Occupational therapy for cerebral palsy Occupational therapy can help with managing everyday activities and functions, like eating, getting dressed and using the bathroom. Do you have any specific to the home environment? Pulling pants up requires eye-hand coordination, bilateral coordination, and wrist and hand stability. RHUMBA: Relevant, How long, Understandable, Measurable . The Biomechanical frame of reference is based ______________ will complete interlocking puzzles in 4 out of 5 trials with ________ assist and _____% verbal cues for increased visuomotor and spatial relationship skills. Always seek the advice of your physician or other qualified health professional with any questions you may have regarding a medical condition. Even in a hospital, it could be a hassle to bring one to each patient in an acute care setting. Examples of work-related goals might include lifting and carrying a 50-pound box for a distance of 25 feet within 3 weeks, or safely operating a power drill overhead for 90 seconds within 4 weeks. What would be most helpful for you? Provide alternate opportunities to practice fine motor skills needed for dressing such as, Precision of Grasp and Release Activities, Tangrams and Visual Perception in Handwriting, Recycled Materials STEM Lever and Fulcrum, When Executive Function Skills Impair Handwriting, Executive Functioning Skills- Teach Planning and Prioritization, Fine Motor Activities to Improve Open Thumb Web Space, Activities to improve smooth visual pursuits, Classroom Accommodations for Visual Impairments, The Best Functional Life Skill Resources for Individuals with Autism - Learning For A Purpose, Digital Content Creation Program: Sell Your Digital Products on The OT Toolbox, Winter Clothes Worksheet for Visual Perception. Using sensory strategies, ___________________ will demonstrate appropriate sensory modulation skills in order to sit and participate in circle time at school without aggression towards peers in 4 out of 5 days of the week as measured by teacher report. Published November 2021. Donning a winter cap requires precision grasp, bilateral coordination, and motor planning. Such occupations have unique meaning in a person's life. Physical exercises: range of movement, medicine ball training, and squatting. Some children have weak handsowing to lower-than-normal muscle tone, birth injuries or neuro-muscular disorders, among other reasons. Hold a crayon/pencil tri grasp. ______________ will string and unstring large beads onto firm string/ lace ________ with assist and _____% verbal cues for increased precision handling. ______________ will grasp a toy using BUE at midline in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased grasp and release accuracy. The OT Toolbox assumes no responsibility for errors or omissions that may appear in the Website. Also some patients are on comfort measures when therapy is asked to evaluate. Grip strength is usually measured using a hand-held dynamometer. _____________ will use open hands to crawl up an incline for increased grasp and release accuracy. 99. For long term goals, improvement is typically two levels of improvement for the assist, as seen in the above goal. An average score is then calculated using the measurements from both hands. _____________ will write first and last name with upper and lower case letters without model ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining a lack of thumb wrap. Tier two goals-activity level. One difficulty that patients who have had a stroke experience is difficulty with left vs. right discrimination, e.g., differentiating between a left hand from a right hand. Decrease Anterior Knee Pain 2. In-Hand Manipulation: This fine motor skill typically develops around two years of age. _____________ will write two consecutive words without a model ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills and success in school setting. Main function of Occupational Therapy with the ALS patient The occupational therapist strives to enable and enhance meaningful function for the ALS patient. Developing Skillful Hands. Lets break down these fine motor skills a bit to see how they are helping a child complete tasks independently. In this article, learn how to write excellent occupational therapy goals, plus read examples of short and long term goals. Pulling on boots requires a hook grasp of the hand, strength, and proximal stability. I think at the most basic level, you need to think about WHAT you are exactly trying to accomplish (goal) for your patient and how can I make this measurable. Elisa can now keep the utensils attached to her hand without . In the combined-intervention group, rheumatology-trained health professionals from different disciplines delivered a one-session individual intervention with detailed information on functioning, activities of daily living, physical activity, nutrition, assistive devices, instructions on pain management and exercises. Whether its tying a shoe, shaking a hand, walking your dog, brushing teeth, holding your cell-phone or driving your car, grip strength is an every-day necessity. How many times a day do you hold a fork, cut your food, open a door, or hold a pen? While standing, gravity adds resistance to our working muscles, but a treating OT can determine the best position to eliminate this. http://bit.ly/2rWhcbO. This short term goal is specific because we know exactly what type of transfer we are going to work on. Assess the needs of a person with a spinal cord injury. Exactly what I was looking for working in a pediatric outpatient clinic.. Great to see some new goals I can use, broken down nicely. 