4.

POSITIONING A PATIENT FOR EXAMINATION OR TREATMENT

Patients are put in special positions for examination, for treatment or test, and to obtain specimens. You
should know the positions used, how to assist the patient, and how to adjust the drapes.
a. Horizontal Recumbent Position. Used for most physical examinations. Patient is on his back with legs
extended. Arms may be above the head, alongside the body or folded on the chest.
b. Dorsal Recumbent Position. Patient is on his back with knees flexed and soles of feet flat on the bed.
Fold sheet once across the chest. Fold a second sheet crosswise over the thighs and legs so that genital
area is easily exposed.
c. Fowler's Position. Used to promote drainage or ease breathing. Head rest is adjusted to desired height
and bed is raised slightly under patient's knees
d. Dorsal Lithotomy Position. Used for examination of pelvic organs. Similar to dorsal recumbent position,
except that the patient's legs are well separated and thighs are acutely flexed. Feet are usually placed in
stirrups. Fold sheet or bath blanket crosswise over thighs and legs so that genital area is easily exposed.
Keep patient covered as much as possible.
e. Prone Position. Used to examine spine and back. Patient lies on abdomen with head turned to one side
for comfort. Arms may be above head or alongside body. Cover with sheet or bath blanket.
NOTE: An unconscious patient, or one with an abdominal incision or breathing difficulty usually cannot lie
in this position.
f. Sim's Position. Used for rectal examination. Patient is on left side with right knee flexed against
abdomen and left knee slightly flexed. Left arm is behind body; right arm is placed comfortably.
NOTE: Patient with leg injuries or arthritis usually cannot assume this position.
g. Knee-Chest Position. Used for rectal and vaginal examinations and as treatment to bring uterus into
normal position. Patient is on knees with chest resting on bed and elbows resting on bed or arms above
head. Head is turned to one side. Thighs are straight and lower legs are flat on bed.
NOTE: Do not leave patient alone; he/she may become dizzy, faint, and fall.
Trendelenburg

Lies supine with head 30 - 40 lower than the feet

Uses: For postural drainage and promotion of venous blood return

Contraindication: Increase intra cranial pressure.

Hypotension may result from this position

Side-lying

Client lies on the side with weight on the hip and shoulder with pillows supporting legs, arm, head
and back
Uses: A choice position for clients with pressure sore or bony prominences of back and sacrum

Contraindications: Clients with post hip replacement and other orthopedic surgery

Figure 1-1. Horizontal recumbent position

Figure 1-2. Dorsal recumbent position.

Figure 1-3. Fowler's position.

Figure 1-4. Dorsal lithotomy position.

Figure 1-5. Prone position.

Figure 1-6. Sims position.

Figure 1-7. Knee-chest position.

A disability may be physical, cognitive, mental, sensory, emotional, developmental or some

combination of these.

Disabilities is an umbrella term, covering impairments, activity limitations, and participation

restrictions. An impairment is a problem in body function or structure; an activity limitation is a
difficulty encountered by an individual in executing a task or action; while a participation
restriction is a problem experienced by an individual in involvement in life situations.
Thus disability is a complex phenomenon, reflecting an interaction between features of a
persons body and features of the society in which he or she lives.
World Health Organization[1]
An individual may also qualify as disabled if he/she has had an impairment in the past or is seen
as disabled based on a personal or group standard or norm. Such impairments may include
physical, sensory, and cognitive or developmental disabilities. Mental disorders (also known as
psychiatric or psychosocial disability) and various types of chronic disease may also qualify as
disabilities.
Some advocates object to describing certain conditions (notably deafness and autism) as
"disabilities", arguing that it is more appropriate to consider them developmental differences that
have been unfairly stigmatized by society.[citation needed]
A disability may occur during a person's lifetime or may be present from birth.

Types of disability
Disability is caused by impairments to various subsystems of the body - these can be broadly
sorted into the following categories.

[edit] Physical disability

Main article: Physical disability
Any impairment which limits the physical function of limbs or fine or gross motor ability is a
physical disability. Other physical disabilities include impairments which limit other facets of
daily living, such as severe sleep apnea.

[edit] Sensory disability

Sensory disability is impairment of one of the senses. The term is used primarily to refer to
vision and hearing impairment, but other senses can be impaired.
[edit] Visual impairment
Main article: Visual impairment

Visual impairment (or vision impairment) is vision loss (of a person) to such a degree as to
qualify as an additional support need through a significant limitation of visual capability
resulting from either disease, trauma, or congenital or degenerative conditions that cannot be
corrected by conventional means, such as refractive correction, medication, or surgery.[2][3][4] This
functional loss of vision is typically defined to manifest with
1. best corrected visual acuity of less than 20/60, or significant central field defect,
2. significant peripheral field defect including homonymous or heteronymous bilateral
visual, field defect or generalized contraction or constriction of field, or
3. reduced peak contrast sensitivity with either of the above conditions.[2][3][4][5]
[edit] Hearing impairment
Main article: Hearing impairment
Hearing impairment or hard of hearing or deafness refers to conditions in which individuals are
fully or partially unable to detect or perceive at least some frequencies of sound which can
typically be heard by most people. Mild hearing loss may sometimes not be considered a
disability.
[edit] Olfactory and gustatory impairment
Impairment of the sense of smell and taste are commonly associated with aging but can also
occur in younger people due to a wide variety of causes.
Further information: Olfaction#Disorders of olfaction
There are various olfactory disorders:

Anosmia inability to smell

Dysosmia things smell different than they should

Hyperosmia an abnormally acute sense of smell.

Hyposmia decreased ability to smell

Olfactory Reference Syndrome psychological disorder which causes the patient to

imagine he has strong body odor

Parosmia things smell worse than they should

Phantosmia "hallucinated smell," often unpleasant in nature

Further information: Taste#Disorders of taste

Complete loss of the sense of taste is known as ageusia, while dysgeusia is persistent abnormal
sense of taste,

[edit] Somatosensory impairment

Main article: Somatosensory disorder
Insensitivity to stimuli such as touch, heat, cold, and pain are often an adjunct to a more general
physical impairment involving neural pathways and is very commonly associated with paralysis
(in which the motor neural circuits are also affected).
[edit] Balance disorder
Main article: Balance disorder
A balance disorder is a disturbance that causes an individual to feel unsteady, for example when
standing or walking. It may be accompanied by symptoms of being giddy, woozy, or have a
sensation of movement, spinning, or floating. Balance is the result of several body systems
working together. The eyes (visual system), ears (vestibular system) and the body's sense of
where it is in space (proprioception) need to be intact. The brain, which compiles this
information, needs to be functioning effectively.

[edit] Intellectual disability

Main article: Intellectual disability
Intellectual disability is a broad concept that ranges from mental retardation to cognitive deficits
too mild or too specific (as in specific learning disability) to qualify as mental retardation.
Intellectual disabilities may appear at any age. Mental retardation is a subtype of intellectual
disability, and the term intellectual disability is now preferred by many advocates in most
English-speaking countries as a euphemism for mental retardation.

