Physiotherapy in Palliative Care Canadian Virtual Hospice

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5 Other Interventions,6 Discharge Planning,7 Occupational Therapy Role. 8 Challenges,9 Conclusion,10 References,Physiotherapy in. palliative care is focused,on providing maximum,comfort for the patient. while maintaining the,highest level of physical,function in the face of. disease progression,Editorial Do Physiotherapists,Have a Role in Palliative Care.
World Health Organization principles of palliative. care WHO 1990,Affirm life and regard dying as a normal process. Neither hasten nor postpone death, Provide relief from pain and other distressing symptoms. Integrate the psychological and spiritual aspects of patient. Offer a support system to help patients live as actively as. possible until death, Offer a support system to help family members cope during. the patient s illness and their bereavement 1 p 5,Study OT and PT in Hospice. The Facilitation of Meaning QOL,and Well being 2004.
Although people lie dying they are still living,living with the hope for improvements of life. despite acceptance that death is inevitable 2p 129. Key Points, Blending of geriatrics and palliative care approach is. ideal 2 p 121 ie focus not only on dying process but. also on other physical problems associated with age. joint pain hearing vision loss fatigue, Rehab in palliative care is a paradox 2 p 122 need to. keep in mind when developing goals,Study OT and PT in Hospice. The Facilitation of Meaning QOL,and Well being 2004.
Key Points continued,smaller number of home exercises improves. compliance and performance 2 p 122,therapist recognition and affirmation of extreme. effort put forth by patient great impact on their,sense of worth 2 p 125. recognize and discuss changes 2 p 125 related to,decline in function. Holistic care by therapist is important,Study The Utilization of Physical.
Therapy in a Palliative Care Unit,Key Points,Physiotherapy program benefited 56 of patients. assessed and who went through a physio,treatment program of 2 weeks. Patients with dementia diagnoses showed more,functional improvements. Receiving a Referral,On Palliative Care physiotherapy works on a. referral basis either from Doctor or Nursing,Review chart and shift report.
Liase with team Nursing MD HCA,Initial Assessment,Determine patient s current physical strength. and functioning,Determine patient and or caregiver s goals. with physiotherapy treatment,May go in with OT for initial visit if we both. have received a referral,Chart documentation on initial assessment. Physiotherapy,Treatments,Ambulation,Walking is the most functional exercise.
Will assess need for mobility aid 2 or 4 wheeled,walker or cane. Many benefits,Reduces stiffness relaxes tight muscles. Upright weight bearing posture,Aides digestion and constipation. change of scenery, Patient has feeling of purpose and feel they can do. something for themselves,Bed Exercises,Used if patient can not ambulate or used for.
additional exercises if they can ambulate,Includes Passive ROM Active ROM and bed. General bed exercises see sample or,specific bed exercises. Handout provided to patient,Exercises also shown to family caregiver so. they can help,Bed Exercises,Goals of PROM AROM,Minimize muscle wasting. Minimize contractures,Maintain joint and connective tissue mobility.
Decrease restlessness,Assist circulation and vascular dynamics. Help maintain patient awareness of movement, Can give caregivers feeling of purpose if they can help with. the exercises, Develop coordination and motor skills for functional. activities AROM 5 p 34 38,Passive ROM Stretching,This may be included in bed exercises. If patient has contractures risk of developing,contractures or muscle tension.
May also be done to relieve discomfort caused by lack of. PROM is generally done to every major joint in the upper. and lower extremity, Stretching will be done to more specific tight musculature. Involve family caregiver,WILL NOT prevent muscle atrophy increase strength. or endurance or assist in circulation to the extent that. active and voluntary muscle contraction does,Progression from Bed. Practicing lie to sit transfer is the next step up. from doing bed exercises,Patient rolls onto side lets legs go off edge of. bed then pushes up to sitting,Once in sitting can dangle for as long as.
Trunk stabilization leg and arm exercises,may be preformed in this position. Transfer assessments are done often on the,palliative care unit. Will work with patient to improve transfer as,best as we can. Nursing does initial assessment and will,contact physio if there are complications or. difficulty with the transfer,Transfers range from,Independent I.
Stand by Assist SBA,1 person assist 1PA,2 person assist 2PA. Mechanical,Sit to stand mechanical lift SARAlift,Total Mechanical lift Hoyer Opera. SARA lift 3000,2 caregivers need to be,present to operate the lift. Patient must be able to,put weight through both,legs hold on with one. arm and able to follow,simple directions,Opera Lift.
Comparable to Hoyer Lift,Must have 2 people,present to operate lift. Respiratory Physiotherapy,If breathing or lung issues respiratory. techniques may be used,Breathing Education,Relaxation techniques. Pursed Lip Breathing,Postural Education,Stretches Breathing Exercises. Pacing Techniques,Effective coughing techniques Huffing.
Respiratory Physiotherapy,Postural Drainage and Pummeling. Both are done with extreme caution and only if,specifically requested by MD. May help patients who are having trouble,coughing up secretions. Caution especially with cancer patients who may,have possible rib metastases. Encourage fluid intake and huffing throughout,Respiratory Physiotherapy.
Physiotherapists are trained in using pulse,Will monitor oxygen saturations throughout. any breathing techniques or mobilization,Will also monitor breathing patterns and. levels of distress,RPE rating of perceived exertion 1 10 scale. MODALITIES,Transcutaneous Electrical Stimulation,Heat Hot pack Parrafin Wax bath. Cold packs,Transcutaneous Electrical Nerve Stimulation.
Applications muscle strengthening pain,relief wound healing. Pain control is the most common application,of TENS especially in palliative care. Depolarizes nerves Action Potential,TENS for Pain Control. Gait Control Theory TENS non nociceptive,TENS interferes with pain stimulus. signals at the spinal cord level A beta nerves,PAIN noxious stimulus When stimulated can inhibit.
A delta Nerves transmission of noxious,Unmyelinated C Nerves. Methods of TENS,Conventional TENS high rate,Acupuncture like TENS. Burst mode,Conventional TENS,A beta nerves can be stimulated by. Conventional TENS,100 150 pps,Only effect is while machine is on so can be. used 24 hours a day or when pain is most,May have lasting effects by interrupting the.
pain spasm cycle,Conventional TENS,Modulation to prevent adaptation. May need intensity turned up throughout,Acupuncture like TENS. Electrical stimulation may stimulate the,production and release of endorphins. enkephalins,Studies have shown that endorphin,enkephalin levels are raised after application. Most effective at frequencies 10 pps,Acupuncture method of TENS can cause this.
Physiotherapy in Palliative Care Presented by Danae Hiebert Physiotherapist Riverview Health Centre Outline 1 Focus and Role of Physio Editorial Studies 2 Receiving a Referral 3 Initial Assessment 4 Treatment Ambulation Bed exercises Passive Range of Motion Stretching Transfers Respiratory Physio Modalities TENS 2 Outline 5 Other Interventions 6 Discharge Planning 7

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