Physical Therapy and Rehabilitation 54 Physical Therapy and Rehabilitation

Introduction Medical assistant Apply cold and heat Assist with ambulation Teach basic exercises Demonstrate how to use a cane, walker, crutches, or wheelchair Discuss with the patient specific therapies for home use Learning Outcome: 54.1 Discuss the general principles of physical therapy. For a full program of physical therapy, a physician generally refers a patient to a licensed physical therapist.

General Principles of Physical Therapy Medical specialty treating Musculoskeletal disorders Nervous disorders Cardiopulmonary disorders Treatments Patient benefits Disorders Learning Outcome: 54.1 Discuss the general principles of physical therapy. A physical therapist uses a variety of treatments, including cold, heat, water, exercise, massage, and traction. Benefits of physical therapy Restores and improves muscle function Builds strength Increases joint mobility Relieves pain Increases circulation Physical therapy is used to treat Arthritis Stroke Lower back pain Muscle spasms Muscle injuries or diseases Pressure sores Skin disorders Burns

Assisting Within a Therapeutic Team Therapeutic team members Medical assistant Coordinate the patient’s schedule Make referrals Document treatments and findings Reinforce instructions for the patient Answer the patient’s questions Learning Outcome: 54.1 Discuss the general principles of physical therapy. Therapeutic team Physicians, nurses, medical assistants, and other specialists who work with patients dealing with chronic illness or recovery from major injuries Your responsibilities may include: Coordinating the patient’s schedule of sessions with different specialists. Explaining a specialist’s treatment approach to the patient. Communicating the physician’s findings to the specialist. Documenting the specialist’s treatments and findings for the physician. Reinforcing the specialist’s instructions for the patient. Answering the patient’s questions. You must have a working knowledge of therapy techniques and keep up-to-date on emerging techniques.

Assisting with Patient Assessment Joint mobility testing Range of motion (ROM) – degree to which a joint is able to move Goniometer Degree of movement compared to a standard Learning Outcome: 54.1 Discuss the general principles of physical therapy. Before the doctor prescribes physical therapy, she assesses the patient’s physical abilities and condition. She inspects and palpates the patient’s joints and muscles and tests the patient’s joint mobility, muscle strength, gait, and posture. Joint Mobility Testing Range of motion (ROM) – the degree to which a joint is able to move Goniometer – device that measures the degree to which a joint is able to move. The joints are measured from the head to the feet, comparing each joint measurement with a standard measurement for that joint.

Assisting with Patient Assessment (cont.) Muscle strength testing Determines the amount of force exerted exert with a group of muscles Compare each side of body Gait testing – assessment of how a patient walks Learning Outcome: 54.1 Discuss the general principles of physical therapy. Muscle strength testing Determines the amount of force the patient is able to exert with a muscle or group of muscles. The patient is asked to resist the pressure that you or the physician applies to each muscle or group of muscles. Strength is rated according to a five-point scale. Both sides of the body are compared. Gait Testing Gait is the way a person walks. Observation and assessment of the patient’s length of stride, balance, coordination, direction of knees (inward or outward), and direction of feet (inward or outward).

Assisting with Patient Assessment (cont.) Posture testing Body position and alignment Checks spinal curves Symmetry of alignment Learning Outcome: 54.1 Discuss the general principles of physical therapy. Posture Testing Posture is body position and alignment. Look at the patient’s spinal curve from the sides, back, and front. Normally, the thoracic spine has a convex curve, and the lumbar spine has a concave curve. The doctor notes the symmetry of alignment of the shoulders, knees, and hips. To assess alignment and degree of straightness of the spine, the doctor asks the patient to bend at the waist and let the arms dangle freely. To assess knee position, the doctor asks the patient to stand with both feet together to determine whether the knees are at the same height, facing forward, and symmetrical.

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 Learning Outcome: 54.1 Discuss the general principles of physical therapy. 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 Learning Outcome: 54.2 Relate various cold and heat therapies to their benefits and contraindications.

Cryotherapy and Thermotherapy (cont.) Factors affecting use Therapy's purpose Location and condition of affected area Patient’s age and general health Monitor patient for signs of tissue damage Be aware of contraindications Learning Outcome: 54.2 Relate various cold and heat therapies and their benefits and contraindications. Performed correctly, cold and heat therapies generally promote healing. Cold therapy can cause damage to underlying nerves and tissues. Heat therapy can cause burns to the skin and underlying tissues . Monitor the patient carefully for signs of tissue damage, which include extreme blanching, redness, or blistering of the skin. You also need to be aware of conditions that contraindicate cold or heat therapies. Refer to Table 54-1 Contraindications, Precautions, and Side Effects Related to Cold and Heat.

