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OSTEOPOROSIS PT and Fitness
OUR TEAM
• Katie O’Hara PT
• Julie Neaderthal PT
• Sheila Gaffney PT
• Mark Snow ATC
GOALS for 2008
• Create a one time PT evaluation form
• Develop educational power point for osteoporosis patients
• Complete Home Exercise booklet to complement the Osteoporosis booklet and create fitness presentation
• Practice and help implement the Fitness Center’s Better Bones program
• PT Osteoporosis One Time Evaluation • Vanderbilt Orthopaedic Institute• PATIENT MEDICAL HISTORY • Name: Jane Doe • MRN: 1234567• Referred by: Dr. • Visit Number: 1 • ICD9: • Patient is a year old F/M with a diagnosis of . • CHIEF COMPLAINT AND CAUSE: osteoporosis • Onset date: • SUBJECTIVE• Pain: Pain Scale (0 = absent 6 = moderate 10 = severe) Current Pain: 0/10 • PRIOR MEDICAL HISTORY• Prior History of Current Problem(s): none multiple episodes; one episode; previous fractures;
previous falls; • Patient's prior treatment history: None • PMHX: none; • Precautions/Contra-Indications/ Allergies • Medications: None • Prior Level of Function: Independent with ADL's, homecare, and selfcare activities: • Current Level of Function: Independent with ADL's and body mechanics; Active exercise program
includes: • Patient stated goal: Patient is able to exercise safely with osteoporosis.
• OBJECTIVE EXAMINATION • Objective Information: • ASSESSMENT/FINDINGS • Problem List: pain; swelling; decreased ROM; decreased strength; decreased flexibility; use of assistive
device; impaired balance; decreased positional tolerance; decreased understanding of safe exercises for osteoporosis;
• • Learning Barriers/Barriers to Goal Achievement: None • Modification to treatment based on identified Learning Barriers/Barriers to Goal Achievement: NA • Rehab Prognosis: Patient has excellent prognosis to meet goals stated below due to: understanding safe
exercises for osteoporosis, understanding the home exercise program, understanding body mechanics and ADL's recommendations, participation in VOI osteoporosis program,
• PLAN OF CARE• PT goals:• 1. Patient verbalizes understanding to decrease episodes of trunk flexion in ADL's and body mechanics.• 2. Patient verbalizes understanding of safe exercises for osteoporosis.• 3. Patient/therapist performed Home Fall Risk Prevention Assessment.• 4. Patient verbalizes understanding of home exercise program.• 5. Patient referred to VOI Fitness Center Osteoporosis Program.• Patient goal: • Independent in use, wear, care and fit of orthtic device
Independent in the use, wear, care and fit of TENS deviceIndependent with home exercise programIndependent with ambulation with assistive devicel----------------- by the end of 1 visit.
• Status of Goal: Met
• Treatment Plan: • Recommendations:PT 1 x only
VOI Fitness Center • Today's Treatment:• VOI osteoporosis booklet provided• body mechanics and ADL instruction• Home Fall Risk Prevention Assessment• Today's Treatment Interventions/Home Exercise Program: • The patient was given both a verbal and written home exercise program. The home
program/exercises were demonstrated and reviewed with the patient. The patient demonstrated understanding of the home program/exercises.
• Home Exercise program includes: • core abdominal exercises given• back extension exercises• scapular retraction exercises with/without theraband• • Goals, Treatment Plan, and Risks/Benefits of Physical Therapy Intervention have been
communicated with and agreed upon by the patient/family/caregivers. Plan of Care has been communicated to members of the multi-disciplinary team.
• The Goals and Treatment Plan were developed in light of the Patient's Goals, Learning Barriers/Barriers to Goal Achievement; and the patient's Rehab Potential.
Movement Safety with Osteoporosis
• Patient Education Presentation – based on the osteoporosis booklet
What is Osteoporosis ?
Osteoporosis is a disease that causesbones to become thin, weak and easyto break.
Causes– family history – diet – Medications– lack of physical activity
Most common fracture sites
Hips
Wrists
Spine
Factors that affect strong bones:
• Positive Factors
– Calcium and Vitamin D intake
– Physical activity –weight bearing improves bone strength
– Maintaining a healthy weight
• Negative Factors
– Smoking and heavy alcohol use
– Medications –ask your doctor
Physical Therapy
Initial EvaluationMedical history Physical Assessment
• Posture • Joint range of motion• Strength• Flexibility• Daily activity
Pain control (if necessary)Exercise
Home Exercise Program
• Stretching and strengthening
• Posture and body positioning /body mechanics
• Fall prevention in the home
Body Mechanics
• Avoid forward bending
• Carry loads close to the body
• Tighten your stomach when you lift items
• Never twist with a load
• Sit up straight with knees level to hips
• Change positions every 30 min
• Sleep with back straight
Making your home safe
• Floors
• Lighting
• Nightlights
• Telephone access
• Electrical cords secured
• Pets
• Throw rugs
Bedroom-Living room safety
• Bedside tables for glasses, lamps and phones
• Sit on the side of bed for a minute before standing to avoid dizziness
• Secure area rugs
• Clear walkways
• Chair and sofa height safe and comfortable
Bathroom-Kitchen safety
• Grab bars for safe entry in/out of shower and tub• Non skid mats at tub, shower & toilet• Keep items in easy reach from knee to shoulder height • Non slip flooring • Rubber backed mat in front of sink • Avoid ladders and step stools to reach overhead • Nightlight between rooms
– Bedroom and bathroom– Hallway
Stairs
• Handrails on both sides
• Non slip surface
• Uncluttered stairs
• Steps more visible
– Marked with tape
Personal safety
• Wear properly fitting non skid shoes
• Avoid ladders
• When doing housework, keep your upper body straight.
– Do not twist at the waist
– Bend from the knees, not from the waist.
– When vacuuming or mopping, bend knees and rock front to back instead of bending over.
• Log roll when getting out of bed
Fitness Better Bones Program
• Individualized exercise program to strengthen bone and prevent injury
• Focus on posture, strength, flexibility, balance, and cardiovascular training
• Learn safe and effective exercise
• Program fees:4 one hour sessions 6 one hour sessions
• $80 Member $100 Member
• $150 Non-member $200 Non-member
• Patient EducationExercise ProgramBooklet