The Caregivers' Role in Rehabilitation 

The ever expanding role of caregivers has grown by leaps and bounds in the last few years. Primary caregivers have always been extensions of their medical facility based counterparts, whether they are doctors, physiologists, nutritionists, or psychologists. The field of rehabilitative medicine is no different.

There is a growing need for rehabilitative and therapeutic practice beyond the traditional medical setting. Even many health clubs are now providing several rehabilitative services once found only in the clinical setting. Caregivers are also in a unique situation to help administer rehabilitative prescriptions for their loved ones as part of the care team.

Effective rehabilitation requires effective communication. Poor communication results in lost time in the rehabilitation process. By maintaining open lines of communication, problems can be minimized and eliminated more readily. Caregivers can insure there is an open and regular dialogue with the other health care professionals involved in their loved one's care.

Along with the task of maintaining lines of communication, the caregiver's role may take the form of implementing some actual program exercises. Some of these exercises may include actively moving an injured limb through a range of motion, assisting in flexibility exercises or even applying manual resistance in strengthening activities. Occasionally testing and recording the progress of the activities are also common assignments given to caregivers. Many caregivers also find themselves in the role of motivator for their loved ones, helping them adhere to their therapy and program. Simply being present can help provide the accountability to keep patients progressing. 

For legal reasons, decisions in programming must be left to the medical professionals in charge of the case. But the caregiver is called upon to question decisions if they don't seem to make sense. Effective caregivers need to make sure their concerns and their loved one's concerns are understood and addressed. It is equally important to understand the strategy of the rehabilitative process and not deviate from the medically designed plan. Please make sure you are comfortable in this assistance role and feel confident you received ample training and supervision for any active role you may play in actual program assistance. 

Documentation of activities is frequently another caregiver responsibility. Report writing, exercise logs, updates, contracts, etc. are all valuable tools for recording and evaluating a program's progression. Make sure all reports are in a legible, orderly format for other health care personnel. Written documentation also proves invaluable should legal matters arise. 

Above all, caregivers must be sensitive to the individual needs of their loved one during the rehabilitative process. Patience and understanding are especially vital in rehabilitative relationships. Caregivers need to be familiar with their loved one's condition, medical terminology and treatment procedures. This will aid in communication and interactions with medical personnel. The more positive the environment and interactions, the more positive the outcomes.

Rehabilitation Terminology

To help insure effective communication throughout the rehabilitation process, here are some commonly used terms to describe certain conditions and exercises. This list is supplemental and in no way extensive. 

Active-assisted exercise: Exercise in which the patient is helped through a ROM (see below) which they are unable to do by themselves.

Active exercise: Exercise in which the movement is done entirely by the patient.
Closed-chain exercise: Any exercise in which the exercising body segment is attached to a fixed surface such as a floor, requiring the entire limb to bear the resistance. An example would be squats for the legs.

Coordination: The working together of various muscles in the execution of movement.

Cross-transfer: A neurological phenomenon in which training the "healthy" limb provides strength increased in the immobilized limb.

DAPRE: A program often used in rehabilitation. The abbreviation stands for "daily adjustable progressive resistance exercise". 

Flexibility: ROM possible in a joint or series of joints.

Limited ROM exercise: Exercise in which the ROM is limited due to an injury or the bio-mechanics of the injury.

Non-weight bearing exercise: An exercise in which the body weight is not borne by the lower extremities. 

Open-chain exercise: An exercise in which the end of the exercising body segment is not fixed to the end of a floor, wall, etc. and is freely movable. Leg extensions are an example of an open-chain exercise for the legs.

Passive exercise: An exercise in which the patient is taken through a ROM by a therapist, caregiver or machine.

Reconditioning: The restoration of pre-injury or pre-deconditioning levels of physical fitness through a program of prescriptive therapeutic exercise.

ROM: An abbreviation for range of motion. This is the measurement of the range that a limb moves through space around its joint.

Rehabilitation Strategies 

Regardless of why your loved one needs a rehabilitation program, the goal of the therapy is to help restore levels of fitness to the pre-injury state or better. In cases of chronic illness or disability, programs focus on improving the quality of life and comfort. To achieve this, many techniques can be employed depending on the therapeutic goals and objectives. 

Before programming begins however, testing of functional capacity is normally done to establish baselines and future progression. The areas tested can be muscular strength, power, endurance, flexibility and range of motion. Some of the devices used include: calipers, isokinetic instruments, goniometers and dynamometers. 

After testing, therapeutic exercise programming and selections begin. The basic program structure allows for a warm-up prior to activity, the reconditioning exercises, then concluding with a cool-down period. 

Most rehabilitation programs are geared towards progression. In regards to resistance training and strength improvement, one of the most commonly used programs is the Daily Adjustable Progressive Resistance Exercise (DAPRE) system. This is a four set exercise program (the first two sets are progressive warm-ups) that take in to consideration the daily variations of a patient's strength levels. Resistance can be applied through weights, machines, latex bands, or manually by the caregiver or therapist.

Another common exercise prescription for strength improvement is isometric exercises. An isometric contraction is when the muscle is neither shortened or lengthened, merely contracted and tensed. Tension is generated, and energy is released in the form of heat, not mechanical work. Pushing against an immovable object such as a wall is an example of isometric exercise. These are especially valuable to a patient who needs to exercise an immobilized limb or when joint motion is hindered by inflammation. Instead of using repetitions to measure work, "seconds of contraction" are the units in isometric programming. 

Flexibility drills, active-assisted exercise and limited ROM exercises are also frequently employed by the therapist and introduced to the caregiver. 

Muscle Function

Below is an example of a few of the major muscle groups that are targeted by rehabilitation programs. You can see how conditioning each area can improve one's quality of life. The person in this example is wheelchair bound (paraplegic).
MUSCLES STRENGTHENED FUNCTIONAL BENEFITS

Shoulders, deltoids (anterior, Self-care, loading/unloading wheelchair, posterior), trapezius. lifting objects, wheelchair sports.

Biceps Transfer activities such as repositioning legs.

Rotar Cuff (supraspinatus, Transfers, pressure relief, counteract subscapularis, infraspinatus, tight internal rotors from wheelchair teres m.). propulsion.

Triceps Transfers, wheelchair propulsion.

Chest (pectoralis major). Wheelchair propulsion, driving and braking.

Back (latissimus dorsi, rhomboids, posterior deltoid) Pressure relief, transfers, pulling activities.
 

Sean Kenny, C.P.T, a certified trainer, author, and guest speaker is a consultant with Mercy Hospital and Pacific Health Education Center in Bakersfield, Ca., reviews exercise protocols for the senior, disabled and diabetic populations. Visit Sean's Fitness Web Site: http://anythingfitness.com, or call (805) 831-0805 
 

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