C A R "Matilde Pérez Palacio" - Physical Therapy Service

PHYSICAL THERAPY SERVICE

ANNUAL WORK PLAN

2016

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 C A R "Matilde Pérez Palacio" - Physical Therapy Service

1. INTRODUCTION
INABIF's "Matilde Pérez Palacio" Residential Care Center provides comprehensive
care to children, adolescents and young people with moderate to severe disabilities
due to neurological disorders, whose ages range from 5 to 27 years old.
This CAR opened on June 27, 2009 with 57 patients, the Physical Therapy Service
had 01 Medical Technologist with a specialty in Physical Therapy and Rehabilitation.
We currently have a population of 99 residents and the Service has 05 Medical
Technologists with a specialty in Physical Therapy and Rehabilitation.
The Physical Therapy Service reports to the Management of the "Matilde Pérez
Palacio" Residential Care Center, which in turn reports to the Protection Services Unit
for Persons with Disabilities of INABIF; it is part of the Technical Team and
supervises the activities of the permanent care staff for the sheltered population.

2. JUSTIFICATION

The purpose of this plan is to establish a set of standards for the planning, execution,
evaluation and treatment of the sheltered population, offering them a quality and
warm service.

3. OBJECTIVES
3.1 GENERAL OBJECTIVE
To recover, maintain and/or improve the maximum physical, psychological and social
abilities of residents with a history of neurological injury and a high degree of multi-
disability.
3.2 SPECIFIC OBJECTIVES
 To stimulate the development of the gross motor area, following the normal
neurodevelopmental sequence.
 Maintain and/or increase the degree of joint amplitudes.
 Decrease muscle spasticity levels.
 Maintain and/or stimulate the development of muscular strength.
 To favor the development of the maximum potential of each child and adolescent.
 To prevent physicopostural alterations.
 Decrease the degree of functional dependence of residents.
 Improve the ventilatory capacity of high-risk residents, reducing respiratory
complications.

4. LEGAL BASIS

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 Political Constitution of Peru.
 Law No. 27337 (Children and Adolescents Code).
 Intervention Manual "Methodological Guidelines for the Comprehensive
Care and Prevention of Abandonment of Persons with Disabilities",
approved by Resolution of the Executive Directorate No. 107 dated February
26, 2015.
 Law 29174 General Law on Residential Care Centers for Children and
Adolescents.
 Manual on Comprehensive Care for Children and Adolescents in INABIF
Homes (2006).
 Procedures Manual and Multidisciplinary Intervention Guidelines of the
Integral Protection Management Unit, approved by Resolution No. 221 of
the Executive Directorate dated November 4, 2005.
 Manual of Intervention in Residential Care Centers for Children and
Adolescents without Parental Care", promulgated by Ministerial Resolution
No. 080-2012-MIMP.
 Law No. 29973 - "General Law on Persons with Disabilities.
 Law N° 28456 - "Labor Law of the Health Professional Medical
Technologist".

5. GOALS
 Physiotherapeutic care for 100% of the population housed in the CAR "Matilde
Pérez Palacio".

6. STRATEGIES
 Use specific physiotherapeutic evaluation sheets.
 Perform the corresponding physiotherapeutic treatment for each resident, according
to the different therapeutic programs.
 Evaluate the total population housed every six months (in order to prevent and/or
detect physical and postural alterations, as well as to observe the results obtained in
the residents served).
 Make initial and/or evolutionary physiotherapeutic reports of the residents attended,
placing them in the matrix file, with a copy in the therapeutic file.
 Develop an intervention plan for each resident.
 Evaluate the development of the intervention plan, using the quarterly monitoring
form.

 Provide guidance and advice to the CAR permanent care staff on the care and/or
postures to be maintained in neurological residents, in order to limit possible
physicopostural alterations and provide quality care.

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 C A R "Matilde Pérez Palacio" - Physical Therapy Service
 Coordinate permanently with the Management and the Multidisciplinary Team on
the therapeutic work carried out with the residents.

7. LINES OR LINES OF ACTION

7.1 PHYSIOTHERAPEUTIC EVALUATION
* Entrance evaluation
* Follow-up evaluation

7.2 PHYSIOTHERAPY
* Application of therapeutic programs (motor reeducation, psychomotor skills,
respiratory physiotherapy and therapeutic pool).
* Application of special methods and techniques (Bobath, Vojta, Castillo
Morales, NDT, Halliwick, others).
* Application of physical agents: heat, hydrotherapy and electrotherapy.

