Support delivery Flashcards
Support the delivery and monitoring of physiotherapy programs for mobility
Preparing for the client’s physio program:
Each of the clients that you assist will have an individualised rehabilitation program.
At the beginning of each session with a client you must read, and understand, what they will need to undertake for that session.
Confirm your interpretation of what is in the client’s medical history, and any additional information they have provided to you, with the physiotherapist prior to commencing the session.
Tasks to complete before starting a session with client:
1) Read and understand individual’s program
2) Confirm understanding with AHP
3) Organise equipment required (as per AHP’s instructions)
4) Prepare area: clean; hazard-free; enough space; items from previous session removed.
5) Confirm client’s availability and ability. Are they well; did they recover from last session; do they think they can do today’s tasks. Attendance does not equal consent; client needs to be informed.
6) Inform client about proposed tasks. Does client consent? Familiarise client with any equipment (particularly if new to them)
(upper?) “6-pack” muscle:
muscle joining groin to knee:
muscle just above knee, medially:
rectus abdominus
gracilis
vastus medialis
Goals of “active functional exercise”:
Enable ambulation; Improve coordination; Improve respiratory capacity; Reduce rigidity; Mobilize joints; Improve balance; Improve circulation; Promote relaxation; Release contracted muscles, tendons, and fascia; Improve exercise performance and functional capacity (endurance)
Therapeutic exercise:
bodily movement prescribed to correct an impairment, improve musculoskeletal function, or maintain a state of well-being.
Therapeutic exercise might be from highly selected activities restricted to specific muscles or parts of the body, or general and vigorous activities that can return a convalescing patient to the peak of physical condition.
Therapeutic exercises aimed at achieving and maintaining physical fitness fall into three major categories: endurance, resistance and/or flexibility
“FIIT”:
Frequency (how often to be done)
Intensity (how hard to perform eg moderately)
Time (how long/duration of exercises)
Type (what specific exercise)
Exercise program phases:
Preparation:
when the athlete or client undertakes general development of their fitness. This is both general aerobic fitness and strength training. The second part of preparation is when the athlete or client is undertaking training for a specific activity either sporting or rehabilitation.
Conditioning:
when the athlete or client is undertaking an exercise program for a specific sport or activity.
Recovery:
time to specifically recover from the rigors of training and competition. Generally there is no specific training plan and usually the coach just gives guidelines to maintain some fitness.
Adaptation:
the body grows and becomes stronger and fitter in response to the training / exercise load.
Repetitions:
Sets:
the number of times an exercise is undertaken per set
the frequency/no. of times a group of repetitions is performed
Single set to failure:
a single set per exercise that is taken to the point of failure. This means that the client is using weights and repetitions that are high enough that they will not be able to complete the set. This training method is known as high intensity training (HIT).
Matrix training:
a form of weight training exercise. When we normally exercise it is just in one plane. In other words we are either moving the body up and down or side to side. The goal of Matrix exercise is that the body moves through a series of exercises that are based on a pattern of partial movements designed to activate muscles at multiple points that aren’t otherwise worked effectively.
Some medical conditions that can have a negative impact on mobility:
Arthritis can affect walking, using stairs, prevent kneeling;
Joint injuries can affect balance and coordination;
Low blood pressure (dizziness) can affect balance and coordination;
Circulation disorders (swelling) can limit movement.
The treating health professional will take these conditions into consideration when they are assessing the client and prescribing a rehabilitation program.
AHAs need to be aware of the presence of these conditions and the potential impact they will have on the client and their mobility so that appropriate assistance and supervision can be provided.
Risks for decreased mobility:
Medical conditions:
Medical conditions such as arthritis, joint injuries, low blood pressure, and circulation disorders can all have a negative impact on the client’s ability to ambulate (walk), use stairs or even walk on sloping surfaces.
Self-limitations:
Low confidence, previous falls, and even poor eye sight can lead to a client self-limiting their mobility due to a belief that they are unable to walk safely.
Lack of resources:
Lack of resources to access walking aids can prevent clients from using these appliances to assist them with their mobility.
Weight bearing and post fracture implications:
Weight bearing is usually described as a percentage of the total body weight, because each leg of a healthy person carries the full body weight when walking, in an alternating fashion.
During rehabilitation after a fracture a small amount of weight may be supported by the affected leg. The weight may be gradually increased up to 50% of the body weight, which would permit the affected person to stand with his body weight evenly supported by both feet (but not to walk).
After a fracture, weight bearing will depend on the healing process – each fracture will be different and will heal at different rates. Pain tolerance during weight bearing and X-rays are used to assess healing and the treating health professional will decide how much weight bearing the client should undertake during the healing process.
Some of the time plastic cast walkers will be used to assist with recovery as they assist with weight bearing during rehabilitation.
Assisting with exercise program:
Your duties might include:
preparing equipment for the session;
greeting clients;
evaluating client ability to participate in the session;
monitoring client activity;
providing feedback to clients and the physiotherapist;
writing case notes in the client medical record after the session has finished.
When you are preparing for a rehabilitation session with the client you will need to confirm that they understand what exercises they will be undertaking, and are able to perform these activities.
