2 Course DescriptionThis course will focus on rehabilitation and patient care. Topics include complications to inactivity, positioning, transfers, body mechanics, gait, assistive devices, adaptive equipment, fall prevention, wheelchairs, total joint arthroplasty, prosthetics and orthotics, range of motion and exercise.
3 Course ObjectivesThe general objective of this course are to provide nursing assistance with education concerning rehabilitation and patient care. Upon successful completion of this course, the student should be able to: 1. Describe the role of the rehabilitation team and nursing assistant with patient care. 2. Identify complications from immobility. 3. Demonstrate levels of assistance, patient positioning and transfers. 4 .Demonstrate good body mechanics during tasks. 5. Demonstrate the ability to safely assist patients during ambulation and transfers. 6. Demonstrate the proper use of assistive devices with ambulation.
4 Course Objectives Continued 7. Identify the demonstrate the basic phases of gait. 8. Identify possible factors related to falls in the elderly. 9. Identify wheelchair components and their function. 10. Demonstrate the use of adaptive equipment. 11. Demonstrate and identify through analysis of case studies and laboratory experience compliance with orthopedic precautions. 12. Identify the use of orthotics and prosthetics. 13. Describe the benefits of exercise. 14. Demonstrate the anatomical planes of motion. 15.Demonstrate skilled technique when performing rom.
5 What is Rehabilitation? A process in which an individual is assisted in reaching their highest level of function and ability.
6 The Rehabilitation Team PHYSICAL THERAPISTOCCUPATIONAL THERAPISTSPEECH -LANGUAGE PATHOLOGISTRESPIRATORY THERAPIST
7 PHYSCIAL THERAPISTEvaluate and treat people with health problems resulting from injury or disease.PTs assess joint motion, muscle strength, endurance, balance, mobility and function.Develop a plan of care appropriate for the patients needs.Provide instruction and education to the patient and caregivers.Progress the patients mobility and function to the fullest possible level.DEMONSTRATE BALANCE ASSESSEMENT
8 Occupational Therapist Evaluate and treats people with problems arising from developmental deficits, physical illness or injury, emotional or cognitive disorders.Develops a plan of care to restore self care, work and leisure skills.Assists the individual in acquiring the knowledge, skills, and attitudes needed for the performance of activities of daily living (ADL)Give examples of ADLs
9 Speech-Language Pathologist Evaluate and treat individuals with speech, language, cognition, voice disorders.Evaluate and treat individuals with swallowing disorders.Treatments include, physical strengthening exercises, instructive repetitive practice, use of audio-visual aids and the introduction of strategies to facilitate functional communication and swallowing.
10 Respiratory Therapist Evaluate and treat individuals with breathing disorders.Disorders include: asthma, bronchitis, emphysema, COPD, heart attach, stroke or trauma, complications at birth, and other disorders.
11 The Role of the Nursing Assistant and Rehabilitation PROM, AAROM, AAROMPOSITIONINGPREVENT COMPLICATIONS SUCH AS PRESSURE ULCERS AND CONTRACTURESMOBILITY TO INCREASE THE INDIVIDUALS ABILILTIES OR TO MAINTAIN CURRENT ABILITIESBATHING AND PERSONAL CARE PROCEDURESENCOURANGE THE INDIVIDUAL TO PERFORM ADLS TO THE FULLEST EXTENT POSSIBLE
12 Complications from Inactivity Weakness and limitations in mobilityContracturesDisuse osteoporosisPressure UlcersDecreased cardiovascular and respiratory functionDecreased gastrointestinal system functionBladder infections and incontinenceDepressionGive examples
13 Complications form Inactivity Weakness and limitations in mobilityMuscles become weak and atrophy, how can this effect the individual?
14 Complications from Inactivity ContracturesMuscle contractures are a result of prolonged immobility and or improper positioning leading to joint stiffness and decreased range of motion.What can be done to prevent muscle contractures?
15 Complications from Inactivity Disuse osteoporosisOsteoporosis is a disease characterized by low bone mass and deterioration of bone tissue leading to fragility and risk of fracture.How can this effect the individuals mobility?