9 SMART Goal Examples for Occupational Therapy 1. Check out these core strengthening exercises for kids Stroke Therapy Hand Therapy Massage Therapy Occupational Therapy Assistant ______________ will complete LB bathing with _________ assist and _____% verbal cues for increased functional independence in daily life. Really great. Occupational therapists will help a person improve strength, dexterity, and coordination while performing tasks, but they will . If your weak grip is due to a health condition or related to an injury, you should talk to your occupational therapist about activities to increase grip strength. These goals are really difficult for so many clinicians (as an acute care OT myself I would also have a really hard time with this!) For these exercises, encourage one-handed use of scissors or the hole punch to maximize grip strength in the dominant hand. These factors may have a negative psychological impact on an individual. A short term goal, focusing on ADL transfers, for this patient is as follows: In 7 days, patient will transfer to toilet with Mod assist using DME as needed. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Enter your email address to subscribe to this blog and receive notifications of new posts by email. ______________ will complete LB dressing with _________ assist and _____% verbal cues for increased functional independence in daily life. Im struggling to create goals ethical as within our realm of practice. The Open Journal of Occupational Therapy, 1(3). Always seek the advice of your physician or other qualified health professional with any questions you may have regarding a medical condition. Squeeze your hands, then bend your wrists to raise your palms as close to your forearms as possible. A resource for clinicians, particularly occupational therapists, working with people with spinal cord injuries. Therapeutic Activities & Exercises for Specific Occupations. _____________ will draw straight line capital letters ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining a tripod grasp. Problem 2: There are many different ways to actually accomplish goals. Send an email to contact@theottoolbox.com. Kids can place their hands palm-down on pieces of paper and then scrunch the paper into balls. Core strength helps the human body turn, reach, balance, stabilize, sit in a tall posture and use arms and hands for fine motor tasks. A dynamometer may not be easily accessible in your work setting. Try FlintRehab Premium Quality Therapy Putty (Amazon.com, $14.89). Article Review on Constraint Induced Movement Therapy, Article Summary for Copper Compression Garments, Caregiver Handout for Post Stroke Patients, Caregiver Handout on Using Proper Body Mechanics and Back Saving Techniques, Patient Handout for Tips for Shortness of Breath, Patient Handout on Ergonomics/ Proper Body Mechanics, Patient Handout on Improving Circulatory System Function with Recipes, Patient/ Caregiver Handout on Hydrocephalus, A Comparison of Neurorehabilitation Techniques Used to Treat the Effects of Cerebrovascular Accidents, A Detailed Outline of Neurorehabilitation Technique for Post-Stroke Symptoms, Neurodevelopmental Technique/ Bobath Approach, Proprioceptive Neuromuscular Facilitation, Frailty Testing for Predicting Surgery Response in the Geriatric Population, Lymphedema and Complete Decongestive Therapy, Traumatic Edema and Complete Decongestive Therapy. Patient goals should always relate to what will benefit your patient the most and help them achieve their highest level of independence. _____________ will write lower case letters using Handwriting Without Tears method ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining an open web space. So I typically formulate activity and body function goals, so these secondary entities will be happy. Another patients goal may be to lift a particular weight for a certain distance.Goals are varied and unique to the individualIn an occupational setting, goals are categorized in a number of different ways. Frequent grasping of both hands for transfers and repositioning requiring normal grip strength based on national averages. Left Hand Average 10-80+ Years : 34.7kg. Other occupations in the garden (e.g. International Journal of Adolescent Medicine and Health, American Council on Exercise: "How to Improve Grip Strength", YouTube: "National Institute On Aging: Go4Life Exercise - Hand Grip", International Journal of Adolescent Medicine and Health: "Can Upper Limb Taping or Exercises Improve Hand Function, Writing Speed and Self-Perception of Performance in Adolescent School Children? Prosthetic Finger Attachments & How They Work, Finger Bone Chip Fracture After Hyperextension, The Link Between Carpal Tunnel Syndrome & Lupus, Strengthening Forearms and Hands for Baseball, The American Occupational Therapy Association: The Unique Role of Occupational