1. Rehabilitation
care given by a specialist to restore or improve function after an illness or injury.
Rehabilitation seeks to move the resident from:
Illness to health
Disability to ability
Dependence to independence

2. The goals of rehabilitation are as follows:
Help resident regain abilities or recover from illness.
Develop and promote a resident’s independence.
Allow resident to feel in control of his or her life.
Help resident accept or adapt to limitations of a disability.
Observe and report the following:
Increase or decrease in abilities
Change in attitude or motivation
Change in general health
Signs of depression or mood changes

3. Assisting with Rehabilitation and Restorative Care
Be patient.
Be positive and supportive
Focus on small tasks and small accomplishments.
Recognize that setbacks occur.
Be sensitive to the resident’s needs.
Encourage independence.

4. REMEMBER:
It is very important for NAs to encourage residents’ independence while assisting with or performing all tasks.
Why?

5. These are some problems that may result from a lack of mobility:
Loss of self-esteem
Depression
Illnesses such as pneumonia or UTI
Constipation
Blood clots
Dulling of senses
Muscle atrophy and contractures
Increased risk of pressure sores

6. What did rehabilitation mean?

7. Regular Ambulation and Exercise
Regular ambulation and exercise help improve:
Health of skin
Circulation
Strength
Sleep and relaxation
Mood
Self-esteem
Appetite
Elimination
Blood flow
Oxygen level

8. Define the following terms:
Ambulation
walking.
Adaptive/assistive devices
special equipment that helps a person who is ill or disabled to perform ADLs.
REMEMBER:
Check the care plan before helping a resident to ambulate.
Keep the resident’s limitations in mind.

9. Remember the following guidelines for cane or walker use:
Make sure cane or walker is in good condition.
Make sure resident is wearing securely fastened non-skid footwear.
Resident should place cane on stronger side.
Resident should place both hands on the walker and walker should be placed no more than 12 inches in front of resident.
Stay near resident on weaker side.
Do not hang purses or clothing on walker.
Report to nurse if cane or walker seems to be the wrong height.

10. Name 3 things that exercise helps improve.

11. 1. Wash your hands. Provides for infection control.
Assisting with ambulation for a resident using a cane, walker, or crutches
Equipment: gait belt, non-skid shoes for resident, cane, walker, or crutches
1. Wash your hands. Provides for infection control.
2. Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.
3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence.

12. Assisting with ambulation for a resident using a cane, walker, or crutches (cont’d.)
Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity.
Before ambulating, properly fasten non-skid footwear on resident. Promotes resident’s safety. Prevents falls.
Adjust bed to a low position. Lock bed wheels. Assist resident to sitting position with feet flat on the floor. Prevents injury and promotes stability.

13. Stand in front of and face resident.
Assisting with ambulation for a resident using a cane, walker, or crutches (cont’d.)
Stand in front of and face resident.
Brace resident’s lower extremities. Bend your knees. Place one foot between the resident’s knees. If resident has a weak knee, brace it against your knee. Promotes proper body mechanics. Reduces risk of back injury.
Place gait belt around resident’s waist over clothing (not on bare skin). Grasp the belt on both sides, while helping resident to stand as previously described. Promotes resident’s safety.

14. Help as needed with ambulation.
Assisting with ambulation for a resident using a cane, walker, or crutches (cont’d.)
Help as needed with ambulation.
a. Cane. Resident places cane about 12 inches in front of his stronger leg. He brings weaker leg even with cane. He then brings stronger leg forward slightly ahead of cane. Repeat.
b. Walker. Resident picks up or rolls the walker. He places it about 12 inches in front of him. All four feet or wheels of the walker should be on the ground before resident steps forward to the walker. The walker should not be moved again until the resident has moved both feet forward and is steady. The resident should never put his feet ahead of the walker. Promotes stability and prevents falls.

15. Assisting with ambulation for a resident using a cane, walker, or crutches (cont’d.)
Crutches. Resident should be fitted for crutches and taught to use them correctly by a physical therapist or nurse. The resident may use the crutches several different ways. It depends on what his weakness is. No matter how they are used, weight should be on the resident’s hands and arms. Weight should not be on the underarm area.
Walk slightly behind and to one side of resident. Stay on the weaker side if resident has one. Hold the gait belt if one is used. Provides security.

