Clin 2 Rachels Part

what is early intervention

what is early intervention

state based

rehab services for qualifying infants and toddlers

what age is early intervention for

less than 3 years old

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

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..

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)

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)

acute care focuses on

functional mobility and planning for discharge from the hospital

what type of equipment is used here

- the same in SNF

variety!

wheelchairs

loftstrand and ax crutches

tilt table

cane

hoyer lift

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..

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..

what variety do you see

adult and pediatric

independent to dependent

goal of inpatient rehab

maximizing independent and return to PLOF

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

what do patients need to qualify SNF

3 night stay in the hospital

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

long term care

who is this for

individuals who may never return home

- so assist level very high

goal of LTC

prevent secondary impairments and education for families

- pediatric and adult here

outpatient who is this for

individual in community

pediatric and adult

low assist levels typically

equipment is WC, lofstrand and ax crutches, canes

focus of outpatient

optimize functional mobility and independence

which patient care setting do you not see pediatrics?

skilled nursing facility

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)

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

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%

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

FIM 6, 7

FIM 6 mod ind = uses AD but ind w that

FIM 7 complete ind = all tasks without modification

what AD is the best for safety?

front wheeled walker

which crutches are better for long term use?

loftstrand

- little to no risk of impingement

- esp w ataxia or neuro condition

what can be used to transfer max assist pts

hoyer lift

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

when choosing the right AD

consider (3)

amount of support needed

motor and cognitive function of pt

WB status of patient

what kinda pts are canes good for

minimal balance or stability impairments

- cannot be used to reduce weight bearing through a LE

what is a rollator good for

patients with endurance impairments

community ambulators

- not good for WB restrictions or balance issues

ex: COPD

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

yes

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

when to use a junior/ped walker

ped patients

pts under 5'2"

when to use a bariatric walker

wider pts

>350 lbs

non-bariatric but extra wide walkers

pts who need a wider device but less than 350 lbs

hemiwalker is best for

hemiplegic pts after a stroke

picture about picking walker/cane

keys to good body mechanics (2)

neutral spine

keep pt within your COM

- again always using counterweight, not lifting

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

yes

- cane should be on unaffected side

when possible, have pt tranfer to their BLANK side

strong

where to be for stairs

behind going up

in front going down

- going down can depend if major height difference

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.

anterior approach hip precautions post THR

no extreme extension

w ER

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

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

back precautions

BLT

No Bending, Lifting, Twisting

WBS

name em

non weight bearing

toe touch WB

partial WB

WB as tolerated

full WB

non wieght bearing

no weight onto limb

toe touch WB

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

partial weight bearing

percentage needs to be defined by surgeon

WBAT

pain/comfort guide WB

- THR, TKR

difference of hemiplegia and hemiparesis

hemiplegia is complete or severe loss of motor function

hemiparesis is milder/partial

plegia = paralysis

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

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

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!

participation

should patients participate in decision making process and treatment?

shift from what model?

yes they should!

we are shifting from paternalist model

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

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

adaption of the ICF for peds is

F words

• Function

• Family

• Fitness

• Fun

• Friends

• Future

health condition/medical diagnosis

specific!

- neuro related diagnoses

- orthopredic related diagnosis

example: stroke, broken bone, deconditioning

which ICF is how disability is experienced by the individual?

- demographic information

personal factors

like age, gender, motivation

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

environmental factors

here we consider stairs, accessibility..

which ICF is body level

example: strength, balance, endurance..

body functions and structure

which ICF is individual level

the "ings" of life

activites

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

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

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..

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)

how to use WB status to determine AD

bilateral NWB

gait pattern?

AD?

N/A - no gait pattern.. not walking

AD: wheelchair

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

TTWB bilateral

gait pattern

AD

gait pattern: N/A.. not walking

AD: wheelchair

unilateral TTWB

gait pattern

AD

gait pattern: 3 point

AD: 2 crutches, walker

bilateral PWB

gait pattern

AD

gait pattern: 2 point or 4 point

AD: 2 crutches

unilateral PWB

gait pattern

AD

gait pattern: 3 point

AD: 2 crutches or walker