7.3 ADMINISTRATIVE ACTIVITIES

* Elaboration of the initial therapeutic report.
* Elaboration of the therapeutic intervention plan.
* Elaboration of therapeutic evolutionary reports.
* Record on the quarterly tracking sheet.
* Record of care, in the monthly record sheet.
* Recording of activities in the occurrence notebook.
* Systematization of information for statistical purposes.
* Fulfillment of other functions assigned by management, which are an
important part of the operation of the RAC.

7.4 TRAINING

Implementation of the training program, aimed at:

* Therapists
 In-house training of therapists (monthly).
 Case discussion (weekly).

* Permanent Attention Staff

 Training workshops (semiannual).

8. DESCRIPTION OF ACTIVITIES

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8.1 PHYSIOTHERAPEUTIC EVALUATION

All children will be evaluated with the physiotherapeutic evaluation form. In

addition, the specific evaluation forms will be used. The following will be
considered:

a- Background: Data related to the resident, which are necessary to reach a

diagnosis and/or for the elaboration of a physiotherapeutic treatment program.

b- Examinations performed

Postural physical examination: Examine posture, using as many

positions as possible:

a) Supine decubitus position

b) Prone position
c) Lateral decubitus (right / left)
d) Seated position
e) Kneeling position
f) Position of plantigrade
g) Biped position
h) Marching

Muscle examination: Evaluate:

a) Tone: hypertonia, hypotonia, dystonia.
b) Trophism: hypertrophy, hypotrophy, normal.
c) Strength: Use muscle test card.

Joint examination: Evaluate joint ranges, decreased or increased, use

goniometry card.

Motor development: To evaluate the neurodevelopmental development of

gross motor skills. Use motor development test, neuroevolutionary test,
reflex activity test.

Other: Examinations specific to each intervention program.

c- Results obtained: Information derived from the therapeutic examinations

applied to each resident.

d- Diagnostic therapeutic impression: Conclusion and formulation of a

physiotherapeutic diagnosis based on the evaluation used.

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e- Intervention plan: Treatment program to be applied to each resident
according to his or her needs and rehabilitation priority.
f- Recommendations: Suggestions made in order to improve the quality of
resident care.

8.2 PHYSICAL THERAPY

During the current year, the Early Intervention program will not be applied due
to the fact that there are only two residents under five years of age; these
residents will be integrated into the Motor Reeducation program.
Residents will be included in one or more treatment programs, considering the
medical diagnosis, functional diagnosis and particular needs, found through the
physiotherapeutic evaluation.

THERAPEUTIC PROGRAMS

 Motor Re-Education - Therapeutic techniques aimed at recovering the

functionality of the different body segments, minimizing the sequelae of a
neurological and/or musculoskeletal alteration. It includes: massage therapy,
kinesiotherapy, application of specific treatment techniques (Bobath, FNP,
Castillo Morales, Vojta, NDT, Orthopedic Manual Therapy, etc.).
 Psychomotricity - Set of methods and techniques that using the human
body and its different movements, as an essential element for the integration
of the motor and psychological aspect, promote the development and
interaction of the person with the environment. It includes: motor
coordination, straightening reactions, balance reactions, body image,
dominance, spatial-temporal structuring, rhythm, etc.
 Respiratory Physiotherapy - Aimed at residents with bronchopulmonary
diseases and obstructed airways. Manual techniques and/or procedures that
contribute to adequate ventilatory mechanics are applied.
 Therapeutic Pool - Care in which the heated pool is used as the main
therapeutic element, using the thermal (analgesia, myorelaxation, increased
metabolism) and mechanical properties of water (flotation, antigravitational
effect, hydrostatic pressure), including: hydrokinesiotherapy, Halliwick
method, Bad Ragaz method and others.

SPECIFIC TREATMENT TECHNIQUES

 Bobath Method (basically consists of inhibiting hypertonia by means of

special postures, facilitating appropriate automatic reactions).

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 Vojta Method (Seeks to trigger reflex locomotion patterns from defined
postures and stimuli).
 Castillo Morales Method (based on the stimulation of the chronomaturation
or integral development of the child).
 PNF method (proprioceptive neuromuscular facilitation, group spiral
movements, following an oblique direction).
 NDT Method (Neurodevelopmental Treatment based on the theory of the
Bobath method).
 Postural Drainage Techniques (based on the use of special postures that
allow the elimination of secretions through the use of gravity).

In the case of detecting physicopostural alterations, referral to the traumatologist

will be requested for the respective treatment: orthopedic footwear, corrective
plaster, corrective surgery, etc.

