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By Sean Kenny
The ever expanding role of
caregivers has grown by leaps and bounds in the last few
years. Primary caregivers have always been extensions of
their medical facility based counterparts, whether they
are doctors, physiologists, nutritionists, or
psychologists. The field of rehabilitative medicine is
no different.
There is a
growing need for rehabilitative and therapeutic practice
beyond the traditional medical setting. Even many health
clubs are now providing several rehabilitative services
once found only in the clinical setting. Caregivers are
also in a unique situation to help administer
rehabilitative prescriptions for their loved ones as
part of the care team.
Effective
rehabilitation requires effective communication. Poor
communication results in lost time in the rehabilitation
process. By maintaining open lines of communication,
problems can be minimized and eliminated more readily.
Caregivers can insure there is an open and regular
dialogue with the other health care professionals
involved in their loved one's care.
Along with the
task of maintaining lines of communication, the
caregiver's role may take the form of implementing some
actual program exercises. Some of these exercises may
include actively moving an injured limb through a range
of motion, assisting in flexibility exercises or even
applying manual resistance in strengthening activities.
Occasionally testing and recording the progress of the
activities are also common assignments given to
caregivers. Many caregivers also find themselves in the
role of motivator for their loved ones, helping them
adhere to their therapy and program. Simply being
present can help provide the accountability to keep
patients progressing.
For legal
reasons, decisions in programming must be left to the
medical professionals in charge of the case. But the
caregiver is called upon to question decisions if they
don't seem to make sense. Effective caregivers need to
make sure their concerns and their loved one's concerns
are understood and addressed. It is equally important to
understand the strategy of the rehabilitative process
and not deviate from the medically designed plan. Please
make sure you are comfortable in this assistance role
and feel confident you received ample training and
supervision for any active role you may play in actual
program assistance.
Documentation of
activities is frequently another caregiver
responsibility. Report writing, exercise logs, updates,
contracts, etc. are all valuable tools for recording and
evaluating a program's progression. Make sure all
reports are in a legible, orderly format for other
health care personnel. Written documentation also proves
invaluable should legal matters arise.
Above all, caregivers must be
sensitive to the individual needs of their loved one
during the rehabilitative process. Patience and
understanding are especially vital in rehabilitative
relationships. Caregivers need to be familiar with their
loved one's condition, medical terminology and treatment
procedures. This will aid in communication and
interactions with medical personnel. The more positive
the environment and interactions, the more positive the
outcomes.
Rehabilitation Terminology
To help insure
effective communication throughout the rehabilitation
process, here are some commonly used terms to describe
certain conditions and exercises. This list is
supplemental and in no way extensive.
Active-assisted exercise:
Exercise in which the patient is helped through a ROM
(see below) which they are unable to do by themselves.
Active
exercise: Exercise in which the movement is
done entirely by the patient.
Closed-chain exercise: Any exercise
in which the exercising body segment is attached to a
fixed surface such as a floor, requiring the entire limb
to bear the resistance. An example would be squats for
the legs.
Coordination: The
working together of various muscles in the execution of
movement.
Cross-transfer: A
neurological phenomenon in which training the "healthy"
limb provides strength increased in the immobilized
limb.
DAPRE: A program
often used in rehabilitation. The abbreviation stands
for "daily adjustable progressive resistance exercise".
Flexibility: ROM
possible in a joint or series of joints.
Limited
ROM exercise: Exercise in which the ROM is
limited due to an injury or the bio-mechanics of the
injury.
Non-weight bearing
exercise: An exercise in which the body weight
is not borne by the lower extremities.
Open-chain exercise:
An exercise in which the end of the exercising body
segment is not fixed to the end of a floor, wall, etc.
and is freely movable. Leg extensions are an example of
an open-chain exercise for the legs.
Passive
exercise: An exercise in which the patient is
taken through a ROM by a therapist, caregiver or
machine.
Reconditioning:
The restoration of pre-injury or pre-deconditioning
levels of physical fitness through a program of
prescriptive therapeutic exercise.
ROM:
An abbreviation for range of motion. This is the
measurement of the range that a limb moves through space
around its joint.
Rehabilitation Strategies
Regardless of why your loved one
needs a rehabilitation program, the goal of the therapy
is to help restore levels of fitness to the pre-injury
state or better. In cases of chronic illness or
disability, programs focus on improving the quality of
life and comfort. To achieve this, many techniques can
be employed depending on the therapeutic goals and
objectives.
Before
programming begins however, testing of functional
capacity is normally done to establish baselines and
future progression. The areas tested can be muscular
strength, power, endurance, flexibility and range of
motion. Some of the devices used include: calipers,
isokinetic instruments, goniometers and dynamometers.
After testing, therapeutic exercise
programming and selections begin. The basic program
structure allows for a warm-up prior to activity, the
reconditioning exercises, then concluding with a
cool-down period.
Most
rehabilitation programs are geared towards progression.
In regards to resistance training and strength
improvement, one of the most commonly used programs is
the Daily Adjustable Progressive Resistance Exercise
(DAPRE) system. This is a four set exercise program (the
first two sets are progressive warm-ups) that take in to
consideration the daily variations of a patient's
strength levels. Resistance can be applied through
weights, machines, latex bands, or manually by the
caregiver or therapist.
Another common
exercise prescription for strength improvement is
isometric exercises. An isometric contraction is when
the muscle is neither shortened or lengthened, merely
contracted and tensed. Tension is generated, and energy
is released in the form of heat, not mechanical work.
Pushing against an immovable object such as a wall is an
example of isometric exercise. These are especially
valuable to a patient who needs to exercise an
immobilized limb or when joint motion is hindered by
inflammation. Instead of using repetitions to measure
work, "seconds of contraction" are the units in
isometric programming.
Flexibility
drills, active-assisted exercise and limited ROM
exercises are also frequently employed by the therapist
and introduced to the caregiver.
Muscle Function
Below is an
example of a few of the major muscle groups that are
targeted by rehabilitation programs. You can see how
conditioning each area can improve one's quality of
life. The person in this example is wheelchair bound
(paraplegic).
Muscles Strengthened
Functional Benefits
- Shoulders, deltoids
(anterior, Self-care, loading/unloading wheelchair,
posterior), trapezius. lifting objects, wheelchair
sports.
- Biceps Transfer activities
such as repositioning legs.
- Rotar Cuff (supraspinatus,
Transfers, pressure relief, counteract
subscapularis, infraspinatus, tight internal rotors
from wheelchair teres m.). propulsion.
- Triceps Transfers,
wheelchair propulsion.
- Chest (pectoralis major).
Wheelchair propulsion, driving and braking.
- Back (latissimus dorsi,
rhomboids, posterior deltoid) Pressure relief,
transfers, pulling activities.
Sean Kenny, C.P.T, a certified
trainer, author, and guest speaker is a consultant with
Mercy Hospital and Pacific Health Education Center in
Bakersfield, Ca., reviews exercise protocols for the
senior, disabled and diabetic populations. Visit Sean's
Fitness Web Site: http://anythingfitness.com, or call
(805) 831-0805
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