"Physical Therapy for Bedridden Patients"
- The brain disease is the number one cause for people becoming bedridden, accounting for about 30 to 50 percent of all cases. It is followed by weakness due to old age at 20 percent, and the breaking of a bone at 10 percent. This means that if we can take steps to reduce the first and third causes above, we can significantly reduce the number of bedridden people.
- If the brain disease has arisen out of a preceding illness such as hypertension, arteriosclerosis, or diabetes, caused in part by a long-term bad habit, then it is important to try to; ?Take moderate exercise. ?Have a balanced diet and cut down on the intake of salt. ?Find an interest and so enjoy life more, taking care to have a rest when necessary. ?Have a regular medical check up so that any illness can be detected early.
- Some diseases are chronic or difficult to recover from, but there are still some important preventative measures that can be taken. A person with such a condition needs to modify their habits and lifestyle, so as to live with their disease. Often such a person is more careful about health and will outlive his healthier but less careful peers.
The above factors can cause people to become bedridden but it is over-caring, or excessive nursing, that can force a person to become permanently confined to bed, i.e. bedfast.
- A young person, after one week in bed, will quickly resume normal activity, but an old person may not. This is because an old person does not have the strength to sit up on his or her own and often both the sick person and the helper think it is easier, and less trouble, not to make an effort. In the short-term this may be fine but in the long-term it is a big mistake.
- • It encourages the sick person to become bedfast and leads to further problems, such as pneumonia, bedsores, and dementia.
- To avoid becoming bedfast it is important to have daily activity and to treat injuries or colds as soon as possible to minimize the time spent in bed.
Early rehabilitation aids recovery --- Start training in bed!
- After a stroke it used to be common practice, in Japan, to prescribe a long rest in bed as a basic treatment.
- This meant that rehabilitation was postponed until months after the original attack.
- However, as a result of a rehabilitation study, it is now accepted that early rehabilitation aids the extent and speed of recovery. If the sick person is conscious and on the road to recovery, then rehabilitation should be started within a week.
Start engaging normal daily activities, such as going to the bathroom and changing clothes at home
- There are some patients who leave hospital, after recovery from the brain disease or a broken bone, who still become bedridden. These patients had recovered some mobility and were able to walk in hospital after rehabilitation. However, they deteriorate at home and lose the function they had gained.
- Hence the importance of continued rehabilitation at home. Home-rehabilitation does not need to be as rigorous or professional as at hospital. It involves simply keeping up the daily physical activities associated with normal living such as eating, going to the bedroom, and getting dressed. This is called “ Rehabilitation for Daily Life”.
- The purpose of rehabilitation implies not only restoring physical condition, but also improvement in the quality of Activity for Daily Life(ADL).
Waking up in the morning, getting dressed, and maintaining a physical separation between the sleeping room and the eating place.
- If a proper separation between the bed and the eating place is not maintained then this leads to the patient becoming bedridden. This is because their general motivation and willingness to go out decreases, resulting in a loss of daily discipline and self-esteem. Such a person gradually loses the structure of their daily habits, night and day become blurred. They might wear nightclothes all day, eat in bed habitually, or slowly lose their purpose and reason for living.
- This often happens to elderly people in facilities for the aged. The medical treatment they are receiving, involving bed-baths and going to the lavatory in bed, may become an obstacle to self-reliance and recovery, even after their initial ailment has settled. If possible they should be encouraged to become self-reliant, going by wheelchair to the eating-room by themselves.
- It is also important to dress neatly and tidily to maintain self-respect and dignity. This not only gives them confidence, but also causes others to show them more respect. Such care over dressing should be encouraged, whether or not the patient is going out. Cleanliness is also most important for looking neat and tidy. Skin, hair, inside the mouth and clothes should be kept clean, to avoid body odors, and to guard against infectious diseases.
Getting out of bed. Using wheelchairs and other equipment to widen range of activity.
- Practical use of many kinds of equipment can be effective in developing self-reliance and getting out of a bedridden state. The initial rest position should be a bed because it is difficult to get into a wheelchair, or use a portable toilet seat, from a tatami floor. There is a special bed called a 'Gatch bed' which can be adjusted, to alter the slope of the head or leg parts, giving support as necessary.
- If a person can sit up in bed then they should try to leave the bed as much as possible every day, even if only for a short time, by using a wheelchair. This reduces bedsores and increases appetite. Also the use of a wheelchair helps to maintain a distinction between the eating-room and the bedroom as mentioned earlier. Those who can use a wheelchair should get out of doors as much as possible to further enrich their lifestyle.
- Thus, the practical use of equipment is effective not only for the elderly at home, but also for those living in institutions. Encouragement of those in institutions or who are patients, in the use such equipment, by medical careers or welfare staff, will facilitate their successful rehabilitation and enable them to return home more easily.
- There are various kinds of enabling equipment such as a bath stretcher, a body position changer and so on. Many of them are now being designed and manufactured. Some of them have been adopted as suitable equipment to be rented or provided by the public system. Japanese government has adopted a dual approach first by studying new types of equipment to encourage self-reliance and second by providing home-help as required.
Reforming and adapting the home by using care devices, handrails and smooth surfaces without bumps.
[ Promoting a properly equipped living environment. ]
- In fact, the elderly, even without paralysis, are apt to stumble because of weakened muscle, the loss of the sense of balance and visual or hearing impairment, though the young may not be able to understand such condition. For this reason the normal steps and varying floor levels in a house become an obstacle to free movement. They often stumble in hallways, bathrooms, lavatories and bedrooms or entrances where there are steps. Such stumbling causes fractures from which it takes a long time to recover. For patients with osteoporosis, this often results in confinement to bed.
- For this reason it is important to reform the living environment by installing handrails, non-slip devices, proper lighting, and by reducing the height of steps in places where they can not be replaced by a slope. In summary, make the environment safer.