1. define important words in this chapter

25Rehabilitation and Restorative Care

1. Define important words in this chapter

abductionmoving a body part away from the midline of the body.

active assisted range of motion (AAROM) exercises to put a joint through its full arc of motion that are done by a resident with some help from a staff member.

active range of motion (AROM)exercises to put a joint through its full arc of motion that are done by a resident alone, without help.

adaptive devices special equipment that helps a person who is ill or disabled perform ADLs; also called assistive devices.



adduction moving a body part toward the midline of the body.

assistive devices special equipment that helps a person who is ill or disabled perform ADLs; also called adaptive devices.

dorsiflexionbending backward.

extensionstraightening a body part.



flexion bending a body part.

foot drop weakness of muscles in the feet and ankles that interferes with the ability to flex the ankles and walk normally.

hyperextension extending a joint beyond its normal range of motion.

opposition touching the thumb to any other finger.



orthotic devices devices applied externally to limbs to support, protect, improve function, and prevent complications.

passive range of motion (PROM) exercises to put a joint through its full arc of motion that are done by staff without the resident’s help.

physiatrists doctors who specialize in rehabilitation.

pronation turning downward.



range of motion (ROM)

exercises that put a joint through its full arc of motion.

rehabilitation

care that is managed by professionals to restore a person to the highest possible level of functioning after an illness or injury.

restorative care

care used after rehabilitation to maintain a person’s function and increase independence.

rotation

turning the joint.

supination

turning upward.


2. Discuss rehabilitation and restorative care

Define the following terms:rehabilitation care that is managed by professionals to restore a person to the highest possible level of functioning after an illness or injury.

physiatrists doctors who specialize in rehabilitation.

restorative care care used after rehabilitation to maintain a person’s function and increase independence.



Here are some factors that affect progress of rehabilitation:• How soon it began• Any pre-existing diseases or injuries• Overall motivation of the resident• Type of facility where resident lives• Combined efforts of staff and others• Attitude of the rehabilitation team• Consistency in following the care plan



REMEMBER:For rehabilitation to succeed, all staff members must work together to return the person to his highest level of functioning. The rehabilitation team is made up of highly skilled and trained professionals, including you.



The rehabilitation team is made up of the following: • Physiatrists• Speech-language pathologists and physical and occupational therapists

• Nurses • Social workers • Discharge planners • Nursing assistants • Resident • Resident’s family and friends



Remember these goals of rehabilitation:• Maintain or regain abilities• Promote independence and help resident to adapt• Prevent complications of immobility



When the goals of rehabilitation have been met, restorative care may be ordered. Restorative care works to maintain a person’s functioning and to increase independence

25 Rehabilitation and Restorative Care

Transparency 25-1: Rehabilitation and Restorative Care

• Understand the diagnosis, the disability and any limitations the resident has.

• Be patient and offer praise frequently.• Maintain a positive attitude.• Listen as much as possible.• Provide plenty of privacy.• Encourage independence.• Encourage daily activity.• Accept setbacks and focus on what the resident can do.

Report observations to the nurse:

• Lack of motivation• Signs of withdrawal and depression• Any change in ability• Decreased strength• Change in ability to perform ROM exercises



Case Studies Discuss how NAs can adapt their motivational styles to fit the different and unique personalities of the following residents:• Mrs. T is a shy, quiet elderly woman learning to dress herself.

• Mr. M is a very proud ex-Marine major who must learn to feed himself.

• Mrs. G is a grandmother who must learn to use a leg brace to walk.

• Mr. J is an athlete who must accept being confined to a wheelchair.



Case Studies (cont’d.) How NAs can adapt their motivational styles to fit the personalities of the following residents (cont’d.):• Mrs. C must now wear a pad for permanent incontinence.

• Mr. D has been told he will never walk again as he and the physicians hoped he would.

• Mr. H has been trying unsuccessfully for two weeks to learn to use special eating utensils.


3. Describe the importance of promoting independence

Think about this question:Even though it may be easier and faster for you to do a task yourself, why is it so important for you to encourage independence in your residents and to allow them to do as much for themselves as is possible?



Promoting each resident’s independence is an important duty of the care team:• Let residents do as much as they can for themselves, regardless of how long it takes or how poorly they are able to do it.

• Even if you think you could do a task better or faster, be patient. Encourage each resident to perform as much self-care as possible.

