Transcript File

Chapter 33
Rehabilitation and
Therapeutic Modalities
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2014 Cengage
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Learning.
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Reserved.
be scanned,
May not
copied
be scanned, copied
or duplicated, or or
posted
duplicated,
to a publicly
or posted
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to a publicly
website,
accessible
in wholewebsite,
or in part.
in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Transferring Patients
• Use good body
mechanics
• From wheelchair to
examination table
• From examination
table to wheelchair
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Assistive Devices
• Walkers
– Provide stability and support when patients
standing or walking
– Ability to ambulate independently with confidence
– Various styles available
• Stationary
• Rolling
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Assistive Devices
• Crutches
– Types prescribed depending on patient’s physical
limitations and abilities:
• Axillary
• Forearm (Lofstrand or Canadian)
• Platform
– Measuring for axillary crutches
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Therapeutic Exercises
• Range of motion
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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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Therapeutic Exercises
• Muscle testing
– Evaluates motion, strength, task potential of a
given muscle
• Types of therapeutic exercise
–
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Active
Passive
Assisted
Active resistance
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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)
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Therapeutic Modalities
• Moist and dry cold
– Moist cold therapies
• Cold compresses and packs
– Dry cold therapies
• Ice packs
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
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
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.
Therapeutic Modalities
• Massage therapy
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Used to relieve minor aches and pains
Safe and advantageous for most individuals
Relieves stress and tension
Complementary or alternative form of medicine
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.