Therapy Equipment

Therapy Equipment That May Be Available

• Abductor Wedges 
• Arm troughs
• Electric toothbrush
• Hand rolls
• Long handled bath sponge
• Long handled brush and comb
• Long handled shoehorn
• Raised toilet seats

Most equipment should be cleaned according to facility policy.

• Parallel Bars - Best if attached to the floor. Remember to check nuts and bolts periodically and keep dusted. The dust can make the bars slick.
• Cycle - used for strength and endurance. Lubricate when needed.
• Weights -  used to build muscle. If velcro on weights are torn. Velcro need to be replaced. 
• Pulleys - Used to increase ROM and build strength. Check for weak areas and replace as needed.
• Hydrocollator - Heating unit for packs and covers. Used to heat an area of the body to provide pain relief or prepare for treatment. Follow the manufacturer's manual for cleaning and maintaining. Keep a daily temperature log. Inspect packs for leakage and replace as needed. Launder the covers periodically. Optimum temperature 165-175 degrees Fahrenheit.
• Bolster - Used to position for exercises. Check for cleanliness.
• Theraband - Stretch material used to provide resistance for strengthening. the different colors indicate how much strength is needed to stretch it.
• Exercise Mat - provides a stable surface for exercise and positioning. Clean according to policy procedure between use.

Wheelchairs

Things to know

Seat Depth (B)

Measure from the most posterior point of the body to the inside of the knee, minus at least two inches. Some prefer more leg overhang to make room for their hand when lifting their leg.

Back Height (C)

Measured from the seat base to the top of the chair back. Power chair riders need upper back support, particularly for the moment of initial acceleration.

Hanger Angle

Determines how far the toes extend away from the body, measured from the horizontal. A tighter angle allows the chair to turn around in less space. Depends in part on ability of the knee to bend towards the perpendicular.

Seat Width (A)

Determined by the widest point of the body from knee to hip, plus an inch to ensure room to move. Consider bulk of clothing, particularly a heavy winter coat, if relevant.

Front Seat to Floor (D)

Measure the leg from the back of the knee to the sole of the foot. Then subtract the thickness of the cushion when it is compressed. Next, add a minimum of two inches for footrest clearance. Do not add the footrest clearance if the chair will be foot-propelled.

Armrest

Armrests are mostly a personal choice, but most often users without much mobility appreciate armrest to help alleviate shoulder and back stress. Armrest also provide additional stability for users with limited upper body balance and are helpful when navigating in and out of the wheelchair.

Additionally, armrest allow users the ability to do pushups, helping relieve pressure as well as protecting clothing from the wheels.

When armrests are not fitted properly, the wheelchair can become more difficult to push. Not all armrest are adjustable. Height should be fitted to allow the forearm to rest fully on the armrest without pushing up on the shoulders. For users who sit at a table or desk, swing away armrest can be beneficial.

There are four basic types of armrest:

1. Full length, fixed height
2. Full length, ajustable height
3. Desk length, fixed height
4. Desk length, ajustable height

Footrest

While not all footrest options are available on all chairs, there are three typical styles of leg/footrest.

1. Swing away, removable
2. Elevating leg rest
3. Fixed riggings

For optimal comfort and safety, leg rest should provide a proper foundation for the legs and feet. The bottom thigh area should be fully supported by the seat while the soles of the feet are supported by the foot rest.

Poorly fitted leg rest can have a destabilizing effect on the chair, making it more difficult to push and navigate due to improper weight distribution.

Anti-tip Bars

These are bars at the back and bottom of the frame that prevent the wheelchair from tipping over backwards.

Safety Tips

1. Pull the wheelchair backward for only short distances
2. Do not tip the wheelchair back to get a resident's feet off the floor.
3. Tip the wheelchair onto the back wheels to lower down or to go up a curb.
4. Use the brakes when transferring into or out of the wheelchair.
5. Attend to the resident's posture.