[edit] Mental health and emotional disabilities

Main article: Mental disorder
A mental disorder or mental illness is a psychological or behavioral pattern generally associated
with subjective distress or disability that occurs in an individual, and which are not a part of
normal development or culture. The recognition and understanding of mental health conditions
has changed over time and across cultures, and there are still variations in the definition,
assessment, and classification of mental disorders, although standard guideline criteria are
widely accepted.

[edit] Developmental disability

Main article: Developmental disability
Developmental disability is any disability that results in problems with growth and development.
Although the term is often used as a synonym or euphemism for intellectual disability, the term

also encompasses many congenital medical conditions that have no mental or intellectual
components, for example spina bifida.

[edit] Nonvisible disabilites

Main article: Invisible disability
Several chronic disorders, such as diabetes, asthma or epilepsy, would be counted as nonvisible
disabilities, as opposed to disabilties which are clearly visible, such as being confined to a
wheelchair.

[edit] Sociology of disability

Main article: Disability studies

[edit] People-first language

Main article: People-first language
The American Psychological Association style guide states that, when identifying a person with
an impairment, the person's name or pronoun should come first, and descriptions of the
impairment/disability should be used so that the impairment is identified, but is not modifying
the person. Improper examples are "a borderline", "a blind person", or "an autistic boy"; more
acceptable terminology includes "a woman with Down syndrome" or "a man who has
schizophrenia". It also states that a person's adaptive equipment should be described functionally
as something that assists a person, not as something that limits a person, e.g., "a woman who
uses a wheelchair" rather than "a woman in/confined to a wheelchair."
A similar kind of "people-first" terminology is also used in the UK, but more often in the form
"people with impairments" (e.g., "people with visual impairments"). However, in the UK, the
term "disabled people" is generally preferred to "people with disabilities". It is argued under the
social model that while someone's impairment (e.g., having a spinal cord injury) is an individual
property, "disability" is something created by external societal factors such as a lack of
wheelchair access to the workplace.[6] This distinction between the individual property of
impairment and the social property of disability is central to the social model. The term "disabled
people" as a political construction is also widely used by international organisations of disabled
people, such as Disabled Peoples' International (DPI).

[edit] Literature
Many books on disability and disability rights point out that "disabled" is an identity that one is
not necessarily born with, as disabilities are more often acquired than congenital. Some disability
rights activists use an acronym TAB, "Temporarily Able-Bodied", as a reminder that many
people will develop disabilities at some point in their lives due to accidents, illness (physical,
mental or emotional), or late-emerging effects of genetics.[dubious discuss][citation needed]

[edit] Masculinity
According to author Daniel J. Wilson, the characteristics of masculinity include strength,
activeness, speed, endurance, and courage. These characteristics are often challenged when faced
with a disability and the boy or man must reshape what it means to be masculine. For example,
rather than define "being a man" through what one can physically do, one must re-define it by
how one faces the world with a disability and all the obstacles and stereotypes that come with the
disability.[7]
In Leonard Kriegel's book, Flying Solo, he describes his fight with poliomyelitis and the process
of accepting his disability in a world that values able-bodiedness. He writes, "I had to learn to be
my own hero, my own role model which is another way of saying that I had to learn to live
with neither heroes nor role models" (pg. 40).[8]
[edit] Femininity
Some note that women who are disabled face what is called a "double disability", meaning they
must not only deal with the stereotypes and challenges posed by femininity, but they must also
deal with those posed by being disabled. Culture also tends to view women as fragile and weaker
than men, stereotypes which are only heightened when a woman has a disability.[7]
According to the "Survey of Income and Program Participation", as described in the book
Gendering Disability, 74 percent of women participants and 90 percent of men participants
without disabilities were employed. In comparison, of those with a form of disability, 41 percent
of women and 51 percent of men were employed. Furthermore, the nondisabled women
participants were paid approximately $4.00 less per hour than the nondisabled men participants.
With a disability, women were paid approximately $1.00 less than the nondisabled women
participants and the men were paid approximately $2.00 less than the nondisabled men
participants. As these results suggest, women without disabilities face societal hardships as
compared to men, but disability added to the equation increases the hardships.[7]

[edit] Theory
The International Classification of Functioning, Disability and Health (ICF), produced by the
World Health Organization, distinguishes between body functions (physiological or
psychological, e.g., vision) and body structures (anatomical parts, e.g., the eye and related
structures). Impairment in bodily structure or function is defined as involving an anomaly, defect,
loss or other significant deviation from certain generally accepted population standards, which
may fluctuate over time. Activity is defined as the execution of a task or action. The ICF lists 9
broad domains of functioning which can be affected:

Learning and applying knowledge

General tasks and demands

Communication

Basic physical mobility, Domestic life, and Self-care (i.e., activities of daily living)

Interpersonal interactions and relationships

Community, social and civic life, including employment

Other major life areas

In concert with disability scholars, the introduction to the ICF states that a variety of conceptual
models has been proposed to understand and explain disability and functioning, which it seeks to
integrate. These models include the following:

[edit] The medical model

Main article: Medical model of disability
The medical model is presented as viewing disability as a problem of the person, directly caused
by disease, trauma, or other health condition which therefore requires sustained medical care
provided in the form of individual treatment by professionals. In the medical model,
management of the disability is aimed at a "cure," or the individuals adjustment and behavioral
change that would lead to an "almost-cure" or effective cure. In the medical model, medical care
is viewed as the main issue, and at the political level, the principal response is that of modifying
or reforming healthcare policy.

[edit] The social model

Main article: Social model of disability
The social model of disability sees the issue of "disability" as a socially created problem and a
matter of the full integration of individuals into society (see Inclusion (disability rights)). In this
model, disability is not an attribute of an individual, but rather a complex collection of
conditions, many of which are created by the social environment. Hence, the management of the
problem requires social action and it is the collective responsibility of society at large to make
the environmental modifications necessary for the full participation of people with disabilities in
all areas of social life. The issue is both cultural and ideological, requiring individual,
community, and large-scale social change. From this perspective, equal access for someone with
an impairment/disability is a human rights issue of major concern.

Other models
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by adding reliable references. Unsourced material may be challenged and removed. (April
2011)

The spectrum model refers to the range of visibility, audibility and sensibility under
which mankind functions.[citation needed] The model asserts that disability does not necessarily
mean reduced spectrum of operations.[citation needed]

The moral model refers to the attitude that people are morally responsible for their own
disability.[citation needed] For example disability may be seen as a result of bad actions of
parents if congenital, or as a result of practising witchcraft if not.[citation needed] This attitude
may also be viewed as a religious fundamentalist offshoot of the original animal roots of
human beings when humans killed any baby that could not survive on its own in the wild.
[citation needed]
Echoes of this can be seen in the doctrine of karma in Indian religions.[citation
needed]

The expert/professional model has provided a traditional response to disability issues

and can be seen as an offshoot of the medical model.[citation needed] Within its framework,
professionals follow a process of identifying the impairment and its limitations (using the
medical model), and taking the necessary action to improve the position of the disabled
person.[citation needed] This has tended to produce a system in which an authoritarian, overactive service provider prescribes and acts for a passive client.[citation needed]

The tragedy/charity model depicts disabled people as victims of circumstance who are
deserving of pity.[citation needed] This, along with the medical model, are the models most used
by non-disabled people to define and explain disability.[citation needed]

The legitimacy model views disability as a value-based determination about which

explanations for the atypical are legitimate for membership in the disability category.
[citation needed]
This viewpoint allows for multiple explanations and models to be considered
as purposive and viable.[citation needed]

The social adapted model states although a persons disability poses some limitations in
an able-bodied society, oftentimes the surrounding society and environment are more
limiting than the disability itself.[9]

The economic model defines disability by a persons inability to participate in work.