16. Assisting with ambulation for a resident using a cane, walker, or crutches (cont’d.)
Watch for obstacles in the resident’s path. Ask the resident to look ahead, not down at his feet. Promotes resident’s safety. Prevents injury.
Encourage resident to rest if he is tired. When a resident is tired, it increases the chance of a fall. Let resident set the pace. Discuss how far he plans to go based on the care plan. Prevents falls.
After ambulation, remove gait belt. Help resident to a position of comfort and safety.

17. Assisting with ambulation for a resident using a cane, walker, or crutches (cont’d.)
Walk slightly behind and to one side of resident. Hold the transfer belt if one is used. Provides security.
Watch for obstacles in the resident’s path. Ask the resident to look ahead, not down down at his feet. Promotes resident’s safety. Prevents injury.
Encourage resident to rest if he is tired. When a resident is tired, it increases the chance of a fall. Let resident set the pace. Discuss how far he plans to go based on the care plan. Prevents falls.

18. Leave bed in lowest position. Remove privacy measures.
Assisting with ambulation for a resident using a cane, walker, or crutches (cont’d.)
Leave bed in lowest position. Remove privacy measures.
Place call light within resident’s reach. Allows resident to communicate with staff as necessary.
Wash your hands. Provides for infection control.

19. Assisting with ambulation for a resident using a cane, walker, or crutches (cont’d.)
Report any changes in resident to nurse. Provides nurse with information to assess resident.
Document procedure using facility guidelines. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

20. Proper Body Alignment
Observe principles of alignment.
Keep body parts in natural positions.
Prevent external rotation of hips.
Change positions frequently, at least every two hours.
Have plenty of pillows available to provide support in the various positions.
Use positioning devices.
Give back rubs as ordered.
REMEMBER:
Proper body alignment aids recovery and prevents injury to muscles and joints.

21. Remember these guidelines for caring for a prosthesis:
Be supportive.
Help with ADLs.
Handle prostheses carefully and follow care plan.
Follow nurse’s or therapist’s instructions for application and removal. Follow manufacturer’s care directions.
Keep prosthesis and the skin under it clean and dry.
Apply stump sock if ordered.
Observe skin on stump and watch for signs of breakdown.
Understand that phantom sensation is real pain.

22. Guidelines for caring for a prosthesis (cont’d.):
Never try to repair a prosthesis. Report problems.
Never display negative feelings about prosthesis or stump during care.
If caring for an artificial eye, never clean or soak the eye in alcohol - it will crack and destroy it.
Store artificial eye in water or saline. Mark container with resident’s name and room number.
Make sure resident with hearing aid wears it and that it is working properly.

23. Define the following terms:
Range of motion (ROM) exercises
exercises that put a joint through its full arc of motion.
Abduction
moving a body part away from the body.
Adduction
moving a body part toward the body.
Dorsiflexion
bending backward.
Rotation
turning a joint.

24. Define the following terms:
Extension
straightening a body part.
Flexion
bending a body part.
Pronation
turning downward.
Supination
turning upward.

25. Body Movements

26. The NA has a different role in each type of ROM exercise:
PROM: NA does all the work and resident does none.
AROM: NA encourages, but resident does all the work.
AAROM: NA assists and supports the resident in doing the work.

27. What is it called when you move a body part away from the torso?

28. NAs can assist in bowel and bladder retraining in these ways:
Follow Standard Precautions.
Explain and follow training schedule.
Keep record of bowel and bladder habits. This will help you predict when a resident will need to eliminate.
Offer a commode or a trip to the bathroom before long procedures.
Encourage plenty of fluids.
Encourage foods that are high in fiber.
Answer call lights promptly.
Provide privacy both in the bed and in the bathroom.
If resident has trouble urinating, try running water in the sink or suggest she lean forward slightly.

29. Assisting in bowel and bladder retraining (cont’d.):
Never rush resident.
Assist with good perineal care.
Discard wastes properly.
Discard incontinence briefs and clothing protectors properly.
If your facility uses washable bed pads or briefs, follow Standard Precautions when handling these items.
Keep an accurate record of urination and bowel movements, including episodes of incontinence.
Never show frustration or anger.

30. Think about this question:
How would you feel if you were unable to control elimination?