Strokes and Fractures Care
The physiotherapeutic and nursing confrontation of strokes and fractures is a fundamental issue for Aktios.The units’ goal is not only to offers to residents the best accommodation but also contributes to their rehabilitation. Aktios has the equipment, expertise and human resources in coping with bone-fracture and stroke. Moreover due to our constant occupation with dementia patients our units are also very experienced in treating neurodegenerative diseases.
New residents at Aktios are welcomed by the Nursing Director or the Head of Nurses along with one of the Psychologists or the Social Worker of Aktios. Prior to taking the medical and psychosocial history of new residents, the nurses familiarize themselves with the new residents and make sure that they feel comfortable and understand the reason and purposeof the interview that will follow. In this way, residents are assisted to understand that theinformation requested will be used for their own benefit in order to build a comprehensive anddetailed care plan. Of course if the individual is not able to give the requested personalinformation on their own, this is provided by his family carers.
Assessment of the nursing condition focuses mostly in the following areas:
- The individual’s self-perception about his health condition
- Habits in his everyday life
- Activities, events and daily life desires that affect or are affected by the person’s level of functionality
- Information regarding his medication
- Level of functionality
Regarding the patient’s level of functionality of the elderly the gathered information involves the following issues:
- Respiratory: distress, pain when coughing, tachycardia, bloody sputum
- Cardiovascular: heart, pain, episodes of tachycardia, dizziness, syncopal episodes
- Communication: any problem that hinders the person’s ability to communicate
- Nutrition – Food: mood and appetite, feeling of satisfaction with the meal, special diet, problems in chewing and swallowing, favorite eating habits and allergies.
- Bowel Function: frequency of stools, use of laxatives drugs
- Βladder Function: frequent urination, incontinence, loss of urine, pain during urination
- Personal appearance: interest and preoccupation with personal appearance or loss of interest
- Mobility – Safety: types of activities, walking, accidents, balance, weakness, dizziness, pain and general kinetic state of legs
- Senses: sight, hearing, use of eyeglasses or other aids
- Sleep: night- time awakenings, frequency and duration of awakening, medication used.
- Social – Emotional – Cognitive Condition: memory problems, difficulty understanding speech, slow response to stimulus, orientation in space and time.
Our units are staffed by experienced nurses who are constantly trained in caring elder people and people suffering from dementia and work being guided by specially trained mentors, and nursing directors under the supervision of Aktios’ nursing management.
Our units are staffed by physiotherapists that have knowledge in mobilization using various methods for musculoskeletal events and for neurological ones.At the same time the cooperation with our neurologist is very important as she activelyparticipates with the interdisciplinary team of Aktios in the design of the rehabilitation plan.Our team always welcomes the contributions of the patient’s doctors.
The patient is undergoing a program of specific exercises to stimulate the body and preventatrophy in order to remove the plaster mobility and muscle power is complete.
The types of kinisiotherapy, the beginning and duration of treatment depend on:
- The type of fracture
- The age of patient
- The area of the fracture.
In kinisiotherapy we pay attention to work in the thresholds of pain to, not to impede thehealing process and to let the patient rest fur sufficient periods of time.
After the healing of the fracture the exercises consist in:
- Active assisted
- Resistance exercises
- Passive exercises
Thermotherapy: It is mainly applied after immobilization in the form of compresses,whirlpools, ultrasound etc.
Cryotherapy: In recent years it has gained ground against thermotherapy.
Kneading: Usually precedes kinisiotherapy. Opinions on its usefulness differ. We emphasize that the massage does not increase the mobility of joints or strengthens themuscles; it just improves local blood circulation, relaxes local spasm of the muscles andreduces pain.
Strokes often result in disability, which usually affects dramatically the social and professional life of the patient. The sudden change in abilities and activities of the individual affects directly not only the patient but also his family environment. The main aim of physiotherapy working with patients suffering from stroke is to improve the motor dysfunction of the patientsso that they become independent eventually be able to reintegrate into society.
The problems that usually occur after a stroke are the following:
- Weakness or paralysis on one side of the body which may be across the side or just in the leg or arm
- Spasticity, muscle stiffness and painful muscle spasms
- Disturbances in the balance and neuromuscular assembly
- Problems of expression and understanding of written and oral speech
- Ignorance of the existence of the other half of his body
- Problems with memory, thinking, attention and learning
- Disorders of urination and defecation
- Difficulty in emotion control
- Difficulties in being able to take care himself
Physiotherapy should begin immediately (within 5-7 days from the onset of stroke), regardless of whether there are small or large deficits, otherwise there is a high risk of becoming permanent. It is no coincidence that even in intensive care units of hospitals, physiotherapists are among the first to be activated in order to improve the health of patients with stroke. The initial physiotherapy sessions include breathing exercises, passive movementof the muscles that have gotten paralyzed and active mobilization or resistance exercises for the muscles in order to start working properly. The aim of physiotherapy is to maintain thepatient’s body in a state that as the clot is removed or the bleeding is absorbed by the body,to begin to recover his strength and mobility as was before the incident.