[citation needed]
It also assesses the degree to which impairment affects an individuals
productivity and the economic consequences for the individual, employer and the state.
[citation needed]
Such consequences include loss of earnings for and payment for assistance by
the individual; lower profit margins for the employer; and state welfare payments. [citation
needed]
This model is directly related to the charity/tragedy model.[citation needed]

The empowering model allows for the person with a disability and his/her family to
decide the course of their treatment and what services they wish to benefit from. This, in
turn, turns the professional into a service provider whose role is to offer guidance and
carry out the clients decisions. This model empowers the individual to pursue his/her
own goals.[9]

The market model of disability is minority rights and consumerist model of disability
that recognizing people with disabilities and their stakeholders as representing a large
group of consumers, employees and voters. This model looks to personal identity to
define disability and empowers people to chart their own destiny in everyday life, with a
particular focus on economic empowerment. By this model, based on US Census data,
there are 1.2 billion people in the world who consider themselves to have a disability. An
additional two billion people are considered stakeholders in disability

(family/friends/employers), and when combined to the number of people without

disabilities, represents 53% of the population. This model states that, due to the size of
the demographic, companies and governments will serve the desires, pushed by demand
as the message becomes prevalent in the cultural mainstream.[10]

[edit] Management
[edit] Assistive technology
Main article: Assistive technology
Assistive Technology is a generic term for devices and modifications (for a person or within a
society) that help overcome or remove a disability. The first recorded example of the use of a
prosthesis dates to at least 1800 BC.[11] The wheelchair dates from the 17th century.[citation needed] The
curb cut is a related structural innovation. Other examples are standing frames, text telephones,
accessible keyboards, large print, Braille, & speech recognition computer software. People with
disabilities often develop personal or community adaptations, such as strategies to suppress tics
in public (for example in Tourette's syndrome), or sign language in deaf communities. Assistive
technology or interventions are sometimes controversial or rejected, for example in the
controversy over cochlear implants for children.[citation needed]
Main articles: Web accessibility and Design for All (in ICT)
As the personal computer has become more ubiquitous, various organizations have formed to
develop software and hardware to make computers more accessible for people with disabilities.
Some software and hardware, such as Voice Finger, SmartboxAT's The Grid, Freedom
Scientific's JAWS, the Free and Open Source alternative Orca etc. have been specifically
designed for people with disabilities while other software and hardware, such as Nuance's
Dragon NaturallySpeaking, were not developed specifically for people with disabilities, but can
be used to increase accessibility.[citation needed] The LOMAK keyboard was designed in New Zealand
specifically for persons with disabilities.[citation needed] The Internet is also used by disability activists
and charities to network and further their goals. Organizations, such as AbilityNet and U Can Do
IT in the US, provide assessment services that determine which assistive technologies will best
assist an individual client.[citation needed] These organizations also train disabled people in how to use
computer-based assistive technology.[citation needed]

[edit] Adapted sports

Main article: Disabled sports

Wheelchair basketball match between South Africa and Iran at the 2008 Summer Paralympics
The Paralympic Games (meaning "alongside the Olympics") are held after the (Summer and
Winter) Olympics. The Paralympic Games include athletes with a wide range of physical
disabilities. In member countries organizations exist to organize competition in the Paralympic
sports on levels ranging from recreational to elite (for example, BlazeSports America in the
United States).
The Paralympics developed from a rehabilitation programme for British war veterans with spinal
injuries. In 1948, Sir Ludwig Guttman, a neurologist working with World War II veterans with
spinal injuries at Stoke Mandeville Hospital in Aylesbury in the UK, began using sport as part of
the rehabilitation programmes of his patients.
In 2006, the Extremity Games was formed for people with physical disabilities, specifically limb
loss or limb difference, to be able to compete in extreme sports.[citation needed] A manufacturer of
prosthetics, College Park Industries, organized the event[citation needed] to give disabled athletes a
venue to compete in this increasingly popular[citation needed] sports genre also referred to as action
sports. This annual event, held in the summer in Orlando, Florida,[citation needed] includes
competitions in skateboarding, wakeboarding, rock climbing, mountain biking, surfing,
motocross and kayaking.[citation needed] Non-profit organizations have created programs to advance
adaptive sports for regular recreation and sport opportunities.[citation needed]

[edit] Discrimination, government policies, and support

Main article: Ableism

[edit] United Nations

On December 13, 2006, the United Nations formally agreed on the Convention on the Rights of
Persons with Disabilities, the first human rights treaty of the 21st century, to protect and enhance
the rights and opportunities of the world's estimated 650 million disabled people. As of April
2011, 99 of the 147 signatories had ratified the Convention.[12] Countries that sign the convention
are required to adopt national laws, and remove old ones, so that persons with disabilities will,

for example, have equal rights to education, employment, and cultural life; to the right to own
and inherit property; to not be discriminated against in marriage, etc.; to not be unwilling
subjects in medical experiments.
In 1976, the United Nations launched its International Year for Disabled Persons (1981), later renamed the International Year of Disabled Persons. The UN Decade of Disabled Persons (1983
1993) featured a World Programme of Action Concerning Disabled Persons. In 1979, Frank
Bowe was the only person with a disability representing any country in the planning of IYDP1981. Today, many countries have named representatives who are themselves individuals with
disabilities. The decade was closed in an address before the General Assembly by Robert Davila.
Both Bowe and Davila are deaf. In 1984, UNESCO accepted sign language for use in education
of deaf children and youth.

[edit] Costa Rica

Under the Ley de Igualdad de Oportunidades (Law of Equal Opportunities), no person can be
discriminated by their disabilities if they are equally capable as another person. This law also
promotes that public places and transport should have facilities that enable people with
disabilities to access them.
May 28 is the Da Nacional de la Persona con Discapacidad (National Disabled People Day) to
promote respect for this population.
Currently the political party Partido de Acceso Sin Exclusin (Access Without Exclusion Party)
fights for the rights of disabled persons, and one congressman, Oscar Lpez, is blind.

[edit] United Kingdom

Under the Disability Discrimination Act (DDA) (1995, extended in 2005), it is unlawful for
organisations to discriminate (treat a disabled person less favourably, for reasons related to the
person's disability, without justification) in employment; access to goods, facilities, services;
managing, buying or renting land or property; education. Businesses must make "reasonable
adjustments" to their policies or practices, or physical aspects of their premises, to avoid indirect
discrimination.[13]
Since 2010 the Disability Discrimination Act has been replaced with the Equality Act 2010. This
act still protects disabled people against discrimination but also encompasses a number of other
characteristics including age, disability, gender reassignment, marriage, pregnancy, race, religion,
sex and sexual orientation.[14]
A number of financial and care support services are available, including Incapacity Benefit and
Disability Living Allowance.[15]
[edit] Employment

The Employers' Forum on Disability (EFD) is a membership organisation of UK businesses.

