© 2009 Delmar, Cengage Learning Chapter 22 Physical Therapy Skills

© 2009 Delmar, Cengage Learning Career Highlight Physical Therapist Assistants( PTAs) are valuable members of the health care team Education requirements: Associate’s Degree Licensure in most states: must pass test after graduation from accredited program and pass in order to practice Duties performed: ROM exercises, heat/cold treatments, ambulating clients w/ assistive devices Work under direction of a Physical Therapist

© 2009 Delmar, Cengage Learning 22:1 Performing Range-of-Motion (ROM) Exercises Purposes of ROM= maintain health of musculoskeletal system Problems caused by lack of movement and activity –Contracture of muscles –Muscle and joint function –Circulatory impairment –Mineral loss –Other problems (continues)

© 2009 Delmar, Cengage Learning (continues) 22:1 Performing Range-of-Motion (ROM) Exercises (continued) Types of ROM –Active ROM –Active assistive ROM –Passive ROM –Resistive ROM

© 2009 Delmar, Cengage Learning Performing Range-of-Motion (ROM) Exercises –Abduction –Adduction –Flexion –Extension –Hyperextension –Rotation –Circumduction –Pronation Principles to observe while performing ROM –Supination –Opposition –Inversion –Eversion –Dorsiflexion –Plantar flexion –Radial deviation –Ulnar deviation Proper terms for movement of each joint; see Fig in text

© 2009 Delmar, Cengage Learning

Performing Range-of-Motion (ROM) Exercises Principles to observe while performing ROM * movements should be slow, smooth, and gentle to prevent injury *provide support above and below joint being exercised *never force joint beyond it’s ROM *do not exercise to point of pain or extreme fatigue *if c/o pain, is SOB, profusely diaphoretic, or pale/dizzy- stop-report to supervisor *encourage patient to assist if able *perform each exercise 3-5 times or as ordered *provide privacy *use good body mechanics

© 2009 Delmar, Cengage Learning 22:2 Transfer (Gait) Belts, Crutches, Canes, or Walkers Patients may require aids, or assistive devices, for ambulation Type used depends on injury and patient’s condition Certain points must be observed when a patient uses crutches, canes, a walker, or a transfer belt Remain alert at all times while ambulating (continues)

© 2009 Delmar, Cengage Learning Transfer (Gait) Belts, Crutches, Canes, or Walkers Transfer (Gait) Belt Basic principles for ambulating a patient with a transfer belt –Proper size –Use underhand grasp –Grasp on back during ambulation(walk behind to side) –Grasp on sides when assisting to stand/sit –Apply over clothing

© 2009 Delmar, Cengage Learning

Crutches—artificial supports –Types: Axillary Crutches, Forearm/Loftstand Crutches, Platform Crutches –Fitting Crutches: Wear shoes Position crutches 4-6inches in front of foot; 4-6 inches to side of foot Length (axillary crutches) 2 inches below armpit Length (forearm crutches) degree bend in each elbow –Crutch-Walking Gaits: 2 Point Gait 3 Point Gait 4 Point Gait Swing-to Gait Swing-through Gait

© 2009 Delmar, Cengage Learning

Cane—provides balance and support –Types: Standard Tripod Quad Walkcane/Hemiwalker –Basic Principles: Hold cane with unaffected “good” side –Fitting: Tip of cane positioned 6-8 inches from side of “good” foot Cane handle should be level top of femur Patients elbow should flex degrees –Gaits: 2 Point Gait 3 Point Gait

© 2009 Delmar, Cengage Learning

Walker—has four legs –Types: Folding Rolling Platform With and without brakes –Fitting: Handles should be level with top of femur Elbows flexed degrees –Gaits: “walk into” : lift walker and position in front with back legs of walker level with toes; then walk into –Basic Principles/Precautions: Do not slide a walker Avoid using as a transfer device

© 2009 Delmar, Cengage Learning Summary Always check ambulation aids before using Make sure aid is properly fitted to patient Use gait taught by therapist Be alert to patient safety at all times

© 2009 Delmar, Cengage Learning Heat/Cold Applications Cryotherapy—use of cold for treatment Applied to the skin –Pain relief –Reduce swelling –Control bleeding –Reduce body temp. Moist Cold: compresses, packs, soaks; more penetrating than dry Dry Cold: ice bags/collars, hypothermia blankets (continues)

© 2009 Delmar, Cengage Learning Heat/Cold Applications Thermotherapy—use of heat for treatment Applied to the skin –Pain relief –Increase drainage and stimulate healing –Fight infection and increase circulation –Muscle spasm relief –Increase muscle mobility (continues)

© 2009 Delmar, Cengage Learning Moist Heat: sitz bath, hot soaks, compresses, paraffin wax treatments Dry Heat: warm-water bags, heating pads, heat lamps (never exceed 120F) Effect of heat and cold applications on blood vessels – heat: dilate- increases blood flow, stimulates healing –cold: constrict- decreases blood flow, pain, swelling Doctor’s order is required for a heat or cold application )

© 2009 Delmar, Cengage Learning Administering Heat/Cold Applications (continued) Checkpoints while application in place Alertness required Safety precautions: –infants/children burn more easily –Watches, rings, metal conducts heat/cold better –Place barrier between skin and heat/cold application Standard precautions (continues)

© 2009 Delmar, Cengage Learning Administering Heat/Cold Applications: Basic Principles ice bag / ice collar –Fill with ice (half ) and water –If ice cubes; rinse with water to remove sharp corners –Check for leaks –Expel air from bag –Place barrier between skin and ice bag –Remove after minutes (continues)

© 2009 Delmar, Cengage Learning Administering Heat/Cold Applications: Basic Principles warm-water bag –Fill with warm water 1/3-1/2 full –Check bag for leaks –Expel air –Use water degrees F –Use thermometer – place barrier between skin and warm water bag –Remove after minutes

© 2009 Delmar, Cengage Learning Administering Heat/Cold Applications: Basic Principles aquathermia pad –Place unit on solid, flat table surface –Fill with distilled water to “fill” line –Screw cap then loosen –Set desired temp with key: degrees F –Remove key –Check for leaks –Cover pad with barrier –Ensure tubing is not below level of bed –Remove after minutes

© 2009 Delmar, Cengage Learning Administering Heat/Cold Applications: Basic Principles moist compress –Protect sheets/clothing from becoming wet –Fill basin with water water/ice OR warm water ( degrees F) –Wring excess water out before placing on patient –Wrap with a bath towel over plastic sheet –Remove after minutes

© 2009 Delmar, Cengage Learning Administering Heat/Cold Applications: Basic Principles sitz bath –Cover legs and shoulders –Privacy –Use correct water temp

© 2009 Delmar, Cengage Learning Summary Doctor’s order required for all heat or cold applications Follow correct procedures to prevent injury to patient Check patient and condition of skin frequently