MP

Rehabilitation and Restorative Care Notes

Rehabilitation and Restorative Care: Comprehensive Notes

  • Important terms and definitions (ROM-related 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 the foot backward toward the shin.
    • Rotation: turning a joint.
    • Pronation: turning downward.
    • Supination: turning upward.
    • Opposition: touching the thumb to any other finger.
    • Hyperextension: extending a joint beyond its normal range of motion.
    • Pronation / Supination: defined above.
    • In addition: Foot drop = weakness of muscles in the feet and ankles that interferes with the ability to flex the ankles and walk normally.
    • Orthotic devices: devices applied externally to limbs to support, protect, improve function, and prevent complications.
    • Assistive devices: special equipment that helps a person who is ill or disabled perform activities of daily living.
    • Foot drop: see above.
    • Positioning devices: help prevent complications from inactivity and immobility; aid in proper body alignment.
    • Abduction wedges/splints/pads (hip wedges): keep hips in proper position after hip surgery.
    • Trochanter rolls: prevent the hip and leg from turning outward.
    • Handrolls: keep hand/fingers in a normal position and help prevent contractures.
    • Finger cushions: keep fingers separated to prevent contractures.
    • Elbow protectors: protect elbows from rubbing, irritation, pressure ulcers.
    • Footboards: keep feet aligned and prevent foot drop; also keep linens off feet.
    • Backrests: support and align the body; may be regular pillows or wedge-shaped foam.
    • Heel protectors: padding around heels to keep feet aligned.
    • Pelvic/spine alignment devices and other positioning aids as listed.

  • ROM and mobility concepts

    • ROM (Range of Motion) exercises: movement through a joint’s full arc.
    • AROM (Active Range of Motion): moves through full arc by the resident independently, without help. AROM: ext{joint movement by resident without help}
    • PROM (Passive Range of Motion): joint movement through ROM performed by staff without resident’s help. PROM: ext{joint movement performed by staff without resident’s help}
    • AAROM (Active Assisted Range of Motion): joint movement through full arc with some assistance from staff. AAROM: ext{resident moves with assistance to complete ROM}

  • Rehabilitation and Restorative Care – Core definitions and goals

    • Rehabilitation care: care managed by professionals to restore a person to the highest possible level of functioning after an illness or injury. ext{rehabilitation care} = ext{professional-led restoration of function}
    • Physiatrists: doctors who specialize in rehabilitation.
    • Restorative care: care given after rehabilitation to maintain a person’s function and increase independence.
    • Goals of rehabilitation: maintain or regain abilities; promote independence and help resident adapt; prevent complications of immobility.
    • When goals are met, restorative care may be ordered to maintain functioning and increase independence.

  • Rehabilitation team and collaboration

    • The rehabilitation team is a multidisciplinary group, including:
    • Physiatrists
    • Speech-language pathologists, physical therapists (PT), occupational therapists (OT)
    • Nurses
    • Social workers
    • Discharge planners
    • Nursing assistants (NAs)
    • The resident and the resident’s family and friends
    • REMEMBER: For rehabilitation to succeed, all staff must work together to return the person to his or her highest level of functioning. The team includes nursing assistants as essential members.

  • Factors affecting rehabilitation progress

    • How soon rehabilitation begins after illness/injury.
    • Any pre-existing diseases or injuries.
    • Overall motivation of the resident.
    • Type of facility where the resident lives.
    • Combined efforts of staff and others involved.
    • Attitude of the rehabilitation team.
    • Consistency in following the care plan.

  • Promoting independence (critical component)

    • Let residents do as much as they can, even if it takes longer or is not perfect.
    • Staff should be patient and encourage self-care to build self-esteem and independence.
    • Independence promotes self-image, attitude, and abilities; self-care helps maintain activity and prevent complications of immobility.
    • When independence is promoted, it supports faster recovery and better long-term outcomes.

  • Case studies: motivational strategies for different resident personalities

    • Mrs. T: shy, quiet woman learning to dress herself; adapt approach to build confidence.
    • Mr. M: proud ex-Marine major learning to feed himself; require respectful acknowledgment of pride while promoting independence.
    • Mrs. G: grandmother learning to use a leg brace to walk; encourage perseverance and celebrate small gains.
    • Mr. J: athlete adjusting to wheelchair confinement; address identity and activity preferences to sustain motivation.
    • Mrs. C: must wear a pad for permanent incontinence; tailor approaches to preserve dignity and independence.
    • Mr. D: told he will never walk again; provide emotional support and focus on achievable goals.
    • Mr. H: two weeks of trying to learn to use special eating utensils; adjust techniques and pace to build success.

