PHYSIOTHERAPY FOLLOWING DISCHARGE Sally Emery Advanced Physiotherapy Practitioner Spinal Outpatient...
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Transcript of PHYSIOTHERAPY FOLLOWING DISCHARGE Sally Emery Advanced Physiotherapy Practitioner Spinal Outpatient...
PHYSIOTHERAPY FOLLOWING DISCHARGE
Sally Emery
Advanced Physiotherapy Practitioner
Spinal Outpatient Department
Introduction
Goals for inpatient rehabilitation- skill development- maximise independence- minimise complications- prepare for discharge back into the community
Handover to Spinal Outpatients on discharge
Maintenance in the community
Need to maintain skills in order to fully function in the community
Reliance on relatives and carers for assistance
Support Network - teaching prior to discharge- outpatient therapist- community therapists
Care of the joints and soft tissues
Stretching exercises
Positioning
Standing frames
Splints/Orthoses
Why stretch?
To prevent stiffness
To maintain flexibility and suppleness in the muscles
To minimise the effects of ongoing spasm/spasticity
To prevent contractures of the joints
To maintain optimal levels of function and independence
Stretching exercises
Aim to take the joints through their full available range of movement
Most important muscles include- calf muscles - pecs- hamstrings - biceps- hip flexors - wrist/hand
Be careful not to overstretch the joints and soft tissues
Positioning
Aims to- maintain symmetrical postures- encourage stretching- reduce spasm- minimise adaptive shortening of the muscles - prevent complications, e.g. contractures
Why stand?
Benefits include
- effective stretching
- reduction in spasm/spasticity
- maintenance of bone density
- improved bladder and bowel function
- psychological effects
Standing Frames
Tilt Table Oswestry Frame
(cont’d)....
Iper Granstand
Assessed for appropriate frame prior to discharge
Requisition made for funding from local Primary Care Trust
Varying level of assistance required to use frame at home
Splints/Orthoses
Upper Limb Splints
Lower Limb Orthoses
Corsets/Braces/Binders
Variety of types
May require assistance to use
Chest Care
Assistance with coughing
Assistance with nebulisers
Suction for the patient with a tracheostomy
Assistance with ventilatory machines
Why cough?
Build up of secretions can affect theability of the oxygen breathed in toreach every part of the lungs
Excess secretions increases the risk of bacterial growth
Increases the risk of chest infection and pneumonia which can be fatal in serious circumstances
Coughing
When coughing, the stomach muscles expel air forcefully from the lungs clearing the passages of secretions or any other obstruction
When the stomach muscles are paralysed the cough is weak and ineffective therefore assistance is required to provide the force behind the cough
Assisted Coughing
Technique using the arm or hands
to strengthen the cough
Performed independently or, more frequently, by somebody else
Needs to be practised in order to be effective as timing and coordination are key factors
(cont’d) Patient takes a deep breath in then pressure is
applied as they cough out
Direction of the pressure is ‘inwards and upwards’ on the stomach muscles, just below the ribs
The sound of the cough can be used as a guide for effectiveness
Rests should be taken between continuous coughs
(cont’d)
Lying Sitting
Nebulisers Variety of medications
Saline helps loosen the secretions so that it can be coughed up more easily
Other drugs (bronchodilators) help widen the passages of the lungs to reduce wheezing and allow the phlegm to pass more freely
Patients who have problems clearing their secretions may be prescribed nebulisers to take daily
Suctioning and tracheostomy care Tracheostomies provide a more effective means of
clearing secretions for patients with ongoing chest problems
May require suctioning using a smallcatheter attached to a suction unit
Tube also needs to be looked after to prevent infection and blockages
Procedures need to be in place in case a blockage occurs
Ventilated patients
Small number of patients
Continuous invasive ventilation viaa tracheostomy
Intermittent ventilation or overnight support via a tracheostomy or a face mask
Basic knowledge of the machine’s components and settings is required
Summary
Once discharged a patient needs to maintain the skills they have learned as an inpatient to prevent any complications
This will enable them to maximise their quality of life
As their relatives, you can help them to do this by assisting them in their maintenance exercises and daily régime
But remember!
Help is at hand!- engage in your relative’s therapy sessions to learn the skills required to help them- once home, contact the Spinal Outpatient Service for further advice and support as
needed- alternatively, assistance from a community therapist can be arranged if appropriate- support from a variety of sources exists for
you as well as your relative