Physio- & occupational therapy inspiration across borders 1 2 - PowerPoint PPT Presentation

Physio- & occupational therapy – inspiration across borders 1

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Physio- & occupational therapy – inspiration across borders Disclosure of speaker’s interests (Potential) c onflict of interest None Company names Potentially relevant company relationships in connection None with event 1  Sponsorship or research None funding 2 None  Fee or other (financial) None payment 3  None Shareholder 4  Other relationship, i.e. … 5

PTU’s Rehabilitation Centre Out patient clinic for: Polio patients Spinal Cord Injury patients Multi trauma patients Patients from other parts of the country and from abroad can stay for 3 weeks The Danish Society of Polio- and Accident Victims 4

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WHOs definition of Rehabilitation Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional level. 6

Many polio survivors require interdisciplinary rehabilitation Interdisciplinary team comprises: • Medical doctor • Occupational therapist • Physical therapist • Social worker • Psychologist • Dietician • Orthopedic technician • The patient 7

Patients steps to follow 1.Assessment by medical doctor 2.Interdisciplinary interview with patient and relatives 3.Assessment by relevant professionals 4.Interdisciplinary conference Mutual goal setting, rehabilitation plan 5.Intervention by relevant professionals following the rehabilitation plan. 6.Interdisciplinary conference after a period of time Evaluation Plan for the future Interpreter is used when patient does not speak native language 8

ICF model Health condition Body functions and structures Activities Participation Environmental Personal- factors factors International Classification of Functioning, Disability and Health, ICF) 9

Rehabilitation plan for patient (constructed example) Health condition: Assessment Disabilities Reduction in body functions and structures Problems in activity and participation Environmental and personal factors Resources Obstructions 10

PLAN – ACTIONS – EVALUATION Main goal Short term Long term Sub goal Intervention Time Responsible Evaluation plan PLAN AFTER REHABILITATION PERIOD 11

Rehabilitation plan for patient (constructed example) Health condition: Polio at age 2 in Somalia Assessment Disabilities Reduction in body functions and structures Problems in activity and participation Reduced strength in both legs Walking distance is reduced, walks with hand support on left thigh. Falls regularly. Left leg is very weak and shorter than the right leg. It is difficult to cook in the kitchen Difficult to take care of the house holding Overweight. Difficult to take the children to kinder garden. Difficult to find a proper job Reduced strength in right arm and hand. Difficult to sew clothes to the children Difficult to participate in activities outside the household Pain in back VAS 7 Feels very tired all the time. Environmental and personal factors Resources Obstructions Husband, 3 children. The husband helps shopping. No education, speaks little native language Has a strong wish to improve her situation. Economy is tight. The social security system pays for technical aids, Small flat on 2nd floor with no lift bandages and helps the family economically. Does not have much energy and life satisfaction, feels lonely some times. 12

Physiotherapy assessment Problems in body Assessment and tests functions and structure Reduced strength in legs Posture (standing and sitting) and gait analysis 6 minutes walk test /10 meters test/walking distance Tendency to fall Timed stands test / Timed up and go Balance test ( Tandem test/Figure of 8) Manual muscle test Test of KAFO in cooperation with orthopedic technician Over weight Weight and height, BMI Back pain Visual Analoge Scale or Numeric Rating Scale Normal physiotherapeutic assessment for back Fatigue and low energy Test of cardio vascular fitness Multidimensional Fatigue Inventory – 20 (MFI 20) Diary of daily activities (showing pain, fatigue and other) 13

Functional tests 6 min walk test / walking distance Timed Stands test Distance walked as fast as possible Time registered for 10 times in 6 minutes rising and sitting 14

Functional tests Balance Tandem test Figure of 8 Walk the figure of eight twice Register time and number of steps outside the line 10 sec 10 sec 10 sec 15

Manual muscle test Grade Strength 0 No muscle contraction 0% 1 Palpable contraction < 5% 2 Gravity eliminated 5 – 10 % 3 Against gravity 10 – 20 % 4 Moderate / good 40 % 5 Maximum resistance > 60 % 16

