Caring for Bed-ridden Elders

5 Tips to Care for Bedridden Elderly at Home

Bedridden elderly, whether they are in that state temporarily or for the long term, can really benefit from the kind of help a home caregiver can provide. Being a caregiver can be challenging but some simple measures will not only ease their job but also ensure elderly loved ones are well cared for during those times when they are particularly fragile.

[This is a part of series of articles on bed ridden patient care. Read more about 5 Kinds of People Prone to Bed Rest ]

What are the signs that need careful attention for bedridden elderly?

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People prone to Bed Rest

5 Kinds of People Prone to Bed Rest

When one hears the word bed-rest, it usually invokes imagery of acute injury or pain and rightly so – because under normal circumstances no healthy human would voluntarily restrict him/herself to bed giving up on all physical activity.

[This is a part of series of articles on bed ridden patient care. Read more about 5 Tips to Care for Bedridden Elderly at Home ]

What does it mean to be on bed rest?

“Bed rest” literally means confinement of an individual to bed, as part of treatment. Wikipedia calls bed rest as rest-cure and defines bed rest as a medical treatment in which a person lies in bed for most of the time to try to cure an illness.

What can cause a person to be on bed rest?

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Recovering from Bypass Surgery

CABG: Recovering from Bypass Surgery

CABG (pronounced "cabbage") may be a familiar term if you or any of your close ones have suffered from a heart attack. Chances of this are quite high, specially if you belong to Indian population.

Studies of Indian immigrants and cross sectional studies in India, have demonstrated that coronary artery disease (CAD) is rampant in Indians and that its prevalence is several folds higher than in industrialized nations. The Global Burden of Diseases (GBD) study reported the estimated mortality from CAD in India at 1.6 million in the year 2000. Extrapolation of this estimate shows the current burden of CAD in India to be more than 32 million patients.

Let’s take a closer look on what is CABG & how to deal with it.

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Knee Replacement Surgery – Care & Exercise

You are about to have Knee Replacement Surgery (TKR). A lot of the long term results of knee replacements depend on how much work you put into it following your operation. Patients who prepare for surgery and actively take part in their care can recover in less time and with less pain. This guide has general information along with tips for things to do before and after surgery to help you make it a success.
You may get different instructions from your surgeon, doctor or physiotherapist. Always follow the directions of your care team. This guide is meant to be used under the direction of your physiotherapist.
Caution: If you have too much pain in your knee to exercise, or if any of the exercises cause more pain or swelling in your knee, stop. Tell your physiotherapist or doctor. If your whole leg becomes swollen or hot, tell your doctor right away!

General Guidelines: Before Surgery                  TKR- Total Knee replacement recovery

If you exercise before surgery you can have a faster and easier recovery. Exercise helps to:

  • Maintain the range of movement of your knee
  • Make your muscles strong
  • Control your pain
  • Build your knowledge of how to exercise after surgery
  • Improve your sleep

Do activities that put less stress on your knee. Try cycling on a stationary bike (upright or seated) for 5-10 minutes, walking in water (water level should be atleast thigh deep). It is best to do specific knee movements and strengthening exercises (in guidance of physiotherapist).

  • Always warm up before exercising. Your physiotherapist may tell you to:
  • Apply moist heat to the front and back of your knee for 5-10 minutes OR Have a warm shower or bath

General Guidelines: After Surgery

Exercise after surgery will help you recover and regain the movement and strength of your knee. Exercise also helps to:

  • Reduce swelling
  • Prevent blood clots (Thrombosis)
  • Control your pain
  • Prevent constipation
  • Improve your sleep

Tips to help you make the most of your Knee (TKR) surgery

DO’s

  • Take your recovery and rehab seriously. Exercise regularly as per the programme charted by your physiotherapist.
  • Continue with your knee replacement rehab programme for at least 3 weeks after surgery, probably 3 months of physiotherapy guided knee exercises to get the best result from your knee replacement.
  • Follow-up regularly with your surgeon, to monitor internal recovery.
  • Walker or crutches should be used until discontinued by Doctor or Physiotherapist.
  • Change knee position at least once an hour, while awake, to avoid stiffness.
  • Home exercises should be performed 3 times everyday unless advised differently by your Physiotherapist.
  • Walking is an excellent activity and you are strongly encouraged to gradually increase your walking distance after you leave hospital.
  • Walk outdoors as long as sidewalks are dry. Consider going to a mall to walk when the sidewalks are wet and slippery.
  • Swimming or walking inside swimming pool (where water level is at least till your thigh) is a very good strengthening exercise that prevents jerks and unnecessary strain on the knee.
  • Stay positive and committed. Don’t give up, and do what you can to keep a good attitude.

