Download Concepts of Rehabilitation Ch 1

Concepts of
Rehabilitation
ATHT 333
Who is on the team?
• The injured person
• Clinician
• Physician
• Parents
• Athletic Training Student
• Coach
As a clinician
• Interpersonal skills
– Competent, energetic, interested,
empathy, active listening skills
• Keep records
• Educate others
– Prepares the injured, more compliance,
family members, coaches
Communication
• AT serves as the center of
communication
• Talk to the patient
– Know when to talk, know when not to
– Right time to use medical terminology
– “I don’t know”…but I’ll find out
– Use your filter
Communication
• With the physician
– Treatment plan, limitations, patient
response
• With family
– At time of injury to develop rapport
• With coach
– Extent of injury, limitations
– Don’t give definitive timelines
• Remember HIPAA
Principles: ATC IS IT
• Avoid aggravation: of the injury
• Timing: start as soon as it is safe
(won’t aggravate injury). Too much
rest is detrimental
• Compliance: better if patient
informed
• Individualization: no “cookbook”
rehab, everyone responds differently
• Specific Sequencing: determined by
body’s healing response
• Intensity: challenge but not
aggravate, need imagination to
modify
• Total patient: cardio, uninjured limb,
kinetic chain
Objectives
• 1. Prevent deconditioning
– Keep up cardio
– Use areas not effected (ie wrist and
hand during shoulder immobilization)
• 2. Rehabilitation of injured part
– Knowledge of injury, healing process,
and methods to be effective and safe
Goals
• Ultimate goal?
– Safe but quick, aggressive but guarded
• Objective and measurable
– Girth, ROM, strength, pain
• Short and Long term
– What is a typical long term goal?
– Short term- weekly/biweekly, determined by
pt’s response, reasonable and attainable
• Ex: reduce edema by 1 cm and increase ROM 15
degrees in 1 week
Examination and
Assessment
• Done continually from time of inx to
RTP
• Use to set goals
Progression
• Exercise progression (isometric ->
isotonic-> isokinetic -> plyometric)
• Program progression- pt must have
flexibility before performing
advanced skills
Outcomes-Based Rehab
• Assessed using a tool devised for
measuring patient’s response and
satisfaction
• 2 categories: general health and region
specific
• Used to modify tx, justify tx, evaluate
effectiveness of protocols, judge
appropriateness of tx responses, asssit in
authorization of payment
Basic Components
Proprioception, coordination, agility
Strength and Muscle Endurance
Flexibility and ROM
Flexibility & ROM
• Flexibility- mobility of muscle
– Muscles loses flexibility when
immobilized
• ROM- movement possible at a joint
– Affected by joint capsule, ligaments,
fascia, scar tissue
• Strength- if pt doesn’t have strength to
move through ROM
Flexibility & ROM
• Must be first thing regained
– Other parameters are based on
flexibility of affected area
– ROM’s impact on healing process
• Scar tissue
Strength and Muscular
Endurance
• Strength- maximum force that a
muscle or muscle group can exert
– Amount of weight in one rep
• Muscular endurance- muscle’s ability
to sustain a sub-maximal force in
either a static or repetitive activity
over time
– Gymnast, marathon runner
• Need both
– Pitcher may have good strength, but
only for 10 pitches
• When you improve in strength, also
gains in endurance and vice versa
Proprioception,
Coordination,Agility
• If any are impaired, increased risk of
injury
• Proprioception- body’s ability to
transmit afferent information
regarding position sense, to interpret
the information, and respond
consciously or unconsciously to
stimulation through appropriate
execution of posture and movement
• Coordination- ability of muscles to
and muscle groups to perform
complicated movements
• Agility- ability to control direction of
the body or its parts during rapid
movement
RTP Criteria
• Fully examine and asses the injured
area, the patient’s ability to
withstand demands of the sport, and
patient’s readiness to return to
competition.
– Full readiness- no pain, swelling,
atrophy; full ROM, flexibility, strength,
endurance, ability to perform sport
specific skills
Stages of Grief
• https://www.youtube.com/watch?v=
G_Z3lmidmrY