Wheel Chair Care

Keeping the wheelchair clean will not only help keep you and the resident healthy and free of infections, but it will make it easier to identify equipment problems as they arise. To keep your wheelchair clean, you can wipe down the surfaces with a damp cloth. Use a mild detergent or a stronger cleaner for stains and sticky spots. Manufacturers often recommend using a car wax on the frame to make regular cleaning easier. Use a sharp tool or pick and carefully clean the wheel axle or caster bearing of any accumulation of  hair, string, or other items that can interfere with the rotation of the wheels.

Remember to always follow facility policy on clean and care of all wheelchairs.

Check the frame for any cracks or breaks in the metal. Any potential problems need to be reported to your supervisor. The upholstery also should be monitored for cracks or tears where the fabric folds or where there are screws through the fabric. Any problems related to fabric wear will need to be reported to your supervisor. If you rely on a seat cushion, check whether it is still providing the padding and support the Resident needs.

Another regular activity is to check all nuts and bolts on the chair to verify that they are tightened (except for the crossbrace pin). If you need to replace any parts, be sure that you are using parts that match those that were supplied by the manufacturer and dealer.

Check that all parts that fold, swivel, pivot, and are removable do so easily. For example, be sure that removable arm rests, foot rests, and braces, etc. are working properly. The crossbrace should fold easily without sticking. The center pin should move freely (this bolt is never tightened). Wheelchairs with reclining backs or tilt mechanisms should recline and return to upright without difficulty. Instead of using petroleum oil on the wheelchair, use an all-purpose silicone lube spray to lubricate the flex points on the chair.

Your regular monitoring and maintenance can ensure that your resident’s wheelchair is operating safely. Your wheel lock needs to be checked to be sure that it engages and releases properly and does not rub against the tire. The lock needs to operate in such a way that it can be engaged and released without having to use excessive force. Also, the casters (front wheels) can present a safety hazard when they are worn out. Check the casters for cracks in the spokes that may eventually cause the caster to collapse.

Proper positioning of resident

1. Hips should be back and in the middle of the seat.
2. trunk upright
3. Discourage slumping

Feet should be supported on the footrest or floor. Do not allow the legs to hang unsupported, as this may decrease circulation to the legs and/or cause increased pressure on skin and nerves. Using footrests will keep the feet out of the way of the front casters.

Accessories that may help maintain positioning

1. Cushions
2. Lateral trunk supports
3. Trays
4. Arm supports
5. Seatbelts - Used to help position the hips back in the wheelchair for safety. Seatbelts may be used for positioning without being considered a restraint if the resident can release the seatbelt independently upon request.
   

Be aware that some positioning devices may be considered a restraint. Consult your facility's policy regarding restraints and their use. It is important that the above equipment be positioned correctly on the wheelchair. Too often the equipment is positioned backwards or in the wrong place. Pay close attention to the proper position as instructed by the therapist.

Modalities

Hot Moist Packs

For centuries, people have known that heat can relieve pain. We soak in hot tubs or apply electric heating pads because we know instinctively that heat will help us feel better.

What exactly does heat do?

1. Heat improves circulation
2. Heat improves cell function (metabolism)
3. Heat decreases stiffness in tendons and ligaments
4. Heat relaxes the muscles and decreases muscle spasm
5. Heat lessens pain

Heat causes dilation of the blood vessels in the area being treated. This increase in blood flow brings fresh blood to the area and takes waste away from it. The result is that heat eases pain and speeds healing.

Hot packs are one of the most popular sources of therapeutic heat.They come in various sizes to fit the body part in need of treatment, and they are clean, inexpensive, and simple to use. Adequate layering of covers is essential since most residents have fragile skin and compromised circulation. It is important when we use moist heat to use it  safely. Hot packs can result in burns if not used properly. Be sure to ask the Therapist if you are not sure what to do. Follow facility procedures when applying hot packs.

Average application time is about 15 - 20 minutes. Always inspect the skin when the hot pack is removed.

Moist heat treatments are more effective than dry heat treatments. This is because moisture transmits heat better than air.

