Assisting with Cold and Heat Therapy and Ambulation 11 Assisting with Cold and Heat Therapy and Ambulation

Learning Outcomes 11.1 Explain how medical assistants might assist with some forms of physical therapy. 11.2 Describe ways to test joint mobility, muscle strength, gait, and posture. 11.3 Discuss the benefits of cold and heat therapies. 11.4 List contraindications to cold and heat therapies. 11.5 Identify various cold and heat therapies.

Learning Outcomes (cont.) 11.6 Demonstrate how to perform cold and heat therapies. 11.7 Describe hydrotherapy methods. 11.8 Identify several methods of exercise therapy. 11.9 Compare different methods of traction. 11.10 Demonstrate how to teach a patient to use a cane, a walker, crutches, and a wheelchair.

Introduction Medical assistant You may also Common duties Apply cold and heat therapy Assist patients with ambulation You may also Teach basic exercises Demonstrate how to use a wheelchair Demonstrate the use of cane, walker, and crutches Discuss therapies with the patient

General Principles of Physical Therapy Physical therapy is a medical specialty that treats Musculoskeletal disorders Nervous disorders Cardiopulmonary disorders

General Principles of Physical Therapy (cont.) Assisting the therapeutic team Members Physicians Nurses Medical assistants Other specialists Coordinate patient schedule Make referrals Explain treatment approach Documentation Reinforce instructions Answer patient questions You must have a working knowledge of therapy techniques.

General Principles of Physical Therapy (cont.) Specialized therapies Art Music Dance Writing Crafts Aquatic Horticultural Equestrian

Patient Assessment Joint mobility testing Muscle strength testing Range of motion (ROM) – degree to which a joint is able to move Goniometer Degree of movement compared to a standard measure Muscle strength testing Determines the amount of force the patient can exert with a group of muscles Compare each side of body

Patient Assessment (cont.) Gait testing The way a person walks (gait and swing) Includes Length of stride Balance Coordination Direction of knees and feet Posture Body position and alignment Checks spinal curves Symmetry of alignment Shoulders Knees Hips

Good Job! Apply Your Knowledge ANSWER: Match description with assessment type: ___ How a person walks A. Joint mobility ___ Range of motion B. Muscle strength ___ Body position and alignment C. Posture ___ Force exerted with a group of muscles D. Gait ___ Goniometer ___ Check spinal curves ___ Length of stride D A C B A C Good Job! D

Cryotherapy and Thermotherapy Applying cold for therapeutic reasons Types Wet or dry Chemical or natural Thermotherapy Applying heat for therapeutic reasons Types Dry Moist

Cryotherapy and Thermotherapy (cont.) Generally promote healing Side effect – damage to underlying nerves and tissues Monitor patient closely Factors affecting the use of these treatments Treatment location Circulation or sensation impairment Temperature tolerance Age

Principles of Cryotherapy Constricts blood vessels Physiologic responses to cold Prevents swelling Controls bleeding Reduces inflammation Anesthetic effect for pain Reduces pus formation Lowers body temperature

Administering Cryotherapy Dry cold applications Ice bags and collars Chemical ice packs Wet cold applications Cold compresses Ice massage

Principles of Thermotherapy Dilates blood vessels Physiologic responses to heat Relieves pain and congestion Reduces muscle spasms Muscle relaxation Reduces inflammation Reduces swelling

Administering Thermotherapy Dry heat therapies Chemical hot packs Heating pad Hot-water bottle Heat lamp Fluidotherapy

Administering Thermotherapy (cont.) Moist heat applications Hot soak Hot compress Hot pack Paraffin bath Diathermy – high-frequency wave achieves deep heat penetration Ultrasound Shortwave Microwave

Apply Your Knowledge Correct! What is the main difference in the effect of cryotherapy and thermotherapy that results in the physiologic response of each? ANSWER: Cryotherapy causes blood vessels to constrict, resulting in its physiologic effects, while thermotherapy causes blood vessels to dilate. Correct!

Hydrotherapy Use of water to treat physical problems Whirlpools Water is agitated by jets of air under pressure Generates hydromassage Relaxes muscles Increases circulation Also used to clean and debride wounds, ulcers, and burns

Hydrotherapy (cont.) Contrast baths Underwater exercises 2 baths, one hot and one cold Patient moves quickly from one to the other Purpose Induces relaxation Improves circulation Greater mobility Underwater exercises Warm swimming pool Buoyancy takes pressure off joints Purpose Promotes relaxation Increases circulation

Apply Your Knowledge Super! What are the main effects of hydrotherapy? ANSWER: Hydrotherapy relaxes muscles, increases circulation, and improves flexibility and mobility. Super!

Exercise Therapy Preventive and therapeutic benefits Flexibility Mobility Muscle tone Strength Primary treatment for fractures, arthritis, and some respiratory diseases Minimizes symptoms Slows disease progression

Exercise Therapy (cont.) Improves muscle tone and strength Maintains ROM Prevents or corrects physical deformities Promotes neuromuscular coordination Improves circulation Relieves stress Lowers cholesterol levels Aids in resumption of normal daily activities

Medical Assistant’s Role Provide patient information Types of exercise programs Treatment plan Provide support and encouragement Assist with ROM exercises Teach the patient and family about ROM exercises.

