1. OSTEOPOROSIS PT and Fitness

2. OUR TEAM Katie O’Hara PT Julie Neaderthal PT Sheila Gaffney PT Mark Snow ATC

3. GOALS for 2008 Create a one time PT evaluation form Develop educational power point for osteoporosis patients Complete Home Exercise booklet to complement the Osteoporosis booklet and create fitness presentation Practice and help implement the Fitness Center’s Better Bones program

4. PT Osteoporosis One Time Evaluation Vanderbilt Orthopaedic Institute PATIENT MEDICAL HISTORY Name: Jane Doe MRN: 1234567 Referred by: Dr. Visit Number: 1 ICD9: Patient is a year old F/M with a diagnosis of. CHIEF COMPLAINT AND CAUSE: osteoporosis Onset date: SUBJECTIVE Pain: Pain Scale (0 = absent 6 = moderate 10 = severe) Current Pain: 0/10 PRIOR MEDICAL HISTORY Prior History of Current Problem(s): none multiple episodes; one episode; previous fractures; previous falls; Patient's prior treatment history: None PMHX: none; Precautions/Contra-Indications/ Allergies Medications: None Prior Level of Function: Independent with ADL's, homecare, and selfcare activities: Current Level of Function: Independent with ADL's and body mechanics; Active exercise program includes: Patient stated goal: Patient is able to exercise safely with osteoporosis.

5. OBJECTIVE EXAMINATION Objective Information: ASSESSMENT/FINDINGS Problem List: pain; swelling; decreased ROM; decreased strength; decreased flexibility; use of assistive device; impaired balance; decreased positional tolerance; decreased understanding of safe exercises for osteoporosis; Learning Barriers/Barriers to Goal Achievement: None Modification to treatment based on identified Learning Barriers/Barriers to Goal Achievement: NA Rehab Prognosis: Patient has excellent prognosis to meet goals stated below due to: understanding safe exercises for osteoporosis, understanding the home exercise program, understanding body mechanics and ADL's recommendations, participation in VOI osteoporosis program, PLAN OF CARE PT goals: 1. Patient verbalizes understanding to decrease episodes of trunk flexion in ADL's and body mechanics. 2. Patient verbalizes understanding of safe exercises for osteoporosis. 3. Patient/therapist performed Home Fall Risk Prevention Assessment. 4. Patient verbalizes understanding of home exercise program. 5. Patient referred to VOI Fitness Center Osteoporosis Program. Patient goal: Independent in use, wear, care and fit of orthtic device Independent in the use, wear, care and fit of TENS device Independent with home exercise program Independent with ambulation with assistive devicel ----------------- by the end of 1 visit. Status of Goal: Met

6. Treatment Plan: Recommendations:PT 1 x only VOI Fitness Center Today's Treatment: VOI osteoporosis booklet provided body mechanics and ADL instruction Home Fall Risk Prevention Assessment Today's Treatment Interventions/Home Exercise Program: The patient was given both a verbal and written home exercise program. The home program/exercises were demonstrated and reviewed with the patient. The patient demonstrated understanding of the home program/exercises. Home Exercise program includes: core abdominal exercises given back extension exercises scapular retraction exercises with/without theraband Goals, Treatment Plan, and Risks/Benefits of Physical Therapy Intervention have been communicated with and agreed upon by the patient/family/caregivers. Plan of Care has been communicated to members of the multi-disciplinary team. The Goals and Treatment Plan were developed in light of the Patient's Goals, Learning Barriers/Barriers to Goal Achievement; and the patient's Rehab Potential.

7. Movement Safety with Osteoporosis Patient Education Presentation – based on the osteoporosis booklet

8. What is Osteoporosis ? Osteoporosis is a disease that causes bones to become thin, weak and easy to break. Causes –family history –diet –Medications –lack of physical activity

9. Most common fracture sites Hips Wrists Spine

10. Factors that affect strong bones: Positive Factors –Calcium and Vitamin D intake –Physical activity –weight bearing improves bone strength –Maintaining a healthy weight Negative Factors –Smoking and heavy alcohol use –Medications –ask your doctor

11. Physical Therapy Initial Evaluation Medical history Physical Assessment Posture Joint range of motion Strength Flexibility Daily activity Pain control (if necessary) Exercise

12. Home Exercise Program Stretching and strengthening Posture and body positioning /body mechanics Fall prevention in the home

13. Body Mechanics Avoid forward bending Carry loads close to the body Tighten your stomach when you lift items Never twist with a load Sit up straight with knees level to hips Change positions every 30 min Sleep with back straight

14. Making your home safe Floors Lighting Nightlights Telephone access Electrical cords secured Pets Throw rugs

15. Bedroom-Living room safety Bedside tables for glasses, lamps and phones Sit on the side of bed for a minute before standing to avoid dizziness Secure area rugs Clear walkways Chair and sofa height safe and comfortable

16. Bathroom-Kitchen safety Grab bars for safe entry in/out of shower and tub Non skid mats at tub, shower & toilet Keep items in easy reach from knee to shoulder height Non slip flooring Rubber backed mat in front of sink Avoid ladders and step stools to reach overhead Nightlight between rooms –Bedroom and bathroom –Hallway

17. Stairs Handrails on both sides Non slip surface Uncluttered stairs Steps more visible –Marked with tape

18. Personal safety Wear properly fitting non skid shoes Avoid ladders When doing housework, keep your upper body straight. –Do not twist at the waist –Bend from the knees, not from the waist. –When vacuuming or mopping, bend knees and rock front to back instead of bending over. Log roll when getting out of bed

19. Fitness Better Bones Program Individualized exercise program to strengthen bone and prevent injury Focus on posture, strength, flexibility, balance, and cardiovascular training Learn safe and effective exercise Program fees: 4 one hour sessions 6 one hour sessions $80 Member $100 Member $150 Non-member $200 Non-member

20. Patient Education Exercise Program Booklet