Chapter 18 Therapeutic Exercise for Rehabilitation

Rehabilitation The process of recovering from an injury through treatment and education Designed to help injured patients regain maximum function, a sense of well- being, and the highest level of independence possible 2

The Rehabilitation Team Physician Physical therapist Athletic trainer Strength and conditioning specialist Physical therapy assistant Physical therapy aide 3

The Rehabilitation Team Patient’s family Teammates and coach The patient 4

The Rehabilitation Environment Successful physical rehabilitation Requires more than medical care Requires belief in a positive outcome Rehabilitative environment should reflect a sense of competence and optimism 5

The Rehabilitation Environment To create an optimal environment for healing, address these considerations: Patient safety Patient environment Patient comfort Staff conduct and professionalism 6

The First Session Patient History Consists of age, past illnesses, inherited conditions, previous therapies, and information about prescribed medications Lists any precautions associated with the patient’s condition Contains facts important to rehabilitation process 7

The First Session Motivating the Patient Greet the patient with a smile. Dress professionally to suit the work environment. Use the patient’s name frequently throughout the treatment session. Express understanding of the nature of the patient’s injury. 8

The First Session Motivating the Patient Make sure the patient understands what is causing the condition. Convey confidence about the physical therapy procedure to the patient. Explain the objectives of the physical therapy to the patient. 9

The First Session Motivating the Patient Point out improvements the patient can watch for while going through the physical therapy sessions. Suggest and/or organize group activities for the patient. Always provide clear and simple directions. Maintain a positive attitude about the techniques used. 10

The First Session Motivating the Patient Provide a clean, organized, and pleasant rehabilitative environment. Always give the patient full attention. Present a professional attitude. Stay in good health in order to display a positive example to the patient and co-workers. 11

Posture and Joint Assessment Proper body alignment is vital to the functioning of the body’s muscles and joints. Patients with poor body alignment Limited in normal movements Joints and tissues surrounding them become stressed 12

Posture and Joint Assessment Active participants in the rehabilitative process must be able to assess a patient’s ability to move and the ways in which body alignment may be affecting that movement. 13

SOAP Notes in Documentation SOAP acronym Subjective findings Objective findings Assessment Plan 14

SOAP Notes in Documentation SOAP notes A concise, easy-to-read method of documenting the patient’s health status Efficient means of recording the patient’s progress as well as difficulties encountered along the way Organized method of communication to other team members 15

Subjective Findings “S” in SOAP is for subjective findings Information about patient and treatment Examples: A family member mentions that the patient is unmotivated at home Patient complains of nausea Patient mentions feeling depressed Patient thinks the coach is pushing too hard for the patient to return to playing 16

Objective Findings “O” in SOAP is for objective findings Documents things that are observable and measurable Examples: Patient ambulates with walker 150 feet Patient refuses treatment for past three days Patient becomes tired when walking, requiring frequent rest 17

Assessment Notes “A” in SOAP is for assessment notes Licensed professional’s opinions of the patient’s condition, progress or obstacles to rehabilitation Examples: Patient seems depressed Patient seems anxious to go home Patient has soreness from custom brace Patient’s balance is now fair 18

Plan “P” in SOAP is for plan States what the rehabilitation team wants to accomplish with the patient in terms of long- and short-term goals Examples: Advance the patient to the use of a cane this week (as able) Make arrangements to go to a local gym Continue to encourage patient’s participation in exercises 19

The Phases of Physical Rehabilitation Successful rehabilitation Complex process that can vary in length of time to complete; depends on severity of the injury and degree of function that must be regained Other variables such as type of health insurance, access to care, etc., also impact success of the program. 20

The Phases of Physical Rehabilitation Three phases of healing must take place in order for the patient to resume pre-injury activities. Phase I: Control inflammation Phase II: Repair Phase III: Remodel 21

Patient Education Patients must be educated about their rehabilitation How they can speed recovery How they can protect the injury What kind of progress they can expect 22

Patient Education Ongoing communication is vital. Patient must be informed of many aspects of rehabilitation Activities of daily living Specific activities to mobilize patients and to help them regain the ability to function in their daily lives using their own capabilities 23

Patient Education Proper body mechanics Nutritional needs to help healing Use of such aids as crutches 24