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Healthcare Service Providers

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Introduction

Health care for individuals with Mobility Impairments, is the maintenance or improvement of health via the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in those living with the Mobility Impairment. This Health care  is delivered by a variety of health care professionals with the assistance of Hospitals and Rehab Units.

Health care starts with the Diagnosis and Treatment of the Mobility Impairment, this treatment most often includes Rehabilitation. Even once the Rehabilitation is complete and the patient returns home, the patient will still rely on a variety of health care professionals throughout the rest of their lives.

Below is a list and brief description of those health care professionals that assist with the maintenance or improvement of our health:

Hospitals and Rehab Units.

When an individual is severely injured or develops a mobility Impairment, they are most often sent to a hospital to be treated and the recover, sometimes these Hospitals have Rehab Units, or are Rehabilitation hospitals.

Rehabilitation hospitals are devoted to the rehabilitation of patients with various neurological, musculo-skeletal, orthopedic and other medical conditions following stabilization of their acute medical issues. The industry is largely made up by independent hospitals that operate these facilities within acute care hospitals. There are also inpatient rehabilitation hospitals that offer this service in a hospital-like setting, but separate from acute care facilities. Most inpatient rehabilitation facilities are located within hospitals.

Rehabilitation hospitals were created to meet a perceived need for facilities which were less costly than general hospitals but which provided a higher level of professional therapies such as speech therapy, occupational therapy, and physical therapy.

A rehabilitation hospital can only be accessed following a stay as an inpatient in a general hospital which has lasted for a certain number of days. The general hospital will evaluate the patient to determine if the patient will benefit from rehabilitation services. A positive determination will be made if the patient is deemed to require a certain level of therapies. If a positive determination is made, a report concerning the patient's needs will be sent to the rehabilitation hospital, which has the discretion to admit or not admit the patient. If the patient is transferred to the rehabilitation hospital, his/her medical records and a recommended treatment plan will be transmitted with the patient. The treatment plan will include daily therapies except on weekends.

In some cases, where mobility is lost, a patient can regain enough strength or learn techniques through a Rehabilitation centre, to become more independent.

Surgeons & Physicians

A physician or medical doctor is a professional who practices medicine, which is concerned with promoting, maintaining, or restoring human health through the study, diagnosis, and treatment of disease, injury, and other physical and mental impairments.

Both the role of the physician and the qualifications vary widely:

  • Physicians may focus their practice on certain disease categories, types of patients, or methods of treatment, these are known as specialist medical practitioners.
  • General practitioners assume responsibility for the provision of continuing and comprehensive medical care to individuals, families, and communities.
  • A surgeon is a doctor who performs operations. These surgeons will often specialize in certain types of operations, examples of these include Plastic Surgeons, Neurosurgeons, cardiothoracic surgery, general surgery, oral and maxillofacial surgery, paediatric surgery, trauma and orthopaedic surgery.

Having a Mobility Impairment guarantees that you more often than not, will have dealings with some, if not all of the above. When choosing a General practitioner, it is beneficial to choose one that is a specialist in your impairment, and try to keep to the same General practitioner  so that you build up a relationship and so they become familiar with your situation.

Nurses & Sisters

When it comes to dealing with individuals with Mobility Impairments Nurses & Sisters, provide Health care in a number of different areas, these include:

  • Nurses & Sisters in hospitals
  • Stomal Sisters
  • Wound Sisters
  • Private home nursing

Nurses & Sisters in hospitals

Nurses & Sisters that work in hospitals help to care for you while recovering from surgery and during your rehabilitation. There care is extremely important to your healing and rehabilitation.

Neglect by them during this time can lead to many other complications, such as pressure soars and bladder infections.

Stomal Sisters

Stomal Sisters or stomal therapists are responsible for helping patients adjust to living with either a permanent or temporary stoma be it a colostomy, ileostomy or urostomy. This role includes pre-operative counselling, immediate post-operative care and education and follow-up assessment and counselling following patient discharge. Some Stomal Therapists also provide the equipment that the patients need.

Stoma

Sometime, for various reasons, a person's bowel or ureter (the tube that transports urine from the kidney to the bladder) is surgically relocated to open onto the abdomen. The opening that is created is called a 'stoma' and is enclosed in a sealed bag system. Stomal therapy is the management of stomas, which RDNS will provide with respect and dignity.

Some people with severe Mobility Impairments like Quadriplegics and Paraplegics choose to have this done, as it gives great advantages to some people with these disabilities.

