Why be active? “Physical activity is the single most useful thing that individuals can do to maintain their health and function and quality of life” (World Health Organisation, 1997) It is a proven fact that physical activity and exercise are good for you and more so for older people in a care setting. It helps maintain and improve quality of life and assist in their independence.
People who are active have a lower risk of stroke, cardio vascular disease, type 2 diabetes, depression and dementia. Exercise can help relieve aches and pains, osteoporosis, increase mobility and loss of muscle strength which decreases incidents of falls and breaking hips which are common with the elderly.
Studies also show that exercise for people with dementia reduces confusion and agitation as well as a decrease in the need for medication. Exercises are aimed at improving and maintaining a person’s ability to carry out their activities of daily living and focus on areas such as mobility, balance, strength and endurance and aerobic fitness i. e. slightly improving their ability to sustain an activity such as walking. Exercise is beneficial in promoting mental health and well being in many ways such as improved self-esteem, reduced anxiety and stress and improved overall well-being.
An exercise plan for a person with limited mobility can help build their strength and flexibility and may bring many benefits such as increased joint mobility, improved balance, risk and prevention of falls, an increase in reaction and improved maintenance and abilities of carrying out activities of daily living. Exercise can also help control and manage conditions such as diabetes, high blood pressure, obesity, heart disease and cholesterol levels, arthritis, osteoporosis and cancers. Exercise is also good for the immune system to help fight infection and viruses.
Also exercise as a group activity is good for an individual as a social aspect as they get to meet and interact with other people. Developing and facilitating an exercise programme In my role as a Healthcare Assistant, many factors have to be taken into account when planning an activity or an exercise programme. On a one to one basis you would refer to their P. E. P. (personal exercise plan) which would have been devised by the Occupational Therapist and Physiotherapist initially on assessment. I will look at this from a group perspective and hopefully show how to plan and facilitate a group session.
You should never assume that planning an activity session will suit all clients. It is beneficial to know of their care plans and to ask them plenty questions of their past interests and likes/dislikes and if it exercise related Adrian McHugh(8), 1900 words to refer to their care plans for their health status and suitability in relation to their capabilities, impairments, are there risk factors involved and are there special aids, equipment, materials or requirements needed.
It is also important to do a risk assessment on the room or area where the session will take place to make sure of a safe environment i.e. enough space, clutter free, make sure windows areaccessible in case it’s too hot or cold.
Before starting a group session it is important to get the consent of those taking part before assisting them to the room or area that it is taking place in. it is important to make sure they are feeling well enough to take part and that they are wearing suitable and comfortable clothing and bring any personal aids necessary. On starting one should inform the group of what the session will entail and how long it will last and ask them to stop the session at any time if they are feeling uncomfortable or sensing any pain.
Also inform those who are assisting to run the session to observe for any potential risk factors such as sweating, breathlessness, pain and even facial expressions. It is important to make the session entertaining as possible, to encourage participation and get them to engage in interaction with other residents taking part to meet their social needs. On finishing the session congratulate all those that took part, make them feel that they are achieving and that the exercises they took part in are for their benefitand will make them feel better and encourage continual participation.
Take those that are higher risk, such as residents with Zimmer frames, rolators etc. back to their rooms first before those in wheelchairs. On returning all clients to their rooms, it is then time to take out their individual care plans and document how the session went for them. The role of record keeping is to monitor a resident’s progress and to see if these sessions are meeting their needs and achieving goals originally set out when assessed by the Occupational Therapist and Physiotherapist. It is also important to document their interaction levels on the day and how they engaged within the session.
Record keeping facilitates continuity of care, safety requirements and can be referred to at any time to check on how a resident is progressing or to check up on a certain date and time for example how the resident interacted when taking part two weeks previous. Record keeping should use clear, straightforward language, be concise, and accurate.
They should clearly differentiate between facts, opinions and judgements. Record keeping should be kept private and confidential but shared with the Multi D team for assessment. Exercise Plan Developed Adrian McHugh(8), 1900 words Patrick (not real name) is 80 years old, resides in a private care facility and has a deficit of Hemiparesis following a stroke. He has weakness on the left hand side of his body, has limited mobility and uses a rolator to walk with.
He has reduced muscular strength on the impaired side of his bodyand has difficulty maintaining his balance at times due to limb weakness and an inability to properly shift his body weight. A reduction in his motor skills has led to difficulties in him performing activities of daily living such as washing, dressing, eating and using the bathroom.
