1. Rehabilitation and Therapeutic Modalities
Chapter 33
Rehabilitation and Therapeutic Modalities

2. Role of MA in Rehabilitation
Whatever the rehabilitation setting, you will most likely be a member of interdisciplinary team of health care professionals
Provider responsible for prescribing rehabilitative medicine
(See Table 33-1: Some of the Specialized Fields of Rehabilitation Medicine)

3. Role of MA in Rehabilitation
Patients may have sustained tremendous loss of physical ability
May be vulnerable to feelings of helplessness
May be able to perform only limited activities of daily living (ADL)
May be completely dependent on another for help
Respect their dignity
Patients’ safety essential

4. Principles of Body Mechanics
Practice of using certain key muscle groups together with good body alignment and proper body positioning to reduce risk for injury to both patient and caregiver

5. Principles of Body Mechanics
Posture
Protects entire body, particularly the back, whether standing, sitting, lying down
Central idea of good posture is body alignment
Standing: body should be balanced
Sitting: keeping spine in neutral position
Lying down: maintaining spine in neutral position

6. Using the Body Safely and Effectively
Keep back as straight as possible and feet shoulder-width apart
Always bend from hips and knees
Pivot entire body instead of twisting it
Use body’s weight to push or pull heavy object

7. Using the Body Safely and Effectively
Obtain help if unable to move patient or object is too heavy
Hold heavy objects close to body
Make sure path is clear and area to receive object is ready before lifting or moving it
Wear body support if job includes much lifting

8. Using the Body Safely and Effectively
Lifting techniques
Get close to object or person being lifted
Keep feet apart, one slightly in front of the other, knees slightly bent
Use large muscles of legs and arms to lift, not back muscles

9. Using the Body Safely and Effectively
Lifting techniques
Keep back straight to transfer workload to larger arm and leg muscles
Avoid twisting movements
Bend from hips and knees, squat down, push up with leg muscles

10. Transferring Patients
Use good body mechanics
From wheelchair to examination table
From examination table to wheelchair
[INSERT FIGURE 33-3]
(See Procedure 33-1: Transferring Patient from Wheelchair to Examination Table)
(See Procedure 33-2: Transferring Patient from Examination Table to Wheelchair)

11. Assisting Patients to Ambulate
Walking provides ultimate level of independence and freedom
Make sure patient is ready to walk
Patient should be wearing good shoes that are flat, supportive, have rubber sole
Handholds or railings within easy reach
Gait belt provides firm hold on patient

12. Assisting Patients to Ambulate
Monitor patient
Ambulate as long as patient has strength
Never push patient beyond endurance
Never hurry patient
Be ready should patient start to fall
(See Procedure 33-3: Assisting the Patient to Stand and Walk)
(See Procedure 33-4: Care of the Falling Patient)

13. Assistive Devices Walking aid such as walker, crutches, cane
Provide stability and support
Type of device depends on disability and patient’s recuperation curve
MAs measure patient for correct size and provide instruction in proper use and care
(See Table 33-2: Types of Assistive Devices)

14. Assistive Devices Walkers
Provide stability and support when patients standing or walking
Ability to ambulate independently with confidence
Various styles available
Stationary
Rolling

15. Assistive Devices Fitting a walker
Height of handgrip adjusted to patient just below patient’s waist or at top of femur
Elbow bent at 30-degree angle when patient standing with hands on handgrip
(See Procedure 33-5: Assisting a Patient to Ambulate with a Walker)

16. Assistive Devices Crutches
Types prescribed depending on patient’s physical limitations and abilities:
Axillary
Forearm (Lofstrand or Canadian)
Platform
Measuring for axillary crutches
(See Procedure 33-6: Teaching the Patient to Ambulate with Crutches)

17. Assistive Devices Crutch-walking gaits
Gait (walk) patient uses depends on patient’s injury and condition
Two-point
Three-point
Four-point alternating
Swing-to
Swing-through
Sitting 
Standing

18. Assistive Devices Canes Used when patient has one weak side
Need this device for longer period than crutches
Standard, or single-tipped
Four-legged, or quad
Walkcane
(See Procedure 33-7: Assisting a Patient to Ambulate with a Cane)

19. Assistive Devices Wheelchairs
Mobile chairs that enable patients with severe ambulation conditions, or no ability to ambulate at all, to get around
Manual or motorized

20. Therapeutic Exercises
Range of motion
Amount of movement present in a joint
Passive (assisted motion)
Active (voluntary motion)
Goniometry: measurement of joint motion
ROM exercises designed to maintain joint mobility
Joint movement has special vocabulary
(See Table 33-3: Terminology of Joint Movement)

21. Therapeutic Exercises
Muscle testing
Evaluates motion, strength, task potential of a given muscle
Types of therapeutic exercise
Active
Passive
Assisted
Active resistance

22. Therapeutic Exercises
Electromyography
Test electrical activity of muscle
Electrostimulation of muscle
Stimulates muscles to exercise
Helpful to nerve-damaged muscle
Prevent atrophy of muscle; help restore muscle function
Transcutaneous electric nerve stimulation (TENS)

23. Therapeutic Modalities
Heat and cold
Heat (thermotherapy)
Acts on body by causing vasodilation
Also acts to speed up inflammatory process
Should not be used longer than its prescribed length of time

24. Therapeutic Modalities
Heat and cold
Cold (cryotherapy)
Constricts blood vessels and slows or stops flow of blood to area (vasoconstriction)
Slows down inflammatory process
Take precautions for heat and cold applications

25. Therapeutic Modalities
Moist and dry heat
Moist heat therapies
Warm soaks
Sitz bath
Warm wet compresses and packs
Paraffin wax bath
Dry heat therapies
Heating pads and packs

26. Therapeutic Modalities
Moist and dry cold
Moist cold therapies
Cold compresses and packs
Dry cold therapies
Ice packs

27. Therapeutic Modalities
Ultrasound
High-frequency acoustic vibration
Uses high-frequency sound waves converted to heat in deeper tissues
Treatment for chronic pain or acute injuries
Potential dangers

28. Therapeutic Modalities
Massage therapy
Used to relieve minor aches and pains
Safe and advantageous for most individuals
Relieves stress and tension
Complementary or alternative form of medicine