Proefschrift

Chapter 5 60 rehabilitation. Symptoms as the evolution of signs of inflammation , neuro-vascular status, weight bearing tolerance, possible changes in alignment of the affected side of the body, quality and function of the soft tissue and involved joints. The progression in functional activities is determined on the basis of the quality of the performance of a functional activity and established in milestones to be achieved at activity level within the ICF areas: mobility, self-care, household, participation, transport (Table 5.1). The therapy progress is not determined by the degree of loading the affected side of the body in kg or in percentage of the body weight because that, as discussed earlier, is an unrealistic representation of reality. When applying the permissive weight bearing method, conscious choices are made to assess the maximum weight bearing capacity of the fixed fracture and the damaged soft tissue. Within this process, we strive towards allowing the patient to apply the activities (formulated in the request for help (see table 1: aftercare aims identification guide)) with normal/optimal motor skills as quickly as possible. If necessary, these activities may be supported with walking aids and orthoses. The quality of the performance of the activity and safety (e.g. preventing stumbling) are leading in this approach. Progress is determined by the quality with which the activity is carried out and is recorded in the list with therapy milestones (see Table 5.1) based on decreasing the use of walking aids. These walking aids contribute to the quality of the gait pattern and to safety and may possibly compensate for a certain limitation in the patient’s conditional capacities such as reduced muscle strength, stability or postural balance reactions. The milestone is only reached if the gait pattern is executed optimally, i.e. resembling normal gait as good as possible, and can be performed independently and safely by the patient. In case of delayed recovery or permanent impairment (due to e.g. complications during rehabilitation), a choice must be made for the best possible gait pattern, optimal for each individual patient. It should include the following aspects: • Safety: reducing the risk of falls. • Distance: achieving a functional walking distance for the patient. • Speed: achieving an acceptable functional walking speed. • Prevention: the chosen strategy with regard to the gait pattern must be a sustainable solution to compensate for the possible physical restrictions and fit the mental and physical capacity of the patient. The aim is to reduce the risk of injury due to e.g. overload. • Variability: the patient is able to adapt his gait to the environmental conditions given. • Visual acceptable: the gait pattern looks acceptable for the patient

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