On the Go Physio

Staying Strong at Home
 by hcsl

Staying strong while staying Independent

Written By

Jessie Snowdon, New Zealand Registered Physiotherapist, Director On the Go Physio Limited, March 2022

Two years into New Zealand’s journey with COVID and these days can seem harder than ever.
We have endured lock downs and now we are in this strange no-man’s land where it feels for
many older adults, that in order to stay safe we must stay home.

Strength is IMPORTANT!

If you are not getting your usual physical activity, or if you have never been that keen on
exercise (!) then you should try and build in some structured exercise every day. Exercise can
come in many ways – gardening, bowls, walking – and although these are all excellent ways
to get in your recommended 150 minutes a week, the real hero of the story is building
strength.

As we age we naturally lose muscle strength, and our muscle fibres change – but age is NOT
a barrier to improving strength and muscle mass. We know that there is a direct link between
strengthening exercises and decreased risk of falls, and we all want that!

How can I strengthen my muscles?

In order to make change you must put your muscles under a certain load…and this means it
must be hard! The great news is that you don’t need to spend much time, if you hit the right
level of ‘hardness’. You can work through a strength programme in 10 minutes!

We recommend that you start with 10 repetitions of each exercise for a few days, and then
find the level at which doing 6-8 of the exercise feels “hard”. “Hard” means that you don’t
feel you could do any more without a rest.

When you have established that level you should work through your whole programme then
take a 2 minute rest. Then, guess what? Do it all again!

Which muscles should I strengthen?

You should strength the muscles you need for function. This means the ones you need for
every day activities like standing up from a chair, walking fast, picking up objects and helping
with balance.

The programme below covers off all of these.

Is there anything I should be careful of?

With all exercise you should be aware of and stop if you experience pain in your muscles or
joints, chest pain, severe shortness of breath or severe dizziness. Remember though that
when you work your muscles hard you can expect to have slight soreness the next day or so,
especially when you have just started.

Ok I’m ready! Show me the exercises!

As you are all individuals it is hard to prescribe one set of exercises for everyone. You will
need to apply some common sense and ensure you feel safe during each exercise. If you are
unsteady, or usually use a walking stick or frame, then ensure you are holding on to the bench
or table – or have your frame in front.

Ready….let’s go!

Exercise one – Standing up and sitting down This works the muscles you need to get from a chair but also to bend down, walk, climb stairs – it is an excellent all-round functional exercise.

❖ Start in a firm chair that you know you can stand up from.
❖ Using both hands lean forward and then stand up.
❖ Repeat this 6-8 times.

Exercise 1

Easy? Make it harder by…

• Speeding up.
• Just use one hand.

• Use no hands (cross arms across chest).
• Sitting on a lower seat.
• Holding something heavy in your arms such as bottled water, or some weights.

Exercise two – rising up onto tiptoes
As long as you aren’t hanging on for dear life this is an excellent whole leg work out.

You need strong calf muscles to walk and for balance.


❖ Hold onto a steady surface such as a kitchen bench or back of a chair.
❖ Rise up onto your tip toes, as high as you can.
❖ Try to go straight up, not forward.
❖ Repeat 6-8 times.

Exercise 2

Easy? Make it harder by…

• Decreasing your hand grip so you just use index fingers.
• Putting a back pack on with weights such as bottled water in it.
• Lift one leg off the ground and take all the weight on one side!

Exercise three – standing on one leg
This works the muscles around your hips and is excellent for stability and balance.

❖ Hold onto a steady surface.
❖ Make your left leg strong and gently lift your right.
❖ Focus hard to ensure your hips stay level – your trunk and shoulders shouldn’t move!
❖ Hold for 5 seconds then swap sides.
❖ Repeat 6-8 times on each side

Easy? Make it harder by

• Standing for 10 seconds
• Decreasing how much you use your hands, change to just index fingers, or no hands!

Exercise four – push ups!

Strong arms are essential for helping you pick up and carry objects, and to push yourself up from a chair, bed or the floor. We often neglect our arms so make sure to include this one!

❖ Stand with your hands against the wall, have a chair next to you if needed.
❖ With fingers spread and arms close to your body allow your elbows to bend so you
come closer to the wall.
❖ Breath out and push away back into standing.
❖ Repeat 6-8 times.

Easy? Make it harder by…

• Using the bench to lean on instead of the wall.
• Increase your speed.