At that point the exercises begin in a seated and upright position, including balance exercises, and finally exercises related to activities of daily living.
The rehabilitation program of an injured person must be applied from the first day becausethe fracture usually involves limiting the movement of an area or of the entire body for aperiod of time, so that with the advent of healing, free joints acquire full mobility.
known that when muscles are immobilized for a long time they gradually lose their toneand their elasticity gets reduced. The lack of movement causes muscle atrophy, edema,adhesions, with major limitations in the movement of joints.
In the period of immobilization isometric exercises are performed in order to prevent muscle atrophy. At the same time the bloodstream is improved. Great importance should be given in breathing exercises and in the process of mobilizing the peripheral joints of the fracture.
The intervention program depends on the following:
- The type of fracture
- The type of orthopedic treatment
- The age and general condition of the patient
The aim of physiotherapy for a patient with fracture is:
- To relieve the patient from pain
- To relax the muscle spasm
- To mobilize the edema
- To facilitate the movement
- To maintain good joint mobility
- To maintain the muscles in good condition and to prevent muscle atrophy.
- To help the respiratory system with special exercises
- To prevent complications
- To return to the previous mobility status and to the physical autonomy of the patient as soon as possible.
The Units’ equipment include bicycle for passive exercise and static bicycle for active training, steps and treadmill in order to retrain and maintain the patient’s mobility and gait, multi-purpose exercise instrument for active muscle training with dumbbells for empowerment, electrotherapy and ultrasound to strengthen the therapeutic outcome, crosstrainers and electric treadmills, wii fit/ wii sports.
The usefulness of electrotherapy in rehabilitation is nonnegotiable. The neuromuscular system works with electric stimuli. The Tens streams are the favorite ones for physiotherapists. They have a wide area of use because they are analgesic. Our unit provides a mobile system of electrotherapy to maximize the therapeutic outcome and to make it possible to transfer it to the patients’ room if their mobility is very limited
The application of ultrasound is mostly widespread in cases of stiffness, rheumatoid diseases or after injuries and prolonged immobility. In short, it helps in increasing the range of movement of any joint for any reason. As with the electrotherapy device, so with the ultrasound device, our unit features a mobile device to facilitate patients with mobility problems.
Bicycle of Passive Exercise
It is one of the favorite tools of our unit. It has helped us in many difficult cases that poor communication did not allow further cooperation. The speed and strength are adjustable according to the patients’ needs and offers the advantage when there is muscle spasm to reverse movement until the spasm is resolved. Additionally, there is the option of isometric motion which means that the force applied by the bike is equal and opposite to the patient’s. It is considered a very useful tool in cases of stroke, Parkinson, dementia and fractures.
Static Bicycle of Active Exercise
We use it when the patient who begun with the passive bicycle need a greater degree of difficulty. The power is adjustable and the speed depends on the user. It is also used in early stages of dementia where there is good communication and mostly with patients of limited mobility, or physically disabled who need to reinforce their endurance, stamina and strength.
Treadmills and Steps
The neurological damages (dementia, Parkinson, stroke) cause motor deficit. One of the greatest difficulties faced by these patients is going up and downstairs and walking. Under the frame of the integrated intervention the unit has hallway with stairs where the patient is trained in the right position, walking and safely moving by stairs.
The next step in walking retraining is the electric treadmill. The patient develops the sense of balance and generally enhances his proprioception. The benefits of walking are well known are relate to various medical conditions such as strokes, Parkinson, fractures, dementia where there is motor deficit.
The same logic with electric treadmill applies to the crosstrained bicycles. It is intended not only to train muscles of the legs but mainly to increase the patient’s proprioception in order tobecome more functional.
In a rehabilitation plan, the patient’s empowerment is of great importance. This is why our unit has a multifunctional gym machine with free weights where we can train large muscle groups like biceps, triceps, quadriceps and abductors and adductors etc. and also by using a combination of moves such as rowing. It is a very useful tool for almost all diseases where strength empowerment is essential.
Wii fit- Wii sports
Wii detects the movement of the player. The Wii Fit is a balance device that combines fun with sports. The Wii Fit “understands” the weight, movement and balance of the player and combined with the appropriate software it works interactively. In this way it enables the effective participation of the body at all “activities”. The Wii Fit includes aerobics, yoga, dance, games and exercises that include balance, sports, etc.
The Wii sports proposes an entirely new way for someone to train and exercise himself from the living room of his home. One can play tennis, baseball, golf, bowling and boxing. As the player improves, so does the level of difficulty, in order to maintain his interest and the sense of competitiveness. Practically there is no limit to the possibilities of the player as the gameadapts and provides stimulus for continuous improvement.
In a place like Aktios that loves movement and uses new technologies, such a tool could not be missed. In a “digital” environment in a specially designed room, our residents are able toworkout, skiing, play bowling, tennis, etc. and to practice in balance, etc. It is the best way tocombine fun with activity especially in groups of elderly people who get easily bored and distracted.