25 Rehabilitation and Restorative Care 1 Define important

25 Rehabilitation and Restorative Care 1. Define important words in this chapter abduction moving a body part away from the midline of the body. active assisted range of motion (AAROM) exercises to put a joint through its full arc of motion that are done by a resident with some assistance from a staff member. active range of motion (AROM) exercises to put a joint through its full arc of motion that are done by a resident himself, without help. adaptive devices special equipment that helps a person who is ill or disabled perform ADLs; also called assistive devices.

25 Rehabilitation and Restorative Care 1. Define important words in this chapter adduction moving a body part toward the midline of the body. assistive devices special equipment that helps a person who is ill or disabled perform activities of daily living; also called adaptive devices. dorsiflexion bending backward. extension straightening a body part.

25 Rehabilitation and Restorative Care 1. Define important words in this chapter flexion bending a body part. foot drop weakness of muscles in the feet and ankles that interferes with the ability to flex the ankles and walk normally. hyperextension extending a joint beyond its normal range of motion. opposition touching the thumb to any other finger.

25 Rehabilitation and Restorative Care 1. Define important words in this chapter orthotic devices applied externally to limbs to support, protect, improve function, and prevent complications. passive range of motion (PROM) exercises to put a joint through its full arc of motion that are done by a staff member, without the resident’s help. physiatrists doctors who specialize in rehabilitation. pronation turning downward.

25 Rehabilitation and Restorative Care 1. Define important words in this chapter range of motion (ROM) exercises that put a joint through its full arc of motion. rehabilitation care that is managed by professionals to restore a person to the highest possible level of functioning after an illness or injury. restorative care given after rehabilitation to maintain a person’s function and increase independence. rotation turning the joint. supination turning upward.

25 Rehabilitation and Restorative Care 2. Discuss rehabilitation and restorative care Define the following terms: rehabilitation care that is managed by professionals to restore a person to the highest possible level of functioning after an illness or injury. physiatrists doctors who specialize in rehabilitation. restorative care given after rehabilitation to maintain a person’s function and increase independence.

25 Rehabilitation and Restorative Care 2. Discuss rehabilitation and restorative care Here are some factors that affect progress of rehabilitation: • How soon it began • Any pre-existing diseases or injuries • Overall motivation of the resident • Type of facility where resident lives • Combined efforts of staff and others • Attitude of the rehabilitation team • Consistency in following the care plan

25 Rehabilitation and Restorative Care 2. Discuss rehabilitation and restorative care REMEMBER: For rehabilitation to succeed, all staff members must work together to return the person to his highest level of functioning. The rehabilitation team is made up of highly skilled and trained professionals, including nursing assistants.

25 Rehabilitation and Restorative Care 2. Discuss rehabilitation and restorative care The rehabilitation team is made up of the following: • Physiatrists • Speech-language pathologists and physical and occupational therapists • Nurses • Social workers • Discharge planners • Nursing assistants • Resident’s family and friends

25 Rehabilitation and Restorative Care 2. Discuss rehabilitation and restorative care Remember these goals of rehabilitation: • Maintain or regain abilities • Promote independence and help resident to adapt • Prevent complications of immobility

25 Rehabilitation and Restorative Care 2. Discuss rehabilitation and restorative care REMEMBER: When the goals of rehabilitation have been met, restorative care may be ordered. Restorative care works to maintain a person’s functioning and to increase independence

25 Rehabilitation and Restorative Care Transparency 25 -1: Rehabilitation and Restorative Care • Understand the diagnosis, the disability and any limitations the resident has. • Be patient and offer praise frequently. • Maintain a positive attitude. • Listen as much as possible. • Provide plenty of privacy. • Encourage independence. • Encourage daily activity. • Accept setbacks and focus on what the resident can do. Report observations to the nurse: • Any change in ability • Decreased strength • Lack of motivation • Sign of withdrawal and depression

25 Rehabilitation and Restorative Care 2. Discuss rehabilitation and restorative care Case Studies How could an NA can adapt his motivational style to fit the different and unique personalities of the following residents? • Mrs. T is a shy, quiet, elderly woman learning to dress herself. • Mr. M is a very proud ex-Marine major who must learn to feed himself. • Mrs. G is a grandmother who must learn to use a leg brace to walk. • Mr. J is an athlete who must accept being confined to a wheelchair.

