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Physical Therapy


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Aerobic capacity and endurance
Ability to use the body's O2 uptake and delivery system
Anthropometric characteristics
Body measurements and fat composition
Arousal, attention, and congition
Degree of responsiveness and awareness
Assistive and adaptive devices
Equipment to aid in performing tasks
Cranial and peripheral nerve integrity
Assessment of sensory and motor functions of cranial and peripheral nerves
Environmental, home, and work barriers
Analysis of physical restrictions to functioning in the environment
Ergonomics and body mechanics
Analysis of work tasks and postural adjustment to perform tasks
Gait, locomotion, and balance
Analyses of walking, moving from place to place, and equilibrium
Integumentary integrity
Health of skin
Joint integrity and mobility
A joint will be assessed to determine whether its support tissue has too much movement (is lax). This involves gliding the bones around the joint to see how much movement or joint play is available. Too much movement may indicate a ligament tear.
Motor function
Control of voluntary movement
Muscle performance
Analysis of muscle strength, power, and endurance
Neuromotor development and sensory integration
Evolution of movement skills and integration of information from the environment
Orthotic, protective, and supportive devices
Determination of need for fit of devices to support weak joints
Analysis of intensity, quality, and frequency of pain
Analysis of body alignment and positioning
Prosthetic requirements
Selection, fit, and use of prostheses
Range of motion
Amount of movement at a joint
Reflex integrity
Assessment of developmental, normal, and pahtological reflexes
Self-care and home management
Analysis of activities necessary for independent living at home
Sensory integrity
Assessment of peripheral and central sensory processing, awareness of movement, and position
Ventilation and respiration/gas exchange
Assessment of movement of air into and out of the lungs, exchange of gases, and transport of blood to perform activities of daily living and exercises
Work, community, and leisure integration or reintegration
Analyses to dtermine whether the patient/client can assume a role in the community or work
Flexibility (Length)
Muscles that commonly get tight in the body and affect alignment and function are the calf muscle, the hamstings, and the hip flexors.
Gait and balance
Ability to walk, noting any deviations from normal gait that might impair normal funciton
Growth and life span development
Therapist that work in a pediatric setting are responsible for determining whether children have delayed development.
Joint range of motion
Joint range of motion is evaluated by use of a goniometer. This device is like a protractor. The goniometer is utilized to objectively determine how much a joint moves (what angle it can move to).
Evaluate normal and abnormal reflexes.
Segmental length, girth, and volume
Tape measures are utilized to determine if a patient has a discrepancy in length of one leg versus the other. In addition, swelling in an extremity or wasting away of a muscle can be objectively recorded using this method.
Skin status
Status of wounds prior to treatment including location, size, nature of wound, etc.
Is established by either performing a manual muscle test or using a device which objectively records how hard a patient is able to push with his or her muscles. A manual muscle test is performed by having the patient hold a position and the therapist determines how much force is utilized to move the extremity.
What are the components of informed consent?
After the evaluation has been completed, the therapist must receive a patient's informed consent prior to beginning the treatment. Includes:
1. Description of the treatment
2. Risks of treatment
3. Expected outcomes
4. Alternatives to said treatment
Describe three considerations in determining what elements of a physical therapy treatment program will be delegated to the physical therapist assistant.
1. The PTA's education
Associate degree in Physical therapy, and upon graduation assistants shouldand do attend continuing education. If they attended courses in a particular area and developed an expertise, then it would be logical to let them do it.
Describe three considerations in determining what elements of a physical therapy treatment program will be delegated to the physical therapist assistant
3. It should be remembered that whatever portion of the treatment is delegated to another individual is still the responsibility of the physical therapist
Discuss whether the physical therapist assistant performs assessment procedures
The assistant performs assessment procedures to help document this progress in an objective manner. The therapist will schedule formal re-evaluations when necessary for revision of goals or make alterations in the plan of care. The assistant makes minor alterations in the treatment according to the patient’s needs and progress. Major changes, which reflect a change in the goals of the plan of care, are referred to the physical therapist for approval.
Therapeutic exercise
Activities to improve physical function and health status; performed actively, passively, or against resistance.
Functional training in self-care and home management
Activities to improve function in activities of daily living and independence in home environment.
Functional training in work, community, and leisure integration or reintegration
Activities to integrate or return the patient/client to work.
Manual therapy techniques
Skilled hand techniques on soft tissues and joints
Prescription, application, and as appropriate, fabrication of devices and equipment
Selection or favrication, fit, and training in the use of devices and equipment to improve function.
Airway clearance techniques
Activities to improve airway portection, ventilation, and respiration
Integumentary repair and protective techniques
Activities to improve wound healing and scar management
Electrotherapeutic modalities
Use of electricity to decrase pain, swelling, and unwanted muscular activity; maintain strength; and improve functional training and wound healing.
Physical agents and mechanical modalities
Use of thermal, acoustic, or radiant enery and mechanical equipment to decrease pain and sweling and improve skin condition and joint movement.
Instruction in activities of daily living (ADL)
This includes dressing, transferring from wheelchair to various surfaces-bed, toilet, car, ambulation referred to as gait training with assistive devices, bed mobility (turning and scooting in bed, rising from bed)
What are Modalities?
a therapeutic agent, usually physical in nature, used for the treatment of a disease process. Modalities can be divided into two basic categories (although there are other modalities that don’t fit nicely into either group) Thermal and electrical
Thermal Agents
These are utilized to decrease pain and muscle spasms, increase blood flow and to warm tissue prior to stretching
What are some thermal agents?
Cryotherapy-use of cold(see table 7-2 for effects-primarily to decrease swelling and pain)