Wound nursing 

Wound nursing  is provide by wound sisters and is the treatment of patients with acute and chronic wounds, patients with an ostomy (those who have had some kind of bowel or bladder diversion), and patients with continence conditions (those with bladder and bowel control and associated skin care issues). These wounds can be caused by medical treatments, diseases, or injuries. Wound Sisters also provide post-surgery treatment and care for patients with ostomies, which are surgical openings that allow for the elimination of bodily waste. These nurses often work with a healthcare team, assessing patients, managing wounds, and monitoring healing.

Wound Sisters provide a modern line of wound care products, for various types of wounds, such as burns, acute and superficial wounds,  and diabetic leg syndrome, including surgically complicated wounds.

Wound healing

Wound healing is an intricate process where the skin or other body tissue repairs itself after injury. In normal skin, the epidermis (surface layer) and dermis (deeper layer) form a protective barrier against the external environment. When the barrier is broken, an orchestrated cascade of biochemical events is quickly set into motion to repair the damage. The wound healing process is not only complex but also fragile, and it is susceptible to interruption or failure leading to the formation of non-healing chronic wounds. Factors that contribute to non-healing chronic wounds are diabetes, venous or arterial disease, infection, and metabolic deficiencies of old age.

Private home nursing

Private home nursing or Home care is supportive care provided in the home by a Qualified Nurse, sometimes called Care Givers. Care may be provided on daily assistance to ensure the activities of daily living are met. Individuals typically desire to remain independent and use Home Care services to maintain their existing lifestyle.

Home Care is ideal for:

  • terminally ill patients, such as hospice care
  • patients recovering from surgery or illness
  • Individuals with a serious permanent severe Mobility Impairments

These services may include short-term nursing, rehabilitative, therapeutic, and assistive home health care. The individual may be helped with daily tasks such as bathing, eating, cleaning the home and preparing meals. These services help the client to stay at home versus living in a facility.

This Non-medical home care is normally paid for by the individual or family, therefore they, will often opt for Home Base Caregivers, which are a cheaper option.

Home Base Caregivers

Home Base Caregivers are a cheaper option, due to the fact that they are less qualified than a nurse, some do home base courses, while some have no qualifications, but learn on the job.

Home Care is often a lower cost solution to long-term care facilities. The largest segment of Home Care consists of licensed and unlicensed non-medical personnel, including Home Base Caregivers or caregivers.

When it comes to Home Base Caregivers, there are a couple of options, they are listed below, from cheapest to most expensive and include:

  1. Ngo's & Npo's that rely on sponsorship or support from the government. They send out there Caregivers, free of charge, or at a very low cost.
  2. Some people choose to hire someone and teach them on the job. They can be hired full-time or part-time, depending on  your needs.
  3. Some people choose to hire someone who is qualified & experienced. They can be hired full-time or part-time, depending on  your needs.
  4. Some people choose to hire Caregivers through agencies.
  5. Companies exist that hire Caregivers, they then hire out there Caregivers.

Each option has its advantages and disadvantages, with price being a big consideration. Each individual will need to decide what best suits their needs.

 Physiotherapy & Occupational Therapists

When it comes to Rehabilitation of individuals with Mobility Impairments Physiotherapy & Occupational Therapists are essential to your improvement, rehabilitation and adaption.

Physiotherapy

Physical therapy or physiotherapy promotes mobility, function, and quality of life through examination, diagnosis, prognosis, and physical intervention (therapy using mechanical force and movements). It is carried out by physical therapists

Physical therapy involves the illnesses, or injuries that limit their abilities to move and perform functional activities as well as they would like in their daily lives. physical therapists  use an individual's history and physical examination to arrive at a diagnosis and establish a management plan and, when necessary, incorporate the results of laboratory and imaging studies like X-rays, CT-scan, or MRI findings, etc.

Physical therapists management commonly includes prescription of or assistance with specific exercises, manual therapy and manipulation, mechanical devices such as traction, education, physical agents which includes heat, cold, electricity, sound waves, radiation, rays, prescription of assistive devices, prostheses, orthoses and other interventions.

Physical therapists also work with individuals to prevent the loss of mobility before it occurs by developing fitness and wellness-oriented programs for healthier and more active lifestyles, providing services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan.

This includes providing therapeutic treatment in circumstances where movement and function are threatened by aging, injury, disease or environmental factors, it is therefore important to continue with physiotherapy throughout your life, even once your rehabilitation period is over.

Physical therapists offer a variety of different types of treatments to assist in rehabilitation and recovery. These include Hydrotherapy and Electrotherapy.

Hydrotherapy

Hydrotherapy, is a form of physiotherapy, that involves the use of water for pain relief and treatment. The term encompasses a broad range of approaches and therapeutic methods that take advantage of the physical properties of water, such as temperature and pressure, for therapeutic purposes, to stimulate blood circulation and treat the symptoms of certain diseases.