16 Complications of Inactivity Pressure UlcersPressure ulcers are lesions caused by unrelieved pressure to any part of the body, especially portions over boney areas.What areas of the body could be at risk?Occiput, spinous process, scapula, ischium, sacrum/coccyx, trochanter, heels/malleolous
17 Complications of Inactivity Decreased cardiovascular and respiratory functionThe heart must work harder to pump blood through the body.The lungs do not expand as fully resulting in decreased efficiency with respiration.How could this prevent an individuals participation during ADLs?
18 Complications of Inactivity Gastrointestinal system functionAppetite may decrease, causing weight loss.Peristalsis slows down, causing indigestion and constipation.Risk of choking and aspiration due to improper positioning.What position would be best during meals?
19 Complications of Inactivity Bladder infection and incontinenceDecreased ability for the bladder to empty completely.Decreased ability to transfer to toilet or commode.How could increased activity benefit an individual during transfers?
20 Complications of Inactivity DepressionCan occur from physical and mental inactivity.How can increased activity benefit an individuals quality of life?
21 The Nursing Assistant and Patient Care A Study of 599 older adults ( age 85 and above) noted the prevalence of disability, defined as inability to perform one or more ADLs, was 64% for women and 55% for men.The prevalence of disability defined as inactivity was 92% for women and 98% for men.Note the significant difference between ability and functional activity.Resnick 2004
22 The Nursing Assistant and Patient Care Encourage increased participation in ADLs.Motivate and provide immediate reinforcement for performing a dressing task.Encourage participation in regular care activities.Promote activity, mobility and independence in daily activities.Promote increased involvement and socialization with others.
23 The Nursing Assistant and Patient Care You are making a difference by encouraging and Supporting your patients! How can you encourage increased participation during ADLs with your patient?
25 Levels of Assistance Independent Independent with adaptive device SetupSupervision or stand by assistanceCueing
26 Levels of Assistance Minimum Assistance Moderate Assistance Maximum AssistanceHave students give examples
27 Levels of Assistance Minimum Assistance Patient performs 75% or more of activity.
28 Levels or Assistance Moderate Assistance Patient performs 50% to 74% of activity.
29 Levels of Assistance Maximum Assistance Patient performs 25 % to 49 % of activity.
30 Body Alignment and Positioning of the Patient Body PositionFowler’sProneSupineLateralSim’sSitting
31 Body Alignment and Positioning of the Patient Fowler’s PositionA semi-sitting positionHead of the bed is raised between 45 and 90 degreesKeep the spine straightSupport the head with a pillowSupport the arms with a pillow
32 Body alignment and Positioning of the Patient ProneOn the abdomen, head to one side with a small pillow under the headPillow under the abdomen to relieve pressure to the chest and backPillows under the lower legs to prevent pressure on the toes
33 Body Alignment and Positioning of the Patient Supine PositionThe bed is flatPatient positioned on their backThe head and shoulders are supported by a pillowSmall pillow under lower legs relieves pressure on the ankles and heelsElevate knees to relieve pressure on the low back
34 Body Alignment and Positioning of the Patient Lateral PositionThe bed is flatUpper leg is in front of the lower leg supported by a pillowPillow positioned along the patients backPillow under the upper hand and arm
35 Body Alignment and Positioning of the Patient Sim’s PositionLeft side-lying positionUpper leg flexed, not resting on lower legPillow supporting upper leg and thighPillow supporting head and shoulderPillow supporting upper arm and hand
36 Body Alignment and Positioning of the Patient Sitting!Back and buttocks against the back of the chairFeet flat on the floor or footplates of wheelchairDo not allow back of knees to rest against the chair
37 Body Alignment and Positioning of the Patient Always follow the patients individual plan of care for positioning and mobility.
38 Body Alignment and Positioning of the Patient Lifting and Moving Patients in Bed PrecautionsFrictionShearing
39 Body Alignment and Positioning of the Patient Friction Occurs when the skin is rubbed against another surface. Shearing Occurs when the skin moves in one direction and other structures remain fixed. Give examples of how friction or shearing can happen.
