Rehabilitation

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Introduction 3 Indications 4 Procedure 5 Management 6 More General Terms 7 Additional Terms 8 References

More Specific Terms

• cancer rehabilitation
• cardiac rehabilitation
• comprehensive rehabilitation
• intense rehabilitation
• neurorehabilitation
• pulmonary rehabilitation
• rehabilitation hospital
• rehabilitation unit
• subacute rehabilitation
• vision rehabilitation

Introduction

• Restoration of the disabled person to self-sufficiency or maximal possible functional independence.

Indications

• deconditioning
• contractures, paralysis
• injury, trauma

Procedure

• Includes:

• physical
• psychological
• social
• vocational
• leisure

• Goals:

• stabilize primary disorder
• prevent secondary complication
• treatment of functional deficits
• adaptation

• patient to disability
• environment to patient
• family to patient

• Rehabilitation settings

• acute medical/ surgical ward
• acute inpatient Rehab unit
• subacute inpatient - transitional care unit ( TCU)
• nursing home
• outpatient
• in home therapy

• Rehabilitation team

• physical therapy
• occupational therapy
• speech-language pathologist
• therapeutic recreation therapist
• rehab nurse
• psychiatrist
• social worker
• psychologist
• prosthetist/orthotist
• vocational counselor

• Assessment:

• functional independence measure
• Barthel index

Management

• progressive mobilization

• bed position/ bed mobility

• avoid neck flexion
• avoid pillows under knees
• avoid external rotation of hip

• stroke
• hip fracture

• keep ankles flexed to 90 degrees
• keep arms abducted

• range of motion ( ROM)

• use functional activities for ROM
• muscles crossing 2 joints more likely to tighten

• hamstrings, gastrocnemius, finger flexors

• sitting tolerance

• end goal: out of bed 12-14 hours/day
• day 3 goal: 2.5 hours sitting tolerance
• limited by pulse & blood pressure response
• correlates with ability to strengthen
• add 15 minutes to sessions TID
• sitting balance also important

• transfers

• bed height so feet touch floor
• put shoes on: do NOT transfer in stockings
• chair parallel to bed, on patient's stronger side with raised footplate between patient's foot & bed
• make sure chair is locked
• remove obstacles
• stand in front of patient - close
• NEVER pull on arm
• patient sits on with slight lean forward
• have patient stand with strong hand on armrest of chair, weak hand on bed
• strong foot, then weak foot with small steps turning until in front of chair
• back legs against chair, sit

• standing

• enables transfers & ADLs
• strengthes multiple muscles

• stair climbing

• if bad leg, use crutches, don't step on bad leg

• up: good leg 1st, crutches & bad leg follow
• down: crutch down 1st, bad leg down, the good leg

• ambulation

• requires patient to sit unsupported & stand up unassisted
• stand slightly behind weak side
• place your right hand on belt & left hand on front of patient's shoulder, but give him/her freedom to move
• never hold patient just by arm or let him/her hold onto you
• always turn to good side
• turns need wide base of support
• to sit down again, walk up to chair (bed/toilet, etc), turn around, back up stepping with good foot 1st, until back of legs against chair
• let go of walker with one hand, reach back to chair armrest, ease down

• exercise

• early gains in strength (1st days to weeks)

• little change in muscle size
• due to neural adaptations

• improves coordination & muscle activation

• exercise in elderly requires longer warm-up & cool-down period
• complete fitness program should contain

• aerobic conditioning

• 20-60 minutes/day
• may be interspersed throughout day
• minimum of 10 minute sessions

• strength training

• isokinetic training better than isotonic or isometric training

• flexibility training

• exercise tolerance testing prior to exercise program

• known coronary artery disease
• symptoms of cardiac angina
• risk factors for coronary artery disease

• diabetics: monitor blood sugar before & after exercise

• specific conditions which may require precautions

• osteoporosis

• protect the spine & extremities
• avoid high impact exercises

• jogging
• high-impact aerobics

• avoid exercise risky for falls
• avoid strenous twisting
• keep spine in proper alignment
• avoid forward flexion

• diabetes mellitus

• watch for hypoglycemia after exercise
• increase carbohydrate intake prior to exercises

• 15 g of carbohydrate for every 30 min anticipated exercise

• proper foot care
• avoid jogging/ running if neuropathy or peripheral vascular disease is present
• avoid resistance training if retinopathy is present due to risk of ocular hemorrhage

• osteoarthritis

• avoid high-impact activities
• swimming or cycling can be helpful
• goal: strong & balanced muscles with good joint range of motion

• hypertension

• ensure blood pressure is well controlled before starting exercise program
• moderate intensity exercise is preferable
• avoid caffeine before a workout
• resistance training should use high repititions, low weights

More General Terms

• physical therapy (PT)
• geriatrics

Additional Terms

• comprehensive rehabilitation
• deconditioning
• disability
• functional independence measure (FIM)
• handicap
• intense rehabilitation
• rehabilitation hospital
• subacute rehabilitation

References

1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
2. Genova, A, UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
3. Brummel-Smith K in: Cassel CK 2003
4. National Guideline Clearinghouseensity and organization of rehabilitation. Ottawa Panel ngc-guideline: [1]
   - Rehabilitation after critical illness. National Institute for Health and Clinical Excellence (NICE) ngc-guideline: [2]

rehabilitation