While you are with us for your week of residential rehabilitation, we like to monitor different factors that give us an overall sense of your wellbeing each day. Wellbeing can have a big impact on how motivated you are during your rehab and how much progress you make over the week so we like to keep an eye on it! We record your sleep pattern, hydration levels, muscle soreness scores, comfort and confidence in the socket and your Rate of Perceived Exertion (RPE).
Many of our patients find it difficult to sleep for several reasons – whether it be getting to sleep or staying asleep. Sleep is incredibly important for your mental and physical health, your quality of life and your safety.
Sleep allows our body time to switch off and recover from the daily tasks. Evidence shows that an amputee uses more energy for walking than a non-amputee so for our patients, it is even more important. Sleep helps with cognitive function, learning, memory and pain modulation – all of which are pivotal in prosthetic rehabilitation. If we don’t get quality sleep, our concentration span reduces which could lead to missing important information when learning to use a new prosthesis.
Throughout the week, patients often find they sleep for longer as they are doing more during rehabilitation. Our aim is that this improved sleep pattern continues at home due to the new increased activity levels gained throughout the week. If we find sleep does not improve, we can explore this further to try to establish the cause. We often teach and practice relaxation techniques to try to help patients switch off to increase those valuable hours of sleep.
We use a scale to monitor our patient’s hydration levels according to the colour of their urine. Each and every function of the body requires water to do its job effectively, which is why it is so important to drink plenty of water to replenish our stocks! If the cells in our body don’t receive enough water they shrink and lose the ability to complete most of their physiological functions.
Water also helps with recovery after exercise by flushing away toxins, for example lactic acid, which contributes to that uncomfortable ache in the muscles the day after activity. If you drink enough water, your muscles should make a faster recovery, meaning you can do more with us the next day- yay!
If you ask our patients, the majority will agree that residential rehab is hard work. You find muscles you haven’t used for years and they definitely let you know about it! We ask you to score any muscle soreness you have each day out of 10 and we monitor whereabouts the discomfort is. This helps us to plan your rehab for the next day - if something is sore we will avoid overloading it again that day to allow recovery.
Socket Comfort Scores
The majority of our patients receive a new prosthesis during their residential rehab. A very common complaint of sockets is that they are uncomfortable, therefore patients don’t use them. As physios one of our biggest goals is to get patients moving so we work very closely with the prosthetists to ensure your socket is as comfortable as possible. We ask our patients to score the comfort of their socket out of 10 each day and if we notice a dip or a consistent area of discomfort, the prosthetists can work on your socket to correct this while you’re with us. The comfort scores usually increase during the week as we tweak the sockets and improve your posture, meaning you’re able to carry on using the limb at home.
Confidence using the prosthesis
Using a new prosthesis with a new socket is daunting and it takes times to get used to it, even if you have had a prosthesis before. Our intensive rehabilitation package gives you the time to practice repeatedly over the week, which helps to increase confidence and improve technique. We try to take our patients out of clinic as much as possible as we all know that walking on a smooth floor between parallel bars is much easier than walking through a park or a busy supermarket! Through pushing the boundaries, we see the confidence scores increase over the week. This, again, will mean you’re more likely to use the prosthesis at home and start to incorporate it into your daily routine.
Rate of Perceived Exertion
At the end of each day, we ask our patients to rate how hard they have worked using this scale (picture). There is no right or wrong with this but it helps us to see what you find most difficult and it helps to guide our treatment the following day. For example, if you score the maximum on the RPE we will often tailor the next day around more manual therapy and hands on work from us to allow you to recuperate.
The scores generally correlate over the week, for example if you score your RPE highly your sleep hours will increase and as your comfort in the socket improves, your confidence is likely to grow too. These scores aren’t the full extent of our monitoring, we chat daily about how you’re feeling but the visual scores just help us to keep a check on your overall wellbeing – contrary to popular belief, we don’t want to send you away each day exhausted and in pain! Patients also say it is nice to see at the end of the week to see how they have improved.
Here is an example of a patients scores: