Orthopaedic Rehabilitation Flashcards
why is it important to know and understand the stages of tissue healing?
for avoidance of excessive stress and strain
what are the stages of healing?
post-operative
regeneration
remodelling
when is classed as the post-operative healing phase?
24-48hours post-op
when is classed as the regeneration phase of healing?
day 5 - 3 weeks +
when is classed as the remodelling phase of healing?
6 weeks - 1 year
what occurs in the post-operative stage of healing?
pain
oedema
healing tissues
what care should be provided during the post-op stage of healing?
reduce pain - multimodal analgesia
cryotherapy
rest
easy movement only - NWB/supported WB
what happens in the regeneration stage of healing?
new collagen fibres are forming
still fragile so requires ‘relative rest’
what care should be provided in the regeneration phase of healing?
controlled lead exercise
passive/active ROM exercises
what happens in the remodelling phase of healing?
consolidation and maturation
what occurs during the remodelling phase of bone healing?
regeneration and remodelling
what occurs during consolidation of tissues?
cellular into fibrous tissue, increasing strength and alignment
what occurs during maturation of tissues?
vascularity and metabolic rate returns to normal (between 10 weeks - 1 year)
what occurs during the regeneration phase of bone healing?
bridging callus forms
what occurs during the remodelling phase of bone healing?
clinical union of bone
what can occur once the remodelling phase of bone healing is completed?
gradual return to normal exercise
what is a common first intervention for cruciate disease cases?
weight loss programmes - obesity is common in patients with cruciate disease
what does the recovery of fractures depend on?
degree of fractures and site
pre-existing disease
degree of soft tissue damage
presence of open wounds
what should be involved in a rehabilitation plan for a fracture patient?
adequate analgesia
restricted exercise
cold compresses
encourage use of the limb
supportive dressing if applicable
why should we encourage use of the limb with fracture patients?
will help to start regain ROM
how can we encourage use of the limb in fracture patients?
can start doing PROM exercises - must be minimal to start to avoid further damage
what is the main difficulty nursing patients with external fixators?
difficulty in applying treatments
how can we aid recovery in patients with external fixators?
cryotherapy
passage/PROM
active exercises (physio)
what type of physiotherapy is important in patients with external fixators?
extension of the distal limb to avoid contracture of the muscles - the limb is usually held in a flexed position
what are the main aspects of managing patients after joint surgery?
main management - multimodal analgesia
pressure dressing 12-24 hours
cryotherapy
PROM
massage can reduce oedema
what are the benefits of PROM after joint surgery?
maintenance of normal ROM
stimulation of blood and lymphatic circulation
stimulation of sensory awareness
what specific management should be considered for patients who have had a THR?
management by experienced staff only - clear signage required
walked slowly in a controlled manner
must be kept settled and calm - mild sedation may be required
when can PROM be started for tendon injuries?
after 3 weeks rest
how long should exercise be limited for tendon injuries/rupture?
3-6 weeks
what are the primary goals of rehabilitation for orthopaedic patients?
weight bearing
regain active range of movement
muscle building
what is the most important aspect of the post-operative period after orthopaedic surgery?
multimodal pain relief - rehabilitation can cause stress on the tissues
what is the function of rehabilitation?
assists with return to function, minimising stress on the surgical site
how can we aid rehabilitation of orthopaedic injury pre-emptively/pre-surgical management?
cryotherapy
support dressings
weight bearing as much as possible
good pain management
assessment of other conditions/lifestyles which may affect treatment
when is cryotherapy most effective?
initial 72hour period
what are the advantages of cryotherapy?
vasoconstriction - reduced inflammation
analgesic effect
reduced tissue oedema
what is the idea application of cryotherapy?
15 mins 3x daily
what temperature is appropriate for heat therapy?
46 degrees C
when might heat therapy be beneficial?
before exercise - increased blood flow = increased elasticity
what are the advantages of massage as a rehabilitation technique?
increases blood flow –> improves oxygen supply and aids removal of waste products –> helps muscle work more efficiently
good enrichment for patient
stimulates venous and lymphatic return
mobilises adhesions
prepares muscles for exercise and aids recovery after
when is the ideal time to perform massage as part of rehabilitation?
as a warm up for physiotherapy session
what assisted therapeutic exercises might be done with orthopaedic patients?
assisted standing
weight shifting
side bending and cervical flexion/extension
balance boards/swiss balls
muscle stimulation (TENS, e-stim)
which active therapeutic exercises might be done with orthopaedic patients?
slow walks
stair climbing
sit to stands, down to sits,
treadmill walking
advanced exercises - dancing, wheelbarrowing, hydrotherapy
when should hydrotherapy be started for orthopaedic patients?
6-12 weeks post-op
how can we best communicate when nursing orthopaedic patients?
record clear and precise details or progress andn any procedures
take videos walking/of wound to show progress
ensure rehab plans discussed as a team and communicated with all involved
