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

Physio- & occupational therapy – inspiration across borders

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Disclosure of speaker’s interests (Potential) c

• nflict of interest

None Potentially relevant company relationships in connection with event 1 Company names None

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Sponsorship or research funding2

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Fee or other (financial) payment3

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Shareholder4

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Other relationship, i.e. …5 None None None None

Physio- & occupational therapy – inspiration across borders

PTU’s Rehabilitation Centre

The Danish Society of Polio- and Accident Victims

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

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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.

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Many polio survivors require interdisciplinary rehabilitation

Interdisciplinary team comprises:

• Medical doctor
• Occupational therapist
• Physical therapist
• Social worker
• Psychologist
• Dietician
• Orthopedic technician
• The patient

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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

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ICF model

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

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Health condition: Assessment Disabilities

Reduction in body functions and structures Problems in activity and participation

Environmental and personal factors

Resources Obstructions

Rehabilitation plan for patient (constructed example)

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PLAN – ACTIONS – EVALUATION Main goal

Short term Long term Sub goal Intervention Time plan Responsible Evaluation

PLAN AFTER REHABILITATION PERIOD

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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 Left leg is very weak and shorter than the right leg. Overweight. Reduced strength in right arm and hand. Pain in back VAS 7 Feels very tired all the time. Walking distance is reduced, walks with hand support on left

• thigh. Falls regularly.

It is difficult to cook in the kitchen Difficult to take care of the house holding Difficult to take the children to kinder garden. Difficult to find a proper job Difficult to sew clothes to the children Difficult to participate in activities outside the household

Environmental and personal factors

Resources Obstructions Husband, 3 children. The husband helps shopping. Has a strong wish to improve her situation. The social security system pays for technical aids, bandages and helps the family economically. No education, speaks little native language Economy is tight. Small flat on 2nd floor with no lift Does not have much energy and life satisfaction, feels lonely some times.

Rehabilitation plan for patient (constructed example)

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Physiotherapy assessment

Problems in body functions and structure Assessment and tests Reduced strength in legs Tendency to fall Posture (standing and sitting) and gait analysis 6 minutes walk test /10 meters test/walking distance 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)

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Functional tests

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

Balance Tandem test Figure of 8

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10 sec 10 sec 10 sec Walk the figure of eight twice Register time and number of steps

• utside the line

Functional tests

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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 %

Occupational therapy assessment

Problems in activity and participation Assessment Cooking in the kitchen Take care of the house holding COPM AMPS Environment Take the children to kinder garden. Sewing clothes to the children. COPM Perfomance analysis/AMPS Work COPM WRI, WEIS, AWP, AWC Participate in activities

• utside the household

COPM Modify intresse checklist

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Canadian Occupational Performance Measure COPM

• Identify the occupational performance

problems experienced by the patient

• Semi-structured interview
• Rating importance, performance and

satisfaction

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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

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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

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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)

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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- sible Evaluation Being able to walk for 15

• minutes. Stop falling.

Weight reduction 7 kg Back pain reduction, so I can sew clothes for my children (VAS ↓3) Reduce fatigue Be able to make dinner with less effort Be able to clean my flat once a week Take children to kindergarten Try KAFO and cane? Exercise program for strength, balance and cardio vascular fitness Exercise program Advisement about nutricion, Change of diet Pain treatment Cardiorespiratory exercise Education Energy management Test in training kitchen: technical aids Home visit: adjust environment Technical aids Aply for electrical scooter Week 1 Week 1 Week 3 Week 1 Week 2 Week 2 Week 3 PT PT Dietician Patient PT +MD? PT+OT Team OT OT Week 12 Be able to work part time Participate in activities outside home Explore job possibilities, contact with Find social activities in her local area Rehousing to ground floor. Scooter Week 3 Week 5 Social worker, OT Psycologist OT 22

Physiotherapy treatment

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

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What do the European guidelines for post polio syndrome say about exercise?

Chapter 18

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

• veruse should be taken with

intermittent breaks, periods of rest between series of exercises, and submaximal work load.

