Focus On…Mobility/Rehabilitation

focuson Mobility/Rehabilitation

‘Current’ trends in rehab therapy

Once considered as part of a sports medicine program, electrotherapy modalities are getting long-term care residents back in the game. Mark Richards explains how

For decades, electrotherapy has been used to help professional athletes and weekend warriors recover from strains, sprains, pain, and injuries. Today, that same sports medicine approach is being offered to seniors.

Electrotherapy is effective for people of all ages. Generally speaking, seniors tend to respond to three types of electrotherapy used in long-term care: electrical stimulation, ultrasound, and diathermy (which involves generating localized heat in body tissues). It is one thing to get a football player back in the game, but it’s an entirely different achievement for a senior to regain the ability to walk or to feed, dress, and groom herself.

Electrotherapy in Long-Term Care Rehab
Rarely is electrotherapy used as stand-alone therapy. It is another option in the therapy toolbox that the clinician can incorporate into the patient’s treatment plan to achieve optimum results. For instance, if a patient has had a total knee replacement, pain may limit how far the knee can be stretched or how much exercise the therapist can administer to improve range of motion (ROM). When, in conjunction with the therapeutic exercise program, the patient is treated with one of the electrotherapy modalities, he or she can better tolerate the ROM and strengthening exercises because swelling and pain have been reduced. In essence, electrotherapy does not replace therapy, but facilitates it.

The FDA has approved 11 different electrical stimulation waveforms, which gives the clinician flexibility in treatment options. With this range of acceptable waveforms, the therapist can select the one best suited for the individual and the condition. The energy provided by electrical stimulation, ultrasound, and short-wave diathermy machines helps to reduce swelling and pain, and increases circulation, which stimulates the cells to heal damaged tissue.

Ultrasound and diathermy machines also have variables that allow the clinician to individualize treatment. For instance, the machines can be adjusted to provide the exact depth of energy penetration and thermal response required, depending on whether the tissue requires heating or not. But as flexible and effective as these machines are, clinicians must receive good training and ongoing support for modality use to reach their full potential.

Contraindications and Risks
As beneficial as electrotherapy interventions might be, each modality has its own unique set of limitations, which depends on each patient’s condition. There are some contraindications. For example, if someone has a pacemaker, the FDA states that diathermy or electrical stimulation cannot be used on that patient, but ultrasound is permissible (except in the area immediately around the pacemaker). If a patient has a metal implant, diathermy cannot be used directly over the implant, but the other two modalities are allowable.

One of the FDA’s broadest contraindications is when a patient has an active cancer. In other words, if there are metastatic lesions or an active tumor in the treatment area, a different care plan must be created because most of the modalities increase circulation and the therapist wants to avoid feeding an active cancer.

Although cognitive impairment or dementia might be a consideration, they do not exclude a patient from electrotherapy treatments. In fact, the treatments are soothing and well tolerated.

The Goals and Benefits of Electrotherapy
Consider someone recovering from a stroke. Perhaps the patient has lost the ability to feed herself because arm function was compromised. Electrostimulation can reeducate weakened or deconditioned muscle in a part of the body that is neurologically impaired. The functional goal is to improve mobility and function in the arm.

Electrical stimulation, ultrasound, and diathermy are also effective in facilitating wound healing and treating contractures, both common and significant problems for nursing home residents. Electrical stimulation can also be used to help treat urinary incontinence.

For most conditions, positive changes are usually noticed within the first two or three treatments. However, for some more challenging problems, it may be a couple weeks before noticeable improvement is observed. A good clinician closely monitors the patient’s response, and if the desired change is not forthcoming, adjusts the plan of care accordingly.

Conclusion
Whether it is provided in-house or by a contracted provider, CMS reimburses for the use of modalities under certain conditions. The ultimate value of electrotherapy lies in the life-altering changes for the patient. To see the light shine in the eyes of someone who relied on a mechanical lift now transfer without it, to watch a person who couldn’t hold a spoon begin to feed himself, and to enjoy the smile of someone who is not in pain are just some of the triumphs of electrotherapeutic rehabilitation. “Sports medicine for seniors” can help your residents get back in the game.


