Therapy and Sports Medicine Chapter Apply therapeutic skills for rehabilitation and injury prevention

Demonstrate Assistive and Therapeutic Techniques Range of motion When patients have limited movement range of motion exercise help keep muscles and joints functioning An example of a psychological benefit of massage therapy is relaxation

Range of Motion ROM Ordering by physician, Administered by physical therapist, nurse assistant or other authorized person Done during daily bath or at other times. Using massage on strained muscle can help increase circulation

ROM is done to avoid Contractures (tightening/shortening of muscle causing permanent flexing of joint, for example foot drop) ROM exercise are done to prevent contractures Muscle atrophy or stiff joints Circulatory impairment (leading to blood clots or decubitius ulcers Mineral loss Other problems, poor appetite, constipation, urinary infections, respiratory problems, and hypostatic pneumonia.

Active ROM Active ROM- Performed by patients who are able to move each joint without assistance. The term that describes the ROM movement when a straight leg is bent at the knee is flexion.

Passive ROM Another person moves each joint for a patient who is not able to exercise. If a person has a cast on their wrist, the motion that can still be done to the wrist and hand is rotation.

Resistive ROM Performed by a therapist against resistance provided by the therapist The training a certified athletic trainer must have a bachelor’s degree. The medical practice that would use a massage therapist as an associate is an orthopedics office.

Movements Abduction Adduction Flexion Extension Hyperextension Rotation Pronation Supination Inversion Eversion Dorsiflexion Plantar Flexion

Principles for Performing ROM Movements should be done slow, smooth, and gentle to prevent injury Support should be provided to the parts above and below the joint being exercised Never force joint beyond range or to the point of pain If patient complains of pain, stop exercise and report it to the supervisor

Repeat three times or as ordered Encourage patient to assist as much as possible Prevent unnecessary exposure of patient Close door, provide privacy Use correct body mechanics at all times

Principles of Ambulatory Assistance Crutches-Usually prescribed by physician Therapist or authorized person fits crutches Appropriate gait must be taught Must be properly fit (axillary pressure can cause damage to radial nerve). When ambulating a pt. with crutches, be sure: the pat supports his/her weight on the hand bars and not the axillary support.

When fitting crutches: Patient should wear good fitting walking shoes with low, broad heels If possible, position patient against wall for support (use chair for additional support) Position crutches 4-6” in front and 4-6” to the side of patient’s foot Allow 2” space between armpit and axillary bar. Adjust hand pieces so that each elbow is flexed at 25-300 angle.

Crutches Gait taught depends upon condition Patients must be taught to support weight on hand bars, NOT axillary supports

Cane Provides balance and support Some have 3 or 4 legs for additional support Used on unaffected (good) side

Walker When helping a client’s who is recovering from a stroke the nurse aide should assist on the clients weak side. 4 legged device Often used for weak patients without leg injuries Must be properly fitted to the pt. Patient must lift walker, place it in front of the body, and walk into it Patients must NOT slide walker

Gait Belt Band of fabric or leather around patient’s waist During transfers or ambulation, health care workers can hold gait belt to provide additional support Gait belt must be the proper size-secure fit around waist but not too tight Belt may have loop to hold, or use an underhand grasp to hold below Grasp belt at the back during ambulation Grasp the belt on both sides while facing the patient Apply gait belt over the patient's clothing at the waist

Safety Checks Remain alert when ambulating patient Walk on weak side and slightly behind patient If the patient starts to fall, use your body to brace the patient Ease the patient to the floor as slowly as possible Protect the patient’s head and neck Stay with the patient and call for help If a patient falls, an incident report must be filled out in most agencies

Massage A traditional backrub uses primarily friction. The massage technique involving making fine, tremulous movement with the fingers or the use of a mechanical device is vibration. During childbirth the massage technique that is used when light, circular strokes over the lower abdomen done during controlled breathing is called Effleurage. During a massage you should encourage the pt. to understand the potential source of healing in his/her own consciousness.

Taping an ankle… When taping an ankle under wrap is used to protect the skin. When taping an ankle, the first piece of tape to go on is a single strip of tape around the ankle, approximately 5 or 6 inches above the malleous. The strip of tape is called an anchor.

Test Your Gray Matter When you are ambulating a pt. with a gait belt, how should you hold the gait belt? When ambulating pt. with crutches, be sure: You go into a pt.’s room and note that the humidifier attached to the oxygen is empty. What should you do? What statement about the walker is true? Sheena has a cast on her wrist. What motion can she still do with her lower arm, wrist and hand? A physician wishes to treat a pts. Hemorrhoids with moist heat. Which of the following applications might be ordered? What term describes the ROM movement when a straight leg is bent at the knee? A pt. has shallow respirations, rapid pulse, restlessness, and cyanosis. The physician will likely order? The pt. supports his/her weight on the hand bars and not the axillary support The walker should be properly fitted to the pt. Hold the back of the belt using an underhand grasp. Notify your supervisor immediately Flexion Sitz bath Oxygen