ORTHO

REHABILITATION
Deepika. R
M.Sc. (Nursing) I –year
College of Nursing
Madras medical college
Chennai-03
 What is Rehabilitation?
 The process

of helping a person
to reach the fullest physical,
psychological, social,
vocational, avocational, and
educational potential consistent
with his or her physiologic or
anatomic impairment,
environmental limitations and
desires, and life plans
DEFINITIONS
• Rehabilitation is defined as “a set of interventions designed to optimize
functioning and reduce disability in individuals with health conditions in
interaction with their environment”.
-WHO
• Orthopedic Rehabilitation, also known as Musculoskeletal
Rehabilitation, is dedicated to treating injuries or illnesses involving the
musculoskeletal system including bones, muscles, tendons, ligaments,
joints, and other connective tissue.
 Definitions:
Pathology
• is a disease or trauma that causes changes in the structure or
function of a specific body tissue or organ
Impairment
• Occurs at the organ system level & is defined as a loss or
abnormality of psychological, physiologic or anatomic
structure or function resulting from pathology

Disability
• Occurs at the personal level & is defined as any restriction
or lack (resulting from an impairment) of ability to perform
an activity in the manner or within the range considered
normal for a human being
 Definitions
 Handicap
 A disability is an inability or restricted ability to perform an
activity within the normal human range, e.g. being unable to walk.
A handicap is a disadvantage resulting from impairment or
disability that limits the social role of an individual
 Activity
 The nature and extent of functioning at the level of the person.
 Participation
 The nature and extent of a person’s involvement in life situations
in relationship to impairments, activities, health conditions, and
contextual factors.
 What is Orthopedic Rehabilitation?
Orthopedic rehabilitation is a therapeutic
approach to recovery, the purpose of which
is to correct musculoskeletal limitations
and alleviate pain from trauma, illness, or
surgery.
The musculoskeletal system consists
of muscles, bones, joints, ligaments,
tendons, and cartilage so orthopedic rehab
can address any of those structures.
Rehabilitation of Orthopedic Patients

 Why rehabilitate?
 Resolve the clinical symptoms
 Return to activity
 General fitness
 From rehabilitation to Prehabilitation
 Decreases the chance of injury.
Why Rehabilitate?

 General Fitness
 Improve Cardiovascular fitness
 Overall strength is improved
 Improve tolerance and endurance
 Why Rehabilitate?

 From Rehabilitation to Prehabilitation

 Prevent reinjury
 Improve proprioception
 Prevent Immobility due to apprehension
Why rehabilitate?

 Resolve clinical symptoms

 Use of modalities
 Use of appropriate medications
 Protect, Relative Rest, Icing, Compression,
and Elevation (PRICE)
 Surgical Indications
Why Rehabilitate?
 Return to Activity-Restoration of Function
 Retard muscle decline in strength and mass
 Deter complications brought about by
immobility
 Maintain or improve flexibility
 Components of Rehabilitation
 Medical Rehabilitation
 Social Rehabilitation
 Vocational Rehabilitation
 What is Rehabilitation Medicine?
Branch of medical science
concerned with the comprehensive
evaluation and management of
patients with impairment and
disability arising from
neuromuscular, musculoskeletal,
cardiovascular, and pulmonary
disorders; also concerned with the
medical, social, vocational, and
psychological aspects arising from
them.
 • Carpal tunnel
Examples of the types of orthopedic injuries and conditions that may require rehab include:

• Arthritis

• Osteoporosis

• ACL(anterior cruciate ligament ) and

meniscus tears
• Broken bones

• Hip, knee, or shoulder replacement

• Stroke

• Sciatica

• Amputation
 Reason for orthopedic rehabilitation
• Doctors may recommend orthopedic rehabilitation for a
variety of reasons.
• These include

• post-surgery recovery.

• treatment of Injuries and

• chronic diseases, such as arthritis.

• Doctor may refer to orthopedic rehabilitation for any of

these common conditions.
• Ankle rehab for ankle injuries, such as Achilles tendon
problems, ankle fractures, and sprains
• Back rehab and lower back rehab for injuries, such as
spinal fractures and herniated spinal discs
 Cont.…..
• Hip rehab for injuries, such as
hip fractures and labrum tears
• Hip replacement rehab after total hip
replacement or hip resurfacing
• Knee rehab for injuries, such as a
dislocated knee or ACL (anterior cruciate
ligament) tear
• Knee replacement rehab after a partial or
total knee replacement
• Shoulder rehab for shoulder pain and
injuries, such as a rotator cuff tear
• Wrist rehab for conditions, such as
carpal tunnel syndrome.
 Who performs orthopedic rehabilitation?
• Orthopedic surgeons oversee orthopedic
rehabilitation.
• Orthopedic surgeons treat, prevent and rehabilitate
bone and joint problems.
• They use medical and surgical approaches to
manage these types of problems.
• Once in a rehab program, will work directly with a
variety of healthcare providers.
• This may include a physical therapist,
an occupational therapist, an exercise physiologist,
and a variety of other rehab specialists.
How is orthopedic rehabilitation performed?
• Orthopedic rehabilitation takes place in many
settings.
• In the hospital, it is part of post-surgery care and
helps you transition safely to being at home.
• Sometimes, people need to go to a rehab center for
extra attention before going home.
• Outpatient orthopedic rehab is available in many
settings.
• This includes hospital clinics, doctors’ offices,
freestanding orthopedic clinics, and health clubs.
Cont.….
• During orthopedic rehabilitation, a rehab
therapist evaluates the condition,
limitations, symptoms, pain level, and
recommendations from the referring
doctor.
• Together discuss personal goals for
rehabilitation and design an individualized
treatment program.
• Rehab specialists use objective
measurements to track progress, such as
• Range of motion,

• Strength, and pain levels.

• Therapist will share progress with the

doctor.
Types of Therapy Used in Orthopedic Rehabilitation

• Physical Therapy
• Occupational Therapy
• Sports Rehabilitation
• Hand Therapy
• Therapeutic Strength and
Endurance Exercises
• Motor Control Exercises
• Cont.……
• Aerobic Exercise
• Functional Activities and Strengthening
• Joint Mobilizations
• Joint Manipulations
• Soft Tissue/Scar Mobilization
• Ultrasound and Electrical Stimulation
• Trigger Point Dry Needling
• Physical therapy (PT)
• Orthopedic physical therapy is a larger branch of physical
therapy that involves rehabilitation of anything related to
joints, bones, ligaments, and muscles.
• It uses several approaches to accomplish this, including
strength training, stretching exercises, massage, heat and
cold therapy, electrical stimulation, and a home exercise
plan.
• These techniques can help you move without pain or with
reduced pain.
• sometimes, other specialties may be included under
orthopedic physical therapy — for example, pediatric PT
can involve orthopedic PT.
Occupational therapy (OT)
• Occupational therapy (OT) to improve
your ability to function in daily activities or
occupations.
• It teaches new ways to approach activities
and how to break down tasks into
manageable sections.
• may also learn how to change the
environment to suit abilities. Adaptive
equipment is another useful component of
OT.
• Examples include splints, canes, Reacher,
and orthotics.
• Sports rehabilitation
• Including sports physical therapy, which
focuses on exercise- and sports-related
injuries and conditions.
• Hand therapy
• Hand therapy is the art and science of
evaluating and treating injuries and
conditions of the upper extremity (shoulder,
arm, elbow, forearm, wrist, and hand).
• Hand therapy uses many therapeutic
interventions to help restore function.
Therapeutic Strength and Endurance Exercises
• Therapeutic Strength Exercises Therapeutic exercise involves
movement prescribed to correct impairments, restore muscular and
skeletal function and/or maintain a state of well-being.
• Therapeutic exercise is a type of physical activity used to treat or
prevent injuries and improve functional outcomes.
• Endurance exercise means a general ability to do any kind
of physical activity that increases heart rate above 50% of the
maximum.
• It can be divided into general endurance and specific endurance.
Cont.….

Motor control exercise is a popular form of exercise that aims to restore

coordinated and efficient use of the muscles that control and support the spine.
The therapist guides the client to practice normal use of the muscles during
simple tasks.
Aerobic exercise refers to the type of repetitive, structured physical activity that
requires the body’s metabolic system to use oxygen to produce energy. Aerobic
exercise:
Improves the capacity of the cardiovascular system to uptake and transport
oxygen.
Examples include walking, cycling, swimming, jogging, dancing, hiking, and
long-distance running.
Motor control exercise and Aerobic exercise
 Functional strength training focuses
on exercising several muscles and joints together
rather than working a particular muscle or group
of muscles independently, resulting in an
individual being able to perform daily activities
with greater ease.
 Functional Activities Examples:
 Getting up and down from a chair/couch.

 Getting on and off the toilet.

 Reaching for something in a low cabinet.

 Getting up from the floor (so important to work on

this with older adults)
 Lifting objects off the floor or low surface.

 Lifting grocery bags.

 Lifting the laundry basket.