Mark Richards is Director of Clinical Services for Aegis Therapies, a national contract provider of rehabilitative therapy services. Partnering with Nautilus«, Aegis Therapies offers Freedom Through Functionality, a program of machine-based strength-training exercise for seniors. It also offers its Geriatrics Enhanced Modalities program, designed to address health conditions common to older people. For more information, phone (877) 877-9889 or visit www.aegistherapies.com. To send your comments to the author and editors, please e-mail richards1206@nursinghomesmagazine.com.
Success Stories

Wound Healing
A 50-year-old woman developed colorectal cancer when she was in her 30s. At that time she received the treatment of the day: cobalt therapy. This intensive treatment was very damaging to the tissues and she developed a large sacral ulcer. Now, 20 years later, the wound had grown so large her family could no longer care for her and she was admitted to a skilled nursing facility, where many different wound care approaches were tried. Medicare indicates that if after 30 days of conservative treatment (wound care dressings, nutritional interventions, pressure relief, etc.) the wound does not show significant improvement, the therapist may begin to treat the wound with electrical stimulation or diathermy. Consequently, after 20 years, electrical stimulation was initiated and in a very short time the size of the wound was reduced by one-half. The wound continued to respond to the point where it was manageable by the family and the patient returned home.

Contracture
Contracture management is a significant issue in long-term care. A contracture may be the consequence of a neuromuscular disorder or stroke. One woman had a contracture so severe that she could not propel her wheelchair. Hoping to restore her mobility, her therapist began a series of electrical stimulation treatments. Eventually she gained enough range of motion and strength in her upper extremities to operate a powered wheelchair. This woman began to feed herself again and was now being cautioned by staff to slow down!

focus on
MOBILITY/REHABILITATION
Patient Lifts
The Viking Series of new mobile lifts from Liko is designed to accommodate a broad range of lifting situations, patient sizes, and medical conditions. Four separate models are available-S, M, L, and XL-to enable easy matching of lift size and capacity to patient size and condition. The flexibility of the lifts, use of common spare parts, and identical operating procedures all contribute to simplifying the purchase, improving caregiver effectiveness, and reducing overall costs.

Dan Gilmore, Liko, 508-553-3993, dgilmore@likoinc.com
Resident Transportation
The ElDorado National Aerotech is a safe, comfortable, and dependable transportation choice. It is available in a variety of lengths and configurations to meet all transportation applications.

Aerotech has been crash tested in an automotive testing facility. The steel-reinforced composite body is highly resistant to impact, rust, and corrosion. The gelcoat exterior keeps its glossy finish for the life of the vehicle and absorbs temperature at a lower rate than metal, making the bus easier to heat and cool. The Aerotech can be equipped with a front or rear wheelchair lift, and the interior can be designed to meet any wheelchair application.

Sonya Bradford, ElDorado National, 785-827-1033, sonyab@enconline.com
Transfer Handles
Mobility Transfer Systems’ MTS transfer handles for spring-based and pan-based beds provide a first line of defense for fall prevention while improving patient independence. The narrow 4″ handles meet all federal and state entanglement guidelines and can be easily removed in an emergency. The spring bed model includes a bed board that sits on top of the springs. The pan bed model attaches directly to the bed frame. Both styles come in single- or double-handle models and require no tools for installation.

Thomas Leoutsakos, Mobility Transfer Systems, Inc., 800-854-4687, thomasmts@aol.com
Rehabilitation Services Provider
Peoplefirst Rehabilitation staffs and manages rehabilitation departments in hospitals, nursing centers, outpatient clinics, and school settings nationwide. Comprehensive treatment plans help patients return home quickly. Peoplefirst developed a proprietary nationwide clinical tracking system that allows tracking of patient outcomes, provides quality assurance, identifies industry trends, streamlines invoicing, and manages reporting. Peoplefirst assists its rehab partners with reimbursement issues, HIPAA implementation, regulatory compliance, and clinical issues.

Jerry Yarnish, Peoplefirst, 502-596-7300, Jerry.Yarnish@peoplefirstrehab.com
Dual-Height Wheelchair
The Elite Invacare Tracer« EX2 from Direct Supply has multiple seat width, depth, and height options, along with front rigging and armrest options. The double-embossed, 33-oz. vinyl upholstery is flame retardant, bacteria resistant, easy to clean, and extremely durable.

Anita Braun, Direct Supply, Inc., 414-358-7391, abraun@directs.com
Stationary Exerciser
If you have residents who want and need exercise but do not have the strength and endurance to use the exercise equipment in your facility, the motor-driven Theracycle, from Exercycle, makes getting exercise easy. The Theracycle’s motor assists its users to get a full body workout-legs, hips, arms, chest, and back. The Theracycle was designed specifically for users with special needs and features easy on and off; a large, comfortable seat and backrest; easy-to-see and -operate controls; and many safety features. The motor assists users to get a great workout, resulting in increased flexibility and endurance, improved stability and balance, and a sense of well-being.

Peter Blumenthal, Exercycle, 508-528-3100, info@exercycle.com
Drawsheet Clamp
The patent-pending Vander-Clip from Vancare, Inc., clamps onto a drawsheet while attached to a total lift or overhead lift. When the lift is raised, the resident is rolled onto his or her side with little or no effort from the caregiver. The efficient, one-person’operated Vander-Clip can be used with any and all total lifts and overhead lifts.

