Functional re education

1. Functional Re-education
Dechasa Imiru (MSc PT)
Lecturer
Department of Physiotherapy
Jimma University
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2. Objectives
After successful completion of this lesson the
students would be able:
Define functional re-education
Explain the benefit and types of functional re-
education
Explain the goal of Transfer Training
Identify Precautions with Transfers
Explain type and level of assistant
List type of transfers
Perform transfers
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3. Functional re-education
Education is the process of teaching and learning
Function- related to day to day activities/functions
Re education means educating something, which is
already known by an individual.
 Functional reeducation
The patient knows the activity or movements that
has be performed but due to injury, ailments,
disease pathology pt. couldn't perform it properly.
“Making the patient independent” is the main
goals
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4. Functional ……
It is a sequence of progressions of position like
the development of the milestone of the child
from lying to standing.
Depends on the condition and level the
independence the program can be designed.
Depending on the positions, the sequence can
be planned and multiple postures may be
overlapped during that program
 Individuality –patient specific, teamwork and
modified movements
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5. Principles of functional reeducation…
 Proper and thorough assessment
 Assessment of functional ability need special attention
 Treatment should be tailor made
 Commands
 Treatment should be task specific
 Never ever discourage the patient
 Feedback should be taken from the pt. and relatives
 Treatment should be effective (physical independence)
 Reviews are needed to record
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6. Functional re-education helps to…
Improve coordination, balance & proprioceptive
Increase strength and endurance of muscle
Increase the dynamic and static stability
Enhance the Improve postural stability
Improve the ambulatory skills
Restore a natural mind body connection
Optimize joint biomechanics
Restore normal movements
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7. Functional re-education can be done on…
On mat
On re-education board
Using parallel bar
Using suspension therapy
Using hydrotherapy
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8. Medical Conditions that can Alter Mobility
Fractures/sprains
Neurological conditions – spinal cord injury,
head injury/TBI, stroke etc.
Degenerative neurological conditions –
Myasthenia gravis, Guilin barren syndrome
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9. Types of functional re education
1. Bed mobility
2. Transfer
3. Ambulation
4. Activities of daily living
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10. # Bed mobility
 Lying(supine, prone, side),Rolling, coming to sit,
Sitting Balance, weight shift and Ability to achieve
pressure relief and preparation for stance if
indicated.
 The progression of bed mobility should be based
on the main theme of normal development
sequence.
Supine  prone prone kneeling half
kneeling standing (mat activity)
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11. Supine to sit
• To get patient from lying down to sitting at the side
of bed
Explain the procedure of what you will be doing
Use proper body Mechanics
Support the patients body and bring them from
supine to sitting at the edge of the bed
Avoid pain as much as possible
Sit with patient to ensure safety, then when
ready position them for comfort or prepare for
transfer
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12. Supine to sit
• Dependent patients:
Move patient by body segments; lower legs, hips,
shoulders, head, etc. to scoot them closer to edge
of bed
Support shoulders while legs are close to EOB (edge
of bed), use proper body mechanics and lift
shoulders as legs lower
Support patient in sitting
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13. Supine to sit
Patients who need min/mod assist:
Have patients move toward EOB by scooting
their legs
 Have them do bridges to scoot hips and trunk,
and lift their neck and shoulders
Once close to EOB, support patients shoulders
and assist them to sit
Patients should use legs to dig into side of bed
to help pull to sitting
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14. Supine to sit: log roll
Patients who need supervision:
Have patient bend knee and reach arm
across body
As knee falls across body and arm
reaches patient will roll onto their side
Once in side lying, pt. will use arm and
opposite elbow to push themselves up as
their legs come off the side of the bed
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15. Sit to stand
Have patient scoot to edge of chair
Pull feet back toward them so ‘’knees are
over the toes’’
Patients will use arm rails/chair rails to push
up on
Use gait belt for better grasp/safety
Can use a count of 1-2-3, have patient lean
forward as they push up; “nose over toes”
ensure no dizziness
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16. 2. Transfers
A transfer is the safe movement of a person
from one surface/location/position to
another.
Planning and organization are required
before a patient attempts a transfer.
Relying on the mental and physical ability of
the patient transfers may be done by the
patient alone,
With assistance of another person or
 by another person.
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17. Benefits of transfers
Maintains & improves joint motion
 Increases strength
 Promotes circulation
 Relieves pressure on the skin
 Improves urinary/respiratory function
 Increases social activity
 Increased mental stimulation
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18. Safety First
Safety must never be compromised
Never select method of transfer by ease of
PT
When in doubt always use an assistant
Always stabilize equipment (use wheel
locks)
Secure all lines when transferring
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19. BEFORE A TRANSFER or Lift
Know patients’ sensory, physical, cognitive,
and behavioral status.
Be aware of any medical precautions.
Know your own abilities and limitations
Use good body mechanics.
Recognize when and how much
mechanical or human assistance is needed
for a safe transfer.
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20. Level of Transfers
Independent transfer
Assisted transfer
Dependent transfer
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21. Independent Transfers
• No assistance of any type needed for any
aspect of the transfer.
• Patient can perform set up and transfer safely
without any assistance.
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22. Assisted Transfer
• Patient actively participates in transfer but
requires assistance
• Types of assisted transfers
– Two-person lift
– Sliding board transfer (SBT)
– Squat pivot transfer
– Standing pivot transfer
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24. Dependent Transfer
Patient does not or cannot actively
participate in transfer.