Cryotherapy and Thermotherapy (cont.) Treatment Location Cryotherapy and Thermotherapy (cont.) Treatment location Circulation or sensation impairment Temperature tolerance Elderly’s sensitivity to cold and heat Learning Outcome: 54.2 Relate various cold and heat therapies and their benefits and contraindications. Treatment Location Thin-skinned areas are more sensitive to cold and heat therapies. Use caution around any broken skin. Circulation or Sensation Impairment May prevent such patients from sensing that a treatment is too cold or too hot. Monitor closely during cryotherapy or thermotherapy. Temperature Tolerance Varies greatly from person to person. Listen carefully to patients for any indication of temperature intolerance. Elderly Patients' Sensitivity to Cold and Heat Usually more sensitive than others to cold and heat. Stay with an elderly patient during its application to check the patient’s skin frequently for excessive paleness or redness.

Principles of Cryotherapy Constricts blood vessels Physiologic responses to cold Prevents swelling Controls bleeding Reduces inflammation Anesthetic effect Reduces pus formation Lowers body temperature Learning Outcome: 54.2 Relate various cold and heat therapies and their benefits and contraindications. Principles of Cryotherapy – causes blood vessels to constrict and involuntary muscles of the skin to contract. These physiologic responses can have the following results: Prevention of swelling by limiting edema, or fluid accumulation in body tissue. Control of bleeding by constricting blood vessels. Reduction of inflammation by slowing blood and fluid movement in the affected area. Provision of an anesthetic effect for pain by reducing inflammation. Reduction of pus formation by inhibiting microorganism activity. Lowering of body temperature.

Administering Cryotherapy Dry cold applications Ice bags and collars Chemical ice packs Wet cold applications Cold compresses Ice massage Learning Outcome: 54.2 Relate various cold and heat therapies and their benefits and contraindications. For best results, cryotherapy should be applied about 20 minutes every hour for the first 48 hours after an injury. The skin becomes cool and pale because blood vessels constrict, decreasing the blood supply to the area. The decreased blood supply also reduces tissue metabolism, oxygen use, and waste accumulation. Dry Cold Applications – some ice packs come with a soft covering; others must be wrapped in a cloth before they are applied to the skin. Wet Cold Applications A cold compress – cloth or gauze pad moistened with ice water. Ice massage – ice cube wrapped in a plastic bag or water frozen in a paper cup. The combination of the cold temperature and the motion of the massage can provide therapeutic relief for the localized pain resulting from a sprain or strain. Refer to Procedure 54-1 Administering Cryotherapy

Principles of Thermotherapy Dilates blood vessels – erythema Physiologic responses to heat Relieves pain and congestion Reduces muscle spasms Relaxes muscles Reduces inflammation and swelling Learning Outcome: 54.2 Relate various cold and heat therapies and their benefits and contraindications. Thermotherapy causes blood vessels to dilate, which increases the blood supply to the area. Increased blood supply brings about an increased tissue metabolism that carries oxygen and nutrients to the cells of the area being treated. The treated skin becomes warm and develops erythema as the capillaries in the skin’s deep layers fill with blood. Swelling is reduced because fluid absorption from the tissues is increased. Thermotherapy is highly effective in relieving pain, congestion, muscle spasms, and inflammation and promoting muscle relaxation.

Administering Thermotherapy Dry heat therapies Chemical hot packs Heating pad Hot-water bottle Heat lamp Fluidotherapy Learning Outcome: 54.2 Relate various cold and heat therapies and their benefits and contraindications. Always monitor heat therapy applications Heat applied for too long may increase skin secretions that soften skin and lower resistance. Heat that is too extreme can burn the skin or increase edema. Dry Heat Therapies Chemical Hot Pack – a disposable, flexible pack of chemicals that becomes hot when you activate it by kneading or slapping it. Heating Pad – a flat pad with electrical coils between layers of soft fabric. Hot-Water Bottle – a flat, flexible, plastic or rubber bottle with a stopper filled with hot water, make sure the water temperature does not exceed 125º F or less for children and elderly. Heat Lamp – uses an infrared or ultraviolet bulb to provide heat; keep 2 to 4 feet from the area being treated. Fluidotherapy – the patient places affected body part in container of glass beads that are heated and agitated with hot air. Refer to Procedure 54-2 Administering Thermotherapy