Types of Exercise Choice based on patient’s physical condition Active mobility Self-directed exercises Increase muscle strength and function Passive mobility Therapist or machine moves the patient’s body part Retain ROM and improve circulation Aided mobility Self-directed with assistance of a device such as exercise machine Retain or improve ROM

Types of Exercise (cont.) Active resistance Works against resistance Increases muscle strength Isometric Patient relaxes and then contracts muscles while in a fixed position Maintains muscle strength if immobilized ROM exercises Move each joint through its full range of motions Improves flexibility and mobility Improves circulation and muscle function

Electrical Stimulation Delivers a controlled amounts of low-voltage electric current to motor and sensory nerves Stimulates muscle Prevents atrophy Helps in healing injured joints Retrains a patient to use injured muscles

Apply Your Knowledge Match description with type of exercise: YIPPEE! Match description with type of exercise: ___ Self-directed; exercise machine A. Isometric ___ Self-directed; no assistance B. Aided mobility ___ Low-voltage current; stimulates C. Active resistance nerves/muscles ___ Relax and contract muscles from D. Electrical fixed position stimulation ___ Exercise against counter-pressure E. Active mobility ___ Move joint through full range F. ROM ANSWER: B E D A C F

Traction The pulling or stretching of the musculoskeletal system Uses Used to treat fractured bones and dislocation, arthritic, or other diseased joints Uses Create and maintain bone alignment Reduce and prevent joint stiffening Correct deformities Reduce and relieve muscle spasms

Traction (cont.) Manual Static Stretching muscles and separating joints by gently pulling on them Improves motion and decreases stiffening Uses Muscle spasms Stiffness Arthritis Static Weight traction using harness and weights Used to relieve muscle spasms

Traction (cont.) Skeletal Mechanical Long-term/heavy weights Pins, wires, or tongs surgically placed Pulleys and weights provide continuous traction Mechanical Device intermittently pulls and relaxes Promotes relaxation

alternately pulls and relaxes Apply Your Knowledge ANSWER: True or False: ___ Static traction uses a harness and weights to induce muscle spasms. ___ Manual traction stretches muscles and separates joints by gently pulling on them. ___ Skeletal traction uses pulleys and weights to provide continuous traction. ___ Mechanical traction maintains constant tension on the extremity. FANTASTIC! F relieve T T F alternately pulls and relaxes

Mobility Aids Devices to improve patients’ ability to ambulate or move about Mobility aid chosen depends on Patient’s disability Muscle coordination Strength Age

Canes Standard Tripod (3 legs) and quad-base (4 legs) Patient who needs only small amount of support Tripod (3 legs) and quad-base (4 legs) Create wide base of support More stable than standard canes Must be adjusted to correct height for patient

Walkers Used by older patients with Provides a sense of stability Difficulty walking unassisted Balance problems Provides a sense of stability Types – Table 11-2 Adjust to proper height for patient

Crutches Transfers weight to the arms Types Axillary Ground to axilla Short-term use Lofstrand, or Canadian Ground to forearm Long-term use

Crutches (cont.) Complications may arise if not measured properly Pressure on nerves in axilla Strain on back, imbalance Measuring for crutches Should be 2 to 3 finger-widths between supports and axilla 30º flexion at elbow

Crutches (cont.) Crutch gaits Four-point – slow gait for a patient who can bear weight on both legs Three-point – used when patient cannot bear weight on one leg Two-point – used when patient can have some weight on both legs; must have good muscle coordination and balance Swing gait – used when patient has severe disabilities

Wheelchairs Type of chair chosen Depends on patient’s disability Length of time wheelchair needed Always ensure patient safety during transfers Use appropriate lifting techniques

Hip-Hip- Hurray! Apply Your Knowledge When would a walker be an appropriate mobility device for use by your patient? ANSWER: Walkers are used by older patients who are too weak to walk unassisted or who have balance problems. Hip-Hip- Hurray!

Referral to a Physical Therapist Referrals to preferred therapists Provide physician’s order Provide patient information Therapists Independent practitioners Hospital or clinic Home health

In Summary 11.1 A medical assistant may be asked to apply cold and heat; teach basic exercises; demonstrate how to use a cane, walker, and crutches; demonstrate how to use a wheelchair; and discuss with the patient specific therapies for use at home. 11.2 Various physical tests are performed on patients, including joint mobility testing, muscle strength testing, gait, and posture testing. 11.3 Cold and heat therapy promote healing and increase patient comfort.

In Summary (cont.) 11.4 Contraindications to cold and heat therapies include circulation problems, pain, and hemorrhage. 11.5 There are various types of cold and heat therapies. These include dry and wet, cold, and heat applications. 11.6 The general steps to applying cold and heat therapies include checking the physician’s order, positioning and draping the patient, applying the pack, and monitoring the patient. 11.7 Various types of hydrotherapy used to treat physical problems include whirlpools, contrast baths, and underwater exercises.

In Summary (cont.) 11.8 There are several methods of exercise therapy, including active mobility, passive mobility, aided mobility, and active resistance. 11.9 The different methods of traction used to treat physical problems include manual, static, skeletal, and mechanical. 11.10 There are various mobility aids, including canes, walkers, crutches, and wheelchairs. Specific instructions for each of these aids must be followed to reduce the possibility of patient injury during their use.

End of Chapter 11 Disability is a matter of perception. If you can do just one thing well, you're needed by someone. ~ Martina Navratilova