Chapter 22 Physical Therapy Skills 2009 Delmar Cengage

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

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

Performing Range-of-Motion (ROM) Exercises Proper terms for movement of each joint; see Fig. 22 -3 in text – – – – Abduction Adduction Flexion Extension Hyperextension Rotation Circumduction Pronation – – – – – Supination Opposition Inversion Eversion Dorsiflexion Plantar flexion Radial deviation Ulnar deviation © 2009 Delmar, Cengage Learning

© 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 (continues) ambulating © 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

© 2009 Delmar, Cengage Learning

• Crutches—artificial supports – Types: Axillary Crutches, Forearm/Loftstand Crutches, Platform Crutches – Fitting Crutches: • Wear shoes • Position crutches 4 -6 inches in front of foot; 4 -6 inches to side of foot • Length (axillary crutches) 2 inches below armpit • Length (forearm crutches) 25 -30 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

© 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 25 -30 degrees – Gaits: • 2 Point Gait • 3 Point Gait © 2009 Delmar, Cengage Learning

© 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 25 -30 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 (continues) blankets © 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 120 F) • 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 15 -20 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 110 -120 degrees F Use thermometer place barrier between skin and warm water bag Remove after 15 -20 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: 95 -105 degrees F Remove key Check for leaks Cover pad with barrier Ensure tubing is not below level of bed Remove after 15 -20 minutes © 2009 Delmar, Cengage Learning

Administering Heat/Cold Applications: Basic Principles • moist compress – Protect sheets/clothing from becoming wet – Fill basin with water/ice OR warm water (100105 degrees F) – Wring excess water out before placing on patient – Wrap with a bath towel over plastic sheet – Remove after 15 -20 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 © 2009 Delmar, Cengage Learning