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Handout Orthopedic Nursing Assisstive Devices

Handout Orthopedic Nursing Assisstive Devices

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Handout Orthopedic Nursing Assisstive Devices
Handout Orthopedic Nursing Assisstive Devices

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Published by: Paul Christian P. Santos, RN on Apr 05, 2009
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05/26/2014

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Assistive devices
Assistive devices for mobility/ambulation can be referred to as ambulatoryaids. Ambulatory aids (eg, canes, crutches, walkers) are used to provide anextension of the upper extremities to help transmit body weight and providesupport for the patient. The type of ambulatory aid needed depends on howmuch balance and weight-bearing assistance is needed.
 
Generally, the moredisabled the individual is, the greater the complexity required in the walkingdevice. A walker supplies the most support, and a standard cane provides theleast.Uses of assistive devices include the following:
Redistribute and unload a weight-bearing lower limb
Improve balance
Reduce lower limb pain
Provide sensory feedbackAdequate upper limb strength, coordination, and hand function are requiredfor the proper use of ambulatory aids.Assistive devices for ADL, as well as for self-care and leisure activities, rangefrom simple objects for daily use (eg, plate guards, spoons with built-uphandles, elastic shoelaces, doorknobs with rubber levers) to complexelectronic devices, such as voice-activated environmental control systems.Batavia and Hammer identified 4 key evaluation and selection criteria forlong-term users of assistive devices.
Effectiveness - The extent to which the function of the device improvesone's living situation, functional capability, or independence
Affordability - The extent to which the purchase, maintenance, or repairof the device causes financial difficulty
Operability - The extent to which the device is easy to operate andadequately responds to demands
Dependability - The extent to which the device operates withrepeatable and predictable levels of accuracy under conditions of reasonable use
Assistive devices and their use for impairments
 
Impairments and the associated assistive devices that aid in ambulation andmobility are as follows:
Mildly impaired balance/stability - Single-point cane
Unilateral lower limb pain/mild weakness - Single-point cane; hold withunaffected side
Moderate impaired balance/stability - Quad cane (narrow or wide base)
Moderate-to-severe unilateral weakness/hemiplegia - Walkcane/hemiwalker
Bilateral lower extremity weakness/paralysis - Bilateral crutches orwalker (pickup or front-wheeled)
Severely impaired stability - Walker (pickup or front-wheeled)
Impaired wrist or hand function - Platform forearm walker
Difficulty climbing stairs - Stair-climbing walker
Impaired bed mobility - Bed rails (half or full); hospital bed (manual orelectrically controlled)
Difficulty with transfer - Transfer (sliding) board
Difficulty getting up from chair - Seat-lift chair or uplift seat assistImpairments and the associated assistive devices that aid in ADL are asfollows:
Limited hand function and fine motor control
o
Eating - Built-up utensils, universal cuff with utensil hold
o
Dressing - Button hook, zipper hook, Velcro closure, sock aid,long shoe horn, elastic shoe laces
o
Bathing - Wash mitts, long-handled sponge
o
Grooming - Built-up combs or brushes, electric toothbrush,electric razor with custom handle
Loss in 1 hand of eating-related functions - Plate guard, rocker knife
Impaired coordination, tremor - Weighted utensils
Impaired range of motion (ROM) of shoulder, proximal weakness -Reacher
Impaired mobility for toileting - Bedside or rolling commode, raisedtoilet seat, grab bars around toilet
Impaired mobility for bathing - Tub transfer bench, hand-held shower,grab bars on tub or shower; shower chairImpairments and associated assistive devices to aid in communication are asfollows:
Difficulty holding pen to write - Built-up pen or pencil
 
Difficulty typing - Typing stick
Reading difficulty caused by impaired vision - Magnifying glasses,talking clock or watch
Difficulty dialing and using phone - Push-button dialing or 1-touchdialing with speaker phone; voice-activated phone
Difficulty calling for help - Simple buzzers or other signaling devicesoperated by switches that require minimal pressure; medical alertsystem, such as Life Alert.Impairments due to complete loss of all 4 limbs or limb motor function:
Brain-computer interface (BCI) devices or motor neuroprostheticdevices are systems that allow individuals to translate in real time theelectrical activity of the brain into overt device control such that itreflects the user’s intentions. In essence, these constructs can decodethe electrophysiologic signals representing motor intent. They do notrely on muscular activity and can therefore provide communication andcontrol for those who are severely paralyzed due toinjuryor disease.
Current BCIs differ in how the neural activity of the brain is recorded,how subjects (human or animal) are trained to produce a specificelectroencephalographic response, how the signals are translated intodevice commands, and which application is provided to the user.Patients with any of a variety of conditions, such as locked-insyndrome, spinal cord injury, stroke, limb loss, or a neuromusculardisorder, may benefit from the implantation of these BCIs, whichaugment the ability of a patient to communicate and interactwith his/her environment.
 
Impaired vision and blindness:
Good, older methods of providing sensory substitution for people withsevere visual impairment include the use of visual-impairment canesand guide dogs. A more complex aid for the visually impaired, ahuman-machine interface utilizing an array of electrical stimulators onthe tongue, has been developed; the technology was quantified usinga standard ophthalmologic test. Using the interface, subjects achievedan average acuity of 20/860 without training; the figure doubledfollowing 9 hours of training. The interface may lead to thedevelopment of practical devices for persons with sensory loss,including individuals who are blind

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