CHAPTER 21 REHABILITATION AND RESTORATIVE CARE LEARNING OBJECTIVES

CHAPTER 21: REHABILITATION AND RESTORATIVE CARE

LEARNING OBJECTIVES Discuss rehabilitation and restorative care Describe the importance of promoting independence Describe assistive devices and equipment Explain guidelines for maintaining proper body alignment Explain care guidelines for prosthetic devices Describe how to assist with range of motion exercises Describe the benefits of deep breathing exercises

REHABILITATION AND RESTORATIVE CARE Rehabilitation Process of rehabilitation Goals of rehabilitation Assisting with rehabilitation Observations that should be reported

IMPORTANCE OF PROMOTING INDEPENDENCE Problems related to lack of mobility

ASSISTIVE DEVICES AND EQUIPMENT Review p. 379, Figure 21 -3 – It shows different items available to assist residents adapting to new limitations.

GUIDELINES FOR MAINTAINING PROPER BODY ALIGNMENT Review chapter 10 for specific instructions for positioning residents.

CARE GUIDELINES FOR PROSTHETIC DEVICES Guidelines for prosthetic devices

HOW TO ASSIST WITH RANGE OF MOTION EXERCISES Range of motion Passive range of motion (PROM) Active range of motion (AROM) Active assisted range of motion (AAROM)

BODY MOVEMENTS

SKILL: ASSISTING WITH PASSIVE RANGE OF MOTION EXERCISES 1. Identify yourself by name. Identify 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 resident’s privacy with curtain, screen, or door. 5. Adjust bed to a safe level, usually waist high. Lock 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 unless the resident complains of pain. Stop performing exercises if resident complains of pain and report to the nurse. 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). Move straightened arm away from side of body to shoulder level and return arm to side of body(abduction/adduction). 9. Elbow. Hold the resident’s 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 the arm (extension) (Fig. 21 -9). Exercise the forearm by moving it so the palm is facing downward (pronation) and then the palm is facing upward (supination). Continued on next

SKILL: ASSISTING WITH PASSIVE RANGE OF MOTION EXERCISES (CONTINUED) 10. Wrist. Hold the wrist with one hand use the fingers of the other hand to help move the joint through the motions. Bend the hand down (flexion); bend the hand backward (dorsiflexion). 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). Touch each fingertip with the thumb (opposition). Bend thumb into the palm (flexion) and out to the side (extension) (Fig. 21 -15). 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). 13. Hip. Support the leg by placing one hand under the knee and one under the ankle. Straighten the leg and raise it gently upward. Move the leg away from the other leg (abduction). Move the leg toward the other leg (adduction). Gently turn the leg inward (internal rotation), then turn the leg outward (external rotation). 14. Knee. Support the leg under the knee and under the ankle while performing ROM for. Continued the knee. on next Bend the knee to the point of resistance (flexion). Return leg to resident’s normal position

SKILL: ASSISTING WITH PASSIVE RANGE OF MOTION EXERCISES (CONTINUED) 15. Ankle. Support the foot and ankle close to the bed while performing ROM for the ankle. Push/pull foot up toward the head (dorsiflexion). Push/pull foot down, with the toes pointed down (plantar flexion). Turn the inside of the foot inward toward the body (supination). Bend the sole of the foot so that it faces away from the body (pronation). 16. Toes. Curl and straighten the toes (flexion and extension). Gently spread the toes apart (abduction). 17. Return resident to comfortable position. Return bed to lowest position. Remove privacy measures. 18. Place call light within resident’s reach. 19. Wash your hands. 20. Report any changes in resident to nurse. 21. Document procedure using facility guidelines. Note any decrease in range of motion or any pain experienced by the resident. Notify the nurse or the physical therapist if you find increased stiffness or physical resistance. Resistance may be a sign that a contracture is developing.

BENEFITS OF DEEP BREATHING EXERCISES Benefits of deep breathing

REVIEW Discuss rehabilitation and restorative care Describe the importance of promoting independence Describe assistive devices and equipment Explain guidelines for maintaining proper body alignment Explain care guidelines for prosthetic devices Describe how to assist with range of motion exercises Describe the benefits of deep breathing exercises