Administering Thermotherapy (cont.) Moist heat applications Hot soak Hot compress Hot pack Paraffin bath Alternating hot and cold packs Learning Outcome: 54.2 Relate various cold and heat therapies and their benefits and contraindications. Moist Heat Applications – used to increase circulation and decrease pain to specific body areas Hot Soak – places the affected body part in a container of plain or medicated water heated to no more than 110º F for about 15 minutes. Hot Compress – a piece of gauze or cloth is soaked in hot water and applied to affected area. Hot Pack – large canvas bag filled with heat-retaining gel; used on a large body area. Paraffin Bath – a receptacle of heated wax and mineral oil that affected area is dipped repeatedly into until the area is covered with a thick coat of wax. The wax remains on the area for about 30 minutes and then is peeled off. Alternating hot and cold packs – increases circulation to area by dilating and constricting blood vessels; apply hot pack first.

Administering Thermotherapy (cont.) Diathermy High-frequency wave achieves deep heat penetration Types Ultrasound Shortwave Microwave Learning Outcome: 54.2 Relate various cold and heat therapies and their benefits and contraindications. Diathermy A type of heat therapy in which a machine produces high-frequency waves that achieve deep heat penetration in muscle tissue. Follow the manufacturer’s instructions regarding the specific equipment in your office. Types Ultrasound – projects high-frequency sound waves that are converted to heat in muscle tissue. Shortwave – uses radio waves that travel through the body between two condenser plates and are converted to heat in the tissues. Microwave – uses microwaves to provide heat deep in body tissues.

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. Learning Outcome: 54.2 Relate various cold and heat therapies and their benefits and contraindications. 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 Learning Outcome: 54.3 Describe hydrotherapy methods. Whirlpools – tanks in which water is agitated by jets of air under pressure.

Hydrotherapy (cont.) Contrast baths Underwater exercises 2 baths, one hot and one cold Affected area is quickly moved from one to the other Underwater exercises Warm swimming pool Buoyancy takes pressure off joints Learning Outcome: 54.3 Describe hydrotherapy methods. Underwater Exercises – promote relaxation and increased circulation.

Apply Your Knowledge Super! What are the main effects of hydrotherapy? ANSWER: Hydrotherapy relaxes muscles, increases circulation, and improves flexibility and mobility. Learning Outcome: 54.3 Describe hydrotherapy methods. Super!

Exercise Therapy Preventive and therapeutic benefits Flexibility Mobility Muscle tone Strength Primary treatment for some disorders and sports injuries Learning Outcome: 54.4 Name several methods of exercise therapy It is a primary treatment for fractures, arthritis, and some respiratory disorders; it can minimize symptoms or help slow disease progression. Exercise improves or restores general health and is especially therapeutic when a patient is weak from illness. Commonly used for treating sports injuries. Exercise therapy focuses primarily on regaining muscle strength and flexibility in the injured area. Refer to Educating the Patient: The Injured Athlete

Exercise Therapy (cont.) Exercise benefits include Improve muscle tone and strength Regain or maintain ROM Promotes neuromuscular coordination Helps patients to resume normal activities of daily living Learning Outcome: 54.4 Name several methods of exercise therapy Other benefits of exercise include Preventing or correcting physical deformities. Improving circulation. Relieving stress. Lowering cholesterol levels.

Role of the Medical Assistant Information resource Source of support and encouragement Assist with ROM Patient instructions Learning Outcome: 54.4 Name several methods of exercise therapy Medical assistant Information resource for the patient and family Source of support and encouragement when exercise programs are long and difficult. Assist with rom exercises and teach the patient and family how to perform them at home. Patient instruction – provide Illustrations of the exercises Written instructions on the number of times to perform the exercise, as prescribed by the doctor.

Types of Exercise Choice based on patient’s physical condition Active mobility Self-directed exercises Increase muscle strength and function Learning Outcome: 54.4 Name several methods of exercise therapy The physician adjusts the level of exercise and may prescribe other forms of physical therapy based on an evaluation of heart and lung function and overall physical condition. Careful preparation before beginning an exercise therapy program helps prevent injuries. Refer to Table 54-2 Preventing and Treating Common Problems of Exercise Therapy. A doctor may also refer a patient to a physical therapist, who will develop an exercise program specifically for that patient. Active Mobility Exercises Performed without assistance. Equipment - stationary bicycle or a treadmill.

