Providing Care and Support to People with Special Needs PDF

COMPETENCY-BASED LEARNING MATERIAL DAISY RUIZ-VIOLETA 1 UNIT OF COMPETENCY : PROVIDE CARE AND SUPPORT TO PEOPLE WITH SPECIAL NEEDS MODULE TITLE : PROVIDING CARE AND SUPPORT TO PEOPLE WITH SPECIAL...

COMPETENCY-BASED LEARNING MATERIAL DAISY RUIZ-VIOLETA 1 UNIT OF COMPETENCY : PROVIDE CARE AND SUPPORT TO PEOPLE WITH SPECIAL NEEDS MODULE TITLE : PROVIDING CARE AND SUPPORT TO PEOPLE WITH SPECIAL NEEDS MODULE DESCRIPTOR : This module covers the knowledge, skills and attitudes required in providing support and assistance to maintain a quality care for people with special needs to be able to enhance their abilities to communicate and to be independent, responding to the physical, medical, health and safety, personal care and home maintenance requirements of people with disabilities. NOMINAL DURATION :150 hours QUALIFICATION LEVEL :NC II SUMMARY OF LEARNING OUTCOMES: Upon completion of this module, the trainee/student must be able to: LO1. Establish and maintain appropriate relationship with people with special needs LO2. Provide appropriate support to people with special LO3. Assist in maintaining well-being of people with special needs LO4. Assist people with special needs to identify and meet their needs LO5. Assist people with special needs in maintaining an environment that enables maximum independent living DAISY RUIZ-VIOLETA 2  SESSION PLAN Sector : HEALTH CARE Qualification Title : CAREGIVING NC II Unit of Competency : Provide care and support to people with special needs Module Title : Providing care and support to people with special needs A. INTRODUCTION: This unit covers the knowledge, skills and attitudes required to the Human Person and the Basic Human Rights, What is Disability, Effects of Disability on Basic Human Rights, Rehabilitation and Therapy, Goal of Rehabilitation and Therapy, What is CPR, Persons with Disabilities and Society, Person with Disabilities and Rehabilitation Professionals, Person with Disabilities in Love Relationship and Having a Family, Education and Employment/Work. B. LEARNING ACTIVITIES LO 1: Establish and maintain appropriate relationship with people with special needs Learning Content Methods Presentation Practice Feedback Resources Time Read Information  Answer Self- Sheet 1.1-1 on Check 1.1-1  The rights of  The rights  Perform Task  Lecture/  Compare answers on CBLM persons with of person Sheet 1.1-1 on discussion Answer Key 1.1-1 projectors, disability with  The rights of  Demonstration  Evaluate own 30  Issues disability person with slides, and return performance using hours confronting  Issues disability visual demonstration Performance Criteria persons with confronting  Issues aids  Brainstorming Checklist 1.1-1 disabilities persons confronting with persons with disabilities disabilities DAISY RUIZ-VIOLETA 3 C. ASSESSMENT PLAN  Written Test  Performance Test  Oral Questioning D. TEACHER’S SELF-REFLECTION OF THE SESSION DAISY RUIZ-VIOLETA 4  Information Sheet 1.1-1  The rights of persons with disability  Issues confronting persons with disabilities Learning Objectives: After reading this INFORMATION SHEET, YOU MUST be able to; 1. Know how to deal with people with special needs are aimed at generating a trusting relationship which includes protecting confidentially, privacy, individual choices and the right to decision making. 2. Know how to suspect for individual differences was demonstrated in all dealings with people with special needs. 3. Know how to support for the interests, rights and decision making of people with special needs was demonstrated in all dealings. 4. Know how to actively encourage and supported people with special needs to communicate ideas, feelings and preferences. This sheet covers the knowledge, skills and attitudes required in providing support and assistance to maintain a quality care for people with special needs to be able to enhance their abilities to communicate and to be independent, responding to the physical, medical, health and safety, personal care and home maintenance requirements of people with disabilities. DAISY RUIZ-VIOLETA 5  SELF-CHECK 1.1-1 TEST I. Encircle the correct answer (15pts) 1. Bodily right. a. Right to live and have bodily integrity. b. Right to food, clothing, shelter, rest and medical care. c. Right to self-determination. d. A and B 2. Economic rights. a. Right to work. b. Right to good working conditions and just wages. c. A and B 3. Mobility rights a. Right to move freely and live wherever one likes. b. Right to good working condition and just wages. c. All of the above d. None of the above 4. Level of the body a. Limited in nature, duration and quality b. Anatomical structure c. Related to impairment, quality, health and other contextual facts d. All of the above 5. Level of activity. a. Limited in nature, duration and quality b. Anatomical structure c. Related to impairment, quality, health and other contextual facts d. None of the above 6. Level of participation a. Anatomical structure b. Limited in nature, duration and quality c. Related to impairment, quality, health and other contextual facts d. All of the above 7. Disease a. Trauma, genetic factors, age. b. Trauma, genetic factors, heredity c. Trauma, genetic factors d. All of the above 8. Environment a. Attitudes, social demands, skills b. Attitudes, social demands, knowledge c. Attitudes, social demands DAISY RUIZ-VIOLETA 6  d. None of the above 9. Physical Therapy (PT) a. Needs of the people with musculoskeletal, neurological, cardiovascular, pulmonary, condition. b. Strength and restore the PWD’s to the highest possible level function. c. Speech and language d. Psychological and emotional problem of the PWD’s 10. Occupational therapy (OT) a. Needs of the people with musculoskeletal, neurological, cardiovascular pulmonary, condition. b. Strength and restore the PWD’s to the highest possible level function. c. Speech and language d. Psychological and emotional problem of the PWD’s 11. Level of the body/Body pant a. Impairment b. Disability c. Handicap d. None of the above 12. Level of activity a. Impairment b. Disability c. Handicap d. None of the above 13. Level of the body and body pant a. Impairment b. Disability c. handicap d. None of the above 14. Level of the body and body pant a. Hypertension and malfunctioning of the brain b. Inability to walk c. Inability to work d. None of the above 15. Level of participation a. Hypertension and malfunctioning of the brain b. Inability to walk c. Inability to work d. None of the above TEST II. ESSAY (15pts) 1. What is CBR? 2. What is PWD? 3. What are the causative factors? DAISY RUIZ-VIOLETA 7 TEST III. Enumeration 1. Basic human rights (8) 2. 3 levels functioning of disability (3) 3. Different types of therapy (4) 4. Examples of individual consequences (3) 5. Examples of family consequences (2) DAISY RUIZ-VIOLETA 8  ANSWER KEY 1.1-1 TEST I. 1. D 2. C 3. A 4. B 5. A 6. C 7. C 8. C 9. A 10. B 11. A 12. B 13. C 14. A 15. C TEST II. 1. CBR means Community-Based Rehabilitation is a vision, a developmental process and a program and service. 2. PWD means Persons with Disabilities 3. Disease (Trauma, Genetic factors) and Environment (Attitudes, Social Demands) TEST III. 1. a. Bodily rights b. Political rights c. Mobility rights d. Social rights e. Economic rights f. Sexual and familial rights g. Religious rights h. Communication rights 2. a. Level of the body/body part b. Level of activity c. Level of participation 3. a. Physical therapy b. Occupational therapy c. Speech pathology d. Psychological and emotional therapies 4. a. Decrease of DAISY RUIZ-VIOLETA 9  a.1 Independence a.2 Mobility a.3 Leisure activities a.4 Social integration a. 5 Finances b. Poor quality of life c. Poor self-esteem 5. a. Need for care b. Distributed social relationship c. Economic Burden DAISY RUIZ-VIOLETA 10  TASK SHEET 1.1-1 Title: Establish and maintain appropriate with people with special needs Performance Objective: 1. Know how to deal with people with special needs are aimed at generating a trusting relationship which includes protecting confidentially, privacy, individual choices and the right to decision making. 2. Know how to suspect for individual differences was demonstrated in all dealings with people with special needs. 3. Know how to support for the interests, rights and decision making of people with special needs was demonstrated in all dealings. 4. Know how to actively encourage and supported people with special needs to communicate ideas, feelings and preferences. Supplies/Materials: Cleaning materials (Detergent soap, brushes, broom mops, rags, glass wiper or squeegee), Legal requirements and regulations regarding supervision, Disinfectants, beddings (blankets, disposable draw sheet, cotton draw sheets, pillow and pillow case) and CBLM Equipment: Assistive devices and Vacuum Cleaner Steps/Procedure: 1. Know how to deal with people with special needs are aimed at generating a trusting relationship which includes protecting confidentially, privacy, individual choices and the right to decision making. 2. Know how to suspect for individual differences was demonstrated in all dealings with people with special needs. 3. Know how to support for the interests, rights and decision making of people with special needs was demonstrated in all dealings. 4. Know how to actively encourage and supported people with special needs to communicate ideas, feelings and preferences. Assessment Method: Direct observation, practical demonstration, oral and written exams. DAISY RUIZ-VIOLETA 11  Performance Criteria Checklist 1.1-1 CRITERIA YES NO Did you…. 