieve consistency in termi-
nology because our notes are the sole record of the episode
of care provided to each patient or client. Another reason is
to show the reader how the patients pathology and impair-
ments influence his or her activities and participation in
daily life. Disablement concepts serve as a foundation for
this text. Throughout the chapters, you will be reminded of
the following 3 important disablement concepts that should
be integrated into your clinical documentation:
1. Documentation should reflect not only measures of

impairment, but also measures of activity limitations
and participation restrictions.

2. Documentation should describe how the patients
impairments relate or contribute to his or her activity
limitations and participation restrictions.

3. Documentation should explain how physical therapy
interventions are bringing about changes in impair-
ments, activity limitations, and participation restric-
tions that relate to the patients therapy goals.

REFERENCES
1. MacDermid JC, Law M, Michlovitz SL. Outcome mea-

surement in evidence-based rehabilitation. In: Law M,
MacDermid JC, eds. Evidence-Based Rehabilitation: A Guide
to Practice. 3rd ed. Thorofare, NJ: SLACK Incorporated;
2014:65-104.

2. Verbrugge LM, Jette AM. The disablement process. Soc Sci
Med. 1994;38(1):1-14.

3. World Health Organization. International Classification
of Functioning, Disability and Health: ICF. Geneva: World
Health Organization; 2001.

4. American Physical Therapy Association. International
Classification of Functioning, Disability, and Health. APTA
Website. http://www.apta.org/ICF/. Updated August 23,
2013. Accessed October 24, 2016.

5. Madden R, Sykes C, Ustun TB. World Health Organization
Family of International Classifications: definition, scope, and
purpose. World Health Organization Website. http://www.
who.int/classifications/en/FamilyDocument2007.pdf?ua=1.
Updated February 2, 2012. Accessed October 24, 2016.

6. World Health Organization. Classifications: International
Classification of Disease. WHO Website. http://www.who.
int/classifications/icd/en/. Updated June 29, 2016. Accessed
October 24, 2016.

7. Escorpizo R, Bemis-Dougherty A. Introduction to spe-
cial issue: a review of the International Classification of
Functioning, Disability and Health and physical therapy
over the years. Physiother Res Int. 2015;20(4):200-209.

8. American Physical Therapy Association. Guide to Physical
Therapist Practice 3.0. APTA Website. http://guidetoptprac-
tice.apta.org/content/1/SEC2.body. Updated August 1, 2014.
Accessed October 24, 2016.

9. Redgate N, Foto M. Pay by the rules: avoid Medicare audits
and reduce payment denials with a sound strategy and prop-
er documentation. Physical Therapy Products. 2003;October/
November:28-30.

Chapter 16

REVIEW QUESTIONS
1. How is a persons health determined today as opposed to 5 decades ago?

2. In your own words, describe disablement.

3. According to the ICF, what is the difference between an impairment, an activity limitation, and a participation
restriction?

4. Why is there a need for disablement models today? Why are they important to you?

5. What is physical therapy documentation? What does it include?

6. Give some examples of ways a physical therapist assistant can incorporate disablement concepts into his or her
documentation.

7. Look at the examples below. Determine if each would be considered an impairment in body function or structure,
an activity limitation, or a participation restriction.

Taking a bath
Going to school
Brushing teeth
Limited shoulder motion
Walking in the community
Going to the grocery store
Ascending/descending stairs
Turning a door knob
Poor endurance
Writing
Working
Poor balance
Donning socks
Bathing

Disablement and Physical Therapy Documentation 7

Read the following scenarios and identify the impairments, activity limitations and participation restrictions.

8. You are working with a 70-year-old male who had a total hip replacement 3 weeks ago. He is now able to move in
and out of the bed independently, transfer to a chair placed at the bedside, and ambulate 25 feet with a standard
walker. He wants to return to driving, golfing, and playing with his grandchildren.

9. You are working with a 10-year-old female in the school system. Her medical diagnosis (pathology) is spastic diple-
gia cerebral palsy. You have been working on ambulating up and down the stairs (which she can perform with min-
imum assist of 1, a quad cane, and a handrail) and increasing the speed of her gait. At the present time, she leaves
her classes early so that she can make it to the next one on time, and she uses the elevator rather than the stairs.

10. Your patient is a 15-year-old who sustained a traumatic closed head injury in a motorcycle accident. He is confused
and disoriented, and he requires constant supervision for his safety. He can walk and get in and out of bed with
supervision. He can also ascend and descend stairs with supervision. He is unable to work.

Rebecca McKnight, PT, MS

Erickson ML, McKnight R. Documentation Basics
for the Physical Therapist Assistant, Third Edition (pp. 9-18)

2018 SLACK Incorporated
9

The Physical Therapy
Episode of Care

Chapter 2

After reading this chapter, the reader will be able to do
the following:
1. Describe a physical therapy episode of care from point

of entry to discontinuation of services.
2. Discuss the various ways patients access a physical

therapist for care.
3. List the 6 elements of the Patient/Client Management

Model.
4. Define and describe each of the 6 elements of the

Patient/Client Management Model.
5. Discuss the roles of the physical therapist and physi-

cal therapist assistant within the Patient/Client
Management Model.

6. Describe the physical therapist assistants responsibili-
ties related to patient care, documentation, and com-
munication.

Sadie had come to terms with the fact that she has mul-
tiple sclerosis. After all, she had witnessed her aunt Linda,
who also was diagnosed with multiple sclerosis, living a
fruitful and productive life even though she had to make
some changes in her daily routine. This did not, however,

keep Sadie from getting frustrated with some of the new
issues she had to face. Most recently, she had been experienc-
ing fatigue, which had been hindering her ability to function
at work. Even more frustrating than the fatigue were the
new symptoms of clumsiness affecting her arms and legs
and causing her difficulty with most of her activities. Upon
her neurologists suggestion, Sadie had been admitted to the
local hospital for treatment. After returning home from the
hospital, Sadie was still experiencing difficulties with her
daily tasks. Her neurologist recommended that Sadie seek a
physical therapist to address her coordinatio

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