1. ASSISTING WITH EXERCISE CHAPTER 23 ASSISTING WITH REHABILITATION

2. BEDREST ORDERED TO: REDUCE PHYSICAL ACTIVITY REDUCE PAIN
ENCOURAGE REST
REGAIN STRENGTH
PROMOTE HEALING
MAY BE ON:
COMPLETE (STRICT) BED REST
BEDREST WITH BATHROOM PRIVILEDGES (BRP)

3. COMPLICATIONS OF BEDREST
CONTRACTURES
CAUSED BY ABNORMAL SHORTENING OF A MUSCLE
MUSCLE IS FIXED IN POSITION, IS DEFORMED, AND CAN NOT BE MOVED
THE PERSON IS PERMANENTLY DEFORMED
ATROPHY
DECREASE IN THE SIZE OR THE WASTING AWAY OF MUSCLE TISSUE

4. COMPLICATIONS OF BEDREST
ORTHOSTATIC HYPOTENSION
ABNORMALLY LOW BLOOD PRESSURE WHEN THE PERSON STANDS UP TO SUDDENLY
WHEN YOU STAND TOO QUICKLY, THE BLOOD PRESSURE DROPS.
THE PERSON MAY FEEL DIZZY, WEAK, HAVE SPOTS BEFORE THE EYES

5. SUPPORTIVE DEVICES
HAND ROLLS PREVENT CONTRACTURES OF THE FINGERS AND WRIST
WHAT CAN YOU USE IF YOU DO NOT HAVE A HAND ROLL?

6. SUPPORTIVE DEVICES FOOTBOARD BED CRADLE
PLACED SO THE SOLES OF THE FEET ARE FLAT AGAINST IT
BED CRADLE
KEEPS THE WEIGHT OF THE TOP LINEN OFF THE FEET AND TOES
THE FOOT IS BENT DOWN
PLANTAR FLEXION

7. SUPPORTIVE DEVICES TROCHANTER ROLL HIP ABDUCTION WEDGE
PREVENTS THE HIP AND LEG FROM ROTATING OUTWARD
HIP ABDUCTION WEDGE
KEEPS THE PERSON’S LEGS ABDUCTED
SPLINT
KEEPS THE ELBOWS,WRISTS,THUMBS, FINGERS, ANKLES, OR KNEES IN NORMAL POSITION

8. RANGE-OF-MOTION EXERCISES
THE MOVEMENT OF A JOINT TO THE EXTENT POSSIBLE WITHOUT CAUSING PAIN
MOVE THE JOINT THROUGH THEIR COMPLETE RANGE OF MOTION
DONE AT LEAST TWICE A DAY
WILL BE ORDERED BY DOCTOR OR NURSE
ACTIVE RANGE-OF-MOTION EXERCISES - DONE BY THE PERSON
PASSIVE RANGE-OF-MOTION EXERCISES - ANOTHER PERSON MOVES THE JOINT
ACTIVE-ASSISTIVE RANGE OF MOTION EXERCISES - THE PERSON DOES SOME OF THE MOVEMENT WITH HELP FROM ANOTHER PERSON

9. TYPES OF JOINTS

10. JOINT MOVEMENTS
ABDUCTION - MOVING A BODY PART AWAY FROM THE MIDLINE OF THE BODY
ADDUCTION - MOVING A BODY PART TOWARD THE MIDLINE OF THE BODY
EXTENSION - STRAIGHTENING A BODY PART
FLEXION - BENDING A BODY PART
ROTATION - TURNING THE JOINT
INTERNAL ROTATION - TURNING THE JOINT INWARD
EXTERNAL ROTATION - TURNING THE JOINT OUTWARD
PLANTAR FLEXION - BENDING THE FOOT DOWN AT THE ANKLE
PRONATION - TURNING THE JOINT DOWNWARD
SUPINATION - TURNING THE JOINT UPWARD