Following the introduction of the DDA the membership of EFD recognised the need for a tool
with which they could measure their performance on disability year on year.
In 2005 80 organisations took part in the Disability Standard benchmark providing the first
statistics highlighting the UK's performance as a nation of employers.
Following the success of the first benchmark Disability Standard 2007 saw the introduction of
the Chief Executives' Diamond Awards for outstanding performance and 116 organisations
taking the opportunity to compare trends across a large group of UK employers and monitor the
progress they had made on disability.
2009 will see the third benchmark, Disability Standard 2009. EFD have promised that for the
first time they will publish a list of the top ten performers who will be honoured at an award
ceremony in December 2009.[16]

[edit] United States

[edit] Discrimination in employment
The US Rehabilitation Act of 1973 requires all organizations that receive government funding to
provide accessibility programs and services. A more recent law, the Americans with Disabilities
Act of 1990 (ADA), which came into effect in 1992, prohibits private employers, state and local
governments, employment agencies and labor unions from discriminating against qualified
individuals with disabilities in job application procedures, hiring, firing, advancement,
compensation, job training, or in the terms, conditions and privileges of employment. This
includes organizations like retail businesses, movie theaters, and restaurants. They must make
"reasonable accommodation" to people with different needs. Protection is extended to anyone
with (A) a physical or mental impairment that substantially limits one or more of the major life
activities of an individual, (B) a record of such an impairment, or (C) being regarded as having
such an impairment. The second and third criteria are seen as ensuring protection from unjust
discrimination based on a perception of risk, just because someone has a record of impairment or
appears to have a disability or illness (e.g. features which may be erroneously taken as signs of
an illness).
[edit] African Americans and disability
According to the 2000 U.S. Census, the African American community has the highest rate of
disability at 20.8 percent,[17] slightly higher than the overall disability rate of 19.4%.[17] Although
people have come to better understand and accept different types of disability, there still remains
a stigma attached to the disabled community. African Americans with a disability are subject to
not only this stigma but also to the additional forces of race discrimination. African American
women who have a disability face tremendous discrimination due to their condition, race, and
gender. Doctor Eddie Glenn of Howard University describes this situation as the "triple
jeopardy" syndrome.[18]

[edit] Social Security Administration

The US Social Security Administration defines disability in terms of inability to perform
substantial gainful activity (SGA), by which it means work paying minimum wage or better.
The agency pairs SGA with a "listing" of medical conditions that qualify individuals for benefits.
[edit] Education
Under the Individuals with Disabilities Education Act, special educational support is limited to
children and youth falling into one of a dozen disability categories (e.g., specific learning
disability) and adds that, to be eligible, students may require both special education (modified
instruction) and related services (supports such as speech and language pathology).
[edit] Insurance
It is illegal for California insurers to refuse to provide car insurance to properly licensed drivers
solely because they have a disability.[19] It is also illegal for them to refuse to provide car
insurance "on the basis that the owner of the motor vehicle to be insured is blind," but they are
allowed to exclude coverage for injuries and damages incurred while a blind unlicensed owner is
actually operating the vehicle (the law is apparently structured to allow blind people to buy and
insure cars which their friends, family, and caretakers can drive for them).[20]

[edit] Demographics
[edit] Difficulties in measuring
The demography of disability is difficult. Counting persons with disabilities is challenging. That
is because disability is not just a status condition, entirely contained within the individual.
Rather, it is an interaction between medical status (say, having low vision or being blind) and the
environment.[citation needed]

[edit] Estimates worldwide

Estimates of worldwide and country-wide numbers of individuals with disabilities are
problematic. The varying approaches taken to defining disability notwithstanding, demographers
agree that the world population of individuals with disabilities is very large. For example, in
2004, the World Health Organization estimated a world population of 6.5 billion people, of those
nearly 100 million people were estimated to be moderately or severely disabled.[21] In the United
States, Americans with disabilities constitute the third-largest minority (after persons of Hispanic
origin and African Americans); all three of those minority groups number in the 30-some
millions in America.[21] According to the U.S. Bureau of the Census, as of 2004, there were some
32 million disabled adults (aged 18 or over) in the United States, plus another 5 million children
and youth (under age 18). If one were to add impairmentsor limitations that fall short of being
disabilitiesCensus estimates put the figure at 51 million.[22]

There is also widespread agreement among experts in the field that disability is more common in
developing than in developed nations.
Nearly eight million men in Europe returned from the World War I permanently disabled by
injury or disease.[23]
About 150,000 Vietnam veterans came home wounded, and at least 21,000 were permanently
disabled.[24] Increased US military involvement has resulted in a significant increase of disabled
military personnel since 2001. According to Fox News, this is a '25 percent' rise, with more than
'2.9 million' total veterans now disabled.[25]
After years of war in Afghanistan, there are more than one million disabled people.[26]
Afghanistan has one of the highest incidences of people with disabilities in the world.[27] An
estimated 80,000 Afghans have lost limbs, mainly as a result of landmines.[28]

[edit] Political issues

This section needs additional citations for verification. Please help improve this article
by adding reliable references. Unsourced material may be challenged and removed.
(February 2010)

Political rights, social inclusion and citizenship have come to the fore in developed and some
developing countries. The debate has moved beyond a concern about the perceived cost of
maintaining dependent people with disabilities to an effort of finding effective ways to ensure
that people with disabilities can participate in and contribute to society in all spheres of life.
Many are concerned, however, that the greatest need is in developing nationswhere the vast
bulk of the estimated 650 million people with disabilities reside. A great deal of work is needed
to address concerns ranging from accessibility and education to self-empowerment and selfsupporting employment and beyond.
In the past few years, disability rights activists have also focused on obtaining full citizenship for
the disabled.
However obstacles reside in some countries in getting full employment, also public perception of
disabled people may vary in areas.

[edit] Disability rights movement

The disability rights movement, led by individuals with disabilities, began in the 1970s. This
self-advocacy is often seen as largely responsible for the shift toward independent living and
accessibility. The term "Independent Living" was taken from 1959 California legislation which
enabled people who had acquired a disability due to polio to leave hospital wards and move back
into the community with the help of cash benefits for the purchase of personal assistance with the
activities of daily living.

With its origins in the U.S. civil rights and consumer movements of the late 1960s, the
movement and its philosophy have since spread to other continents influencing self-perception,
organization and social policy.

[edit] Disability insurance

Disability benefit, or disability pension, is a major kind of disability insurance, and is provided
by government agencies to people who are temporarily or permanently unable to work due to a
disability. In the U.S., disability benefit is provided within the category of Supplemental Security
Income, and in Canada, within the Canada Pension Plan. In other countries, disability benefit
may be provided under Social security systems.
Costs of disability pensions are steadily growing in Western countries, mainly European and the
United States. It was reported that in the UK, expenditure on disability pensions accounted for
0.9% of Gross Domestic Product (GDP) in 1980, but two decades later had reached 2.6% of
GDP.[29][30] Several studies have reported a link between increased absence from work due to
sickness and elevated risk of future disability pension.[31]
A study by researchers in Denmark suggests that information on self-reported days of absence
due to sickness can be used to effectively identify future potential groups for disability pension.
[32]
These studies may provide useful information for policy makers, case managing authorities,
employers, and physicians.
Private, for-profit disability insurance plays a role in providing incomes to disabled people, but
the nationalized programs are the safety net that catch most claimants.

