1. Chapter 21: Rehabilitation and Restorative care

2. Learning objectives Discuss rehabilitation and restorative care
Describe the importance of promoting independence
Describe assistive devices and equipment
Explain guidelines for maintaining proper body alignment
Explain care guidelines for prosthetic devices
Describe how to assist with range of motion exercises
Describe the benefits of deep breathing exercises

3. Rehabilitation and restorative care
Process of rehabilitation
Goals of rehabilitation
Assisting with rehabilitation
Observations that should be reported
Rehabilitation is care that is given by specialists to help restore or improve function after an illness or injury.
The process of rehabilitation is about moving the resident from
Illness to health
Disability to ability
Dependence to independence
These are the goals of rehabilitation:
Help resident regain function or recover from illness
Develop and promote a resident’s independence
Allow resident to feel in control of his life
Help resident accept or adapt to the limitations of a disability
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.
Involve residents in their care.
NAs should observe and report the following signs and symptoms:
Increase or decrease in abilities
Change in attitude or motivation
Change in general health
Signs of depression or mood changes

4. Importance of promoting independence
Problems related to lack of mobility
The following problems 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 ulcers
Regular ambulation and exercise help improve:
Quality and health of skin
Circulation
Strength
Sleep and relaxation
Mood
Self-esteem
Appetite
Elimination
Blood flow
Oxygen level
Remember: It is important to get a doctor’s approval before starting a new exercise or activity program. Certain medical conditions might make exercise risky or might require adaptations to ensure safety. Warming up and cooling down are important elements of an exercise program. These processes help prevent injury.

5. Assistive devices and equipment
Review p. 379, Figure 21-3 – It shows different items available to assist residents adapting to new limitations.
Remember: Residents using new ambulatory aids will likely be off-balance. NAs should stay close by and observe residents for signs of dizziness.

6. Guidelines for maintaining proper body alignment
Review chapter 10 for specific instructions for positioning residents.
Proper body alignment:
Observe principles of alignment.
Keep body parts in natural positions.
Prevent external rotation of hips.
Change positions often, at least every two hours.
Review chapter 10 for specific instructions for positioning residents.

7. Care guidelines for prosthetic devices
NAs should remember these guidelines for prosthetic devices:
Handle them carefully.
Follow instructions for application, removal, and care.
Keep prosthesis and skin dry and clean.
Apply stump sock if ordered.
Observe skin for signs of breakdown.
Do not try to fix a prosthesis.
Do not show negative feelings about prosthesis.
Follow these instructions in caring for an artificial eye:
Wash hands.
Provide privacy.
Put on gloves
Instructions for caring for an artificial eye (cont’d):
Wash artificial eye with solution and rinse in warm water.
Never clean or soak the artificial eye in rubbing alcohol – it will crack and destroy it.
When the artificial eye is removed, wash eye socket with warm water or saline.
Store artificial eye in water or saline in an eye cup or basin lined with a soft cloth or a piece of gauze. Mark container with resident’s name and room number.
To reinsert eye, moisten it and place it far under upper eyelid. Pull down on lower eyelid and the eye should slide into place.

8. How to assist with range of motion exercises
Passive range of motion (PROM)
Active range of motion (AROM)
Active assisted range of motion (AAROM)
Range of motion (ROM) exercises are exercises that put a particular joint through its full arc of motion. Passive range of motion (PROM) exercises are exercises to put a joint through its full arc of motion that are performed by a person alone, without the affected person’s help. Active range of motion (AROM) are exercises to put a joint through its full arc of motion that are performed by the affected person alone, without help. Active assisted range of motion (AAROM) exercised are exercises to put a joint through its full arc of motion that are performed by a person with some help from the affected person.
NAs should remember the differences between the types of ROM exercises:
PROM - NA does all the work, and resident does none.
AROM - NA encourages resident, but resident does all the work.
AAROM - NA assists and supports the resident in doing the work.

9. Body 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
Dorsiflexion – bending backward
Rotation – turning a joint
Pronation – turning downward
Supination – turning upward
Opposition – touching the thumb to any other finger

10. Skill: assisting with passive range of motion exercises
1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.
5. Adjust bed to a safe level, usually waist high. Lock bed wheels.
6. Position the resident lying supine—flat on her back—on the bed. Use proper alignment.
7. While supporting the limbs, move all joints gently, slowly, and smoothly through the range of motion to the point of resistance. Repeat each exercise at least three times unless the resident complains of pain. Stop performing exercises if resident complains of pain and report to the nurse.
8. Shoulder. Support the resident’s arm at the elbow and wrist while performing ROM for the shoulder. Place one hand under the elbow and the other hand under the wrist. Raise the straightened arm from the side position upward toward head to ear level and return arm down to side of the body (extension/flexion). Move straightened arm away from side of body to shoulder level and return arm to side of body(abduction/adduction).
9. Elbow. Hold the resident’s wrist with one hand and the elbow with the other hand. Bend the elbow so that the hand touches the shoulder on that same side (flexion). Straighten the arm (extension) (Fig. 21-9). Exercise the forearm by moving it so the palm is facing downward (pronation) and then the palm is facing upward (supination).
1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.
5. Adjust bed to a safe level, usually waist high. Lock bed wheels.
6. Position the resident lying supine—flat on her back—on the bed. Use proper alignment.
7. While supporting the limbs, move all joints gently, slowly, and smoothly through the range of motion to the point of resistance. Repeat each exercise at least three times unless the resident complains of pain. Stop performing exercises if resident complains of pain and report to the nurse.
8. Shoulder. Support the resident’s arm at the elbow and wrist while performing ROM for the shoulder. Place one hand under the elbow and the other hand under the wrist. Raise the straightened arm from the side position upward toward head to ear level and return arm down to side of the body (extension/flexion). Move straightened arm away from side of body to shoulder level and return arm to side of body(abduction/adduction).
9. Elbow. Hold the resident’s wrist with one hand and the elbow with the other hand. Bend the elbow so that the hand touches the shoulder on that same side (flexion). Straighten the arm (extension) (Fig. 21-9). Exercise the forearm by moving it so the palm is facing downward (pronation) and then the palm is facing upward (supination).
Continued on next slide