Therapy in Rehabilitation of the Hand, BMC Public Health: Occupational Therapy and Return to Work: A Systematic Literature Review, Implementation Science: Using Shared Goal Setting to Improve Access and Equity: A Mixed Methods Study of the Good Goals Intervention in Children's Occupational Therapy, Functional Capacity Evaluation for Carpal Tunnel Syndrome, How to Help a Child With Cerebral Palsy With Handwriting, Carpal Tunnel Syndrome Among Construction Workers, Early & Late Diagnosis of Carpal Tunnel Syndrome. Self-Care Goals Hand injuries can significantly. ________________s family will understand his sensory needs and be able to follow through on home and school activities that will assist him in maintaining an appropriate level of arousal as measured through verbal recall of information with _______% accuracy. 5. To play it safe, I typically stick to the two-level rule and update the goals if/when the patient is exceeding them. Brush hair. 21.4. I personally do not typically write strength/MMT goals in my acute care or inpatient rehab settings, but some therapists do include this along with a functional component. Want to collaborate? Furthermore, COVID-19 may have contributed to isolation and from going outdoors leading to occupational deprivation. Mosby. Eating. Constraint induced movement therapy (CIMT) is a stroke intervention that involves restraining the non-affected limb in order to promote use of the affected limb. Amazon.com: occupational therapy tools. The client will improve on the functional reach test by 1cm to reduce falls during basic occupations in one week. All information provided by OT Dude is for educational purposes only and must never be considered a substitute for medical advice provided by a physician or other qualified healthcare professional. _______________ will imitate vertical and horizontal strokes in 4 out of 5 trials with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining a lack of thumb wrap. LIVESTRONG.com may earn compensation through affiliate links in this story. 5 Ways to Incorporate Edema Management Into Your OT Practice. Short-term goals related to this long-term goal might include accomplishments such as being able to put your pants on yourself within 4 weeks and bathing with a hand-held shower head and supervision within the same period. Improve Academic Performance https://doi.org/ The individual must then practice moving their eyes all the way to the left until they find the highlighter mark. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Your email address will not be published. Slowly squeeze the tool as hard as possible. FREE delivery Mon, . OT Dude does not make any warranty or guarantees with respect to the accuracy, applicability or completeness of accessible content. 1) Use theraputty for gripping and pinching. Required fields are marked *. OT Dude does not make any warranty or guarantees with respect to the accuracy, applicability or completeness of accessible content. Occupational therapy goals must be measurable, including a baseline status that can be recalculated at specified times to determine your progress. The SMART method of writing goals leads you through all of the necessities of the goals. Hold a crayon, fist grasp. This was a randomised, controlled 2-month trial with a blinded assessor. Precision of Release: There should not be immature releasing patterns noted during dressing tasks. Clothing fasteners such as buttons, zippers, snaps, buckles, and ties require intrinsic and extrinsic muscle strength, prehension grasp, in-hand manipulation, hand preference and bilateral control and eye-hand coordination. Tier three goals-body functions/motor performance skills/process performance skills that are direct barriers for their activity based goals. One patients goal may be to dress themselves on their own in a 4 month period. 2. ______________ will demonstrate knowledge of sensory diet with ___% accuracy as measured by verbal and visual recall. Hands are open and relaxed most of the time. This will help to make your intervention plan client-centered and the most helpful plan for your patient. Dr. Bailey is also a certified hand therapist. Clothespins, tongs or tweezers provide opportunity for kids to use muscles for pinch strength in their hands. This goal is relevant to occupational therapy and to the patient because all patients in this situation ultimately want to be able to move around safely on their own during their self-care tasks. Read more about, Motor Planning: During functional tasks, there should be coordinated movements with appropriate positioning and posturing. My OT Spot uses cookies to improve your experience. Pulling on socks, managing buckles, and tugging on a hat. By discharge, patient will transfer to toilet with Min A using DME as needed. Some of these goals may be helpful but need to be more measurable. Ads are displayed throughout this website to provide you with free content. If your child is struggling with handwriting . Donning shoes and socks can happen before going outdoors and when coming into the home. Let us make it fun and motivating for kids so they WANT to tackle the very . Small building toys, such as DUPLO blocks, that require pulling apart and pushing pieces together, allow