40 Body Alignment and Positioning of the Patient Before Positioning of the PatientFollow the patients plan of careAsk a coworker for helpPractice good hygieneIdentify the patient and explain the procedure to the patientPrivacy and drapingLock the bed wheelsRaise the bed for proper body mechanics
41 Body Alignment and Positioning of the Patient Turning the Patient Towards YouCross the patient’s far arm over their chest. Bend the elbow of the near arm, bringing the hand to the head of the bed.Place one hand on the patient’s far shoulder and one on the patient’s hip.Gently roll the patient toward you in a smooth motionPut up side rails and utilized pillows for comfort and support
42 Body Alignment and Positioning of the Patient Turning the Patient Away from YouHave the patient bend his knees and cross their armsPlace your one arm under the patients head and shouldersThe other hand and forearm under the patient’s low backKeep your back straight and bend your body at the hips and kneesGently pull the patient toward youRoll the patient slowly and carefully away from you by placing one hand on the patient’s shoulder and one under the hips.
43 Body Alignment and Positioning of the Patient Moving the Patient to the Head of the BedLift top bedding and expose draw sheetNursing assistant on each side of the patientGrasp the draw sheet or place one arm under the patient’s thighs and other under the shouldersOn the count of three move the patient smoothly towards the head of the bedUse pillows for comfort and positioning
44 Body Alignment and Positioning of the Patient Logrolling the PatientMay be indicated for patient’s that have had spinal injury or surgeryPlace a pillow between the patient’s legsThe patient’s arms are crossedUsing a turning sheetRoll the patient towards youTurn the patient as a unit
45 Transfers Transfer Guidelines Know your patients required level of assistanceKnow the method of transferUse a transfer belt unless contraindicatedNever pull on a patient’s arms or shouldersAlways lock the wheels on the bed and wheelchairAlways have the patient wear nonskid footwearPrepare the area…be aware of tubes, orthotics or other equipment in the area
46 Transfers Transfer Guidelines Continued Transfer the patient to their strongest sideAlways explain the procedure to the patient and test the patients understandingStand close to the patientEncourage appropriate body alignmentAllow the patient to assist as much as possible
47 Transfers Transfer Belt Always apply over clothing Tighten the belt snugThe belt should not cause discomfort or restrict breathingBe able to slide your open hand under the beltDo not position the buckle over the spine
48 TransfersBed to ChairHave the chair positioned along the bed wheels lockedStand in front of the patientPatient seated at the edge of the bedPatients feet flat on the floorGrasp the transfer belt from underneathBrace your knees against the patients kneesAsk the patient to push down on the mattress and stand on the count of three.Pull the patient to a standing position
49 Transfers Bed to Chair Continued Support the patient in a standing positionTurn the patient and ask the patient to grasp the far arm of the chairContinue to turn the patient to the front of the chairGently lower the patient as you bend your kneesMake sure the patient is properly positioned and comfortableRemove the transfer belt
50 Transfers Bed to Chair with Two Assistants Nursing assistance on each side facing the patientPatient seated at the edge of the bedPatients feet flat on the floorEach assistant grasps the transfer belt from underneath. The other hand grasps the belt from the backNursing assistant closest to the chair has room to pivot to allow patient access to the chairBrace your knees against the patients knees
51 Transfers Bed to Chair with Two Assistance Continued Ask the patient to push down on the mattress and stand on the count of three.Pull the patient to a standing positionBoth nursing assistance assist the patient to turn slowly and smoothly towards the chairGently lower the patient as you bend your kneesMake sure the patient is properly positioned and comfortableRemove the transfer belt
52 Transfers Sliding-Board Transfers Slide-boards are used with patients with good upper body strength and sitting balance.Requires wheelchair with removable arm rests and swing away leg rests.Patients must have clothing on their lower body to prevent friction and shearing
53 Transfers Mechanical lift Used for transfers of heavy patients with decreased ability.Mechanical lifts vary in style and function.Make sure you are trained in the use of the mechanical lift at your facility.Always check slings, straps, hooks and chains for safety.Make sure the patient’s weight does not exceed the recommendation of the manufacture.
