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Rehabilitation - Methods

Merck Manual of Geriatrics (3rd Edition), 2000

Rehabilitation Topics:     | | Methods Methods The physician or rehabilitation team determines which methods of rehabilitation are appropriate.
Leisure or recreational therapy is often appropriate for demented or institutionalized patients who need some exercise but not the specialized resources of physical therapy.
Specific problems (eg, blindness, heart disease, stroke, hip fracture, leg amputation) may require specialized rehabilitation.
Physical Therapy Before prescribing physical therapy, the physician ensures that the patient is medically stable and notes any cardiac, pulmonary, neurologic, or musculoskeletal limitations.
After evaluating the patient, the physical therapist, working closely with the physician, develops and implements a prioritized treatment plan, then monitors it, adjusting goals and therapy as needed.
Because caloric requirements are increased during rehabilitation, caloric intake must be increased accordingly to prevent weight loss and nutritional deficits.
Range-of-motion exercises: Several physical therapy techniques can help improve range of motion, which commonly becomes restricted after a stroke or prolonged bed rest.
Restricted range of motion can cause pain, reduce functional abilities, and predispose patients to pressure sores.
In healthy elderly persons, the range of motion for certain joints is usually lower than would be normal for younger patients ( ), but this age-related decrease does not usually prevent the elderly from being able to perform ADLs without assistance.
Exercises to increase range of motion are indicated for all elderly patients with restricted motion, unless functional deficits are profound.
Range-of-motion exercises may be: Active, for patients who can exercise without assistance Active assistive, for patients whose muscles are too weak to exercise without assistance (and who also require strengthening exercises) or for patients who experience discomfort during joint movement Passive, for patients who cannot actively participate ( ) Active-assistive or passive range-of-motion exercises must be performed very gently.