Clin 2 Rachels Part

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what is early intervention

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1

what is early intervention

state based

rehab services for qualifying infants and toddlers

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2

what age is early intervention for

less than 3 years old

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3

focus of early intervention

helping children reach developmental milestones!

some common diagnoses are premature birth or medical conditions that will result in a developmental dealy

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4

what is school based intervention

built into education system in individualised education plans

must be greater than 3 yo up to 21 yo

varied levels of supervision and equipment needs..

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5

goal of school based intervention

helping children participate to the best of their abilities in the classroom and at school

common diagnoses: cerebral palsy, down syndrome, genetic conditions (these also apply to early intervention)

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6

acute care

where is this and what populations

in the hospital

pediatric and adult

varied clinical presentation

- dif diagnoses and ages

- and varied abilities (dependent to independant)

many specialized units within this (neuro, trauma, ortho, cardiac, gen med)

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7

acute care focuses on

functional mobility and planning for discharge from the hospital

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8

what type of equipment is used here

- the same in SNF

variety!

wheelchairs

loftstrand and ax crutches

tilt table

cane

hoyer lift

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9

can adults go to childrens hospitals?

yes

often ones that had a childhood disability that you want to keep seeing same physician

lot of super specific diagnosis..

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10

Inpatient Rehabilitation

when do people go here

for intensive therapy following acute care stay

have to tolerate 3 hours of therapy a day

need to have comprehensive needs to qualify PT OT SLP

- neuro, ortho, trauma..

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11

what variety do you see

adult and pediatric

independent to dependent

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12

goal of inpatient rehab

maximizing independent and return to PLOF

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13

skilled nursing facility

when do patients go here

after acute care stay

- and when not able to tolerate the 3hrs of IPR

comprehensive needs

variety of assistance here again

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14

what do patients need to qualify SNF

3 night stay in the hospital

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15

focus of SNF

maximizing independent and return to PLOF

- same as IPR

- acute care is more functional, planning for discharge

- LTC preventing more impairments, educating

- outpatient dif

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16

long term care

who is this for

individuals who may never return home

- so assist level very high

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17

goal of LTC

prevent secondary impairments and education for families

- pediatric and adult here

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18

outpatient who is this for

individual in community

pediatric and adult

low assist levels typically

equipment is WC, lofstrand and ax crutches, canes

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19

focus of outpatient

optimize functional mobility and independence

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20

which patient care setting do you not see pediatrics?

skilled nursing facility

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21

T/F all patient care setting you will see a range independent to dependent patients

false!

LTC

- typically only higher assist levels (mod to max)

simple outpatient

- typically lower end of assist (ind to mod)

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22

FIM = functional independence measure

how many levels

and what are they

FIM 1 = total assistance

FIM 2 = maximal assistance

FIM 3 = moderate assistance

FIM 4 = minimal (contact) assistance

- CGA variation..

FIM 5 = standby assist

FIM 6 = modified indepedence

FIM 7 = complete independence

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23

FIM 1, 2, 3

FIM 1 total = less than 25% effort

FIM 2 max = less than 50%, at least 25%

FIM 3 mod = less than 75%, at least 50%

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24

FIM 4,5

FIM 4 = min = at least 75% effort

- can assume all body weight, needs guidance

FIM5 SBA = needs cueing or coaxing

CGA = variation - pt needs occasional contact for balance/ dynamic stablity

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25

FIM 6, 7

FIM 6 mod ind = uses AD but ind w that

FIM 7 complete ind = all tasks without modification

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26

what AD is the best for safety?

front wheeled walker

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27

which crutches are better for long term use?

loftstrand

- little to no risk of impingement

- esp w ataxia or neuro condition

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28

what can be used to transfer max assist pts

hoyer lift

<p>hoyer lift</p>
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29

what is a tilt table used for

circulation, cognition, muscle activation, proprioception

- typically for patients w severe injuries

esp used if pt laying down for a long time

weight bearing good for bone health

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30

when choosing the right AD

consider (3)

amount of support needed

motor and cognitive function of pt

WB status of patient

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31

what kinda pts are canes good for

minimal balance or stability impairments

- cannot be used to reduce weight bearing through a LE

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32

what is a rollator good for

patients with endurance impairments

community ambulators

- not good for WB restrictions or balance issues

ex: COPD

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33

front wheeled walker can reduce/eliminate WB through a LE?

yes

- this is best for patients w balance, strength, and mobility impairments

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34

when to use a junior/ped walker

ped patients

pts under 5'2"

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35

when to use a bariatric walker

wider pts

>350 lbs

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36

non-bariatric but extra wide walkers

pts who need a wider device but less than 350 lbs

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37

hemiwalker is best for

hemiplegic pts after a stroke

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38

picture about picking walker/cane

<p></p>
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39

keys to good body mechanics (2)

neutral spine

keep pt within your COM

- again always using counterweight, not lifting

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40

T/F if possible, you should assist pt on affected side

yes

- cane should be on unaffected side

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41

when possible, have pt tranfer to their BLANK side

strong

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42

where to be for stairs

behind going up

in front going down

- going down can depend if major height difference

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43

posterior approach hip precautions post THR

no hip flexion past 90

no adduction past neutral

no IR

so watch sitting, dont cross legs, dont point toe in.