11. Skill: assisting with passive range of motion exercises (continued)
10. Wrist. Hold the wrist with one hand and use the fingers of the other hand to help move the joint through the motions. Bend the hand down (flexion); bend the hand backward (dorsiflexion). Turn the hand in the direction of the thumb (radial flexion). Then turn the hand in the direction of the little finger (ulnar flexion).
11. Thumb. Move the thumb away from the index finger (abduction). Move the thumb back next to the index finger (adduction). Touch each fingertip with the thumb (opposition). Bend thumb into the palm (flexion) and out to the side (extension) (Fig ).
12. Fingers. Make the hand into a fist (flexion). Gently straighten out the fist (extension). Spread the fingers and the thumb far apart from each other (abduction). Bring the fingers back next to each other (adduction).
13. Hip. Support the leg by placing one hand under the knee and one under the ankle. Straighten the leg and raise it gently upward. Move the leg away from the other leg (abduction). Move the leg toward the other leg (adduction). Gently turn the leg inward (internal rotation), then turn the leg outward (external rotation).
14. Knee. Support the leg under the knee and under the ankle while performing ROM for the knee. Bend the knee to the point of resistance (flexion). Return leg to resident’s normal position (extension).
10. Wrist. Hold the wrist with one hand and use the fingers of the other hand to help move the joint through the motions. Bend the hand down (flexion); bend the hand backward (dorsiflexion). Turn the hand in the direction of the thumb (radial flexion). Then turn the hand in the direction of the little finger (ulnar flexion).
11. Thumb. Move the thumb away from the index finger (abduction). Move the thumb back next to the index finger (adduction). Touch each fingertip with the thumb (opposition). Bend thumb into the palm (flexion) and out to the side (extension) (Fig ).
12. Fingers. Make the hand into a fist (flexion). Gently straighten out the fist (extension). Spread the fingers and the thumb far apart from each other (abduction). Bring the fingers back next to each other (adduction).
13. Hip. Support the leg by placing one hand under the knee and one under the ankle. Straighten the leg and raise it gently upward. Move the leg away from the other leg (abduction). Move the leg toward the other leg (adduction). Gently turn the leg inward (internal rotation), then turn the leg outward (external rotation).
14. Knee. Support the leg under the knee and under the ankle while performing ROM for the knee. Bend the knee to the point of resistance (flexion). Return leg to resident’s normal position (extension).
Continued on next slide

12. Skill: assisting with passive range of motion exercises (continued)
15. Ankle. Support the foot and ankle close to the bed while performing ROM for the ankle. Push/pull foot up toward the head (dorsiflexion). Push/pull foot down, with the toes pointed down (plantar flexion). Turn the inside of the foot inward toward the body (supination). Bend the sole of the foot so that it faces away from the body (pronation).
16. Toes. Curl and straighten the toes (flexion and extension). Gently spread the toes apart (abduction).
17. Return resident to comfortable position. Return bed to lowest position. Remove privacy measures.
18. Place call light within resident’s reach.
19. Wash your hands.
20. Report any changes in resident to nurse.
21. Document procedure using facility guidelines. Note any decrease in range of motion or any pain experienced by the resident. Notify the nurse or the physical therapist if you find increased stiffness or physical resistance. Resistance may be a sign that a contracture is developing.
15. Ankle. Support the foot and ankle close to the bed while performing ROM for the ankle. Push/pull foot up toward the head (dorsiflexion). Push/pull foot down, with the toes pointed down (plantar flexion). Turn the inside of the foot inward toward the body (supination). Bend the sole of the foot so that it faces away from the body (pronation).
16. Toes. Curl and straighten the toes (flexion and extension). Gently spread the toes apart (abduction).
17. Return resident to comfortable position. Return bed to lowest position. Remove privacy measures.
18. Place call light within resident’s reach.
19. Wash your hands.
20. Report any changes in resident to nurse.
21. Document procedure using facility guidelines. Note any decrease in range of motion or any pain experienced by the resident. Notify the nurse or the physical therapist if you find increased stiffness or physical resistance. Resistance may be a sign that a contracture is developing.

13. Benefits of deep breathing exercises
Deep breathing exercises offer these benefits:
Help expand the lungs
Clear lungs of mucus
Prevent infection
Remember: NAs should not assist with deep breathing exercises if they have not been trained to do so; they must ask the nurse for instructions.

14. Review Discuss rehabilitation and restorative care
Describe the importance of promoting independence
Describe assistive devices and equipment
Explain guidelines for maintaining proper body alignment
Explain care guidelines for prosthetic devices
Describe how to assist with range of motion exercises
Describe the benefits of deep breathing exercises
Rehabilitation and restorative care were discussed. The importance of promoting independence was described. Assistive devices and equipment were discussed and guidelines for maintaining proper body alignment were reviewed. Care guidelines for prosthetic devices were outlined and range of motion exercises were described. Benefits of deep breathing exercises were described, as well.