Training techniques that make a difference in staging rehabilitation and tips for setting tasks that will not fail | column | 日常で気軽に実践できる片麻痺のリハビリ方法や機能を低下させない生活習慣などを解説

Explaining the definition and meaning of grading

The term "staging" is frequently used in the fields of medicine, nursing care, and rehabilitation, but there is a big difference between its general meaning and how it is used in clinical practice. In everyday life, "staging" means to organize things in an orderly manner, but in the field of rehabilitation, it is an essential concept for setting goals according to the patient's condition, adjusting training content, and checking progress.

Staging is a practical framework that divides the rehabilitation evaluation, training, and planning into phases according to the physical, mental, and functional status of the patient, and leads them to achieve their goals without difficulty. Specifically, it incorporates the following elements:

Basic structure of staging in the rehabilitation field

In this way, grading is not just a way to "sort" or "prioritize," but is the basis for all decisions, including training plans, support policies, and family guidance. Because of grading, "what can be done in the current state," "the next function to aim for," and "the training methods required for that" are logically organized, and on-site decisions and guidance are consistent.

The ICF (International Classification of Functioning, Disability and Health) perspective is also essential for staging. In the ICF, the subject must be evaluated according to factors such as "mental and physical functions and structures," "activity," and "participation," and appropriate intervention must be provided. Staging is based on this ICF perspective and is also a "translation" that seamlessly connects evaluation to implementation.

Furthermore, the grading system also makes it easier to share information not only with therapists, but also with caregivers and family members. By sharing specific information such as "We are now in the latter half of the recovery period and have stabilized in standing, so next we will begin mobility training," rather than using vague expressions such as "I can't do it yet" or "We will wait and see," everyone can easily understand the significance and necessity of the training.

The risks of inappropriate staging

If rehabilitation staging is designed correctly, it can be a compass for the patient's recovery, but on the other hand, incorrect staging can cause serious problems. The most common cases are "overload," "setting goals that are difficult to achieve," and "goals that are vague and impossible to evaluate."

For example, forcing walking training on a patient without muscle strength or range of motion has the potential to lead to falls or the recurrence of pain. Furthermore, moving on to housework or shopping training when ADL ability is still low can lead to the patient feeling frustrated or even losing motivation to continue training.

Main risks of improper staging

Furthermore, mistakes in the design of the stages can lead to mistakes in coordination not only with therapists, but also with caregivers and families. Common cases in the field include "changes in the method of care have not been shared" and "the environment has not been improved to match the progress." This is a typical case where the quality of the overall support is scattered when the stages are unclear.

With a precise step-by-step plan, for example, "the patient can eat on their own, but supervision is only required when moving around," or "full assistance with toileting is required only in the morning," the caregiver can clearly understand their role, and the patient can concentrate on rehabilitation without confusion.

What to do during the "acute" phase of rehabilitation

The "acute phase," the initial stage of rehabilitation, is a medical phase that is administered immediately after the onset of illness or injury, primarily during hospitalization. This applies to patients with strokes, spinal cord injuries, traumatic fractures, and those immediately after surgery, and is a period in which maintaining life and preventing complications are given top priority. Training and intervention during this period serve to avoid complications by getting patients out of bed early, and to build a foundation for progressing to the next stage as quickly as possible.

During the acute phase, there is a high risk of developing conditions such as joint contractures, muscle atrophy, aspiration pneumonia, deep vein thrombosis, and bedsores, so simply resting is not always safe. Under the doctor's instructions, and while thoroughly managing risks, support is required to keep the body moving, even if only to a minimum.

The specific training content and objectives are as follows:

Training time is generally short-term intervention of about 20 to 30 minutes per day, but this is the result of prioritizing medical safety. Rather than increasing the amount of training, it is considered more important to "regularly evaluate and manage physical condition," and a flexible attitude is required to change the training content according to the condition.

In addition, during the acute phase, the patient's ability to understand is often reduced, so collaboration with multiple professions, including family members and nurses, is essential. For example, adjusting the living environment, such as properly positioning the patient after training and arranging cushions to support the joints, is also an important factor in improving the effectiveness of training.

What kind of training is emphasized during the "recovery period"?

The recovery period is the phase in which patients are no longer in danger of losing their life and begin to fully recover their functions. In the case of cerebrovascular disease, recovery begins approximately one month after the onset of the disease, and in the case of orthopedic disease, recovery begins 10 to 2 weeks after surgery. The main goal is to increase independence through the acquisition of activities of daily living (ADL) and to return to home and society.

During this period, the volume, frequency, and variety of training is at its highest. In rehabilitation wards designated by the Ministry of Health, Labor, and Welfare, rehabilitation training is possible for up to three hours per day, with physical therapy, occupational therapy, and speech-language-hearing therapy working together in a planned manner.

The main training contents are as follows:

The defining feature of this stage is that it focuses on "staged training design." In other words, it clarifies what the patient can currently do and what they should be able to do next, and uses task practice or CI therapy that matches the current state to gradually improve function.

Necessary support during the maintenance and daily living stages

The maintenance and daily living stage is when intensive rehabilitation training comes to an end and the focus shifts to life at home and in the community. In this phase, the focus is on "maintenance" and "utilization" rather than on improving function, and on "improving quality of life." Assuming life at home after discharge, important themes include preventing recurrence, reducing the need for assistance, and supporting independence.

During the maintenance phase, the training location shifts from hospitals to home rehabilitation, day care, local rehabilitation centers, etc. Below is a summary of the main support provided during the living phase.

At this stage, the perspectives of "activity" and "participation" are important. In terms of the ICF, support is required not just for "physical function," but also for activities of daily living (ADL), role-playing activities (IADL), and even community interaction.