After Patrick suffered a stroke and was in recovery he was assessed by the Occupational Therapist and Physiotherapist and a PEP (personal exercise plan) was devised, focusing on exercises and stretching to improve strength, endurance, range of motion and balance skills with a view to independenceand maintaining as muchmobilitypossible.
Treatmentalso focuses on improving sensation and motor abilities, allowing Patrick to better manage hisactivities of daily living. Repeated practice and regular activity will help increase control and flexibility. It is important to put the body parts affected through the same movements they would go through if not paralysed. This is known as Range of Motion (ROM) exercises and its purpose is to keep muscles, ligaments and joints flexible to enhance nerve healing. Patrick’s exercise plan is person centred on a one to one basis but he is also encouraged to participate in any group session which would benefit him.
Continuous active participation is critical to his motor learning and recovery process; therefore it’s important to keep him motivated so he can make continual improvements. Patrick currently has a PEP in place which is done with the Rehabilitation Assistant 3 days per week: Exercise 1 To maintain hand flexibility These are a list of hand flexibility exercises that can be done on a daily basis.
(a) With the closed fist, practise counting from one to five with the fingers and then in reverse. (b) Pick up objects of various sizes. (c) Play with a stress ball or squeezing a sponge ball. (d) Using sign language (diagram below) form each letter of the alphabet, also known as finger spelling. Adrian McHugh(8), 1900 words http://www. neuroaid. com/en/blog/post-stroke-disabilities/hand-ex ercises-for-stroke-patients/
Exercise 2 To work on the muscles in the shoulder This can be done in his bed. He will lay on his back, arms by his side and then raise hand towards ceiling lifting the shoulder blade from the bed and hold for 5 seconds, rest and repeat several times. Exercise 3 To improve hip control for walking activities Lying on the bed have unaffected leg flat on the bed with the affected leg bent. Cross the affected leg over the other leg. Lift the affected leg again and un-cross resuming set position.
Repeat crossing and un-crossing motion several times. Adrian McHugh(8), 1900 words Exercise 4 A motion exercise for the pelvis, hip and knee This exercise can reduce stiffness and is beneficial for rolling over and moving in bed. Lying on your back with your hands resting on your stomach, bend the knees with feet flat on the ground.
Then hold knees together and slowly move them as far to the right as possible then return to centre. Repeat the same for the left hand side, Repeat exercise several times. Exercise 5 To maintain ankle motion needed for walking This exercise is also beneficial for the wrist and elbow. Stand, facing the wall at arm’s length, feet flat on the floor slightly parted and body weight equally balanced. At chest level hold the affected hand against the wall with the good hand. Slowly bend the elbows leaning into the wall which stretches the back of the lower legs.
Heels to remain on the floor. Finally, straighten the elbows by pushing away from the wall. Repeat several times. Adrian McHugh(8), 1900 words http://www. stroke. org/site/DocServer/hope4. pdf? docID=524 (Exercises 2 – 5) Patrick is also encouraged to take part in group sessions in the afternoon such as the Sonas programme, dancing and bowling. Sonas programme is good for his gross motor skills as it involves using small musical instruments, bean bags and balls with a touch of dancing involved.
It is also good for interaction with other residents and cognitive such as memory games and reminiscing. Dancing is good for aerobic and cardio as well as working on muscle tone, balance and posture as well as the social aspect. Bowling is good for his hand grip as well balance and muscle and joint movement of hinge and ball and socket joints of the elbow and shoulder as well as a social event.
Before any exercise takes place it is important that Patrick is wearing comfortable clothes and shoes, is fit and well to take part and a warm up takes place first for a few minutes such as sitting on a chair and marching his feet and shaking out his arms and hands. Below is a schedule of a typical week that Patrick takes part in, which would cover strength i. e. lifting little weights to help muscle mass, endurance i. e. walking, gardening, swimming etc. to increase the heart and breathing rates for a period of time to help the cardio vascular and respiratory systems and aerobic exercises such as dancing and arm and leg exercises that get the heart and breathing rates up.
MONDAY TUESDA Y WEDNESDA Y THURSDA YFRIDAY Adrian McHugh(8), 1900 words Morning Hand Functionin g Aerobic Exercise Dancing Endurance Exercise Strength Exercise Afterno on Sonas movie Reminiscence Therapy Bingo Bowling Like any exercise plan it has its strengths and weaknesses. Its strong points are definitely that it improves quality of life and is important for continuity of care. It has all the benefits of physical activity as discussed previously but exercise and group sessions also has a social side to it, interacting with other residents, the fun factor and enjoying each other’s company giving a sense of wellbeing and independence.
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