PHYSIOTHERAPY FOLLOWING DISCHARGE

Sally Emery

Advanced Physiotherapy Practitioner

Spinal Outpatient Department

Introduction

Goals for inpatient rehabilitation- skill development- maximise independence- minimise complications- prepare for discharge back into the community

Handover to Spinal Outpatients on discharge

Maintenance in the community

Need to maintain skills in order to fully function in the community

Reliance on relatives and carers for assistance

Support Network - teaching prior to discharge- outpatient therapist- community therapists

Care of the joints and soft tissues

Stretching exercises

Positioning

Standing frames

Splints/Orthoses

Why stretch?

To prevent stiffness

To maintain flexibility and suppleness in the muscles

To minimise the effects of ongoing spasm/spasticity

To prevent contractures of the joints

To maintain optimal levels of function and independence

Stretching exercises

Aim to take the joints through their full available range of movement

Most important muscles include- calf muscles - pecs- hamstrings - biceps- hip flexors - wrist/hand

Be careful not to overstretch the joints and soft tissues

Positioning

Aims to- maintain symmetrical postures- encourage stretching- reduce spasm- minimise adaptive shortening of the muscles - prevent complications, e.g. contractures

Why stand?

Benefits include

- effective stretching

- reduction in spasm/spasticity

- maintenance of bone density

- improved bladder and bowel function

- psychological effects

Standing Frames

Tilt Table Oswestry Frame

(cont’d)....

Iper Granstand

Assessed for appropriate frame prior to discharge

Requisition made for funding from local Primary Care Trust

Varying level of assistance required to use frame at home

Splints/Orthoses

Upper Limb Splints

Lower Limb Orthoses

Corsets/Braces/Binders

Variety of types

May require assistance to use

Chest Care

Assistance with coughing

Assistance with nebulisers

Suction for the patient with a tracheostomy

Assistance with ventilatory machines

Why cough?

Build up of secretions can affect theability of the oxygen breathed in toreach every part of the lungs

Excess secretions increases the risk of bacterial growth

Increases the risk of chest infection and pneumonia which can be fatal in serious circumstances

Coughing

When coughing, the stomach muscles expel air forcefully from the lungs clearing the passages of secretions or any other obstruction

When the stomach muscles are paralysed the cough is weak and ineffective therefore assistance is required to provide the force behind the cough

Assisted Coughing

Technique using the arm or hands

to strengthen the cough

Performed independently or, more frequently, by somebody else

Needs to be practised in order to be effective as timing and coordination are key factors

(cont’d) Patient takes a deep breath in then pressure is

applied as they cough out

Direction of the pressure is ‘inwards and upwards’ on the stomach muscles, just below the ribs

The sound of the cough can be used as a guide for effectiveness

Rests should be taken between continuous coughs

(cont’d)

Lying Sitting

Nebulisers Variety of medications

Saline helps loosen the secretions so that it can be coughed up more easily

Other drugs (bronchodilators) help widen the passages of the lungs to reduce wheezing and allow the phlegm to pass more freely

Patients who have problems clearing their secretions may be prescribed nebulisers to take daily

Suctioning and tracheostomy care Tracheostomies provide a more effective means of

clearing secretions for patients with ongoing chest problems

May require suctioning using a smallcatheter attached to a suction unit

Tube also needs to be looked after to prevent infection and blockages

Procedures need to be in place in case a blockage occurs

Ventilated patients

Small number of patients

Continuous invasive ventilation viaa tracheostomy

Intermittent ventilation or overnight support via a tracheostomy or a face mask

Basic knowledge of the machine’s components and settings is required

Summary

Once discharged a patient needs to maintain the skills they have learned as an inpatient to prevent any complications

This will enable them to maximise their quality of life

As their relatives, you can help them to do this by assisting them in their maintenance exercises and daily régime

But remember!

Help is at hand!- engage in your relative’s therapy sessions to learn the skills required to help them- once home, contact the Spinal Outpatient Service for further advice and support as

needed- alternatively, assistance from a community therapist can be arranged if appropriate- support from a variety of sources exists for

you as well as your relative