 Joint mobilization:
A joint mobilization is a manual therapy technique, which depending on how its
implemented and the goals of the therapist, can help temporarily reduce pain,
improve joint function, and increase the range of motion around that joint.
Example: Exercises that are considered joint mobilization are flexion, extension,
tibia femoral glide, patella motion, long axis distraction, and other motions like
lateral movement and rotation.
Joint manipulation:
Joint manipulation is a type of passive movement of a skeletal joint It is usually
aimed at one or more 'target' synovial joints with the aim of achieving a
therapeutic effect.
Joint manipulation:
 Soft Tissue Mobilization

Soft Tissue Mobilization (STM) uses

stretching and deep pressure to break up rigid
muscle tissue, relax muscle tension, and move
fluids trapped in the tissues that cause pain and
inflammation.
STM is used to treat soft tissue injuries
including muscle strains and sprains.
It is a type of manual therapy.
 Electrical Stimulation
Electrical stimulation can be used in several ways
in rehabilitation.
Transcutaneous Electrical Nerve Stimulation
(TENS) can help reduce pain by using a low-
voltage current across the skin to block pain
signals.
Neuromuscular Electrical Stimulation (NMES)
uses electricity to stimulate muscle contraction,
which can help rebuild a muscle after surgery or
trauma that has affected the muscle or the nerve.
 Dry needling
• Trigger point dry needling is a skilled
intervention that uses a thin filiform needle to
penetrate the skin and
• stimulate underlying myofascial trigger points,
muscular and connective tissues for the
management of neuromusculoskeletal pain and
movement impairments.
• “Dry needling” is a very effective form of
therapy that is growing in popularity and usage.
 REHABILITATION TEAM
•Physiatrist
•Physical Therapist
•Occupational Therapist
•Rehabilitation Nurse
•Psychologist
•Speech and language therapist
•Orthotist/prosthetist
•Social worker Patient
•dietitians; pharmacists
•case managers and
•other clinical and support staff.
 Physiatrist

 Team leader

 Coordinates the various members
to achieve the goal set.
 Manages the medical aspects and

medical complications that arise
during rehabilitation
 Occupational Therapist
 Evaluate and train patients in ADLs and
IADLs
 Explore vocational and
avocational interests
 Evaluates the patient’s skill within
the community
 Train patients in the use of modified
environment, assistive devices, and UE
prostheses
 Educate the patient’s family to maintain
independence
 Physical Therapist

 Use of physical agents for

treatment
 Assist patient in functional
restoration, especially for gross
motor functions
 Train use of LE prostheses
 Psychologist

 Helps the patient and

significant others to prepare
psychologically for full
participation
 Testing for intelligence,
personality, psychological status
 counseling
 Rehabilitation Nurse
 Direct personal care of
patients
 Addresses the ADLs

 Assist in medication
management
 Educate families on the
related disabilities
 Assist in the use of adaptive
devices
 Speech and Language Therapist
 Evaluates and treat patients with
neurogenic disorders such as aphasia,
dysarthria, apraxia, cognitive-
communication impairments, dysphagia
 Educates patients/families on the care of
tracheostomy tubes, dysphagia, and
alternative communication.
 Social Worker
 Evaluates the patient’s total living
condition, including:
Lifestyle
 Finances
 Employment
 history

 AssessCommunity
the impact of disability with
resources
the above-mentioned factors
 Facilitate assistance to cope with
such impact.
 Orthotist/Prosthetist
 Evaluates, designs, and
fabricates orthoses and/or
prostheses.

 Follow up and educate users

on the care and maintenance
of such devices
 Other team members
 Vocational Counselor
 Recreation Therapist
 Spiritual counselor
 Rehabilitation
Engineer
The Team Approach

Physiatrist

P. T. O.T.

patient S.&L. T.
Ortho./

Prosthe.
Social Psych.
Nurse
 The Physiatric Approach
 Physiatric History
 Chief complaint HPI
 Final Hx
 ADL
 Community
activities
 Vocational
 activities
 Functional Goals
 Psychosocial Hx
 •The Physiatric Approach
 Past Medical History
 Review of Systems
 Functional
Examination
 Musculoskeletal
Examination
 Neurological
Examination
Musculoskeletal examination
 Activities of Daily Living
Mobility
Bed mobility
Wheelchair
mobility
Transfers
Ambulation
Self Care
Dressing
Self feeding
Bathing
grooming
 Activities of Daily Living
Communication
Writing
Typing/computer
use Telephone use
Use of special
communication devices

Environmental Hardware
Keys
Faucets
Light
switches
Use of
windows
and doors
Instrumental Activities of Daily Living
Home Management
 Shopping
 Meal planning
 Meal preparation
 Cleaning
 Laundry
 Child care
 recycling
 Instrumental Activities of Daily Living
Health Mgt.
Handling medication
Knowing health risks
Making medical

appointments







Safety Mgt 

Fire safety awareness

Response to dangerous
situations
Response to alarms
 Instrumental Activities of Daily Living
 Environmental
Hardware
 Vacuum cleaner
 Stove/oven
 Refrigerator
 Microwave ovens
 Gait Analysis
 Important physiatric tool
 May help show functional
weakness
 Divided into 2 major
phases:
 Stance phase
 Swing phase
 Swing Phase