8.3 ADMINISTRATIVE ACTIVITIES:

 Monthly record of care as part of the therapeutic work, in order to

quantitatively visualize the work done in the service.
 Recording in the occurrence notebook, of the various activities performed in
the service.
 Prepare initial and/or evolutionary therapeutic reports for each resident,
according to the therapeutic program in which he/she is included. These
reports are submitted to management for forwarding to the respective family
courts. The therapeutic progress report is elaborated every six months; the
initial therapeutic report is elaborated upon admission of the resident.
 Develop the intervention plan after the initial assessment, or at the start of a
new therapeutic program rotation.
 Record every three months on the quarterly tracking sheet.
 Each resident has a therapeutic file common to physical, occupational and
speech therapy services, which must be updated periodically by the therapist
in charge. The therapeutic file will have the following structure:

1. First Tab (Reports and Intervention Plans)

 Medical report

2. Second Tab (Physical Therapy)

 Intervention plan
 Quarterly tracking sheet

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 C A R "Matilde Pérez Palacio" - Physical Therapy Service
 Progress report
 Initial therapeutic report

3. Third Tab (Speech Therapy)

 Intervention plan
 Quarterly tracking sheet
 Progress report
 Initial therapeutic report

4. Fourth Tab (Occupational Therapy)

 Intervention plan
 Quarterly tracking sheet
 Progress report
 Initial therapeutic report

 Data collection and screening in order to systematize data related to the

institution's information systems.
 In order to adequately organize the CAR, there are internal positions
necessary for its normal operation, such as: technical team coordinator,
coordinator of therapy services, civil defense coordinator, volunteer
coordinator, coordinator of the educational area, etc. These positions are
appointed by the management on a periodic basis, require responsibility and
compliance, and demand working hours for their proper execution.

8.4 TRAINING
Two training workshops have been scheduled for the permanent staff of the
CAR "Matilde Pérez Palacio".

These will have a maximum duration of three hours during two consecutive
days, taking place in the physical therapy rooms. The following will be used:
blackboards, multimedia equipment, sound equipment, case presentations,
stretchers, etc.
The training workshops will aim to:

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 Train permanent care staff on issues related to the management, care

and attention of residents with disabilities.
 Encourage participation in the treatment of residents with disabilities.
 To achieve a better understanding of the problems of residents with
disabilities.
 Improve the quality of care for residents with disabilities.

TOPICS:
o April - Massage therapy workshop.

o August - Kinesiotherapy workshop course.

9. RESOURCES
9.1 HUMAN RESOURCES:

Five Medical Technologists in Physical Therapy and Rehabilitation:

 Lic. Gustavo Campaña Garcia
 Mg. Lucia Quispe Valladares
 Lic. Maria Jacinto Cahuana
 Lic. Robert González Cáceres
 Lic. Ruben Calixtro Calixtro Calixtro

SUPPORT BODIES:
a) Internal:
* Address CAR "Matilde Pérez Palacio".
* Administration CAR "Matilde Pérez Palacio".
* Technical Team of the CAR "Matilde Pérez Palacio".

b) External:
* University volunteering
* High school volunteering
* NGO Volunteering

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 C A R "Matilde Pérez Palacio" - Physical Therapy Service

9.2 MATERIAL RESOURCES

The Physical Therapy Service periodically requests materials, equipment, as

well as orthopedic shoes and other implements from the Management, which
are taken care of and managed by the Administration of the CAR "Matilde
Pérez Palacio".

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10. SCHEDULE OF ACTIVITIES

FIRST SECOND THIRD FOURTH

QUARTER QUARTER QUARTER QUARTER
ACTIVITIES

JAN FEB SEA ABR MAY JUN JUL AGO SEP OCT NOV DEC

1 Physiotherapeutic evaluation X X

2 Physiotherapy X X X X X X X X X X X X

3 PAP training X X

4 Administrative activities X X X X X X X X X X X X

Each physical therapist has a group of residents under his/her care, to whom he/she provides therapeutic care on an annual basis,
since every twelve months the therapists rotate groups of residents.

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............................................. ..............................................
Maria Antonieta Jacinto Cahuana Luisa Lucia Quispe Valladares
MEDICAL TECHNOLOGIST MEDICAL TECHNOLOGIST
Physical Therapy and Rehabilitation Physical Therapy and
Rehabilitation
CTMP 3428 CTMP 5042

.............................................. .............................................
Edwin Robert González Cáceres Florencio Rubén Calixtro Calixtro
Calixtro
MEDICAL TECHNOLOGIST MEDICAL TECHNOLOGIST
Physical Therapy and Rehabilitation Physical Therapy and Rehabilitation
CTMP 3499 CTMP 0955

..............................................
Gustavo Pedro Campaña García
MEDICAL TECHNOLOGIST
Physical Therapy and Rehabilitation

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