What is Task Practice?

Task practice is a type of repetitive task training used in rehabilitation, which encourages the brain and neural circuits to relearn specific movements or functions over and over again, leading to functional recovery. It has been scientifically proven that repetitive practice activates neuroplasticity, making it easier to form compensatory circuits in damaged areas of the brain.

Task Practice is carried out in the following process:

1. A detailed assessment of the current level of movement (e.g., grasping, lifting, carrying, etc.)
2. Break down the desired actions into smaller steps
3. Repeating the same movement at high frequency (20-30 repetitions per set, multiple times per day)
4. Real-time feedback and correction (mirror, video, therapist guidance, etc.)
5. Once the operation is stable, proceed to the next level of the task.

This type of training is considered particularly effective for upper limb paralysis, ataxia, and reduced dexterity after a stroke, and is widely used in rehabilitation facilities both in Japan and abroad.

Key features and benefits of Task Practice

The greatest strength of Task Practice is that it is based on real-life movements. For example, because it involves repeating specific actions such as holding a teacup to one's mouth or hanging clothes on a hanger, it is highly reproducible in real life, and the results of the training can be easily applied to everyday life.

Problem-oriented approach in practice

The Task Oriented Approach is a practical rehabilitation method that aims to simultaneously improve physical function and activities of daily living (ADL) through tasks that mimic actual daily activities. This approach is based on the principle of neurorehabilitation that "purposeful movements" are the most effective for motor learning in the brain and body, and has been highly evaluated in the field of rehabilitation in recent years.

This method focuses not on simple muscle training or increasing the range of motion of joints, but on "actions" that are directly related to the patient's daily life. For example, everyday tasks such as "hanging out the laundry," "eating with chopsticks," and "opening your wallet to pay" are reproduced as training content.

Problem-oriented approach in practice

These tasks are graded according to the patient's level based on the evaluation, and the difficulty of the tasks is changed as the patient progresses. For example, training in hanging laundry can be applied in stages, such as "from pin-type clothespins to clothespins with a strong spring" or "from sitting in a chair to standing."

Successful task-oriented rehabilitation requires an accurate understanding of the patient's needs and lifestyle, and the ability to reflect this in the tasks. The essence of the task-oriented approach is rehabilitation that contributes to the reconstruction of a "life that is unique to each individual," rather than general tasks.

Staging rehabilitation is not as simple as simply progressing through training in order. It is necessary to design optimal training methods and support content for each stage according to the condition and living environment of each individual patient, and the goals of ADL (activities of daily living). In particular, approaches such as Task Practice, CI therapy, and preshaping are important techniques that greatly affect the speed and quality of functional recovery.

In fact, reports from the Ministry of Health, Labor and Welfare and the Japan Occupational Therapists Association show that in facilities where a gradual training plan is in place, the independence and motor functions of users are significantly improved. If the grading is done appropriately, patients themselves are more likely to feel that they are "able to do more," which helps maintain their motivation for rehabilitation.

On the other hand, if the stage design is incorrect, the training may become painful and may lead to withdrawal or functional decline. If you feel that "there is no progress in movement" or "the training is not suitable for the person," it is necessary to review the stage. It is important to be aware that staging is not just a progress chart, but a dynamic process of repeated evaluation and adjustment.

The methods and ideas introduced in this article are effective not only for occupational therapists, but also for family members and care managers involved in home care. By correctly understanding the step-by-step approach and applying it to daily training, the quality of life (QOL) of users will definitely improve. From among the many rehabilitation methods available, it is important to select a scientifically based staging. This is the essence of the support that is needed now.

Power Assist Series Supports Hemiplegia Rehabilitation - LAP Corporation

LAP Corporation has developed and provides the Power Assist Series to support rehabilitation at home for people with hemiplegia due to cerebral infarction or accidents. This series is a robot that uses air pressure to gently move paralyzed joints in the fingers, ankles, and wrists to assist rehabilitation training. It can be easily used at home, enabling continuous rehabilitation. The product lineup includes the Power Assist Hand for fingers, the Power Assist Leg for ankles, and the Power Assist Wrist for wrists, and is compatible with the rehabilitation of each part of the body. Through these rehabilitation assistance robots, we will contribute to the recovery of function and improvement of the quality of life of everyone.

LAP Co., Ltd.
address	2-1-40 Oikawa, Atsugi City, Kanagawa Prefecture, 243-0212
phone	046-204-9343

inquiry

Q. How long does it actually take for the rehabilitation staging to have an effect?
A. The period in which effects appear depends on the patient's illness and ADL status, but the standard rehabilitation process from the acute phase to the daily living phase takes approximately 3 to 6 months. In training that applies Task Practice to daily life, there have been cases where the accuracy of movements has improved in about 2 weeks, and by setting up proper training in stages, it is possible to speed up the improvement of function and independence.

Q. What are the consequences of incorrect staging? Do you have any concrete examples?
A. Inappropriate staging carries the risk of causing mental frustration for patients (due to muscle weakness and progression of joint contracture due to overload). For example, if the ADL assessment is incorrect and training is set prior to the physical ability of the patient, the patient may fail to perform self-help movements and have a negative reaction to the training. As a result, it has been reported that it becomes difficult to continue training, which ultimately leads to a decline in daily life functions and an increase in the amount of care required. Accurate assessment of staging and judgment based on the occupational therapist's experience are essential.

Company name: LAP Co., Ltd.
Location: 2-1-40 Oikawa, Atsugi City, Kanagawa Prefecture, 243-0212
Telephone number: 046-204-9343