 Covers 40 % of the gait

cycle
 Initial swing
(acceleration)
 Midswing
 Terminal swing
(deceleration)
 Stance phase

 Covers 60 % of the
gait cycle
 Loading response
(heel strike)
 Midstance (foot flat)
 Terminal stance (heel off)
 Preswing (toe off)
Considerations in Rehabilitation
 Goal setting
 Understanding the functions
of the team members
 Autonomy of each
member
 Understanding the needs of
the patient
Physiologic Response to Heat
Heat

Decreased Increased Increased

Blood viscosity tissue temp Local sweating

Increased Arteriolar
Phagocytosis
Dilatation

Increased
Increased Increased
Capillary
Capillary Flow Capillary Pressure
Permeability

Increased
Increased
Clearingof
Supply of nutrients
Metabolic waste
 CRYOTHERAPY
Cold

Decreased
Tissue Temp.

Increased
Blood Viscosity Decreased
And Metabolism
Vasoconstrictio
n

Decreased Removal of Decreased Decreased

Decreased
By Products Production of Leucocyte Phagocyte
Bleeding
Metabolites Activity

Retard Healing
 What is being Rehabilitated?

 Discovering the type of injury

 Microtrauma
 Chronic cases
 Due to repetitive disruption of the structures
 Macro trauma
 Often acute cases
 Due to specific events
What is being Rehabilitated?
Accurate Diagnosis of the
Injury:

Identifies areas that are in need of

Rehabilitation Evaluates the effects


of injury to:
 Function and physiology
 Adaptation

 anatomy
Principles of Rehabilitation In Orthopedic Patients

Treatment Planning
 Based on 3 stages of rehabilitation
Acute
Recovery stage
Functional stage
 Acute stage
 Focus of treatment
 Clinical symptom
 Tissue injury
 Tools for rehabilitation
 Rest and/or
immobilization
 Physical
modalities
 Medications
 Manual therapy
 Initial exercise
 surgery
 Acute Stage

Criteria for
advancement
 Pain control
 Adequate tissue
healing
 Near normal ROM
 Tolerance for
strengthening
 Recovery stage
The focus of treatment:
 Tissue overload complex
 Functional biomechanical deficit
complex

•Tools:
Manual therapy
Flexibility
Proprioception
/neuromuscular control
Specific exercise
 Recovery Stage
 Criteria for
advancement:
 No pain
 Complete tissue
healing
 Essentially pain-free ROM
 Good flexibility
 75 to 80 % strength
Functional Stage
Focus of treatment
•Functional biomechanical deficit complex
•Subclinical adaptation complex
Tools
• Exercises
• Technique/skills
instructions
• Specific functional
program
 Functional Stage
 Criteria for return to
play or function
 No pain
 Full pain-free ROM
 Normal strength and
balance
 Good general fitness
 Normal mechanics
NURSES ROLE
 General Responsibilities of the Rehabilitation Staff Nurse
 specialized knowledge and clinical skills

 Coordinates educational activities and uses appropriate resources

 Performs hands-on nursing care by utilizing the nursing process to achieve quality
outcomes for clients
 Provides direction and supervision of axillary nursing personnel,

 Coordinates nursing care activities in collaboration with other members of the

interdisciplinary rehabilitation team to facilitate the achievement of overall goals
 Coordinates a holistic approach to meeting patient's medical, vocational, educational,
and environmental needs
 Encourages others to become CRRN certified, obtain advanced degrees, participate
on committees, and/or join professional organizations
• Facilitates community education
ROLES AND DUTIES OF THE REHABILITATION STAFF NURSE

• Teacher
• Caregiver
• Collaborator
• Client Advocate
 Benefits of Ortho Rehab at Home

 Comprehensive rehab and recovery at your

home
 Optimal range of motion for the joints

 Regain Stability and Mobility with renewed

confidence
 More independence and better quality of life

 Efficient pain control

Adaptive devices for ortho rehabilitation
Adaptive devices:
 Conclusion
 Rehabilitation of patients rests on
accurate diagnosis, proper
identification of roles, cooperation
among the different disciplines, and
a potent but practical goal setting.
 The patient is always the focus of
treatment and should have a quality
of life that is deemed most
acceptable.
 Conclusion
• orthopedic
rehabilitation helps people
recover from various
conditions, restoring their
range of motion, body
function, muscle strength,
and joint flexibility.
• As a conservative measure,
it has helped many people
heal and improve their
quality of life.