Do not use hot packs when:

1. Presence of bleeding or swelling
2. Suspected blood clot
3. Areas of poor circulation
4. Fever
5. If resident is unable to sense hot or cold.
6. Resident has dementia
7. Area to be treated is cancerous.
8. Treatment area has infection.
9. Treatment area has a rash.

Paraffin Wax

This treatment is done on the hands and/or feet. The moisture and deep heat penetration leaves the skin, muscles, and joints feeling rejuvenated and rested.
Because it is so versatile, paraffin is used in a variety of settings by a range of healthcare, wellness, and beauty professionals. Paraffin therapy is used by physical, occupational, massage, and athletic therapists; hand therapists; reflexologists; rehabilitation, pain management, and arthritis specialists; physicians and nurses; chiropractors and podiatrists; and a host of other medical professionals for the heat treatment of arthritis pain and stiffness, inflammation, strains, muscle spasms, and more.

Average application time is 15 - 20 minutes. Always inspect the skin at the start and conclusion of the treatment. Usually the hand/foot is dipped 8 - 10 times then covered with a plastic bag and wrapped in a towel to hold the heat in for the treatment duration. Remove resident’s jewelry and wash hands before dipping. Wax temperature for hands is usually 126-135 degrees F and is 113-126 degrees F for the feet. Always follow you facility policy.

Paraffin use is contraindicated for the following conditions:  Should not be used in the presence of open cuts or wounds, inflammatory skin conditions, neoplasm [growths],fever, blood clot, resident with dementia, presence of bleeding or swelling, peripheral vascular disease where circulation is impaired, acute inflammation or when sensation of the extremity is reduced or absent (such in some cases diabetes) If there is any question about peripheral vascular disease or decreased sensation of the extremities, consult a physician or physical therapist before using. Should not be used on areas subject to hemorrhaging or in cases involving abnormal sensitivity to heat. Do not use if dermatitis due to paraffin sensitivity occurs.

Ace Bandages

What is it? An ace wrap is an elastic bandage that comes in different sizes. The wrap comes in a roll with metal clips, with tape to fasten it in place, or Velcro. The bandage may be from 2 to 6 inches (5 to 15 cm) wide and 4 to 6 feet (1.2 to 1.8 m) long.

Benefits - An ace wrap puts gentle pressure on the tissue around an injury. The ace wrap also gives support to the injured area. Following are other reasons you may need to use an ace wrap.

1. To help reduce swelling of an injured area of the body.
2. To hold wound bandages in place.
3. To wrap around an arm or leg splint during healing.
4. To improve blood flow to a limb like an arm or leg.
5. To hold cold or hot packs in place on a body part, such as an arm.

How is the ace wrap used? Usually your supervisor will show you how to wrap the bandage. The following example may help you learn how to wrap a bandage around an ankle. These directions may be used to wrap the bandage around your hand, wrist, elbow, or knee.

1. Hold the rolled bandage with one hand and with the other hand put the loose end on top of the foot.
2. While holding the loose end, wrap the bandage twice around the foot. Be sure to overlap the ace wrap.
3. After the foot has been wrapped twice, move your hand to the heel.
4. Wrap the bandage moving toward the ankle. The bandage should be wrapped in a spiral way like making a figure 8.
5. Leave the heel uncovered.
6. Cross the bandage over the foot, moving upward, and pass it behind the ankle.
7. Move the bandage down and cross it over the top of the foot.
8. Wrap the bandage under the foot to complete the 8 figure. Repeat this one more time.
9. Pass the bandage around your calf and start wrapping it toward the knee.
10. Stop wrapping below the knee. You don't need to start coming down again.
11. The end of the bandage can be fastened with tape or metal clips.