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44

anterior approach hip precautions post THR

no extreme extension

w ER

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45

lateral approach hip precautions post THR

no hip flexion past 90

no adduction past neutral

no IR

+ no active hip abudction

ALWAYS VERIFY W SURGEON ORDERS

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46

sternal precautions

No pushing, pulling, lifting more than 5-10

dont reach behind your body or above your head w both arms

- use a pillow to brace incision site

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47

back precautions

BLT

No Bending, Lifting, Twisting

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48

WBS

name em

non weight bearing

toe touch WB

partial WB

WB as tolerated

full WB

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49

non wieght bearing

no weight onto limb

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50

toe touch WB

toes can rest on the ground for balance, but not for weight bearing

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51

partial weight bearing

percentage needs to be defined by surgeon

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52

WBAT

pain/comfort guide WB

- THR, TKR

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53

difference of hemiplegia and hemiparesis

hemiplegia is complete or severe loss of motor function

hemiparesis is milder/partial

plegia = paralysis

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54

be sensitive in communication - people are going through moments of trauma

(especially acute care and subacute...)

how would you handle a bariatric walker

or gait belt

im going to get equipment that will be a better fit for you

gait belt: going to put this on you for your safety

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55

patient centered care

patients and families are BLANK with the provider and the care team

partners

- we are experts of movement, not someone elses life

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56

4 core concepts of patient centered care

respect and dignity

- pts should have autonomy

information sharing

- ensure pts informed of their medical info

participation

- they should participate in process

collaboration

- communicate!

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57

participation

should patients participate in decision making process and treatment?

shift from what model?

yes they should!

we are shifting from paternalist model

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58

what is key for patient centered care and shared decision making

communication!

studies show pts want to be listened do, want the truth, risks, options, want choices

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59

ICF was created when and by who

2001

by WHO - world health organization

this is the framework for describing and organizing information on function and disability

<p>2001</p><p>by WHO - world health organization</p><p>this is the framework for describing and organizing information on function and disability</p>
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60

adaption of the ICF for peds is

F words

  • Function

  • Family

  • Fitness

  • Fun

  • Friends

  • Future

<p>F words</p><ul><li><p>Function</p></li><li><p>Family</p></li><li><p>Fitness</p></li><li><p>Fun </p></li><li><p>Friends</p></li><li><p>Future</p></li></ul>
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61

health condition/medical diagnosis

specific!

- neuro related diagnoses

- orthopredic related diagnosis

example: stroke, broken bone, deconditioning

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62

which ICF is how disability is experienced by the individual?

- demographic information

personal factors

like age, gender, motivation

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63

which ICF is the environment in which the person is carrying out ADLs

environmental factors

here we consider stairs, accessibility..

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64

which ICF is body level

example: strength, balance, endurance..

body functions and structure

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65

which ICF is individual level

the "ings" of life

activites

- sitting, standing, walking, running, talking, writing

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66

if pt is in the ICU for a while, sitting up for how long can be pretty difficult

15 minutes

- be mindful of this with cardiac chairs

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67

from acute care therapists often recommend a freq of PT after discharge which helps determine what type of PT facility

what are these

2-3 d/wk = HH outpatient

5-7 d/wk = SNF/IPR

- we don't recommend destinations bc insurance..

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68

what is the AM-PAC

Activity Measure for Post Acute Care

helpds determine whether is is safe to return home

cutoff of 18 for discharge locations (6 is total dependence)

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69

how to use WB status to determine AD

<p></p>
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70

bilateral NWB

gait pattern?

AD?

N/A - no gait pattern.. not walking

AD: wheelchair

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71

unilateral NWB

gait pattern

AD

gait pattern: swing to or swing through

AD: 2 crutches or walker for swing to

2 crutches for swing through

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72

TTWB bilateral

gait pattern

AD

gait pattern: N/A.. not walking

AD: wheelchair

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73

unilateral TTWB

gait pattern

AD

gait pattern: 3 point

AD: 2 crutches, walker

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74

bilateral PWB

gait pattern

AD

gait pattern: 2 point or 4 point

AD: 2 crutches

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75

unilateral PWB

gait pattern

AD

gait pattern: 3 point

AD: 2 crutches or walker

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