11. JOINT MOVEMENT

12. RANGE - OF - MOTION EXERCISES
WHEN DELEGATED RANGE-OF-MOTION EXERCISES YOU WILL NEED THIS INFORMATION TO SAFELY COMPLETE THE TASK
WILL YOU PERFORM ACTIVE, PASSIVE, OR ACTIVE ASSIST RANGE-OF-MOTION
WHICH JOINT WILL YOU BE EXERCISING
HOW OFTEN WILL YOU BE DOING THE EXERCISE
HOW MANY TIMES WILL YOU REPEAT EACH EXERCISE
RECORD THE FOLLOWING:
* THE TIME YOU PERFORMED THE EXERCISES
* THE JOINTS THAT WERE EXERCISED
* THE NUMBER OF TIMES THE EXERCISES WERE PERFORMED ON EACH JOINT
* ANY COMPLAINTS OF PAIN OR STIFFNESS
* TO WHAT DEGREE DID THE PATIENT ASSIST

13. PERFORMING RANGE-OF-MOTION EXERCISES
EXERCISE ONLY THE JOINTS THE NURSE TELLS YOU TO EXERCISE
EXPOSE ONLY THE BODY PART BEING EXERCISED
USE GOOD BODY MECHANICS
SUPPORT THE PART BEING EXERCISED
MOVE THE JOINT SLOWLY, SMOOTHLY, AND GENTLY
DO NOT FORCE A JOINT BEYOND ITS PRESENT RANGE OR MOTION OR TO THE POINT OF PAIN
REPEAT EACH EXERCISE 5 TIMES PER JOINT
KNOW THE FACILITY POLICY IN REGARDS TO RANGE OF MOTION EXERCISES FOR THE NECK

14. AMBULATION IS THE ACT OF WALKING
SOME PEOPLE ARE WEAK AND UNSTEADY
CHECK THE CARE PLAN TO SEE WHAT ASSISTANCE IS NEEDED
ALWAYS USE A GAIT BELT
KNOW THE PERSON’S LIMITATIONS
* HOW FAR CAN THEY WALK
* ANY PARALYSIS OR WEAKNESS IN LEGS
* ANY ASSISTIVE DEVICE (CANE, WALKER, CRUTCHES)
THE PERSON MUST WEAR NON-SKID SHOES
DANGLE THE PERSON FOR A FEW MINUTES BEFORE STANDING THEM UP
WALK TO THE SIDE AND SLIGHTLY BEHIND THE PERSON
STAND ON THE PERSON’S WEAK SIDE
THE PERSON SHOULD LOOK FORWARD, NOT AT THE FLOOR
ENCOURAGE THEM TO WALK NORMALLY

15. THE FALLING PERSON DO NOT TRY TO PREVENT THE FALL
YOU COULD HURT YOURSELF OR THE PATIENT BY DOING SO
IF A PERSON BEINGS TO FALL, STEP BACK AND EASE HIM TO THE FLOOR
THIS ALLOWS YOU TO CONTROL THE FALL
DO NOT ALLOW THE PERSON TO GET UP UNTIL CHECKED BY THE NURSE

16. WALKING AIDES CRUTCHES
CRUTCHES ARE USED WHEN THE PERSON CANNOT USE ONE LEG OR WHEN ONE LEG IS WEAK
MUST HAVE RUBBER TIPS ON THE BOTTOM
CHECK ALL BOLTS FOR TIGHTNESS
WEAR NON-SKID SHOES
MUST BE ADJUSTED CORRECTLY FOR PERSON’S HEIGHT

17. CANES
CANES ARE USED FOR WEAKNESS ON ONE SIDE OF THE BODY. THEY HELP PROVIDE BALANCE AND SUPPORT
CANES ARE HELD ON THE STRONG SIDE OF THE BODY
DIFFERENT CANES MEET DIFFERENT NEEDS OF THE PERSON
WALKING CANE
TRIPOD
QUAD

18. THREE-POINT GAIT
SUPPORT WEIGHT ON STRONG LEG AND MOVE CANE FORWARD ABOUT INCHES
THE WEAK LEG IS ROUGHT FORWARD EVEN WITH THE CANE
SHIFT WEIGHT TO THE WEAK LEG AND THE CANE, MOVING THE STRONG LEG FORWARD AHEAD OF THE CANE
REPEAT MOTIONS TO MOVE AHEAD

