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Debbie

Debbie has been homeless for 5 years. One night she was assaulted, resulting in damage to her spine. She has some trunk and lower-extremity weakness, but the neurologist believes that the damage will not be permanent. She is to wear a thoracic-lumbar-sacral brace to protect the spine and limit spinal motion while she is out of bed. Your initial examination is 2 days after her admission to the rehabilitation unit. During your examination, you will need to inspect different areas of her body for additional integumentary damage and will need to assess her mobility out of bed. How will you initially approach this patient? Are there any considerations during the examination of this patient that may be different from other patients? As you inspect her for injuries, which positions and draping techniques will you employ and why?

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Introduction

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Draping, or covering, a patient appropriately during a therapeutic intervention is a relatively uncomplicated process, but at the same time it is one of the most powerful opportunities for setting a tone of respect and professional rapport and for establishing the patient's therapeutic expectations.

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What Draping Accomplishes

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For the clinician, draping provides necessary access to specific areas of the body for examination and intervention and allows sufficient movement for functional tasks. For the patient, appropriate draping provides:

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  • ▪ Protection of the patient's modesty and dignity

  • ▪ Warmth and comfort: People receiving treatments sometimes have conditions that make regulating body temperature difficult. They are also more still than an active therapist and may therefore need additional covering to be comfortably warm.

  • ▪ Protection of vulnerable skin, such as wounds, surgical sites, scars, and neurologically impaired areas.

  • ▪ Protection of patients' clothing: Fabric near the treatment site tends to become soiled with perspiration, wound drainage, lubricants, etc.

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Gaining an understanding of the patient's personal sense of modesty, dignity, and personal boundaries is essential to effective draping and professional interaction. The greater the amount of exposure necessary during the treatment process, the greater the importance of that understanding.

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Awareness of Abuse: Empowerment, Trust, and Control

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Survivors of abuse have higher instances of musculoskeletal problems such as low-back pain, pelvic pain, and headaches.1 Therefore, it is not uncommon for the physical therapist to treat someone who is a survivor of child abuse or has experienced or is still experiencing some form of abuse.

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Loss of trust, violation of boundaries, and disempowerment are common consequences of abuse among children and adults.1,2 Consequently, bodily exposure, touch, positioning, and particular exercises may trigger intense emotional reactions at any time during patient interactions with health-care providers.

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Abuse may be physical, sexual, psychological, or any combination of these. Although we may have assumptions about who may be a victim of abuse, abuse is not limited to any specific demographic group—children ...

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