Types of Exercise Passive mobility Aided mobility Therapist or machine moves the patient’s body part Retain ROM and improve circulation Aided mobility Self-directed with using a device Retain or improve ROM Learning Outcome: 54.4 Name several methods of exercise therapy Passive Mobility Exercises – help retain patients’ ROM and improve their circulation. Aided Mobility Exercises – uses device like an exercise machine or a therapy pool.

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 Learning Outcome: 54.4 Name several methods of exercise therapy

Types of Exercise (cont.) ROM exercises Moving each joint through its full range of motions Improves flexibility and mobility Types Active Passive Learning Outcome: 54.4 Name several methods of exercise therapy ROM Exercises Slowly and gently moving each joint through its full range of motion. Typically prescribed after a joint injury. A physical therapist assesses the patient and determines a recommended regimen of ROM exercises. Types of ROM exercises Active range of motion exercises – performed by the patient without assistance. Passive range of motion exercises – performed by the patient with the help of another person or a machine.

Electrical Stimulation Delivery of controlled amounts of low-voltage electric Stimulates muscles Prevents atrophy Helps in healing injured joints Retrains a patient to use injured muscles Learning Outcome: 54.4 Name several methods of exercise therapy Electrical stimulation helps prevent atrophy in muscles that cannot move voluntarily by causing the muscles to contract involuntarily and relax. Electrical stimulators deliver controlled amounts of low-voltage electric current to motor and sensory nerves to stimulate muscles. Aids in healing injured joints and in revitalizing muscles. Helps retrain a patient to use injured muscles by creating a perceivable connection between the stimulus (muscle movement) and the area of the brain that controls those muscles.

Apply Your Knowledge ANSWER: 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 Learning Outcome: 54.4 Name several methods of exercise therapy C F

Massage Benefits Relaxation and counters effects of stress  heart rate and blood pressure  pain due to tight muscles Improves concentration Promotes restful sleep Relaxes the mind Learning Outcome: 54.5 Describe the types of massage used in rehabilitative medicine. Massage uses pressure, kneading, stroking, vibration, and tapping to positively affect patients’ health and well-being. Benefits Helps the patient relax and counteracts the effects of stress. The heart rate and blood pressure are lowered and blood circulation and lymph flow are increased. Helps reduce pain caused by tight muscles and helps relax muscle spasms. Improve concentration, promotes restful sleep, and helps the mind relax.

Massage (cont.) Swedish Massage Neuromuscular massage Stimulates circulation and lymph flow Five basic strokes Neuromuscular massage Targets specific muscles Releases tension Relieves pain and pressure on nerves Learning Outcome: 54.5 Describe the types of massage used in rehabilitative medicine. Swedish Massage Stimulates circulation and lymph flow with five basic strokes that manipulate the body’s soft tissues. Strokes include Pétrissage (kneading) Effleurage (stroking) Tapotement (percussion) Vibration Friction Neuromuscular Massage Applied to specific muscles and helps release tension and knots, relieve pain and release pressure on nerves, and increase blood flow. Trigger point therapy is one type of neuromuscular massage in which strong finger pressure is applied to trigger points in the muscles.

Apply Your Knowledge AAH Yes! What is the difference between Swedish massage and neuromuscular massage? ANSWER: Swedish massage stimulates circulation and lymph flow with five basic strokes that manipulate the body’s soft tissues. Neuromuscular massage is applied to specific muscles and helps release tension and knots, relieve pain and release pressure on nerves, and increase blood flow. Learning Outcome: 54.5 Describe the types of massage used in rehabilitative medicine. AAH Yes!

Traction The pulling or stretching of the musculoskeletal system Uses Create and maintain bone alignment Reduce and prevent joint stiffening Correct deformities Reduce and relieve muscle spasms Learning Outcome: 54.6 Compare different methods of traction. Traction – pulling or stretching of the musculoskeletal system to treat fractured bones and dislocated, arthritic, or other diseased joints. Traction may be also used to: Reduce or prevent abnormal muscle shortening Relieve compression of vertebral joints

Traction (cont.) Manual Static Gentle pull on muscles and joints Improves motion and decreases stiffening Static Harness and weights Used to relieve muscle spasms Learning Outcome: 54.6 Compare different methods of traction. Manual Traction The physical therapist performs manual traction by using his hands to pull a patient’s limb or head gently. Stretches the muscles and separates the joints, allowing for greater motion and less stiffening. Used for muscle spasms, stiffness, and arthritis. Static Traction or weight traction A therapist places a patient’s limb, pelvis, or chin in a harness and attaches weights through a pulley system. This type of traction is commonly used to relieve muscle spasms.