1. Know how to deal with people with special needs are aimed at generating a trusting relationship which includes protecting confidentially, privacy, individual choices and the right to decision making? 2. Know how to suspect for individual differences was demonstrated in all dealings with people with special needs? 3. Know how to support for the interests, rights and decision making of people with special needs was demonstrated in all dealings? 4. Know how to actively encourage and supported people with special needs to communicate ideas, feelings and preferences? DAISY RUIZ-VIOLETA 12 EVIDENCE PLAN Competency CAREGIVING NCII standard: Unit of PROVIDING CARE AND SUPPORT TO PEOPLE WITH competency: SPECIAL NEEDS Ways in which evidence will be collected: Oral Questioning Demonstration Written The evidence must show that the trainee… The rights of persons with disability Issues confronting persons with disabilities NOTE: *Critical aspects of competency DAISY RUIZ-VIOLETA 13  SESSION PLAN Sector : HEALTH CARE Qualification Title : CAREGIVING NC II Unit of Competency : PROVIDE CARE AND SUPPORT TO PEOPLE WITH SPECIAL NEEDS Module Title : PROVIDING CARE AND SUPPORT TO PEOPLE WITH SPECIAL NEEDS A. INTRODUCTION: This unit covers the knowledge, skills and attitudes required to the prevention, early detection and rehabilitation of different disabilities, rehabilitation of children with disability, rehabilitation of disabilities among the elderly and rehabilitation of disabilities among children and elderly. B. LEARNING ACTIVITIES LO 2: Provide appropriate support to people with special needs Learning Content Methods Presentation Practice Feedback Resources Time  Prevention, Read Information  Answer Self- early Sheet 2.1-1 on Check 2.1-1 detection and  Prevention,  Perform Task rehabilitation early Sheet 2.1-1 on of different detection  Lecture/  Prevention,  Compare answers on CBLM disabilities and discussion early detection Answer Key 2.1-1 projectors,  Rehabilitatio rehabilitatio 30  Demonstration and  Evaluate own n of n of slides, and return rehabilitation performance using hours disabilities different visual demonstration of different Performance Criteria among the disabilities aids  Brainstorming disabilities Checklist 2.1-1 elderly  Rehabilitati  Rehabilitation  Rehabilitatio on of of disabilities n of disabilities among the disabilities among the elderly common elderly DAISY RUIZ-VIOLETA 14  among  Rehabilitati  Rehabilitation children and on of of disabilities elderly disabilities common common among among children and children elderly and elderly C. ASSESSMENT PLAN  Written Test  Performance Test  Oral Questioning D. TEACHER’S SELF-REFLECTION OF THE SESSION DAISY RUIZ-VIOLETA 15  Information Sheet 2.1-1  Prevention, early detection and rehabilitation of different disabilities  Rehabilitation of children with disability  Rehabilitation of disability among the elderly  Rehabilitation of disabilities common among children and elderly Learning Objectives: After reading this INFORMATION SHEET, YOU MUST be able to; 1. Know how to support and provide to people with special needs in accordance with their needs, rights and self-determination. 2. Know how to assist and provide to people with disabilities according to the employment organization guidelines. 3. Know how to identify and provide information required by people with special needs. 4. Know how to recognized, reacted the limitations regarding differences and appropriate assistance was sought to ensure that the rights of people with special needs are upheld. This unit covers the knowledge, skills and attitudes required to the prevention, early detection and rehabilitation of different disabilities, rehabilitation of children with disability, rehabilitation of disabilities among the elderly and rehabilitation of disabilities among children and elderly. DAISY RUIZ-VIOLETA 16  SELF-CHECK 2.1-1 TEST I. Fill in the blanks (25pts) ________________ 1. Clean and sanitary environment. ________________ 2. Breast-feeding. ________________ 3. Condition wherein the child has problem with movement and body positioning due to brain damage. ________________ 4 – 9. Types of Celebral palsy ________________ 5. ________________ 6. ________________ 7. ________________ 8. ________________ 9. ________________ 10. Condition wherein a child has difficulty relating to people and things in his/her environment. ________________ 11. Condition caused by a misplaced extra chromosomes which consequently will affect the growth and development of a child. ________________ 12. Sudden loss of consciousness in a short time or a temporary or sudden change in mental state. ________________ 13. Mentally delayed or has a slow capacity to think. ________________ 14. Progressive characterized by the gradual weakening of the muscles. ________________ 15. Can only say a few words with separated vowels. ________________ 16. Cutting of one part of the body. ________________ 17. Condition caused by tearing or over stretching of ligament. ________________ 18. Condition of joints where there is pain or swelling. ________________ 19. Where there is massive production of phlegm in the lungs resulting in severe cough. ________________ 20. Wherein the person has difficulty breathing due to the narrowing of the passageway of oxygen in the lungs. ________________ 21. Wherein lung tissues are inflamed due to bacteria or virus. DAISY RUIZ-VIOLETA 17 ________________ 22. Condition where in an inflammation of the lungs occur because of bacteria. ________________ 23. Loss of muscle power or paralysis and loss of sensation in the affected body parts. ________________ 24. Condition wherein there is a lateral curvature of the spine. ________________ 25. All the extremities are paralyze. Quadriplegia Mental retardation Pulmonary Tubercolosis Amputation Spinal cord injury Sprain Pneumonia Hemiplegia Asthma Monoplegia Bronchitis Triplegia Arthritis Paraplegia Scolosis Diplegia Muscular dystrophy Quadriplegia Speech delay Celebral palsy Autism Malnutrition Down’s Syndrome Infectious diseases Convulsion/Epilepsy DAISY RUIZ-VIOLETA 18  ANSWER KEY 2.1-1 1. Infectious diseases 2. Malnutrition 3. Celebral palsy 4. Quadriplegia 5. Diplegia 6. Paraledgia 7. Triplegia 8. Hemiplegia 9. Monoplegia 10. Autism 11. Down’s Syndrome 12. Convulsion/Epilepsy 13. Mental Retardation 14. Muscular dystrophy 15. Speech delay 16. Amputation 17. Sprain 18. Arthritis 19. Bronchitis 20. Asthma 21. Pneumonia 22. Pulmonary tuberculosis 23. Spinal cord injury 24. Scolosis 25. quadriplegia DAISY RUIZ-VIOLETA 19  TASK SHEET 2.1-1 Title: PROVIDING APPROPRIATE SUPPORT TO PEOPLE WITH SPECIAL NEEDS Performance Objective: 1. Know how to support and provide to people with special needs in accordance with their needs, rights and self-determination. 2. Know how to assist and provide to people with disabilities according to the employment organization guidelines. 3. Know how to identify and provide information required by people with special needs. 4. Know how to recognized, reacted the limitations regarding differences and appropriate assistance was sought to ensure that the rights of people with special needs are upheld. Supplies/Materials: Legal and legislative requirements, play area with appropriate toys and paddings, dummies (baby and toodler), gates on stairs, cover on electrical socket, fire exit, cleaning materials and CBLM Equipment: Assistive devices (wheelchair, commode, cane, crutches and walker) and Fire Extinguisher Steps/Procedure: 1. Know how to support and provide to people with special needs in accordance with their needs, rights and self-determination. 2. Know how to assist and provide to people with disabilities according to the employment organization guidelines. 3. Know how to identify and provide information required by people with special needs. 4. Know how to recognized, reacted the limitations regarding differences and appropriate assistance was sought to ensure that the rights of people with special needs are upheld. Assessment Method: Direct observation, practical demonstration, oral and written exams. DAISY RUIZ-VIOLETA 20  Performance Criteria Checklist 2.1-1 CRITERIA YES NO Did you…. 1. Know how to support and provide to people with special needs in accordance with their needs, rights and self- determination? 2. Know how to assist and provide to people with disabilities according to the employment organization guidelines? 3. Know how to identify and provide information required by people with special needs? 