Transcript Osteoporosis PT and Fitness - Vanderbilt University Medical Center

OSTEOPOROSIS
PT and Fitness
OUR TEAM
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Katie O’Hara PT
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Julie Neaderthal PT
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Sheila Gaffney PT
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Mark Snow ATC
GOALS for 2008
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Create a one time PT evaluation form
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Develop educational power point for osteoporosis patients
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Complete Home Exercise booklet to complement the Osteoporosis
booklet and create fitness presentation
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Practice and help implement the Fitness Center’s Better Bones
program
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PT Osteoporosis One Time Evaluation
Vanderbilt Orthopaedic Institute
PATIENT MEDICAL HISTORY
Name: Jane Doe
MRN: 1234567
Referred by: Dr.
Visit Number: 1
ICD9:
Patient is a year old F/M with a diagnosis of .
CHIEF COMPLAINT AND CAUSE: osteoporosis
Onset date:
SUBJECTIVE
Pain: Pain Scale (0 = absent 6 = moderate 10 = severe) Current Pain: 0/10
PRIOR MEDICAL HISTORY
Prior History of Current Problem(s): none multiple episodes; one episode; previous fractures;
previous falls;
Patient's prior treatment history: None
PMHX: none;
Precautions/Contra-Indications/ Allergies
Medications: None
Prior Level of Function: Independent with ADL's, homecare, and selfcare activities:
Current Level of Function: Independent with ADL's and body mechanics; Active exercise program
includes:
Patient stated goal: Patient is able to exercise safely with osteoporosis.
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OBJECTIVE EXAMINATION
Objective Information:
ASSESSMENT/FINDINGS
Problem List: pain; swelling; decreased ROM; decreased strength; decreased flexibility; use of assistive
device; impaired balance; decreased positional tolerance; decreased understanding of safe exercises for
osteoporosis;
Learning Barriers/Barriers to Goal Achievement: None
Modification to treatment based on identified Learning Barriers/Barriers to Goal Achievement: NA
Rehab Prognosis: Patient has excellent prognosis to meet goals stated below due to: understanding safe
exercises for osteoporosis, understanding the home exercise program, understanding body mechanics
and ADL's recommendations, participation in VOI osteoporosis program,
PLAN OF CARE
PT goals:
1. Patient verbalizes understanding to decrease episodes of trunk flexion in ADL's and body mechanics.
2. Patient verbalizes understanding of safe exercises for osteoporosis.
3. Patient/therapist performed Home Fall Risk Prevention Assessment.
4. Patient verbalizes understanding of home exercise program.
5. Patient referred to VOI Fitness Center Osteoporosis Program.
Patient goal:
Independent in use, wear, care and fit of orthtic device
Independent in the use, wear, care and fit of TENS device
Independent with home exercise program
Independent with ambulation with assistive devicel
----------------- by the end of 1 visit.
Status of Goal: Met
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Treatment Plan:
Recommendations:PT 1 x only
VOI Fitness Center
Today's Treatment:
VOI osteoporosis booklet provided
body mechanics and ADL instruction
Home Fall Risk Prevention Assessment
Today's Treatment Interventions/Home Exercise Program:
The patient was given both a verbal and written home exercise program. The home
program/exercises were demonstrated and reviewed with the patient. The patient demonstrated
understanding of the home program/exercises.
Home Exercise program includes:
core abdominal exercises given
back extension exercises
scapular retraction exercises with/without theraband
Goals, Treatment Plan, and Risks/Benefits of Physical Therapy Intervention have been
communicated with and agreed upon by the patient/family/caregivers. Plan of Care has been
communicated to members of the multi-disciplinary team.
The Goals and Treatment Plan were developed in light of the Patient's Goals, Learning
Barriers/Barriers to Goal Achievement; and the patient's Rehab Potential.
Movement Safety with Osteoporosis
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Patient Education Presentation – based on the osteoporosis booklet
What is Osteoporosis ?
Osteoporosis is a disease that causes
bones to become thin, weak and easy
to break.
Causes
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family history
diet
Medications
lack of physical activity
Most common fracture sites
Hips
Wrists
Spine
Factors that affect strong bones:
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Positive Factors
– Calcium and Vitamin D
intake
– Physical activity –weight
bearing improves bone
strength
– Maintaining a healthy
weight
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Negative Factors
– Smoking and heavy alcohol
use
– Medications –ask your
doctor
Physical Therapy
Initial Evaluation
Medical history
Physical Assessment
• Posture
• Joint range of motion
• Strength
• Flexibility
• Daily activity
Pain control (if necessary)
Exercise
Home Exercise Program
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Stretching and strengthening
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Posture and body positioning /body mechanics
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Fall prevention in the home
Body Mechanics
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Avoid forward bending
Carry loads close to the body
Tighten your stomach when you lift items
Never twist with a load
Sit up straight with knees level to hips
Change positions every 30 min
Sleep with back straight
Making your home safe
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Floors
Lighting
Nightlights
Telephone access
Electrical cords secured
Pets
Throw rugs
Bedroom-Living room safety
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Bedside tables for glasses, lamps and phones
Sit on the side of bed for a minute before standing to avoid
dizziness
Secure area rugs
Clear walkways
Chair and sofa height safe and comfortable
Bathroom-Kitchen safety
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Grab bars for safe entry in/out of shower and tub
Non skid mats at tub, shower & toilet
Keep items in easy reach from knee to shoulder height
Non slip flooring
Rubber backed mat in front of sink
Avoid ladders and step stools to reach overhead
Nightlight between rooms
– Bedroom and bathroom
– Hallway
Stairs
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Handrails on both sides
Non slip surface
Uncluttered stairs
Steps more visible
– Marked with tape
Personal safety
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Wear properly fitting non skid shoes
Avoid ladders
When doing housework, keep your upper body straight.
– Do not twist at the waist
– Bend from the knees, not from the waist.
– When vacuuming or mopping, bend knees and rock front to back
instead of bending over.
Log roll when getting out of bed
Fitness Better Bones Program
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Individualized exercise program to strengthen bone and prevent
injury
Focus on posture, strength, flexibility, balance, and cardiovascular
training
Learn safe and effective exercise
Program fees:
4 one hour sessions
6 one hour sessions
$80 Member
$100 Member
$150 Non-member
$200 Non-member
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Patient Education
Exercise Program
Booklet