• Independence helps self-esteem, along with speeding recovery. Self-care also helps the body stay active and prevents complications of immobility.



REMEMBER:Encouraging independence has positive effects on self-image, attitude, and abilities.



Think about these questions:How do you think it would feel to need help lifting a fork to your lips at mealtime? How would it feel to need help getting dressed each morning?


4. Explain the complications of immobility and describe how exercise helps maintain health

REMEMBER:Activity is an essential part of a person’s life. When a person becomes immobile and inactive, the body does not respond well.


4. Explain the complications of immobility and describe how exercise helps maintain health

Remember these complications of immobility, organized by body system:• Gastrointestinal: constipation• Urinary: urinary tract infection (UTI)• Integumentary: pressure ulcers and slow-healing wounds

• Circulatory: blood clots, especially in the legs• Respiratory: pneumonia• Musculoskeletal: muscle atrophy and contractures• Nervous: depression or insomnia• Endocrine: weight gain


Transparency 25-2: Benefits of Exercise

• Gastrointestinal: promotes appetite and aids regular elimination

• Urinary: improves elimination, helping to decrease infection

• Integumentary: improves the quality and health of the skin

• Circulatory: improves circulation• Respiratory: reduces the chance of infections, such as pneumonia, and improves oxygen level

• Musculoskeletal: increases blood flow to the muscles and improves strength

• Nervous: improves relaxation and sleep • Endocrine: increases metabolism, helping to maintain healthy weight


5. Describe canes, walkers, and crutches

Know these points about canes, walkers, and crutches:• Cane helps with balance—does not completely support weight.

• Different types of canes are C cane, functional grip cane, and quad cane.

• Walkers help with stability and some weakness.• Crutches are used when a person can bear limited weight or no weight.



Remember these guidelines for canes, walkers, and crutches:• Check canes, walkers, or crutches for damage before using.

• Make sure resident is wearing non-skid shoes with laces tied.

• Watch for and avoid unsafe environmental situations.• Encourage good posture.• Do not rush resident.



Guidelines for canes, walkers, and crutches (cont’d.):• Do not hang heavy items on the walker.• Have resident use cane on his stronger side.• Stay near the person on the weaker side.• Move resident to bed or chair if he experiences pain.

• Return resident to bed or chair when finished.

Assisting with ambulation for a resident using a cane, walker or crutches

Equipment: gait belt, non-skid shoes for resident, cane, walker, or crutches

1. Identify yourself by name. Identify the resident. Greet 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 the resident’s privacy with a curtain, screen, or door.


5. Adjust bed to a low position so that the resident’s feet are flat on the floor. Lock bed wheels.

6. Put non-skid footwear on resident and securely fasten.

7. Stand in front of and face resident.

8. Place gait belt below the rib cage and above the waist. Do not put it over bare skin. Check to make sure that breasts are not caught under the belt. Grasp belt securely on both sides.


9. Brace resident’s lower legs with your legs to prevent slipping. This can be done by placing both of your knees in front of the resident’s knees.

10. On the count of three, slowly help resident to stand.

11. Help as needed with ambulation.


a. Cane. Resident places cane about six inches, or a comfortable distance, in front of his stronger leg. He brings weaker leg even with cane. He then brings stronger leg forward slightly ahead of cane. Repeat.


b. Walker. Resident picks up or rolls the walker. He places it about six inches, or a comfortable distance, in front of him. All four feet or wheels of the walker should be on the ground before resident steps forward to the walker. The walker should not be moved again until the resident has moved both feet forward and is steady. The resident should never put his feet ahead of the walker.


c. Crutches. Resident should be fitted for crutches and taught to use them correctly by a physical therapist or nurse. The resident may use the crutches several different ways. It depends on the weakness. No matter how they are used, weight should be on the resident’s hands and arms. Weight should never be on the underarm area.


12. Walk slightly behind and on the weaker side of resident. Hold the gait belt, if one is used.

13. Watch for obstacles in the resident’s path. Ask the resident to look ahead, not down at his feet.

14. Encourage resident to rest if he is tired. When a person is tired, it increases the risk of a fall. Let resident set the pace. Discuss how far he plans to go based on the care plan.


