Welcome to Week Two
PTA 103!
Universal Design - Deconditioning
1 Introduction
Physiological monitors and patient support equipment provide much needed technology to maximize healing and function from illness and injury. These devices also sustain life for individuals who would not otherwise survive without it. A necessary consequence of this added technology is prolonged bed rest. In this lesson, we will explore how adaptations to bed rest effect body systems and rehabilitation potential. Specifically, we will learn how PT can minimize complications associated with prolonged bed rest
2 Lesson Objectives
By the end of this lesson, you should be able to
- Describe physiological adaptations to bed rest (cardiovascular, hematologic, musculoskeletal, respiratory, metabolic, thermoregulatory, psychiatric, and nutrition)
- Describe predominant adaptive responses to reduced muscle use
- Identify which skeletal sites are most susceptible to bone loss secondary to disuse
- Describe medical conditions commonly associated with bed rest
- Identify and describe tests and measures which may be used to document progress or status in the patient who is confined to bed
3 Content for Deconditioning
Directed Learning
Back in the fall.....
In PTA 100, your Pagliarulo text book and Moodle resources summarized tests and measures used in physical therapy. You were exposed to the Guide to PT practice patterns, and PT tests and measure categories. 1. We recommend reviewing the Test and Measures Flash Cards, so that you can refresh your knowledge of each of the categories. You may want to go back through your PTA 100 text (Chapter 11) and Unit 3 Exam notes, specifically on the Cardiopulmonary section. Reviewing the PT tests and measures and medical tests/procedures/cardiac diagnoses should help lend more meaning to the discussion of pathology as it relates to bed rest.
Next, play the Deconditioning Power Point
The Power Point (click here) provides a case example and then summarizes the effects of bed rest on the body systems.
Regardless of the pathology, the impacts of ( and the rehab approaches for) deconditioning - reconditioning remain the same. The Power Point has specific references to patients of advanced age, so you can start to distinguish particular considerations for the geriatric population.
Next, read the selections from Cameron, Chapter 23
Summative information from the Cameron text is included in the Power Point. We recommend going through the Power Point first and then completing the Cameron readings for specific information on indications for selected tests and measures used for treating the effects of bed rest. Cameron does a great job of providing specific quantitative references of what is considered normal and impaired. Spend some time with the section on Exercise Intensity, and practice calculating maximum HR methods and HRR reserve methods for exercise prescription. Be sure to pay attention to the Tables and Boxes. Specific Test and Measure criteria are available in the text. It may be helpful to look over the standardized tests to give some context into the types of questions/activities that are used to determine functional outcome/capacity. As a PTA, it is important that you understand the expectations for decreases in function (physiologically and in ADLs) so that you can select, prioritize, modify, and discontinue treatment in safe and effective ways.
Repeat, Repeat, Repeat
Remember the big picture...could you explain to a patient why it is important for their heart, lungs, muscles, bones, bowels, skin, and mood to get out of bed? Do you have some strategies to maximize confidence and success? Can you recognize and interpret signs, symptoms and outcomes that would require communication with the PT? When would you coordinate interventions/recommendations with other members of the health care team? How are you going to document patient response and progress to justify skilled services and medical necessity?
3 Content for Deconditioning
3.1 Factors Which Result in Confinement to Bed
Why are Patients on Bed Rest?
- Patient care technology has advanced to prolong life and facilitate recovery through specialized patient support
- In order for the technology to work with minimal risk for exacerbation of symptoms and/or secondary injury, activity and positions are often restricted
Factors Which Result in Confinement
- Pain management
- Fluid and electrolyte maintenance
- Medication administration
- Hemodynamic monitoring
- Nutrition
- Wound care
- Emotional/psychological issues
- Use of CNS depressants for stabilization
- Depression due to illness and hospitalization
Result = Physical Work Capacity Reduction
Multiple body systems are negatively impacted by bed rest. Changes can occur in as early as one week:
- Cardiovascular
- Pulmonary
- Hematologic
- Musculoskeletal
- Metabolic
- Thermoregulatory
- Immune system
- Neuroendocrine
- Psychological Functions