4. Know how to recognized, reacted the limitations regarding differences and appropriate assistance was sought to ensure that the rights of people with special needs are upheld? DAISY RUIZ-VIOLETA 21 EVIDENCE PLAN Competency CAREGIVING NCII standard: Unit of PROVIDE CARE AND SUPPORT TO PEOPLE WITH competency: SPECIAL NEEDS Ways in which evidence will be collected: Oral Questioning Demonstration Written The evidence must show that the trainee… Prevention, early detection and rehabilitation of different disabilities Rehabilitation of children with disability Rehabilitation of disabilities among the elderly Rehabilitation of disabilities common among children and elderly NOTE: *Critical aspects of competency DAISY RUIZ-VIOLETA 22  SESSION PLAN Sector : HEALTH CARE Qualification Title : CAREGIVING NC II Unit of Competency : Provide care and support to people with special needs Module Title : Providing care and support to people with special needs A. INTRODUCTION: This unit covers the knowledge, skills and attitudes required Sensory integration techniques, training in activities in daily living, work simplification and conversation of energy technique, transfer, gait training, stimulation for speech, breathing and coughing techniques, preparation and application of hot pack/hot compress, preparation and application of cold compress/cold packs, immersion in cold water, immersion in hot water, immersion in a hot/cold water and pre-natal exercise. B. LEARNING ACTIVITIES LO 3: Assist in maintaining well-being of people with special needs Learning Content Methods Presentation Practice Feedback Resources Time  Answer Self-  Lecture/ Read Information  Compare answers on CBLM Check 3.1-1 discussion Answer Key 3.1-1 projectors,  Common Sheet 3.1-1 on  Perform Task  Demonstration  Evaluate own 30 treatment  Common Sheet 3.1-1 on slides, and return performance using hours procedures treatment  Common visual demonstration Performance Criteria  Brainstorming procedures treatment aids Checklist 3.1-1 procedures C. ASSESSMENT PLAN  Written Test  Performance Test  Oral Questioning D. TEACHER’S SELF-REFLECTION OF THE SESSION DAISY RUIZ-VIOLETA 23  Information Sheet 3.1-1 Common Treatment Procedures Learning Objectives: After reading this INFORMATION SHEET, YOU MUST be able to; 1. Know how to supervised clients in accordance with the legal requirements and regulations. 2. Know how to explain, model and implement rules for safe play. 3. Know how to maintain direct contacts with individuals/group. 4. Know how to identify and act upon potential risk to prevent or minimize risk. 5. Know how to identify hazards and potential hazards in the environment and clients are informed accordingly. 6. Know how to discuss and practiced emergencies and evacuation procedures. 7. Know how to used supervision as an opportunity to interact with client. This sheet covers the knowledge, skills and attitudes required Sensory integration techniques, training in activities in daily living, work simplification and conversation of energy technique, transfer, gait training, stimulation for speech, breathing and coughing techniques, preparation and application of hot pack/hot compress, preparation and application of cold compress/cold packs, immersion in cold water, immersion in hot water, immersion in a hot/cold water and pre-natal exercise. DAISY RUIZ-VIOLETA 24  SELF-CHECK 3.1-1 TEST I. ESSAY 1. Define the following a. Tactile b. Proprioception c. Vestibular d. Auditory e. Visual 2. Discuss briefly the breathing technique and the coughing technique. 3. Discuss briefly preparation of hot packs and hot compress. 4. Discuss briefly preparation of cold packs and cold compress. 5. Immersion to hot and cold water. DAISY RUIZ-VIOLETA 25  ANSWER KEY 3.1-1 1. a. The sense of touch serves as protection from being hurt and to recognize the characteristic of the things. b. Gives the information to the brain regarding to the position and extend of movement of the different body parts. c. Allows the brain to determine which is above and below, what is the position of the head in relation to gravity and to maintain balance. d. Allows the brain to identify and integrate different sounds that a person hears. e. Allows the brain to process everything that is seen and used in all activities. 2. Breathing technique 1. Do this breathing exercise while half-lying position with one’s back resting on the three to four pillows place one on top of another. 2. Place one hand on the chest and the other on the stomach. 3. Inhale through the nose. 4. Exhale slowly through the mouth while making the sound “pssst”. 5. In exhaling again, avoid moving the chest, neck or shoulder. 6. Do the above exercise six times every six hours. There should be a rest between set of six. Coughing Technique 1. Do the breathing exercise describe above. 2. On the third count, instead of exhaling with a “psstt” sound, hold a breath then cough twice. One must feel a certain stiffening in the stomach area while coughing. 3. Things needed:  2 towels with one folded according to the size of the part to be treated.  Boiled water  2 plastic bag  2 wash basin Procedure: A. 1. Spread a towel or a clean piece of cloth in a wash basin (towel 1). Get another towel folded according to the size of the part to be treated (towel 2). Place it at the center of towel 1 in the wash basin. Pour the boiling water into towels 1 and 2. 2. Then fold towel 1 to wrap towel 2. Twist the ends of towel 1 to partly squeeze the hot water out of the towels. 3. Place these inside a plastic bag. 4. Wrap them with a moist towel B. 1. Expose sufficient amount of sand under the sun. 2. If it is hot enough place the sand in a bottle. 3. Wrap it with a moist towel. 4. A. Preparing a cold compress Immerse two towels in a basin of cold water for 5 up to 7 minutes. Then take the towels out of the basin and squeeze them. DAISY RUIZ-VIOLETA 26  Procedure of cold compress Place the cold compress alternately for 15 minutes on the affected part or on the forehead in case of high temperature. The coldness stays for 5 to 10 minutes. B. Preparing cold packs Prepare some crushed ice in a plastic bag. Wrap this with towel. Procedure: 1. Apply oil on the affected part. This is to prevent ice burn. 2. Apply the cold pack on the affected part for 15 minutes. 3. Remove the cold pack after every 3 minutes in order to avoid burns. 5. Prepare 2 basins or buckets. Fill one of them with cold water and the other with hot water. The water must not be boiling hot so as not to cause burns. Procedure: 1. Immerse the affected part for 3 minutes in the container with hot water after 3 minutes, take it out of the water. 2. Then immerse for one minute in the other container with cold water 3. Repeat steps 1 and 2 five times. 4. Wipe it dry. DAISY RUIZ-VIOLETA 27  TASK SHEET 3.1-1 Title: Assisting in Maintaining well-being of people with special needs Performance Objective: 1. Know how to supervised clients in accordance with the legal requirements and regulations. 2. Know how to explain, model and implement rules for safe play. 3. Know how to maintain direct contacts with individuals/group. 4. Know how to identify and act upon potential risk to prevent or minimize risk. 5. Know how to identify hazards and potential hazards in the environment and clients are informed accordingly. 6. Know how to discuss and practiced emergencies and evacuation procedures. 7. Know how to used supervision as an opportunity to interact with client. Supplies/Materials: Legal Requirements and regulation regarding safe play, Evacuation and emergency exits, Non-purpose built center, Purpose built center, Fences and Locking mechanism and CBLM Equipment: Assistive devices Steps/Procedure: 1. Know how to supervised clients in accordance with the legal requirements and regulations. 2. Know how to explain, model and implement rules for safe play. 3. Know how to maintain direct contacts with individuals/group. 4. Know how to identify and act upon potential risk to prevent or minimize risk. 5. Know how to identify hazards and potential hazards in the environment and clients are informed accordingly. 6. Know how to discuss and practiced emergencies and evacuation procedures. 7. Know how to used supervision as an opportunity to interact with client. Assessment Method: Direct observation, practical demonstration, oral and written exams. DAISY RUIZ-VIOLETA 28  Performance Criteria Checklist 3.1-1 CRITERIA YES NO Did you…. 1. Know how to supervised clients in accordance with the legal requirements and regulations? 2. Know how to explain, model and implement rules for safe play? 3. Know how to maintain direct contacts with individuals/group? 4. Know how to identify and act upon potential risk to prevent or minimize risk? 5. Know how to identify hazards and potential hazards in the environment and clients are informed accordingly? 6. Know how to discuss and practiced emergencies and evacuation procedures? 7. Know how to used supervision as an opportunity to interact with client? DAISY RUIZ-VIOLETA 29 EVIDENCE PLAN Competency CAREGIVING NCII standard: Unit of PROVIDE CARE AND SUPPORT TO PEOPLE WITH competency: SPECIAL NEEDS Ways in which evidence will be collected: Oral Questioning Demonstration Written The evidence must show that the trainee… Common treatment procedures NOTE: *Critical aspects of competency DAISY RUIZ-VIOLETA 30  SESSION PLAN Sector : HEALTH CARE Qualification Title : CAREGIVING NC II Unit of Competency : Provide care and support to people with special needs Module Title : Providing care and support to people with special needs A. INTRODUCTION: This unit covers the knowledge, skills and attitudes required a Guidelines of Body mechanics, Client’s Daily level of activity, Guidelines assisting the client, Positioning a client in bed, Moving a client up in bed with his help, Moving a client up in bed Two people, Moving a client up in bed One person, Rolling the client (Log Rolling), Raising the client head and shoulder. B. LEARNING ACTIVITIES LO 4: Assist people with special needs to identify and meet their needs Learning Content Methods Presentation Practice Feedback Resources Time  Guidelines of Read Information  Answer Self- Body Check 4.1-1 mechanics Sheet 4.1-1 on  Perform Task  Client’s Daily  Guidelines  Lecture/ Sheet 4.1-1 on  Compare answers on CBLM level of of Body discussion  Guidelines of Answer Key 4.1-1 projectors, activity mechanics  Demonstration Body  Evaluate own 30  Guidelines  Client’s slides, and return mechanics performance using hours assisting the Daily level visual