a. ice packs (CP)

b. ice massage(see figure 2-13 on page 39)

c. cold whirlpool

d. cold compression
What is electrical stimulation?
transcutaneous electrical nerve stimulation (TENS)-application of an electrical current for the reduction of pain
Iontophoresis-utilization of electricity to drive medication across the skin to reduce pain and inflammation
Neuromuscular electrical stimulation (NMES)-utilized to electrically stimulate muscle in cases of paralysis or weakness
Interferential and High voltage galvanic stimulation-electrical stimulation used to decrease pain, reduce muscle spasms, reduce edema, etc.
Superficial Heat
a. Hot packs(HMP)
b. Paraffin
c. Fluidotherapy
d. Whirlpool
Effects and Indications
Effects: Increases blood flow
Increases metabolism; promotes healing and removal of waste products
Decrease pain
Decrease stiffness
Indications: Muscle spasm, pain, Joint stiffness, wound care
Deep heat
a. Ultrasound (US)
b. short wave diathermy (SWD
Effects: Increases blood flow
Increase metabolism; promotes healing and removal of waste products
Decreases pain
Decreases stiffness
Indications: Muscle spasm, pain, and joint stiffness
Cryotherapy-use of cold
a. ice packs (CP)
b. ice massage
c. cold whirlpool
d. cold compression
Effects: Decreases blood flow
Decreases metabolism
Decreases edma
Decreases pain
Indications: Acute injury, swelling, pian, muscle spasm, postexercise
Electrical Stimulation
1. transcutaneous electrical nerve stimulation (TENS)
2. Iontophoresis
3. Neuromuscular electrical stimulation (NMES)-
4. Interferential and High voltage galvanic stimulation-electrical stimulation
Effects: Decrease pain
Decreas edema
Promotes wound healing
Muscle re-education
Decrease spasticity
Indications: Pain, edema, wounds, nerve regeneration, muscle weakness/imbalance
Manual techniques
The physical therapist and assistant utilize manual techniques for mobilizing joints, fascia (connective tissue) and relaxation of muscle. These techniques include massage, myofascial release (picture page 37), and joint mobilization
What is PROM?
PROM-passive range of motion-the clinician moves the patients joints through their normal range of motion to prevent stiffness from developing
Used by patient who are restricted to bed rest, have paralysis, or in a coma.
What is AAROM?
AAROM-active assistive range of motion-utilized when patients are extremely weak and require assistance to move
What is AROM?
AROM-active range of motion, patient completes the exercise independently
What are three types of rested exercise?
Isometric, Isotonic, and Isokinetic
What is Isometric exercise?
A type of exercise in which there is little to no joint movement, used when joints are actively inflammed. Muscle contraction without visible join movement. Example-pushing against a wall
What is a Isotonic exercise?
Use of weights and other resistive devices to strengthen the muscle.
Two Types
Concentric-muscle contraction that produces or controls joint motion resulting in muscle shortening. EX:Flexing elbow with dumbell in hand
Eccentric-muscle contraction that produces or controls joint motion resulting in muscle lenghtening.
EX:Extending elbow with dumbell in hand
What are Isokinetic exercises?
Specialized devices which allow the patient to exercise at a variety of speeds with the resistance adjusting to the patient’s level of strength.
EX:Knee extension using an isokinetic device
What are some other treatments?
1. Application of orthoses and external supports (braces, splints, bandages to support joints and improve function
2. Prostheses (instruction in use of artificial limbs)
3. Pulmonary Hygiene(breathing techniques and postural drainage-techniques to clear lungs of sputum, picture page 38)
4. Traction (distraction of joints using manual or mechanical techniques) See page 40
5. Wound care (debridement-removing dead tissue, bandaging, etc)
Why do you need written documentation in a patient's chart?
Written documentation in the form of an initial evaluation provides a baseline for determining progress and documenting the need for physical therapy in cases of third party reimbursement. Written notes communicate to other professionals the treatment rendered in physical therapy as well as to other physical therapy professionals that might care for the patient in the therapist’s absence. It also serves as a legal record of treatment in case the patient’s case should undergo litigation.
What is the difference between narrative and SOAP note format?
