Basic concept of rehabilitation – An orthopedic nurse is a nurse who specializes in treating patients with bone, limb, or musculoskeletal disorders. Nonetheless, because orthopedics and trauma typically follow one another, head injuries and infected wounds are frequently treated by orthopedic nurses.
Ensuring that patients receive the proper pre-and post-operative care following surgery is the responsibility of an orthopedic nurse. They play a critical role in the effort to return patients to baseline before admission. Early detection of complications following surgery, including sepsis, compartment syndrome, and site infections, falls under the purview of orthopedic nurses.
Basic concept of rehabilitation
In the landmark 1966 paper Accidental Death and Disability: The Neglected Disease of Modern Society, priorities were identified for the development of trauma care in America. Rehabilitation of the injured was one of the significant problems identified in that document. Major strides have been made in both the techniques and organization of prehospital care, resuscitation, surgery, and intensive care. The development of rehabilitation services has lagged behind that of acute care.
Each year, more than 145,000 people die due to injury in America. In 1995, over 2.5 million individuals hospitalized for trauma survived to hospital discharge, accounting for 8 percent of all hospital discharges. In 1985, $158 billion was spent on injury, including insurance costs, lost work, and medical costs. In 1996, the Centers for Disease Control (CDC) estimated the annual cost of brain injury alone at $38 billion.
Trauma systems must strive to reduce impairment due to injury and return individuals to their highest possible functional role.
Brain injury and spinal cord injury, because of their tremendous impact on function, necessitate the greatest application of rehabilitative resources. While orthopedic injuries also require special services and lead to significant disability, many life-threatening visceral injuries do not lead to long-term disability.
[Ref- Ernest e. moore’s trauma, 5th edition.page-1151]
Define rehabilitation:
Rehabilitation has been defined as the restoration of the individual to the fullest physical, mental, social, vocational and economic capacity attainable.
[Ref-Lippincott Adult orthpaedic Nursing,P-3]
Or
Rehabilitation is an organized program of medical and clinical treatment designed to maximize residual physical, perpetual and cognitive abilities following disablement.
[Ref-SN Nanjunde Gowda’s “Foundations of Nursing”, 1″ edition, p-697]
Or
Rehabilitation can be defined as the total process of preserving or restoring an individual to the highest level of physical and socio-economic independence which he can reach.
[Ref-MARY POWELL ‘S orthopedic nursing and rehabilitation, 9 edition, page-661]
Basic principles of rehabilitation:
1. To begin as early as possible (first 24-48 hours).
2. To assess the patient systematically (first 2-7 days).
3. To prepare the therapy plan carefully.
4. To build up in stages.
5. To include the type of rehabilitation approach specific to deficits.
6. To evaluate patient’s progress regularly.
[Ref-SN Nanjunde Gowda’s “Foundations of Nursing” fedition, P-698]
Goal of rehabilitation:
1. Attention to the prevention of disabling complications during the acute phase of treatment can minimize required interventions during the rehabilitation phase of treatment.
2. Secondary disabilities are decrements of function that follow the impairments that result from trauma, most often because of prolonged immobilization of the patient. Although rarely life threatening, they can limit eventual function and contribute greatly to total health care cost
Types of rehabilitation:
The process of rehabilitation can be classified into two type according to the application.
1. Preventive rehabilitation, that’s applied in the community and in the hospital. 2. Restorative (or medical) rehabilitation as practiced in special centre.
[Ref-MARY POWELL ‘S orthopedic nursing and rehabilitation, 9th edition, page-661]
The rehabilitation team:
Rehabilitation is based around an interdisciplinary team, orchestrating different therapies in a coordinated manner. Mobility, activities of daily living, communication, and sexual function are issues that must be addressed by the team. The psychological well-being of the injured individual must also be addressed. The team must recognize the need for vocational training in order to assist the victim in returning to (or developing) a productive role in society. Finally, the patient’s need for financial and social support must be assessed and a plan for access to ongoing services developed.
Overall leadership of the team should be held by the rehabilitation physician (physiatrist), but leadership of a specific phase may be held by any member of the team based on his or her expertise. It is best if the entire team hold team meetings during which each patient is discussed.
Member of the rehabilitation team:
a. Physiatrist:
The physiatrist reviews the history, and examines the patient thoroughly to determine the patient’s abilities and disabilities, and then prescribes appropriate therapies. He or she also orders adaptive equipment, prosthetics, and orthotics. This physician has a crucial role in communication with the patient, family, rehabilitation team, and other members of the hospital staff. Physiatrists prescribe medications to alleviate pain and spasticity, bowel and bladder programs to provide safe, hygienic elimination after nerve injury; electromyography/nerve conduction velocity studies to diagnose nerve and muscle pathology; and edema management.
b. Orthopedist:
The orthopedist assesses and treats patients with fractures, joint injuries, or ligamentous tears. Before and after surgical intervention, the rehabilitation team follows guidelines for weight bearing and range of motion set by the orthopedist. In patients with isolated orthopedic injuries, the orthopedist often directs the
rehabilitation process.
c. Physical Therapist :
Physical therapy is the most commonly used therapy discipline. The therapist evaluates the patient’s strength, range of motion, balance, and coordination, and leads the patient in exercises to improve function. The physical therapist instructs the patient in ambulation, use of ambulation aids, wheelchair usage, stairs, curbs, and ramps. Modalities for pain relief and wound managementâť”such as heat, cold, electrical stimulation, hydrotherapy, massage, and tractionâť are an important part of physical therapy. Physical
therapists also instruct the patient in the use of lower extremity prosthetics and orthotics.
