2. CHAPTER © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54 Physical Therapy and Rehabilitation

3. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-2 54.1 Discuss the general principles of physical therapy. 54.2 Relate various cold and heat therapies to their benefits and contraindications. 54.3 Recall hydrotherapy methods. 54.4 Name several methods of exercise therapy. Learning Outcomes

4. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-3 54.5 Describe the types of massage used in rehabilitation therapy. 54.6 Compare different methods of traction. 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. Learning Outcomes

5. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-4 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

6. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-5 General Principles of Physical Therapy Physical therapy –Medical specialty treating Musculoskeletal disorders Nervous disorders Cardiopulmonary disorders –Treatments –Patient benefits –Disorders

7. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-6 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

8. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-7 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

9. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-8 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

10. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-9 Assisting with Patient Assessment (cont.) Posture testing –Body position and alignment –Checks spinal curves –Symmetry of alignment

11. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-10 Apply Your Knowledge Match description with assessment type: ___ How a person walksA.Joint mobility ___ Range of motionB.Muscle strength ___ Body position and alignmentC.Posture ___ Force exerted with a group of musclesD.Gait ___ Goniometer ___ Check spinal curves ___ Length of stride C D C B A A D ANSWER:

12. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-11 Cryotherapy and Thermotherapy Cryotherapy –Applying cold for therapeutic reasons –Types Wet or dry Chemical or natural Thermotherapy –Applying heat for therapeutic reasons –Types Dry Moist

13. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-12 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

14. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-13 Cryotherapy and Thermotherapy (cont.) Treatment location Circulation or sensation impairment Temperature tolerance Elderly’s sensitivity to cold and heat

15. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-14 Principles of Cryotherapy Constricts blood vessels Physiologic responses to cold –Prevents swelling –Controls bleeding –Reduces inflammation –Anesthetic effect –Reduces pus formation –Lowers body temperature

16. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-15 Administering Cryotherapy Dry cold applications –Ice bags and collars –Chemical ice packs Wet cold applications –Cold compresses –Ice massage

17. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-16 Principles of Thermotherapy Dilates blood vessels – erythema Physiologic responses to heat –Relieves pain and congestion –Reduces muscle spasms –Relaxes muscles –Reduces inflammation and swelling

18. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-17 Administering Thermotherapy Dry heat therapies –Chemical hot packs –Heating pad –Hot-water bottle –Heat lamp –Fluidotherapy

19. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-18 Administering Thermotherapy (cont.) Moist heat applications –Hot soak –Hot compress –Hot pack –Paraffin bath –Alternating hot and cold packs

20. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-19 Administering Thermotherapy (cont.) Diathermy –High-frequency wave achieves deep heat penetration –Types Ultrasound Shortwave Microwave

21. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-20 Apply Your Knowledge 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.

22. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-21 Hydrotherapy Use of water to treat physical problems Whirlpools –Water is agitated by jets of air under pressure –Generates hydromassage Relaxes muscles Increases circulation

23. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-22 Hydrotherapy (cont.) Contrast baths –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

24. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-23 Apply Your Knowledge What are the main effects of hydrotherapy? ANSWER: Hydrotherapy relaxes muscles, increases circulation, and improves flexibility and mobility.

25. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-24 Exercise Therapy Preventive and therapeutic benefits –Flexibility –Mobility –Muscle tone –Strength Primary treatment for some disorders and sports injuries

26. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-25 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

27. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-26 Role of the Medical Assistant Information resource Source of support and encouragement Assist with ROM Patient instructions

28. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-27 Types of Exercise Choice based on patient’s physical condition Active mobility –Self-directed exercises –Increase muscle strength and function

29. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-28 Types of Exercise Passive 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

30. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-29 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

31. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-30 Types of Exercise (cont.) ROM exercises –Moving each joint through its full range of motions –Improves flexibility and mobility –Types Active Passive

32. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-31 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

33. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-32 Apply Your Knowledge Match description with type of exercise: ___ Self-directed; exercise machineA.Isometric ___ Self-directed; no assistanceB.Aided mobility ___ Low-voltage current; stimulates C.Active resistance nerves/muscles ___ Relax and contract muscles fromD.Electrical fixed position stimulation ___ Exercise against counter-pressureE.Active mobility ___ Move joint through full rangeF.ROM D E F C A YIPPEE! B ANSWER:

34. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-33 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

35. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-34 Massage (cont.) Swedish Massage –Stimulates circulation and lymph flow –Five basic strokes Neuromuscular massage –Targets specific muscles –Releases tension –Relieves pain and pressure on nerves

36. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-35 Apply Your Knowledge 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. AAH Yes!

37. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-36 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

38. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-37 Traction (cont.) Manual –Gentle pull on muscles and joints –Improves motion and decreases stiffening Static –Harness and weights –Used to relieve muscle spasms

39. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-38 Traction (cont.) Skeletal – performed for injuries requiring long traction time and heavy weights Mechanical – device that intermittently pulls and relaxes

40. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-39 Apply Your Knowledge 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. F T T F alternately pulls and relaxes relieve ANSWER: F A N T A S T I C !

41. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-40 Mobility Aids Devices to improve patients’ ability to ambulate or move about Mobility aid chosen depends on –Patient’s disability –Muscle coordination –Strength –Age

42. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-41 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

43. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-42 Walkers Used by patients who –Cannot walk unassisted –Have balance problems Provides a sense of stability Adjust to proper height for patient

44. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-43 Crutches Transfers weight to the arms Types –Axillary Ground to axilla Short-term use –Lofstrand, or Canadian Ground to forearm Long-term use

45. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-44 Crutches (cont.) Measure to fit –Too long Crutch palsy Back pain –Too short Back pain Imbalance

46. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-45 Crutches (cont.) Crutch gaits –Tripod or standing position –Determine proper gait –Slow or fast gaits

47. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-46 Crutches (cont.) Four-point gait –Slow gait –Bear weight on both legs –Stable and save

48. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-47 Crutches (cont.) Three-point –Cannot bear weight on one leg –Must have good muscle coordination and arm strength

49. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-48 Crutches (cont.) Two-point Swing gait Swing-to Swing-through

50. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-49 Wheelchairs Type of chair –Depends on patient’s disability –Length of time wheelchair needed Always ensure patient safety during transfers Use appropriate lifting techniques

51. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-50 Referral to a Physical Therapist Referrals –Provide physician’s order –Provide patient information Therapists –Independent practitioners –Hospital or clinic –Home health

52. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-51 Apply Your Knowledge 1.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! 2.What is the role of the medical assistant related to referrals for physical therapy 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

53. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-52 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.

54. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-53 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

55. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-54 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.

56. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-55 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.

57. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-56 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.

58. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-57 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

59. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 54-58 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