May be able to assist minimally.
Types of dependent transfers:
• Sliding transfer from cart to table (team transfer)
• Three person carry
• Hydraulic lift transfer
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25. Levels of Assistance for Transfers
Maximum Assistance
Moderate Assistance
Minimal Assistance
Contact Guard
Stand By/supervision
Independent
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26. Maximum Assistance (Max A)
PT provides assist for
about 75% of total
patient’s work
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27. Moderate Assistance (Mod A)
PT provides assist for
about 50% of total
patient’s work
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28. Minimal Assistance (Min A)
PT provides assist for
about 25% of total
patient’s work.
Requires assist for
balance, to move an
extremity or assistive
device.
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29. Contact Guard (CGA)
PT supervises patient’s
work by CONTINUOSLY
guiding or guarding
with touch/contact for
support/balance
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30. Close Guarding Assist
PT supervises patient’s
work by INTERMITTENTLY
guiding or guarding with
touch/contact
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31. Stand – By Assist
Patient can perform
activities without assist but
do not do it consistently
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32. Independent (I) Transfer
PT supervises the
patient without any
assist
Verbal cues may be
require
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33. Amount of Assistance
When more than one person is required to
transfer a patient safely the number of people
required to complete the transfer is
documented
Example – 2 people required to use moderate
assistance
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34. General Rules of Transferring
Proper body mechanics
Use Transfer belt
Instruction and verbal cue
Complete the transfer
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35. Body Mechanics
Proper attention to body
mechanics and the relationship
of center of mass and base of
support allow the therapist to
maintain the safest position
while working with a patient.
*the patient close to your BOS
to decrease stress on your back
and arms.
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36. USE A TRANSFER BELT
Transfer belts are used around
the patients waist to provide a
secure point of contact and
control for the therapist.
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37. Instructions and Verbal Cues
A patient should always be informed the transfer
to be performed and what they are expected to
do.
Instructions should be in a manner that can be
understood by the patient.
Instructions should be short and clear
If more than one person is transferring a patient,
communication is essential.
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38. Completing The Transfer
The transfer is NOT complete until the patient
is safely and securely in the new position.
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39. Types of Transfers
 Bed Mobility Transfers
 Independent
 With assistance
 Dependent (sliding transfer)
 Sitting Transfers
 Push up
 Sliding board
 Two person lift
 Standing Transfers
 standing Pivot
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40. Bed Mobility Transfers
Bed mobility transfers can be done independently or
with assist to move in bed.
Patients may need assist with bed mobility due to
weakness, obesity, Para or quadriplegia, amputation or
cognitive problems.
Bed mobility can help to prevent pressure ulcers/sores
and decrease joint contractures.
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41. Bed mobility- independent transfers
supine  side lying
sitting on edge of
bed/table
 Can also be taught to
avoid excessive strain on
LB.
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42. Bed Mobility- with Assistance
Assist from therapist
Assist from assistive
devices i.e. bed rails and
trapeze (should only be
used if necessary.
REMEMBER the goal is to
get patient independent if
possible
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43. Bed mobility- Sliding Transfer
Used to move
patient to/from cart
and treatment table.
3 or more
clinicians perform
the transfer using a
draw sheet.
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44. Sitting - up transfer
A push up transfer is
used when patient
Have enough
strength to lift
themselves from the
supporting surface
and sufficient sitting
balance to move
safely.
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45. Sitting assisted transfers - sliding board transfers
 Can be done with assist
of PT or (I)
 A sliding board is used
when a patient does not
have enough strength to
lift most of the weight of
the buttocks,
 sufficient sitting balance
to move in a sitting
position safely but can
not perform push up
transfers.
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47. Sitting -Two Person Lift
The 2 person lift is an
assisted transfer with
max assist of 2 people.
This type of transfer is
often used to move a
pt. from WC to/from
floor or lower surface.
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48. Standing pivot transfer
 Used when a patient, can sit,
stand, pivot, and bear some
weight on the LE, but have some
weakness, paresis, paralysis, or
loss of balance or sensation, which
necessitates assistance to transfer
safely.
 Amount of assist will vary usually
moderate to minimal assist
 Better to transfer leading with
stronger LE in MOST cases.
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49. Hydraulic Lift
A hydraulic lift is a
mechanical device that
allows one person to
transfer a dependent
patient.
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50. Time to Transfer
Introduce Self To Patient
Explain What Will Happen During Rx
Explain What Is Expected of Patient
Is Patient Ready? Does He Need Shoes Or Other
Clothing?
Assess Area For Safety
Use Gait Belt
Use Proper Body Mechanics
Make Sure Surfaces Are As Level As Possible
Give Clear, Concise Commands
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51. 3. Ambulation
Clients who have been immobile even for a
short time may require assistance
A client may require the use of an assistive
device to increase stability, to Support a weak
extremity and to reduce the load on weight
bearing structures
Use of a gait belt
Surfaces:
Even and Uneven
inclines/declines
change in surface (tile to carpet to grass)
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52. 4. Activities of daily living
 Gait training with an appropriate assistive
device, like walker or cane
Walking in smooth surface.
Walking in rough surface and in obstacles,
Squatting, toileting , dressing, feeding
Stair climbing
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53. Questions ???
Doubt
Comments
Feedbacks
You are Warmly
welcome!
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54. The End!!!
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