demonstration  Client’s Daily Performance Criteria client of activity aids  Brainstorming level of activity Checklist 4.1-1  Positioning a  Guidelines  Guidelines client in bed assisting assisting the  Moving a the client client client up in DAISY RUIZ-VIOLETA 31  bed with his  Positioning  Positioning a help, a client in client in bed  Moving a bed  Moving a client up in  Moving a client up in bed Two client up in bed with his people bed with his help,  Moving a help,  Moving a client up in  Moving a client up in bed One client up in bed Two person bed Two people  Rolling the people  Moving a client (Log  Moving a client up in Rolling) client up in bed One  Raising the bed One person client head person  Rolling the and shoulder  Rolling the client (Log client (Log Rolling) Rolling)  Raising the  Raising the client head client head and shoulder and shoulder C. ASSESSMENT PLAN  Written Test  Performance Test  Oral Questioning D. TEACHER’S SELF-REFLECTION OF THE SESSION DAISY RUIZ-VIOLETA 32  Information Sheet 4.1-1  Guidelines of Body mechanics  Client’s Daily level of activity  Guidelines assisting the client  Positioning a client in bed  Moving a client up in bed with his help,  Moving a client up in bed Two people  Moving a client up in bed One person  Rolling the client (Log Rolling)  Raising the client head and shoulder Learning Objectives: After reading this INFORMATION SHEET, YOU MUST be able to; 1. Know how to discuss the basic idea of good body mechanic. 2. Know how to apply good body mechanics during activities on and off the job. 3. Know how to explain to someone else (client or caregiver) how to use good body mechanics. This sheet covers the knowledge, skills and attitudes required a Guidelines of Body mechanics, Client’s Daily level of activity, Guidelines assisting the client, Positioning a client in bed, Moving a client up in bed with his help, Moving a client up in bed Two people, Moving a client up in bed One person, Rolling the client (Log Rolling), Raising the client head and shoulder. BODY MECHANICS BODY MECHANICS The term body mechanics refers to the way of standing and moving one’s body so as to prevent injury, avoid fatigue, and make the best use of strength. You should understand the rules of good body mechanics and learn to apply them to your work and everyday life. You will find you will be less tired and will feel better at the end of the day. Once you understand how to control and balance your client’s body. This is a major safety factor for both of you. Remember, low-back problems are one of the leading causes of employee sick time. It is most important that you learn good body mechanics to protect your back and your job. BASE OF SUPPORT The base of support determines how stable your balance will be. Try standing with both feet together. How far can you reach forward? Sideways? You probably lost your balance very quickly. Now stand with your feet separated about 6 to 8 inches with one foot a half-step ahead of the other. Repeat reaching forward and sideways. You reach farther this time before DAISY RUIZ-VIOLETA 33 losing your balance. That is because by separating your feet you made your base of support larger and your balance more stable (Figure 1) Figure 1. Providing the proper base of support for each activity will allow you to work in a safe manner and be less tired at the end of the day. CENTER OF GRAVITY The center of gravity of any object is the point at which, when held, you will have the greatest control over the object with the least amount of effort. A person’s center of gravity is located around the pelvic area (Figure 2). When moving or assisting a client, support him through his center of gravity. By holding a client close to his center of gravity and your center of gravity, you will have the greatest amount of control with the least amount of effort. The client will also feel that you have control and will be more likely to trust you and follow your directions. Figure 2. Be aware of your center of gravity and your base of support as you work. BALANCING When you must lift heavy objects, spread your feet apart and bend your knees. This will lower your center of gravity, increase stability, and broaden your base of support. For people to balance themselves, their center of gravity must remain within their base of support. Getting up from a sitting position is one example. Some people have difficulty getting up from a sitting position because they are afraid to lean forward far enough, so their center of gravity is not balanced over their base of support. If you help them move their buttocks out over their feet (properly positioned), they will usually balance quite well and learn to lose their fear. DAISY RUIZ-VIOLETA 34 STRONGEST MUSCLES Generally, the muscles that flex (bend) the joints are the strongest. In your arms, you have the greatest power and control when you are lifting with your palms facing up. In your legs, your hip flexors and your knee flexors are strongest. This is why you bend your hips and knees slightly when using good body mechanics. This puts the muscle in the best position to do heavy work. Your strongest muscles are not in your back, so do not expect your back to do heavy work. GUIDELINES: GOOD BODY MECHANICS  When an action requires physical effort, try to use as many groups of muscles as possible. For example, use both hands rather than one hand to pick up a heavy piece of equipment.  Use good posture. Keep your body aligned properly. Keep your back straight. Have your knees bent. Keep your weight evenly balanced on both feet.  Check your feet when you are going to lift something. They should be at least 12 inches apart. This will give you a broad base of support and good balance.  If you think may not be able to lift the load or if it seems too large or heavy, get help.  Lift smoothly to avoid strain. Always count “one, two, three” with the person with whom you are working. Do this with both the client and with other helpers.  If you have to move or lift a heavy object or person, use a lumbar support. A support can be obtained from your agency, or you may prefer to purchase one of your own so it is always available to you.  When you want to change the direction of movement: a. Pivot (turn) with your feet b. Turn with short steps c. Turn your whole body without twisting your neck and back.  Get close to the load that is being lifted  When you have to move a heavy object, it is better to push it, pull it, or roll it rather than lift and carry it.  Use your arms to support the object. The muscles of your legs actually do the job of lifting, not the muscle of your back. (Figure 3)  The muscles that bend your elbow are stronger that the ones that straighten it out – your greatest lift power is in pulling.  When you are doing work, such as giving a back rub, making a corner on a bed, or exercising a client, work with the direction of your efforts, not against them.  When working with a client in a hospital bed (bathing, dressing, exercising, etc.) raise the bed to a comfortable position for you. Also, move the client close to the side of the bed where you are working.  When working with a client in a bed that does not raise up, if you must stand, put one foot up on the lowered side rail or on a footstool to relieve the pressure on your lower back. Remember the same rules of a broad base of support: Use the strongest muscles DAISY RUIZ-VIOLETA 35  for the work and keep your center gravity close to your work apply when you are working with a regular bed.  Avoid twisting your body (or your client’s body) as much as you can. Figure 3. (a) Use your longest and strongest muscles. (b) Use your center of gravity and base of support as you lift and move objects. REMEMBER:  Knowing how your body balances means you will know how your client’s body balances.  Use proper body mechanics – protect your back, it is the only one you have.  Proper body mechanics need to be used whenever you stand or move. It cannot be only on-the-job behavior.  An injured back is painful, inconvenient, and costly. CLIENT’S DAILY LEVEL OF ABILITY DAILY ABILITY LEVEL Each client is different. Depending on many factors, such as age, disability, weather, and the family pressures, a client may be totally or partially dependent on you or fully independent. Activities performed one day may not be possible the next. It is your responsibility to check the daily ability level of the client before you ask him to perform an activity. Observe the client’s activity tolerance each day. Note if it decreases or increases. Checklist  Can the client hear and understand you?  Can the client follow directions?  How much can the client do alone?  How does the client look? DAISY RUIZ-VIOLETA 36   What are his vital signs?  Will pain be a factor in this activity?  Are joint motions limited?  Does the client tire easily? Your role is to help the client complete the activity, not to do it for him. Because you are not in the house all the time, the client and his family must know how to give care when you are not there. They will learn from your supervisor and your example. By setting a good example, you will teach and you will assist the client and his family in accepting whatever limitations remain. GUIDELINES: ASSISTING CLIENTS  Expect the client to do as much as possible.  Help only when needed.  Work at the client’s level and speed.  Direct activity instead of asking for it. For example, say “It is time to stand, Mrs. N” instead of “Do you want to stand up, Mrs. N?” If Mrs. N says “No!” What do you do then?  