  • Promoting independence: practical guidelines

    • Let residents perform tasks they can do; avoid rushing.
    • Patience and encouragement are essential; even slow progress supports self-esteem and recovery.
    • Independence benefits self-image, attitude, and abilities; supports ongoing activity and reduces complications.

  • Critical thinking prompts about independence

    • Reflect on how it feels for a resident to need help lifting a fork to the lips at mealtime.
    • Consider how it feels to need help getting dressed each morning and how independence impacts dignity.

  • Complications of immobility and how exercise helps (by body system)

    • Gastrointestinal: constipation; exercise promotes appetite and regular elimination.
    • Urinary: urinary tract infections (UTIs); exercise improves elimination and reduces infection risk.
    • Integumentary: pressure ulcers and slow-healing wounds; exercise improves skin health and blood flow.
    • Circulatory: blood clots (especially in legs); exercise improves circulation.
    • Respiratory: pneumonia; exercise reduces infection risk and improves oxygenation.
    • Musculoskeletal: muscle atrophy and contractures; exercise increases blood flow and strength.
    • Nervous: depression or insomnia; exercise promotes relaxation and sleep.
    • Endocrine: weight gain; exercise increases metabolism and helps maintain healthy weight.

  • Key material: Benefits of exercise (summary)

    • Gastrointestinal: promotes appetite and regular elimination.
    • Urinary: improves elimination, reducing infection risk.
    • Integumentary: improves skin quality and health.
    • Circulatory: improves circulation.
    • Respiratory: reduces infection risk (e.g., pneumonia) and improves oxygen levels.
    • Musculoskeletal: increases blood flow to muscles and improves strength.
    • Nervous: improves relaxation and sleep.
    • Endocrine: increases metabolism, helping to maintain healthy weight.

  • Canes, walkers, and crutches – key points

    • Cane benefits: helps with balance but does not fully support weight.
    • Types of canes: C cane, Functional grip cane, Quad cane.
    • Walkers: provide stability and support for weakness.
    • Crutches: used when weight-bearing is limited or not allowed.
    • Safety checks before use: inspect equipment for damage; ensure resident wears nonskid shoes; cane on the resident’s stronger side; avoid hanging heavy items on the walker; encourage proper posture; stay close on the weaker side; do not rush; move resident to bed/chair if pain occurs; return to bed/chair after activity.

  • Ambulation with cane, walker, or crutches – step-by-step guidelines

    • Equipment needed: gait belt, nonskid shoes, cane/walker/crutches.
    • 1. Identify yourself by name and identify the resident; greet him/her by name.
    • 2. Wash your hands.
    • 3. Explain the procedure clearly; maintain face-to-face contact when possible.
    • 4. Ensure privacy with curtain/screen/door.
    • 5. Adjust bed to lowest position;_LOCK bed wheels; assist resident into a sitting position with feet flat; adjust bed height as needed.
    • 6. Put nonskid footwear on the resident and secure.
    • 7. Stand in front of and facing the resident with feet about shoulder-width apart.
    • 8. Place gait belt around the waist over clothing; ensure skin folds are not caught under the belt.
    • 9. Grasp belt securely on both sides with hands in an upward position.
      1. If needed, brace lower extremities to assist standing (knees against resident’s knees or toe-to-toe); keep back straight.
      1. On the count of three, slowly help the resident stand, keeping the gait belt in place.
      1. Assist with ambulation as needed.
      1. Cane technique (example): place cane ~6 inches in front of the stronger leg; the weaker leg moves to the cane level; then move the stronger leg forward.
      1. Walker technique: move walker forward about 6 inches; keep all four feet on ground; move the walker first, then the feet; never place feet ahead of the walker.
      1. Crutches technique: proper fitting by PT; weight on hands/arms (not underarms); multiple ways depend on weakness.
      1. Walk slightly behind and to one side of the resident for the full ordered distance; stand on the weaker side if there is one.
      1. Watch for obstacles; guide the resident to look forward, not at the floor; anticipate hazards.
      1. Encourage rest if tired; fatigue increases fall risk; let the resident set the pace; discuss planned distance per care plan.
      1. After ambulation, remove gait belt; assist to bed/chair; ensure comfort; remove footwear; check alignment.
      1. Return bed to lowest position; remove privacy measures.
      1. Leave call light within reach.
      1. Wash hands.
      1. Be courteous and respectful at all times.
      1. Report any changes to the nurse; document procedure per facility guidelines.

