OSTEOPOROSIS PT and Fitness

1. OSTEOPOROSIS PT and Fitness

2. OUR TEAM • Katie O’Hara PT • Julie Neaderthal PT • Sheila Gaffney PT • Mark Snow ATC

3. 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

4. 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.

5. 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

6. 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.

7. Movement Safety with Osteoporosis • Patient Education Presentation – based on the osteoporosis booklet

8. What is Osteoporosis ? Osteoporosis is a disease that causes bones to become thin, weak and easy to break. Causes • family history • diet • Medications • lack of physical activity

9. Most common fracture sites Hips Wrists Spine

10. 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 Factors that affect strong bones:

11. Physical Therapy Initial Evaluation Medical history Physical Assessment • Posture • Joint range of motion • Strength • Flexibility • Daily activity Pain control (if necessary) Exercise

12. Home Exercise Program • Stretching and strengthening • Posture and body positioning /body mechanics • Fall prevention in the home

13. 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

14. Making your home safe • Floors • Lighting • Nightlights • Telephone access • Electrical cords secured • Pets • Throw rugs

15. 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

16. 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

17. Stairs • Handrails on both sides • Non slip surface • Uncluttered stairs • Steps more visible • Marked with tape

18. 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

19. 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 sessions6 one hour sessions • $80 Member $100 Member • $150 Non-member $200 Non-member

20. Patient EducationExercise ProgramBooklet