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FirstHealth of the Carolinas
Orthopaedic rehab It’s all about goals By Mary Griffin

When David Mathias had bilateral knee replacements last September, it turned out to be the best choice he ever made, thanks in large part to the orthopaedic rehab he received through the FirstHealth Centers for Rehabilitation.

“I had a full week of rehab in-house before I left, which was outstanding,” he says. “When I was discharged, I had a choice of which rehab facility to use, and I chose FirstHealth outpatient rehab. I took my surgery seriously, and I took my rehab seriously, too.”

At FirstHealth Centers for Rehabilitation, orthopaedic rehab is all about goals and the hard work patients have to do in order to achieve them. Mathias had a few goals of his own.

“By Thanksgiving, I wanted to get down on my knees to play with my grandchildren and return to playing golf as quickly as possible,” he says.

According to Jill Botnick, director of outpatient and regional rehab services, physical therapists conduct a comprehensive musculoskeletal evaluation using tests to measure muscle strength, joint range of motion, walking, balance and more.

The results are then compiled into a list of impairments and functional limitations that the physical therapist can use to help the patient improve. “A plan incorporating varying treatment techniques, like therapeutic exercise and manual joint mobilization, is then developed to help patients achieve their goals,” says Botnick

Before surgery, Mathias prepared himself for what was to come. He went on a weight-reduction program, exercised extensively to prepare his legs and arms, and lost 60 pounds. With the surgery behind him, the hard work began.

“When I first got there, we sat down together, and Kathy (Holder), my physical therapist, said, ‘Here’s what we think you should accomplish, but what are your goals?’” Mathias says. “When she knew what they were, she really geared some of my exercises toward getting up and down from my knees, and then bending and twisting for my golf game. It wasn’t a case of opening up a notebook and saying here’s what you need. They customized my program for my age and needs.”

Mathias’s therapy lasted seven or eight weeks, with three visits weekly. For him, exercises involved two immediate goals: knee strength and flexibility.

“I got on a table and extended my leg straight out,” he says. “The next part was very painful. I had to lie on my back and slide my leg back and bend my knee. The goal was to bend it as far as possible. That was excruciating, but you can’t recover unless you push yourself through a little pain and discomfort.”

“It wasn’t a picnic,” he says, “but the therapists were fantastic. I got a real, one-on-one relationship, and that gave me the full benefit of the services. I really felt like a part of what was going on.”

When his rehab was finished, Mathias was able to accomplish everything he’d set out to do and more.

“I got to crawl around the floor with my grandchildren, and I’m also playing golf again,” he says.

For more information on the FirstHealth Centers for Rehabilitation, call (800) 213-3284.

David Mathias, who had both knees replaced last year, works with Kathy Holder, P.T., a physical therapist with FirstHealth of the Carolinas.

Rehab at home
Home health therapy is often the bridge between hospitalization and outpatient rehabilitation. The patient’s recovery at home is crucial to his/her overall success.

FirstHealth Home Care has a team of physical and occupational therapists who work closely with their patients, beginning with an in-home assessment.

“Based on an extensive assessment of the patient in his or her own home environment, the therapist can determine the best plan of care to achieve maximum success,” says Patty Upham, director of FirstHealth Home Care.

“Before establishing a baseline from which to work, the therapist determines where patients are in their recovery as well as where they were before their surgery or injury,” says physical therapist Bill Robins.

The therapist works closely with the patient to develop realistic and achievable goals, and patient participation is essential. The goal is for each patient to reach his/her maximum potential.

“The patients have to be motivated to succeed,” says Robins. “That makes all the difference. They have to be willing to do the work.”

The inpatient
road to

The road to recovery begins almost immediately after joint replacement surgery.

According to Cindy Sayce, director of Inpatient Rehabilitation and Acute Care Programs at FirstHealth Moore Regional Hospital, the acute care therapist will see patients who have had joint replacement surgery the day following their procedure.

“At the very least, we get the patient to just sit on the side of the bed,” she says. “But most patients will stand, and the therapist may even work with them on taking a couple of steps.”

The acute-care goal for the first three to four days is getting the patient up and starting to learn how to move his or her new joint(s).

From the acute-care setting, patients who have had bilateral (both sides) joint replacements typically go to the Inpatient Rehabilitation Center inside Moore Regional Hospital for further therapy. There the patient is involved in physical and occupational therapy for three hours a day, five days a week, and nurses who specialize in rehabilitation help patients practice the skills they learn in therapy.

Patient goals are usually to become independent with everyday tasks—including walking, going up and down stairs, self-care and home-management skills. “Sometimes patients leave rehab doing more for themselves then they were doing before their surgery,” Sayce says.

From inpatient rehab, which usually lasts seven to 14 days, most patients go directly home, either for in-home or outpatient rehabilitation, Sayce says.

Less intensive inpatient orthopaedic rehabilitation is also offered at the Palmer Hinson Care Unit at FirstHealth Richmond Memorial Hospital in Rockingham and at FirstHealth Montgomery Memorial Hospital in Troy. For more information on all of the inpatient orthopaedic rehabilitation services offered by FirstHealth of the Carolinas, call (800) 213-3284.