Plan ahead. Gather all equipment and put it in place before you begin the activity.  Know your own capabilities.  Give the client short, simple directions.  Praise the client for following directions. If he does not do something correctly, stop the activity and redirect him until the correct activity is done. That way, the client will get used to doing the activity the correct way only.  Your body language (your tone of voice, facial expression, the way you touch, etc.) will be received more strongly than the meaning of the words you use. Make sure your nonverbal messages fit the words you use.  Touch is the most important of the senses. You will be giving contact care to your client. If you are comfortable with this, they will be too.  Always use smooth, steady motions with clients. Avoid sudden jerking movements. POSITIONING A CLIENT IN BED BODY SUPPORT AND ALIGNMENT Many of your tasks require lifting and moving clients. Some clients will be able to help you. Some will not. A bedridden client must have his position changed at least once every 2 hours. Proper support and alignment of the client’s body are important. The client’s body should be straight and properly supported; otherwise, his safety and comfort might be affected. The correct positioning of the client’s body is referred to as body alignment or bed positioning. Arrangement or adjustment of the client’s body is made so that all parts of the body are in their proper positions in relation to each other. Proper body DAISY RUIZ-VIOLETA 37 alignment can be seen as proper standing posture. When people lie in bed, it is often necessary to use pillows and rolled-up towels to keep this alignment. Some conditions and injuries, as well as special client care treatments, make it difficult or even dangerous for a client to be in a certain position. You will be told as to any special positions that your client requires. A client who is unable to move needs to have his position changed every 2 hours to:  Minimize the possibility of muscle tightness  Reduce the chance of skin breakdown  Maintain proper body alignment  Make the client comfortable  Avoid delayed rehabilitation If a client is not properly position during the first part of his illness, it can create problems that must be taken care of before rehabilitation can begin. This often prevents or delays exercises and activities that would allow a client to function more fully. For example, if a client who is not properly positioned in bed develops a decubitis, or bedsore, it will have to heal before he can start exercises. USING THE CORRECT TERMS Clients who need physical therapy or any other types of assistance usually have some type of disability. They may have a weakness or an injury on one side. This side is not the bad side. There is nothing bad about it. Refer to it as the involved side. This means it is involved in the treatment. Refer to the other side as the uninvolved side. To point out continually to your client the fact that you, too, call his weak side the bad side will only discourage him from using it. If your client understands the concept of right and left, refer to his limbs in those terms. At times, you will have to touch the arm or leg you want him to move. You may also have to demonstrate the activity first. You will hear the words functional and nonfunctional. Functional describes the usefulness of something. It may be an activity or a body part. An activity such as folding clothes, making salad, or combing one’s hair is a functional activity because it produces a desired result. Nonfunctional body parts will not perform a useful activity. You can see that words are important and that they describe the way you feel and the way you see the client and his disability. MOVING CLIENTS IN BED For good positioning, the client must be up at the head of the bed. If your client can stand, even briefly, have him sit over the edge of the bed. Help him to stand and move his buttocks up toward the head of the bed. Repeat the process until he is in a good position to lie back down with his head at the top of the bed. In this way, you not only have your client back where you want him, but he will have exercised his muscles, heart, balance system, and coordination system all at the same time. You also have taught him a valuable activity that he can use in the future when he is stronger. DAISY RUIZ-VIOLETA 38  For those clients who cannot move themselves, a pull sheet can help you move the client in bed more easily. A regular extra sheet folded over many times and placed under the client can be used as a pull sheet. The cotton draw sheet can also be used as a pull sheet. When moving the client, roll up the pull sheet tightly on each side next to the client’s body. Grip the rolled portion underhand to slide the client into the desired position. By using the pull sheet, you avoid friction and irritation to the client’s skin that touches the bedding. COMMONLY USED POSITIONS A client can be positioned on the back, stomach, or either side or in a position halfway between side lying and stomach lying. It will depend on the client’s diagnosis, condition, and comfort which one you choose to use also, remember that just because a client cannot move without help when asked does not mean that he will stay for 2 hours in the correct position. Keep checking your client for proper position. GENERAL POSITIONING RULES  A rolled-up washcloth makes an excellent support for the hand.  If an arm or leg is swollen, try to keep the part higher than the heart. Gravity will help the extra fluid drain from the limb.  Any open skin will heal more quickly if pressure is reduced and air is allowed to circulate around it.  Position and support only nonfunctional parts of the body. The rest should be left free to move. This will help the blood to circulate.  Proper positioning can help a client maintain or recover his best possible state of health. POSITIONING A CLIENT ON HIS BACK  Place: A small comfortable pillow under the client’s head A small hand towel folded under the shoulder blade of the weak side A bath towel folded under the hip of the weak side A washcloth rolled up in the hand on the weak side A weak arm and elbow on a pillow higher than the heart A small pillow under the calf of the weak leg with the heel hanging off the mattress edge (Figure 4)  Loosen the top sheet so pressure is removed from the toes. Figure 4. Be sure the client is both safe and comfortable as you place the towels and pillows. DAISY RUIZ-VIOLETA 39 Figure 5. Remember, the client also has a center of gravity and must be in proper alignment when he is in bed. POSITIONING A CLIENT ON HIS UNINVOLVED SIDE A.  Place a small pillow under the head. Keep the head in alignment with the spine.  Roll a large pillow lengthwise, and tuck it in at the client’s back to prevent him from rolling and to give him support.  Place: A pillow in front to keep the arm the same height as the shoulder joint A medium pillow between the client’s knees (the top knee may be slightly bent or both may be bent) A small pillow between the ankles and feet (Figure 5) B.  Place: A small pillow under the head A large pillow under the involved arm to keep it level with the shoulder joint A large pillow at the stomach area (if the client wishes) for the client to roll onto POSITIONING A CLIENT ON HIS INVOLVED SIDE The same principles of positioning are used as listed, plus:  The client’s comfort will be the key to how and where support should be used.  Change the client’s position more frequently than when he is positioned on the uninvolved side.  With disability can come a lessened sense of pain and pressure. Check the involved side for signs of pressure and skin irritation. PROCEDURE: MOVING UP A CLIENT UP IN BED WITH HIS HELP 1. Wash your hands. 2. Tell the client you are going to help him move up in the bed. 3. Lock the wheels on the bed, if they are present, if possible. 4. Raise the whole bed to a height best for you. 5. Remove the pillow. Put the pillow on a chair at the foot of the bed. 6. Put the side rail in the up position on the far side of the bed. DAISY RUIZ-VIOLETA 40 7. Put one hand under the client’s shoulder. Put your other hand under the client’s buttocks. 8. Tell the client to bend his knees and brace his feet firmly on the mattress. 9. Tell the client to put his hands on the mattress to help push. 10. Have your feet 12 inches apart. The foot closest to the head of the bed should be pointed in that direction. 11. Bend your knees. Keep your back straight. 12. Facing the client and turned slightly toward the head of the bed, bend your body from your hips. (Figure 6) 13. At the signal “one, two, three”, have the client pull with his hands toward the head of the bed and push with his feet against the mattress. 14. At the same time, help him to move toward the head of the bed by sliding him with your hands and arms. 15. Put the pillow back in place. Reposition the client correctly. 16. Make the client comfortable. Lower the bed to the lowest horizontal position, if possible. 17. Wash your hands. 18. Chart your observations of the client during this procedure. Figure 6 PROCEDURE: MOVING A CLIENT UP IN BED, TWO PEOPLE 1. Ask another person to work with you. 2. Wash your hands. 3. Tell the client you and your partner are going to move him up in bed. Say this even if he appears to be unconscious. 4. Remove the pillow from the bed. Place it on a chair. 5. Lock the wheels on the bed, if they are present. 