disability experience
- commonly share shame and inferiority
- desire to NOT be identified as a person with disability
- those labeled as “disabled” often feel devalued and stigmatized
- individual differences
social model (from kübler-ross)
- shock and horror
- denial
- anger
- bargaining
- depression
- acceptance or adjustment
person-first language
- person comes first
- avoid referring to person by their condition
- such terminology “objectifies” an individual
goals
- must be postive
- occupation-based
- functional-action-oriented
- measurable
- observable
- realistic-time frame
- in collaboration with the client
goals 4 components
- functional outcome-inorder to
- objective skill or behavior-client will
- measurable-with
- duration or time frame-in
long-term goals
projected status at completion
short-term goals
incremental, successive steps
balance screening instructions
- review client’s history and create an occupational profile
- note client’s diagnoses, medications and possible side effects, any history of falling, and prior level of function
- assess client’s blood pressure-abnormal levels can lead to dizziness
- asses balance in sitting position
interventions for balance impairment
- approaches used to address balance impairment can be determined by underlying deficit and would be more appropriate if there is potential to improve deficit through remediation, compensation or adaptation
- may begin with compensatory and or adaptive approach to increase safety and independence
- remedial techniques include: increasing ROM, strength, endurance when motor dysfunction effected on balance, fall prevention
specific interventions for balance impairment
remediation of balance impairments
- if indicated that client factors can be improved, remediation (biomechanical) approach is appropriate
- exercises and occupation-based activities can be used to improve core, UE and lower extremity strength or activity tolerance, by gradually increasing weight/repetition
reaching can be improved by
gradually increasing activity demands for reaching during training or rote exercises, wile seated unsupported as long as it is safe
therapist starts by ensuring client achieves postural alignment
- pelvis in neutral to anterior tilt with equal weight bearing on ischial tuberosities
- trunk extended in a midline orientation
- shoulders symmetrical and positioned anterior to hips
- hips and knees flexed and neutrally rotated
- both feet securely on floor
occupation-based challenges requiring active weight shift
- incorporating tasks that demand movement on variety of planes
- any combination of movements plus upward or downward directions
compensating for balance impairments
- safe weight shifting
- bracing with contralateral UE
- getting dressed in bed
- alternate methods of lower body dressing
- toileting hygiene while sitting
- pants over knees before standing
- standing activities in front of chair in case of balance lost
- pull pants over knees before standing from toilet
- position directly in front to avoid reaching
- making bed while lying in it
- wear terry cloth bathrobe to dry instead of towel
supports added to home environment
- grab bars
- stair lifts
- caine, walker, wheelchair
- positioning equip in wheelchair
- stair railings
- toilet safety handles
- reacher
- bed rails for transfer
- electronic life chairs
- nonslip floor surfaces
- pant clip for toilet clothing management
- transfer boards for lateral seated transfers
- setting for decreased reaching
- setting for seated tasks
- placing tools on counter within reach
standing up and sitting down
- transition from standing and sitting- essential for daily occupations
- sit-to-stand transfer requires intact balance with integration of adequate mobility at pelvis, hips, postural alignment, postural adjustments, weight shifting, and strength in core and lower extremities
functional ambulation
- walking is essential for many daily occupations
- OTs address walking with clients who wish to improve performance such as bathroom, kitchen, vocational, leisure and educational occupations
fall prevention
- adaptive strategies
- environmental evaluation
- medication review (especially psychotropic drugs)
- exercise programs (cardiovascular problems)
- AOTA fall prevention toolkit
non-weight-bearing
no weight is placed on injured limb
touch-down weight-bearing
injured limb used only for balance
partial weight-bearing
percentage of body weight is placed on injured limb
weight-bearing as tolerated
“comfortable” amount of weight placed on limb (measured by patient’s comfort level, not by percentage of body weight)
full weight-bearing
full body weight is placed on injured limb
hip-specific precautions: posterolateral (posterior) approach
- no hip flexion >90 degrees
- no internal rotation
- no adduction