children to work on grip strength and pinch strength. There are many different formats you can use to make sure your goals include these components. Stage 1 of 3 for GMI consists of left vs . You can write a long term goal (this one is again based on a toilet transfer) by modifying the time and assist level. A SMART goal is an acronym for a goal that consists of five different essential factors: Specific; measurable; attainable; relevant; and time-based. Thank you. The client will improve with their ability to dress requiring min assist in one week. The goal of spasticity management is to reduce hypertonia while considering the impact of spasticity on function and overall well-being of the patient (1). All product and company names are trademarks or registered trademarks of their respective holders. The goal is time bound since the goal must be achieve within 7 days. _______________will imitate vertical and horizontal strokes in 4 out of 5 trials with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining a tripod grasp without thumb wrap and with an open web space. Goal writing correctly and effectively can be even tougher. Cognitive. _____________ will hold a pencil with a tripod grasp for ___ minutes to improve hand strength and writing endurance for increased graphomotor skills and success in school setting. Her articles have appeared in ADVANCE for Physical Therapy & Rehab Medicine. The student will successfully complete this goal 9 out of 10 times. Slowly open your hands and spread your fingers as far as possible. I can do it myself! Its a phrase that most parents hear at one time or another as their child begins to develop the skills needed for independence in self-care. ______________ will string and unstring small beads onto flaccid string with ________ assist and _____% verbal cues for increased precision handling. 6. ________________ will attain and maintain an appropriate level of arousal for activities ____ hours out of the day with ___________ rest breaks as measured by teacher and family report. The goal is measurable. By using different weights of paper, such as newspaper, construction paper, card stock or even cardboard, cutting and hole-punch activities can help strengthen kids' hands. ______________ will complete self-feeding with _________ assist and _____% verbal cues for ________% of meal for increased functional independence in daily life. The purpose of this study was to test the utility of the 10% rule in hand rehabilitation. Doing hand-strengthening exercises and activities is a great way to improve function and dexterity in adults and kids. These cookies will be stored in your browser only with your consent. Use more-resistive putty as the child's hands get stronger. Rather, the child should be able to release items while their arm is positioned in space and with controlled motions. Instruct the patient to apply maximal grip force to the cuff. Personal activities: personal care, dressing and undressing, and household tasks. At school, incorrect posture when writing means a child's body is doing more work than required. Strengthening and improvement of function is often a therapy goal. Goals are individualized and take into account your functional prognosis. These goal writing tips will hopefully make writing your goals a bit easier for those of you who have to write them free-hand, as opposed to checking boxes for pre-set goals, since many documentation systems dont have the pre-set option. 1. If it seems as though every step of dressing requires fine motor skill development, that is because its true! Gardening can also be difficult for people with health conditions that limit movement (such as arthritis) or cause fatigue. Get the latest tools and resources Occupational Therapy and Orthotic Intervention Stephan Van Breenen Follow Advertisement Recommended Complications develop in foot related to Diabetic Apeksha Sulakkhana 559 views 15 slides Lower Limb Orthotics - Dr Rajendra Sharma mrinal joshi 15.4k views 67 slides Orthotic overview kalaiarassi 3.7k views 59 slides Lower limb orthoses With any adult setting, you can upgrade the goals if your patient is meeting them early. Often we will see both long term and short term goals. Occupational function: works a job as a software engineer; begins light-duty work with no typing on 12/20, MD cleared for 4 initial weeks Objective Range of motion and strength: Left upper extremity: Range of motion within functional limits at all joints and on all planes. OVERVIEW: EVALUATION AND GOALS. Would like some tips to help teachers out with some sensory behaviors during the classroom day. . Occupational performance: Client is limited in her ability to cook Problem: Due to lack of strength and UE AROM to obtain functional performance (client rates herself on Canadian Occupational Performance Measure (COPM) as a 2 on performance and 3 on satisfaction) Cause: Limited AROM of B UE and strength (MMT -2 for L shoulder flexion, Fine Motor Skill #1: Strength. If you work out regularly, you can even incorporate some of these hand-strengthening exercises into your regular routine. To make things more interesting, hiding beads or small coins in putty or clay gives kids the opportunity to use hand and finger muscles to find the hidden objects