25 Rehabilitation and Restorative Care 2. Discuss rehabilitation and restorative care Case Studies (cont'd): • Mrs. C must now wear a pad for permanent incontinence. • Mr. D has been told he will never walk again as he and the physicians hoped he would. • Mr. H has been trying unsuccessfully for two weeks to learn to use special eating utensils.

25 Rehabilitation and Restorative Care 3. Describe the importance of promoting independence Think about this question: Even though it may be easier and faster for you to do a task yourself, why is it so important for you to encourage independence in your residents and to allow them to do as much for themselves as is possible?

25 Rehabilitation and Restorative Care 3. Describe the importance of promoting independence Promoting each resident’s independence is an important duty of the care team: • Let residents do as much as they can for themselves, regardless of how long it takes or how poorly they are able to do it. • Even if an NA could do a task better or faster, she must be patient and encourage each resident to perform as much selfcare as possible. • Independence helps self-esteem, along with speeding recovery. Self-care also helps the body stay active and prevents complications of immobility.

25 Rehabilitation and Restorative Care 3. Describe the importance of promoting independence REMEMBER: Encouraging independence has positive effects on self-image, attitude, and abilities.

25 Rehabilitation and Restorative Care 3. Describe the importance of promoting independence Think about these questions: How do you think it would feel to need help lifting a fork to your lips at mealtime? How would it feel to need help getting dressed each morning?

25 Rehabilitation and Restorative Care 4. Explain the complications of immobility and describe how exercise helps maintain health REMEMBER: Activity is an essential part of a person’s life. When a person becomes immobile and inactive, the body does not respond well.

25 Rehabilitation and Restorative Care 4. Explain the complications of immobility and describe how exercise helps maintain health Remember these complications of immobility, organized by body system: • Gastrointestinal: constipation • Urinary: urinary tract infection (UTI) • Integumentary: pressure ulcers and slow-healing wounds • Circulatory: blood clots, especially in the legs • Respiratory: pneumonia • Musculoskeletal: muscle atrophy and contractures • Nervous: depression or insomnia • Endocrine: weight gain

25 Rehabilitation and Restorative Care Transparency 25 -2: Benefits of Exercise • Gastrointestinal: promotes appetite and aids regular elimination • Urinary: improves elimination, helping to decrease infection • Integumentary: improves the quality and health of the skin • Circulatory: improves circulation • Respiratory: reduces the chance of infections, such as pneumonia, and improves oxygen level • Musculoskeletal: increases blood flow to the muscles and improves strength • Nervous: improves relaxation and sleep • Endocrine: increases metabolism, helping to maintain healthy weight

25 Rehabilitation and Restorative Care 5. Describe canes, walkers, and crutches Know these points about canes, walkers, and crutches: • Cane helps with balance but does not completely support weight. • Different types of canes are C cane, functional grip cane, and quad cane. • Walkers help with stability and some weakness. • Crutches are used when a person can bear limited weight or no weight.

25 Rehabilitation and Restorative Care 5. Describe canes, walkers, and crutches Remember these guidelines for canes, walkers, and crutches: • Check canes, walkers, or crutches for damage before using. • Make sure resident is wearing fastened, nonskid shoes. • Have resident use cane on his stronger side. • Do not hang heavy items on the walker. • Encourage proper posture. • Stay near the person on the weaker side. • Do not rush resident. • Move resident to bed or chair if he experiences pain. • Return resident to bed or chair when finished.

Assisting with ambulation for a resident using a cane, walker or crutches Equipment: gait belt, nonskid shoes, cane, walker, or crutches 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 1. Provide for the resident’s privacy with a curtain, screen, or door. 2. Adjust the bed to the lowest position so that the resident’s feet are flat on the floor. Lock the bed wheels. 3. Put nonskid footwear on resident and securely fasten. 7. Stand with feet about shoulder-width apart. Bend your knees. Keep your back straight. 8. Place gait belt around resident’s waist over clothing (not on bare skin).