d. Occupational Therapist :
Occupational therapists evaluate upper extremity range of motion, strength, coordination, and self-care skills. They instruct patients in these areas as well as in transfers needed for self-care. They can fabricate upper extremity splints as well as guide patients in the use of adaptive equipment, splints, and upper extremity prostheses. Occupational therapists conduct cognitive and perceptive evaluations and treat deficits in these areas. Physical and occupational therapists also conduct home evaluations to assess barriers and the patient’s ability to manage activities of daily living, and they are involved with family
training.
e. Speech Therapist :
Speech therapists are involved in the evaluation and treatment of communication disorders such as aphasias, dysarthrias, and apraxias. Evaluation and treatment of swallowing disorders is a crucial component of speech therapy. Speech therapists are involved with the evaluation and treatment of cognitive deficits and instruct patients in the use of augmentative communication devices.
f. Rehabilitation Nurse:
Rehabilitation nurses specialize in the personal care of physically impaired patients. This includes medication management, hygiene, bowel and bladder programs, and the use of adaptive equipment.
g. Psychologist and Neuropsychologist:
The rehabilitation psychologist and neuropsychologist are primarily involved in the testing of perception, memory, and reasoning. They also evaluate personality and psychological status as well as coping skills. Psychologists aid patients in the development of problem-solving skills and help patients and families adapt to disabilities. Neuropsychologists evaluate cognitive function and attendant skills (e.g., reading, mathematics) and implement training programs to overcome or circumvent deficits.
h. Psychiatrist:
The psychiatrist is primarily involved in the identification and treatment of psychopathologist either preexisting or secondary to brain injury or normal/abnormal psychological reactions to injury. Drug therapy for sleep deprivation, treatment for substance dependence, and therapy for alterations in behavior that interfere with treatment are all the province of the psychiatrist.
i. Recreational Therapist :
The recreational therapist uses leisure activities to promote recovery. This starts with a thorough assessment of the patient’s interests and capabilities. Recreational activities are then used to improve strength, endurance, and concentration. These activities also aid in the patient’s reintegration to the community. Play therapy may be extremely important in the treatment of the injured child.
j. Vocational Counselor:
The vocational counselor evaluates vocational interests, aptitudes, and skills. He or she counsels patients who must change or adjust their jobs. Vocational counselors also provide information on job training and placement.
k. Prosthetist/Orthotist:
The prosthetist/orthotist is a key member of the rehabilitation team, being responsible for the evaluation of patients requiring braces and artificial limbs as well as the design and fabrication of these devices.
l. Nursing Staff:
The trauma nurse must function as a member of the rehabilitation team. As the bedside patient advocate, the nurse frequently identifies the physical, psychological, and behavioral needs of the patient (and his or her family) earlier than any other member of the team. Prevention of decubitus ulcers and contractures is part of the trauma nurse’s primary role; however, impairments of bowel, bladder, speech, motor, and swallowing function are more readily apparent to the nurse than to any other member of the team. The
trauma nurse coordinator should participate as a leader in the institutional rehabilitation team.
m. Respiratory Therapist:
The respiratory therapist’s involvement in rehabilitative care has increased as a result of the movement of ventilator-dependent patients into rehabilitation facilities. In addition to efforts for weaning of these patients from ventilatory support, these therapists help the spinal cardiac injured patient learn techniques of respiratory clearance.
n. Social Worker:
The social worker’s role in the rehabilitation team varies on an institutional basis. In some hospitals, the social worker is primarily involved in financial and placement issues, identifying the appropriate rehabilitation facility for transfer from an acute care center, and arranging such transfer. In others, the social worker may participate in patient and family counseling and social support. This family/patient support service is important in helping the patient and his or her family to cope with the immediate changes that may occur after injury and to develop plans for ongoing coping.
o. Case Manager:
The role of the case manager is to assess, plan, implement, coordinate, and monitor an injured patient’s health needs as a means of controlling escalating health care costs. There are two different types of case managers: an external case manager and an internal one. The external case manager manages the claim for an employee or insurance company. The internal case manager works directly with the patient to monitor and expedite the injured patient’s progress through the system.
p. Anesthesist & Pain Management:
Pain management is of particular importance in the care of patients undergoing the rehabilitation process. Acute pain must be rduced to allow patient cooperation with range of motion and strengthening, particularly for those with extremity injury. Chronic pain syndromes present challenges for those with amputation, extremity injury, brain injury, or spinal cord injury and frequently require a multidisciplinary approach. Anesthesiologists often provide leadership for pain management.
[Ref- ERNEST E. MOORE’S TRAUMA, 5th edition.page-1152]
Definition of disability:
Disability is the consequence of an impairment that may be physical, cognitive, mental, sensory, emotional, developmental, or some combination of these. A disability may be present from birth, or occur during a person’s lifetime.
Or
Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations.
[Ref-WHO, definition)
Or
Limitation in the ability to pursue an occupation because of a physical or mental impairment; also: a program providing financial support to one affected by disability went on disability after the injury.
Prevent complications and deformities of a disable patient: Complication and deformities of illness or injury can often be prevented by:
- Frequent changes of position.
- Proper positioning in bed.
- Exercise and
- Progressive ambulation.
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