15. After ambulation, remove gait belt. Make resident comfortable.

16. If leaving the resident in bed, return bed to lowest position. Remove privacy measures.

17. Leave call light within resident’s reach.

18. Wash your hands.

19. Be courteous and respectful at all times.

20. Report any changes in the resident to the nurse. Document procedure using facility guidelines.


Define the following terms:adaptive/assistive devices special equipment that helps a person who is ill or disabled perform ADLs.

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.

6. Discuss other assistive devices and orthotics



Assistive or adaptive devices can help people who are recovering from an illness or adapting to a physical disability. Examples are special combs, plate guards, and prostheses:



Positioning devices are used to help prevent complications from inactivity and immobility. These devices aid in proper body alignment and positioning.



Know the types of positioning devices:• Backrests can be regular pillows or special wedge-shaped foam pillows. They provide support and comfort and maintain proper body alignment.

• Footboards are padded boards or pillow-like devices placed against the resident’s feet to keep them properly aligned. They help prevent foot drop. Foot drop is a weakness of muscles in the feet and ankles that interferes with the ability to flex the ankles and walk normally. Footboards are also used to keep linens off the feet.

• Bed cradles or foot cradles are used to keep bed covers from resting on the resident’s legs and feet.



Types of positioning devices (cont’d.):• Heel protectors are padded protectors wrapped around feet and heels to help keep feet properly aligned, which helps prevent foot drop.

• Abduction wedges/splints/pads (hip wedges) keep hips in proper position after hip surgery.

• Trochanter rolls are rolled-up bath blankets or towels that prevent the hip and leg from turning outward.



Types of positioning devices (cont’d.):• Handrolls are cloth-covered or rubber grips that keep the hand and/or fingers in a normal and natural position. Handrolls help prevent finger, hand, or wrist contractures.

• Finger cushions are stuffed devices made of terry cloth or a similar material that keep the fingers separated. They help prevent contractures of the thumb or fingers.

• Elbow protectors are padded protectors wrapped around elbows to help prevent rubbing, irritation, and pressure ulcers.



Orthotic devices are devices applied externally to a limb for support and protection. They keep the joints in the correct position and are used to improve function and prevent complications, such as contractures. Other names for orthotic devices are splints or braces.


7. Discuss range of motion exercises Define the following terms:range of motion (ROM) exercises that put a joint through its full arc of motion.

passive range of motion (PROM) exercises to put a joint through its full arc of motion that are done by staff without the resident’s help.

active range of motion (AROM)exercises to put a joint through its full arc of motion that are done by a resident alone, without help.

active assisted range of motion (AAROM) exercises to put a joint through its full arc of motion that are done by a resident with some help from a staff member.


7. Discuss range of motion exercises

Define the following term:hyperextension extending a joint beyond its normal range of motion.


Transparency 25-3: Body Movements


7. Discuss range of motion exercises Define the following terms:abductionmoving a body part away from the midline of the body.

adduction moving a body part toward the midline of the body.

dorsiflexionbending backward.

rotation turning the joint.



Define the following terms:extensionstraightening a body part.

flexion bending a body part.

pronation turning downward.

supination turning upward.



Define the following term:opposition touching the thumb to any other finger.



Remember these guidelines for range of motion (ROM):• Follow the care plan.• Use proper body mechanics.• Begin at the head and work down.• Support the joint above and below.



Guidelines for range of motion (ROM) (cont’d.):• Follow instructions for limiting ROM exercises.• Maintain privacy at all times.• Never push further than what is comfortable.• Keep the body in good alignment.• Give holistic care while performing ROM exercises. Praise often.

Assisting with passive range of motion exercises

1. Identify yourself by name. Identify the resident. Greet 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 the resident’s privacy with a curtain, screen, or door.

5. Adjust the bed to a safe level, usually waist high. Lock the bed wheels.


6. Position the resident lying supine—flat on his or her back—on the bed. Position body in good alignment.

7. Repeat each exercise at least three times.

8. Shoulder. Support resident’s arm at elbow and wrist while performing ROM for 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 wrist with one hand. Hold the elbow with the other hand. Bend elbow so that the hand touches the shoulder on that same side (flexion). Straighten arm (extension).


Exercise forearm by moving it so palm is facing downward (pronation) and then upward (supination).

10. Wrist. Hold the wrist with one hand. Use the fingers of your other hand to help 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 the thumb away from the index finger (abduction). Move the 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).


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. 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). Turn the leg outward (external rotation).


