Stuck in a Rut While Providing In-Room Therapy?

CREATIVE WAYS TO ENGAGE ISOLATED PATIENTS

Whether your patient is actually in isolation, or just confined to their room during the COVID-19 pandemic or any cold/flu epidemic, therapists are often limited to treating patients bedside in their room. While it may be frustrating to not have your rehab gym and all the equipment that comes with it, you still have your two best tools with you all the time: your hands and your brain. Focusing on functional treatments during room isolation is not only efficient, but allows you to focus on all the functional things that patients must learn to do every day. Here are a few examples:

• Bed Mobility

  • Rolling, supine to sit, sit to supine, scooting in supine, scooting in sitting, bridging, clamshells, one legged bridges, trunk rotation

• Transfers

  • Bed to chair, chair to bed, wheelchair (w/c) to commode, commode to w/c, sit to stand from bed, sit to stand from chair, sit to stand from w/c, sit to stand from recliner, w/c to shower, shower to w/c, arising from the floor

• Ambulation

  • Bed to bathroom, bathroom to bed, negotiating around obstacles in the room, assessing the correct ambulation device, training with an ambulation device, environmental adaptations to make room more functional for them

• Activities of Daily Living (ADLs)

  • Retrieving clothing from closet, retrieving bath items from drawer, bathing/showering, toileting, grooming, dressing, eating, teaching to use adaptive equipment, sweeping the floor, making the bed, washing dishes, meal prep

  • Environmental adaptations to make ADLs safer, such as:

    • Does that closet rod need to be lowered?

    • Is that grab bar in the bathroom meeting their needs?

  • Using the phone, using the tablet or computer to make face-to-face calls with family, managing medications, managing money, writing checks, making coffee, folding clothes and putting them away in a closet or drawers while standing to build activity endurance, etc.

• Therapeutic Exercise

  • Supine in bed: clamshells, bridges, trunk rotation, scooting in supine

  • Seated on chair: all lower extremity exercises with or without resistance (use manual resistance or assign them their own theraband), chair push-ups, upper extremity theraband exercises, ROM

  • Teaching home exercise program: sit to stands, ROM, standing endurance

  • For hand strength: move water from one bath pan to another using a sponge, breathing exercises using a straw to move a tissue or to lift a paper off the table

• Neuro Re-Education

  • Balance exercises: supported to unsupported sitting, supported to unsupported standing, eyes open, eyes closed, feet apart to feet narrow

  • Gross motor and fine motor: retrieve items from the floor with a reacher, balloon games for balance

  • PNF exercises for muscle re-education, weight shifting from side to side, weight bearing through the elbow or hand

• Modalities

  • Many modalities are portable and can still be brought to the patient’s room. Don’t forget to use a cover for your Shortwave Diathermy head, and keep electrode packages labeled for each patient to prevent cross contamination. The main cabinet of the modality can easily be wiped down before/after treatment with a disinfecting wipe. Don’t forget to disinfect any electrotherapy cables as well as the US head. Modalities are a great tool for managing pain and improving strength, so don’t feel like you cannot continue to use them.

• Cognitive Treatments

  • Use the bedside table in front of a chair for a desk

  • Cards, money, games, memory, and attention tasks (be sure to disinfect items if bringing in or removing from the patient’s room)

  • Filling pill boxes from pill bottles

  • Table top writing activities

  • Use picture activities from the laptop or tablet rather than paper cards that can’t be disinfected.

The list is endless, just use your imagination and look around you for disposable items to incorporate into your treatments or items that are easy to disinfect. As always, whenever you are providing billable services to a resident, the services must be skilled. Be sure that you always document the “why” you did something with a patient versus the “what”.  The “why” is what shows the skills that you used to provide the service. With a little creativity, your patient will never be bored staying in the room for treatment sessions, and they can continue to meet their goals during times of isolation.

Written by: Elizabeth Johnson, PT, CDP, RAC-CT