This is an excellent starting point with four functional exercises. If you repeat all these then
you should have a good 10-minute daily walk out. If you would like so extra balance
exercises then read on!

EXTRA BALANCE EXERCISES


Balance exercises are harder to prescribe as everyone is at very different levels and you need to keep safe! Here are some options for balance work but ensure you are by a sturdy surface and work within your abilities.


Exercise one: Standing still balance
❖ Stand with your feet together, without holding on, for 10 seconds

 

Ex 5

Easy? Make it harder by…


• Turning your head slowly side to side.
• Closing your eyes (with care).
• Changing your foot position into “step”.
Exercise two: walking backwards
❖ Carefully walk backwards alongside your bench. If you normally use a frame or walking
stick then ensure you use if for this exercise.
❖ Focus on long, slow steps.

Exercise three: walking in a figure 8


❖ In an open space you can put down two objects (salt and pepper shakers, two water
bottles) about 1 metre apart.
❖ Weave around these in a figure 8.
❖ Use your walking frame or stick if this is normal for you.

Easy? Make it harder by…

• Moving the objects closer.
• Going faster!
Congratulations!

You are now carrying out a great exercise plan. If you are able to you
should include regular walking at a good pace out in the community. You should also
ensure that once you have done your daily exercises you don’t sit down the rest of day.
Every 30 minutes you should be up on your feet, even if just for a minute or two.
If you would like more advice or and individualised treatment plan then we offer clinic,
home and online appointments and would love to help you regain and maintain your
strength.

Original Article By: Jessie Snowdon, New Zealand Registered Physiotherapist, Director On the Go Physio Limited, March 2022
in News
 by hcsl

What does a Physiotherapy programme look like in Aged Care?

Prior to contracting a Physiotherapist, or as part of your Physiotherapy service review process, you should consider what your goal is in having physiotherapy input.  These should include key values such as Meaningful Outcomes for residents.

We asked Jessie Snowden of On The Go Physio what should felt was important for a Physiotherapy programme to which she offered the following:

For us this means we carry out thorough assessments, find out what is important or meaningful to the resident, their whānau and how this impacts their functioning in the aged care environment. Our input with people can range from rehabilitation to a previous level of function.  This may be intensive physio input for a few weeks, to ensuring someone is safe and comfortable with appropriate seating and pressure care at the end of life (which could be one visit only).

This level of assessment means that you need to ‘budget’ for 40-60 minutes (sometimes longer for complicated admissions) of physiotherapy time for a new assessment and possibly longer if they are needing to make referrals, liaise with other services and family. Follow up visits will be shorter. It is recommended that if you have a set number of hours per week that your staff and the physiotherapist are clear on expectations and priorities. If you only contract 2 hours per week it is not fair to have 10 new assessments on your ‘urgent’ list!

Some facilities have a set standard of 6 monthly reviews of all their residents. Although we do undertake these if asked, it is often more meaningful to use physiotherapy skills for those residents who may improve with input, or who your staff need assistance with due to functional decline. We suggest  if a 6 monthly review is wanted, then the RN is able to carry this out by considering if there have been changes in mobility, falls rates or other physical changes affecting function. If not then your physiotherapy dollar could be better spent on residents with clear rehabilitation needs or declining function.  The key goal here being to optimise mobility and maintain as much independence as possible.

Once the Physiotherapy service is up and running you can expect your physiotherapist to provide a clearly written assessment and a clear treatment plan, including either a discharge comment or a review date. Ideally you will maintain data related to Physiotherapy input and be able to see clearly if your allocated time is meeting the needs of your staff and residents.

Finally consider which residents will be eligible for physiotherapy assessments. If you are funding a Physiotherapy service you may choose to extend this to your hospital level and rest home level of care residents but not to independent studio units/apartments as these residents will usually be eligible for DHB funded services. Some DHBs will happily provide physiotherapy to rest home level of care residents and some put guidelines around who they will see. Depending on your DHB and care philosophy you may choose only to fund Physiotherapy services to hospital level of care residents or to extend this to rest home. In our company we work with aged care facilities who operate under both of these models and the key is to have it clear to both your Physiotherapist and staff who are completing referrals.

Spend your dollar wisely!

