The role of the Physiotherapist:
The role of the Physiotherapist is to assess and treat any movement problems people may experience after their injury.
The Philosophy of our service:We follow a:
With both of these in mind we try to maximise our patients potential for recovery.
Aims- i.e. muscle length changes
2. Maximising motor performance
- providing opportunities for task specific practice
3. To improve physical fitness and reduce the effects of physical fatigue.
4. Preparing the person for rehabilitation
- establishing an attitude of active participation
- education of families and friends and involvement in therapy
How the aims are achieved:- being realistic about recovery time frame
Physiotherapists at Liverpool BIRU undertake a variety of measures in order to maintain/ improve muscle length.
1. Assessment of joint ROM
- identification of muscles at risk of shortening and measurement of appropriate joint ROM
2. Low load prolonged stretches
-length of time ranges from 30minutes to 8 hours.
- length of time ascertained by remeasuring
- choice of splint or positioning programme
Tilt tabling
- ankle and knee stretch
- stimulation of baro receptors
- good for respiratory system and arousing patient
- intermittent joint and bone compression
3. Serial Casting
- indicated when other measures fail to maintain adequate joint range or when contracture already present. This is often conducted post botox injection.
2. MOTOR LEARNING
-Observation of movement.
-Analysis of movement.
-Testing of hypotheses
-Training
- establish goals
- instructions and feedback
- structuring the environment
- part and whole task practice
- progression of practice
- remeasurement of performance
3. FITNESS TRAINING
-patients undergo a submaximal fitness test on the treadmill or exercise bike. From that test, a fitness training programme is devised. Patients usually come for fitness training for 30 minutes in the morning, and also attend a circuit class 3 times a week.
4. ACTIVE PARTICIPATION
-patients are given a timetable each week and if mobile, encouraged to bring themselves to the gym on time.
-if patients are able to do practice independently, they may be given exercises to complete on their own.
-goals are set with patients and feedback is given to them as to how they are progressing towards their goals.
-family members are given handouts on our service and invited to attend therapy sessions when possible. If family members are interested, they can be given extra practice to do with their relative in the gym or on weekends.
Service Provided:Staff:
Leanne Hassett (Senior Inpatient Physiotherapist)
Jane Liu (Permanent Grade 1. 0.5 Inpatient position)
San Trang (Rotating Grade 1)
Susan Twigden (Physiotherapist Assistant)
Referral:
Blanket referral. We assess and treat all inpatients in the unit.
Individual Therapy:
Most patients receive 30-60 minutes daily of individual therapy. This involves task specific exercises to improve the ability to eg. stand up, walk, climb stairs, run and reach and grasp objects. If they have no significant problems, they may only attend fitness training and circuit class.
Fitness Training:
Patients who are able to participate in a fitness programme will attend the gym daily for approximately 30 minutes of fitness training. This usually involves walking or jogging on the treadmill and/or riding the exercise bike.
Stretching Programme:
The stretching programmes are designed by the physiotherapist and usually carried out by the physiotherapist assistant during the week, and the nursing staff on weekends. These programmes may be carried out in the gym or on the ward depending on the stretches and splints required.
Groups:
We run two groups for inpatients; hand group and circuit class. Hand group is run in conjunction with the Occupational Therapists and is run two mornings a week. Patients who have difficulty with reaching or fine manipulation and who are able to participate in a group setting will attend. Therapists will assist patients to do functional retraining for their upper limb. The circuit class is run three afternoons a week. There are ten stations which patients move around to at which the patients do an exercise for two minutes. Those patients who are not able to mobilise around can do exercises at a set station. The aim of this class is to increase the amount of practice patients can do, to improve cardiovascular fitness and strength of muscles in a group setting.
Relative Involvement:
Family and friends are welcome to become involved in physiotherapy, however there is no obligation for involvement. The gym can become very noisy at times and we request that only 1-2 relatives are in the gym at one time per patient. If families would like to do extra physiotherapy practice in quiet times or on the weekends the physios can write down exercises and show how to do them. The physios can also teach how to put on splints and stretches if families would like to be involved.
2. COMMUNITY SERVICE:
Staff
Tim Fairbairn- Senior Community Physiotherapist
Jane Liu – 0.5 FTE – Physiotherapist for Transitional Living Unit and community.
Referrals
Clients have to be accepted by the Community Outreach Team. Referrals to Thelma Osoteo (Senior Case manager- Ph- 98285510). If physiotherapy is specifically requested please contact Tim Fairbairn as well.
Services Provided
The type of service provided is determined by the treating physiotherapist in liaison with the client. Determining factors include proximity to other services, family support, available transport and the most suitable environment for practice.
1. Home based programs. Physiotherapy programs are established and reviewed regularly at the clients home. This consists of a range of task specific retraining, strengthening exercises, fitness and stretching programs.
TREADMILL TRAINING WITH BODY WEIGHT SUPPORT
In June 2000 Liverpool Hospital Auxillary generously donated a Z-lift harness system to be used above the existing treadmill. This has allowed clients who would be unable to walk to practice walking with the assistance of a harness and the removal of body weight whilst walking.
DATABASE
The physiotherapy team with the help of the Data manager, have developed a physiotherapy outcomes database. A number of measures are recorded on admission and discharge. This provides us with detailed information about the types of patients we have had through the unit, and how well patients in general progress during their time here. Types of measures that are recorded include:
-The 8 neurological clinical indicators designed by the NSW branch of Neurology Study Group of the Australian Physiotherapy Association
-Walking speeds over 10 metres and in 6minute walk test
-Use of wheelchairs and aides on discharge
-Running speed over 50 metres
-Time to ascend and descend 4 stairs 3 times
RESEARCH
The physiotherapy team have been involved in a number of research projects. In the last year we were involved in project looking at clinical gait assessment after traumatic brain injury. This year we have been involved in a multicentre project looking at serial casting vs stretching and exercise for elbow contracture. Both of these projects have been headed up by Dr Anne Moseley from the Rehabilitation Studies Unit at Ryde.
QUALITY IMPROVEMENT PROJECTS:
All members of our team have been involved in QI projects looking at how best to improve our service. The current projects include:
The next project to begin this year will be to look at the implementation of an evidence based upper limb protocol on the ward.
If you have any questions regarding the program used at Liverpool BIRU please contact Leanne Hassett Leanne.Hassett@swsahs.nsw.gov.au or phone (02) 9826 4744.
Last modified: Thursday, 20 April 2006