search.noResults

search.searching

dataCollection.invalidEmail
note.createNoteMessage

search.noResults

search.searching

orderForm.title

orderForm.productCode
orderForm.description
orderForm.quantity
orderForm.itemPrice
orderForm.price
orderForm.totalPrice
orderForm.deliveryDetails.billingAddress
orderForm.deliveryDetails.deliveryAddress
orderForm.noItems
R EHABI L I TATION


mobility and reduce caregiver injury. l Application of the best practice care skills.


Best practice guidelines recommend that safe patient handling and mobility technology can positively influence the quality of patient care, mobilisation, rehabilitation and activities of daily living.14,15 Promoting the patient’s functional mobility and making it possible to participate in activities of daily living can create a chain of positive effects that lead to their improved quality of life as well as reduced workload on the staff, thus creating better working conditions. In order for this chain of positive benefits to flow, the right environment, equipment, knowledge and skills are required to foster safe patient care.16,17


Therapeutic activities as part of a rehabilitation plan as illustrated in Figure 3 can challenge patients to mobilise earlier in the recovery process.18


In bed mobilisation


Where out of bed mobilisation is contra- indicated or options are limited, there are still methods for supporting early mobility and recovery based on the patient’s clinical presentation. Early rehabilitation interventions are generally graded and adopted in the daily routine within the bed space. Depending on the presentation and ability of the patient, daily passive and active movements (with and without gravity and against resistance) may be advocated to improve muscle tone and strength.19


Stretches may also be used to help maintain joint range of motion and muscle length, prevent associated contractures and shortening of muscle groups.20


Figure 2. Positioning


The use of postural positioning therapy (postural drainage) has been advocated for the management of respiratory conditions in critically ill patients.21


Regular repositioning


can aid with lung secretion management and help to improve ventilation.22


Various seated


upright positions, in bed with supportive aids, allows specific areas of the respiratory system to be isolated to help drain secretions from one or more lung segments into the central airway where it can be removed actively or with manual physiotherapy


techniques.23 Alternate side lying positions


also have a number of clinical benefits, aiding with postural drainage of pulmonary secretions improving respiration, with evidence to support reduced incidence of pneumonia and other respiratory challenges with regular positional changes and appropriate turn angles.24 Alternatively, prone positioning can


support the management of adult respiratory distress syndrome.25


Prone positioning


sessions in critical care, may require a patient to spend up to 16 hours out of every 24-hour period in the prone position.26 Lengthy prone positioning sessions in critical care, are associated with an increased frequency of pressure ulcer development,27 which could delay rehabilitation. A continuation of respiratory rehabilitation


may start with a gradual repositioning into upright sitting in bed, utilising the reverse Trendelenburg or cardiac chair position. While not as effective as sitting out in a chair, an upright-seated position in bed has a number of clinical benefits.28


The change


in position potentially allows the patient to orientate within their surroundings, providing a better position for communication, eating and drinking or functional activities.29 As clinically appropriate, the patient can be progressed, using specialist equipment from a supine to standing position. This progressive verticalisation into a standing position provides additional benefits over the chair position by facilitating increased proprioceptive feedback through the load bearing joints preventing or reducing the impact of immobilisation of bone demineralisation.30


Upright positioning is often used, as an 86 l WWW.CLINICALSERVICESJOURNAL.COM OCTOBER 2020


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92