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Our Family Is Crazy
Clinical Model Resource

Now Available
By: Kele Murdin
Date: February 24, 2022

Simply the Best (Tina Turner’s song…)
By Kele Murdin, Clinical Knowledge Broker

Note: this article is available as a PDF at the end of the article

We are excited to share our newest resource for Infinity Rehab’s Clinical Model. We’re calling it: Clinical Model – Simplified (click here to download your version). It is also available to download below.

There’s nothing new to learn here…just a simplified visual representation of the most straightforward path to ensuring your patients consistently receive the benefit of best-evidence care. This resource is all on one page, and the electronic version has links to supporting materials as well!

In this version, rather than all the options you might want to consider across multiple days, you’ll see the most direct path to using the evidence, and it’s the same for every visit. Let’s take a look.

First, the patient types are all still here. They are just grouped as Intensity Primary (Types 1, 2, 3, and 5) or Prevention & Wellness Primary (Types 4 and 6)

Now let’s look at the interventions for the Intensity Primary group.

Things to point out about OT Intensity Primary group:

• Patient self-management interventions are still a hallmark of each intervention. Try focusing on 3 elements:

–Patient selecting a goal
–Linking therapy activities to selected goal
–Rating participation at the end

• There’s now a choice for the intensity part of each intervention. You can choose to do an activity to biomechanical failure or for an extended duration to reach the target HR training zone.
We need to reach one of these exercise targets every session.

• Last task of the session is teaching training skills/habit/routines.

• Provide the interventions in this order to ensure your patient receives the benefit of best-evidence care.

Things to point out about PT Intensity Primary group:

• The first intervention of each session is about building aerobic capacity and reaching the target HR training zone.

–For patients who are walking, interval training is the most straightforward and efficient strategy to meet this exercise target. Our data show it’s also something we are really good at.
–For patients who are not walking or are very limited in walking capacity, use a repeated functional task or circuit to reach the target HR.

• Move next to a HIRT task. We recommend finding 2-3 tasks you can use with multiple patients. We like:

–Sit-to-side lying
–Sit-to-stand
–Unilateral step-up

Some things to point out about the Prevention & Wellness group.

First try Intensity Primary, if appropriate. Let the patient prove to you they cannot tolerate Intensity primary (1 week).

• For OT, be sure to include patient self-management strategies as they are critical for this group.

Early caregiver training and equipment assessments are key to success. Use all of your creativity to identify compensatory and adaptive strategies that will maximize the
patient’s
participation in life roles.

• Reminder: frequency is lower for these patients: OT 3-5 days, PT 2-3 days

o Stagger treatment days
o Communicate realistic expectations for function with the patient, family, and building
o Try this, “I’m not sure your body can tolerate the treatments needed to improve your strength (breathing, endurance, etc.), but we’ll know by trying in the next week. If not, we will switch
directions and focus on compensating for what’s hard, train the folks who will be working with you, and set up the environment so that you can participate in the things that matter to you.”

In closing, we hope the commonality of intervention across the patient types is more obvious. Remember:

Type 2 and Type 1 patients are really on a continuum. We simply split them to give guidance about where to start intervention.

• We expect Type 2 patients to become Type 1, so don’t worry if you are struggling to select between these 2 types. These are patients who might need more PT than OT.

• While it’s not always the case, Type 3 patients usually become Type 1 once their weight-bearing restrictions are lifted. It’s common to discharge these patients from skilled
care before this transition then see them again once the restrictions are lifted. These are patients who might need more OT than PT.

• Our Type 5 patients are small in number and are usually patients with LE amputations without a prosthesis or those with a spinal cord injury. These are patients who might
need more OT than PT.

• The distinction between Type 4 and Type 6 patients is largely one of degree with Type 4 patients having preserved walking function.


Clinical Model Resource Now Available

By: Kele Murdin
Date: February 24, 2022


Simply the Best (Tina Turner’s song…)
By Kele Murdin, Clinical Knowledge Broker

Note: this article is available as a PDF at the end of the article

We are excited to share our newest resource for Infinity Rehab’s Clinical Model. We’re calling it: Clinical Model – Simplified (click here to download your version). It is also available to download below.

There’s nothing new to learn here…just a simplified visual representation of the most straightforward path to ensuring your patients consistently receive the benefit of best-evidence care. This resource is all on one page, and the electronic version has links to supporting materials as well!

In this version, rather than all the options you might want to consider across multiple days, you’ll see the most direct path to using the evidence, and it’s the same for every visit. Let’s take a look.

First, the patient types are all still here. They are just grouped as Intensity Primary (Types 1, 2, 3, and 5) or Prevention & Wellness Primary (Types 4 and 6)

Now let’s look at the interventions for the Intensity Primary group.

Things to point out about OT Intensity Primary group:

• Patient self-management interventions are still a hallmark of each intervention. Try focusing on 3 elements:

–Patient selecting a goal
–Linking therapy activities to selected goal
–Rating participation at the end

• There’s now a choice for the intensity part of each intervention. You can choose to do an activity to biomechanical failure or for an extended duration to reach the target HR training zone.
We need to reach one of these exercise targets every session.

• Last task of the session is teaching training skills/habit/routines.

• Provide the interventions in this order to ensure your patient receives the benefit of best-evidence care.

Things to point out about PT Intensity Primary group:

• The first intervention of each session is about building aerobic capacity and reaching the target HR training zone.

–For patients who are walking, interval training is the most straightforward and efficient strategy to meet this exercise target. Our data show it’s also something we are really good at.
–For patients who are not walking or are very limited in walking capacity, use a repeated functional task or circuit to reach the target HR.

• Move next to a HIRT task. We recommend finding 2-3 tasks you can use with multiple patients. We like:

–Sit-to-side lying
–Sit-to-stand
–Unilateral step-up

Some things to point out about the Prevention & Wellness group.

First try Intensity Primary, if appropriate. Let the patient prove to you they cannot tolerate Intensity primary (1 week).

• For OT, be sure to include patient self-management strategies as they are critical for this group.

Early caregiver training and equipment assessments are key to success. Use all of your creativity to identify compensatory and adaptive strategies that will maximize the
patient’s
participation in life roles.

• Reminder: frequency is lower for these patients: OT 3-5 days, PT 2-3 days

o Stagger treatment days
o Communicate realistic expectations for function with the patient, family, and building
o Try this, “I’m not sure your body can tolerate the treatments needed to improve your strength (breathing, endurance, etc.), but we’ll know by trying in the next week. If not, we will switch
directions and focus on compensating for what’s hard, train the folks who will be working with you, and set up the environment so that you can participate in the things that matter to you.”

In closing, we hope the commonality of intervention across the patient types is more obvious. Remember:

Type 2 and Type 1 patients are really on a continuum. We simply split them to give guidance about where to start intervention.

• We expect Type 2 patients to become Type 1, so don’t worry if you are struggling to select between these 2 types. These are patients who might need more PT than OT.

• While it’s not always the case, Type 3 patients usually become Type 1 once their weight-bearing restrictions are lifted. It’s common to discharge these patients from skilled
care before this transition then see them again once the restrictions are lifted. These are patients who might need more OT than PT.

• Our Type 5 patients are small in number and are usually patients with LE amputations without a prosthesis or those with a spinal cord injury. These are patients who might
need more OT than PT.

• The distinction between Type 4 and Type 6 patients is largely one of degree with Type 4 patients having preserved walking function.

© 2019 Avamere Family of Companies
© 2019 Avamere Family of Companies
>
© 2019 Avamere Family of Companies