Abnormal gait pattern
- Gait practice (break gait down into manageable parts
- Graded exercises depending on deficit
- Stretching depending on deficit
- Gait aid to unload (if painful limb)
- Gait aid to support (if balance/strength-related issues)
- Hydrotherapy to pracitce gait pattern in unloaded environment
- Bracing/taping
Acute dyspnea
- SOS for SOB
- Pursed lip breathing
- Remove triggers
Chronic dyspnea
- Pursed lip breathing
- Secretion removal tachniques (if secretions are contributing to dyspnea)
- Cardiovascular conditioning
Decreased functional mobility
- Practice the functional task or components of the task
–> Bed mobility (e.g. supine to sit, rolling)
–> Increase sitting tolerance (at edge of bed or in chair/wheelchair)
–> Transfer practice (e.g. slide board, stand step around)
–> Sit to stand practice
–> Ambulate practice (short distance with or without gait aid)-assess for appropriate gait aid
–> Stair practice - Strength exercise (bed, sitting or standing)
- Pacing & planning
- Time treatment with medications if necessary (e.g. pain meds)
Decreased muscle length
- Stretching (e.g. static, dynamic, PNF techniques)
- ROM exercises
- Soft tissue techniques
- Heat
Decrease muscle strength
- Use condition-specific exercise
DVT risk (Post-op Pt and has not mobilized)
- Monitor for DVT:
–> Inspect bil calf for redness, swelling, warmth, tenderness
–> Homan’s test (passive DF with knee extended)
–> if suspected, DO NOT mobilize and immediately report to the team (nursing staff, physician) - AROM/PROM for lower extremities
- Mobilize as tolerated
- Ankle pumps
- Compression socks
Fatigue
- Pacing and planning
- Energy conservation
- Activity modification
Comorbidities:
- HT
- Hypercholesterolemia
- Obesity
- Atherosclerosis
- Type 2 DM
- Cardiovascualr exercise within safe intensity (modified BORG 3-5)
E.g. Acute: mobilizing from bed to chair, chronic: walking for 20 minutes - Educate the Pt on modifiable risk factors associated with their co-morbidities
- Consult with team or phyiscian to ensure appropriate medical management of their co-morbidities
- Refer to a community health program to provide
- HT specific: Monitor BP & ensure the Pt is at a safe level to mobilize (under 200/110 to mobilize)
- DM specific: Educate Pt about and monitor for S&S of hypoglycemia associated with DM & exercise
Increased tone/spasticity
- Bracing/splinting
- Stretching
- ROM exercises
- Strengthening
- Positioning
Incorrect gait aid or patient requires a gait aid (and gait aid is not specified)
Refer to Gait Aid Selection Flowchart
Inflammation (from acute soft tissue injury)
- Modalities (E.g. pulsed US, laser)
- PEACE & LOVE
–>Protection: avoid aggravating activities for a few days
–>Elevation
–>Avoid anti-inflammatories: Avoid icing
–>Compress: reduce swelling
–>Education: Avoid unnecessary passive Rx & medical investigation
–>Load: pain guided gradual return to activity
–>Optimism: Condition your brain for optimal recovery by being confident and positive
–>Vascularization: pain free cardiovascular activity to inc. blood flow to repairing tissues
–>Exercise: Restore mobility, strength and proprioception by adopting an active approach to recovery
Joint stiffness
- ROM exercise working in the range of stiffness (AROM, AAROM, PROM)
- Manual therapy (joint mobilization, traction)
–>Direction to improving which range
–>grading
Poor posture
- Stretch muscle that tend to become tight in forward flexed posture (e.g. DNE, UFT, Pects, hip flexors)
- Strengthen muscles that tend to become weak in forward flexed posture (e.g. DNF, MFT/LFT, rhomboids, spinal extensors, glutes)
- Education (e.g. ergonomics)
- Soft tissue techniques
- Heat for muscle relaxation
- Manual therapy
- Bracing/orthotics
Pain
- Modalities (e.g. TENS)
- Education (e.g. activity modification)
- PEACE & LOVE
- Manual therapy
- Positioning
- Relaxation technique
- Time PT Rx with pain medications
Poor sitting balance
- Seated balance exercises (e.g. static, big/small BOS, eyes open/closed, internal/external perturbations)
- Seated core strengthening exercise (e.g. partial sit up, weight shift, seated marching)
Poor standing balance
- Standing balance exercise (e.g. static, big/small BOS, eyes open/closed, internal/external pertubations)
- Proprioception exercises
- Strengthening exercises depending on deficit
- Use of gait aids
Prevent complications of bed rest
- PROM/AAROM/AROM
- Bed exercise (heel slides, ankle pumps, glute squeeze, bridge)
- Graded mobilizations
–> Sitting in bed
–> Sitting at edge of bed
–> Standing
–> Pre-ambulatory exercises (marching, heel raise, toe raise)
–> Ambulation - Deep breathing exercise
Pulmonary secretions
Secretion removal technique
- Active:
–> Huffing, coughing
–> Active cycle of breath
–> PEP mask/flutter, acapella
- Passive:
–> PD
–> Precussion, vibration
Breathing techniques
- Diaphragmatic breathing with or without inspiratory hold
- Breath stacking
Respiratory accessary muscle use
- Diaphragmatic breathing
- Educate on peroper breathing techniques
Smoking
- Education on the effects of smoking on respiratory health
- Refer to community support if the Pt was ready to change
Unable to participate in meaningful activity (work, posr, hobby)
- Start gradually and make a plan for adding more tasks if no exacerbation occurs
- Liaise with coach/strength and conditioning specialist
- Progressive agility and sport specific exercises when able
–> Sidestepping, grapevine
–> Explosive movements
–> Star drill
–> Change of direction drills
–> Running forward/backward, hopping - Gradual return to sports
–> Non-contract practice (e.g. drills)
–> Contact practice (e.g. scrimmage)
–> Partial gameplay (e.g. 1st half only)
–> Full gameplay - Gradual return to work
–>number of hours
–>demand of tasks - Use of bracing/taping
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1.2 Common Problem & corresponding Rx22
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1.3 Contraindication to treatment25
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1.1 Developing a Rx Plan5
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2.1 Developing Goals & Pt Collaboration7
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3.1 Collaboration, Consultation and Referral to Others17
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4.1 Monitor, Reassessing and Modifying the Plan10
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4.2 Promoting Self-Management11
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5.1 Discharge Planning and Transitioning Care14
