Introduction of self
Discuss about the Constraint-Induced Movement Therapy In Stroke.
Introduction of self- After positioning the patient up the bed, the interview should be initiated with the introduction of the occupational therapist to the patient with warm greetings. After establishing a rapport with the patient, the occupational therapist might enquire about any type of physical difficulties that the patient is facing.
L- An elderly patient
I- The occupational therapist.
T- Pulling the patient up from the edge of the bed.
E- An acute medical ward
The techniques and the reason
Sliding sheets are useful in turning the patient or moving up the bed or providing bed bath to the client. The slide sheets work by reducing the friction and hence less force is required for moving the clients.
The techniques initiates with placing of the slide sheet, grabbing the end of the slide sheet for pulling the patient.
The body of a patient may slide when the person is in bed for a long time. While pulling up the patient to the bed, an occupational theorist should assess the patient medically before trying an attempt to lift him/ her. Verbal prompts should be carried out with the person before assisting the person to get up or before lifting the person. It should be remembered that the goal is to pull up the patient and not lift (Kennedy et al., 2012).
It is necessary to place a bed sheet between the slide sheet and the skin to reduce the friction between the skin and the slide sheet and thus maintain the skin integrity.
It is necessary to keep the edges of the slide sheet to the edge of the bed as a guide.
In case the bed is large then larger slide sheets are recommended.
The clients should be rolled to their sides pulling and straightening the sheet on the other side. It is recommended to keep a pillow or a soft support to prevent the patient from banging their head. Removing the slide sheet
The slide sheet has to be removed after the patient has been moved up. While removing it the slide sheets should be tucked to from one side and then the bottom sheet is removed first from the other side. The slide sheets have to be applied beneath with the buttocks up as the thighs will not be in contact with the loose mattress. It should be ensured that the client foot are not in the bed linin. The patient’s ankle should be held firmly for anchoring the feet to the mattress. The client should be asked to push upwards by using their feet, ensuring that their buttocks are not lifted from the bed.
Slide Sheets: Techniques and the reason
The slide sheets should be grabbed at the upper back and hips of the patient on the side of the bed. Putting one leg forward the weight should be given on the back leg and on the count of three the occupational therapist should full the sheets towards the head of the bed. The whole thing should be repeated unless the person gets the right position.
Mr. White is 83 year old New Zealand European elderly patient. Care should be taken while interacting, to maintain the dignity of the patient. It has to be understood that Mr. White’s hearing disability and physical burden is withdrawing him from social interaction with his friends. Due to which the patient might feel depressed hence it is necessary to provide a conducing environment before the interview.
The following questions can be asked in the interview-
- How are you feeling currently Mr. White?
- How much are you having difficulty in hearing me?
- Do you face difficulties to do your daily chores?
- Are you having difficulties in walking?
- Are you bale to maintain your personal hygiene?
- Do you face difficulties while bending?
After the conduction of the interview the therapist can educate the patient or the patient’s family with some physiotherapies that can be practiced at home.
The therapist should exchange some greetings with the Asian women. The therapist should be culturally aware before interacting the patient and verbal consent should be taken while handling the women.
L- An Asian woman
I- The occupational therapist.
T- Helping the patient to sit up and then lifting her in to the nearby chair.
E- Community rehabilitation or stroke.
The said technique can be useful as it would avoid any unwanted muscular strain to pull the patient up in the bed. Patient surviving from stroke often have weakness on one side of the body or have difficulty in movement. The below mentioned techniques are some of the novel approaches to move the patient.
Initially the client will be helped to raise her head that would help the therapist of raising her upper body such that they are resting on the elbows and the lower arm. Their hands should be place flat bedside their hips on the bed. Their rams can be used to push themselves up in a sitting position (Kennedy et al., 2012).
Apart from this several kinds of aids can be used to help out Mrs. Wong to sit up in bed like the bed levers, bed blocks or the overhead poles (Kennedy et al., 2012).
In case Mrs. Wong does not have enough upper limb support or balance in the upper portion of the body, then she can be immobilized by hip itching, where the clients are assisted to walk up the bed on their buttocks.
Interview with Mr. White
At first the patient has to be asked to sit up in bed. Then Mrs. Wong should be asked to close her hands to fists behind their hips. She will be helped to push herself up in the bed with the help of her heels. In this technique hand blocks can be used (Kennedy et al., 2012).
While helping out the client to sit at the edge of the bed the client should be assisted in bending her knees. Following that she should be assisted in rolling on to her sides by turning the head in the direction of the roll, rotating the bend knees in the direction of the roll by placing the arms across the chest.
The client should be helped to use her hand and the elbow for pushing up and lowering the legs on the floor. A slide sheet can be used for patients for bringing their feet at the edge of the bed. In case Mrs. Wong faces severe difficulties while mobilization, a bed lever can be used to pull them up in the sitting position (Corbetta et al., 2012). In case of an electric bed the head of the bed can be raised automatically without causing any pain to the client.
