1. Physical Therapy and Rehabilitation54
Physical Therapy and Rehabilitation

2. 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: 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.

3. General Principles of Physical Therapy
Medical specialty treating
Musculoskeletal disorders
Nervous disorders
Cardiopulmonary disorders
Treatments
Patient benefits
Disorders
Learning Outcome: 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

4. 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: 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.

5. 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: 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.

6. 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: 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).

7. Assisting with Patient Assessment (cont.)
Posture testing
Body position and alignment
Checks spinal curves
Symmetry of alignment
Learning Outcome: 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.

8. 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: Discuss the general principles of physical therapy. C
Good Job! D

9. 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: Relate various cold and heat therapies to their benefits and contraindications.

10. 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: 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.

11. 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: 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.

12. 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: 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.

13. Administering Cryotherapy
Dry cold applications
Ice bags and collars
Chemical ice packs
Wet cold applications
Cold compresses
Ice massage
Learning Outcome: 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

14. 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: 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.

15. Administering Thermotherapy
Dry heat therapies
Chemical hot packs
Heating pad
Hot-water bottle
Heat lamp
Fluidotherapy
Learning Outcome: 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

16. Administering Thermotherapy (cont.)
Moist heat applications
Hot soak
Hot compress
Hot pack
Paraffin bath
Alternating hot and cold packs
Learning Outcome: 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.

17. Administering Thermotherapy (cont.)
Diathermy
High-frequency wave achieves deep heat penetration
Types
Ultrasound
Shortwave
Microwave
Learning Outcome: 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.

18. 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: Relate various cold and heat therapies and their benefits and contraindications.
Correct!

19. 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: Describe hydrotherapy methods.
Whirlpools – tanks in which water is agitated by jets of air under pressure.

20. 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: Describe hydrotherapy methods.
Underwater Exercises – promote relaxation and increased circulation.

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

22. Exercise Therapy Preventive and therapeutic benefits
Flexibility
Mobility
Muscle tone
Strength
Primary treatment for some disorders and sports injuries
Learning Outcome: 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

23. 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: Name several methods of exercise therapy
Other benefits of exercise include
Preventing or correcting physical deformities.
Improving circulation.
Relieving stress.
Lowering cholesterol levels.

24. Role of the Medical Assistant
Information resource
Source of support and encouragement
Assist with ROM
Patient instructions
Learning Outcome: 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.

25. Types of Exercise Choice based on patient’s physical condition
Active mobility
Self-directed exercises
Increase muscle strength and function
Learning Outcome: 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.

26. 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: 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.

27. 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: Name several methods of exercise therapy

28. Types of Exercise (cont.)
ROM exercises
Moving each joint through its full range of motions
Improves flexibility and mobility
Types
Active
Passive
Learning Outcome: 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.

29. 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: 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.

30. 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: Name several methods of exercise therapy C F

31. 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: 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.

32. 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: 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.

33. 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: Describe the types of massage used in rehabilitative medicine.
AAH Yes!

34. 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: 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

35. 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: 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.

36. Traction (cont.)
Skeletal – performed for injuries requiring long traction time and heavy weights
Mechanical – device that intermittently pulls and relaxes
Learning Outcome: 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.

37. 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: Compare different methods of traction. F
alternately pulls and relaxes

38. 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: 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.

39. Canes Standard – provide small amount of support Tripod and quad-base
Correct height
Elbow bent degrees
Should not lean on cane for support
Learning Outcome: 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

40. 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: 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

41. 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: 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.

42. Crutches (cont.) Measure to fit Too long Too short Crutch palsy
Back pain
Too short
Imbalance
Learning Outcome: 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.

43. Crutches (cont.) Crutch gaits Tripod or standing position
Determine proper gait
Slow or fast gaits
Learning Outcome: 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.

44. Crutches (cont.) Four-point gait Slow gait Bear weight on both legs
Stable and save
Learning Outcome: 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.

45. Crutches (cont.) Three-point Cannot bear weight on one leg
Must have good muscle coordination and arm strength
Learning Outcome: 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.

46. Crutches (cont.) Two-point Swing gait Swing-to Swing-through
Learning Outcome: 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.

47. 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: 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.

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

49. 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 : 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

50. 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.

51. 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

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

53. 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.

54. 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.

55. 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

56. 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