Pat Vanderheiden, Vancare, Inc., 800-694-4525, pvancare@hamilton.net
Compact Lift
The AscendÖ is the newest addition to the HoyerPro« family of lifts. Available from Sunrise Medical, the Ascend has a compact footprint that allows for easy and safe transfers from within a resident’s room to smaller areas, such as the bathroom. It is lightweight and has a 375-lb. lifting capacity, and is accompanied with multiple grip points for the resident. With its 4.5″ leg clearance, the Ascend fits under most low beds. Other features include a removable foot tray, adjustable knee pads, and a powered base.

Stefani Thomas, Sunrise Medical, 715-342-7126, stefani.thomas@sunmed.com
Standing/Raising Aid
The ARJO SARA Plus is an ergonomic standing and raising aid that mobilizes residents during everyday activities such as transfers and toileting. Extra resident support is given by the Comfort Circle, which comprises the Arc-Rest and a sling selected for individual needs. The Arc-Rest is an integral part of the lifting mechanism, providing upper body support during the raising action. Another feature, the Pro-Active Pad, a height-adjustable knee support, promotes a better transition to the standing position by allowing natural flexion of the ankle.

Amy McCaw, ARJO, Inc., 800-323-1245, amy.mccaw@arjousa.com
Scooter
The Invacare Lynx scooter allows users to accomplish daily activities with ease. Designed with a four-piece assembly/disassembly, it can be easily taken apart when needed. The scooter’s compact size and seamless functionality allow it to easily transition from tight turns within the facility to wide-open spaces outdoors. The Lynx scooter also offers a travel range of approximately seven miles, making long trips worry-free.

Sohail Ahmad, Invacare Continuing Care Group, 440-329-6000, SAhmad@invacare.com
Rehab Outcomes Database
AEGIS Therapies’ rehab outcomes are illustrated in its ROM National Database, which is JCAHO-approved. More than 475,000 AEGIS patients have been profiled at the beginning and end of their therapies. The average improvement was a full one point on the ROM scale. A summary of the latest results from the AEGIS ROM Database is available.

Patti Daniels, Aegis Therapies, 479-201-5288, patti_daniels@beverlycorp.com
Multistation Exerciser
Endorphin Corporation has introduced the 340 TRI-CORE Balance and Stabilization Multistation, an exercise machine that combines three products into one space-saving multistation. Included in the TRI-CORE are the Functional Pulley, the STS Sit-to-Stand Exerciser, and the 355 Series with e1 resistance system. Each product is unique, yet they work together to improve the user’s balance and stabilization. The multistation’s compact design maximizes floor space while allowing up to three users to exercise simultaneously.

Niki Plutis, Endorphin, 727-545-9848, marketing@endorphin.net
Stander With Tray
Altimate Medical’s EasyStand Evolv with Shadow Tray fully supports and follows the user from sitting to standing, with tray access from all positions. It enables the resident to change positions as needed while using the tray to participate in games, read, and socialize. The Shadow Tray flips up and pivots out of the way for easy transfers. The tray is securely attached under the seat and includes a safety mechanism that prevents it from shifting. The Evolv’s lifting design mimics the body’s natural pivot points, maximizing function and minimizing shear. More than 40 options can be added to its modular base at any time.

Bryanne Freitag, Altimate Medical, 507-697-6393, bryanne@easystand.com
Air-Powered Lift
The CAMEL (Complete Air Moving Elevating Lift) by Mangar USA helps to get residents off the floor after a fall. The air-powered cushion inflates gently beneath residents, first sitting them up and then lifting them into a sitting position ready to stand or transfer. The CAMEL will lift a person weighing up to 700 lbs., making it useful for bariatric residents, but it is still comfortable for someone weighing less than 100 lbs. By using the CAMEL, the risk of injury to both the resident and caregiver is reduced.

The CAMEL packs away neatly into a lightweight and compact bag, making it easy to transport. It can be used by individuals without assistance, reinstating independence for those prone to falls.

Hannah Rogers, Mangar International, [44] (015) 442-67674, hrogers@mangar.co.uk
Rehabilitation Services
Hallmark Rehabilitation enhances the quality of life for its patients. Hallmark’s programs give physical therapists, occupational therapists, speech pathologists, and directors of rehabilitation the resources they need to make elders’ golden years healthier and happier.

Velvet Mayes, Hallmark Rehabilitation, 877-793-0859, vmayes@hrehab.com

Topics: Articles , Rehabilitation