How to Use One Crutch

If you have an injury to your lower body, you may need to use crutches to get around. While it is
more common to use two crutches for support, there are times when your doctor or physical
therapist may recommend using just one. In addition, if you are using two crutches it is safer to
use just one crutch when going down stairs. There is a right and wrong way to use crutches,
especially when using just one. Below are some common tips.
Difficulty:
Easy

Instructions
1. Set The Right Height
o

Before using your crutch make sure it is set to the right height. Stand up straight
and place the crutch under your arm. The crutch height should be set so that you
can fit two to three fingers between the top of the crutch and your armpit.
o

2
Next check the hand grip. Let your arm hang down relaxed. The hand grip should
be at the same height as your wrist. This means your wrist and elbow should be
slightly bent when placing the hand on the hand grip. This prevents you from
locking your wrist or elbow joint as you use the crutch.

3
Support your weight with your hands. You should not try to hold your body
weight with your armpits, as you can cause nerve damage.

2. Be Careful Using Stairs

o

1
Be safe going up and down stairs. If you are using two crutches, you will need to
learn how to go up and down stairs using just one crutch. Using two crutches to
use stairs, especially when going down is very unsafe. Stand near the stair railing
with your unaffected foot on the railing side and hold the railing. Place the crutch
under the arm of the affected side.

2
To go up stairs, keep the crutch on the floor. Push off the crutch and the railing
and lift yourself up to the first stair, landing on the unaffected side. Then bring the
crutch up to the stair you are standing on. Continue up the rest of the stairs, by
lifting yourself up fist and then bring the crutch.

3
To go downstairs, place the crutch on the stair below you. Support yourself on the
crutch and the railing and carefully lower yourself down to the next step, landing
on the unaffected side. Continue down the rest of the steps placing the crutch first
and then lowering down.

3. Getting Up and Down From a Chair Properly

o

1
Get up safely. Place the crutch in the hand of the affected side and use the hand
grip. Slide all the way to the very end of the chair as this makes it easier to push
up.

2
Lean forward from the hips and keep the back straight. Place your other hand on
the arm of the chair. Push off the chair arm, the crutch hand grip and your foot on
the unaffected side to come up.

3
To sit down, back up to the chair until you can feel the seat of the chair against the
back of your knees. Hold the hand grip, with the crutch on the affected side.
Reach the buttocks back and hold onto the arm of the chair.

4
Use the hand grip on the crutch and the arm of the chair to slowly lower yourself
down to the edge of the chair, then slide back. Avoid crashing down into the chair,
as this can lead to back and other injuries.

5
This process should also be used when getting in and out of bed.

4. Walking with One Crutch

o

1
When walking with just one crutch, hold the crutch on the opposite side of the
affected leg. It is common to want to use the crutch on the injured side, however
this just causes you to lean and put more pressure on the injury.

2
When stepping swing the crutch through as you step with the affected side. The
crutch and your foot should hit the floor at the same time. Then step through with
the unaffected leg

3
. By holding the crutch on the opposite side you can take weight off of the injured
side and better support yourself as you walk.

5. Things to Consider
o

If you are new to using a crutch, make sure your doctor or physical therapist
shows you how to use it properly. You can make your injury worse and even
create new injuries with a crutch that is used improperly.
o

2
Have someone nearby you when first learning, especially when using stairs or
getting up and down out of a chair. Crutches take some time to get used to and to
get your balance on.

3
The screws in your crutches can loosen over time. Check them regularly to make
sure they are tight. Remove scatter rugs, keep your floors neat and picked up and
immediately wipe up spills to avoid falls.

Read more: How to Use One Crutch | eHow.com http://www.ehow.com/how_4841743_use-onecrutch.html#ixzz1RHbo2xEa

Four-Point Crutch Gait

Indication:
Weakness in both legs or poor coordination.
Pattern Sequence:
Left crutch, right foot, right crutch, left foot. Then repeat.
Advantages:
Provides excellent stabilty as there are always three points in contact with the ground
Disadvantages:
Slow walking speed

Three-Point Crutch Gait

Indication:
Inability to bear weight on one leg. (fractures, pain, amputations)
Pattern Sequence:
First move both crutches and the weaker lower limb forward. Then bear all your weight down
through the cruthes, and move the stronger or unaffected lower limb forward. Repeat.

Advantages:
Eliminates all weight bearing on the affected leg.
Disadvantages:
Good balance is required.

Two-Point Crutch Gait

Indication:
Weakness in both legs or poor coordination.
Pattern Sequence:
Left crutch and right foot together, then the right crutch and left foot together. Repeat.
Advantages:
Faster than the four point date.
Disadvantages:
Can be difficult to learn the pattern.

Swing-Through Crutch Gait

Indications:
Inability to fully bear weight on both legs. (fractures, pain, amputations)
Pattern Sequence:
Advance both crutches forward then, while bearing all weight down through both crutches,
swing both legs forward at the same time past the crutches.
Advantage:
Fastest gait pattern of all six.
Disadvantage:
Energy consuming and requires good upper extremity strength.

Swing-To Crutch Gait

Indications:
Patients with weakness of both lower extremities.

Pattern Sequence:
Advance both crutches forward then, while bearing all weight down through both crutches,
swing both legs forward at the same time to (not past) the crutches.
Advantage:
Easy to learn.
Disadvantage:
Requires good upper extremity strength.

Tripod Crutch Gait

Indications:
Initial pattern for patients with paraplegia learning to do swing to gait pattern.
Pattern Sequence:
Advance the left crutch, then the right crutch, then drag both legs to the crutches
Advantage:
Provides good stability.
Disadvantage:
Very energy consuming.

Introduction To Walkers Canes and Crutches

Ambulation aids are for clients with pain or unable to bear weight on the legs; or with
limitations in strength, joint motion, balance, coordination or sensation. The key to
enhanced mobility and safety is matching the aid to the user's needs, abilities,
limitations and environment.
Alone or in combination, ambulation aids enable the user to function more freely, but the
user needs "gait training" to achieve the most normal, efficient and safest walking
pattern possible.
Understanding the clinical parameters involved in matching the device to the client allows
you to authorize an appropriate choice, question an order that appears
inappropriate, or spot a mismatch of client and equipment.