54 TransfersCase study Mr. Jones recently underwent spinal surgery and requires assistance for bed mobility and transfers. Per MD orders Mr. Jones is not to twist or turn his back. Which method would be best to assist Mr. Jones to a side lying position?Lab time: Per instructor demonstrate selected bed mobility and transfer techniques.
56 Body MechanicsBody Mechanics The way we move during an activity. Proper body mechanics involves good posture, balance and using stronger body parts for work. Good body mechanics reduces your risk for injury.
57 Body MechanicsBody Alignment The way the head, neck, trunk, arms and legs align with each other. Good alignment is essential for efficient safe function and movement.
58 Body MechanicsBase of Support Is the area in which an object rests. In standing a wide base of support gives you greater stability.
59 Body Mechanics Rules for Good Body Mechanics It is easier to pull, push or roll an object than to liftAvoid jerky movementsUse the larger leg and arm musclesKeep the work as close to your body as possibleKeep the work at a comfortable height to avoid bendingKeep your body in good physical condition to reduce injuryKeep your body in good alignment with a wide base of support
60 Body Mechanics Lifting Use the strong muscles of the legs for lifting. Bend at the knees and hip, keep your back straight.Lift straight upward in a smooth motion.
61 Body Mechanics Reaching Stand directly in front of and close to the object.Avoid twisting or stretching.Maintain good alignment and base of support.Be cautious of moving heavy objects.
62 Body Mechanics Pivoting Place one foot slightly ahead of the other. Turn both feet at the same time, pivot on the heel of one foot and toe of the other.Maintain good alignment and base of support.
63 Body Mechanics Avoid Stooping Squat Avoid bending at the waist Use the strong muscle of the leg to return to upright position.Lab time: Demonstrate proper body mechanics when assisting an individual during transfers.
64 Ambulation and Mobility Ambulation The act of walking. Gait The way in which a person walks.
65 Ambulation and Mobility Normal Gait Pattern Repeats a basic sequence of limb motions that serve to progress the body along a desired path while maintaining weight-bearing stability.
66 Ambulation and Mobility Gait is divided into two phases Stance – The entire time the foot is on the floor. Swing – When the foot is off the floor.
67 Ambulation and Mobility Body Alignment and Posture The patient must be able to stand straight on one leg as he swings the other leg to take a step.
68 Ambulation and Mobility Gait TipsStand on the patients affected sideUse a gait belt if the patient requires assistancePatient should stand as erect as possibleFeet should be 4 to 6 inches apartWith each step the heel should land on the floor firstProper foot wearPrepare the area, clear walkwaysSafe use of assistive device
69 Ambulation and Mobility Gait Tips ContinuedAllow adequate timeEncourage large even stepsAllow the patient to do as much as they canWhen turning, avoid sharp pivots or twistingMake shorter steps when turning
70 Ambulation and Mobility Gait Tips ContinuedAvoid letting the upper body get ahead of the lower bodyDo not lean upper body too far forwardDon’t rushIf your patient shows signs of illness notify the nurseNever leave your patient unattended
71 Ambulation and Mobility Assistive Devices for Ambulation Crutches Canes Walkers
72 Ambulation and Mobility CrutchesTypically not recommended for older adultsLofstrand crutches have a cuff that surrounds the forearmPlatform Crutches permit weight-bearing on the forearm
73 Ambulation and Mobility CanesQuad canes have four prongs and offer a wide base of support.Single pronged cane are for assisting with balanceCanes are used on the strong side of the bodyThe patient will use a two point or three point gait
74 Ambulation and Mobility Two Point Gait Cane Affected leg Unaffected leg Three Point Gait Cane, affected leg When there is no affected leg, weight bearing is equal on both legs.Lab time: Per instructor demonstrate use of assistive devices.