Assisting with ambulation for a resident using a cane, walker or crutches 1. (cont’d) Check to make sure that skin or skin folds (for example, breasts) are not caught under the belt. Grasp the belt securely on both sides, with hands in an upward position. 2. If resident is unable to stand without help, brace (support) resident’s lower extremities. This can be done by placing one of your knees against the resident’s knee or by placing both of your knees against both of the resident’s knees. Bend your knees. Keep your back straight. 10. On the count of three, with hands still grasping the gait belt on both sides and moving upward, slowly help resident to stand. 11. Help as needed with ambulation.

Assisting with ambulation for a resident using a cane, walker or crutches a. Cane. Resident places cane about six inches, or a comfortable distance, in front of his stronger leg. He brings weaker leg even with cane. He then brings stronger leg forward slightly ahead of cane. Repeat.

Assisting with ambulation for a resident using a cane, walker or crutches b. Walker. Resident picks up or rolls the walker. He places it about six inches, or a comfortable distance, in front of him. All four feet or wheels of the walker should be on the ground before resident steps forward to the walker. The walker should not be moved again until the resident has moved both feet forward and is steady. The resident should never put his feet ahead of the walker.

Assisting with ambulation for a resident using a cane, walker or crutches c. Crutches. Resident should be fitted for crutches and taught to use them correctly by a physical therapist. The resident may use the crutches several different ways. It depends on what his weakness is. No matter how they are used, weight should be on the resident’s hands and arms. Weight should not be on the underarm area.

Assisting with ambulation for a resident using a cane, walker or crutches 12. Walk slightly behind and to one side of resident for the full ordered distance, while holding onto the gait belt. Stand on the weaker side if the resident has one. 1. Watch for obstacles in the resident’s path. Ask the resident to look forward, not down at his the floor, during ambulation. 2. Encourage the resident to rest if he is tired. When a person is tired, it increases the chance of a fall. Let resident set the pace. Discuss how far he plans to go based on the care plan. 15. After ambulation, remove gait belt. Help resident to the bed or chair. Make resident comfortable. Check that the resident is in proper alignment. 16. Leave bed in lowest position. Remove privacy measures. 1. Leave call light within resident’s reach.

Assisting with ambulation for a resident using a cane, walker or crutches 1. Wash your hands. 19. Be courteous and respectful at all times. 20. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

25 Rehabilitation and Restorative Care 6. Discuss other assistive devices and orthotics Define the following terms: adaptive/assistive devices special equipment that helps a person who is ill or disabled perform activities of daily living. foot drop weakness of muscles in the feet and ankles that interferes with the ability to flex the ankles and walk normally. orthotic devices applied externally to limbs to support, protect, improve function, and prevent complications.

25 Rehabilitation and Restorative Care 6. Discuss other assistive devices and orthotics Assistive or adaptive devices can help people who are recovering from an illness or adapting to a physical disability. Examples are special combs, plate guards, and prostheses:

25 Rehabilitation and Restorative Care 6. Discuss other assistive devices and orthotics REMEMBER: Positioning devices are used to help prevent complications from inactivity and immobility. These devices aid in proper body alignment and positioning.

25 Rehabilitation and Restorative Care 6. Discuss other assistive devices and orthotics Know the types of positioning devices: • Backrests can be regular pillows or special wedge-shaped foam pillows. They provide support and comfort and maintain proper body alignment. • Footboards are padded boards or pillow-like devices placed against the resident’s feet to keep them properly aligned. They help prevent foot drop. Foot drop is a weakness of muscles in the feet and ankles that interferes with the ability to flex the ankles and walk normally. Footboards are also used to keep linens off the feet. • Bed cradles or foot cradles are used to keep bed covers from resting on the resident’s legs and feet.

25 Rehabilitation and Restorative Care 6. Discuss other assistive devices and orthotics Types of positioning devices (cont'd): • Heel protectors are padded protectors wrapped around feet and heels to help keep feet properly aligned, which helps prevent foot drop. • Abduction wedges/splints/pads (hip wedges) keep hips in proper position after hip surgery. • Trochanter rolls are rolled-up bath blankets or towels that prevent the hip and leg from turning outward.