Key Considerations
The client's general condition

Include any respiratory, auditory, cardiac, orthopedic (e.g., braces, calluses

and bunions, foot deformities), neuromuscular or mental problems. Visual
field defects and auditory difficulties may affect a user's balance and gait.
Obesity can affect stamina, balance, stability and gait. Congenital or acquired
deformities (e.g., scoliosis, leg length differences) are also important.
The client's learning ability
Visual, oral, written ability to learn new tasks, motivation, body awareness
and attention span are critical to training in the proper use of an ambulation
aid. Equally important are cognitive functioning, sound judgment and task
planning.
The client's physical stability and balance
Coordination (hand-eye, fine and gross motor), grip strength, endurance,
flexibility, fluidity, posture, range of motion, upper and lower body strength
including differences in specific body parts. Also important to observe are the
client's head and trunk tilt, symmetry of stride, ability to turn, excessive
shoulder dip, ankle or foot motion, and foot drag. The presence of tremors,
involuntary movements of extremities, spasticity or rigidity is critical.
Social & vocational environments
Assess social as well as vocational environments so the client can ambulate
effectively in both. When the user encounters slick surfaces, rugs, uneven
floors, narrow doorways or halls, oversized furniture or stairs, does the
ambulation device hinder or assist him? Consider also the client's need for
portable oxygen, history of falls, and training required to use the device
properly. Depending upon the consistency of supervision, one device may be
more appropriate than another.

Caution

Make sure the client can use the device effectively. If the user feels frustrated
by a complex device, he won't use it and it is a wasted expenditure. A quality
HME provider should have a liberal exchange policy and a commitment to
personalized attention until the client is matched with the ambulation device
fitting his needs and abilities.

CANES
Parts of a Cane or Walking Stick
A cane or walking stick has four main parts:

The handle can be almost any shape but is usually a knowb. L shaped, crutch, opera T pistol grip
or hook.
The shaft is the straight part of the cane (though it may be twisted or bent) and although usually
made of wood or metal, can be made of bone, bamboo, or plastic
The collar attaches the handle to the shaft and is usually a band of metal
The ferrule or tip is the end of the can. It is usuallu made of copper and other metals or rubber. It
protects the tip ot the can from wear and tear..

Uses for a Cane or Walking Stick

Medical reasons to use a cane:
Canes provide support and stability
Canes improved balance.
Canes take stress and pain from the legs and feet.
Canes provide safety and security for those afraid of falling
Canes promote independence
Other reasons to carry a cane:
Canes are useful as a hook for reaching things
Canes provide protection
Canes are a tool for hikers
Canes are attractive and fun to carry
Using a Cane or Walking Stick
Hold the cane of your strong side or.
Hold the cane opposite your weaker or painful leg
Move the cane opposite leg together.
Climbing stairs:
First step up with the strong leg.

Pushing up move the cane and the weak leg to that same step.
Going down stairs:
First step down with the cane and and weak leg.
Using the cane for support, lower the strong leg to the same step.
Safety Tips:
Check cane often for where
Does it have a good, strong tip..
In the winter add an ice pick.
Be sure cane is the correct height
Make sure the cane cane is sturdy- should it have a base, stornger shaft, etc.?
Is there enough strenght and co-ordination to use a cane.
Consult a doctor or physical therapist if you there are doubts about the cane or its use.
Sizing a Cane
Turn the cane upside down and put the handle on the floor.
Stand with your arms at your sides.
The tip of the cane should be at the level of your wrist.
To Adjust Wooden Canes:
With the cane is upside down, mark the cane at the level of the wrist.
Remove the rubber tip.
cut the cane 1/2 inch shorter than the marked spot it.
Replace rubber tip.
To Adjust Aluminum Canes:
Most aluminum canes have holes and pins to adjust within one inch of the desired height.

Aluminum Canes

are very light

have height adjustments

accurate fit easily obtained

can be fitted with a wide base or extra legs for greater stability

Traditional wooden canes

Are heavier
Can be height adjusted, but can not be made taller

Have infinite possibilities for style

Tips at the end of the cane

Provide traction

Absorb shock

Suction cups can grip the floor

Rubber and metal tips grip the ice

Stabilizers can help with balance

Additional features

Folding canes
Seat canes

Canes with holders to lean on a table

Wrist straps to hold the can without setting it down

Forearm cuffs and platforms to shift weight to the upper arm if there is limited

A reacher accessory helps with picking things up from the floor

Canes are not designed to substitute for weight bearing on the legs, but rather to afford
weight-bearing relief. Support may be increased during emergency maneuvers, such

as when the user slips or stumbles on a wet surface and the cane takes the brunt of
the impending fall. A cane also improves balance and security by adding a third
point of ground contact, and alters the biomechanics of walking in a way that may
relieve painful joints.
Without a cane, a user may feel more pain, be non-ambulatory or may walk with an unstable gait
pattern. While most fixed-length canes are still made of wood with a curved handle, many of
today's adjustable-length canes are made of aluminum tubing with plastic or foam grips.
Proper selection is key, as is client training in the appropriate use of a cane. A poorly fitted cane
or misuse of an appropriate cane may aggravate the user's limitations, impede healing or increase
the risk of injury from a fall.

Cane Caution

Design: If the user should avoid weight bearing at the wrist, platform crutches
or a walker with a platform attachment should be used in place of a cane.

Key Considerations
1. Evaluate the client's outdoor environment and personal space to select a
cane that is an aid, not a hindrance. Quad canes, in general, stand
independently, but the base is more cumbersome when hung from the back
of a wheelchair. That's of special concern in tight living quarters
or work sites.
2. Although small-based quad canes are generally less stable than those with
large bases, they are also less likely to interfere with a user's foot while
walking.
3. Single point or straight canes are indicated when gait or balance are mildly
disturbed; only minimal support is needed; there is an endurance problem; or
pain is present but does not prevent weight bearing.
4. Side walkers (hemi) and quad canes are the devices of choice for clients with
poor balance or one-sided weakness (hemiparesis) from stroke or other injury.
Some quad canes have a set of vertical legs and a set of legs angled outward
at the base. This model requires the user to walk with the angled legs facing
away from the body.
5. Design variations in canes and handgrips make it easy to fit the cane to the
client's need. A cane with a handle centered over the tip is better balanced.
Some have special handgrips to provide more comfortable or biomechanically
correct hand positions. For transport, some canes come with a wrist strap,
while others are retractable.
6. Ensure the device is compatible with the clients lifestyle, desires, and goals.
The more conspicuous or heavy the device, the less likely the client will use
it. The more training required to use it, the more likely it will remain in the

closet. If consistent use for increased safety is the goal, it's important to bow
to client preference for simplicity.

Special features
Some canes have adjustable-angle tilt handles. Youth and tall adult sizes are available. Confirm
with your HME dealer whether ice tips (retractable sharp points that dig into ice for better
gripping), wrist strap, vinyl cover or cane holder are included or are extras to be purchased
separately. Optional handgrips of Devon or Hypalon are now available.

CRUTCHES
Traditional wooden crutches with wing-nut adjustments are still commonly used by healthy
people with short-term needs. But newer crutch designs - bright anodized (colored) aluminum
with push-button adjustments - are not so obviously institutional and have fast become the
"crutch of choice" for professionals and consumers alike.
The physically fit or younger client with good balance and strength may find crutches more
practical for walking and stair climbing. Crutches can support more than 50 percent of body
weight during ambulation. The three types of crutches are axillary, forearm (also known as
Lofstrand) and platform.