75 Ambulation and Mobility Weight bearing is the amount of weight that may be applied on an extremity.Non-weight bearingToe touchPartial weight bearingWeight bearing as toleratedFull weight bearing
76 Ambulation and Mobility Non-weight bearing: lower extremity not to bear weight and usually not permitted to touch the ground. Toe touch: the patient can rest the toes of the involved lower extremity on the ground for balance, but not weight bearing.
77 Ambulation and Mobility Partial weight bearing: A limited amount of weight bearing, such as five pounds, unless a specific amount is confirmed by the MD. Weight bearing as tolerated: The amount of weight bearing may vary from minimal to full, depending on the patients tolerance. Full weight bearing: Full weight bearing is permitted.
78 Ambulation and Mobility WalkersStandardWheeledplatform
79 Ambulation and Mobility Disorders Which Can Affect GaitStrokeMultiple sclerosisHuntington’s diseaseParkinson’sArthritisAmputationsOrthopedic issues
80 Ambulation and Mobility Stroke (Cerebral vascular Accident) A blockage or hemorrhage of a blood vessel leading to the brain, causing inadequate oxygen supply and damage to brain tissue. May result in hemiplegia, loss of body control, dysphagia (swallowing issues), Aphasia, speech impairments, Changing emotions, impaired memory, urinary incontinence or frequencyWhat member of the rehab team would treat issues with swallowing?
81 Ambulation and Mobility Multiple Sclerosis A chronic degenerative disease of the CNS which destroys the myelin sheath the surrounds the nerves. May result in muscle weakness, visual impairments, tremors, numbness, speech issues, dizziness, memory and judgment, bowel and bladder dysfunction.
82 Ambulation and Mobility Huntington’s Disease A hereditary disease of the CNS characterized by brain deterioration and loss of control over voluntary movements, speech impairments, mental deterioration.
83 Ambulation and Mobility Parkinson’s Disease A progressive nervous disease associated with the destruction of brain cells that produce dopamine. May result in tremors, stiff muscles, slow movement, stooped posture and impaired balance, mask-like expression, swallowing issues, memory and speech, bladder impairments
84 Ambulation and Mobility Arthritis Acute or chronic inflammation of the joint resulting in pain and stiffness.
85 Ambulation and Mobility Amputations Patient may have a prosthesis.
86 Ambulation and Mobility Orthopedic Issues An injury or disorder or recent surgery of the musculoskeletal system.Lab time: Per instructor students to role play assisting patients with selected disorders.
87 Fall Prevention, Adaptive equipment, Wheelchairs
88 Fall PreventionFalls are not part of the normal aging process. But are due to an interaction of factors.Falls are due to:Impairments in mobilityUneven steps, shuffling gait, unsafe use of assistive device
89 Fall Prevention Falls are due to: Transfers difficulty with moving from sitting to standingDrop sittingLanding too close to the edge of the seat
90 Fall Prevention Falls are due to: Impaired standing balance Leaning off centerLoss of balance when attempting to standLoss of balance when bending or reaching
91 Fall PreventionFalls are due to:Multiple medications
92 Fall Prevention Falls are due to: Postural hypotension Check blood pressure
93 Fall Prevention Falls are due to: Impaired vision Impaired hearing Impaired position senseImpaired cognition
94 Fall PreventionFalls are due to:Improper footwearFoot deformities
95 Fall Prevention Falls are due to: Environmental hazards Objects in walkwayInadequate lightingUnsafe stair managementClass discussion: What can the nursing assistant due to help prevent falls?
96 Adaptive EquipmentAdaptive Equipment Devices or equipment designed and fabricated to improve performance in activities of daily living.
97 Adaptive Equipment Bathing and Toileting Long handled sponge Curved bath brushHand held showerGrab barsTub seat/benchRaised toilet
98 Adaptive Equipment Dressing Dressing stick Sock aids Reachers Button and zipper aidLong-handled shoehornElastic shoe laces
99 Adaptive Equipment Eating Comfort grip curved utensils Scoop dish Plate guardsDrinking mugs with large handles or coversLab time: Per instructor demonstrate use of adaptive equipment.