A final note here. Physiotherapists are highly skilled healthcare professionals who will be an asset to your team. The days of Physiotherapists spending all their time on walking programmes are long gone and you should set your expectations high for a physiotherapist who will add quality of life to your residents and cost benefit to your organisation. To use your physiotherapist wisely I strongly recommend you have the expectation that your care staff will have time to walk with people who are safe to do so.  We also encourage you to employ or allocate a Physiotherapy assistant hours into your roster to implement Physiotherapy plans. For information on using Physiotherapy assistants please look at an earlier article here .

This article was kindly contributed by Jessie Snowdon – Director of On the Go Physio. On the Go Physio provide physiotherapy services to over 20 facilities in Christchurch and Moving and Handling training to many more facilities and the CDHB.

in News
 by hcsl

Maintaining independence – maximising mobility

When it comes to maintaining functional ability for residents whether in a retirement village setting or in an aged residential care facility, the input for a skilled Physiotherapist is a huge advantage in setting up strengths and balance or falls prevention programmes.

Getting in the support of that type of expertise is certainly going to help residents maximise their potential.  Not all professionals are created equal and physiotherapists are no different to other professionals!  How do you go about choosing a Physiotherapist though and what should you check for when selecting the right person to support physical therapy for your residents.

I asked local well know registered Physiotherapist Jessie Snowdon what she thought on this topic.  Here’s what she recommends:

How to choose a physiotherapist for your aged care facility.

Physiotherapists are a key member of the healthcare team in aged care facilities. Having physiotherapy input can improve quality of life for your residents, improve safety and lessen workloads of your care staff. Many physiotherapists are also able to offer moving and handling training onsite as part of their service.  Physiotherapists who are passionate about aged care are usually very special people – so how can you pick them?

This article is written with contracted physiotherapy services in mind but many aspects will apply to employing a physiotherapist directly.

Ask about their experience

In order to meet the varied needs of residents in aged care, physiotherapists need to have a broad clinical background. I would suggest that your physiotherapist should have experience in most of the following clinical areas.  Because this is a long list you should be seeking a physiotherapist with a minimum of 5 years’ experience – or actively supervised by a more senior colleague.

  • Orthopaedics
  • Neurology
  • Dementia (even if not working in a specific dementia facility)
  • Cardiac respiratory
  • Moving and handling
  • Basic seating and wheelchair assessment
  • Falls prevention
  • Arthritis
  • Chronic Pain
  • Pressure injury prevention

Ask about their professional development

To maintain registration in New Zealand, a physiotherapist must adhere to The Physiotherapy Board Code of Standards which is available to the general public here. They must also have a minimum of 100 hours CPD per 3 years, show evidence of reflective practice and have one professional peer review per 3 years. At On the Go Physio we require a peer review each year and active ongoing engagement with colleagues and professional development.

It is not uncommon for aged care facilities to directly contract a physiotherapist working as a sole trader. This can be an isolating role for a physiotherapist and it is important they regularly engage in professional development and in supervision and peer review.  If you are employing, rather than contracting, a physiotherapist you will need to budget for this as it is reasonable that you meet these costs.

Eight quick questions when choosing a physiotherapist contractor

As well as the right experience and compliance with physiotherapy regulations, contractor physiotherapists are also businesses in their own right (whether a sole trader or employee of a company) and need to operate as such. These are some legal requirements and compliance issues you should consider.

  1. Ask to see and maintain a copy of their Annual Practicing Certificate (APC – a new one will be issued annually and you should have a copy of this prior to 1st April of each year).
  2. Ask for a copy of their professional indemnity and public liability insurance certificates.
  3. Ask to view their (or their employers) health and safety policy.
  4. Ask if they undertake regular supervision or mentoring to help assure their own professional safety.
  5. Ask them to arrange for a colleague to undertake a clinical notes audit within 3 months of starting in the role and annually following this. Ask for a copy. (You may need to negotiate this and if there will be a cost it would not be unreasonable for you to consider paying this).
  6. How will they cover your facility during periods of leave.
  7. Are they a member of Physiotherapy New Zealand – this is not compulsory but demonstrates a dedication to their profession and provides development opportunities.
  8. What moving and handling training experience do they have? Will they be happy to provide training or will you need to contract those services separately.

 This article was kindly contributed to by Jessie Snowdon – Director of On the Go Physio. On the Go Physio provide physiotherapy services to over 20 facilities in Christchurch and Moving and Handling training to many more facilities and the CDHB.

A further article will follow on how to set up a Physiotherapy service in your facility.

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