Traction (cont.) Skeletal – performed for injuries requiring long traction time and heavy weights Mechanical – device that intermittently pulls and relaxes Learning Outcome: 54.6 Compare different methods of traction. Skeletal Traction Performed in inpatient facilities on patients whose injuries require long traction time and heavy weights. Pins, wires, or tongs are surgically inserted into bones. After surgery, the pins, wires, or tongs are attached to pulleys and weights to provide continuous traction. Mechanical Traction – special device that intermittently pulls and relaxes a prescribed body part, such as the neck.

Apply Your Knowledge FANTASTIC! 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 Learning Outcome: 54.6 Compare different methods of traction. 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 Learning Outcome: 54.7 Carry out the procedure for teaching a patient to use a cane, a walker, crutches, and a wheelchair. Mobility aids – also called mobility assistive devices.

Canes Standard – provide small amount of support Tripod and quad-base Correct height Elbow bent 20-25 degrees Should not lean on cane for support Learning Outcome: 54.7 Carry out the procedure for teaching a patient to use a cane, a walker, crutches, and a wheelchair. Canes provide support and help patients maintain balance. They are especially useful for patients with weaknesses on one side of the body, joint disability, or neuromuscular defects. A standard cane Best for a patient who needs only a small amount of support Disadvantage – the curved handle concentrates most of the patient’s weight in one small area of the hand. Tripod canes and quad-base canes – multiple legs create a wide base of support, making them more stable than a standard cane. Refer to Procedure 54-3 Teaching a Patient How to Use a Cane

Walkers Used by patients who Provides a sense of stability Cannot walk unassisted Have balance problems Provides a sense of stability Adjust to proper height for patient Learning Outcome: 54.7 Carry out the procedure for teaching a patient to use a cane, a walker, crutches, and a wheelchair. Walkers have a lightweight, easy-to-use aluminum frame that is open on one side and has four widely placed, adjustable rubber-tipped legs for various heights. The patient stands within the frame and leans on the upper bar, which has a handgrip on each side. They are designed to give a sense of stability when ambulating. A physical therapist selects a walker that suits the patient’s abilities and height. Correctly adjusted walker should reach patient’s hipbone. Refer to Table 54-3 Types of Walkers and Procedure 54-4 Teaching a Patient How to Use a Walker

Crutches Transfers weight to the arms Types Axillary Ground to axilla Short-term use Lofstrand, or Canadian Ground to forearm Long-term use Learning Outcome: 54.7 Carry out the procedure for teaching a patient to use a cane, a walker, crutches, and a wheelchair. Crutches Allow a patient to walk without putting weight on the feet or legs by transferring that weight to the arms. Axillary crutches reach from the ground to the armpit and are designed for short-term use. Lofstrand, or Canadian, crutches Reach from the ground to the forearm. Have a handgrip extension attached at a 90-degree angle and a metal cuff that fits securely around the patient’s forearm.

Crutches (cont.) Measure to fit Too long Too short Crutch palsy Back pain Too short Imbalance Learning Outcome: 54.7 Carry out the procedure for teaching a patient to use a cane, a walker, crutches, and a wheelchair. Measuring the Patient for Crutches Crutches must be measured to fit each patient to prevent back pain and nerve injury to the armpits and palms. Axillary crutches that are too long Put pressure on nerves in the armpit, causing a condition called crutch palsy. Force the patient’s shoulders forward, causing strain on the back and making ambulation difficult. Crutches that are too short Force the patient to bend forward during ambulation. Causing back pain or imbalance, which can lead to falls. To confirm a correct fit be sure The patient is wearing the type of shoes he will wear when walking. The patient is standing erect with feet slightly apart. The crutch tips are positioned 2 to 4 inches in front of the patient’s feet and 4 to 6 inches to the side of each foot. The axillary supports allow 2 to 3 finger-widths between supports and armpits. The handgrips are positioned to create 30-degree flexion at the elbows.

Crutches (cont.) Crutch gaits Tripod or standing position Determine proper gait Slow or fast gaits Learning Outcome: 54.7 Carry out the procedure for teaching a patient to use a cane, a walker, crutches, and a wheelchair. The standing, or tripod, position Have the patient stand erect and look straight ahead. The crutch tips should be 4 to 6 inches in front of and 4 to 6 inches away from the side of each foot. To determine the proper gait for a patient assess the patient’s muscle coordination and physical condition. Instruct Use a slow gait in crowded areas or when feeling tired. Use a faster gait in open places or when feeling more energetic. Using various gaits and speeds enables the patient to exercise different muscle groups and improve overall conditioning.

