1. School of Health Sciences Robert Gordon University Aberdeen United Kingdom Anne Wallace and Dawn Mitchell

2. Faculty of Health and Social Care School of Applied Social Studies School of Health Sciences School of Nursing and Midwifery School of Pharmacy and Life Sciences

3. School of Health Sciences Diagnostic Radiography Occupational Therapy PhysiotherapySport & Exercise Science Health Promotion

5. Occupational Therapy and Physiotherapy Education at RGU 4 year BSc Hons Degree Courses Practice Placements and volunteer patients Inter-professional working on the courses Thorough assessment, problem solving and clinical reasoning. 2 year MSc Pre-reg Physiotherapy

6. Plan for Today Physiotherapy Practice in rehabilitation – Anne Wallace Principles and practice of Occupational therapy – Dawn Mitchell The team and Case study – working together

7. Physiotherapy Practice in Rehabilitation and Team working Anne Wallace Subject Lead Physiotherapy RGU Aberdeen a.wallace@rgu.ac.uk

8. Physiotherapy

9. Physiotherapy- a definition Physiotherapy uses physical methods to affect recovery and rehabilitation of individuals which may involve reducing pain, increasing function and improving quality of life.

10. Physiotherapy Scope of Practice In the UK Independent practitioners First line referrals Work in extended scope roles e.g. Prescribing, ventilation, bronchoscopy, injecting Consultant physiotherapists

11. Where do Physiotherapists work? Hospital including ICU and women's health Out patient clinics Mental health Learning disabilities and Paediatrics Sport and leisure Industry Schools

12. 3 main areas of clinical focus Cardio respiratory, Musculo-skeletal Neurological. These can be separate or combined. Elderly patients often require all the physiotherapist skills.

13. Benefits of exercise and activity Bone density Cardio-vascular Respiratory Mental health and cognitive ability Cancer – colon and breast Diabetes Falls prevention (Warburton et al 2006)

14. Physiotherapy Principles Accurate assessment Diagnosis or identification of problems Setting goals Modification of treatment depending on response using anatomical, physiological measurement and patient response. Evaluation and accurate recording

15. Physiotherapy for cardiac problems Physiotherapy can be used medical and surgical cardiac conditions. Once medically stable it is important that they exercise in a controlled manner and keep mobilising and exercising for years to come to reduce the risk of further cardiac events, improve function and quality of life. When exercising other existing pathologies must be considered

16. Phases of cardiac rehabilitation ONCE STABLE Phase I – patient encouraged to mobilise on the ward and increase function prior to going home Phase II – patient given instructions to increase walking tolerance at home. Visit or phone call. Phase III – patient returns to the hospital for cardiac rehabilitation classes

17. Phase III Patient is tested using Shuttle walk test and Q of L questionnaire -15 min warm up -30min CV exercise -10 min cool down -Education classes Exercise is monitored using RPE scale and HR and progressively increased 6-12 week programme x 2 per week

18. Perceived Exertion scale

19. COPD and chest conditions On admission patient may require chest physiotherapy to position, improve breathing, remove sputum and mobilise. Pulmonary rehabilitation classes can also be given. Education on prevention of recurring problems

20. Spiral of Inactivity Inactivity Breathlessness and Fear Inactivity

21. Rehabilitation of Neurological patients Stroke, Parkinson’s disease, Multiple sclerosis, TBI, MND and many more Early mobilisation essential Maximising Function through muscle activation, Task specific practice, Tone management Balance rehabilitation, Walking/transfer aids preventing secondary complications and prescribing orthotics

22. Musculoskeletal- outpatients -Back and neck problems and joint problems, - -arthritis -Sports injury -A variety of specialised techniques including mobilisation and manipulation -Electrical techniques to reduce pain --Exercise and education

23. Musculoskeletal- inpatients Amputees, hip and Knee replacements Mobility problems Falls Exercise and rehabilitation including walking practice provision of walking aids and orthotics. Wheel chair and prosthetic assessment

24. Advances in Physiotherapy Physiotherapy like all health care professions has to respond to the challenges of a constantly changing health care keeping the population well as well as treating the patient that is ill.

25. Team Working as a team has been proven to be of benefit to give the patient the best outcome A team is more than it component members working separately The team can be as big or as small as the patient requires The team needs a leader and agreed goals

26. Types of Team Multidisciplinary – Team approach but each discipline works towards own goals Interdisciplinary/Interprofessional – Team approach where all professions work towards shared goals WHOSE GOALS?

27. Issues in teams Communication Time pressures Differences in Professional Cultures Negative professional stereotypes Trust and respect Joint training / team building Different professional philosophies or ideologies Cameron and Lart (2003)

28. Case Study Mrs Bell 76 years old Early Parkinson's Disease on medication Lives with husband Found fallen in the bathroom

29. Falls – cause and effect Reduced Occupational Performance in Activities of Daily living

30. Team Patient Occupational therapists DoctorsPhysiotherapistNursesPharmacist Speech Therapist OptometristFamilyOther

31. Patient Goals Early Goal -to get to and use the bathroom independently - to get dressed Medium term Goal - to go home and resume her role as housewife -Long term Goal -Return to activities in the community -Role as grandparent, wife, church group member

32. Early Stage Goals Goal Early stage Doctor / pharmacist NurseOccupational Therapist Physio therapist -to get to and use the bathroom independently -to get dressed -Managing medication to manage symptoms -- ensure medically stable and for to mobilise - Caring and promoting independence -Independent transfers - Safe washing technique -- dressing practice and managing clothes -Promote mobility, muscle strengthening and walking aid -- sitting balance

33. Early mobility

34. Medium term Goals Goal Medium stage NursesOccupational Therapist Physio therapist - to go home and resume her role as housewife --to help mobilise the patient and encourage her to gain confidence and promote independence -Confidence building -Liaison with carers / MDT -Home visit to identify risks /barriers to performance -Environmental adaptation / Equipment provision -Meal preparation practice / teaching safe techniques -Confidence building -Liaison with carers / MDT Progress independent mobility Stair practice Practice getting up from floor -Continued balance /strengthening exercises -Confidence building -Liaison with carers / MDT

37. Home Visit

38. Longer Term Goals Goal Late stage Occupational Therapist Physio therapist -Return to activities in the community -Role as grandparent, wife, church group member Outdoor mobility / public transport practice Visit to community facilities Adaptation / skills enablement to participate in roles Outdoor mobility / strengthening exercise Pacing Exercise class

39. Mobility

40. Continued Rehabilitation in the Community

42. References http://www.nhs.uk/Livewell/fitness/Documents/older-adults-65-years.pdf BHF Technical Report :Physical Activity Guidelines in the UK: Review and Recommendations May 2010 Scottish Health Survey 2012 http://www.scotland.gov.uk/Resource/0043/00434590.pdf CAMERON, A. and LART, R., 2003. Factors Promoting and Obstacles Hindering Joint Working: A Systematic Review of the Research Evidence. Journal of Integrated Care, 11(2); pp 9-17. Darren E.R. Warburton, Crystal Whitney Nicol, Shannon S.D. Bredin (2006) Health benefits of physical activity: the evidence CMAJ March 14, 2006 174(6) | 801-809 Langlos F et al (2012) Benefits of Physical Exercise on Cognition and Quality of Life in frail older Adults. J Gerontol Psycohol Set Soc Sci (2013) 68 (3) 400-404

43. Thank you for listening. Any questions?