Contraindications

While screening for, assessing or providing rehabilitation interventions, it is important to rule out any contraindications.

Contraindications to providing interventions for rehabilitation include:

• Suspected untreated fracture at the site – for example if someone presents to you with wrist pain and swelling after falling on an outstretched hand and has not had any imaging done on the wrist.
• Bony block at a joint (myositis ossificans) – this is where a bone forms when it should not, often in a muscle after injury, resulting in lack of movement at the joint
• Acute inflammation/infection at the site – signs of inflammation / infection include pain, heat, redness, swelling and loss of function
• Severe heart disease - signs of heart disease which worsen with normal physical activity
• Severe brain injury - with cognitive difficulties including problem solving, judgment, and reasoning)
• Osteoporosis - weak or brittle bones, history of frequent fractures
• Bleeding tendencies - history of unexplained bleeding in different parts of the body

Common problems that may arise during the provision of rehabilitation and how to handle them

Some problems may be noted during the delivery of rehabilitation interventions. These problems may be as a result of the functioning difficulties or due to the interventions being provided.

The following are common problems and techniques on how to manage them:

1.     Problem: Poor balance while standing. This can lead to falls resulting in injuries.

Safety considerations:

• Stand on the weaker side of the person to provide support

2.     Problem: Poor gait, frequent falls

Safety considerations:

• Stand on the weaker side of the person to provide support when providing interventions.
• Have a rail, bed or sturdy chair on the other side if there is no one available to assist.
• Remove clutter and slippery items from the environment Make doorway accessible (eg. Portable ramp).
• Make sure the person is wearing appropriate footwear for the environment, socks will generally be slippery for the person.
• Provide a walking aid eg. Walking frame

3.     Problem: Difficulty with sitting upright

Safety considerations:

• Support the person with pillows
• Sit on a clinical stool or chair in front of them, ready to support them if needed

4.     Problem: Poor cognition, memory, attention/concentration, difficulty following the right sequence, poor judgement of safety

Safety considerations:

• Provide visual (hard copy of interventions) and verbal cues
• Reduce distractions such as closing the door or putting off the TV or radio
• Provide simple, clear instructions – one step at a time is best
• Be ready to provide physical assistance
• Ensure a family member is with you, who knows them well
• If the person cannot communicate with you, ask the family member if needed, how the person expresses themselves including pain
• Do not let person practice activities independently

5.     Problem: Vision problems (eg. Visual neglect and vision impairments)

Safety considerations:

• Relocate assistive products and other equipment within the person’s visual field
• Provide verbal cues

6.     Problem: Hearing problems (difficulty hearing)

      Safety considerations:

• Provide visual instructions or cues
• Use a sign language interpreter if possible

7.     Problem: High levels of fatigue (extreme tiredness) or breathlessness

Safety considerations:

• Plan for multiple rest periods during interventions
• Ensure they have good support while sitting down (chair with a backrest and arm rests is best)
• If person is on medication to manage fatigue and breathlessness, check if it can be taken before interventions begin
• Ask them if there is a better time of the day, where they have more energy to complete the assessment. Ensure you plan their care based on the different levels of energy they have, at different times of the day