Don’ts :

For 6-8 weeks after surgery, avoid:

  • Any pivoting (twisting) on your knee 2.Kneeling down 3.Squatting
  • Avoid high impact activities that cause jerk and stress on the knee joint, example running, jogging, rock climbing etc.
  • Avoid unnecessary stress on your knee by lifting very heavy objects. This can cause damage to your new knee.
  • Avoid using Indian traditional toilet, instead use a Western Commode (WC) or toilet chair.

Immediately after surgery, you can continue to do the following in bed :

1. Deep Breathing and Coughing Exercises : Knee replacement rehab - Pump your ankles
Until you are up and moving well, take at least 10 deep breaths, followed by a cough, every hour that you are awake.
2. Pump Your Ankles :
When lying down, move feet up and down and in circles. Repeat 10 -15 times every hour you are awake.
3. Buttock Contractions
Tighten your buttock muscle and hold for a count of 5 seconds. Repeat five to ten times, three to four times each day

4. Moving your new knee :

It is important to move your knee soon after the operation unless your surgeon or physiotherapist tells you not to. This will minimize stiffness, pain and swelling, and reduce the formation of scar tissue. Check with your physiotherapist for guidance about the best way to warm up your new joint.

 

To Keep Pain and Swelling under control, once you are home:

1. Rest Your Joint          TKR - Rest your joint

  • Change positions often (every 20 minutes) when you are awake. Try sitting, standing, and walking.
  • Pace yourself. Take things easy and slow.
  • Lie down 3 times a day for 30 minutes on your bed.
  • Put your leg up and support it with a rolled towel or with pillows (as shown).

2. Use Ice
Ice your knee when it is hot and red, painful and after exercises. (If your knee is very stiff and painful, check with your physiotherapist before icing
Follow these steps:

  • If your scar is not healed, cover it with a clean bandage and clean plastic wrap
  • Put a damp hand towel over your knee
  • Put a flexible gel pack, or plastic bag with crushed ice on your knee
  • Leave the ice ON for 10 minutes. Take it OFF for 10 minutes. Put it back ON for 10 minutes. Repeat 4-6 times a day
  • DO NOT use ice if your doctor has told you that the circulation to your legs is poor and that you should avoid using ice or heat

3. Use Pain Medicine
Use your pain medicines as prescribed by your doctor. Tell your doctor if the pain is too much or not improving.

4. Use Walking Aids
Use the walking aid that your physiotherapist has measured and recommended. Do not change or stop using the walking aid until your physiotherapist or surgeon tells you to. Walkers, crutches and canes help to:

  • Reduce the stress on your knee Reduce pain Improve your balance and reduce falls
  • Remember it is better to have a good walking pattern using two crutches than to limp and risk losing balance.

5. Sleep :

It helps with rest and recovery. It is normal to have some sleepless nights up to 12 weeks after your knee surgery.

Consult an expert at ReLiva Physiotherapy & Rehab to learn more about rehab, Mobility Techniques and tips to make your Total Knee Replacement (TKR) Surgery a success.

 

Related Reading:

Physiotherapy at home

Ageing Knees? Don’t go weak in your Knees

Five Ways to check your Knee health

Arthritis – Do your Joints Pain?

 

cardiac physiotherapy

CardioVascular Diseases – Improving Heart Health via Cardiac Rehab Program

India is one of the most populous countries in the world. The present health scenario suggests that our country is undergoing an epidemiological transition. The epidemiological infectious diseases are getting superseded by the non-communicable diseases (NCD). Estimates indicate that NCDs account for 53% of total deaths in India & Cardiovascular diseases (CVD) mortality tops the list of NCD deaths with 45% of deaths accounted by CVD.#1

Increasingly even the government setups in India are also acknowledging and approving of Cardiac Rehab Programs as effective and needed to ensure SPEEDY Recovery and enhance surgical OUTCOME (cardiac surgery).

