Rehabilitation and Therapeutic Modalities Chapter 33 Rehabilitation and Therapeutic Modalities

Role of MA in Rehabilitation Whatever the rehabilitation setting, you will most likely be a member of interdisciplinary team of health care professionals Provider responsible for prescribing rehabilitative medicine (See Table 33-1: Some of the Specialized Fields of Rehabilitation Medicine)

Role of MA in Rehabilitation Patients may have sustained tremendous loss of physical ability May be vulnerable to feelings of helplessness May be able to perform only limited activities of daily living (ADL) May be completely dependent on another for help Respect their dignity Patients’ safety essential

Principles of Body Mechanics Practice of using certain key muscle groups together with good body alignment and proper body positioning to reduce risk for injury to both patient and caregiver

Principles of Body Mechanics Posture Protects entire body, particularly the back, whether standing, sitting, lying down Central idea of good posture is body alignment Standing: body should be balanced Sitting: keeping spine in neutral position Lying down: maintaining spine in neutral position

Using the Body Safely and Effectively Keep back as straight as possible and feet shoulder-width apart Always bend from hips and knees Pivot entire body instead of twisting it Use body’s weight to push or pull heavy object

Using the Body Safely and Effectively Obtain help if unable to move patient or object is too heavy Hold heavy objects close to body Make sure path is clear and area to receive object is ready before lifting or moving it Wear body support if job includes much lifting

Using the Body Safely and Effectively Lifting techniques Get close to object or person being lifted Keep feet apart, one slightly in front of the other, knees slightly bent Use large muscles of legs and arms to lift, not back muscles

Using the Body Safely and Effectively Lifting techniques Keep back straight to transfer workload to larger arm and leg muscles Avoid twisting movements Bend from hips and knees, squat down, push up with leg muscles

Transferring Patients Use good body mechanics From wheelchair to examination table From examination table to wheelchair [INSERT FIGURE 33-3] (See Procedure 33-1: Transferring Patient from Wheelchair to Examination Table) (See Procedure 33-2: Transferring Patient from Examination Table to Wheelchair)

Assisting Patients to Ambulate Walking provides ultimate level of independence and freedom Make sure patient is ready to walk Patient should be wearing good shoes that are flat, supportive, have rubber sole Handholds or railings within easy reach Gait belt provides firm hold on patient

Assisting Patients to Ambulate Monitor patient Ambulate as long as patient has strength Never push patient beyond endurance Never hurry patient Be ready should patient start to fall (See Procedure 33-3: Assisting the Patient to Stand and Walk) (See Procedure 33-4: Care of the Falling Patient)

Assistive Devices Walking aid such as walker, crutches, cane Provide stability and support Type of device depends on disability and patient’s recuperation curve MAs measure patient for correct size and provide instruction in proper use and care (See Table 33-2: Types of Assistive Devices)

Assistive Devices Walkers Provide stability and support when patients standing or walking Ability to ambulate independently with confidence Various styles available Stationary Rolling

Assistive Devices Fitting a walker Height of handgrip adjusted to patient just below patient’s waist or at top of femur Elbow bent at 30-degree angle when patient standing with hands on handgrip (See Procedure 33-5: Assisting a Patient to Ambulate with a Walker)

Assistive Devices Crutches Types prescribed depending on patient’s physical limitations and abilities: Axillary Forearm (Lofstrand or Canadian) Platform Measuring for axillary crutches (See Procedure 33-6: Teaching the Patient to Ambulate with Crutches)

Assistive Devices Crutch-walking gaits Gait (walk) patient uses depends on patient’s injury and condition Two-point Three-point Four-point alternating Swing-to Swing-through Sitting  Standing

Assistive Devices Canes Used when patient has one weak side Need this device for longer period than crutches Standard, or single-tipped Four-legged, or quad Walkcane (See Procedure 33-7: Assisting a Patient to Ambulate with a Cane)

Assistive Devices Wheelchairs Mobile chairs that enable patients with severe ambulation conditions, or no ability to ambulate at all, to get around Manual or motorized

Therapeutic Exercises Range of motion Amount of movement present in a joint Passive (assisted motion) Active (voluntary motion) Goniometry: measurement of joint motion ROM exercises designed to maintain joint mobility Joint movement has special vocabulary (See Table 33-3: Terminology of Joint Movement)

Therapeutic Exercises Muscle testing Evaluates motion, strength, task potential of a given muscle Types of therapeutic exercise Active Passive Assisted Active resistance

Therapeutic Exercises Electromyography Test electrical activity of muscle Electrostimulation of muscle Stimulates muscles to exercise Helpful to nerve-damaged muscle Prevent atrophy of muscle; help restore muscle function Transcutaneous electric nerve stimulation (TENS)

Therapeutic Modalities Heat and cold Heat (thermotherapy) Acts on body by causing vasodilation Also acts to speed up inflammatory process Should not be used longer than its prescribed length of time

Therapeutic Modalities Heat and cold Cold (cryotherapy) Constricts blood vessels and slows or stops flow of blood to area (vasoconstriction) Slows down inflammatory process Take precautions for heat and cold applications

Therapeutic Modalities Moist and dry heat Moist heat therapies Warm soaks Sitz bath Warm wet compresses and packs Paraffin wax bath Dry heat therapies Heating pads and packs

Therapeutic Modalities Moist and dry cold Moist cold therapies Cold compresses and packs Dry cold therapies Ice packs

Therapeutic Modalities Ultrasound High-frequency acoustic vibration Uses high-frequency sound waves converted to heat in deeper tissues Treatment for chronic pain or acute injuries Potential dangers

Therapeutic Modalities Massage therapy Used to relieve minor aches and pains Safe and advantageous for most individuals Relieves stress and tension Complementary or alternative form of medicine