25 Rehabilitation and Restorative Care 6. Discuss other assistive devices and orthotics Types of positioning devices (cont'd): • Handrolls are cloth-covered or rubber grips that keep the hand and/or fingers in a normal and natural position. Handrolls help prevent finger, hand, or wrist contractures. • Finger cushions are stuffed devices made of terry cloth or a similar material that keep the fingers separated. They help prevent contractures of the thumb or fingers. • Elbow protectors are padded protectors wrapped around elbows to help prevent rubbing, irritation, and pressure ulcers.

25 Rehabilitation and Restorative Care 6. Discuss other assistive devices and orthotics Orthotic devices are devices applied externally to a limb for support and protection. They keep the joints in the correct position and are used to improve function and prevent complications, such as contractures. Other names for orthotic devices are splints or braces.

25 Rehabilitation and Restorative Care 7. Discuss range of motion exercises Define the following terms: range of motion (ROM) exercises that put a joint through its full arc of motion. passive range of motion (PROM) exercises to put a joint through its full arc of motion that are done by a staff member, without the resident’s help. active range of motion (AROM) exercises to put a joint through its full arc of motion that are done by a resident himself, without help.

25 Rehabilitation and Restorative Care 7. Discuss range of motion exercises Define the following term: active assisted range of motion (AAROM) exercises to put a joint through its full arc of motion that are done by a resident with some assistance from a staff member. hyperextension extending a joint beyond its normal range of motion.

25 Rehabilitation and Restorative Care Transparency 25 -3: Body Movements

25 Rehabilitation and Restorative Care 7. Discuss range of motion exercises Define the following terms: abduction moving a body part away from the midline of the body. adduction moving a body part toward the midline of the body. extension straightening a body part. flexion bending a body part. dorsiflexion bending backward.

25 Rehabilitation and Restorative Care 7. Discuss range of motion exercises Define the following terms: rotation turning the joint. pronation turning downward. supination turning upward. opposition touching the thumb to any other finger.

25 Rehabilitation and Restorative Care 7. Discuss range of motion exercises Remember these guidelines for range of motion (ROM): • Follow the care plan. • Maintain privacy at all times • Use proper body mechanics. • Support the joint above and below. • Keep the body in proper alignment • Begin at the shoulders and work down. • Follow instructions for limiting ROM exercises. • Never push further than what is comfortable. • Provide holistic care while performing ROM exercises. Praise often.

Assisting with passive range of motion exercises 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with a curtain, screen, or door. 1. Adjust the bed to a safe level, usually waist high. Lock the bed wheels. 6. Position the resident lying supine—flat on her back—on the bed. Use proper alignment. 7. While supporting the limbs, move all joints gently, slowly, and smoothly through the range of motion to the point of resistance. Repeat each exercise at least three times. Stop if any pain occurs.

Assisting with passive range of motion exercises 8. Shoulder. Support the resident’s arm at the elbow and wrist while performing ROM for the shoulder. Place one hand under the elbow and the other hand under the wrist. Raise the straightened arm from the side position upward toward head to ear level and return arm down to side of the body (extension/flexion).

Assisting with passive range of motion exercises 1. (cont’d) Move straightened arm away from side of body to shoulder level and return arm to side of body (abduction/adduction). 9. Elbow. Hold the wrist with one hand the elbow with the other hand. Bend the elbow so that the hand touches the shoulder on that same side (flexion). Straighten arm (extension).

Assisting with passive range of motion exercises 1. (cont’d) Exercise forearm by moving it so the palm is facing downward (pronation) and then the palm is facing upward (supination). 10. Wrist. Hold the wrist with one hand. Use the fingers of your other hand to help the joint through the motions. Bend the hand down (flexion). Bend the hand backward (dorsiflexion).

Assisting with passive range of motion exercises 1. (cont’d) Turn the hand in the direction of the thumb (radial flexion). Then turn the hand in the direction of the little finger (ulnar flexion). 11. Thumb. Move thumb away from the index finger (abduction). Move thumb back next to the index finger (adduction).

Assisting with passive range of motion exercises 1. (cont’d) Touch each fingertip with the thumb (opposition). Bend thumb into the palm (flexion) and out to the side (extension).

Assisting with passive range of motion exercises 12. Fingers. Make the hand into a fist (flexion). Gently straighten out the fist (extension). Spread the fingers and the thumb far apart from each other (abduction). Bring the fingers back next to each other (adduction).