Axillary's and forearm crutches

Axillary crutches, provide stability with a padded piece held between the chest wall and upper
arms, and may be easier to use by those with weak arms. The forearm crutch presents a
streamlined appearance, is less cumbersome than the axillary crutch, and allows the client to use
his hands without dropping the crutches. More appropriate for people with long-term needs, the
forearm crutch features a flexible cuff that surrounds the forearm just below the elbow, helping
to reduce arm strain. Cuffs that adjust both in length above the handgrip and in diameter afford
the most comfort. The forearm crutch requires a strong handgrip and is less stable than the
axillary crutch. Many axillary and forearm crutch models now have telescoping mechanisms that
retract the shaft for easy transport.

Platform crutch
With padded platforms, or "troughs," upon which the forearms rest and vertical handgrips to hold
on to, the platform crutch provides a larger area of contact for transmission of the load to the
shoulder girdle. To help the user's hand lift the crutch, an adjustable strap holds the forearm to
the platform. This kind of crutch is an alternative for people with gripping limitations or
problems bearing weight in the hand, wrist or forearm. It offers more stability than the standard
forearm crutch.

Ease of adjustment

For the frail or vision-impaired user, ease of adjustment is key. Crutches with push buttons
instead of wing nuts are easier to adjust, and the user is less likely to lose any parts (washers,
bolts, wing nuts, etc.). Generally, replacing adjustment bolts on wooden crutches requires more
effort to align the parts compared to aluminum crutches. Some models have spring-loaded
adjustment buttons that are pulled out instead of pushed in to release the mechanism. These are
easier to use than push buttons, which require constant pressure and good hand coordination.

Special features
Crutch manufacturers offer sizes for children, youth and tall adults as well as different tip sizes
and ice tips. Cushions and grips also come in varied sizes. Some forearm crutches offer front or
side opening cuffs. Added options include spun ends to reduce noise, stair deflectors for added
safety, contoured and non-rotating handgrips, locking wing nuts, and client fitting-scale
indicators.

WALKERS
For significant weight-bearing needs, when the choice is between a walker and crutches, evaluate
the need for more stable support provided by a walker versus the versatility of crutches (such as
on stairs). Because the walker is more stable and can stand by itself, older clients find this device
easier to manage. When primary use is within a single-level home, the walker is a good choice,
although fitting through doorways and bathrooms may present problems. Many current walker
designs, of aluminum with adjustable-length legs, are foldable, allowing greater storage and
portability than rigid models.

Walker Caution

A carrying pouch or basket may allow safer ambulation if the user needs to
carry items.
Some walkers are not safe for people weighing more than 230 pounds.

In a multi-level living situation, it may be safer to have one walker upstairs

and one downstairs with special stair railings or a lift to facilitate access
between floors.

The legs of some reciprocal walkers have been found to slant inward and
become increasingly unstable as the legs are lengthened. Assess each model
for this flaw when considering a reciprocal walker.

Key Considerations
1. Walkers vary greatly in weight, so evaluate the upper body strength of the
user. Wheeled walkers are appropriate for a client who needs enhanced
stability but may not need to rely onthe walker for weight bearing; or for a
client with little upper body strength.
2. Certain wheeled models fitted with cable brakes require a firm griping action
to stop - suitable only for clients with the requisite hand strength and

cognitive function. Other models have direct-action brakes that require only
that weight be placed on the walker to activate.
3. Folding walkers are useful for the highly mobile person (e.g., a car user) if the
individual can fold, unfold and secure the walker in open position. For the
client with a tendency to lose balance backward, using a slightly lowered
walker brings his height forward.
4. A walker disrupts normal gait pattern and is usually prescribed only after
other ambulation aids have been found unsuitable. Use of a walker requires
basic but essential training for both indoor and outdoor terrain. Your client
needs a level of cognitive functioning enabling him to remember proper use
of the walker from moment to moment. If the client is unable to understand
or retain how to use the walker, he may be at greater risk for injury.

Environmental Considerations
Evaluate the home, work and recreation environment for accessibility. In tight bathrooms, for
example, a standard walker prevents access and grab bars may need to be installed as alternative
means of support. Certain walker models are designed for use over the toilet; others are flared,
allowing closer access to bedside, chair and commode.

Design, adaptations and fit

Walkers with two folding locks require less force to unlock than single-lock
models, but they also require more steps to complete folding. On some
walkers, the front two legs can be replaced with wheels or low-friction pegs,
enabling the user to roll or slide the walker instead of lifting it, while the
rubber tips on the rear legs act as brakes. However, the wheeled walker is
less stable and doesn't roll easily over carpet or rough terrain.
Reciprocal walkers are articulated to allow each side to be moved forward
independently, facilitating the normal walking pattern of opposing motion,
which the standard walker inhibits. A reciprocal walker is often an appropriate
interim device between crutches and a walker, but is not suitable for weight
bearing.
Hemi-walkers adapt for use with one hand. The side walker is both a walker
and a four-footed, pedestal-base cane with a grip. Some side walkers have an
additional handgrip to help the user rise from a seated position. The wide
footprint of most side walkers makes it more stable than a quad base cane
and tends to support more weight. However, the side walker can be heavier
and easier to trip over than quad canes.

Special features and options

For tall users, extra-long leg attachments can be purchased. Some walker models offer flexible
handles, ice tips, sling seat, carrying pouch or basket, rear glide and brake attachments, platform
and forearm attachments, corrosion-resistant brass push buttons for height adjustment, one-step

folding with palm release, and positive locking. Models are available in pediatric and small-adult
sizes.
Range of motion exercises reduce stiffness, prevent deformities, and help keep your joints
flexible. the "range-of-motion" is the normal amount your joints can be moved in certain
directions.
If your joints are very painful and swollen, move them gently through their range of motion.
If you have a limb that is unable to complete range of motion exercises independently, then
consider self range of motion exercises.
Move your joints through their full range of motion every day.
Daily activities, such as housework, climbing stairs, dressing, bathing, cooking, lifting, or
bending do NOT move your joints through their full range of motion. They should NOT replace
these therapeutic exercises.
A person may increase a joint's range of motion through regular, gentle stretching exercises as
directed by a health professional. Often these exercises are recommended after an injury or
surgery to help prevent joint stiffness.
Just as there are different types of flexibility, there are also different types of range of motion
stretching. Stretches are either dynamic (meaning they involve motion) or static (meaning they
involve no motion).
The different types of range of motion are:
1. AROM - active range of motion
2. AAROM - active assisted range of motion
3. SROM - self range of motion
4. PROM - passive range of motion

