Transcript L8c-Generic-Risks-Monitoring_Nov11

EXERCISE AFTER STROKE
Specialist Instructor Training Course
L8c
The role of the Specialist Exercise
Instructor
Clinical Risks & Monitoring of
Participants
John Dennis
Content
• What is clinical risk
• Monitoring of participants
• Participant self monitoring
Learning Outcomes
At the end of this session, you should be able to;
• Explain/ demonstrate understanding of
clinical risks and how to identify them
• Apply principles of risk management and
monitoring of participants
• Discuss how to avoid risks in your classes.
Essential Reading
Further detail about the topics discussed
in this session can be found in section
8.6 – 8.8 of the course manual
How do we know about risks?
• From effective communication from referrer. (if
necessary read between the lines)
• From robust assessment by instructor
• Close observation of participants & interactions
with environment/ others (continued assessment)
• By knowledge imparted
• By knowledge internalised
Risks
Generic risks
Clinical risks
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•Health
•Falls
•Impairment issues
•Ability issues
•Fatigue issues
•Mode of delivery
•Participant equipment
•Added participant risks
Environmental
Equipment
Modes of delivery
Communication
Clinical Risk
Health
• Stable? (cardiac, cognitive, performance,
deteriorated since referral?
• Appropriate class / location/access?
• Changes in limb power / sensation / balance /
tone?
• Change in endurance / fatigue?
Falls
• Causes variable – cardiac, sensory, balance,
weakness, tonal
• Need strategy to manage participants post fall
Clinical Risk
Impairment Issues
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Soft tissue changes
Joint integrity
Tone
Weakness
Other movement disorders
Sensory
Cognitive
Clinical Risk
Ability Issues
• Functional limitations
• Clinical limitations
e.g. co-morbid pathologies, medication issues
• Balance deficits
• Gait difficulties
• Transfer difficulties
• Cognitive changes
• Behavioural changes
Clinical Risk
• Fatigue Issues
• Mode of delivery e.g. Too intense too
soon
• Participant Equipment Splints, footwear,
spectacles, hearing aids, walking sticks,
etc.
Clinical Risk
Added Participant risks:
• Behaviour – May be unaware of
personality changes
• Alcohol / drugs – policy is clear!
Monitoring
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Tone
Deterioration in performance
Decreased co-ordination / balance
Increased weakness
Fatigue
Co-morbitities / pathologies
Monitoring 1.
Risk / avoid Strategies to reduce risks - Ensure
Increased
Abnormal
levels of tone
 Check posture at start/ during each
exercise
+/- secure limb
 Ensure lateral (outward) upper limb
rather than medial (inward) rotation in
resistance exercises
 Ensure self-assisted solutions
Monitoring 2
• Low tone /
subluxation at
shoulder (and
other joints)
Joints, especially the
shoulder - can be pulled
out of alignment if the is
a traction force greater
than the participant can
actively support.
Monitoring 3
Risk / Avoid
Strategy /Solution
↑ associated reactions
(shoulder)
“Correct posture” modalities /
functional activities e.g. walk,
bike, avoid rowing
↓ postural alignment /
symmetry
Stop exercise / check posture,
alignment and resistance level. If
reoccurs -> change activity
Safety
Risk / Avoid
Strategy /Solution
↓ postural stability ↑ falls
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↑ fatigue
 Avoid via Fartlek / active rests etc
↓ visual field / acuity / hearing
 Effective positioning of visual and aural
cues
kinaesthetic awareness/
sensory neglect
 Regular position shifts on equipment
Cognitive / communication
difficulties
Ensure chair/ wall supported options
 Ensure Instructions simple and
understood
 Consult person peers, family members
for communication tips.
Monitor closely the self
Avoid any chances
monitoring of clients for:
of missed
educational
 Pain
opportunities
 Excess SOB
 Tonal change
 ROM
Participant Self-monitoring
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Body mass index charts / weight
Reminders on heart rate
Blood pressure
Timed balance
No of repetitions / circuit components
achieved
• Self feedback questionnaire