Occupational therapy assessment Problems in activity and Assessment participation Cooking in the kitchen COPM Take care of the house AMPS holding Environment Take the children to COPM kinder garden. Perfomance analysis/AMPS Sewing clothes to the children. Work COPM WRI, WEIS, AWP, AWC Participate in activities COPM outside the household Modify intresse checklist 17

Canadian Occupational Performance Measure COPM - Identify the occupational performance problems experienced by the patient - Semi-structured interview - Rating importance, performance and satisfaction 18

Assessment of Motor and Process skills AMPS - - observational assessment - measure the quality of ADL performance: physical effort, efficiency, safety, need for assistance - motor and process skills 19

Occupational therapy assessment • Performance context - interview • 2. Identify strength and problems - COPM • 3. Observe and performance analysis - AMPS • 4. Define/clarify or interpret cause • 5. Select model for intervention 20

Conclusion of patient history and physical examination • What are the reasons for limitations and problems? • What do the patient wish to achieve? • What can be done? • Goals and rehabilitation plan is made in cooperation with the patient (and relatives) 21

PLAN – ACTIONS – EVALUATION Main goal Short term Improvement of gait function and reduce falling. Reduction af back pain Long term Being able to participate in activities outside home, to take children to kindergarten and school and to be able to sew clothes again Sub goal Intervention Time plan Respon- Evaluation sible Being able to walk for 15 Try KAFO and cane? Week 1 PT Week 12 minutes. Stop falling. Exercise program for strength, balance and cardio vascular fitness Weight reduction 7 kg Exercise program Week 1 PT Advisement about nutricion, Change of diet Week 3 Dietician Back pain reduction, so I can sew Patient clothes for my children (VAS ↓3) Pain treatment Week 1 PT +MD? Reduce fatigue Cardiorespiratory exercise Week 2 PT+OT Education Team Energy management Be able to make dinner with less Test in training kitchen: technical aids Week 2 OT effort Home visit: adjust environment Be able to clean my flat once a Technical aids week Take children to kindergarten Aply for electrical scooter Week 3 OT Be able to work part time Explore job possibilities, contact with Week 3 Social worker, OT Participate in activities outside Find social activities in her local area Week 5 Psycologist 22 home Rehousing to ground floor. Scooter OT

Physiotherapy treatment Sub goals Intervention Being able to walk 15 Strength exercising if possible Gait training with KAFO minutes , Improve gait function Training in climbing stairs and reduce falling Walking with cane Balance exercising Weight reduction Cardio vascular fitness training and strength training Back pain reduction Various physical therapy management Reduce fatigue and Cardio vascular fitness training improve energy Education in coping strategies / energy management Technical aids 23

What do the European guidelines for post polio syndrome say about exercise? Supervised muscular training, is a safe and effective way to prevent further decline of muscle and can even reduce symptoms of muscular fatigue, muscle weakness, and pain. Precautions to avoid muscular overuse should be taken with intermittent breaks, periods of rest between series of exercises, and submaximal work load. 24 Chapter 18

Muscle status and exercise Muscle status in actual Muscle strength in Exercise Number of repetitions muscle group actual muscle group 3 x 10 – 15 repetitions No new weakness Normal No restrictions Strength 5 60% -75% of 1 RM for untrained patients/older Be aware of reactions of the training 3 x 10 – 15 No new weakness Reduced Moderat strength Strength 4 exercising repetitions 50% of max (1 RM) rising to max 70% of 1 RM 3 x 8 – 12 New weakness Reduced Non fatiguing exercising Strength 4 40 - 50 % of max repetitions (1 RM) New weakness or no Very reduced No resistance Depending of the new weakness Strength 3 and below individual person Almost no muscle Very reduced No exercise strength General Slow progression of the exercise programme and adjust according to the patients reactions of the exercises. If there is muscle twitching, further reduced strength or more muscle pain than usual, the programme must be adjusted. Adjust the load, number of repetitions, timing of breaks or the way of exercising 25