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Integration of Physical Agents into Therapeutic Treatment Approaches: Observable Responses Chapter 2.

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Presentation on theme: "Integration of Physical Agents into Therapeutic Treatment Approaches: Observable Responses Chapter 2."— Presentation transcript:

1 Integration of Physical Agents into Therapeutic Treatment Approaches: Observable Responses Chapter 2

2 Examination, Evaluation, and Intervention Examination – The process of obtaining history, performing relevant system reviews, and selecting and administering specific tests and measures Examination – The process of obtaining history, performing relevant system reviews, and selecting and administering specific tests and measures Evaluation – Process in which P.T. makes clinical judgments based on data gathered during examination Evaluation – Process in which P.T. makes clinical judgments based on data gathered during examination Intervention – Purposeful and skilled interaction of the P.T or P.T.A. with the patient/client Intervention – Purposeful and skilled interaction of the P.T or P.T.A. with the patient/client

3 Observable responses to Interventions Skin Color: Skin Color: Initially observe condition & color of pt’s skin prior to Rx Initially observe condition & color of pt’s skin prior to Rx Fairer the skin the “pinker” it looks when exposed to heat Fairer the skin the “pinker” it looks when exposed to heat Need to carefully watch darker skinned pt. Need to carefully watch darker skinned pt. Circulatory Irregularities & skin blanching: Circulatory Irregularities & skin blanching: Blanching: describes the response to applied pressure on the surface o skin following an increase in local circulation Blanching: describes the response to applied pressure on the surface o skin following an increase in local circulation If no blanching then can indicate underlying tissue has impaired circulatory function & may indicate pt has increased sensitivity to heat or cold If no blanching then can indicate underlying tissue has impaired circulatory function & may indicate pt has increased sensitivity to heat or cold

4 Observable responses cont. Mottling of the skin: Mottling of the skin: Follows superficial heat and is indicated by spotting patches of erythema Follows superficial heat and is indicated by spotting patches of erythema Molting is warning sign of potential overheating Molting is warning sign of potential overheating Palpable observations: Palpable observations: Muscle guarding & spasm: Muscle guarding is an indication of motor units firing to protect area in response to trauma; Helps prevent movement from occurring in the injured area; Pt reports “feel a muscle spasm”; When treating muscle spasms important to palpate area before & after Rx Muscle guarding & spasm: Muscle guarding is an indication of motor units firing to protect area in response to trauma; Helps prevent movement from occurring in the injured area; Pt reports “feel a muscle spasm”; When treating muscle spasms important to palpate area before & after Rx Skin surface temperature: Application of heat cause increase in skin surface temp & application of cold causes decrease in skin surface temp Skin surface temperature: Application of heat cause increase in skin surface temp & application of cold causes decrease in skin surface temp

5 Pain assessment Pain is the most difficult complaint to quantify & document objectively Pain is the most difficult complaint to quantify & document objectively Visual & numerical analog pain scales: Visual & numerical analog pain scales: 0__________________________________10 0__________________________________10 No pain E.R. Pain Pain ratings: Pain ratings: Ask “”what are you feeling now?” instead of yes/no questions Ask “”what are you feeling now?” instead of yes/no questions Anatomic pain drawings Anatomic pain drawings Allow pt to locate just where he or she is experiencing discomfort Allow pt to locate just where he or she is experiencing discomfort Facial expression of pain: Facial expression of pain: Facial muscles will contract in response to pain; “looks like” pt is in pain Facial muscles will contract in response to pain; “looks like” pt is in pain

6 Pain Scales

7 Questions to Ask Questions should not reinforce the concept of pain by using “pain” in the question Questions should not reinforce the concept of pain by using “pain” in the question Don’t ask “Do you still hurt?” or “Are you in pain?” Don’t ask “Do you still hurt?” or “Are you in pain?” Ask “What are you feeling now?” Ask “What are you feeling now?”

8 Other Means to Assess Pain Facial expressions Facial expressions Ability to perfrom activity Ability to perfrom activity ROM ROM Pain meds decrease Pain meds decrease

9 Mobility & function These are objective assessment tools for the pt complaining of pain These are objective assessment tools for the pt complaining of pain If following Rx a pt has increased ROM then usually one can assume pain has decreased If following Rx a pt has increased ROM then usually one can assume pain has decreased

10 Edema Assessment Edema is an abnormal increase in amount of interstitial fluid; May be diffuse or localized. Edema is an abnormal increase in amount of interstitial fluid; May be diffuse or localized. Circumferential joint measurement: Circumferential joint measurement: Use non-stretch tape measure Use non-stretch tape measure Use same tape each time Use same tape each time Same individual measures Same individual measures Measure same time each day Measure same time each day Measure using same bony landmarks Measure using same bony landmarks Measure using same technique Measure using same technique Measure using same unit of measure (in or cm) Measure using same unit of measure (in or cm)

11 Edema assessment cont. Volumetric water displacement: Volumetric water displacement: Used when edema confined to distal extremeities Used when edema confined to distal extremeities Volumeter is device that measures water displacement to record volume that an extremity submerged in water occupies Volumeter is device that measures water displacement to record volume that an extremity submerged in water occupies Measure same time each day Measure same time each day Temp of water same Temp of water same Depth of immersion of extremity same Depth of immersion of extremity same Unit of measure same (ounce or mililiters) Unit of measure same (ounce or mililiters) Simply says there’s swelling, but not where Simply says there’s swelling, but not where

12 Edema Assessment cont. Joint mobility or Ease of movement: Joint mobility or Ease of movement: Edema can impede joint movement Edema can impede joint movement Measure ROM with goniometer Measure ROM with goniometer Performance of an activity limited by edema Performance of an activity limited by edema ADL’s may be impaired by edema ADL’s may be impaired by edema Ex. Difficulty putting on sock & shoe with swollen ankle Ex. Difficulty putting on sock & shoe with swollen ankle

13 Muscle spasm Assessment Muscle spasm or muscle guarding may severely inhibit a pt’s recovery Muscle spasm or muscle guarding may severely inhibit a pt’s recovery Muscle tone & tissue compliance: Muscle tone & tissue compliance: Muscle tone refers to resistance of the muscle to passive stretch or elongation (how tight it feels); Assumes shortened state & feels harder than uninvolved tissue when palpated Muscle tone refers to resistance of the muscle to passive stretch or elongation (how tight it feels); Assumes shortened state & feels harder than uninvolved tissue when palpated Postural assessment: Postural assessment: If patient has muscle guarding that involves postural muscles, pt’s posture may be affected; If patient has muscle guarding that involves postural muscles, pt’s posture may be affected; Forward head posture is where head is displaced anteriorly on C-spine because o increases anterior & posterior muscle guarding Forward head posture is where head is displaced anteriorly on C-spine because o increases anterior & posterior muscle guarding Range of mobility: Range of mobility: Increased muscle spasms = decreased joint ROM; need to measure Increased muscle spasms = decreased joint ROM; need to measure

14 Muscle strength assessments Can be accomplished either manually or with the use of sophisticated equipment Can be accomplished either manually or with the use of sophisticated equipment Manual muscle Test (MMT): determines strength by assessing specific muscle contractions or gross muscle actions (grades are given to muscle contraction) Manual muscle Test (MMT): determines strength by assessing specific muscle contractions or gross muscle actions (grades are given to muscle contraction) CYBEX isokinetic dynamometer: is a machine that stabilizes & tests muscles CYBEX isokinetic dynamometer: is a machine that stabilizes & tests muscles


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