1. Activity and Exercise

2. Key Terms 1. Abduction – Movement away from body. 2.Active Range of Motion – Range of motion exercises completed by the resident without assistance. 3.Adaptive Equipment – Items such as eating utensils which are altered to make them easier to use by residents with functional limitations. 4.Adduction – Movement towards the body. 5.Ambulate – To walk or assist the resident to walk. 6.Atrophy – Decrease in size and strength, also referred to as wasting. 7.Body Alignment – Correct position of the body for good posture. 8.Contractures – Shortening or contraction of a muscle. May be due to spasms or paralysis and may be permanent. 9.Exercise – Physical activity or series of specific body movements designed to strengthen the body or parts of the body. 10.Extension – To straighten. 11.Rehabilitation – A process in which the resident is assisted in reaching their highest level of ability physically, mentally and emotionally. 12. Restorative Care – Nursing care that is planned to promote resident’s health and regain as much of their independence as possible.

3. 13. Semi-Fowler’s Position – Body position alignment of resident sitting in bed with the head of the bed elevated to between 30-45 degrees. Also referred to as Low Fowler’s. 14. Side-Lying Position – Body alignment position of resident lying on their back in bed. Also referred to as lateral position. 15. Supine Position – Body alignment position of resident lying on their back in bed. 16. Transfer – Move from one surface or place to another. 17. External Rotation – To rotate the joint away or outward. 18. Flexion – To bend. 19. Fowler’s Position – Body position alignment of resident sitting in bed with the head of the bed is elevated to between 60-90 degrees. Also referred to High Fowler’s. 20. Hemiplegia – Paralysis of one side of the body. 21. Internal Rotation – To rotate the joint inward. 22. Paralysis – Loss of ability to move a part or all of the body. 23. Paraplegia – Paralysis (loss of sensation of voluntary movement) of the lower part of the body and both legs.

4. 24. Passive Range of Motion – Exercises completed for residents who are paralyzed or unable to move their own joints freely or may not even be able to move. Also referred to as PROM. 25. Progressive Mobilization – Process that builds on activity steps which increase the resident's abilities. 26. Quadriplegia – Paralysis of all four of the extremities and the trunk. 27. Range of Motion – Moving body joints through their normal motion.

8. Benefits of Exercise Exercise is the physical activity or a series of specific movements designed to strengthen the body or parts of the body. Benefits of exercise: 1. Improves circulation and the functioning of the body 2. Keeps residents mobile 3. Allows residents to be more independent

9. Importance of rest and sleep with activity and exercise: Adequate rest and sleep promotes improved strength, endurance and successful results with exercise activities Plan rest times as part of the resident's daily activity Plan resident’s night routine to promote a restful sleep Assists the resident to remain mentally alert Exercise helps to avoid boredom Resident’s self esteem is improved Exercise and activity allows for socialization.

10. Nursing Care: Nursing care that is planned to promote resident’s health and regain as much of their independence as possible May also be referred to as a retraining program.

11. Characteristics of restorative nursing care: Slow lengthy process a. weeks b. months c. indefinitely Designed to maintain a resident's condition May prevent a decrease in resident's ability to perform ADL's: a. instead of feeding a resident, encourage self feeding as able and as on care plan Care is given in a skilled care facility or in a home setting

12. Common goals Increase resident’s physical abilities Maintain resident’s current abilities Prevent complications a. pressure sores b. contractures Assist the resident to adapt to their limitations Improve their quality of life.

13. Psycho-social effect of immobility Loss of self esteem Low self concept Poor body image Increased dependence on others Inactivity can lead to depression Withdrawal Isolation Loneliness.

14. Nursing assistant responsibility to assist resident’s participation in activities and exercise: Plan work so that residents can attend activities Check the activity calendar to be aware of what activities are offered Help residents dress properly for the activity Talk to residents about their activities and praise their accomplishments.

15. Guidelines and Considerations when Moving, Transferring and Lifting Residents Plan the moves: Check the resident's care plan for directions and any special needs such as weakness on one side of body. Residents with hemiplegia (paralysis) as a result of a stroke will have weakness on one half of their body, (right or left). Ask for assistance if needed Organize the equipment needed Explain the procedure to the resident Be certain the resident understands what is to be done.

16. Importance of Range of Motion Exercises Range of motion exercises are necessary for the resident with limited mobility, to maintain and/or strengthen muscle as well as prevent joint stiffness.

17. Types of Range of Motion Exercise: Active-resident performs exercises for self Passive-resident exercises are done by a member of the health care team

18. Skills of Activity and Exercise Ambulate Walk with a Cane Walk with a Walker Wheelchair Transfer Wheelchair Transport Wheelchair Transfer (two-person) Mechanical Lift Supine Position Placement Side-lying Position Placement Move Up In Bed Move Up In Bed Using Lift Sheet Passive Range of Motion of the Shoulder and Elbow Passive Range of Motion of the Hip and Knee Support Stocking Application

19. 1.Walk with a Cane 2.Walk with a Walker 3.Wheelchair

21. Patients Ambulation

22. Move Up In Bed

23. Walk with Cane/Walker

24. Purpose of Range of Motion Exercises: Prevent deformities Prevent pain Maintain normal function Increase joint function Increase circulation Promote sense of well-being Increase independence

28. Guides for Range of Motion Exercises : Follow care plan instruction Never do passively what the person can do actively for self Force is never used in a range of motion exercise Allow time between rest between joints when exercising Instruct resident to inform nursing assistant if pain experienced Move joint through full range or to point of resistance Range of motion is more effective in bed than in wheelchair