Restoration, Compensation, and prevention

PT through the acute phase of care

neurologic intensive care unit

specialized care unit

PT through the subacute phase of care

inpatient rehabilitation facility

transitional care unit (skilled nursing facility)

PT through the chronic phase of care

outpatient rehabilitation facility

community setting

home setting

therapist considerations during the acute phase

reviewing the medical record and communicating with the medical team

goals in the acute phase

monitor changes in pt status & promote early mobilization

early stimulation of hemiparetic side to promote functional reorganization

encourage positive outlook for rehab process

interventions during the acute phase

bed mobility

sitting

transfers

locomotion

ADL training

ROM

splinting

positioning

with instruction, education and training (especially caregiver training)

therapist considerations of subacute phase

tolerance to daily rehabilitation

goals of the subacute phase

continuation of acute phase (getting pt ready for everyday life)

goals of the chronic phase

inpatient interventions + CIMT, bilateral training, virtual reality (VR) training & electromechanical-assisted walking

goals of outpatient chronic phase

flexibility, strength, balance, locomotion, endurance, UE function, HEP prescription

goals of homecare chronic phase

home environmental recommendations and adaptations

goals of community setting phase

recreational activities, community fitness, programs, & water-based activity

direct interventionists types

recovery, compensatory, preventative

recovery/restorative interventions goal

restoring to the patient's pre-morbid status

recovery/restorative interventions directed towards

remediating or improving the patient's status in terms of impairments, activity limitations, participation restrictions and recovery of function

what should you ask yourself for recovery/restorative interventions

neural plasticity potential

change in muscle strength, endurance, etc.

10 principles of neuroplasticity

use it or lose it

use it & improve it

salience (very important)

repetition

intensity

specificity

age

time

transference

interference

what should be promoted first

neural plasticity

compensatory interventions goal

promote optimal function... without full recovery

compensatory interventions adaptations/modifications occur to

the task, activity, or environment

adaptation compensatory interventions is

using the involved segment and adapting with remaining motor elements

substitution compensatory interventions is

functions are replaced or taken over by different body segments using different motor patterns

compensation intervention examples

use of intact limbs to compensate for those with weakness

use of sensory conservation and joint preservation techniques

use of environmental adaptations to optimize performance

substitution training is when the patient is made aware of

movement deficiencies & changes required to complete the functional task

substitution training is important because

it requires the pt to practice to relearn the task

alternate ways may be proposed, broken down, and adopted

examples of substitution training

post-CVA with hemiparesis: using the less-affected UE to dress

post-CVA with unilateral neglect: color-coding shoes to dress

concern of utilizing substitution training

focus on the less-involved segments may suppress recovery and contribute to learned nonuse of impaired segments

when should substitution training not be performed

place a point of focus if there is potential for recovery

when should substitution training be performed

when recovery potential is limited

when the pt presents with significant comorbidities, impairments, functional limitations with little or no expectation for additional recovery

what can be used together to maximize function

restorative & compensatory/substitution

when should restorative & compensatory/substitution should be used together

when restorative interventions are unrealistic or unsuccessful

preventative interventions are directed towards

minimizing potential problems and maintaining health

*can be delivered through education

intervention selection considerations

examination and evaluation of the patient

physical therapy diagnosis

prognosis

goals and expected outcomes

your role in intervention and selection considerations

know foundational science

know intervention components to determine which may be successful

protocols have limitations so how should interventions be considered

identify all possible intervention options

identify the best probability of success

promote shared decision-making

pick interventions that accomplish more than one goal

consider intervention sequencing

what should be considered when designing a POC and selecting interventions

consider patient variability, timeframe of injury/impairment onset, nature of the impairments