Tips for safety and comfort:

1. Be careful not to wrap the bandage too tight because it may cut off blood flow.
2. To help with blood flow, take off the bandage 2 times a day if in the plan of care. Leave it off for a few minutes and wrap it again.
3. If the part of your body with the ace wrap feels numb or tingling, remove the bandage. Gently rub the area. Rewrap the bandage when the area feels better.
4. If the part of your resident's body with the ace wrap becomes cold or turns blue, remove the bandage.
5. Have extra ace wraps. This will let you wash one when it gets dirty and have another ace wrap to use.

Notify your Supervisor if

1. Resident has pain or cramping on the body part where the bandage is wrapped.
2. Resident has tingling or numbness that does not go away after removing the bandage.
3. The skin around the bandage looks blue, pale, and feels cold.
4. You see redness that was not present when the bandage was first applied.

Slings  

In the rehabilitation setting there are many uses for slings. Obviously if a resident has a fractured arm he may have a sling to support his arm even if a cast is in place. Residents who have suffered a stroke can often benefit from a sling if they have a flaccid arm and leg support. Most often the support is needed while the resident is walking so that his arm does not hang free. If an arm does hang free, it can lead to supplication at the shoulder joint, or in most instances, increased pain. There are a wide variety of slings available, so be sure to check with the physical therapist for the proper application of the sling.

Splints and Casts

Splints and casts support and protect injured bones and soft tissue, reducing pain, swelling, and muscle spasm. In some cases, splints and casts are applied following surgery.
Casts are custom-made and applied by your doctor or an assistant. Casts are often made of plaster or Fiberglas. Splints or half casts also can be custom-made, especially if an exact fit is necessary. Other times, a ready-made splint will be used. These off-the-shelf splints are made in a variety of shapes and sizes, and are much easier and faster to use. They have Vulgar straps which make the splints easy to adjust, and easier to put on and take off. Unfortunately, splints offer less support and protection than a cast and may not a treatment option in all circumstances.

In most cases the splints, braces, or positioning devices are lined up with specific body parts or joints. In all cases, placing something on, or next to the body increases the risk for skin breakdown. For this reason special care must be taken to monitor the reaction of the skin to the application of the splint, brace, or positioning device. The monitoring plan generally includes the following:

1. Gradually increasing the time of wear. Generally the therapist will provide a schedule of the recommended wearing/use times.
2. Before applying a splint, brace, or positioning device a visual inspection of all the skin that will come into contact with it is performed.
3. After removing their splint, brace, or positioning device the visual inspection of the skin is repeated. Any reddened or pink areas should be noted. These areas of redness should disappear within 15-20 minutes of the removal of the device. Any redness that remains beyond this time should be reported to the therapist and nurse. Modifications to the wearing schedule, and or device, may be necessary.

Always keep the following in mind:

1. A soft device does not ensure that there will be no problems.
2. Padding between a device and the reddened area may actually increase the pressure in the area rather than decrease it.
3. Bony parts of the body are especially at risk for pressure from these devices.
4. Skin at the edges of the devices is also at a higher risk for problems.
5. Moisture may build up and increase the risk for skin breakdown and infection. Refer to the therapist for methods to address moisture.
6. Splints need to be cleaned. Refer to the therapist for the proper care and cleaning of each type of splint.

Ankle- Foot Orthosis (AFO'S)    

Ankle-foot orthosis is A brace (usually plastic) worn on the lower leg and foot to support the ankle, hold the foot and ankle in the correct position, and correct foot-drop. Abbreviated AFO. Also known as a foot-drop brace.

Ankle-foot orthoses (AFOs) are considered medically necessary for ambulatory individuals with weakness or deformity of the foot and ankle who require stabilization for medical reasons and have the potential to benefit functionally.

The Physical Therapist will be an integral part of deciding which style of AFO to use. If you notice an AFO that is not functioning properly, or a resident who could possibly use and AFO, notify the physical therapist.

Please go to the "Discussion Board" tab in the Control Panel. Answer the questions for this unit. If you need help with the Discussion Board, you can find it under "Class Information." After finishing the Discussion Board, go to "Assignments" and take the test for this unit. You may then continue to the next unit.