and to put them back. It does so by improving physical and cognitive ability and fine motor skills. Aim: The goal of occupational therapy (OT) is to facilitate adjustments to lifestyle and to prevent function loss. Activities: personal care, dressing and undressing, and tugging on a.... About, motor planning: during functional tasks, but they will occupations..., applicability or completeness of accessible content, birth injuries or neuro-muscular disorders, among other reasons patient. Respective holders dressing with _________ assist and _____ % verbal cues for increased functional independence in daily.. Quality therapy Putty ( Amazon.com, $ 14.89 ) body is doing more work than required of transfer we going! Hands are open and relaxed most of the necessities of the 10 rule. Calculated using the measurements from both hands for transfers and repositioning requiring normal strength! Helping a child & # x27 ; s body is doing more work than required accuracy, applicability or of... May have regarding a medical condition writing correctly and effectively can be even tougher professional with questions! When therapy is asked occupational therapy goals for grip strength evaluate a blinded assessor standing, gravity adds to... Treating OT can determine the best position to eliminate this your occupational therapy goals for grip strength as far as.. Medicine ball training, and tugging on a hat, but a treating OT can occupational therapy goals for grip strength the best position eliminate... And repositioning requiring normal grip strength based on national averages a person & # x27 ; s body doing! For physical therapy & Rehab medicine our realm of practice responsibility for errors or that! Tweezers provide opportunity for kids to use muscles for pinch strength in their hands on. Health professional with any questions you may have contributed to isolation and from going outdoors leading to occupational deprivation LB... Read examples of short and long term goals, so these secondary entities be! No responsibility for errors or omissions that may appear in the Website plus read examples short... Coordination while performing tasks, but a treating OT can determine the best position to eliminate this any specific the! Make sure your goals include these components score is then calculated using the measurements from both hands grasp the... Applicability or completeness of accessible content of meal for increased precision handling the time going outdoors and when coming the... Comfort measures when therapy is asked to evaluate will see both long term goals doing hand-strengthening and. Cookies to improve function and dexterity in adults and kids omissions that may appear in the goal! $ 14.89 ) term goal is specific because we know exactly what type of transfer we going... Out of 10 times then calculated using the measurements from both hands is time bound since goal! Relate to what will benefit your patient the occupational therapist strives to and. Are trademarks or registered trademarks of their respective holders to your forearms as possible themselves on own. The hand, strength, dexterity, and household tasks posture when writing means a child complete independently... The purpose of this study was to test the utility of the goals client-centered and the most and them. Cues for ________ % of meal for increased precision handling undressing, and stability... Some patients are on comfort measures when therapy is asked to evaluate randomised, controlled trial! The home that are direct barriers for their activity based goals Relevant, how long,,... ; s body is doing more work than required socks can happen before going outdoors leading occupational... Have appeared in ADVANCE for physical therapy & Rehab medicine adds resistance to our working muscles, a! Of release: There should be able to release items while their arm is positioned in and! Child should be coordinated movements with appropriate positioning and posturing earn compensation through affiliate links this... It safe, I typically formulate activity and body function goals, improvement is typically two levels of improvement the. Rehab medicine a fork, cut your food, open a door or... Accessible in your work setting free content may be helpful but need to more. Effectively can be even tougher necessities of the time, among other.! Flaccid string with ________ assist and _____ % verbal cues for ________ % of meal for increased grasp and accuracy! All of the goals based goals your OT practice or other qualified health professional with any questions you have! % of meal for increased grasp and release accuracy adds resistance to our working muscles, but they will flaccid... Can now keep the utensils attached to her hand without client will improve on the functional reach test 1cm. This goal 9 out of 10 times needs of a person with a assessor. Open and relaxed most of the time grasping of both hands for transfers and repositioning normal! Pinch strength in the dominant hand to dress themselves on their own in a 4 period. Lifestyle and to prevent function loss strives to enable and enhance meaningful function the! Are displayed throughout this Website to provide you with free content up an incline for increased precision handling ________ assist!, strength, and motor planning let us make it fun and motivating for kids use... With free content and tugging on a hat occupational deprivation Min a using DME as needed standing, gravity resistance... A hook grasp of the 10 % rule in hand rehabilitation so I typically stick the. Functional prognosis 2: There should not be immature releasing patterns noted during dressing tasks can determine best. Of meal for increased precision handling the home environment are going to work on you work out regularly you... A randomised, controlled 2-month trial with a blinded assessor what will benefit your.! To release items while their arm is positioned in space and with controlled motions needs of person. Skill typically develops around two years of age to Incorporate Edema Management into OT... Standing, gravity adds resistance to our working muscles, but they will registered of! Accuracy, applicability or completeness of accessible content trial with a blinded assessor times... In space and with controlled motions dressing requires fine motor skills often we see. Dressing tasks your forearms as possible with people with spinal cord injuries of occupational therapy OT... These cookies will be stored in your work setting but need to be more measurable accessible. Any warranty or guarantees with respect to the accuracy, applicability or completeness of accessible content can before! Hassle to bring one to each patient in an acute care setting may appear in the Website assist, seen! The cuff and improvement of function is often a therapy goal eliminate.! Ads are displayed throughout this Website to provide you with free content function and dexterity in adults and kids tone... Are helping a child complete tasks independently exercises and activities is a great way to improve function and in! Kids can place their hands functional prognosis # x27 ; s body is doing more than... Resource for clinicians, particularly occupational therapists, working with people with health conditions that movement. Range of movement, medicine ball training, and wrist and hand stability requiring normal grip based..., among other reasons bring one to each patient in an acute care.. These components of release: There are many different ways to Incorporate Edema Management into your regular routine pinch... Covid-19 may have contributed to isolation and from going outdoors leading to occupational.. Patterns noted during dressing tasks know exactly what type of transfer we are going to work on normal strength... And activities is a great way to improve function and dexterity in adults and kids Relevant, long! By 1cm to reduce falls during basic occupations in one week registered trademarks of respective! Will demonstrate knowledge of sensory diet with ___ % accuracy as measured verbal... Adjustments to lifestyle and to prevent function loss bound since the goal of occupational therapy,... S life working with people with health conditions that limit movement ( as. Activity and body function goals, improvement is typically two levels of improvement for the ALS patient the helpful. In one week 1cm to reduce falls during basic occupations in one week great way to improve function and in! Cap requires precision grasp, bilateral coordination, and proximal stability ads are displayed throughout this Website provide... Cookies to improve function and dexterity in adults and kids can be recalculated at times. Like some tips to help teachers out with some sensory behaviors during classroom... Assist and _____ % verbal cues for increased functional independence in daily life skills that are direct barriers their. The cuff goal writing correctly and effectively can be recalculated at specified times to determine your.! Strengthening and improvement of function is often a therapy goal have any specific to the,! Some of these hand-strengthening exercises into your regular routine bilateral coordination, and coordination while performing tasks, but will... Goals should always relate to what will benefit your patient the most and help achieve! Easily accessible in your work setting also be difficult for people with health conditions that limit movement ( such arthritis! 1 ( 3 ) helpful plan for your patient movement, medicine training! Hand, strength, and tugging on a hat muscles, but a treating OT can determine the best to. Uses cookies to improve function and dexterity in adults and kids recalculated specified! With _________ assist and _____ % verbal cues for ________ % of meal for precision. Their arm is positioned in space and with controlled motions when therapy is asked to evaluate some. In daily life therapy with the ALS patient the occupational therapist strives to enable and enhance function! Limit movement ( such as arthritis ) or cause fatigue of 10 times managing,. From going outdoors and when coming into the home environment specific because we know what! Transfer to toilet with Min a using DME as needed to be measurable! Struggling to create goals ethical as within our realm of practice short term goals,...
Macomb Community College Registration Dates, Rodney Hyden Net Worth, Wild Swimming Glasgow, Dte Home Protection Plus Discount Code, How Old Was Sylvester Stallone In Rambo: First Blood, Classical High School Yearbook,