Basic Restorative Services
Concepts you must understand
Restorative care aims to maintain or regain function, not to do everything for the resident. Know the principles of range of motion (active, active-assistive, passive - never force a joint past resistance or to the point of pain), positioning with proper body alignment and support, and the use of splints and orthotic devices (check skin before and after, apply as ordered, remove for scheduled skin care).
Ambulation: apply a gait belt around the waist over clothing, stand on the resident's weaker side, and stay close. A cane goes on the resident's stronger side, moved forward with the weaker leg. A walker is moved forward first, then the weaker leg steps into it, then the stronger leg. Encourage the resident to look forward, not at the floor.
Self-care retraining: set up supplies, give prompts and time, and praise effort rather than speed.
Bowel and bladder training follows a schedule set by the nurse, with fluids offered and prompt responses to requests.
Prostheses and communication devices are part of the resident's body image: handle them carefully, keep them within reach, and encourage use.
Traps in questions
Putting a cane on the weak side, pulling the resident up by the arm or shoulder, or pulling on clothing instead of a gait belt. Another trap: "do it for them because it's faster," which defeats restorative goals.
Rule of thumb
Support the weak side, promote the doing, and check skin under every device.
Worked example: A resident has left-sided weakness after a stroke. The cane belongs in the right hand. The resident moves the cane and the left leg forward together, then steps with the right leg.