6. Raise the whole bed, if possible, to a height good for you. 7. Stand on one side of the bed. The person assisting will stand on the opposite side. 8. Both of you should stand slightly turned toward the head of the bed. Your feet should be about 12 to 14 inches apart. The foot closest to the head of the bed should be pointed in that direction. Bend your knees. Keep your back straight. 9. Use a draw, pull, or turning sheet is always preferred for moving a client up in bed. This avoids fraction between the client’s skin and bedding. It will prevent irritation of the skin. DAISY RUIZ-VIOLETA 41  10. You will be sliding the client’s body when you move him up in bed. Roll the draw sheet up to the client’s body and grab underhand. Shift the weight of your body from your back leg to your front leg up near the head of the bed. By keeping your back and arms “locked” in position when you shift your weight, your legs will help you use your body weight to your advantage and pull the client up. 11. Explain step 10 to both your assistant and the client. Count to three as pre-arranged. You and your partner will move together to slide the client gently toward the head of the bed. (Figure 7) 12. Replace the pillow. Position the client correctly. Raise the side rails (if necessary). Replace the bed to the original horizontal position. 13. Wash your hands. 14. Chart any observations you may have made while doing this procedure. Figure 7. When a family member helps you review the process with him BEFORE you move the client PROCEDURE: MOVING A CLIENT UP IN BED, ONE PERSON 1. Wash your hands. 2. Tell the client you are going to move him up in bed. Say this even if he appears unconscious. 3. Ask the visitors to leave, if appropriate. 4. Remove the pillow from the bed. Place it on chair. 5. Lock the wheels on the bed, if they are present. 6. Raise the whole bed, if possible, to a height that is comfortable for you. 7. Stand at the head of the bed. One foot should be in close to the bed, the other slightly behind. 8. Reach over the top of the draw sheet. Roll the edge and grab it. 9. On a count of three, “lock” your arms and back into one unbendable unit and shift your weight to your back leg. The client will slide easily to the top of the bed with the sheet. Make sure you do this slowly and use good body mechanics. (Figure 8) 10. Replace the pillow. Position the client correctly. Raise the side rails. Replace the bed to its original horizontal position. 11. Wash your hands. 12. Chart your observation of the client during the procedure. DAISY RUIZ-VIOLETA 42  Figure 8. Use the sheet and good body mechanics to move the client PROCEDURE: MOVING A CLIENT TO ONE SIDE OF THE BED ON HIS BACK 1. Wash your hands. 2. Tell the client you are going to move him to one side of the bed on his back without turning him. Explain that this is a safety measure so that, when he is turned to his side, he’ll be in the center of the bed. 3. Lock the wheels on the bed, if they are present. 4. Raise the whole bed to the highest position best for you. 5. Lower the backrest and footrest, if this is allowed. 6. Put the side rail in the up position on the far side of the bed. 7. Loosen the top sheets but do not expose the client. 8. Place your feet in good position – one in close to the bed and one back. Slide both your arms under the client’s back to his far shoulder, then slide the client’s shoulder toward you by rocking your weight to your back foot. (Figure 9) 9. Keep your knees bent and your back straight as you slide the client. 10. Slide both your arms as far as you can under the client’s buttocks and slide his buttocks toward the same way. Use a pull (turning) sheet whenever possible for helpless clients. 11. Place both your arms under the client’s feet and slide them toward you. 12. Replace and adjust the pillow, if necessary. 13. Remake the top of the bed. 14. Make the client comfortable. Lower the bed to its lowest horizontal position. 15. Wash your hands. 16. Chart your observations of the client during this procedure. DAISY RUIZ-VIOLETA 43 Figure 9. As a safety measure, do this before turning the client so that when he is turned to his side, he’ll be in the center of the bed. PROCEDURE: ROLLING THE CLIENT (LOG ROLLING) 1. Wash your hands. 2. Tell the client you are going to roll him to his side as if he were a log. 3. Lock the wheels on the bed, if they are present. 4. Raise the whole bed to the best height for you. 5. Raise the side rail on the far side of the bed. 6. Remove the pillow from under the client’s head, if allowed. 7. Move the client to your side of the bed as in the previous procedure. While moving a client to one side of the bed on his back. 8. Raise the side rail closest to the client, and go to the other side of the bed and lower that rail. 9. By holding the client at his hip and shoulder, roll the client toward you onto his side. Turn him gently. (Figure 10a and 10b) 10. Place the client in a good bed position, and remake the top covers of the bed. 11. Wash your hands. 12. Chart your observations of the client during this procedure. Figure 10a Figure 10b DAISY RUIZ-VIOLETA 44  PROCEDURE: RAISING THE CLIENT’S HEAD AND SHOULDER 1. Never pull on a client’s arm to lift him up. If assistance is required, slide your arm under the shoulder blade to lift. Or raise the head of the bed, if possible. 2. If a client has some strength in one or both arms, “plant” your feet in the proper position, hold your arm out steady, and let the client pull up on you. That way you remain stationary while the client does to work. You then have one hand free to adjust the pillow, and so on. (Figure 11) 3. Remember, good body mechanics are important to your success. Figure 11. Client’s hand should be under your armpit and placed on your shoulder across his waist. DAISY RUIZ-VIOLETA 45  SELF-CHECK 4.1-1 TEST I. ESSAY (35pts) 1. Define the following: a. Body mechanics b. Base of support c. Center of gravity d. Align e. Daily activity level f. Activity tolerance g. Body alignment DAISY RUIZ-VIOLETA 46  ANSWER KEY 4.1-1 1. a. Body mechanics. Proper use of the human body to do work and to avoid injury and strain. b. Base of support. Part of the body that bears the most weight. c. Center of gravity. Point at which, when held, he will have the greatest control over object. d. Align. To put the body into its proper anatomical position. e. Daily ability level. The capability of the client to perform an activity on a given day. f. Activity tolerance. The most activity the client will be able to do. g. Body alignment. Arrangement of the body in a straight line, placing a body parts in correct anatomical position. DAISY RUIZ-VIOLETA 47  TASK SHEET 4.1-1 Title: Assisting people with special needs to identify and meet their needs Performance Objective: 1. Know how to discuss the basic idea of good body mechanic. 2. Know how to apply good body mechanics during activities on and off the job. 3. Know how to explain to someone else (client or caregiver) how to use good body mechanics. Supplies/Materials: Towels, pillows, pillow case, linens, draw sheet, rubber sheet and CBLM Equipment: Bed Steps/Procedure: 1. Know how to discuss the basic idea of good body mechanic. 2. Know how to apply good body mechanics during activities on and off the job. 3. Know how to explain to someone else (client or caregiver) how to use good body mechanics. Assessment Method: Direct observation, practical demonstration, oral and written exams. DAISY RUIZ-VIOLETA 48  Performance Criteria Checklist 4.1-1 CRITERIA YES NO Did you…. 1. Know how to discuss the basic idea of good body mechanic? 2. Know how to apply good body mechanics during activities on and off the job? 3. Know how to explain to someone else (client or caregiver) how to use good body mechanics? DAISY RUIZ-VIOLETA 49 EVIDENCE PLAN Competency CAREGIVING NCII standard: Unit of PROVIDE CARE AND SUPPORT TO PEOPLE WITH competency: SPECIAL NEEDS Ways in which evidence will be collected: Oral Questioning Demonstration Written The evidence must show that the trainee… Guidelines of Body mechanics Client’s Daily level of activity Guidelines assisting the client Positioning a client in bed Moving a client up in bed with his help Moving a client up in bed Two people Moving a client up in bed One person Rolling the client (Log Rolling) Raising the client head and shoulder NOTE: *Critical aspects of competency DAISY RUIZ-VIOLETA 50  SESSION PLAN Sector : HEALTH CARE Qualification Title : CAREGIVING NC II Unit of Competency : Provide care and support to people with special needs Module Title : Providing care and support to people with special needs A. INTRODUCTION: This unit covers the knowledge, skills and attitudes required Rehabilitation routine, working with the physical therapist, ROM, Helping a client to sit up, Transferring the client, Speech and language therapy, dealing with a hearing loss, working with an occupational therapist, Assisting the client toileting in bed, Toileting on a commode, Toileting in a bathroom and Bathing (Undress and Dress), Assisting in Meal preparation and feeding. B. LEARNING ACTIVITIES LO 5: Assist people with special needs in maintaining an environment that enables maximum independent living. Learning Content Methods Presentation Practice Feedback Resources Time  Rehabilitatio Read Information  Answer Self- n routine Sheet 5.1-1 on Check 5.1-1  Working with  Rehabilitati  Perform Task the physical on routine Sheet 5.1-1 on therapist  Lecture/  Working  Rehabilitation  Compare answers on CBLM  ROM discussion with the routine Answer Key 5.1-1 projectors,  Helping a  Demonstration physical  Working with  Evaluate own 30 