Assisting with passive range of motion exercises 13. Hip. Support the leg by placing one hand under the knee and one under the ankle. Straighten the leg and gently raise it upward. Move the leg away from the other leg (abduction). Move the leg toward the other leg (adduction).

Assisting with passive range of motion exercises 1. (cont’d) Gently turn the leg inward (internal rotation). Turn the leg outward (external rotation).

Assisting with passive range of motion exercises 14. Knee. Support resident’s leg under the knee and ankle while performing ROM for knee. Bend the knee to the point of resistance (flexion). Return leg to resident’s normal position. (extension).

Assisting with passive range of motion exercises 15. Ankle. Support the foot and ankle close to the bed while performing ROM for the ankle. Push/pull foot up toward head (dorsiflexion). Push/pull foot down, with the toes pointed down (plantar flexion).

Assisting with passive range of motion exercises 1. (cont’d) Turn inside of the foot inward toward the body (supination). Bend the sole of the foot away from the body (pronation). 16. Toes. Curl and straighten the toes (flexion and extension).

Assisting with passive range of motion exercises 1. (cont’d) Gently spread the toes apart (abduction). 2. Make resident comfortable. Return bed to lowest position. Remove privacy measures. 3. Leave call light within resident’s reach. 4. Wash your hands. 5. Be courteous and respectful at all times. 6. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

25 Rehabilitation and Restorative Care Exam 1 Multiple Choice. Choose the correct answer. 1. Which of the following issues regarding rehabilitation and restorative care should be reported to the nurse? (A) Whether the resident’s family is visiting (B) How much television the resident watches (C) Whether the resident uses the call light too many times per day (D) The resident shows signs of depression 2. Which of the following statements is true of a nursing assistant’s role in restorative care? (A) If a resident takes too long to do a task by himself, the nursing assistant should do it for him. (B) The nursing assistant should give the resident pain medication before the rehabilitation session begins. (C) The nursing assistant should recognize that setbacks occur and be reassuring. (D) The nursing assistant should tell the family progress is happening faster than it really is so they can feel better about the situation.

25 Rehabilitation and Restorative Care Exam 1 (cont'd) 3. Guidelines for rehabilitation and restorative care include (A) Not following the care plan if the resident seems to be making more progress than expected (B) Discouraging activity to make sure the resident gets enough rest (C) Providing plenty of privacy to avoid distractions and embarrassment (D) Focusing on setbacks so the resident will be motivated to do better 4. Complications of immobility for the nervous system include (A) Pneumonia (B) Depression or insomnia (C) Weight gain (D) Constipation

25 Rehabilitation and Restorative Care Exam 1 (cont'd) 5. How does regular activity and exercise benefit the integumentary system? (A) Interaction between the resident and his roommate is improved. (B) The resident’s spiritual needs are fulfilled. (C) Resident’s family has a better opinion of the facility. (D) Quality and health of the skin is improved. 6. Benefits of regular activity and exercise for the endocrine system include (A) Increased metabolism (B) Improved circulation (C) Improved relaxation and sleep (D) Increased blood flow to the muscles and improved strength

25 Rehabilitation and Restorative Care Exam 1 (cont'd) 7. A cane is used (A) To help a person with balance (B) For residents who cannot bear weight on one leg (C) To provide stability when a person is unsteady or has some weakness (D) When a resident cannot get out of bed 8. How many feet does a quad cane have? (A) 1 (B) 2 (C) 3 (D) 4

25 Rehabilitation and Restorative Care Exam 1 (cont'd) 9. When a resident has one weaker leg (A) The cane should be held on the weaker side (B) The cane should be held on the stronger side (C) The resident should use a wheelchair (D) The resident should not get out of bed 10. When a resident uses a cane, walker, or crutches, the nursing assistant should (A) Stay on the resident’s stronger side (B) Stay on the resident’s weaker side (C) Walk in front of the resident (D) Walk behind the resident

25 Rehabilitation and Restorative Care Exam 1 (cont'd) 11. Orthotic devices are used to (A) Keep joints in correct position and improve function (B) Assist residents with ADLs (C) Maintain proper body alignment (D) Prevent rubbing, irritation, and pressure ulcers 12. Passive range of motion exercises are done (A) When a resident cannot move on her own (B) By the resident herself (C) By the resident with some help and support from the nursing assistant (D) By a doctor or physical therapist only

