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