slides, client to sit and return therapist the physical performance using hours visual up demonstration  ROM therapist Performance Criteria Brainstorming aids  Transferring   Helping a  ROM Checklist 5.1-1 the client client to sit  Helping a  Speech and up client to sit up language  Transferrin  Transferring therapy g the client the client DAISY RUIZ-VIOLETA 51   Dealing with  Speech and  Speech and a hearing loss language language  Working with therapy therapy an  Dealing  Dealing with a occupational with a hearing loss therapist hearing loss  Working with  Assisting the  Working an client with an occupational toileting in occupationa therapist bed l therapist  Assisting the  Toileting on a  Assisting client toileting commode the client in bed  Toileting in a toileting in  Toileting on a bathroom bed commode  Bathing  Toileting on  Toileting in a (Undress and a commode bathroom Dress)  Toileting in  Bathing  Assisting in a bathroom (Undress and Meal  Bathing Dress) preparation (Undress  Assisting in and Feeding and Dress) Meal  Assisting in preparation Meal and Feeding preparation and Feeding C. ASSESSMENT PLAN  Written Test  Performance Test  Oral Questioning D. TEACHER’S SELF-REFLECTION OF THE SESSION DAISY RUIZ-VIOLETA 52  Information Sheet 5.1-1  Rehabilitation routine  Working with the physical therapist  ROM  Helping a client to sit up  Transferring the client  Speech and language therapy  Dealing with a hearing loss  Working with an occupational therapist  Assisting the client toileting in bed  Toileting on a commode  Toileting in a bathroom  Bathing (Undress and Dress)  Assisting in Meal preparation and Feeding Learning Objectives: After reading this INFORMATION SHEET, YOU MUST be able to; 1. Know how to define rehabilitation. 2. Know how to discuss the many things that therapist take into considerations when they establish a program for their client. This unit covers the knowledge, skills and attitudes required Rehabilitation routine, working with the physical therapist, ROM, Helping a client to sit up, Transferring the client, Speech and language therapy, dealing with a hearing loss, working with an occupational therapist, Assisting the client toileting in bed, Toileting on a commode, Toileting in a bathroom and Bathing (Undress and Dress), Assisting in Meal preparation and feeding. DAISY RUIZ-VIOLETA 53  REHABILITATION WHAT IS REHABILITATION? Rehabilitation is the process of relearning how to function, in the best possible way, as an independent person despite a disability. Rehabilitation is not easy and not always pleasant but, with proper direct and encouragement, the client can accomplish his goals. Sometimes, a client will use a brace or support for an injured body part. Be sure you completely understand the care and use of this piece of equipment. The way in which you assist the client will communicate to him if you really believe he will succeed or if you feel his attempts are useless. Be alert to your verbal and nonverbal communications. ESTABLISHING A REHABILITATION ROUTINE Before a therapist establishes a routine for the client, she reviews the whole client profile, including his environment. Your objective reporting during this assessment will help establish a useful individualized program for your client. Some of the factors taken into consideration during this assessment are:  How much active motion does the client have?  How much passive motion does the client have?  Symptoms of all medical diagnoses that may affect function.  Sensory deficits in vision, hearing, speech, touch, balance or proprioception (knowledge of limb position in space with eyes covered).  How does the client see his situation? His disability?  Attitude. Is he depressed, euphoric, angry, cooperative, resentful, or frustrated? Is he motivated: does he want to try to do things for himself?  Ability. What can he do for himself? What does he attempt to do?  Previous level of function. Which limb is dominant (used for most activities)? What did he do before he became disabled? If a person did not have the desire to do something before an illness, he may not be motivated to do it afterward.  Priorities. A priority is something the client wants to do. Often, the priority is something that we might not feel is important, but achieving it makes the client feel less handicapped. It could be a little thing like putting on makeup, setting hair, shaving, tying shoes, using the telephone, or signing checks.  Equipment. What is the client using now, and what does he need to help him function (hospital bed, commode, crutches, catheter, walker, cane, brace, splints, or adaptive equipment such as built-up spoons or dressing sticks)?  Environmental barrier. Those things in the client’s home that make it difficult for him to care for himself: a second floor bathroom when a client cannot climb stairs, throw rugs that can trip him, narrow doorways that prevent him from moving from room to room in a wheelchair, heavy furniture that he cannot pass in a walker or with crutches or a cane, or a bed without side rails to help him sit up. DAISY RUIZ-VIOLETA 54   Support system. The people involved in the care of a client. Besides the homemaker/home health aide, are there family members or friends who will assist him to regain functional independence? WORKING WITH A PHYSICAL THERAPIST MUSCLES, JOINTS, MOVEMENT Joints are where two or more bones meet to form a movable area of the skeletal frame. Muscles move the bones. If muscles are not used, they can shorten and tighten. This makes the joint motions painful and limited. Muscle shortening can happen in a short time. Therefore, it is important that clients are helped to use their muscles. This is done by encouraging them to do normal daily activities and their prescribed exercises. (Figure 1). Figure 1. Assist the clients with proper exercises to keep muscles flexible. You may be instructed by your supervisor to place your hands in different position than indicated in the photo. This is acceptable, provided the patient’s head is supported and the rules of safety and good body mechanics are observed. (Figure 2) DAISY RUIZ-VIOLETA 55 Figure 2. Depending on the client’s condition and comfort, alternate hand positions may be used. RANGE OF MOTION EXERCISES There are four types of range-of-motion (ROM) exercises. Each is ordered for a specific purpose. TYPES CLIENT HELPER Passive Takes client through ROM Clients does not help Active/Assist Active Motion Helps to make motion easier; moves part farther than client can Active Done totally by client Resistive Active motion Makes exercise harder by providing resistance to motion but allows completion of motion GUIDELINES: ASSISTING WITH ROM  Do not start ROM exercises until you have received specific instructions for your particular client.  Never take a client beyond the point of pain. Pain is a warning sign and should be heeded. Report client pain to your supervisor.  Report to the supervisor if the client does not do the exercises when you are not in the house.  Report to the supervisor if the client is finding the exercises harder to do rather than easier.  Use the flat part of your hand and fingers to hold the client’s body parts. Do not grip with your fingertips. Some people are sensitive to pressure. Some people are ticklish.  If you forget what to do, think of your own body and how it works.  Talk to the client. Explain what is being done and why. Even if the person does not appear to understand, the tone of your voice and touch of your hands can help you communicate. DAISY RUIZ-VIOLETA 56   Better communication greatly improves your chances for client cooperation.  Do each exercise three to five times or as you have been instructed.  Follow a logical sequence during the exercises so that each joint and muscle is exercised. For example, start at the head and work down to the feet.  Be gentle – never bend or straighten a body part farther than it will go.  Slow, steady movement of a tight muscle will help, the muscle relax and so increase the joint range.  Include the family or caregivers in the activity so they can learn and continue the exercises when you are not there. PROCEDURE: RANGE OF MOTION 1. Wash your hands. 2. Explain to the client that you are going to help him exercise his muscles and joints. 3. Ask visitors to leave, if appropriate. 4. Offer the client the bedpan or urinal. 5. Drape the client for modesty. 6. Raise the bed to the highest horizontal position, if possible. 7. Lower the side rail on the side you are working, if possible. Move the client close to you. 8. Proceed with the exercises as you have been instructed. (Figure 3) 9. Make the client comfortable. 10. Wash your hands. 