Hydrotherapy is the used in the treatment of a variety of different conditions, including  paralysis, arthritis and related rheumatic complaints. Hydrotherapy differs from swimming because it involves special exercises that you do in a warm-water pool. The water temperature is usually 33–36ºC, which is warmer than a typical swimming pool.

You’ll normally have hydrotherapy treatment with a physiotherapist who will show you how to do the exercises. The focus of the exercises can be adjusted to help your range of movement or strength, depending on your symptoms.

Hydrotherapy tends to be different to aquarobics, which can be quite strenuous, as it’s generally more focused on slow, controlled movements and relaxation.

Electrotherapy

Electrotherapy is the use of electrical energy as a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. Electrotherapy is primarily used in physical therapy for relaxation of muscle spasms, prevention and retardation of disuse atrophy, increase of local blood circulation, muscle rehabilitation and re-education electrical muscle stimulation, maintaining and increasing range of motion, management of chronic and intractable pain, post-traumatic acute pain, post surgical acute pain, immediate post-surgical stimulation of muscles to prevent venous thrombosis, wound healing and drug delivery.

Electrotherapy has also been researched and accepted in the field of rehabilitation for the following:

1. Pain management - Improves range of joint movement

2. Treatment of neuromuscular dysfunction

  • Improvement of strength
  • Improvement of motor control
  • Retards muscle atrophy
  • Improvement of local blood flow

3. Improves range of joint mobility - Induces repeated stretching of contracted, shortened soft tissues

4. Tissue repair

  • Enhances microcirculation and protein synthesis to heal wounds
  • Increased blood flow to the injured tissues increases macrophages to clean up debri
  • Restores integrity of connective and dermal tissues

5. Acute and chronic edema

  • Accelerates absorption rate
  • Affects blood vessel permeability
  • Increases mobility of proteins, blood cells and lymphatic flow

6. Peripheral blood flow - Induces arterial, venous and lymphatic flow

7. Iontophoresis

  • Delivery of pharmacological agents
  • DC (direct current) transports ions through skin
  • Common drugs used:
  • Dexamethasone
  • Acetic acid
  • Lidocaine

8. Urine and fecal incontinence

  • Affects pelvic floor musculature to reduce pelvic pain and strengthen musculature
  • Treatment may lead to complete continence

9. Lymphatic Drainage - Stimulate lymphatic system to reduce edema.

Occupational Therapists

Occupational therapy (OT) is the use of assessment and treatment to develop, recover, or maintain the daily living and work skills of people with a physical, mental, or cognitive disorder. Occupational therapists also focus much of their work on identifying and eliminating environmental barriers to independence and participation in daily activities.

Occupational therapy is a client-centered practice that places emphasis on the progress towards the client's goals. Occupational therapy interventions focus on adapting the environment, modifying the task, teaching the skill, and educating the client/family in order to increase participation in and performance of daily activities, particularly those that are meaningful to the client. Occupational therapists promote skill development and independence in all daily activities. For an adult, this may mean looking at the areas of self-care, home-making, leisure, and work. For children, this may include playing in the park with friends, washing hands, going to the bathroom, cutting with scissors, drawing, etc.

A big part of Occupational therapy is the development of tools or braces and the education of the patient on how to use these tools, to make daily activities possible or easier to do. Below are examples of a few such tools:

  • Eating braces for feeding oneself-for an individual that has limited use of the hands or fingers.
  • Righting braces for righting-for an individual that has limited use of the hands or fingers.
  • Braces or Devices for Hobbies or Sport.- This enables an individual that has limited use of limbs or hands or fingers, to still take part.
  • Leg Braces that enable you to Stand.

Occupational therapists also develop braces to improve posture, etc. Below are examples of a few such tools:

  • Arm braces - To keep your arm straight & prevent your arms from becoming permanently bent.
  • Hand braces - To keep your fingers straight & prevent them from curling.
  • Back braces, etc - To keep your posture straight & prevent the person from becoming round shouldered.

Occupational therapists often work closely with professionals in physical therapy, speech therapy, nursing, social work, and the community.

Dietitian 

A dietitian (or dietician) is an expert in human nutrition and the regulation of diet. A dietitian alters their patient's nutrition based upon their medical condition and individual needs. Dietitians are the only healthcare professionals licensed to assess, diagnose, and treat nutritional problems.

Regulating the diet of patients with certain conditions or mobility impairments is out of physician's scope of expertise, thus a dietitian must be called to permit any changes based upon their knowledge of nutritional biochemistry. Dietitians work in a variety of settings including hospitals, health-maintenance organizations, private practices, and other health-care facilities.

After learning about a patient's health history, favorite foods, eating and exercise habits, the dietitian helps the person to set goals and to prioritize. Follow-up visits often focus on maintenance and monitoring progress.

References

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