Crutches (cont.) Four-point gait Slow gait Bear weight on both legs Stable and save Learning Outcome: 54.7 Carry out the procedure for teaching a patient to use a cane, a walker, crutches, and a wheelchair. Four-Point Gait Three points of contact with the ground at all times, it is stable and safe. Useful for patients with leg muscle weakness, spasticity, or poor balance or coordination.

Crutches (cont.) Three-point Cannot bear weight on one leg Must have good muscle coordination and arm strength Learning Outcome: 54.7 Carry out the procedure for teaching a patient to use a cane, a walker, crutches, and a wheelchair. Three-Point Gait Allows the patient’s weight to be carried alternately by the crutches and by the unaffected leg. Appropriate for amputees, patients with tissue or musculoskeletal trauma, and those recovering from leg surgery.

Crutches (cont.) Two-point Swing gait Swing-to Swing-through Learning Outcome: 54.7 Carry out the procedure for teaching a patient to use a cane, a walker, crutches, and a wheelchair. Two-Point Gait Faster than the four-point gait. Used by patients who can bear some weight on both feet and have good muscle coordination and balance. Swing Gaits – patients with severe disabilities, like leg paralysis or deformity, may use one of two swing gaits – the swing-to gait or the swing-through gait.

Wheelchairs Type of chair Depends on patient’s disability Length of time wheelchair needed Always ensure patient safety during transfers Use appropriate lifting techniques Learning Outcome: 54.7 Carry out the procedure for teaching a patient to use a cane, a walker, crutches, and a wheelchair. The physical therapist will select an appropriate wheelchair depending on the patient’s disability and the length of time the wheelchair will be needed. You will be responsible for transferring the patients from the wheelchair to the examining table and back to the wheelchair after the exam. Preventing injury during patient transfer Ask for help if patient is weak, heavy, or unstable. Explain to patient the steps of transfer you will use. Before starting transfer, make sure wheelchair is in locked position and patient is sitting at front of wheelchair seat. When you lift, use the large muscles in your thighs. When lifting, bend from the knees and keep your back straight. Count to 3 and enlist patient’s help on count of 3.

Referral to a Physical Therapist Referrals Provide physician’s order Provide patient information Therapists Independent practitioners Hospital or clinic Home health Learning Outcome: 54.8 Model the steps you should take when referring a patient to a physical therapist. Be sure to document referrals in the patient’s chart.

Hurray! Apply Your Knowledge When would a walker be an appropriate mobility device for use by your patient? ANSWER: Walkers are usually used by patients who are too weak to walk unassisted or who have balance problems. Hurray! What is the role of the medical assistant related to referrals for physical therapy Learning Outcomes : 54.7 Carry out the procedure for teaching a patient to use a cane, a walker, crutches, and a wheelchair. 54.8 Model the steps you should take when referring a patient to a physical therapist. ANSWER: The medical assistant may be asked to contact the therapist directly or to give the patient a written order and information about contacting the therapist. The referral must also be documented in the patient’schart

In Summary 54.1 Physical therapy is a medical specialty for the treatment of musculoskeletal, nervous, and cardiopulmonary disorders using a variety of treatments, including cold, heat, water, exercise, massage, and traction.

In Summary 54.2 There are various types of cold and heat therapies, including dry and wet cold and heat applications. Cold and heat therapy promote healing and increase patient comfort. Contraindications to cold and heat therapies include circulation problems, pain, and hemorrhage

In Summary (cont.) 54.3 Various types of hydrotherapy used to treat physical problems include whirlpools, contrast baths, and underwater exercises. 54.4 There are several methods of exercise therapy, including active mobility, passive mobility, aided mobility, and active resistance.

In Summary (cont.) 54.5 The two major types of massage used in rehabilitation therapy are Swedish and neuromuscular. Swedish massage uses 5 basic strokes to manipulate soft tissues. Neuromuscular massage is applied to specific muscles and helps release tension and knots, relieve pain and release pressure on nerves, and increase blood flow.

In Summary (cont.) 54.6 The different methods of traction used to treat physical problems include manual, static, skeletal, and mechanical 54.7 The various mobility aids include 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.

In Summary (cont.) 54.8 You may be asked to contact the specialist directly or to give the patient a written order and information about contacting the specialist. Keep a file with information about the therapists your office uses, noting the forms and information each therapist requires

End of Chapter 54 Disability is a matter of perception. If you can do just one thing well, you're needed by someone. ~ Martina Navratilova