What are Cardiovascular Diseases?

Cardiovascular diseases (CVDs) are a class of diseases that involves heart or blood vessels. Common CVDs include-Read More

physiotherapy after surgery

Recovering After Surgery With Physiotherapy

Physiotherapy post surgery in the hospital and at Home

Physiotherapy after surgery is an integral part of treatment for patients who are or have been hospitalized as prolonged immobilization puts patients at risk for complications such as deconditioning, muscle weakness, myopathy and neuropathy, respiratory infections, and contractures. It is important for such patients to consider physiotherapy at home as an integral part of the recovery process.

The main aim of a physiotherapist is to assist your return to normal activities of daily living after hospitalisation. Physiotherapists typically help with many aspects of your treatment while in the intensive care unit (ICU) and will continue working with you when you transfer to a general ward until you leave hospital to go home. Even at home, in many cases a physiotherapy home care program can significantly aid the recovery of patient. ReLiva Physiotherapy's home care program is designed and our physiotherapists understand the requirements for post surgical/ post ICU patients

Our home visit physiotherapist will assess and treat :

  • neurological,
  • musculoskeletal and
  • cardiorespiratory complications of the patients and help them in recovery.

The physiotherapist is involved in specific patient positioning, suctioning, mobilization, ambulation, strengthening and balance exercises, passive range of motion exercises and airway clearance techniques.

As per Dr Farhad Kapadia, Consultant Physician, M.D, M.R.C.P, D.A (U.K.), E.D.I.C, FRCP: "Physiotherapy may be our best tool in getting the patient rapidly functional after a critical illness, and it needs to become an integral aspect of intensive care"

Benefits of physiotherapy:

  • Enables the patients to recover from the episodes of hospital as early as possible
  • Prevent post op complications
  • Teach the patient how to manage their own recovery post discharge
  • Facilitate safe and early discharge by reducing the length of stay in the hospital
  • Improves the quality of life

Physiotherapy helps in:

  • Improve the cardiovascular endurance
  • Improved performance of daily tasks
  • Improves the strength and endurance of the muscles
  • Improves the lung capacity
  • Makes the patient mobile and independent
  • Improves the airway clearance
  • Early mobilization of ventilated patients by a physiotherapist reduces mortality, and results in improved physical function and mobility

Physiotherapy post surgery:

The main aim is to return to the normal activities as early as possible.

Routine post operative physiotherapy intervention comprises of breathing exercises, circulatory exercises and early mobilisation to prevent complications and education in home management cardiovascular fitness, limiting restrictions due to medical procedure and

Positioning: To prevent complications like bedsores, congestion in the lungs, change of positions after regular intervals become important.

Chest PT:

  • Breathing exercises are important for the patient to reduce the chest infections and improve the air entry in the lungs. It also helps complete expansion of the thorax in order to have an effective breathing. Breathing exercises includes deep breathing exercises, segmental breathing exercises, thoracic expansion exercises, pursed lip breathing exercises and active cycle of breathing techniques.
  • Coughing huffing techniques where the patient is taught how to do forceful expiration by supporting the wound to get rid of the accumulated sputum actively
  • Airway clearance: physiotherapists help to clear the excess sputum by different techniques like positioning the patient, postural drainage, suctioning and use of different expiratory devices

Limb PT:

  • It is important to maintain blood circulation following surgery to reduce the risk of deep vein thrombosis due to immobility. Hence mobility exercises are important.
  • Also, it helps to improve and maintain the joint mobility and muscle strength which eventually gets deconditioned due to illness

Mobilisation:

  • Early mobilisation is a key factor in reducing post operative complications, enabling a quick recovery and timely discharge from hospital. Patient is assisted to get out of bed by physiotherapist on the day of your operation or the following day depending upon the type of the surgery. The final goal is to increase patients mobility making them independent and training stair climbing if required.

