Therapy Issues in Therapy Issues in SCISCI

Presented by:Presented by:

Anthony I. Calilung, PT, MS, Anthony I. Calilung, PT, MS, RN RN

Rehabilitation isRehabilitation isThe process of helping a The process of helping a

person achieve the highest person achieve the highest level of function, level of function,

independence, and quality of independence, and quality of life possible. From the Latin life possible. From the Latin "habilitas," which means to "habilitas," which means to

make able.make able.

To promote functional To promote functional independence, prevent independence, prevent

unnecessary complications, unnecessary complications, and enhance overall quality and enhance overall quality

of lifeof life. .

PTPT

Physical Therapy is a rehabilitation Physical Therapy is a rehabilitation specialty that is provided by a specialty that is provided by a licensed individual. The Physical licensed individual. The Physical Therapist works with an individual to Therapist works with an individual to help them regain functional abilities help them regain functional abilities such as walking, getting in/out of bed, such as walking, getting in/out of bed, strength, balance, gross motor skills, strength, balance, gross motor skills, endurance and improve safety skills.endurance and improve safety skills.

OTOT

Occupational Therapy is a rehabilitation Occupational Therapy is a rehabilitation specialty that is provided by a licensed specialty that is provided by a licensed individual. The Occupational Therapist works individual. The Occupational Therapist works with individuals to help people return to with individuals to help people return to ordinary tasks around home and at work by ordinary tasks around home and at work by maximizing physical potential through lifestyle maximizing physical potential through lifestyle adaptations and possible use of assistive adaptations and possible use of assistive devices. Some of the areas the therapist may devices. Some of the areas the therapist may help the individual regain function in are self help the individual regain function in are self feeding, oral hygiene, dressing/bathing skills, feeding, oral hygiene, dressing/bathing skills, visual/perceptual coordination, splinting and visual/perceptual coordination, splinting and adaptive equipment. adaptive equipment.

KTKT

• Kinesiotherapy is a rehabilitation specialty that Kinesiotherapy is a rehabilitation specialty that is provided by a certified individual to help is provided by a certified individual to help improve their strength, endurance, and improve their strength, endurance, and mobility. mobility.

• The KT provides therapeutic exercise The KT provides therapeutic exercise programs and education to help improve programs and education to help improve general strength, endurance, joint range of general strength, endurance, joint range of motion, balance, coordination and safety with motion, balance, coordination and safety with daily functional activites. daily functional activites.

• KT can also provide aquatic therapy, driver KT can also provide aquatic therapy, driver training and cardiac conditioning programs. training and cardiac conditioning programs.

When do you get Skilled When do you get Skilled TherapyTherapy

• Potential to increase/improve functionPotential to increase/improve function• Functional goals: functional meaning; to have a Functional goals: functional meaning; to have a

purpose or outcome; when therapy will improve purpose or outcome; when therapy will improve a persons ability to participate in/perform their a persons ability to participate in/perform their daily activities.daily activities.

• Skilled services are those which require the skills Skilled services are those which require the skills of technical or professional personnel (physical of technical or professional personnel (physical and occupational therapists). In order to be and occupational therapists). In order to be deemed "skilled," the service must be so deemed "skilled," the service must be so inherently complex that it can be safely and inherently complex that it can be safely and effectively performed only by, or under the effectively performed only by, or under the supervision of, professional or technical supervision of, professional or technical personnel.   personnel.  

How long do I get How long do I get therapy?therapy?

• Dependent upon each personDependent upon each person• Generally as long as there continues to be Generally as long as there continues to be

goalsgoals• Generally as long as progress continuesGenerally as long as progress continues

– What does plateau mean?What does plateau mean?• Therapy is dependent on: Therapy is dependent on:

• Medical clearanceMedical clearance• ParticipationParticipation

• **This can change at any time. **This can change at any time.

ROMROM

• RRange ange OOf f MMotion-The movement in otion-The movement in which each joint should/or is capable of which each joint should/or is capable of moving.moving.

• This should be performed every dayThis should be performed every day• This can be done by Therapy (initially) This can be done by Therapy (initially)

then taught to family and nursing to then taught to family and nursing to continue and follow up withcontinue and follow up with

• This should be done for every joint; This should be done for every joint; arms and legsarms and legs

ROM cont.ROM cont.

It is important to maintain the It is important to maintain the length of the muscles to prevent length of the muscles to prevent contracture, maintain ease of contracture, maintain ease of hygiene and keep muscle length hygiene and keep muscle length within normal limits incase recovery within normal limits incase recovery to that muscle occurs to ensure to that muscle occurs to ensure function is not compromised.function is not compromised.