  • Additional assistive devices and orthotics – overview

    • Assistive devices: examples include special combs, plate guards, prostheses, etc.; help patients recover from illness or adapt to disability.
    • Orthotic devices (splints or braces): externally applied devices to support/protect joints, improve function, and prevent complications; may be called splints or braces.
    • Positioning devices (as above) to prevent complications from inactivity and immobility; aid in proper body alignment.

  • Types of positioning devices (detailed)

    • Backrests: regular pillows or wedge-shaped foam; maintain proper alignment.
    • Footboards: padded boards placed against feet to keep them aligned and prevent foot drop; also keep linens off feet.
    • Bed cradles/foot cradles: keep bed covers off legs/feet.
    • Heel protectors: padded wraps around feet/heels to maintain alignment.
    • Abduction wedges/pads: hip wedges to maintain proper hip position post-surgery.
    • Trochanter rolls: rolled blankets to prevent hip/leg turning outward.
    • Handrolls: grips to keep hands/fingers in a natural position; prevent contractures.
    • Finger cushions: terry cloth pads to keep fingers separated.
    • Elbow protectors: padded protectors to prevent rubbing and ulcers.

  • ROM exercises – overview and guidelines

    • Range of Motion (ROM) exercises: move joints through full arc.
    • Guidelines for 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 beyond what is comfortable.
    • Provide holistic care and frequent praise.

  • Passive Range of Motion (PROM) – specific procedures

    • PROM is performed by staff without resident’s help.
    • PROM procedure (general steps):
    • 1. Identify yourself and resident; greet.
    • 2. Wash hands.
    • 3. Explain procedure clearly; maintain face-to-face contact.
    • 4. Ensure privacy.
    • 5. Adjust bed to a safe level (waist high); lock bed wheels.
    • 6. Position resident supine (on back) with proper alignment.
    • 7. Move joints gently, slowly, and smoothly through ROM to the point of resistance; repeat each exercise at least three times; assess for pain; stop if pain.
    • 8. Shoulder: support elbow and wrist; raise arm from side to head/ear level (extension/flexion) and return; abduction/adduction (side-to-side).
    • 9. Elbow: flexion (hand touches shoulder); extension.
      1. Forearm: pronation (palm down) and supination (palm up).
      1. Wrist: flexion; dorsiflexion; radial and ulnar flexion.
      1. Thumb: abduction/adduction; opposition; flexion/extension.
      1. Fingers: fist (flexion); extension; abduction/adduction; oppose.
      1. Hip: support under knee and ankle; abduction/adduction; internal/external rotation.
      1. Knee: flexion toward resistance; extension.
      1. Ankle: dorsiflexion (toward head); plantar flexion (toes point down); supination; pronation.
      1. Toes: flexion/extension; abduction; adduction.
      1. Return resident to comfortable position; ensure bed at lowest position; privacy measures removed; call light within reach.
      1. Hand hygiene; courtesy; report changes; document per guidelines.

  • Active and assisted ROM – definitions and guidelines

    • AROM: resident moves through ROM independently; allow full effort.
    • AAROM: resident moves with some staff assistance; gradually reduce assistance as tolerated.
    • PROM: already detailed above; ensures safe ROM when resident cannot move limbs.

  • Case-based and practical exercises (teaching prompts)

    • When guiding ROM or ambulation, emphasize patient safety, privacy, and comfort.
    • Observe for pain, fatigue, or signs of distress; stop and reassess before continuing.

  • Summary: practical implications for clinical practice

    • A strong rehabilitation program requires early initiation, motivation, consistent staff involvement, and collaboration among team members.
    • The ultimate goals are to maximize independence, prevent complications, and support the resident’s quality of life during recovery and ongoing care.

  • Quick reference: key takeaways for staff

    • Always verify care plans and follow ROM limits.
    • Ensure privacy, safety, and proper alignment during all movements.
    • Use gait belts for ambulation; secure footwear; monitor for pain and fatigue.
    • Maintain professional communication with residents and families; report changes promptly.
    • Promote independence and patient dignity in every interaction.