We have also included a special page on range of motion exercises for babies.
Flexibility: the ability to move a joint through a series of articulations in a full non-restricted,
pain-free range of motion (ROM).
Stretching: techniques used to lengthen shortened soft tissues at the musculotendinous units to
facilitate an increase in ROM.
Stretching has an impact on both contractile and non-contractile soft tissues. Passive stretching to
the elastic limit can allow these tissues to resume the original resting length. Passive stretching
beyond the elastic limit into plasticity will lead to a greater soft tissue length compared to the
original resting length when the stretch is removed. Prolonged lengthening of the contractile

units of muscle, the sarcomeres, into the plastic ROM progressively leads to increased soft tissue
length due to an increased number of sacomeres in series. Non-contractile units of muscle are
ligaments, joint capsule, and fascia which all consist of collagen and elastin fibers. Prolonged
lengthening of collagen up to its yield point leads to tissue lengthening due to permanent tissue
deformation. Elastin fails without deformation with high loads. The more elastin the tissues
contain, the more flexible the tissues. To avoid damaging soft tissues, healing and remodeling
time must be allowed between periods of stretching.
Indications:
Essential for establishing normal ROM of joints and soft tissue
Important decreasing risk of injury to the musculotendinous unit
Prevent contractures and adaptive shortening
Combats the effects of prolonged immobilization
Optimal flexibility will reduce stresses to surrounding joints and tissues
Contraindications: Do not stretch
Around acutely inflamed or infected joints
Patients who are already hypermobile
Patients when shortened muscles are providing stability if normal joint stability is decreased or
assists with functional abilities such as in persons with paraparesis
Across a joint when a bony block prevents motion
Guidelines and Precautions:
It is optimal to warm up before stretching vigorously
To increase flexibility, the muscle must be overloaded or stretched beyond its elastic ROM, but
not to the point of pain
Exercise caution when stretching muscles around painful joints
Avoid over-stretching ligaments and capsules that surround joints
Use caution if history of steroid use
Use caution stretching patients with known or suspected osteoporosis, or who have been on
prolonged bed rest
Ballistic stretching should be done only by patients who are already flexible
Stretching should be performed at least 3 times per week, but between 5 and 6 will yield
maximal results
Use caution stretching patients with frail integument
Use caution stretching older patients because their collagen loses its elasticity and they have
reduced capillary blood supply.
Equipment / supplies needed: Occasionally towels, buttress material, or straps are used to fixate
or position a body part.
Stretching Methods:
Static Stretch: involves stretching a muscle to the point of discomfort and then holding it at that
point for an extended period of time. Can be held between 3 and 60 seconds. Optimal stretch

time is between 15 and 30 seconds. Advantages: Prolonged low load will best facilitate a long
lasting change in ROM Least likely to exceed the limits of the tissue extensibility Requires less
energy expenditure Produces minimal muscle soreness
Ballistic Stretch: dynamic, rapid action of repetitive bouncing motions applied to the muscle
being stretched. The antagonistic muscle group of the muscle being stretched initiates the
motion. It is an effective technique for athletes but creates increased chance of muscle soreness
and injury. Uncontrolled force and proposed neurologic inhibitory influences of rapid stretch
may cause injury.
Proprioceptive Neuromuscular Facilitation (PNF) Stretching Techniques:
The first three of the following techniques incorporate use of the stretch reflex. All muscles
contain mechanoreceptors that when stimulated, stimulate the central nervous system. The
muscle spindles and the Golgi tendon organs are sensitive to changes in length. Muscle spindles
immediately increase muscle tension in response to an increase in length and fire for at least 6
seconds. The Golgi tendon organs over-ride the muscle spindles after 6 seconds and cause reflex
relaxation of the antagonistic muscle allowing extensibility limits to be extended.
1. Hold Relax (HR): a. Passively move limb until the comfortable end range b. 6-10 sec submaximal isometric contraction of the antagonist (muscle to be stretched) against resistance c.
This is followed by a concentric contraction of the agonist combined with light pressure from the
therapist for a maximal stretch on the antagonist for 6-10 sec d. Repeat b. and c.
2. Contract Relax (CR): a. Passively move limb until the comfortable end-range b. 6-10 sec submaximal contraction of the antagonist (muscle to be stretched) isotonically against the resistance
of the therapist c. The antagonist relaxes as the therapist moves the limb passively through as
much ROM as possible returning to end-range for 6-10 sec d. Repeat b. and c.
3. Slow Reversal-Hold-Relax (SRHR), also Contract-Relax-Agonist-Contraction (CRAC): a.
Passively move limb until the comfortable end range b. Isotonic contraction of the agonist c.
Followed by isometric contraction of the antagonist (muscle to be stretched) for 6-10 sec d.
Repeat b. and c.
4. Rhythmic Initiation: indicated when tone or muscle spasm is sensitive to stretch. a. Full
PROM into the direction desired b. Commands are given Relax let me move you, followed by
now you do it with me.
5. Rhythmic rotation: indicated when tone or muscle spasm is sensitive to stretch. a. Supported
full PROM into the direction desired b. Rotation of the body part alternately in both directions in
a slow rhythmic manner around a longitudinal axis for 10 sec c. The command to Relax and let
me move you. is given. d. Once relaxation is achieved, the limb is moved passively or actively
into the newly gained range.
Patient Education: Patient should be instructed in proper techniques for self-stretching.
Documentation:

 Name of muscle(s) to be stretched

Method of stretching
Position
Length of time stretch maintained
Frequency stretch is performed
Alternatives: Stretching is more effective when the intramuscular temperature is increased.
Tissue heated to 103 degrees Farenheit is optimal and can be achieved through either therapeutic
modalities or low-intensity warm-up exercises.
The following exercises can help keep your joints moving. Follow these tips to get the most
benefit.
1. Do these two to three times a day.
2. Do each exercise 3 to 10 times.
3. Move slowly. Do not bounce.
4. Breathe while you exercise and count out loud.
5. Begin exercises slowly, doing each exercise a few times only and gradually build up to more.
6. Try to achieve full range of motion by moving until you feel a slight stretch, but don't force a
movement.
7. Don't try to help others do their exercises by moving their arms or legs.
8. STOP exercising if you have severe pain.

Disabled Caregiver Jobs

Filed under Disabled Caregiver
If you are a compassionate and responsible person looking for a career that is in high demand,
consider being a disabled caregiver. A disabled caregiver is someone who takes care of people
who are not able to or have never been able to properly care for themselves. By assisting and
caring for them, they can regain a sense of normalcy in their lives.
There are a variety of different types of people that you would help care for with a disabled
caregiver job. Disabled caregivers assist those who suffer from many different types of
disabilities or illnesses that prevent them from being able to take care of themselves. Disabled
caregivers are also responsible for taking care of the elderly who are not able to function as they
once did.

Caring For Disabled Jobs Responsibilities

A disabled caregiver is responsible for supporting the patient both physically and emotionally.
You are responsible for a number of duties and activities that can include but are not limited to,

Helping the client get bathed and dressed

Doing the cleaning

Lifting the disabled individual and assisting them in wheelchair transfers

Performing daily functions such as assisting them or bathing them in the

shower or tub.

Preparing and organizing their personal documents

Complete the laundry

Be able to operate their handicap equipment

Changing their dressings which can include adult diapers if they are no longer
able to go by themselves

Grocery shopping or running errands

Doing the cooking

Assisting them in living their lives with the most dignity and freedom they are
still able to have.

Being a friend or someone they can trust and being the emotional support
when they are down

Careers Providing Caring For Disabled and Handicapped

There are certain things that a disabled caregiver must go to school for and
get a certification, if you choose this career field. If you are already a disabled caregiver, there
are always ways to improve your skills when caring for the disabled. There are special classes
you can take at the local college to improve your techniques. Other ways you can improve are to
educate yourself on certain illnesses and disabilities by researching them through the Internet or
checking out books on the subject at the local library. If you want a job where you are looking
after the disabled, then use the job search engine located on the right sidebar. You will be sure to
find caregiver jobs in your local area. Good luck!
Tags: Careers Providing Caring For Disabled and Handicapped