Narrative allows maximum flexiblity but is completely unstructured. SOAP combines bothe a standardized and narrative form.
Written notes of treatment are generally written in two forms: narrative and SOAP note format. Narrative notes are less structured and flexible and allow the professional to document the treatment without format. SOAP notes have a particular format following the acronym.
What does SOAP stand for?
S: subjective (what did the patient or family say)
O: objective (what were the results of tests, observations, and what was the treatment rendered)
A: assessment (what is the overall assessment of the patient’s condition and goals)
P: plan (what is the specific plan of treatment to achieve those goals)
List 3 ways in which physical therapy personnel may serve as consultants.
Therapists and assistants are sometimes called on to give their opinions outside the clinical environment. For example, a therapist might be called to give expert testimony about the disability associated with a particular injury. Recommendations might be given about how to modify a facility to make it accessible to those with a disability. Professionals might review medical charts for insurance carriers to determine whether physical therapy treatment was warranted. Physical therapists could also sit on boards or committees that decide policies about health care issues.
Verbal Communication
Physical therapists and assistants must communicate effectively with patients, patient’s family members, other health care workers and the physician in charge of the patient’s care. Verbal communication will be discussed in more detail later in the semester.
Non-verbal Communication
Non-verbal communication refers to a health care workers or patient’s body language. Professionals must be aware of the messages sent by these means. This topic will be discussed in greater detail later in the semester.
List 5 administrative duties that physical therapy personnel may be involved in.
Every professionals work entails some amount of administrative duties. However, as a supervisor in a physical therapy clinic, the percentage of time devoted to these activities is of course greater. These activities include planning, communication, delegating, managing, directing, supervising, budgeting, and evaluating.
What is an in-service?
Physical therapy staff are often called upon by other departments to present in-services on the topic of transfers and body mechanics (how to move someone from wheelchair to bed and back using proper care for the back). After attending a continuing education seminar, individuals often present the information learned to the department in which they work in order that all can benefit from the information. Physical therapist and assistant education programs also allow clinicians to present their area of expertise in order to expand their knowledge base.
Why is research necessary?
Physical therapy research is key to determining the most effective treatment approach coupled with the best patient outcome. Research today is done in academic setting by faculty and by clinicians conducting clinical research. Clinicians may for instance determine that a certain treatment reduces hospital length of stay, reduces pain medications or makes the patient more functional 1-year done the road. This type of information is critical for insurance carriers that determine whether certain treatments will be paid for.
What are characteristics of an effective PT and PTA?
Efficient, Team Player,Gets along well with others, Patience, Able to motivate others, Knowledgeable, confident, Open minded, Compassionate,
Organized, Respectful, Honest, Professional looking-clean, appropriate attire, Prompt, Polite,
Self-directed, Life-long learner
Critical thinker.
Where do physical therapists and assistants work?
Physical Therapists and physical therapist assistants work in a variety of work places. One of the most widely known is a hospital (acute care facility). After discharge from the hospital, the PT or PTA may see the patient in a rehabilitation facility, skilled nursing facility, extended care facility or home health. If a physical therapist or assistant works in pediatrics, they may go to schools to work with children or work in a facility that specializes in treating children. In outpatient clinics, physical therapy personnel usually see patients with orthopedic (bone and joint) and sports injuries.

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