How to confirm client understands exercises and is able to perform:
Speak with the client, explaining what each of the exercises are;
Demonstrate the exercises;
Get the client to perform the exercises for you to assess their ability;
Provide feedback and correction as needed.
Providing guidance during program:
Verbal encouragement:
Welcoming the client, and informing them about the planned activities for the session.
New clients will need time to become familiar with the rehabilitation environment, and how to use the equipment. Each client will need to become orientated and given the time to develop skills. This will take a varying amount of time for each person depending on their condition, and personal circumstances.
Engage them with the activity, and any other clients participating:
Introduce clients to each other when in group sessions.
It is important to encourage clients to engage with the rehabilitation exercises – practice will improve technique and develop confidence, this in turn helps the client maintain a positive attitude towards their rehabilitation, and will encourage adherence to the program.
Review of progress:
Let the client know the progress they have made towards achieving their goals.
Specific verbal feedback:
Regular feedback will reinforce their understanding of the activities involved in the rehabilitation program. In turn, this will help the client to maintain focus as well as improve their participation and task competition. Remember, rehabilitation goals are only achieved if the client undertakes the prescribed exercise program.
Feedback can include:
answering questions;
encouraging the client to continue with exercises;
demonstrating to the client progress against rehabilitation goals;
utilizing self-management and self-monitoring strategies;
facilitating attendance at the rehabilitation clinic and/or community participation activities.
Explaining any changes required:
Correcting the client’s technique with constructive feedback.
Integrate skills into daily activities:
The rehabilitation environment is a structured environment where the client attends to undertake specific activities as determined by the treating health professionals.
However, the client will also benefit from integrating these tasks / skills into their normal daily activities, as one of the goals of rehabilitation programs is that they can return to normal living after having recovered from their injury. The client will need to take advantage of opportunities to complete tasks for themselves at home as much as possible so that improvements and skills they have developed in rehabilitation are transferred to their day to day activities
Example:
Skill transfer
A client has been undertaking a rehabilitation program for 7 weeks following a car accident where she injured her back. She has been making very good progress during the rehabilitation sessions and can now sit, walk and stand pain free. She reports that getting into and out of a car is difficult due to the twisting motion involved, and often leads to pain developing at the injury site.
The physiotherapist asks her to start practicing this activity with a chair, and shows her how to do so in a way that is pain free. The client is then asked to practice this new seating technique whenever she is going to sit on a normal chair to develop her skill so that she will be able to get into and out of a car without hurting herself. This is also known as skill transfer, whereby the client may practice doing one activity (sitting on a chair) to help with another activity (getting in and out of the car).
Monitor the client during and after the program:
Clients attending a rehabilitation clinic need to be supervised and monitored at all times. This can range from general supervision, to clients that need to have someone working with them all of the time.
An example of general supervision might be an athlete recovering from injury. This client might be highly motivated and familiar with the rehabilitation process so might need only a small amount to supervision and assistance.
A client that might need one-on-one assistance could be an older person with multiple medical conditions, who is in the early stage of recovering from surgery.
Does the treatment plan need modification?
When you are working with clients in a rehabilitation setting the exercise program might need to be modified.
Indicators that an exercise program might need to be changed include persistent pain, the inability to perform or complete tasks, the client requesting different exercises, or the client having successfully undertaken the prescribed treatment but not yet achieved rehabilitation goals.
When these things have occurred you need to report to the treating physiotherapist so they can modify a client program according to individual need.
Pain or distress during treatment:
It is important to let clients know that they should tell you if they are in pain or getting distressed. Clients are entitled to ask to slow down, change the tasks they are undertaking, request further explanation or stop what they are doing.
When this occurs you must assist the client to become comfortable, even if this does include stopping the exercises.
Use your own observation skills as well! If the client is struggling to complete tasks, is grimacing or holding onto an injured body part you might need to step in and ask them to slow down or stop an exercise for their own safety.
You must report client distress, or pain, to the treating physiotherapist immediately for management.
Ongoing feedback/communication with AHPs is essential:
so the treating health professionals are aware of:
progress;
adherence issues;
complications;
goal attainment.
This allows them to monitor rehabilitation progress and / or make any changes to the treatment program that may be needed
Forms of feedback:
SPECIFIC:
such as letting a client know they are using the correct technique when performing a particular exercise.
WRITTEN/VERBAL:
Feedback can be written or verbal, it can be phrased negatively or positively
GENERAL:
for example, encouraging the client to continue until they have completed the required number of repetitions of an exercise.
Adherence:
a measure of client compliance.
During each treatment session you will evaluate how well the client is adhering to the prescribed treatment.
This is done through both objective measures and subjective measures.
It is important to differentiate between these things when reporting to the AHP, whether this is verbally or in writing.
Objective measures:
Monitoring or evaluation that is tested. For example how many repetitions of an exercise the client can undertake, and with which weight.
Subjective measures:
Opinions and observations – things that have not been directly measured such as how difficult the activity appeared to be.
What is a Disability?
A disability is a significant absence or loss of function. This can be either physical, mental or a combination of both.
After an injury or illness an individual may have a significant loss of function, such as mobility limitations, reduction in manual handling skills, or damage to the ability to communicate due to speech loss. Each person will be different in their circumstances, and will also have individual needs that have to be address as they go through rehabilitation.