W/C’sW/C’s

When is a w/c appropriate?:When is a w/c appropriate?:– when there is a good idea of whether a when there is a good idea of whether a

person is appropriate for power or person is appropriate for power or manual mobility –not always in the manual mobility –not always in the beginning of therapybeginning of therapy

– Weight is stableWeight is stable

– Which one is correct for you?Which one is correct for you? – Manual Manual – PowerPower

ManualManual

– can you push the chair?can you push the chair?– does it need to fold?does it need to fold?– what does it need to fit your body what does it need to fit your body

medically?medically?– What type of activities do you/are you What type of activities do you/are you

going to perform in your chair?going to perform in your chair?– Where are you going to live?Where are you going to live?

PowerPower

• Are you eligible for a power chair?Are you eligible for a power chair?• If so:If so:

– Can you drive a power chairCan you drive a power chair– Where are you going to live?Where are you going to live?– What types of things are you going to What types of things are you going to

do in the chair?do in the chair?– What types of things to you need on the What types of things to you need on the

chair medically?chair medically?

2 wheelchairs?2 wheelchairs?

• According to VA policy: According to VA policy:

– If you have a power chair you are If you have a power chair you are eligible for a backup eligible for a backup manualmanual in case in case your power needs repair.your power needs repair.

– If you have a manual you are eligible for If you have a manual you are eligible for a backup manual in case your primary a backup manual in case your primary manual needs repair.manual needs repair.

CushionsCushions

• TypesTypes– FoamFoam– GelGel– AirAir

Every person has a cushion that is most Every person has a cushion that is most appropriate for them.appropriate for them.

Considerations when choosing a cushion:Considerations when choosing a cushion:

Age, skin condition, injury, can they Age, skin condition, injury, can they care for the cushion, seating ability. care for the cushion, seating ability.

CushionsCushions

Air Gel Air Gel FoamFoam

Pressure ReliefPressure Relief

• What is it?What is it?• Pressure relief is relieving the pressure Pressure relief is relieving the pressure

off the skin to allow for blood flow back off the skin to allow for blood flow back to that areato that area

• What constitutes a pressure relief?What constitutes a pressure relief?•Tilt to 60 degrees Tilt to 60 degrees •Every 15 minutes for a full 2 minutesEvery 15 minutes for a full 2 minutes•Do not stay in your tilt Do not stay in your tilt •Other types of pressure relief?Other types of pressure relief?

Assistive Devices (PT)Assistive Devices (PT)

• SlideboardSlideboard• WalkerWalker• CaneCane• Canadian crutchesCanadian crutches• CrutchesCrutches

Assistive Devices (OT)Assistive Devices (OT)

• LH spongeLH sponge• LH reacherLH reacher• Sock aidSock aid• Shoe hornShoe horn• Mobile arm supportMobile arm support• Universal cuffUniversal cuff• Driver training-adaptive equipment Driver training-adaptive equipment

for driving..for driving..

Assistive Devices (OT)Assistive Devices (OT)

Assistive TechnologyAssistive Technology

• Hand splintsHand splints• ECU’s-environmental control unitsECU’s-environmental control units

– Are you appropriate?Are you appropriate?

• Computer accessComputer access

HISA GrantHISA Grant

• Home Improvement Structural AdaptationHome Improvement Structural Adaptation• The amount depends on whether or not you The amount depends on whether or not you

are service connected and to what extent. are service connected and to what extent. • It is used for structural adaptations of It is used for structural adaptations of

YOUR HOME ONLY to allow you to YOUR HOME ONLY to allow you to function better.function better.

• EX: widen doorways, install a permanent EX: widen doorways, install a permanent ramp, kitchen or bathroom adaptations for ramp, kitchen or bathroom adaptations for accessibility.accessibility.

HISA Grant cont.HISA Grant cont.

• A consult has to be sent by your A consult has to be sent by your doctor or therapist to Prosthetics for doctor or therapist to Prosthetics for you to obtain the form.you to obtain the form.

• You then have to get 3 quotes and You then have to get 3 quotes and return that to prosthetics and return that to prosthetics and reimbursement is addressed by that reimbursement is addressed by that department.department.

• This is a one time grant. Once you This is a one time grant. Once you have used it, its gone. If you move have used it, its gone. If you move you do not get to start over.you do not get to start over.

SafetySafety

• Safety is very important during therapy. Safety is very important during therapy. It is just as important to maintain safety It is just as important to maintain safety as it is to progress your therapy.as it is to progress your therapy.– Don’t perform activities that have not been Don’t perform activities that have not been

cleared by your doctor or therapist.cleared by your doctor or therapist.– Make sure you have the proper supervision.Make sure you have the proper supervision.– Do not attempt to try an activity that has not Do not attempt to try an activity that has not

been performed by your therapist.been performed by your therapist.

The End!The End!

Thanks for your time and attention.Thanks for your time and attention.

Questions?Questions?