19. A WALKER GIVES MORE SUPPORT THAN A CANE
THE WALKER IS PICKED UP AND MOVED ABOUT 6 TO 8 INCHES IN FRONT OF THE PERSON
THE PERSON MOVES THE WEAK LEG FORWARD
THEN MOVES THE STRONG LEG FORWARD
DO NOT LET THE PERSON DRAG THE WALKER ON THE FLOOR - IT MUST BE PICKED UP
MAY HAVE WHEELS ON THE WALKER TO ASSIST WITH MOVEMENT
MAY HAVE BASKETS OR TRAYS ATTACHED TO THE FRONT SO THEY MAY CARRY ITEMS WITH THEM

20. BRACES BRACES SUPPORT WEAK BODY PARTS
THEY PREVENT OR CORRECT DEFORMITIES OR PREVENT JOINT MOVEMENT
SKIN AND BONY PROMINENCES UNDER THE BRACE ARE KEPT CLEAN AND PROTECTED
REPORT ANY COMPLAINTS OF PAIN OR DISCOMFORT
THE NURSE OR CARE PLAN WILL TELL YOU WHEN TO APPLY THE BRACE

21. REHABILITATION
THE PROCESS OF RESTORING THE PERSON TO HIS OR HER HIGHEST POSSIBLE LEVEL OF FUNCTIONING
MUST LOOK AT THE “WHOLE” PERSON - PHYSICAL, PSYCOLOGICAL, SOCIAL, AND ECONOMIC
GOALS ARE DIFFERENT FOR EACH INDIVIDUAL
STRIVE TO MAKE PERSON AS INDEPENDENT AS POSSIBLE

22. PHYSICAL ASPECTS
REHABILITATION BEGINS WHEN PERSON IS FIRST ADMITTED TO HEALTH CARE FACILITY
NURSING CARE IS GIVEN TO PREVENT COMPLICATIONS THAT WILL IMPACT REHABILITATION EFFORTS
SELF-CARE IS A MAJOR GOAL
PERSON WILL PERFORM ACTIVITIES OF DAILY LIVING AS INDEPENDENTLY AS POSSIBLE
MAY NEED ASSISTIVE DEVICES

23. PROSTHESIS AN ARTIFICIAL REPLACEMENT FOR A MISSING BODY PART
THE PERSON IS MEASURED AND FITTED FOR THE PROSTHESIS
THE PERSON LEARNS HOW TO USE THE PROSTHESIS

24. PSYCHOLOGICAL AND SOCIAL ASPECTS
SELF-ESTEEM MAY BE AFFECTED BY LOSS OF FUNCTION OR APPEARANCE
THE PERSON MAY FEEL WORTHLESS OR UNATTRACTIVE
THE PERSON MAY DENY THE DISABILITY
THEY MAY BE DEPRESSED, ANGRY, AND HOSTILE
THE PERSON MUST BE MOTIVATED TO IMPROVE OR REHABILITATION WILL NOT BE SUCCESSFUL
THE PERSON MUST ACCEPT HIS OR HER LIMITATIONS
THE FOCUS IS ON WHAT THE PERSON CAN DO - NOT ON WHAT THEY CANNOT DO
PROGRESS MAY BE SLOW SO SHOW POSITIVE ENCOURAGEMENT FOR ANY SMALL SUCCESS OR PROGRESS THE PATIENT SHOWS

25. ASSISTING WITH REHABILITATION
MAINTAIN THE PERSON’S DAILY ROUTINE
GIVE GOOD NURSING CARE TO PREVENT COMPLICATIONS
REPORT ANY SIGNS OF COMPLICATIONS
APPLY ASSISTIVE DEVICES AS NEEDED
DO NOT GIVE SYMPATHY OR PITY THE PERSON
ENCOURAGE THE PERSON TO BE INDEPENDENT WHEN PERFORMING ADL’S
DO NOT HURRY THE PERSON. GIVE THEM TIME TO COMPLETE THE TASK
GIVE PRAISE FOR EVERY PROGRESS MADE, EVEN IF THE PROGRESS WAS SMALL
PROVIDE EMOTIONAL SUPPORT
BE UNDERSTANDING
BE FAMILIAR WITH EQUIPMENT AND ASSITIVE DEVICES
FOCUS ON WHAT THE PERSON CAN DO
ALLOW THE PERSON CHOICES WHEN APPROPRIATE