100 Wheelchair The wheelchair Postural support- The surface that is in contact with the user’s body.Mobility base – Consists of the tubular frame, arm-rests, foot supports, and wheels.
101 Wheelchair Wheelchair Brakes Brakes must be engaged during a transfer Inspect the brake mechanism for safety
102 Wheelchair Seat Belts Prevents falls Assists in positioning Check POC for seat belt use
103 WheelchairDrive wheels – the large wheels used for propulsion Outer rim – used by the patient to propel the wheelchair Projections – for patients with decrease ability to grasp
104 Wheelchair Armrests Full length Desk length Removable or fixed Adjustable height
105 Wheelchair Footrests/Leg-rests Fixed or removable Pivoting or non-pivotingElevating leg-restsCalf supports
106 Wheelchair Tilt in Space A fixed back to seat angle Permits changes in orientation for pressure relief and or different activities
107 Wheelchair One Arm Drive Applying pressure to one rim turns the wheelchairPump lever to provide propulsion
108 Wheelchair Wheelchair Size Seat depth Seat width Back height Armrest heightSeat to footplate lengthFootplate sizeLab time: Per instructor demonstrate safe use of wheelchair. Identify wheelchair components and use.
109 Total Joint Arthroplasty, Prosthetics and Orthotics
110 Total Joint Arthroplasty Also know as total joint replacementOver 400,000 procedures a yearPrimary candidates are people with chronic joint pain from arthritisPurpose of surgery is to relieve pain and restore function
111 Total Joint Arthroplasty Total Knee Arthroplasty Portions of the knee joint are replaced with metal and plastic Components shaped to allow Continued motion of the knee.
112 Total Joint Arthroplasty Total Knee ArthroplastyMultidisciplinary teamorthopedic surgeon, nursing staff, rehab team
113 Total Joint Arthroplasty Total Knee ArthroplastyRehabilitation Phase 1: Inpatient acute carePromotion of ROMIndependence with bed mobility, transfers and gaitRestoration of safety and independence with ADLs
114 Total Joint Arthroplasty Continuous Passive Motion (CPM) A machine that performs PROM exercise on the affected knee joint. Often prescribed by orthopedic surgeons Protocol varies always check with patients poc.Lab time: If available have nursing assistant experience CPM
115 Total Joint Arthroplasty Total knee ArthroplastyRehabilitation Phase II: Skilled Nursing FacilityGoals are the same as Phase IEducation of family members and caregiversPlanning of homecare needs
116 Total Joint Arthroplasty Total Knee ArthroplastyRehabilitation Phase III: Outpatient Home HealthFocus on safety in homeProgression of ROM, transfers, gait and ADLs
117 Total Joint Arthroplasty Total Hip Arthroplasty The hip joint is preplaced by a prosthetic implant.
118 Total Joint Arthroplasty Total Hip PrecautionsPatients should not:Flex the hip more than 90 degreesCross the affected leg over midlineInternally rotate the hipCheck weight-bearing precautionsLab time: Have nursing assistance role play assisting a patient with THA during bed mobility and transfers.
119 Total Joint Arthroplasty Total Hip ArthroplastyRehabilitation Phase I: Inpatient acute careEducation regarding precautions with transfers and movementsPostoperative exercises: Ankle pumps, quad sets, gluteal sets, heel slides.
120 Total Joint Arthroplasty Total hip precautionsRehabilitation Phase II: Skilled Nursing FacilityReinforce total hip precautionsIncrease independence with gait and transfersPrepare for safety in homeProgress to outpatient home health care
121 Total Joint Arthroplasty Equipment NeedsRaised toilet seatTub bench or seatAdaptive equipment to assist with ADLsWalker, crutches or caneLab time: Demonstrate tub bench transfers maintaining orthopedic precautions following TJA.
123 Prosthetics and Orthotics Prosthesis - An artificial extension that replaces a missing body part. Orthotic- a device that serves to protect, restore or improve function.