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Muscle status and exercise

Muscle status in actual muscle group Muscle strength in actual muscle group Exercise Number of repetitions No new weakness Normal Strength 5 No restrictions 60% -75% of 1 RM for untrained patients/older Be aware of reactions of the training 3 x 10 – 15 repetitions No new weakness Reduced Strength 4 Moderat strength exercising 50% of max (1 RM) rising to max 70% of 1 RM 3 x 10 – 15 repetitions New weakness Reduced Strength 4 Non fatiguing exercising 40 - 50 % of max (1 RM) 3 x 8 – 12 repetitions New weakness or no new weakness Very reduced Strength 3 and below No resistance Depending of the individual person Almost no muscle strength Very reduced No exercise 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

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Principles for training endurance (and strength) for polio survivors:

• Slow progression
• Training in intervals
• Breaks in training session
• Low to moderate resistance

+ many repetitions

• Avoid excessive pain and

fatigue

Exercising

Cardio vascular exercising 40 – 70 % of heart rate reserve 11 – 14 on RPE Borg

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Warm water exercising Individual program or group training

Exercising

Group exercising on land: General exercises, balance, therapy balls, Pilates, relaxation, mindfulness, weight loss

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Occupational therapy treatment

Sub goals Treatment Be able to make dinner with less effort Activity pacing, energy conservation Adjustment environment Technical aids: special chair Take children too kindergarden Technical aids: electrical scooter Be able to work part time Contact with ”unemployment assisstance”, recommendations about adjustments in environment and technical aids Participate in activities

• utside the house

Activity log Plan and prioritize between different activities

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Compensatory model

• Knowledge about the disease and its

consequences

• Assistive device
• Adaptation in the environment
• Occupational balance

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Occupational balance

• Become aware of your own ability
• Become aware of daily activities
• Balance between activity and rest
• Balance between different activities
• Prioritize and plan!

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Intervention

• Change of lifestyle
• Adapt the daily activities
• Find and learn new way of doing everyday

activities

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Polio education

• Polio issues
• Exercising

principles

• Technical aids
• Psychological

reactions

• Coping
• Exchange of

experience

Evaluation

Check up after 3 months on how plan is going concerning:

• Walking with KAFO and falling frequency
• Exercising and fitness
• Weight reduction
• Working in household
• Taking children to kindergarten
• Back pain level
• Fatigue
• Social activities

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Name: Social security number:

PLAN AFTER REHABILITATION PERIOD

Continuation of exercise program Continuation of diet Further need of technical aids? Medication? Social activities

REHABILITATION TEAM

Names of persons in the rehabilitation team 35

Does a interdiciplinary intervention make a difference for the polio survivor?

• A positive turning point in life-how persons with late effects of polio

experience the influence of an interdisciplinary rehabilitation

• programme. Lund et al, 2010

Conclusion:This qualitative study has shown that persons with late effects of polio can benefit from an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme and experience positive changes in their management of daily activities and in their view of their late effects of polio, their future and their self.

• Outcome of physiotherapy as part of a multidisciplinary rehabilitation in

an unselected polio population with one-year follow-up: an uncontrolled

• study. Bertelsen, Broberg, Madsen. 2009

Conclusion:This study shows that patients with late effects of polio, who experience new problems related to polio, can benefit from an individually planned multidisciplinary intervention with emphasis on physiotherapy, and the improvement in physical capacity and general health can remain at one-year follow-up.

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Research about physical and occu- pational therapy for polio survivors

• Occupations that people with late effects of polio perceive difficult to
• perform. Appelin et al, 2014
• Associations between perceptions of environmental barriers and

participation in persons with late effects of polio, Lund, Lexell 2009

• Short-term effects of aerobic exercise on functional capacity, fatigue,

and quality of life in patients with post-polio syndrome. Oncu, et al 2009

• Effects of resistance training in combination with coenzyme Q10

supplementation in patients with post-polio: a pilot study, Skough et al 2008

• Cardiorespiratory responses to upper extremity aerobic training by

postpolio subjects, Kriz et al,1992

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Thank you for your attention and participation

• Any further questions or

comments?

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