The above mentioned treatment principles were the general ones. But the treatments differs in different surgeries viz; orthopedic surgeries, abdominal surgeries, cardiothoracic surgeries, vascular surgeries, neuro surgeries.

To determine the treatment needs,the physiotherapist assesses the patients physical function including:

  • Pain, swelling, joint range of motion, muscle strength, muscle coordination, mobility status, balance, respiratory status and cardiovascular fitness in ortho surgeries
  • Pain, discrepancies in balance, coordination, muscle weakness and fatigue, work of breathing, and loss of range of movement, loss of cardiovascular fitness and mobility status in abdominal and cardiovascular surgeries
  • Pain, muscle tone, consciousness, orientation, work of breathing, balance and coordination, sitting and standing ability, synergy patterns, gait in neuro surgeries.

If you or your loved ones, have been recently discharged from the hospital after a long stay, the patient needs to continue supervised physiotherapy treatment to ensure complete recovery in the long term basis. Please feel free to give us a call at 9920991584 and speak to our physiotherapists should you require any assistance.

 

Related Reading:

Stroke Rehab: A Complete Care and Recovery

Stroke Treatment and Life afterwards

Physiotherapy at Home

 

Home-visit-reliva-e1499147209587-1

Dreams come true!

Painful knees are a very common occurrence among the elderly and so was with Mr Narayanaswamy. He continued to live with painful knees which eventually hampered his everyday activity. There was chronic pain and despite medication his walking and general movement began to decline. He continued to console himself that the reduced activity and stamina was owing to his increasing age.

But after a prolonged period of about two years, by when he was bed-ridden and almost totally inactive – he underwent total knee replacement as advised by his doctor.

After an initial rehab of knee replacement, an average person usually reports significant improvement in walking and other movements. Unfortunately Mr Narayanaswamy was not showing any signs of recovery. Instead he consistently suffered from fever and weight loss. Eventually a TB infection was diagnosed that had affected the TKR implant too. So a revision surgery had to be performed on him shortly, thereafter.

It is at this stage that I got to meet Mr S. Narayanaswamy – who had gone through so much in the last two years. Not just being physically weak he was feeling mentally drained too. He recalls “After I came from the hospital, I was very low on physical as well as mental strength. I was depressed also.  Even the slightest of movement made me breathless.

I was to be his home visit Physiotherapist from ReLiva. On his initial assessment, I realized that it was not just his stamina, he was even having difficulty balancing himself while standing. He had been bed-ridden and completely inactive for more than a year.

As a physiotherapist, I identified that his immediate goal was to improve his balance, regain strength and thereafter build up his stamina. All of these eventually will help him regain self-confidence.

Knee replacement recovery with Reliva

Together we worked hard day-in and day-out. I would visit him regularly at his place and work on his goals through a combination of therapy and exercises. Gradually he showed signs of recovery and began to stand properly on his own. We systematically progressed to the next set of exercises. Now I had prescribed him several movements to be done on his own during the rest of the day. The committed and sincere person that he was, he would do those home exercises diligently on most occasions. We were moving from one strength to another.

It was at the end of another session of physiotherapy when he broke the news with a beaming smile that he was thinking of visiting his daughter abroad!

We had come a long way. Here was a man who was completely bed-ridden for a year and a half and could not even speak on the telephone for more than a minute and NOW – he wanted to travel overseas! He was daring to dream and together we shall have to make his dream come true! We now worked towards a deadline when he could walk independently to take this long journey on his own.

After another bout of intense physiotherapy, he reported, “my energy level has gone up, I have regained my emotional strength, there is no depression, no breathlessness! I am walking properly and climbing stairs.”

Last, I saw him the day before he was to take his flight and he walked on his own with his walking stick. We did some strengthening exercises which he would continue doing on his own while he was away. He told me that “I am a happy individual now. I am back to life!” … what he didn’t realise was : What a happy and delighted therapist he was leaving behind in me watching his dream come true!

As shared by Dr Shrutika Parab (PT). Dr Shrutika is a home visit physiotherapist with ReLiva Physiotherapy. She is popular among her clients for her enthusiastic and positive approach. 

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