25 Rehabilitation and Restorative Care Exam 1 (cont'd) 13. When assisting with ROM exercises, the nursing assistant should begin at the ______ and work her way ______ the body. (A) Abdomen, up (B) Feet, up (C) Shoulders, down (D) Thighs, down 14. Abduction is (A) Bending a body part backward (B) Another name for the hip (C) Another name for the leg (D) Moving a body part away from the body

25 Rehabilitation and Restorative Care Exam 1 (cont'd) 15. Bending a body part is called (A) Extension (B) Rotation (C) Flexion (D) Supination

25 Rehabilitation and Restorative Care Exam 2 Multiple Choice. Choose the correct answer. 1. Adduction is (A) Moving a body part away from the body (B) Straightening a body part (C) Moving a body part toward the body (D) Bending backward 2. A doctor who specializes in rehabilitation is called a (A) Psychiatrist (B) Psychologist (C) Physiatrist (D) Pulmonologist

25 Rehabilitation and Restorative Care Exam 2 (cont’d) 3. Bending backward is also called (A) Rotation (B) Dorsiflexion (C) Supination (D) Opposition 4. Weakness of muscles in the feet and ankles is (A) Pronation (B) Supination (C) Foot drop (D) Phlebitis

25 Rehabilitation and Restorative Care Exam 2 (cont’d) 5. When a joint is extended beyond its normal motion, it is (A) Flexed (B) Opposed (C) Pronated (D) Hyperextended 6. A type of device used to help a disabled person perform activities of daily living is a(n) (A) Orthotic device (B) Assistive device (C) Restorative device (D) Range of motion device

25 Rehabilitation and Restorative Care Exam 2 (cont’d) 7. Exercises that put a joint through its full arc of motion and are done by a resident alone, without help, are called (A) Active range of motion exercises (B) Assistive range of motion exercises (C) Passive range of motion exercises (D) Extended range of motion exercises 8. When a resident is using crutches, where should her weight be concentrated? (A) On her thighs (B) On her underarms (C) On her hands and arms (D) On her shoulders

25 Rehabilitation and Restorative Care Exam 2 (cont’d) 9. What is a benefit of regular activity and exercise for the respiratory system? (A) An increased chance of infection (B) A reduced chance of pneumonia (C) Diminished oxygen level (D) Decreased circulation 10. Turning upward is also called (A) Rotation (B) Pronation (C) Flexion (D) Supination

25 Rehabilitation and Restorative Care Exam 2 (cont’d) 11. Turning downward is also called (A) Supination (B) Hyperextension (C) Pronation (D) Extension 12. One complication of immobility for the integumentary system is (A) Constipation (B) Blood clots (C) Muscle atrophy (D) Pressure ulcers

25 Rehabilitation and Restorative Care Exam 2 (cont’d) 13. Straightening a body part is also called (A) Flexion (B) Pronation (C) Extension (D) Adduction 14. One way for a nursing assistant to promote a successful restorative care program is to (A) Create a loud, vibrant environment (B) Discourage relationships between residents (C) Allow for private visits from family and friends (D) Make most of the daily decisions for residents

25 Rehabilitation and Restorative Care Exam 2 (cont’d) 15. Which of the following is an example of a physical cue used to help promote independence? (A) The NA puts her hand around the resident’s hand helps the resident bring a spoonful of food to her mouth. (B) The NA asks the resident to take a sip of water. (C) The NA tells the resident to swallow after putting food in her mouth. (D) The NA lists all of the steps in the procedure that the resident needs to complete. 16. A resident should place a cane about _______ inches in front of his stronger leg. (A) 8 inches (B) 12 inches (C) 14 inches (D) 6 inches

25 Rehabilitation and Restorative Care Exam 2 (cont’d) 17. The NA should perform range of motion exercises at least _______ times for each joint. (A) 9 (B) 5 (C) 3 (D) 6 18. Rehabilitation revolves around the concept of (A) Palliative care (B) Holistic care (C) Outcome care (D) Primary care