Lecture Clinical procedures for medical assisting (4/e): Chapter 11 – Booth, Whicker, Wyman

Chapter 11 - Assisting with cold and heat therapy and ambulation. In this chapter you will learn: Explain how medical assistants might assist with some forms of physical therapy; describe ways to test joint mobility, muscle strength, gait, and posture; discuss the benefits of cold and heat therapies; list contraindications to cold and heat therapies; identify various cold and heat therapies;...

Assisting with Cold

and Heat Therapy

and Ambulation

Learning Outcomes

11.1 Explain how medical assistants might assist with

some forms of physical therapy

11.2 Describe ways to test joint mobility, muscle strength,

gait, and posture

11.3 Discuss the benefits of cold and heat therapies

11.4 List contraindications to cold and heat therapies

11.5 Identify various cold and heat therapies

Learning Outcomes (cont.)

11.6 Demonstrate how to perform cold and heat

therapies

11.7 Describe hydrotherapy methods

11.8 Identify several methods of exercise therapy

11.9 Compare different methods of traction

11.10 Demonstrate how to teach a patient to use a cane, a

walker, crutches, and a wheelchair

– Demonstrate how

to use a wheelchair – Demonstrate the use of cane,

walker, and crutches

– Discuss therapies

General Principles of Physical Therapy

– Cardiopulmonary

disorders

General Principles of Physical Therapy

– Make referrals – Explain treatment approach

– Documentation – Reinforce instructions

 You must have a  working knowledge of 

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 measure

• Muscle strength testing

– Determines the amount of force the patient can

exert with a group of muscles

Patient Assessment (cont.)

• Gait testing

– The way a person

walks (gait and swing)

– Symmetry of alignment

• Shoulders

• Knees

• Hips

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

• Cryotherapy

– Applying cold for

therapeutic reasons

• Dry

• Moist

Cryotherapy and Thermotherapy

sensation impairment– Temperature tolerance– Age

Principles of Cryotherapy

• Constricts blood vessels

• Physiologic responses to cold

– 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

• Physiologic responses to heat

– Relieves pain and congestion

– Reduces muscle spasms

– Muscle relaxation

– Reduces inflammation

– Reduces swelling

Administering Thermotherapy

• Dry heat therapies

– Chemical hot packs

– Heating pad

– Hot-water bottle – Heat lamp

– Fluidotherapy

Administering Thermotherapy (cont.)

– Moist heat applications

high-• 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.

• Relaxes muscles

• Increases circulation

– Also used to clean and debride

wounds, ulcers, and burns

Hydrotherapy (cont.)

• Contrast baths

– 2 baths, one hot

and one cold – Patient moves

quickly from one to the other

– Warm swimming pool

– Buoyancy takes pressure off joints – Purpose

• Promotes relaxation

• Increases circulation

Apply Your Knowledge

What are the main effects of hydrotherapy?

ANSWER: Hydrotherapy relaxes muscles, increases

circulation, and improves flexibility and mobility

• Primary treatment for fractures,

arthritis, and some respiratory

diseases

Exercise Therapy (cont.)

• Exercise

– Improves muscle tone

and strength– Maintains ROM

– Prevents or corrects

physical deformities– Promotes

neuromuscular coordination

– Improves circulation– Relieves stress

– Lowers cholesterol levels

– Aids in resumption of normal daily activities

Medical Assistant’s Role

• Provide patient

information

– Types of exercise

programs – Treatment plan

• Provide support and

– Retain ROM and improve circulation

• Aided mobility

– Self-directed with assistance of a device such

as exercise machine – 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

• ROM exercises

– Move each joint through its full range of motions

– Improves flexibility and mobility

– Improves circulation and muscle function

Electrical Stimulation

• Delivers a controlled amounts of

low-voltage electric current to motor and

sensory nerves

– Stimulates muscle

– Prevents atrophy

– 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

• The pulling or stretching of the

musculoskeletal system

– Used to treat fractured bones and dislocation,

arthritic, or other diseased joints

• Uses

– Create and maintain bone alignment

– Reduce and prevent joint stiffening

– Correct deformities

– Reduce and relieve muscle spasms

– Improves motion and

decreases stiffening– Uses

Traction (cont.)

• Skeletal

– Long-term/heavy

weights– Pins, wires, or tongs

surgically placed– Pulleys and weights

provide continuous traction

• Mechanical

– Device intermittently pulls and relaxes

– Promotes relaxation

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

• Mobility aid chosen depends on

– Patient’s disability

– Muscle coordination

– Strength

– Age

• Standard

– Patient who needs only small amount of

support

• Tripod (3 legs) and quad-base (4 legs)

– Create wide base of support

– More stable than

standard canes

• Must be adjusted to

• Used by older patients with

– Difficulty walking unassisted

• Transfers weight to the arms

• Ground to forearm

Crutches (cont.)

• Complications may arise

if not measured properly

– Pressure on nerves in axilla

– Strain on back, imbalance

• Measuring for crutches

– Should be 2 to 3 widths between supports and axilla

finger-– 30º flexion at elbow

Crutches (cont.)

• Crutch gaits

– Four-point – slow gait for a patient who can

bear weight on both legs – Three-point – used when patient cannot

bear weight on one leg – Two-point – used when patient can have

some weight on both legs; must have good muscle coordination and balance

– Swing gait – used when patient has severe

• Type of chair chosen

– Depends on patient’s disability

– Length of time wheelchair needed

• Always ensure patient safety during

transfers

• Use appropriate lifting techniques

Apply Your Knowledge

When would a walker be an appropriate mobility

device for use by your patient?

ANSWER: Walkers are used by older patients who

are too weak to walk unassisted or who have balance

problems.

Hip-Hip-

Referral to a Physical Therapist

In Summary

11.1 A medical assistant may be asked to apply cold and

heat; teach basic exercises; demonstrate how to use

a cane, walker, and crutches; demonstrate how to use

a wheelchair; and discuss with the patient specific therapies for use at home

11.2 Various physical tests are performed on patients,

including joint mobility testing, muscle strength testing, gait, and posture testing

11.3 Cold and heat therapy promote healing and increase

patient comfort

In Summary (cont.)

11.4 Contraindications to cold and heat therapies include

circulation problems, pain, and hemorrhage

11.5 There are various types of cold and heat therapies

These include dry and wet, cold, and heat applications

11.6 The general steps to applying cold and heat therapies

include checking the physician’s order, positioning and draping the patient, applying the pack, and monitoring the patient

11.7 Various types of hydrotherapy used to treat physical

problems include whirlpools, contrast baths, and underwater exercises

In Summary (cont.)

11.8 There are several methods of exercise therapy,

including active mobility, passive mobility, aided mobility, and active resistance

11.9 The different methods of traction used to treat

physical problems include manual, static, skeletal, and mechanical

11.10 There are various mobility aids, including canes,

walkers, crutches, and wheelchairs Specific instructions for each of these aids must be followed

to reduce the possibility of patient injury during their

End of Chapter 11

Dis ability is  a matter of  perception. If you can do 

jus t one thing well,  you're needed by 

s omeone.

~ Martina Navratilova