124 Prosthetics and Orthotics Principal Lower Limb ProstheticsPartial footBelow kneeAbove kneeKnee and hip disarticulation
125 Prosthetics and Orthotics Partial FootTrans-metatarsal AmputationPatient bears most weight on the heelDecreased time on the affected foot during gaitPlastic socket fixed to a rigid plateProtects amputated ends
126 Prosthetics and Orthotics Below KneeTibia and Fibula is transectedKnee joint is intactProstheses include a foot-ankle assembly and socketLimb fits into a custom molded socket
127 Prosthetics and Orthotics Above KneeAmputation between the femoral epicondyles and greater trochanterProsthesis consists of foot-ankle assembly, shank, knee unit, socket and suspension device
128 Prosthetics and Orthotics Hip DisarticulationAmputation of the femur and or part of the pelvisProsthesis has hip, knee and foot assembliesPlastic molded socket to support weight on remainder of pelvis
129 Prosthetics and Orthotics The Rehabilitation TeamWorks closely with the physician and prosthetistTrains the patient to don, use and maintain the prosthesisLab time: Per instructor if available demonstrate and identify components prosthetics.
131 Prosthetics and Orthotics Foot OrthosisMay be an internal modification in the shoe or external modificationCan enhance function by relieving pain and improving the quality of gait
132 Prosthetics and Orthotics Ankle- foot orthosesorthosis consists of the shoe and plastic or metal componentMost AFOs prescribed to control ankle motion by limiting plantar-flexion and or dorsi-flexion, or by assisting motionProvides stability
133 Prosthetics and Orthotics Knee ankle foot orthosesConsists of shoe, ankle control, knee control and superstructureMost KAFOs include a pair of uprights and knee hinges
134 Prosthetics and Orthotics Hip knee ankle foot orthosesAddition of a pelvic belt band and hip joints converts the KAFO to an HKAFOHip joint is usually a metal hinge which prevents abduction, adduction and hip rotationLab time: If available demonstrate donning doffing AFO.
136 ExerciseWhat is Exercise? A physical activity done to improve or maintain one or more components of physical health.
137 Exercise Why Exercise? Increased strength Increased balance Increased enduranceIncreased flexibilityIncreased skill in an activityIncreased independence
138 ExerciseForms of ExerciseAerobicIsometricActiveResistive
139 ExerciseAerobic- sub maximal, rhythmic, repetitive exercise of large muscle groups, during which the needed energy is supplied by inspired oxygen
140 ExerciseIsometric- Exertion during which the muscle does not change length.
141 ExerciseActive- Exercise that is performed without any assistance.
142 ExerciseResistive- Training with resistance to movement to increase muscle strength through the use of weights, bands, ones own body weight.
143 Range of MotionRange of motion exercises are performed to prevent the development of contractures, muscle shortening, and tightness in capsules, ligaments and tendons. Range of motion exercises enhance mobility and provide sensory stimulation with is beneficial to the patient.
144 Range of Motion AROM – carried out independently by the patient PROM – ROM performed without the assistance of the patientAAROM- Carried out by the patient with assistance to facilitate normal muscle function.
145 Range of Motion Anatomical Planes of Motions Flexion Extension AbductionAdductionOppositionInternal rotationExternal rotationDemonstrate each
146 Range of Motion Anatomical Planes of Motion Continued Supination PronationInversionEversion
147 Range of Motion Range of Motion General Guidelines Check the POC or ask the nurse of rehab teamExplain the procedure to the patientMake sure the patient is comfortably positionedEncourage the patient to assist if able and indicatedExpose only the body part you are exercising
148 Range of Motion Range of Motion General Guidelines Continued Support each joint by placing one hand above and one hand below the joint.Watch the patients face for gestures which indicate discomfort. Stop! Reposition or use a lighter touch and or contact the nurse or rehab teamOnly move the joint within its available range, never push past the point of resistancePerform 3 to 5 repetitions slow and controlledROM significantly improves joint functioning
149 Range of Motion Precautions Fractures or dislocations Orthopedic precautionsWounds or pressure ulcersCombative or resistant patientsSpasticity or rigidityLab time: nursing assistance to perform AROM, AAROM and PROM. Demonstrate understanding of planes of motion.
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