Gently turn the leg inward (internal rotation). Turn the leg outward (external rotation).


14. Knees. Support resident’s leg under the knee and ankle while performing ROM for knee. Bend the knee to the point of resistance (flexion). Return leg to resident’s normal position. (extension).


15. Ankles. Support the foot and ankle close to the bed while performing ROM for the ankle. Push/pull foot up toward head (dorsiflexion). Push/pull foot down, with the toes pointed down (plantar flexion).


Turn inside of the foot inward toward the body (supination). Bend the sole of the foot away from the body (pronation).

16. Toes. Curl and straighten the toes (flexion and extension).


Gently spread the toes apart (abduction).

17. While supporting the limbs, move all joints gently, slowly, and smoothly through the range of motion to the point of resistance. Stop exercises if any pain occurs.

18. Return bed to lowest position. Remove privacy measures.


19. Leave call light within resident’s reach.

20. Wash your hands.

21. Be courteous and respectful at all times.

22. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

25Rehabilitation and Restorative CareExamMultiple Choice. Choose the correct answer.1. Which of the following issues regarding rehabilitation and restorative care should be reported to the nurse?(A) Whether the resident’s family is visiting(B) How much television the resident watches(C) Whether the resident uses the call light too many times per day(D) The resident shows signs of depression

2. Which of the following statements is true of a nursing assistant’s role in restorative care?(A) If a resident takes too long to do a task by himself, the nursing assistant should do it for him.(B) The nursing assistant should give the resident pain medication before the rehabilitation session begins.(C) The nursing assistant should recognize that setbacks occur and be reassuring.(D) The nursing assistant should tell the family progress is happening faster than it really is so they can feel better about the situation.


Exam (cont’d.)3. Guidelines for rehabilitation and restorative care include:(A) It is okay not to follow the care plan if the resident seems to be making more progress than expected(B) Discourage activity to make sure the resident gets enough rest(C) Provide plenty of privacy to avoid distractions and embarrassment(D) Focus on setbacks so the resident will be motivated to do better

4. Complications of immobility for the nervous system include:(A) Pneumonia(B) Depression or insomnia(C) Weight gain(D) Constipation


Exam (cont’d.)5. How does regular activity and exercise benefit the integumentary system?(A) Interaction between the resident and his roommate is improved.(B) The resident’s spiritual needs are fulfilled.(C) Resident’s family has a better opinion of the facility.(D) Quality and health of the skin is improved.

6. Benefits of regular activity and exercise for the endocrine system include:(A) Increased metabolism(B) Improved circulation(C) Improved relaxation and sleep(D) Increased blood flow to the muscles and improved strength


Exam (cont’d.)7. A cane is used:(A) To help a person with balance(B) For residents who cannot bear weight on one leg(C) To provide stability when a person is unsteady or has some weakness(D) When a resident cannot get out of bed 8. How many feet does a quad cane have?(A) 1(B) 2(C) 3(D) 4


Exam (cont’d.)9. When a resident has one weaker leg:(A) The cane should be held on the weaker side(B) The cane should be held on the stronger side(C) The resident should use a wheelchair(D) The resident should not get out of bed

10. When a resident uses a cane, walker, or crutches, the nursing assistant should:(A) Stay on the resident’s stronger side(B) Stay on the resident’s weaker side(C) Walk in front of the resident(D) Walk behind the resident


Exam (cont’d.)11. Orthotic devices are used to:(A) Keep joints in correct position and improve function(B) Assist residents with ADLs(C) Maintain proper body alignment(D) Prevent rubbing, irritation, and pressure ulcers

12. Passive range of motion exercises are done:(A) When a resident cannot move on her own(B) By the resident herself(C) By the resident with some help and support from the nursing assistant(D) By a doctor or physical therapist only


Exam (cont’d.)13. When assisting with ROM exercises, the nursing assistant should begin at the ______ and work her way ______ the body.(A) Abdomen, up(B) Feet, up(C) Head, down(D) Thighs, down

14. Abduction is(A) Bending a body part backward(B) Another name for the hip(C) Another name for the leg(D) Moving a body part away from the body


Exam (cont’d.)15. Bending a body part is called(A) Extension(B) Rotation(C) Flexion(D) Supination

1. define important words in this chapter

Documents

face resident

resident steps

resident picks

resident places cane

residents feet

residents hands

residents privacy

residents knees