Medical assisting Administrative and clinical procedures (5e) Chapter 54 Physical therapy and rehabilitation

After studying this chapter you will be able to understand: Discuss the general principles of physical therapy, relate various cold and heat therapies to their benefits and contraindications, recall hydrotherapy methods, name several methods of exercise therapy,…

Physical Therapy and Rehabilitation

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

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

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

General Principles of Physical Therapy

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

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

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

Assisting with Patient Assessment (cont.)

• Posture testing

– Body position and alignment

– Checks spinal curves

– Symmetry of alignment

Apply Your Knowledge

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

Cryotherapy and Thermotherapy

– Applying cold for

therapeutic reasons

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

Cryotherapy and Thermotherapy (cont.)

Principles of Cryotherapy

• Constricts blood vessels

• Physiologic responses to cold

formation – Lowers body temperature

Administering Cryotherapy

• Dry cold applications

– Ice bags and collars

– Chemical ice packs

• Wet cold applications

– Cold compresses

– Ice massage

Principles of Thermotherapy

• Dilates blood vessels – erythema

• Physiologic responses to heat

– Relieves pain and congestion

– Reduces muscle spasms

– Relaxes muscles

– Reduces inflammation and

swelling

– Fluidotherapy

Administering Thermotherapy (cont.)

• Moist heat applications

– Hot soak

– Hot compress

– Hot pack

– Paraffin bath – Alternating hot and cold packs

Administering Thermotherapy (cont.)

– High-frequency wave achieves deep heat

penetration – Types

• Ultrasound

• Shortwave

• Microwave

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.

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

Apply Your Knowledge

What are the main effects of hydrotherapy?

ANSWER: Hydrotherapy relaxes muscles,

increases circulation, and improves

flexibility and mobility

• Primary treatment for some

disorders and sports injuries

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

Role of the Medical Assistant

• Information resource

• Source of support and encouragement

• Assist with ROM

• Patient instructions

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

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

Types of Exercise (cont.)

• ROM exercises

– Moving each joint through its full range of

motions – Improves flexibility and mobility

– Types

• Active

• Passive

– Helps in healing injured joints

– Retrains a patient to use injured muscles

Apply Your Knowledge

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

• 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

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.

• 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

Traction (cont.)

• Manual

– Gentle pull on muscles and joints

– Improves motion and decreases stiffening

• Static

– Harness and weights

– 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

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

!

Mobility Aids

• Devices to improve patients’ ability to

ambulate or move about

– Patient’s disability

– Muscle coordination

– Strength

– Age

– Elbow bent 20-25 degrees

– Should not lean on cane

for support

• Used by patients who

– Cannot walk unassisted

– Have balance problems

• Provides a sense of

stability

• Adjust to proper height

for patient

Crutches (cont.)

• Crutch gaits

– Tripod or standing position

– Determine proper gait

– Slow or fast gaits

Crutches (cont.)

• Four-point gait

– Slow gait

– Bear weight on both legs

– Stable and save

Crutches (cont.)

• Two-point

• Swing gait

• Type of chair

– Depends on patient’s disability

– Length of time wheelchair needed

• Always ensure patient safety during

transfers

• Use appropriate lifting techniques

Referral to a Physical Therapist

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

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

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.