In this case there has been a lateral transfers where the patient has to be moved from one sitting position to the other. Before using any techniques risk assessment should be done before moving out the patient. Wheel chairs or general chairs with movable armrests can be used for positioning the patient (Hung et al., 2014).
At first the surface to which the client has to be moved should be at right angle to the position of the client.
The client should get hold of armrest of the chair and position her arms on the bed and the hand flat on the floor. The patient should lean forward, placing their leading foot in the direction in which they are moving (Hung et al., 2014). The client should push up through their arms and their legs and then moved across to sit in the chair. Mrs. Wong may also find it easier to stand erect and then transfer to a walker.
Mr. Wong is an Asian woman and hence the therapist might face problems in communicating with the patient. The therapist should assure the patient in a culturally safe way.
Interview questions:-
- How are you feeling Mrs. Wong?
- Can you understand my language?
- Do you ace difficulties while moving your left arm and legs?
- Do you have pain while moving them? How much can you rate your pain?
- Do you face difficulty in maintaining your personal hygiene?
- What kind of difficulty do you face?
- Do you feel pain on bending?
- Do you maintain your medications regularly?
In this case the patient can be taught to divide the complex task in to simple task and then encourage the patient to perform the entire task. Therapists can help out the patients in identifying the functional change such as the installation of the grab bars in the bathroom such that it becomes easier for the patients to mobilize.
Techniques for helping Asian woman sit up
The therapist should enter the room with consent of the patient, would greet him before transferring him to the wheelchair. The OT would be able to engage in communication in a language that is comprehensible to the patient.
L- A 19 year old Maori man
I- The occupational therapist.
T- Helping the patient to sit up and then moving him in to a wheelchair.
E- A spinal unit
Rationale for choosing the movement techniques
The below mentioned technique would provide less strain on the already existing musculoskeletal injury. Awkward positions may further deteriorate the condition and may case unwanted pain.
Transferring a patient from the bed to wheelchair requires specific techniques to prevent falls or musculoskeletal injury in patients. Furthermore the carer can also be at risk of musculoskeletal injuries, sprains or strains to the back, shoulder, necks, legs, knees and arms due to high weight lifting or awkward postures, fast movement or uneven loading (Nas et al., 2012).
This case scenario helps the transfer of the Manaaki, in the wheel chair from the edge of the bed. In such a case a walker can be useful for Manaaki to get transferred to the wheelchair. The walking frame has to be kept directly in front of the patient. It should be made sure that the chair is raised to level of 90 degree with the bed (Nas et al., 2012). The patient should be asked to position themselves with her arms on the armrest of the walker and her feet spread flat on the floor. The patient should be asked to lean forward towards the walker. The patient stands with the help of the walking frame supported by the caregiver. The patient then moves to the chair while holding to the walking frame. The patient is positioned before the chair. The client sits down placing the hands on the arm rest. The client is then assisted to sit down in the chair with the help of the care giver and the walker.
There are few things that has to be considered, such as positioning of the seat or the furniture or the wheelchair such that there is enough space for both the patient and the caregiver and such that the carer can be at the side of the client all the time.
Furthermore, care should be taken about the clothing as clothing can get arrested and may cause fall. While transferring Manaaki, care should be taken such that the brakes are on and the footplates are removed.
- How are you feeling Manaaki?
- Are you facing difficulty in maintaining your balance?
- Can you grade your pain?
Manaaki can be taught by the OT to do self-care, dressing, hygiene, grooming, toileting, learning the wheel chair postures, strengthening, stretching, tenodesis training, fine motor activities, desensitization and training about visual perception (Waters & Rockefeller, 2010). The OT can educate the patients regarding the setting up of a wheel chair accessible bedroom. The patient can be taught about the arm circles and the neck roles, wrist roles and the door stretch. Manaaki should be addressed in a culturally safe way.
References
Corbetta, D., Sirtori, V., Moja, P. L., & Gatti, R. (2010). Constraint-induced movement therapy in stroke patients: systematic review and meta-analysis. European journal of physical and rehabilitation medicine, 46(4), 537-544.
Hung, J. W., Chou, C. X., Hsieh, Y. W., Wu, W. C., Yu, M. Y., Chen, P. C., … & Ding, S. E. (2014). Randomized comparison trial of balance training by using exergaming and conventional weight-shift therapy in patients with chronic stroke. Archives of physical medicine and rehabilitation, 95(9), 1629-1637.
Kennedy, C. A., Amick III, B. C., Dennerlein, J. T., Brewer, S., Catli, S., Williams, R., … & Franzblau, A. (2010). Systematic review of the role of occupational health and safety interventions in the prevention of upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time. Journal of occupational rehabilitation, 20(2), 127-162.
Nas, K., Yazmalar, L., ?ah, V., Ayd?n, A., & Öne?, K. (2015). Rehabilitation of spinal cord injuries. World journal of orthopedics, 6(1), 8.
Waters, T. R., & Rockefeller, K. (2010). Safe patient handling for rehabilitation professionals. Rehabilitation Nursing, 35(5), 216-222.
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