11. Chart that you have completed the exercises. Also note anything you observed about the client during the procedure. Figure 3. a. Shoulder Flexion with elbow straight, raise arm over head, then lower, keeping arm in front of you the whole time. b. Shoulder abduction and adduction with elbow straight, raise arm over head, then lower, keeping arm out to the side the whole time. c. Shoulder internal and external rotation bring arm out to the side. Do NOT bring elbow out to shoulder level. Turn arm back and forth so forearm points down toward feet, then up toward head. With arm alongside body and elbow bent at 90◦ angle, turn arm so forearm points across stomach, then out to the side. DAISY RUIZ-VIOLETA 57 d.. Shoulder horizontal abduction and adduction keeping arm at shoulder level, reach across chest past opposite shoulder, then reach out to the side e. Elbow flexion and extension with arm alongside body, bend elbow to touch shoulder, then straighten elbow out again. f. Forearm pronation and supination with arm alongside the body and elbow bent to 90◦ (a right angle), turn forearm so palm faces first toward head, then forward feet. g. Wrist flexion and extension Bend wrist up and down. h. Wrist flexion and extension bend wrist back and forth, and in a circle. i. 1&2. Finger flexion and extension make a fist, then straighten fingers out together. j. 1&2. Finger flexion and extension touch tip of each finger to its base, then straighten each finger in turn. k. 1&2. Finger abduction and adduction with fingers straight, squeeze fingers together, then spread them apart. DAISY RUIZ-VIOLETA 58 l. Finger/thumb opposition touch thumb to the tip of each fingers to make a circle. Open hand fully between touching each finger. m. Hip/Knee flexion and extension bend knee and bring it up toward chest, keeping foot off bed. Lower leg to bed, straightening knee as it goes down. n. Quad sets with leg flat on bed, tighten thigh muscles to straighten the knee, hard, pushing it into the bed. Hold for count of five, then relax. Repeat exercise with rolled towel under the knee. o. Straight leg raising keeping the knee straight, raise leg up off the bed. Return slowly to the bed, keeping the knee straight. p. Hip abduction and adduction with leg flat on bed and knee pointing to the ceiling, slide leg out to the side. Then slide it back to touch the other leg. q. Hip internal and external rotation with legs flat on bed and feet apart, turn both legs so knees face outward. Then turn them in so knees face each other. r. Hip internal and external rotation (variation) with one knee bent and foot flat on the bed, turn leg so knee moves out to the side, then inward across the other leg. Do each leg separately. s. Bridging with both knees bent up, feet flat on bed, push on bed with feet to raise hips (as in lifting for a bedpan). Hold for count of five, then relax. t. Ankle dorsiflexion and extension bend ankles up, down, and from side to side. u. Toe flexion and extension bend and straighten toes. DAISY RUIZ-VIOLETA 59 CHOOSING A CHAIR FOR A CLIENT A client usually spends all or at least part of the day out of bed. But where is “out of bed”? Sometimes a client will sit in a wheelchair, a favorite reclining chair, the sofa, or a kitchen chair. Which is best? There are several guidelines to follow when choosing a chair:  The chair should provide good support to the client’s back.  A reclining chair is difficult to get out of, especially when the client is tired.  The type of chair that gives the client the most independence is best.  The types of chairs available must be considered.  The chairs that are safest should be used. A dining room chair or straight-back chair provides a great deal of support. One with arms is best, if it is available. The client should be able to sit with his feet resting on the floor or to place his feet on the floor comfortably without straining. Otherwise, he will not be able to get up safely. A wheelchair can provide good support while allowing the client freedom to move around the house. However, a wheelchair is not for every client. If you think a wheelchair might be useful to your client, discuss this with the therapist or your supervisor before you suggest it to the client. If a wheelchair is used, always have the brakes locked when standing the client up or sitting him down. Never leave a confused client restrained in a wheelchair with his feet on the foot pedals. There is the possibility that the client will think his feet are on the floor and try to stand up. TRANSFERRING CLIENTS FROM PLACE TO PLACE To transfer a client means to help him move from one place to another (for example, from his bed to a chair and back again). How well the transfer goes depends on how much confidence your client has in you. Know yourself. Know your capabilities. Always stay within your capabilities. If you feel confident, your client will sense this and have confidence in you, too. When a person loses the use of a body part, it becomes very important to him to control what remains. Use this to your advantage. Observe the client’s abilities and do not help him more than necessary. A guarding belt (any leather belt buckled around the midsection) can help you with a large client and give you better control over his center of gravity. (Figure 4) Before a person can move from bed to another place, he must come to a sitting position with his legs over the side of the bed. You can help the client by raising the head of the bed, is possible. This gives him extra assistance. Raise the bed to a high horizontal position so the client is almost standing when he slides off the bed. Be sure the bed is locked and anchored against a wall so it does not move. DAISY RUIZ-VIOLETA 60  Figure 4. Assisting a client wearing a guarding belt PROCEDURE: HELPING A CLIENT TO SIT UP 1. Wash your hands. 2. Ask any visitor to step out of the room, if appropriate. 3. Tell the client what you are going to do. 4. Roll the client on his side, facing you. Bend his knees. 5. Reach one arm over to hold him in back of his knees. 6. Place your other arm under the neck and shoulder area. (Figure 5a) 7. Position your feet with a wide base of support and your center of gravity close to the bed. 8. On the count of “one, two, three”, shift your weight to your back leg. While you are doing this, swing the client’s legs over the edge of the bed while pulling his shoulders to a sitting position. (Figure 5b) 9. Remain in front of the client with both your hands on him for support. Do not leave him until you are sure he is stable. 10. Proceed with the remainder of the transfer. (For a client who requires only a little assistance, the procedure remains the same. Direct the client through the steps above and support him when necessary. Be sure to remain with him in the sitting position until he is stable.) DAISY RUIZ-VIOLETA 61 TAKING CARE OF BUSINESS Taking care of business (TCOB) is necessary as you are moving, transferring, and directing clients. Concentrate on what you are doing and be aware of what is going on around you. Dizzy spells, sudden weaknesses, or loud noises can cause lapses in concentration that could cause a client to fall or lose his balance. If you are TCOB, you will usually be able to prevent serious injury to the client and yourself. USING A MECHANICAL LIFT Some clients are too weak or too heavy to be transferred by another person. In such cases a mechanical lift is used. Practice using the model you have available. Some of them are slightly different, but the principles of operation are all the same. (Figure 6) DAISY RUIZ-VIOLETA 62  (figure 6. A mechanical lift) PROCEDURE: USING A PORTABLE MECHANICAL CLIENT LIFT 1. Assemble your equipment; Mechanical lift Sling 2. Wash your hands. 3. Tell the client that you are going to get him out of the bed by using the portable mechanical client lift. (You may need the help of a second person as a partner) 4. Position the chair next to the bed with the back of the chair in line with the headboard of the bed. 5. Cover the chair with a blanket or sheet. 6. By turning the client from side to side on the bed, slide the sling under the client. 7. Attach the sling to the mechanical lift with the hooks in place through the metal frame facing out. 8. Have the client fold both arms across his chest, if possible. 9. Using the crank, lift the client from the bed. 10. Guide the client’s legs. 11. Lower the client into the chair. 12. Remove the hooks from the frame of the portable mechanical lift. 13. Leave the client safe and comfortable in the chair for the proper amount of time according to your instructions. 14. To get the client back to bed, put the hooks facing out through the metal frame of the sling, which is still under the client. 15. Raise the client by using the crank on the mechanical client lift. Lift him from the chair into the bed. Have your partner guide the client’s legs. DAISY RUIZ-VIOLETA 63  16. Lower the client into the center of the bed. 17. Remove the hooks from the frame. 18. Remove the sling from under the client by having him turn from side to side on the bed. 19. Put a pillow under the client’s head. Properly position the client. 20. Remake the top of the bed. 21. Raise the side rails to the up position. 22. Lower the bed to its lowest horizontal position. 23. Wash your hands. 24. Chart your observation about the client during this procedure. HELPING A CLIENT TO STAND AND SIT The procedure to help a client stand up can be used with both clients who need a great deal of assistance and those who need very little. By using the same sequence of actions each time, you teach the person how to stand up by himself. Help him only when necessary, but remain in good position to guard him as he stands. Keep your directions short. Memorize the following sequence. Then you will not have to stop and remember what to say to clients each time you help them. You should be able to concentrate on how the client is following your directions, not on trying to remember them yourself. PROCEDURE: HELPING A CLIENT TO STAND 1. “Move to the front of your chair or bed. Put your hands on the arms of the chair.” This client is sitting over the edge of the chair or bed. Place one of your knees between his knees. Your feet should be in good position and you should be close to the chair or bed. If the client has a weak knee, brace it with your knee. (figure 7a) 2. “Put one foot under you”. This should b