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Chapter 22

Chapter 22. Physical Therapy Skills. 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

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Chapter 22

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  1. Chapter 22 Physical Therapy Skills

  2. 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

  3. 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)

  4. 22:1 Performing Range-of-Motion (ROM) Exercises(continued) • Types of ROM • Active ROM • Active assistive ROM • Passive ROM • Resistive ROM (continues)

  5. 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 • Principles to observe while performing ROM • Supination • Opposition • Inversion • Inversion • Eversion • Dorsiflexion • Plantar flexion • Radial deviation • Ulnar deviation

  6. 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

  7. 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 ambulating (continues)

  8. 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

  9. Crutches—artificial supports • Types: Axillary Crutches, Forearm/Loftstand Crutches, Platform Crutches • Fitting Crutches: • Wear shoes • Position crutches 4-6inches 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

  10. 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

  11. 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

  12. 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

  13. 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 blankets (continues)

  14. 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)

  15. Moist Heat: sitz bath, hot soaks, compresses, paraffin wax treatments • Dry Heat: warm-water bags, heating pads, heat lamps (never exceed 120F) • 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 )

  16. Administering Heat/ColdApplications(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)

  17. Administering Heat/ColdApplications: 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)

  18. Administering Heat/ColdApplications: 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

  19. Administering Heat/ColdApplications: 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

  20. Administering Heat/ColdApplications: Basic Principles • moist compress • Protect sheets/clothing from becoming wet • Fill basin with water water/ice OR warm water (100-105 degrees F) • Wring excess water out before placing on patient • Wrap with a bath towel over plastic sheet • Remove after 15-20 minutes

  21. Administering Heat/ColdApplications: Basic Principles • sitz bath • Cover legs and shoulders • Privacy • Use correct water temp

  22. 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

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